Schlegel-UW Research Institute for Aging

Transcription

1 Schlegel-UW Research Institute for Aging 5-Year Report

2 The RIA aims to enhance care and living for older adults through the development and implementa on of innova ve research and training programs. Eleven Schlegel Villages provide living research environments in which innova ons are tested and living classrooms in which innova ve prac ce development models are developed. Seniors in other congregate se ngs and those living independently in the community are also welcome to par cipate. Results are widely disseminated to benefit seniors and caregivers everywhere. Contact us to discuss research opportuni es.

3 Letter from the Executive Director The Schlegel-UW Research Ins tute for Aging (RIA) is the vision of Dr. Ron Schlegel, a long- me faculty member at the in the Department of Health Studies and Gerontology. It was my privilege, as Dean of the Faculty of Applied Health Sciences at the me, to help shepherd this proposed partnership through the University to Senate Approval in The genesis for this Ins tute evolved in the 1990 s through the work of Dr. Eric Roy (Kinesiology at UW), who created a Func onal Abili es Program at the Village of Winston Park in Kitchener, Ontario. Building on the Schlegel values of caring people, passion, innova on, and posi ve, can-do a tude, Dr. Roy demonstrated that it is never too late to recover func on, enhance some degree of independence, and thereby promote quality of life for residents. The Func onal Abili es Program has more recently been incorporated into a Program for Ac ve Living (PAL), which encompasses func onal abili es, fitness and plas city of aging, as well as staff wellness. Another core program embedded within the Ins tute from the outset is the Murray Alzheimer Research and Educa on Program (MAREP). Ken Murray, a local businessman and philanthropist, walked with his wife, Helen, through the fog of demen a for ten years and asked cri cal ques ons for which there were no clear answers. Out of that uncertainty, Ken provided seed funding and the second core area of the RIA was born. Dr. Sherry Dupuis (Recrea on and Leisure Studies at UW), and her team have grown that program to a level of interna onal recogni on and prominence. Subsequently, seven more research themes emerged on the bases of relevance for the residents and clusters of research exper se/interest from local universi es. To that end, Ron Schlegel has ini ated four Schlegel Research Chairs in Aging (co-funded by the ), to help create a cri cal mass in these themes. More Chairs are projected over the next ten years. The other primary partner for the RIA is Conestoga College whose faculty and staff have been instrumental, along with Associate Director of the RIA (Josie d Avernas), in prac ce development for front-line providers of care. Ron has also provided funding in this context for a Schlegel Chair for Enhanced Seniors Care at Conestoga. As part of the evolu on of the RIA, it became an independent non-profit, charitable founda on in While the and Conestoga College con nue to be the primary partners through Memoranda of Understanding, addi onal exci ng collabora ons have been forged with the University of Guelph, Sheridan College (Sheridan Elder Research Centre), and the Centre for Family Medicine in Kitchener, to name a few. This report provides a snapshot of the exci ng programs that have evolved, and the interes ng researchers/partners that are involved. It has been an exci ng five years and we feel that the best is yet to come. Michael T. Sharra, Ph.D. Execu ve Director Schlegel-UW Research Ins tute for Aging (RIA)

4 Table of Contents 3 The RIA: enhancing care for older adults through research and training partnerships 4 Figure 1: RIA Model 6 Figure 2: RIA Organiza onal Structure 9 Research 10 Schlegel Research Chairs 12 Agri-food for Healthy Aging (A-HA) 14 Fitness and Plas city 16 Func onal Abili es Program (FAP) 18 Murray Alzheimer Research and Educa on Program (MAREP) 20 Op mizing Medica ons for Seniors 22 Spiritual Care for Seniors 24 Vascular Aging and Brain Health 26 Senior-Friendly Physical Environments 28 Geriatric Medicine 31 Prac ce Development 32 Program and Policy Development and Evalua on 34 Workforce Op miza on 37 Applica on 38 Schlegel Villages: Research and Development Sites 39 Project Applica on Highlights 43 RIA s Next 5 Years 44 Goal and Strategic Aims

5 The RIA Enhancing care of older adults through research and training partnerships As a charitable, non-profit founda on, the Schlegel-UW Research Ins tute for Aging (RIA) links research, training and prac ce to enhance care and quality of life for seniors (see Figure 1). These links are created through partnerships. RIA s primary research partner is the, with researchers in nine theme areas (first circle in Figure 1). RIA s main prac ce development partner is Conestoga College. The vast majority of the workforce in Long Term Care is college-trained, including personal support workers, registered prac cal nurses, registered nurses, physio/occupa onal therapy assistants and more. The focus of this partnership is evidence-informed training program development for staff already working in Long Term Care and for students in programs that lead to careers working with seniors (second circle in Figure 1 on Page 4). RIA takes its responsibility to support the conduct of research seriously, but equally as important is the responsibility to ensure that the outcomes are used to inform programs, to be integrated into training, and to influence policy. 3

6 Eleven con nuum of care Villages comprise the primary research and development sites for the RIA, where innova ons are conceived and tested, and those elements found to be effec ve are immediately integrated into prac ce (prac ce development). Learnings from these ac vi es are widely shared via a knowledge transfer strategy that includes integra on into educa on curricula, tradi onal publica ons and conference presenta ons, and more immediately via par cipa on in networks such as the Seniors Health Research Transfer Network (SHRTN). Figure 1: RIA Model Research () Practice Development (Conestoga College) Murray Alzheimer Research & Education Program Functional Abilities Program Spiritual Care for Aging Optimizing Medications for Seniors Fitness & Plasticity of Aging Program Agri-food for Healthy Aging Geriatric Medicine Vascular Aging & Brain Health Senior-Friendly Physical Environments Living Classroom Curriculum Development Professional Development Program Workforce Optimization Research & Evaluation Application (Schlegel Villages) Village of Erin Meadows, Mississauga Village of Humber Heights, Etobicoke Village Riverside Glen, Guelph Village of Sandalwood Park, Brampton Village of Tansley Woods, Burlington Village of Taunton Mills, Whitby Village of Wentworth Heights, Hamilton Village of Winston Park, Kitchener Village of Glendale Crossing, London Village of Aspen Lake, Windsor Coleman Care Centre, Barrie 4

7 Schlegel Family from le to right: Rob, Ron, James, Brad, and Barb. Photo credit: Michael Hostetler The RIA is a product of the philanthrophic spirit and vision of Dr. Ron Schlegel, whose family has been providing Long Term Care to Ontario residents since the 1950 s. Owner and operator of eleven re rement and Long Term Care facili es across Ontario, he commi ed more than $6 Million to develop and launch the Ins tute in $4 Million of which went to the first four Schlegel Research Chairs, and $200,000 per year for 10 years to RIA infrastructure. RIA finances con nue to be supplemented by grants, contracts, and other dona ons. Today the primary goal of the RIA is to enhance the care of older adults in both community-based and Long Term Care environments through the development and implementa on of innova ve research and training programs. The research collabora ons and training ini a ves fostered by the RIA are prac cal, hands-on, and have a direct link to resident quality of life. 5

8 The objectives of the RIA are to: Translate research to prac cal training applica ons for caregivers. Develop innova ve evidenceinformed programs and disseminate to the health care system and general popula on throughout Ontario, Canada and Interna onally. Contribute up-to-date content to curricula in colleges and universi es, training people for careers in seniors care. Provide educa on and training related to health and wellbeing of older adults and their families. Develop a research knowledge base to improve care in communitybased and Long Term Care environments. Involve researchers, educators, caregivers, seniors and families in the research process and in training program development and implementa on. A 13-member Board or Directors with University, College and community membership provides strategic leadership to the RIA researchers and staff. See Figure 2 for organiza onal structure. RIA Organizational Structure Conestoga College - Training & education with operations (i.e. living classroom) - Meetings & participation as required specific to program & projects M.O.U Board of Directors M.O.U - Link research opportunity with research capacity (i.e. living research environments) - Meetings & participation as required specific to program & projects Schlegel Chair for Enhanced Seniors Care Satellite Community Colleges & Learning Centres Executive Director Associate Director Satellite Community Colleges & Learning Centres Schlegel-UW Research Chairs in Aging PROGRAM EVALUATION Schlegel Health Centres Clinical populations (insititutional & community) for research application PRACTICE DEVELOPMENT RESEARCH PROGRAMS Curriculum Development 6 Professional Development Program Workforce Optimization Senior- Friendly Physical Environment Agri-food for Healthy Aging Fitness & Plasticity of Aging Functional Abilities Program Geriatric Medicine Murray Alzheimer Research & Education Program Optimizing Medications for Seniors LIVING RESEARCH ENVIRONMENTS - Schlegel Villages (Windsor, London, Kitchener, Guelph, Hamilton, Burlington, Mississauga, Brampton, Etobicoke, Whitby, Barrie) Spiritual Care for Seniors Vascular Aging & Brain Health

9 Current RIA Board Members Ron Schlegel, Chairman & C.E.O., RBJ Schlegel Holdings Josie d Avernas, Associate Director, RIA Mike Sharra, Execu ve Director, RIA Susan Ellio, Professor & Dean, Faculty of Applied Health Sciences, University of Waterloo Rich Hughson, Professor & Schlegel Research Chair in Vascular Aging & Brain Health, Jake Thiessen, Community Representa ve Marlene Raasok, Associate Vice-President, School of Health & Life Sciences and Community Services, Conestoga College James Schlegel, President, RBJ Schlegel Holdings Bob Kallonen, C.O.O., Schlegel Villages Ken Murray, Community Representa ve Ashok Sharma, Joint Chief of Staff, St. Mary s Hospital and Grand River Hospital Joseph Lee, Chair & Lead Physician, The Centre for Family Medicine Family Health Team John Richards, Chair of Cer ficate Programs and Con nuing Educa on, School of Health & Life Sciences and Community Services, Conestoga College Partnerships In addi on to the primary partnerships previously described (pg. 3), the RIA collaborates with a number of universi es, colleges, research ins tutes and networks, including: Canadian Ins tute for Advanced Research (CIFAR). RIA is closely aligned with CIFAR s Social Interac ons, Iden ty and Well-Being program. In par cular, researchers from the United Kingdom affiliated with CIFAR, Drs Alex and Cath Haslam, are working with the RIA to explore changes in social iden ty among seniors as they encounter life transi ons through different living and care arrangements, and how social iden ty and social connec ons impact well-being through these transi ons. Centre for Family Medicine Family Health Team. RIA collaborates with this academic Family Health Team in the development, implementa on and evalua on of new approaches to care for seniors (and others), with complex primary care needs. A jointly developed Research, Training and Innova on Centre provides specialized interprofessional clinics, including a Memory Clinic, Persistant Pain Clinic, Conges ve Heart Failure Clinic, Mobility Clinic and more. Lawson Health Research Ins tute at Parkwood Hospital. RIA collaborates closely with the Aging, Rehabilita on and Geriatric Care Program, as well as the Canadian Centre for Ac vity and Aging, two programs within the Lawson Ins tute. Ontario Research Coali on. RIA is one of seven research centres that par cipate in the Ontario Research Coali on of Research Ins tutes/ Centres on Health and Aging. This coali on aims to increase Ontario s capacity for research and knowledge genera on related to health and aging, and to strengthen the interface between Ontario researchers and policy makers working on issues related to health and aging. Seniors Health Research Transfer Network (SHRTN). RIA is a founding member of SHRTN, a knowledge exchange network funded by the Ontario Ministry of Health and Long Term Care that links caregivers working with seniors in Ontario to researchers and policy makers. SHRTN s vision is to be the place to go for the latest knowledge and best prac ces regarding seniors health and health care. Sheridan College. RIA collaborates with the Sheridan Elder Research Centre, whose Director, Pat Spadafora, heads up several programs dealing with the crea ve and performing arts. Dance sessions are held at three of the Schlegel Villages (SV), where residents enjoy both the dance steps and research opportuni es. RIA/SV is also a major industry partner in a $2.3 Million SERC grant. University of Guelph. Through a unique partnership with the University of Guelph, RIA spearheaded the forma on of the Agri-food for Healthy Aging (A-HA) research program. A core group of four researchers and a program manager par cipate in a mul -disciplinary ini a ve that focuses on realizing innova ve food and nutri on strategies to improve quality of life for older adults in Ontario. University of Ontario Ins tute of Technology (UOIT). RIA partners with researchers at UOIT interested in exploring the role that technology can play to allow seniors to live independently as long as possible. RIA also has worked with UOIT on the adapta on of its interprofessional prac ce curriculum to primary care providers already working in the community. A Health Force Ontario grant allowed this partnership to develop the program, implement it, provide mentorship support, and evaluate its impact. 7

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11 Research Schlegel Research Chairs Research Theme Areas Project Highlights The RIA promotes research relevant to aging in community and care se ngs. It focuses on prac ce-relevant research as a driving force behind innova on and quality care. Since its launch in 2005, the RIA has been involved in research projects at the frontline within re rement and Long Term Care (R/LTC) communi es, bringing a targeted prac cal benefit to older adults in care se ngs. Among other topics, researchers affiliated with the RIA are inves ga ng spirituality, balance and posture, func onal abili es and demen a, in order to improve quality of life for older adults. The RIA collaborates with researchers from many disciplines with varying backgrounds and exper se, to facilitate and conduct research relevant to seniors care. Winston Park resident Harold Steed works with researcher Dr. Lora Giangregorio and Jenna Johnson during a study within the RIA s Func onal Abili ies Program. Photo credit: J. Bielaski 9

12 SCHLEGEL RESEARCH CHAIRS The RIA has been instrumental in engaging experts in Neuroscience, Geriatric Medicine and Health Care for older adults. There are currently three Schlegel Research Chairs at the (soon to be four), plus one Schlegel Chair at Conestoga College. Kristie Clark, R.N., M.Sc.N. Schlegel Chair for Enhanced Seniors Care, Conestoga College Kris e s role is to help bridge the gap between prac ce and educa on in geriatrics for the health sciences program at Conestoga College. This role includes guest lecturing, developing con nuing educa on in seniors care programs, par cipa ng in applied research, consul ng regarding seniors content in curricula, as well as par cipa ng on a number of program advisory commi ees and leadership projects. Her research interests include role clarity in long-term care, social support, demen a and caregiver rela onships, as well as responsive behaviours. Dr. Safa Elgamel, M.D., Ph.D. Schlegel Research Chair in Neuroscience, Dr. Elgamel is an Associate Professor in the Department of Kinesiology at the. Physical and cogni ve well-being are key components for healthy aging, and she is interested in studying the rela on between physical and cogni ve health of older adults. Of par cular interest to her is the role of physical ac vity in improving the different domains of cogni on, and in slowing the progression of age-associated mild cogni ve impairment and Alzheimer disease. Dr. George Heckman, M.D. Schlegel Research Chair in Geriatric Medicine, 2010-present Dr. Heckman is an Associate Professor in the Department of Health Studies and Gerontology at the. He holds specialist creden als from the Royal College of Physicians and Surgeons of Canada in Internal Medicine and Geriatric Medicine. Research interests include the management of heart disease among older adults, including complica ons such as demen a. Thanks to contribu ons from the Waterloo-Wellington Local Health Integra on Network (WWLHIN) and Grand River Hospital in 2010, Dr. Heckman is working with local providers and planners to enhance geriatric medicine in the region of Kitchener- Waterloo. 10

13 Dr. Carlos Rojas-Fernandez, Pharm.D. Schlegel Research Chair in Geriatric Pharmacotherapy, 2010-present Dr. Rojas-Fernandez is an Assistant Professor at the University of Waterloo s School of Pharmacy. Prior to joining the and the RIA, he worked in the Neuroscience Research and Development division of Bristol Myers Squibb as Senior Medical Science Liaison ( ). The goal of his clinical research program is to enhance the quality of life and care of older adults by addressing three common issues with medica on: (1) overuse, (2) underuse, and (3) misuse. Opportuni es for op mizing medica ons in older adults are now being iden fied, priori zed and developed into appropriate clinical research projects. Dr. Rojas-Fernandez and his team u lize various research methods, as appropriate, including popula on-based methods, as well as qualita ve methods. Dr. Rich Hughson, Ph.D. Schlegel Research Chair in Vascular Aging & Brain Health, 2010-present Dr. Hughson s research is inves ga ng the links between cardiovascular aging and changes in brain blood flow. Evidence is showing that important lifestyle factors such as regular exercise and appropriate nutri on can help to keep blood vessels from s ffening. What is not known yet is how effec vely this will assist in maintaining higher brain blood flow with aging. Another problem under inves ga on is the dizziness that can occur because brain blood flow decreases in many older people when they get up from lying bed or si ng in a chair. It might be unexpected but these down to Earth problems of aging have parallels in astronauts on the Interna onal Space Sta on and Dr. Hughson is using what he learns from studying astronauts to help with the aging research and to inspire seniors to exercise. The RIA has proposed a new Schlegel Research Chair in the field of Nutri on and Aging at the University of Waterloo, with a targeted start date of July This new chair will be responsible for conduc ng research in clinical human nutri on and will interact with the Agri-food for Healthy Aging (A-HA) program. To further develop the RIA presence at Conestoga College, another Schlegel Chair will be hired to replace Kris e Clark, as she has moved on to work within the Schlegel Villages as a Director of Nursing Care. 11

14 Agri-food for Healthy Aging (A-HA) Program Manager: Research Scien sts: Jessica Bowes (Demeter), M.Sc. Schlegel-UW RIA Lisa Duizer, Ph.D. University of Guelph Alison M. Duncan, Ph.D., R.D. University of Guelph Heather H. Keller, Ph.D., R.D., F.D.C. University of Guelph Ken D. Stark, Ph.D. The Agri-food for Healthy Aging (A-HA) ini a ve is a collabora ve research group created through the efforts of the RIA, University of Waterloo, University of Guelph, and MaRS Landing. A-HA s core research scien sts hold exper se in areas of applied nutri on and diete cs, nutri onal sciences, food science, and human health. By exploring linkages between agriculture, food, nutri on and health, A-HA aims to realize innova ve opportuni es for Ontario s agri-food and health sectors to improve health and well-being of older adults. Current A-HA research ac vi es include: evalua ng dietary meal op ons for older adults with swallowing difficul es; exploring methods of texture modifica on for fresh meat and vegetables in re rement and Long Term Care homes (R/LTC); sensory evalua on of omega-3 enriched foods prepared in R/LTC; understanding issues faced by families experiencing demen a, specifically related to food and meal mes, and exploring consump on, understanding and mo va ng factors related to func onal foods in older adults. A-HA also has a core mandate of knowledge transla on and transfer (KTT). With funding from the Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA)/University of Guelph Partnership via the Agri-Food and Rural Link program in 2010, A-HA is currently implemen ng a 3-year KTT project where the objec ves are to share research results, increase collabora ve research and dissemina on opportuni es, build community connec ons and stakeholder partnerships, and train Highly Qualified Personnel (HQP). Specific ac vi es to connect with health professionals in communitybased and congregate se ngs, food industry, government, and academia include: communica on efforts such as an annual newsle er, social media sites (e.g. Twi er), and a blog; hos ng/a ending networking and dissemina on events, and; par cipa on in a knowledge mobiliza on group - a Nutri on Community of Prac ce within the Seniors Health Research Transfer Network. Follow A-HA on Twi er for instant research and dissemina on These efforts will collec vely contribute to a thriving agri-food sector by engaging producers and the food industry in realizing market opportuni es for older adults, and by helping health professionals realize health 12

15 benefits to consuming Ontario s innova ve agrifoods (e.g., func onal foods). Effec ve knowledge sharing is impera ve to realize the value of A-HA s research and facilitate a posi ve change. Without the widespread par cipa on from community as well as industry partners, this collabora ve group and its valuable KTT ac vi es would not exist. Dr. Heather Keller is co-chair of the Canadian Malnutrition Task Force - an initiative of the Canadian Nutrition Society. Phase 4 of the research is s ll in data collec on as of the end of A meal me sa sfac on ques onnaire was developed to assist researchers and re rement home operators in measuring the level of meal me sa sfac on within the resident popula on. Through focus groups the team will determine appropriate ques ons for older adults while crea ng a tool that is superior to what already exists. Future studies will undertake valida on and reliability tes ng. Dr. Heather Keller presen ng at 2009 Health Professionals Forum. Photo credit: Royal Agricultural Winter Fair Social Interac on and the Meal me Experience in a Re rement Se ng Dr. Heather Keller, University of Guelph (2009-present) Dr. Keller s research started with an observa onal study to iden fy and describe social interac on that occurs in the dining rooms of re rement homes. These observa ons made up the first phase of research to explain why meal mes are so important in these se ngs. Phase 2 of this research involved the development of a meal me social interac on measure. The research team developed a tool that assists in tracking social interac on, especially before and a er interven ons designed to promote a posi ve social experience. In order to be er understand what was observed in phase 1, the team engaged re rement home residents in interviews to find out what makes their meal mes important. The third phase was instrumental to understanding rela onships and interac ons between tablemates, meal me roles, and residents rela onship with food. Dietary requirements of residents living in re rement homes - are they ge ng enough omega-3 fa y acids? Dr. Ken Stark, (2007-present) Dr. Stark and his research team are interested in studying the composi on of food eaten by residents living in R/LTC - both in meals that they are given and in snacks they consume independently. They are focusing on the level of omega-3 fa y acids in the diet since these essen al fa y acids have health benefits in areas such as cardiovascular disease and macular degenera on. Preliminary research results provided ra onale to conduct another study exploring func onal food strategies as a poten al interven on technique to increase levels of omega-3 fa y acids in the diets of residents. By the end of 2010, the research team completed data collec on for sensory evalua on of omega-3 enriched foods that were already being consumed by residents (e.g. mashed potatoes). Dr. Stark and the research team hope to move this research forward by conduc ng an interven on study using the omega-3 enriched foods developed in order to determine whether a diet enhanced with enriched foods will result in higher blood levels of the beneficial fa y acid. 13

16 Fitness and Plasticity of Aging Program Coordinator: Michael T. Sharra, Ph.D. Schlegel-UW RIA Research Scien sts: Safa Elgamel, Ph.D. Jim Frank, Ph.D. St. Jerome s University Lori Ann Vallis, Ph.D. University of Guelph Bill McIlroy, Ph.D. Susan Brown, M.Sc. Schlegel-UW RIA 14 The term plas city refers to the ability to mold or change the shape of something. Aging is all about change, some of it posi ve, some of it nega ve, and some of it neutral. There are some declines that are inevitable with age, such as arterial wall rigidity, kidney reserve and impaired chemical regula ons. Early work in this program was designed to look at the nature of change within the respiratory system of older adults. It is clear that the diaphragm loses its capacity to work at maximum power and the lungs lose their elas city. This impacts performance even in those who may run marathons all their life. Nevertheless, the majority of older adults have major reduc ons (up to 50%) in their aerobic endurance capacity in part from aging, but equally from sedentary living. Our society at all ages is faced with an inac vity epidemic which is transla ng Village of Winston Park resident, Bud Starr. into obesity, Type 2 diabetes and coronary heart disease at much earlier ages. This is where the term plas city comes in. For most people, it is never too late to improve the risk profile. Specifically, it is possible to recapture strength, aerobic capacity and mobility. Older adults should not expect to become Olympic athletes - instead, their goal should be to remain func onally independent for as long as possible. There is considerable research evidence demonstra ng that the body (and brain) are s ll plas c into the 90s and that this plas city can result in changes to func onal abili es. The literature is also clear in revealing that the secret of maintaining func onal independence is to maintain or improve fitness level. Light, modest physical ac vity may not be sufficient to delay or forestall the loss of func on in various body systems. On the other hand, brisk walking, balance-mobility prac ce and strength training are very good investments to enhance func onal fitness in older adults. The

17 Village of Riverside Glen resident, Anna Strickland. Photo credit: Jaimie Killingbeck kinesiologists employed at the Schlegel Villages are well-posi oned and well-trained to assist residents in fulfilling this worthwhile objec ve. Use of Neurogym equipment in the Schlegel Villages Dr. Mike Sharra, (2009-present) This equipment is used to enhance resident func onal independence by strengthening muscles and improving balance and coordina on. The Sit To Stand Trainer (STS) uses a weighted pulley system to assist residents as they a empt to rise up from a chair to the standing posi on. The hardest point in that movement is the first 4 cms and this is where the apparatus is invaluable. The amount of weight can easily be lessened as the resident gains leg strength. The other value of this unit is that it can be managed by one staff person reducing both the need for two-person li s and the risk of low back injury....the secret of maintaining functional independence is to maintain or improve fitness level. Func onal Fitness Assessment (FFA) Dr. Mike Sharra, (2009-present) The FFA assessment tool measures the individual s overall level of func on during simple ac vi es of daily living (ADL). This 30-minute assessment is administered to every new resident coming into the re rement neighbourhoods of the Schlegel Villages. Tradi onal measurements of strength, endurance, flexibility, and balance/coordina on are collected. In addi on, the use of accelerometers and a force plate unobtrusively provide a wealth of further informa on which can iden fy subtle nuances of movement that can t be detected by observa on and may be precursors to a major balance/mobility problem. Dr. Bill McIlroy oversees the technology and informa on derived from this part of the FFA enabling iden fica on, tracking and management of mobility and balance perterba ons. Village of Riverside Glen resident, Anne Pryde, using Sit To Stand Trainer (STS). Photo credit: Jaimie Killingbeck 15

18 Functional Abilities Program (FAP) Program Coordinator: Eric Roy, Ph.D. Research Scien sts: Renee MacPhee, Ph.D. Wilfred Laurier University Michael T. Sharra, Ph.D. Schlegel-UW RIA Bill McIlroy, Ph.D. Pat Spadafora, M.S.W. Sheridan Ins tute of Technology and Advanced Learning Sheridan Elder Research Centre Lora Giagregorio, Ph.D. Quincy Almeida, Ph.D. Wilfred Laurier University Denise Connelly, Ph.D. University of Western Ontario Lori Ann Vallis, Ph.D. University of Guelph The Func onal Abili es Program (FAP) started in early 1995 as the Residen al Elder Assessment Program (REAP), directed by Drs Eric Roy and Jim Frank, both Professors in the Department of Kinesiology at the University of Waterloo, with es to the Neurobehavioural Assessment Unit and the Centre for Applied Health Research in the Faculty of Applied Health Sciences. The transi on from REAP to FAP was based on a memorandum for partnership between The Village of Winston Park and the University of Waterloo in April The program was readily adopted at Winston Park and would later be recognized as a Leading Edge program by the Canadian Council on Health Services Accredita on. In 1997, one Kinesiologist was hired to work with the residents in the Long Term Care sec on of Winston Park. The following year, the program expanded to include residents living in the re rement home, and a second Kinesiologist was hired. From there, the program has grown along with the expansion of the Schlegel Villages. FAP is now a key program in each of the 11 Villages. The primary objec ve of FAP is to improve or maintain individual residents levels of func onal abili es using innova ve assessment, rehabilita on, and training programs. 16 Village of Riverside Glen resident, Pam Myers, par cipa ng in FAP swimming program. Photo credit: Jaimie Killingbeck

19 Movement ma ers: Introductory dance classes in re rement care Pat Spadafora, Sheridan Elder Research Centre (2009) The research team focused on inves ga ng whether or not the type of exercise being offered would contribute to increased par cipa on by older adults in physical ac vity programming. They were also interested in exploring any physical and/or psychosocial benefits of dance. Instead of offering exercise classes that focus on repe ve, non-func onal movements, the research team engaged older adults in a 12-week (2 classes/ week) dance program taught by professional dance instructors that mixed ballet and contemporary styles. Physical and psychosocial measures were used to evaluate any changes in life sa sfac on, self-reported health status of older adults, and physical func on before and a er the program. The results of the physical assessments were largely inconclusive, making it difficult for the research team to speculate any causal rela onship between physical a ributes (e.g., endurance) and dance par cipa on. Instead, the researchers will consider the rela ve merit of the physical assessments used in this project for future interven ons. On the other hand, the psychosocial benefits (both measured and anecdotal) are promising residents began mee ng between sessions to prac ce, and indicated that the classes were a tremendous opportunity to meet other residents. Further research is required to fully inves gate the rela onship between func on (both physical and psychosocial) and par cipa on in dance classes, but there is great poten al for including dance classes in recrea on programs for older adults. A compara ve study examining rela onships between muscle weakness and func onal measures of posture and gait Lori Ann Vallis, University of Guelph (2010) Sarcopenia (age-related muscle loss) is a common problem for older adults. It can lead to impairment of ac vi es of daily living, loss of strength, an increased number of falls, and an increased incidence of hip fracture. Although sarcopenia can be devasta ng to an individual s func onal status, there are ways to improve muscle strength and therefore reduce the risks associated with muscle loss. The challenge is that it is difficult to measure the extent of muscle loss using simple clinical tasks. It is much easier to assess muscle loss using expensive, specialized equipment that is not available to most clinicians. The purpose of this study was to compare and evaluate the different methods of assessing muscle weakness that have been previously used in research involving older adults. Using biomechanical, clinical and nutri onal assessments, the research team was able to iden fy some simple clinical tasks that, when used in combina on, could predict the degree of muscle loss in the study popula on with approximately 65% accuracy. The implica on of these results is that it is rela vely simple for clinicians to monitor changes in overall strength for older adults, thereby affording them the opportunity to modify lifestyle factors such as exercise and nutri on to a enuate muscle loss. 17

20 Murray Alzheimer Research and Education Program (MAREP) Program Coordinator: Sherry Dupuis, Ph.D. Research Scien sts: Lori Schindel-Mar n, Ph.D. Ryerson University Tamara Sussman, Ph.D. Bryan Smale, Ph.D. Research Associates: Jennifer Carson Ph.D. Candidate Lisa Loiselle, M.A. MAREP, Colleen Whyte Ph.D. Candidate Leah Sadler, M.H.S. MAREP, 18 Since its incep on in 1993, MAREP has made significant progress in bridging the gap between research and prac ce in order to enhance the ability of all involved in demen a care to respond more appropriately and respec ully to the needs of people living with Alzheimer disease and other related demen as. In the last few years, MAREP has been able to develop important and innova ve research-based educa onal tools and forums including a video, Breaking the Silence: Giving Voice to Persons Dr. Sherry Dupuis, MAREP Program Coordinator and Research Scien st. with Demen a, a CD- ROM Demen a Care Educa on Series, a Responsive Behaviour Video and Resource Guide, and an annual learning and sharing forum designed specifically for persons living with demen a and their partners in care. MAREP is par cularly excited about the latest and most innova ve educa onal project based on the research-based play called I m S ll Here and have recently received funding to evaluate the impact of this tool on demen a care. MAREP research examines issues targeted at improving the quality of the day-to-day lives of persons living with demen a and their families and includes projects such as: The Ontario Demen a Caregiver Needs project conducted as part of the Ontario Alzheimer Strategy The Transi ons in Long Term Care project focused on improving the transi on from community care to Long Term Care The Responsive Behaviour Study, which is examining behaviours in the demen a context The Ea ng Together Study designed to examine issues around food and meal me for persons with demen a and their family partners in care

21 Culture change in long-term care Dr. Sherry Dupuis, Dr. Carrie McAiney, McMaster University (2009-present) This project looks at how to ensure that everyone involved in the care of people living with Alzheimer disease or a related demen a - including family members, formal care providers, and persons living with demen a themselves - are ac ve par cipants and decision makers in their care. This project is funded through the Community-University Research Alliance program of the Social Sciences and Humani es Research Council. Family Transi on Research Program Dr. Sherry Dupuis, Dr. Bryan Smale, This mul -phased, on-going research program is working towards developing a comprehensive understanding of the transi on process and experience of moving a family member to a Long Term Care se ng from the perspec ve of all those involved in the process. The ul mate goal of this research is to develop a planning framework that would ensure a successful transi on process. Knowledge Transla on Through Research-Based Drama on Demen a: Evalua ng Change in Understanding, Imaging and Ac on Dr. Sherry Dupuis, Dr. Gail Mitchell, York University Dr. Chris ne Jonas-Simpson, York University The broad purpose of this research is to evaluate the impact of a research-based drama produc on called I m S ll Here, in changing understanding, images, and ac ons about demen a and demen a care. The hour-long drama takes themes from research about life with demen a (including Alzheimer s disease), and builds several story lines showing different persons living with demen a and their rela onships with friends, family, and care partners. The primary research objec ves are: to examine how personal understanding of demen a can change with the introduc on of a research-based drama produc on to evaluate the impact of a research-based drama produc on on persons understanding, images, and ac ons of and towards persons with demen a in the short-term (i.e., six weeks), and long-term (i.e., one year), a er seeing the drama to examine differences in the impact of the drama between two groups of persons (family and formal care providers - including leaders and policy makers) This research has powerful social implica ons. It can help change the meaning and understanding of demen a. It can influence imaging and ac ons about demen a and demen a care, and it can help to break down the s gma associated with demen a. A sample of MAREP resources The By Us For Us Guides are a series of resources created by and for persons with demen a. They are designed to equip persons with demen a with the necessary tools to enhance their well-being and manage daily challenges. For more informa on, please visit h p:// Living and Transforming With Loss & Grief Managing Triggers Enhancing Wellness Memory Workout Enhancing Communica on Tips & Strategies 19

22 Optimizing Medications for Seniors Program Coordinator: Carlos Rojas-Fernandez, Ph.D School of Pharmacy Jake Thiessen, Ph.D. ( ) School of Pharmacy Research Scien sts: Tom Smillie, Ph.D. The goal of this collabora ve ini a ve is to improve care and overall quality of life for seniors. In keeping with this commitment, the School of Pharmacy was charged with the responsibility of hiring a geriatric pharmacotherapy specialist who would focus on op mizing medica on effec veness and pa ent safety. Included in the mandate is the need to: 1. Iden fy and evaluate pa ent, clinician, and system factors that contribute to the safe and effec ve use of medica ons among the elderly 2. Evaluate the effects of medica ons on pa ent, clinical, psycho-social, and economic outcomes in the geriatric se ng 3. Develop and use data repositories and novel popula on-based methods to op mize the uses of medica ons and to iden fy or confirm adverse events 4. Characterize general pa erns of medica on use to determine their effect on clinical, humanis c, and economic outcomes In an eye-catching publica on from the U.S. Ins tute of Medicine ( To Err is Human ), the authors (Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors) indicate that: Seniors are par cularly at risk for medica on-related problems. While medica ons are probably the single most important factor in improving the quality of life for older Americans, the na on s seniors remain especially suscep ble to medica on-related problems due to physiological changes, higher incidences of mul ple chronic diseases and condi ons, and greater consump on of prescrip on and over-the-counter medica ons. It s es mated that medica on-related problems are among the top five greatest health threats for older [adults]. For example, 28% of all hospitaliza ons among seniors are due to adverse drug reac ons, and 32,000 seniors suffer hip fractures each year due to falls caused by medica on-related problems. In addi on to medica on errors, other types of medica on-related problems include: Underuse of medica ons Overuse of medica ons Use of inappropriate medica ons Adverse drug reac ons, including drug interac ons Lack of adherence to drug therapy (pa ent noncompliance) And as with medical errors, the authors conclude that half of medica on-related problems are preventable. 20

23 Inves ga ng poten al medica on-related contributors to falls among older residents with a recent fall: A study of older adults living in congregate care se ngs Dr. Carlos Rojas-Fernandez, School of Pharmacy, (2010-present) The purpose of the proposed project is to iden fy poten ally modifiable, medica on-related risk factors for falls among older people with recent falls. Iden fying medica on-related risk factors that are poten ally modifiable is of significant value to enhancing the future clinical care of older people residing in congregate care se ngs. The informa on gathered from this study will be used to develop targeted educa onal, systems, and clinical ini a ves aimed at enhancing the care of residents and reducing their future fall risk. This will be accomplished in a separate project that will prospec vely iden fy residents at risk for falls (who have modifiable medica on-related risk factors) and target them for a comprehensive medica on assessment aimed at fall risk reduc on. Assessment of current pa erns of psychotropic drug use for the treatment of behavioural and psychological symptoms of demen a (BPSD) Dr. Carlos Rojas-Fernandez, School of Pharmacy, (2010-present) The purpose of the proposed project is to characterize pa erns of psychotropic drug use in residents with behavioural and psychological symptoms of demen a (BPSD) for use in future enhancement of care ini a ves. Characterizing contemporary pa erns of psychotropic drug use for the treatment of BPSD is a cri cal first step in the overall process of enhancing the future clinical care of residents with BPSD. Various best prac ces exist for op mal pharmacotherapy of BPSD that are well described in the literature and can readily be adopted for use in congregate care se ngs. The informa on gathered from this study will be used to develop targeted educa onal, systems and clinical ini a ves aimed at enhancing the care of residents and op mizing the use of psychotropic medica ons for BPSD.

24 Spiritual Care for Seniors Program Manager: Research Scien sts: Marianne Mellinger, D.Min. Conrad Grebel University College Catherine Haslam, Ph.D. University of Exeter England Renate Ysseldyk, Ph.D. Carleton University The purpose of this program is to promote research and educa on in the field of spirituality that will benefit the lives of current and incoming residents and staff in re rement and Long Term Care. What is spirituality? There is no one accepted defini on of spirituality, but typically most defini ons include the following characteris cs: Spirituality: That which lies at the core of each person s being, that is concerned with ul mate meaning and purpose and that is expressed through values, hopefulness, voca on, and rela onship with oneself, others, the natural world and the transcendent. It may or may not include religious prac ces. The word spirituality came into common usage in the 1960s. People born before 1935 may experience spirituality as a foreign concept, for some it may even have nega ve connota ons. This group is more likely to be sustained by familiar religious prac ces (Henry Simmons, Ph.D.). Some of the current research and educa onal ini a ves within this theme include: Compiling a user-friendly mul -faith manual of spiritual prac ces, prayers, sacred texts and rituals A one-day seminar for professionals and the general public on Spiritual Care for Seniors Iden fying spiritual prac ces that assist in successful transi on into con nuing care facili es Sample of Spiritual Care for Seniors events: Creating Faith-Friendly Health Care Institutions November 19, 2010 Conrad Grebel University College Spirituality and Palliative Care: An Interdisciplinary Approach to the End of Life November 13, 2009 Conrad Grebel University College The Social Cure: Seniors, Social Connections and Health August 7, Caring for the Spiritual Lives of Seniors November 14, 2008 Conrad Grebel University College

25 Environmental scan of spiritual prac ces within the Schlegel Villages Dr. Marianne Mellinger, Conrad Grebel University College, (2007) The goal of this project was to be er understand the spiritual needs of residents, staff, and family members of residents. Focus groups consis ng of residents, family members, and staff were conducted across the Schlegel Villages that focused on the following ques ons: Tell a story or describe an experience in your life that you would describe as spiritual. When you hear the words spiritual care what word or phrase, or idea comes to you? What would you say is your most spiritual need? When you have spiritual concerns, whom do you talk to? What have you most appreciated about the spiritual care you receive? Name two wishes you have for the spiritual care at [name of specific facility]? Four significant and consistent themes emerged from the focus groups. These themes form the basis for further research and inquiry, and are being explored and developed further in the context of program development. Residents from the Village of Humber Heights having tea. Your Social Groups, Health and Well-Being Dr. Renate Ysseldyk, Carleton University Dr. Catherine Haslam, University of Exeter (2009-present) Being a member of various social groups (e.g., singing groups, spor ng groups, book clubs, etc), can protect health and well-being because these groups provide an important source of social support and a sense of belongingness. However, some previous research suggests that religious groups might protect health and wellbeing even further because of the important beliefs that group members also share. The goal of this study was to explore the rela onships between various group memberships, including religious groups, to see how being part of those groups might affect health outcomes, such as cogni ve ability and well-being. At the me of prin ng, data analysis was ongoing. Final results will be available early in In early 2010, the RIA was approached by the Canadian Ins tute For Advanced Research (CIFAR) to explore the possibility of developing a formal research to prac ce partnership with a group of researchers from the University of Exeter in England. CIFAR enables Canadian researchers to work on interna onal research teams that are custom built to transform their fields of study (ww2.cifar.ca). With enthusiasm, the RIA accepted the proposal and has since formed a formal link with the University of Exeter s research team led by Drs Alex Haslam and Catherine Haslam. The Haslam team engages in applied research in several areas including: the representa on of memory, iden ty con nuity and change, memory rehabilita on, organiza onal psychology and social psychology. Their previous work in congregate care, as well as their knowledge of how to translate the results of research into ac on within the context of Long Term Care, makes them ideal partners for the RIA. The collabora on has begun with the comple on of one study examining the rela onship between involvement in social groups, health and well-being (see above), and will con nue in the summer of 2011 when members of the team will visit Canada over a period of 9 weeks to inves gate ways to op mize reminiscence groups within Long Term Care and re rement homes in order to have the biggest impact on memory, cogni ve func on, and well-being. 23

26 Vascular Aging and Brain Health Program Manager: Research Scien sts: Rich Hughson, Ph.D. Michael T. Sharra, Ph.D. Schlegel-UW RIA Myra Fernandes, Ph.D. Research Associates: Andrew Robertson Ph.D. Candidate The Vascular Aging and Brain Health Program is inves ga ng the links between cardiovascular health and the decline in cogni ve func on with aging. Our studies to date have shown a link between s ffer arteries throughout the body and lower brain blood flow. Addi onal preliminary research suggests that people with low brain blood flow do not perform as well on tests that require quick decision making. In current research that is funded by the Canadian Ins tutes of Health Research and the Heart and Stroke Founda on we are trying to discover how these changes happen. We are using noninvasive tools such as Kinesiologist, Joanne Schwartzentruber, from the Village of Winston Park working with resident Dorothy Bird. Photo credit: Steve Edgar ultrasound imaging to inves gate the proper es of blood vessels and to measure blood flow into the different regions of the brain, and we are taking small blood samples to measure markers of accelerated aging to try to understand the mechanisms. The importance of this work stems from the fact that many aspects of cardiovascular aging can be slowed or prevented by lifestyle changes related to exercise and diet, and when necessary by appropriate medica on. Specific preven on and treatment strategies based on this research will maximize the chances for all of us to maintain high quality of life as age. 24

27 Research Assistant, Kim Bowman, and resident Barbara O Riley at the Village of Winston Park. Does exercise increase cerebral blood flow in healthy older adults and in older adults with mild cogni ve impairment? Dr. Safa Elgamel, (2010) The purpose of this study is to determine the rate of increase in blood flow to the brain in response to exercise in older adults, and if the increase in brain blood flow is associated with improved cogni ve func on. The change in demography of aging has resulted in an increase in the number of older adults with mild cogni ve impairment (MCI) and subsequent Alzheimer disease (AD). There is no known effec ve treatment for MCI; however improving the blood supply to the brain in older adults with memory/ cogni ve impairment may preserve or improve their cogni ve performance. Examining the effect of physical ac vity on cogni ve func ons and the mechanisms by which aerobic training may improve cogni on in older adults is crucial because of our limited knowledge of an effec ve alterna ve treatment for AD. Aerobic training has the added benefit of posi ve impacts on other body systems, as constrasted with medica ons which are associated with a range of side effects. In this study, the effect of exercise on brain blood flow is examined in healthy older adults and in older adults with MCI. The rela on between performance on cogni ve screening measures and brain blood flow is also explored. Combined cogni ve training and physical ac vity for older adults Dr. Safa Elgamel, Dr. Mike Sharra, (2010-present) As the average age of the popula on rises, so too does the prevalence of age-associated memory problems. Some people experience memory problems only occasionally while others experience them much more o en. No ma er the type of memory problem that the individual may experience, it is important to understand the factors that contribute to those challenges, and what interven ons might reduce their frequency and/or severity. Studies suggest that physical ac vity is associated with higher performance on cogni ve measures and reduces the risk of cogni ve decline. In addi on, factors such as mental s mula on are associated with a reduced risk of cogni ve decline in older adults. This project explores the impact of combining the two types of ac vi es. This study examines if combined physical/cogni ve training (walking while responding to brain s mula ng tasks) over a period of six months improves memory, mood, and func onal abili es of older adults, compared to a group that does not receive the training. 25

28 Senior-Friendly Physical Environments Program Coordinator: John Lewis, Ph.D. Research Scien sts: Andrew Laing, Ph.D. Andrew Kaczynski, Ph.D. Kansas State University 26 Williamsburg development in Kitchener, Ontario. The aging of Canada s popula on, will present significant challenges in rela on to the built environment i.e., the buildings, structures and open spaces in which we live, work and play. In the Region of Waterloo, lowdensity urban development, a characteris c of many other growing communi es, is not par cularly age-friendly. Features such as rapid suburbanisa on, dispersed development pa erns, the lack of adequate pedestrian infrastructure, separa on of land uses and automobile dependence all present significant obstacles to the independence of seniors. Nevertheless, good architecture and urban design can play a major role in allowing seniors to remain ac ve both physically and socially in their local communi es. While there is a significant body of research that inves gates housing demand and the characteris cs of accessible building environments for seniors, there is compara vely li le research that explores the rela onship between aging and the urban environment (i.e., public spaces). In par cular, research is needed to explore the characteris cs/determinants of good urban design and its rela onship to healthy physical, cogni ve and social aging. A significant issue challenging urban planners and designers is the range of assessment frameworks, criteria and indicators - e.g., accessibility standards, universal design principles, walkability indices, neighbourhood quality of life indicators etc. - that relate to the capacity of the urban environment to support people in later life. Dr. John Lewis is working with the RIA to address the following objec ve: To iden fy, test and apply a range of methods for assessing architectural and urban environments to document their relevance and capacity to generate defensible indicators of architectural and urban design that is suppor ve of healthy aging. Thus far, Dr. Lewis has implemented a subjec ve assessment instrument through interviews with 28 residents to elicit qualita ve percep ons of built environment features, both within and surrounding Winston Park, that facilitate or interfere with physical, social and cogni ve ac vity. The second phase of work during the summer of 2010 involved a detailed inventory and assessment of Winston Park and the Williamsburg neighbourhood using assessment models and metrics that are published and broadly recognised within the urban planning and design professions. One outcome of this research will be a cri cal appraisal for prac cing planners of alterna ve built environment assessment methods that is grounded in residents lived experience of their communi es. A further outcome will be the dissemina on of findings from the subjec ve and objec ve assessment exercises. Through specific recommenda ons for architectural and landscape retrofits to the Winston Park facility, it is our hope that findings from this research will enhance the quality of life of current residents and influence the design

29 and management of future Schlegel Villages developments and beyond. Environmental planning for individuals living with Alzheimer disease Dr. John Lewis, (2009) The objec ve of this project was to learn more about the specific way-finding challenges of older adults, and to inves gate the viability of using computer simula on as a poten al research and design tool. Through a series of interviews and focus groups with older adults, the research team was able to iden fy common naviga onal challenges both inside buildings and in the community. Using a computer simula on of one of the Schlegel Villages, older adults were able to suggest modifica ons to the built environment that would make naviga on easier for them and see their sugges ons simulated in real- me. Novel compliant floors aimed at reducing fallrelated injury risk Dr. Andrew Laing, Alexander (Sandy) Wright, M.Sc. Candidate, (2010) The objec ve of this project is to examine the proper es of novel compliant floors in order to determine if they influence balance in older adults living in residen al care se ngs. Previous research has demonstrated that the floors are capable of absorbing enough force to reduce the likelihood of catastrophic injury a er a fall. The current project is geared at determining to what extent these floors affect balance control in older adults. The research team hopes to demonstrate that elements of the built environment (i.e., flooring), can assist in crea ng a safer environment for older adults, in both community and congregate se ngs. Dr. John Lewis is on the Mayor of Waterloo s advisory council for city planning for older adults. Front entrance of the Village of Taunton Mills. 27

30 Geriatric Medicine Program Coordinator: George Heckman, M.D., Ph.D. Research Scien sts: Sharon Kaasalainen, Ph.D. McMaster University Joseph Lee, M.D. The Centre for Family Medicine Thomas Hadjistavropoulos, Ph.D. University of Regina Linda Lee, M.D. The Centre for Family Medicine In 2009, the University of Waterloo and three funding partners announced the appointment of a renowned geriatric medicine specialist to a new research Chair that will usher in enhanced health care for seniors in the local area and eventually across Canada. The, together with Ron Schlegel, the Waterloo Wellington Local Health Integra on Network and the Ministry of Health and Long Term Care, introduced Dr. George Heckman, who specializes in aging and cardiovascular disease, as the Schlegel Research Chair in Geriatric Medicine. An investment of over $1 Million supports the Chair and his team as they conduct research to improve the delivery of health care to seniors in Waterloo Region and Wellington County. With this appointment and ini al investment, RIA s geriatric medicine research theme area was born. While much of the research in this theme area is focused on Dr. Heckman s research program, the RIA works collabora vely with other researchers to inves gate medical issues that have an impact on the lives of seniors. Previously, Heckman was an assistant professor of medicine at McMaster University specializing in chronic disease management in community, residen al and Long Term Care se ngs. He conducts leading trans-disciplinary research on aging that involves professors in Waterloo s Faculty of Applied Health Sciences working in areas including gerontology, physiology, and health services evalua on. As the Schlegel Chair, my focus will be on conduc ng research that will benefit frail seniors, said Heckman. Frailty and chronic diseases can be managed in a proac ve way, with the primary goal being to keep seniors as func onal as possible where they choose to live, reduce the need for ER visits and hospitaliza on, and ul mately to reduce the pressures on Long Term Care. We hope the work will serve as an example for other communi es. The new Research Chair collaborates with the Waterloo Wellington Local Health Integra on Network to develop an integrated model of health care for seniors. This work covers an inventory of current services to iden fy barriers and poten al solu ons for their 28 Village of Winston Park resident, Alice McNaughton, with her partner in care.

31 integra on, along with developing a list of senior-focused health ini a ves. As well, the integrated healthcare approach will provide learning opportuni es for health sciences students, nursing students, and medical residents and students. Adap ng the Canadian Cardiovascular Society recommenda ons on heart failure: A consensusbased approach with stakeholder input Dr. George Heckman, (2010) Heart failure (HF) affects up to 45% of older Long Term Care (LTC) home residents, in whom it is complicated by frailty, func onal decline, cogni ve impairment and psychiatric symptoms. The presence of HF leads to greater morbidity, mortality, and resource use. HF therapies are under-u lized in LTC, despite poten al benefits for outcomes of interest to frail older pa ents. Barriers to the implementa on of HF guidelines in LTC include diagnos c uncertainty, polypharmacy, limited access to tests, specialists, and other resources. Furthermore, there is uncertainty over whether recommended HF therapy achieves clinically meaningful results for frail persons nearing the end of life. In other jurisdic ons, HF management programs for LTC have been shown to improve pa ent outcomes, though these targeted less frail residents or relied on resources not readily available in Ontario facili es. Importantly, none of these programs were designed with the benefit of the systema c input from all LTC staff roles required for successful implementa on. The objec ve of this project is to develop HF care processes for LTC. These processes will be based on the Canadian Cardiovascular Society (CCS) HF guidelines, and will be designed to op mally u lize the skill sets of all LTC staff roles, be minimally disrup ve to work rou nes, and focus on achieving outcomes relevant to LTC residents. This project will u lize mixed-methods and unfold over two years. A study evalua ng a pain assessment interven on in long-term care Dr. Sharon Kaasalainen, McMaster University Dr. Thomas Hadjistavropoulos, University of Regina Dr. Ramesh Zacharias, Schlegel Villages (2010-present) Previous research has documented that pain is o en not treated adequately in LTC facili es. This work has also shown that regular use of pain assessment in LTC leads to an increase in PRN (i.e., as needed ) medica on usage, reduced pain levels, and reduced levels of caregiver stress. However, these studies did not describe any significant decrease in the number of regularly scheduled, physician-prescribed interven ons (e.g., medica on change, massage, more frequent reposi oning, etc.), designed to be part of a sustainable pain management care plan. This study will demonstrate that pain can be more effec vely monitored and managed if communica on between physicians and other health care providers is op mized. 29

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33 Practice Development Program and Policy Development and Evaluation Research & Training for Workforce Optimization Working closely with Conestoga College and Schlegel Villages as prac ce sites providing Long Term Care and re rement living, the RIA is implemen ng a collabora ve prac ce model that is research-informed and prac cerelevant. It is designed to inspire collec ve innova on in care models, and to promote interprofessional, residentcentred prac ce. Conestoga College Skills Lab located at the Village of Riverside Glen. 31

34 Program and Policy Development and Evaluation Program Collaborators: Josie d Avernas, M.Sc. Schlegel-UW RIA Susan Brown, M.Sc. Schlegel-UW RIA Paul Stolee, Ph.D. 32 Working closely with the Schlegel Villages prac ce sites providing Long Term Care (LTC) and re rement living, the RIA has developed a framework to guide needs assessmentprogram development and evalua on. The framework incorporates factors considered essen al for effec ve integra on of knowledge into prac ce, and borrows from the PARIHS framework (Promo ng Ac on on Research Implementa on in Health Services) and KIM framework (Knowledge Integra on Model). Integra on of Ministry Ini a ves into Long Term Care Josie d Avernas, Schlegel-UW RIA Heather MacDonald, Schlegel-UW RIA (2007) The Long Term Care Homes Branch (LTCHB) worked with the RIA to be er understand how Ministry-funded ini a ves are implemented and integrated to impact the care of residents in LTC. A total of 92 staff from eight Schlegel Villages provided input and opinions on awareness, implementa on and integra on. Nine focus groups of leadership teams at each home and 27 key informant interviews augmented this informa on with opinions and insights about barriers and synergies to integra on and innova ons to improve integra on. Fourteen ini a ves were examined, including Best Prac ce Guideline Coordinators, Psychogeriatric Resource Consultants, P.I.E.C.E.S, various nursing ini a ves, one- me equipment funds, and more. Results showed a general lack of integra on across these ini a ves both with each other and with rou ne resident care within the LTC home. Eight barriers to integra on were iden fied, including tradi onal MOHLTC structure of branch and program silos, limited awareness about individual ini a ves, inadequate communica on, cumbersome process of applica on and ming for implementa on, hidden costs. Recommenda ons for improvement were offered, many of which are being acted on by the MOHLTC.

35 which has triggered the need for legal services. In this respect, legal services are used in a reac ve way rather than as a preventa ve service. Recommenda ons for next steps included development and pilot tes ng of a proac ve model for basic and preventa ve legal services. Integrated Access to Jus ce for Middle Income Seniors: Whitby Legal Service Assessment Project Josie d Avernas, Schlegel-UW RIA Lydia Stewart-Ferreira, Ph.D. Candidate, Osgoode Hall Law School Heather MacDonald, Schlegel-UW RIA (2009) This project was a preliminary step towards be er understanding jus ce issues for middle income seniors and iden fying poten al approaches to improving access. The overall purpose was to focus on one community in Whitby, Ontario to be er understand the legal service needs of seniors, their challenges in accessing those needed services, and to explore innova ve approaches to be er meet those needs and facilitate removal of iden fied barriers to access. The project also sought to make recommenda ons for future work in this area. With funding from the Law Founda on of Ontario, the RIA interviewed seniors, staff who work with seniors, and legal service providers. Lack of awareness of services, system complexity, financial barriers as well as physical/language/a tudinal barriers to access were iden fied as key factors limi ng seniors access to legal services when they need them. Findings showed that middle income seniors may not recognize an issue as one with legal implica ons, and even when they do, don t know the right ques ons to ask. Once aware they could benefit from legal advice, they find the legal system hard to navigate with a patchwork of services that are not integrated across legal, health and social services. Challenges of referral fa gue, case management and follow up appear to be exacerbated by a crisis in the client s life Evalua on of a Transi onal Care Unit Josie d Avernas, Schlegel-UW RIA (2009) Working with Lakeridge Health, the Central East Local Health Integra on Network, and the Central East Community Care Access Centre, the Village of Taunton Mills pilot tested a 20-bed Transi onal Care Unit (TCU) housed within its re rement home. The TCU aimed to contribute to improved flow through the emergency room at Lakeridge Health by shortening length of stay of alterna ve level of care (ALC) pa ents, thereby freeing up beds sooner for emergency room pa ents requiring admission. The evalua on examined length of stay, pa ent sa sfac on, changes in final des na on, as well as costeffec veness. Results showed that the TCU provided excellent care and a restora ve environment to the 98 pa ents it served during the 10 month pilot. Significantly, of the 21 pa ents with an ul mate des na on of Long Term Care when they arrived to the TCU, 8 improved sufficiently that they were able to return home or into a re rement se ng. It improved pa ent flow at the hospitals because every day spent in the TCU was a hospital day saved for that person. The TCU prevented a total of 4,722 hospital days in the 10-month period. This opened hospital beds to those truly in need of acute care. This also saved the system an es mated $1.5 Million. In spite of its success, the TCU closed on March 15 due to new direc on from the Ministry of Health and Long Term Care requiring that all such units operate under Long Term Care regula ons. 33

36 Research & Training for Workforce Optimization Program Collaborators: Josie d Avernas, M.Sc. Schlegel-UW RIA Susan Brown, M.Sc. Schlegel-UW RIA Marlene Raasok, MHSA Conestoga College Ins tute of Technology and Advanced Learning John Richards, Ph.D. Conestoga College Ins tute of Technology and Advanced Learning 34 A key element of the RIA s collabora ve prac ce model is living classrooms on-site in care homes that engender spontaneous interac on among students, staff and residents and provide students with first-hand experience in Long Term Care and re rement living environments. For example, the Village of Riverside Glen serves as a Conestoga Campus for students enrolled in the college s Personal Support Worker program and Prac cal Nursing program. Currently approximately 40 students a end classes daily at the Village of Riverside Glen. Students spontaneously interact Kris e Clark, M.Sc.N. Conestoga College PSW, Margaret Ritzmann, helping a resident at the Village of Riverside Glen. Photo credit: Steve Edgar with residents and come to appreciate the joy of working with seniors. In one of many examples, a student was working on her term paper in the café area and was joined by a resident, who, she discovered, had educa on and a long career closely related to the topic of her paper. This was of great benefit to the student and resident alike. The student obtained important insights for her paper, and the resident found meaning in her day. It is examples like this that demonstrate achievement of Schlegel Villages mission: to provide life purpose for residents within a caring community environment. Currently, the students are using temporary classroom space, but when the new building opens (currently under construc on) it will include purposebuilt classroom space, computer labs, a clinical room with mannequins, model bedroom and common area spaces typical of Long Term Care. Living classroom space is also in place at the Village of Winston Park in Kitchener, where Conestoga College delivers courses in Recrea on Management for Older Adults, as well as a bridging program to allow PSWs to build on their training and experience to qualify to work as Registered Prac cal Nurses. A unique feature that makes this program very popular is its design as a part- me studies program. A second key element of our collabora ve prac ce model is professional development programs for staff working with seniors. The award-winning Excellence in Resident-Centred Care program illustrates this. Mo vated by an interest within Schlegel Villages to enhance the skills of PSWs in providing care that is resident-centred, a working group led by Kris e Clark completed a needs assessment, reviewed the literature on best prac ces, then developed and implemented this innova ve training approach. In line with RIA s objec ve of dissemina on of results and knowledge transfer, plans are underway to package and market

37 this course broadly to Long Term Care homes in Ontario and beyond. A third key element of the collabora ve prac ce model is integra on of gerontology content and interprofessional principles into college and university curricula across a wide spectrum of programs that train students des ned for careers working with seniors. The Schlegel Chair for Enhanced Seniors Care takes the prac ce-based learning from working closely with staff in Long Term Care and re rement living, and working closely with staff at Conestoga College, enriches the gerontology content in various courses. Interprofessional Educa on Project ( ) With funding from HealthForceOntario, Conestoga College collaborated with the RIA and two Long Term Care homes to develop a role clarity framework for the nursing care team and key behaviours for interprofessional prac ce. One of these homes the Village of Riverside Glen - took on the addi onal challenge of pu ng these concepts into prac ce. Organiza onal changes were made, including the introduc on of a new posi on on the care team of Neighbourhood Coordinator. Impact evalua on is underway. General Manager, Paul Brown, and Director of Recrea on, Ted Mahy, from the Village of Riverside Glen. Photo credit: Steve Edgar Director of Nursing Care, Jela Jakovljevic, and another staff member helping a resident at the Village of Humber Heights. Photo credit: Steve Edgar Interprofessional Leadership Project ( ) In response to system challenges associated with providing op mal health care to seniors, the Village of Taunton Mills, the University of Ontario Ins tute of Technology (UOIT) and the RIA partnered to develop and implement a project designed to build capacity for interprofessional (IP) care. The project had two main components: an educa on program in IP care consis ng of training sessions and a prac cum project; and a care coordina on role to assist clients, caregivers and community partners to navigate the community system of care so that they can access the most appropriate health and community supports and build partnerships among community care providers. Results of pre- and post-program surveys of the 34 course par cipants were very posi ve. Projects completed by par cipants demonstrated a strong grasp of the key goals of IP care: person-centred care, enhanced collabora on, communica on, and integra on of care. The majority of survey respondents reported that the quality of care provided to seniors by their organiza on improved as a result of this program, including improvements in client-centred care, reduced wait mes for care, improved health promo on and greater pa ent sa sfac on with care. 35

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39 Application Schlegel Villages Project Application Highlights The Schlegel-UW Research Ins tute for Aging has the capacity to translate the results of research into programs and services for older adults. Research proposals are screened and approved based, in large part, on how applicable the work is to the care of older adults. Research teams then work with staff and residents at our Research & Development sites to collect data and mobilize the knowledge gained into prac ce. The circle is completed through dissemina on and diffusion beyond the R&D sites to benefit seniors everywhere. Winston Park resident, Irv Manske, receiving recogni on from Canadian astronaut, Bob Thirsk, for his incredible accomplishment in the Get Fit For Space ini a ve. Photo credit: Bill Bowern 37

40 Schlegel Villages Research & Development Sites Imagine a world in which frontline workers define concepts and needs for research projects, research teams conduct the research on-site, and the knowledge thus generated is immediately incorporated into staff training programs to improve care and quality of life of seniors. Imagine further that the learning from these experiences is incorporated into curriculum at the College and University level for students training for careers in seniors care. RIA makes this work, through partnerships with the (for research), Conestoga College (for training) and eleven seniors campuses in southwestern Ontario offering a con nuum of care from independent living through to long-term care. These living research environments and living classrooms operate under the corporate umbrella of the Schlegel Villages and include the following sites: The Village of Aspen Lake - Windor, Ontario Long Term Care The Village of Erin Meadows - Mississauga, Ontario Long Term Care Coleman Care Centre - Barrie, Ontario Long Term Care The Village of Glendale Crossing - London, Ontario Long Term Care The Village of Humber Heights - Etobicoke, Ontario Re rement and Long Term Care The Village of Sandalwood Park - Brampton, Ontario Long Term Care The Village of Tansley Woods - Burlington, Ontario Long Term Care The Village of Taunton Mills - Whitby, Ontario Re rement and Long Term Care The Village of Wentworth Heights - Hamilton, Ontario Long Term Care The Village of Winston Park - Kitchener, Ontario Re rement and Long Term Care The Village of Riverside Glen - Guelph, Ontario Re rement and Long Term Care Not only do the 2,500 residents who live in these Villages benefit from the culture of research and innova on that RIA fosters, other seniors and organiza ons are welcome to par cipate in RIA projects. It also contributes beyond these communi es to system-wide policy and prac ce improvement. Materials and informa on are shared with others providing care to seniors in community and Long Term Care se ngs, and with other system networks to promote research-informed quality care. 38

41 Project Application Highlights Get Fit For Space Dr. Mike Sharra, Schlegel-UW RIA, University of Waterloo (2009) Through the connec on with Dr. Richard Hughson, the RIA collaborated with the Canadian Space Agency (CSA) on this ini a ve by involving each of the Schlegel Villages in a corporate physical ac vity challenge. Being in space, with zero gravity, accelerates the aging process for astronauts - i.e., more rapid loss of muscle mass, bone density and motor control. Amazingly, the countermeasure in space is the same one that our older adults use on earth physical ac vity! Astronauts walk on a treadmill or ride a cycle ergometer for up to two hours per day. This does a enuate the losses. While our residents do not have to exercise that much, regular physical ac vity every day will also slow down the rate of loss. This Get Fit For Space program that embraced all Schlegel Villages earned RIA the 2009 Innovator Award from the Interna onal Council on Ac ve Aging for our crea ve role in promo ng Ac ve Aging. Canadian astronaut, Bob Thirsk, with Dr. Mike Sharra, Execu ve Director of the RIA, and residents from the Village of Winston Park. Photo credit: Bill Bowern 39

42 Project Application Highlights Using Apprecia ve Inquiry to Change the Culture of Aging in Long Term Care Jennifer Carson, Ph.D. Candidate, ( present) RIA and Schlegel Villages embarked on a system-wide, mul -year ini a ve to provide more choice and flexibility into the lives of those living in the Villages. The inspira on for this ini a ve came from the work of the Pioneer Network, a movement to change the culture of aging from an ins tu onal model of care towards a social model of living. Using Apprecia ve Inquiry, an organiza onal development strategy that focuses on the systema c discovery of what gives a system life, a 3-day Apprecia ve Inquiry Summit yielded eight aspira onal statements. Each of the Villages developed opera onal plans based on these aspira onal statements. Residents, family members and team members were all involved in this process. The process and results of this ini a ve are being evaluated within an ac on research paradigm. The evalua on of this process is the topic of Jennifer Carson s Ph.D. disserta on. This project is a great example of simultaneous ac on research, where research informs programming, and vice versa. Schlegel Villages Apprecia ve Inquiry Summit (September 2010) in Innisfil, Ontario. 40 Conestoga College Skills Lab located at the Village of Riverside Glen. Evalua on of the Living Classroom (2010-present) The Living Classroom concept developed by Conestoga, the RIA and Schlegel Villages was designed with the express purpose of adding value to the student experience, as well as to the care centre environment, by inten onally integra ng learning and care ac vi es. The Living Classroom at the Village of Riverside Glen began in October 2008 with an intake of Personal Support Workers. In September 2009 an intake of Registered Prac cal Nursing students was added. The number of students has increased each year. An evalua on is underway to examine impacts of this Living Classroom experience from the point of view of students as well as from the point of view of the Long Term Care home: Do students feel be er prepared to embark on a career working with seniors? Have their career choices shi ed towards a preference for working in a seniors environment? Has the living classroom improved staff recruitment and reten on? Do residents enjoy a greater sense of life purpose through opportuni es to contribute to the Living Classroom? Data collec on is underway, with results expected by summer of 2011.

43 Excellence in Resident-Centred Care (ERCC) Kris e Clark, Conestoga College A key element of the RIA s collabora ve prac ce model is professional development programs for staff working with seniors. Mo vated by an interest to enhance the skills of Personal Support Workers in providing care that is resident-centred, a working group led by Kris e Clark completed a needs assessment, reviewed the literature on best prac ces, then developed and implemented this innova ve training approach for Personal Support Workers. Using a peer-led train-the-trainer model, ten 45-minute modules helped PSWs hone their care skills and carry out their tasks in a residentcentred way. Each module enhanced prac cal skills in an ac ve learning format and within a resident-centred framework in specific areas such as restraint use, con nence care, wound care, oral care, infec on control, nutri on and hydra on. This program received the OLTCA s Quality Improvement Innova on of the Year Award in This program was delivered in nine long term care homes, and approximately 70% of the 800 PSWs were trained to date. A change in culture towards more resident-centredness is evident and confirmed by evalua on results. Evalua on results also showed that it s more than enhanced skills of PSWs that have made this program a success. Equally important was embedding this program into the fabric of daily life for staff in the Long Term Care or re rement home. A sustainability plan accompanied the training program, including an organiza on-wide policy promo ng resident-centredness across all departments, incorpora ng elements of this program into orienta on for new staff, ongoing professional development across all departments, using a train-the-trainer approach with Personal Support Workers delivering the modules to their peers on-site. The training program is now available to PSWs across Ontario through Conestoga College. ERCC gradua on (Summer 2009) at The Village of Wentworth Heights. 41

44 RIA s First 5 Years At a Glance 2005 RIA is approved by Senate as a Research Institute Executive Director and Associate Director are hired. RIA becomes a non-profit, charitable foundation. Ron Schlegel announces $4 Million donation to support joint Schlegel Research Chairs adding to the $2 Million already committed to support RIA infrastructure. RIA and Conestoga College sign Memorandum formalizing the collaboration. Kristie Clark begins as Schlegel Chair for Enhanced Seniors Care. Dr. Safa Elgamel begins as Schlegel Research Chair in Neuroscience. RIA and Centre for Family Medicine sign Memorandum formalizing the collaboration. RIA and sign Memorandum formalizing the collaboration. RIA and University of Guelph sign Memorandum formalizing the collaboration. Dr. George Heckman begins as Schlegel Research Chair in Geriatric Medicine. Dr. Carlos Rojas-Fernandez begins as Schlegel Research Chair in Geriatric Pharmacotherapy. Dr. Rich Hughson begins as Schlegel Research Chair in Vascular Aging and Brain Health. 27 research projects are underway.

45 RIA s Next 5 Years The mission of the RIA is to enhance the care of seniors in both community-based and Long Term Care environments through research, training and prac ce partnerships. This mission has guided RIA s work since it was formed as a senate-approved ins tute at the in 2005, and then incorporated as a nonprofit charitable organiza on in Through a strategic planning session held in April 2010, a five-year strategic plan has been developed that retains the original mission and sets out an overarching goal for the next five years and five strategic aims. 43

46 Goal for the Next 5 Years: To be one of the top five research institutes for aging in the world. By 2015, RIA will be widely recognized as a catalyst for thought and action. RIA will be credited with having improved the lives of seniors everywhere through innovations springing from its unique ability to incubate ideas, test them, replicate them, and package them for widespread application. Strategic Aims for the Next 5 Years Strategic Aim #1 To be the first ins tute in Canada to co-locate research, training and prac ce for seniors care and quality of life on one university campus, including full con nuum of living op ons from independent living to long-term care. Strategic Aim #2 To a ract and develop a cri cal mass of world-class leaders in aging research and prac ce development. Strategic Aim #3 To be a leader in human resource development and quality improvement across the seniors care con nuum. Strategic Aim #4 To be recognized as the leader for policy- and prac ce-relevant advice by government, decision-makers and others engaged in research, training and prac ce related to seniors care and quality of life. 44 Strategic Aim #5 To disseminate successes beyond the Research & Development sites.

47 For more information... h p:// The RIA website has a complete list of current and completed projects, research scien sts and Follow the RIA on Twi er to receive quick research and dissemina on updates! RIA staff Mike Sharra, Ph.D. Execu ve Director Josie d Avernas, M.Sc. Associate Director davernas@uwaterloo.ca Susan Brown, M.Sc. Research Coordinator sgbrown@uwaterloo.ca Kate Wilson Administra ve Assistant kwilson@uwaterloo.ca Jessica Bowes, M.Sc. Program Manager, A-HA jcbowes@uwaterloo.ca

48 Schlegel- Research Ins tute for Aging Enhancing care for older adults through research and training partnerships. 325 Max Becker Drive, Suite 202 Kitchener, ON N2E 4H5 t e. w.