Rural gerontological health: Emergent questions for research, policy and practice

Poulin, Laura I.L.; Skinner, Mark W.; Hanlon, Neil

doi:10.1016/j.socscimed.2020.113065

Cited by 24 publications

(27 citation statements)

References 45 publications

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“…Older age and dementia are risk factors for functional decline both during and after hospitalization [4] and, independent of illness, older rural community dwellers have poorer functional health, higher rates of disability [17], and higher 30-day hospital readmission rates [18] than their urban counterparts. Rural communities additionally face entrenched health service deprivation (reduced health resources and health system infrastructure), as well as geographical impediments to healthcare access (distance, isolation, and widely dispersed populations), leaving many older people dependent on informal family care [19]. These key features have been overlooked in previous trials evaluating TC and, thus, their findings have limited applicability to rural communities [20].…”

Section: Poor Fit Between Transitional Care and Rural Communitiesmentioning

confidence: 99%

Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

Fox

Sidani

Butler

et al. 2021

Implement Sci Commun

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Background Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities. Methods In this multimethod study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15–20 people with dementia and 15–20 family-caregivers in each province will rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions’ acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will (1) rate the acceptability of the interventions and (2) participate in semi-structured focus group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8–10 healthcare providers per focus group) will be held for a total of 8–12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings. Discussion Findings will (1) include a set of acceptable interventions for rural transitional care that promote older patients’ functioning and family-caregivers’ ability to support patients’ functioning, (2) identify resources needed to incorporate the interventions into rural transitional care, and (3) provide high-quality evidence to inform new transitional care practices and policies and guide future research.

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Section: Poor Fit Between Transitional Care and Rural Communitiesmentioning

confidence: 99%

Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

Fox

Sidani

Butler

et al. 2021

Implement Sci Commun

Self Cite

View full text Add to dashboard Cite

show abstract

“…Older age and dementia are risk factors for functional decline both during and after hospitalization [4] and, independent of illness, older rural community dwellers have poorer functional health, higher rates of disability [17] and higher 30-day hospital readmission rates [18] than their urban counterparts. Rural communities additionally face entrenched health service deprivation (reduced health resources and health system infrastructure), as well as geographical impediments to healthcare access (distance, isolation, and widely dispersed populations), leaving many older people dependent on informal family care [19]. These key features have been overlooked in previous trials evaluating TC and, thus, their ndings have limited applicability to rural communities [20].…”

Section: Poor Fit Between Transitional Care and Rural Communitiesmentioning

confidence: 99%

Optimizing Hospital-to-Home Transitions for Older Persons in Rural Communities: A Participatory, Multimethod Study Protocol

Fox

Sidani

Butler

et al. 2021

Preprint

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Background: Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet, prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities. Methods: In this multi-method study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15 - 20 people with dementia and 15 - 20 family-caregivers in each province will: rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions’ acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will: 1) rate the acceptability of the interventions, and 2) participate in semi-structured focus-group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8 - 10 healthcare providers per focus group) will be held for a total of 8 - 12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings. Discussion: Findings will: 1) include a set of acceptable interventions for rural transitional care that promote older patients’ functioning and family-caregivers’ ability to support functioning; 2) identify resources needed to incorporate the interventions into rural transitional care; and 3) provide high-quality evidence to inform new transitional care practices and policies, and guide future research.

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“…The Canadian Geographer / Le Géographe canadien 2022, 66(1): 145-155 the subfield of health (formerly medical) geography, which both influences and limits the range of issues explored and approaches taken (Skinner et al 2015). Second, work in this area has been strongly linked to conceptual frameworks and priority concerns that prevail in the field of social gerontology, which itself is heavily informed by the fields of community health and epidemiology, psychology, and human ecology (Poulin et al 2020). Third, and related to the two earlier observations, there are strong threads running through much of this literature that presumes a naturalness and inevitability of physical, cognitive, and social decline of older persons, and a deficit view of rural places and spaces that pose a risk to those aging in these environments (Skinner and Winterton 2018).…”

Section: Views Of "Rural Aging" At a Distance: Prevailing Areal-repre...mentioning

confidence: 99%

“…Here we pay particular attention to the role of understandings derived from areal-representational accounts of rural aging that convey a sense of inherent vulnerability and precariousness of older people who live in rural places. While it can be argued that such deficit-laden narratives were intended as a more representative (and hence representational) counterpoint to supposed preexisting idyllic constructions of "the rural," the force of these narratives over many decades of policy, scholarship, and media portrayal has been to re-inforce a sense of rural distance and otherness (Poulin et al 2020). To this we would add that the strength and pervasiveness of the "rural as vulnerable" narrative has been to privilege a narrow view of rural aging, with all that this implies not only for aging" is (re-)presented in dominant forms of discourse, but also in terms of the normative influences at play in how older people feel and act in the world.…”

Section: Normativitymentioning

confidence: 99%

“…In this paper, we make the case that geographers should pay greater attention to the idea of rural aging as complex spatiotemporal assemblages of people and the places and spaces they occupy. We outline an approach that recognizes and builds on previous geographic scholarship about rural aging in Canada, but also seeks new insights that draw on relational and more-than-representational approaches to the study of person/place transformations (Poulin et al 2020). Such an approach offers a means for the discipline to address a persistent "blind spot" that has long overlooked the extent to which older persons are capable of transforming their places and spaces of daily living (Finlay and Finn 2020).…”

Section: Introductionmentioning

confidence: 99%

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On older person/place transformations: Towards a more‐than‐representational geography of aging in rural Canada

Hanlon

Skinner

2021

Canadian Geographies / Géographies canadiennes

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Rural areas of Canada are being transformed by population aging.• More-than-representational approaches to this topic offer much promise to gain a more nuanced appreciation of aging-through-place.• More research and policy considerations are needed to support the mutual constitution of older persons and rural places.The spatial variability of population aging in rural areas of Canada, and the demographic processes that underlie these areal patterns, are reasonably well understood. Research to date emphasizes processes of population redistribution (e.g., net out-migration), regional economic change (e.g., resource-based economic restructuring), and chronologically-centred models of bodily decline as the major features of population aging in rural contexts. This literature has informed a wide range of gerontological research and policy, but there is much more to be said about becoming older in rural Canada. In this paper, we present the outline of a postrepresentational approach to rural aging. We consider the influence of relational and non-representational forces acting on the experience of aging in rural Canada. We then draw on reflections of earlier work in a particular geographic setting as a means to tease out "more-than-representational" considerations for discussion. We also echo recent calls to address a "blind spot" in geographic scholarship that overlooks the considerable extent to which older persons re-shape their community environments. We conclude with an invitation for a greater engagement with older person/place transformations, including closer attention to the processes and performances of "aging-through-place" in other Canadian settings.

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Rural gerontological health: Emergent questions for research, policy and practice

Cited by 24 publications

References 45 publications

Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

Optimizing Hospital-to-Home Transitions for Older Persons in Rural Communities: A Participatory, Multimethod Study Protocol

On older person/place transformations: Towards a more‐than‐representational geography of aging in rural Canada

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