Ongoing Projects

Research @ YU-CARE

 

Seniors -Adding Life to Years (SALTY)

Seniors – Adding Life To Years (SALTY) is a four-year study on quality of life among people in late life who are living in residential long-term care settings, their caregivers and supporters.

The project, involving decision makers, clinicians, care providers, including family and friends care, is being conducted in Ontario, British Columbia, Alberta and Nova Scotia, led by Professor Janice Keefe at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging.

The SALTY research program is organized in 4 streams that address interrelated themes in late life care.  Diverse members of the SALTY team are engaged in (1) monitoring care practices, (2) mapping approaches to care relationships, (3) evaluating innovative practices and (4) examining policy contexts.

York U Faculty of Health Professor Tamara Daly will co-lead stream two “approaches to care relationships” with Professor Ivy Bourgeault of University of Ottawa and Dr. Katie Aubrecht of Mount Saint Vincent. This research is mapping the social and relational dimensions of quality of life and quality of care in LTC facilities, providing fresh insight into the relationships that “add life to years” and the implications for improving late life care for Canadians, focusing on programs, practices and policies being used in residential long-term care facilities across British Columbia, Alberta, Ontario and Nova Scotia. Stream two will be housed at the York University Centre for Aging Research and Education.

This project is funded by the Canadian Institutes for Health Research, the Nova Scotia Health Research Foundation, the Michael Smith Foundation for Health Research and the Alzheimer Society of Canada.

Link to Y-file news release

For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).

What’s Past is Prologue: Comparing Long-term Care Workers and Working Conditions Between Canada and Nordic Countries 10 Years Later

In 2006, our team was funded by CIHR to conduct the Long-term Care Workers’ Survey (LTC-WS) to better understand the work of Canada’s highly gendered LTC labour force and to compare conditions here with the Nordic countries. This groundbreaking survey was conducted in three Canadian provinces (Ontario, Manitoba, Nova Scotia) as well as Sweden, Norway, Denmark and Finland, and later in Germany and Japan. It advanced knowledge about work in LTC facilities in Canada and internationally, highlighting issues surrounding gender, work and care. The results underlined challenges related to staffing, models of care and workers’ exposure to violence in LTC facilities in Canada.

Today Canada’s long-term care (LTC) workforce is undergoing major shifts in demographics, working conditions and work organization, involving new challenges and opportunities. Our team has been funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) to provide fresh comparative insight into the nature of contemporary work in LTC. Led by Dr. Tamara Daly, a CIHR Research Chair in Gender, Work and Health, this four year mixed-method project brings together a multi-disciplinary team of experts and partners representing LTC workers across the country. It focuses on exploring the current nature of work in LTC five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia.

A new, expanded survey for LTC workers is currently underway, as are complementary surveys for informal caregivers, paid companions, and managers in LTC facilities to build on the work started with the Invisible Women Study. Survey results, together with findings from ethnographic observation, focus groups and interviews, will improve understanding of work, working conditions, and work organization. In collaboration with our Nordic colleagues, who are also conducting a revised survey for LTC workers, we will extend and expand current understandings of different forms of work in different jurisdictions. In examining a wide spectrum of formal and informal work in LTC settings, this project will provide urgently needed insights into recent changes as well as key challenges and opportunities for the future in this important sector.

For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).

Re-imagining Long-term Care Residential Care; International Study of Promising Practices

Long-term residential care is where many of our most vulnerable members live and, in spite of moves towards aging in place, where many will continue to live in the future. It is also a workplace for thousands of paid and unpaid providers, most of whom are women and many of whom are from racialized communities. It is a barometer of values and practices; a signal of economic, cultural and social perspectives. It raises issues well beyond specific services and practices; issues such as human and social rights, the role of the state, responsibilities of individuals and families, work organization and skills; and notions of care. Yet too often it is characterized as failure; failure of the family to care, failure of the health care system to cure and failure of the individual to live independently, perhaps explaining why it has received so little research and policy attention. Instead of focusing mainly on failures, this project identifies promising practices for conceptualizing and organizing long-term care, learning from and with other countries. What approaches to care, to work organization, to accountability, to financing and ownership offer the most promising practices when the goal is to treat both providers and residents with dignity and respect, to understand care as a relationship and to take differences and equity into account? What contexts and conditions support these practices, allowing residents and providers to flourish? These are questions for the social sciences and humanities, as well as for those who deliver, those who organize and those who need care.

For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).

Invisible Women: Gender and the Shifting Division of Labour in Long-term Residential Care

How does growth in the number of private duty carers coupled with the care work performed by unpaid students, volunteers and family members in long-term residential care facilities impact the organization of care? The study is specifically interested in how occupational health and safety and the division of labour are affected by the informal care provided by people other than those employed at the facility. It is mostly women who are employed in long-term residential care. Recent health human resources research does recognize that women are the overwhelming majority of paid providers but consideration of gender in relation to paid health care work is not common, as is evident when reviewing the 2010 health systems trends report from the Ontario Ministry of Health and Long-Term Care. While we have little information on the gendered dimensions of paid work in long term residential care, we have next to no information about the other paid and unpaid carers in facilities, nor is this informal care acknowledged in research or in policy. Addressing this gap is of vital importance because of the implications for our understanding of facility care, of the safety of the space and of the people who live and work there. We will survey all nursing homes and retirement homes in Ontario, and conduct interviews and detailed observations of units in 5 facilities in Toronto and with selected residents and their carers in each of the 5 facilities to elicit answers to several important overarching questions: 1. How has the division of labour shifted for facility employees due to the work performed by informal carers (i.e. paid private duty carers, students, volunteers and family members)? 2. In what ways are workloads and occupational health and safety in the facilities affected by the care performed by these other carers? 3. Finally, how do we understand the amount of time available for care (e.g. staff intensity) when we account for work performed by other carers?

For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).

The Cardiovascular Health Awareness Program (CHAP) for the South Asian Community in York Region: Assessing volunteer participation and the gender and ethno-specific impacts

INTRODUCTION This important project applies more than a decades worth of work done as part of the Cardiovascular Health Awareness Program (CHAP) to the goal of reducing the impact of cardiovascular disease for York region’s South Asian community. Through a series of studies, CHAP has been shown to be an acceptable intervention to reduce participants’ blood pressure, encourage lifestyle changes and to optimize drug regimens. The project aims to extend its proven successes by adapting its material and approaches to the York Region South Asian Community, to assess the voluntary model of program delivery, and to identify gender and ethno-specific impacts of the program. RESEARCH QUESTION & OBJECTIVES The main research questions are: 1. What adaptation strategies to the Cardiovascular Health Awareness Program (CHAP) should be put in place in order to successfully prevent and manage chronic disease among the South Asian community? 2. How can we address gender and ethno-specific impacts? 3. What are the best strategies to optimize the recruitment, retention and health promotion role of peer health educators among the South Asian Community?

For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).

Limited physical activity and bed rest in seniors with complex chronic disease

This grant focuses on identifying research priorities to prevent decreased mobility in older persons with CCD following an acute illness episode. The meetings will be conducted in two phases. In Phase 1 we will identify research priorities to prevent decreased mobility following an acute illness episode in this population. In Phase II, we will develop a research action plan which jointly addresses gaps in the knowledge and stakeholder information needs, and forge new partnerships for the future projects. Outcomes include: an action plan outlining future research initiatives which are relevant to stakeholders' information needs and represent a gap in evidence in this area.

For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).

Nurse and organizational readiness to deliver best elder care: The key to Ontario’s ability to design and implement Senior Friendly Hospital plans

Many provincial health authorities committed to developing Senior Friendly Hospitals after improved outcomes were identified when older adults received services based on the Acute Care for Elders (ACE) model of service delivery. The ACE model speaks to the unique and central role of nurses, yet little is known about nurses’ capacity to provide best elder care. The goal of this project is to better understand nurses’ needs to provide best elder care. The project will examine the relationships between organizational (team collaboration, geriatric resources, and leadership support) and nurse (skill and knowledge in geriatric nursing and patient & family centred-care, and ACE role agreement) characteristics, nurse outcomes (role clarity, job satisfaction and turnover intentions), and nurses’ perspectives on best elder care. We will ask up to 3615 nurses to complete relevant surveys, and up to 80 nurses participate in focus groups to further our understanding of their needs and to identify strategies to help nurses provide best elder care. This project is critical to the success of Senior Friendly Hospital initiatives. It will provide information that decision-makers in provincial health authorities can use to enhance nurses’ ability to ensure that older adults have good health and discharge outcomes during hospitalization.

For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).

Phase 1 of an early rehabilitation intervention for older adults with complex chronic disease

Intense physical activity is often undesirable and unacceptable to older adults experiencing an acute illness or exacerbation of a chronic condition. Yet, inactivity in the form of bed rest is has many known adverse health consequences. To address this issue, we are developing 2 low intensity exercise programs with input from older adults. We are evaluating older hospitalized adults opinions about the programs. The results will be used to refine the interventions, clarify patient characteristics on which to tailor the interventions and define the required resources prior to testing their effects in a future clinical trial.

For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).

Systematic review of acute hospital geriatric intervention units

Specialized geriatric services have been designed to prevent the complications of hospitalization for acutely ill older adults with complex chronic disease. In this review we are examining all of the information that has been written about these services. We are describing the activities that are delivered in each service, and we are evaluating which services are best at preventing complications for older adults.

For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).

Validating a response format to facilitate responding in older adults

This study evaluates if a response tree maintains the psychometric properties in, and improves older hospitalized adults' responding to, several standardized surveys measuring symptoms of orthostatic hypotension, fatigue, and sleep quality. The results will: 1) provide data validating the use of the revised scales; and, 2) have implications for how other self-report scales are designed for use with older hospitalized adults. These are important considerations since the data generated from such surveys are used all the time for evaluation, accountability and quality improvement purposes (e.g. Hospital Report Card and Patient Satisfaction Surveys).

For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).

Healthy Brain Aging Project

Investigating how functional and structural brain changes relate to cognitive and social functioning, and how these changes are impacted by modifiable lifestyle factors (e.g. diet, physical activity levels). Gary Turner and Nathan Spreng (Cornell University).

For more information about this project, please contact: Dr. G Turner (grturner@yorku.ca).

Attention and Balance Project

Investigating how attention capacity impacts balance control and, ultimately falls risk, in older adults. Will Gage and Gary Turner.

For more information about this project, please contact: Dr. G Turner (grturner@yorku.ca).