‘Systems thinking is a discipline for seeing wholes. It is a framework for seeing interrelationships rather than things, for seeing patterns of change rather than static “snapshots.” ’ ‐Peter Senge. The current research examined the psychological construct of systems thinking alongside other established psychological constructs of intelligence, personality, cognitive complexity and creativity to distinguish systems thinking as an independent psychological construct. Across two studies, results suggest that, while systems thinking may overlap with some of these constructs, notably intelligence and cognitive complexity, these constructs did not fully explain obtained variance in systems thinking scores and suggest that systems thinking may indeed be a distinct, perhaps foundational, psychological construct that may exist as an individual difference dimension. This exploratory study discusses the theoretical implications of systems thinking as well as further psychometric validation of the Systems Thinking Scale. © 2018 John Wiley & Sons, Ltd.

This chapter examines associations between psychotropic medications and mortality in long-term care home (LTCH) settings. We report new findings with census-level data from all new admissions to long-term care homes in the province of Ontario, Canada (i.e., 20,414 new residents). The data include three linked sets that indicate mortality during the financial years 2010-2011 and 2011-2012. One dataset, the Resident Assessment Instrument 2.0 (RAI 2.0), provides information on demographics, functional capability, clinical conditions, clinical diagnoses, mortality risk, and psychotropic medications. The latter include antipsychotics, antidepressants, analgesics, anxiolytics, and hypnotics. Administration of the RAI 2.0 occurs at resident intake, at quarterly intervals and annually. New analyses reported here examine predictors of daily and pro re nata (i.e., PRN or "as needed") prescriptions of psychotropic medications. However, the most important analyses concern predictors of mortality within intervals of up to 90 days from the final RAI 2.0 assessment. After control for confounding variables, the findings indicate (1) attenuated mortality with daily prescription of frequently prescribed psychotropics (i.e., antipsychotics, antidepressants, and analgesics), (2) augmented mortality with PRN prescriptions for each type of psychotropic medication, and (3) evidence that PRN prescribing overturns beneficial effects of daily prescriptions, whereas the latter reduces the deleterious effects of PRN prescribing.

Objective/Background Antipsychotic use appears to increase mortality risk among older adults with dementia. Whether this risk is similar for regular or intermittent use is unknown. This scoping review aims to explore the temporal association between antipsychotic use and mortality risk for older institutionalized adults. Method We conducted a scoping review using Medline (PubMed), EMBASE, CINAHL, and the Cochrane libraries between October 2018 and January 2019. Results Twenty‐eight articles met review criteria. We found that different antipsychotic medications present different safety profiles. The risk of mortality was highest with conventional antipsychotic use and within 40 days of antipsychotic initiation. Conclusions Conventional antipsychotic use increases mortality for older institutionalized adults. The evidence for atypical antipsychotics is less clear. Mortality risk appears highest within 30 to 40 days of initiating antipsychotic treatment. This temporal association suggests increased mortality may actually be the result of some previously unrecognized illness, comorbidity, change in health status, or increased frailty, rather than an idiosyncrasy of the antipsychotic itself.

No abstract

Supportive housing, including retirement homes and assisted living, is increasingly touted as a suitable living option for Canadian older adults. This scoping review describes the nature and content of studies that explore underlying factors that motivate older adults to relocate to supportive housing. We conducted a search of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycINFO, which identified 34 articles for review. Articles reviewed employed a variety of methods and guiding theoretical frameworks, of which the push and pull framework appeared to be most common. This review suggests that health and functional deficits are important reasons for relocation to supportive housing for older adults. Further longitudinal data are required to more comprehensively describe medical and social determinants for relocation and its consequences, in order to better describe this growing population and better align policies with the needs of older adults contemplating or undergoing relocation.