Aging in a Changing World

Aging in a Changing World

Researchers and trainees from the Centre for Hip Health and Mobility (CHHM) were active participants and leaders at the Canadian Association on Gerontology’s conference, “Aging in a Changing World” (Oct. 18-20th, in downtown Vancouver), which was attended by over 700 attendees from 20 countries.

The Walk the Talk team (NPI: Dr. Heather McKay) hosted a symposium focused on the intersection of the built environment and older adults’ mobility, with both speakers and the discussant underscoring implications for policy and practice. The symposium was convened by Dr. Joanie Sims-Gould, Dr. Heather McKay served as the discussant, and Walk the Talk team members, Dr. Maureen Ashe, Anna Chudyk and Dr. Phillipa Clarke, presented papers. In other sessions, Kaityln Gutteridge presented on the use of GPS to characterize the outdoor mobility of older adults, Catherine Craven presented on client safety in home care, Dr. Joanie Sims-Gould presented on novel knowledge translation strategies in the long term care setting, and Dr. Heather Hanson presented the results of a feasibility study on mobility following hip fracture. With an emphasis on prevention, detection, and putting research into action, the team collectively represented CHHM, our mission, and our values.

Please see below for an outline of these presenters and their abstracts.

 

Hanson, Heather

Mobility Following Hip Fracture - Results from a Feasibility Study

Heather M. Hanson 1 ,2, Erin Gorman1 ,2, Erin Macri1 ,2, Wendy Cook3 ,4, Penny Brasher5, Pierre Guy1 ,6, Maureen Ashe1 ,2

1Centre for Hip Health and Mobility, Vancouver, BC, Canada, 2Department of Family Practice, University of British Columbia, Vancouver, BC, Canada, 3Department of Medicine, University of British Columbia, Vancouver, BC, Canada, 4Providence Health Care, Vancouver, BC, Canada, 5Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada, 6Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

Background: Hip fractures are significant events for older adults with increased risk for mobility disability and subsequent low trauma fractures; yet literature highlights care gaps for assessing falls risk factors and bone health following hip fracture. Therefore, we aimed to evaluate the effects of a specialized follow-up clinic for older adults after hip fracture.

Methods: This was a feasibility study of a follow-up clinic after hip fracture. Participants were recruited in hospital and invited to participate at least 3 months post fracture repair. Following baseline assessment (3 months), participants attended a specialized clinic and were assessed by a geriatrician and physiotherapist. The primary outcome was mobility as measured by the Short Physical Performance Battery (SPPB); secondary outcomes included determination of physical activity and sedentary behaviour patterns using accelerometry.

Results: Nine older adults (mean age 78.8; range: 66-94 years) were enrolled in the study. At baseline, participants' scores for the primary outcome (SPPB) ranged from 0-11 out of 12 points; median (IQR) = 7 (2.5-8.5). On average, participants spent 81% of the day in sedentary time; this translated to 11.5 hours of sedentary time each day, 3 hours of light activity and 6 minutes of moderate activity. This presentation will highlight the results at 12 months post fracture, for mobility and sedentary behaviour and physical activity.

Conclusion: This study characterises the mobility trajectory of a small group of older adults within the first year following hip fracture.



Sims-Gould, Joanie

Equipping the Puzzle Makers During Care Transitions: The Unanswered Questions of Hip Fracture Patients

Kerry Byrne 1, Joanie Sims-Gould2, Elisabeth Hicks2, Emily Piraino1, Paul Stolee1
1University of Waterloo, Waterloo, Ontario, Canada, 2Centre for Hip Health and Mobility , Vancouver, British Columbia, Canada

Background: A universal finding in care transitions research is that patients report confusion and difficulty navigating health care systems. A major contributing factor is a lack of information at the right time, in the right place, from the right person.  This presentation is based on data from a multi-site ethnographic field study aimed at understanding information exchange between health care providers, patients and families during post operative care transitions in Canada.

Method: An ethnographic study consisting of qualitative interviews and observations of patients was conducted in Ontario and British Columbia. Twelve hip fracture patients were followed throughout their transitions from hospital based to community settings. Data were collected at multiple points across the care continuum. Analysis techniques included topic and analytical coding, memo writing and peer debriefing.

Results: The first theme, short-term vs long-term puzzle making, highlighted the nature and types of questions patients had during care transitions. These ranged from questions related to the surgery itself such as ‘What happened to me’, to more existential types of questions such as ‘What is in store for me?   The second theme, patient networking skills and strategies, emphasized the proactive, practical and innovative strategies engaged in by patients along the care continuum.

Conclusions: Care transition programs should focus on biopsychosocial models to ensure short-term and long-term ‘puzzles’ are addressed. Understanding and building on current techniques and strategies used by patients can assist health care providers to facilitate more informed and engaged patients during care transitions.

Gutteridge, Kaitlyn

Use of Global Positioning Systems (GPS) in Characterizing the Outdoor Mobility of Older Adults

Kaitlyn Gutteridge 1, Meghan Winters1 ,3, Anna Chudyk1 ,2, Maureen C. Ashe1 ,2, Joanie Sims-Gould1 ,2, Heather A. McKay1 ,2 (1Centre for Hip Health and Mobility, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3Simon Fraser University, Burnaby, BC, Canada)

Background: Mobility is critical for the health and well-being of older adults, and to allow them to age-in-place. Research studies typically capture travel behavior through self-report travel diaries. However diaries can be subject to recall bias, perhaps especially so in the older adult population. Further, diaries allow outcomes such as "number of trips/day", but little on the spatial location of travel. Our goal was to investigate Geographic Positions Systems (GPS) as a method to capture detailed travel patterns.

Methods: We gathered GPS data from 100 participants of the Walk the Talk Survey, a cross-sectional study of older adults (age 65+) with low socio-economic status, living across Greater Vancouver neighbourhoods with a range of walkability characteristics. Participants recorded daily travel (location, mode, purpose) in 7-day travel diaries, and wore a GPS device (BT-1000X) during waking hours. We report on the quality of the data collected by both methods, and on feedback from participants and staff on their experiences.

Results: In total, 89 of the 100 participants had at least 1 full day of data, and 79 had at least 3 days. There was marked variability between participants in the amount of travel within and beyond their neighbourhoods.

Conclusions: This exploratory study illustrated a novel method to capture travel behavior that can be applied in future research initiatives, with certain protocol refinements (e.g., charging devices). The rich GPS data provided can facilitate innovative spatial analyses, and more precision on where, and when, people are out and about in their communities.

 

Hanson, Heather 

Recruitment for a Pragmatic RCT - View from the Front

Heather Hanson 1 ,2, Erin Macri1 ,2, Wendy Cook3 ,4, Penny Brasher4, Pierre Guy1 ,6, Maureen Ashe1 ,2
1Centre for Hip Health and Mobility, Vancouver, BC, Canada, 2Department of Family Practice, University of British Columbia, Vancouver, BC, Canada, 3Department of Medicine, University of British Columbia, Vancouver, BC, Canada, 4Providence Health Care, Vancouver, BC, Canada, 5Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada, 6Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

Background: Hip fractures are significant events for older adults with an increased risk for mobility disability and subsequent low trauma fractures. The time period immediately following a hip fracture and hospitalization can be stressful. Consequently, research trials to evaluate interventions to address care gaps can often encounter challenges recruiting participants. The objective of this investigation was to describe the recruitment process involved in an RCT evaluating a specialized follow-up clinic for older adults after hip fracture.

Methods: We recruited from two academic teaching hospitals using two methods to approach and invite participants to take part in the study. A recruitment co-ordinator screened for eligibility and invited eligible older adults to enrol. The study inclusion criteria were: older adults (65 years+) who were within 12 months following a low-trauma hip fracture; community-dwelling before and after hip fracture; and with no diagnosis of dementia.

Results: Approximately 500 hospital charts of older adults with hip fracture were reviewed within a 16 month time period. Approximately 60% of participants were not eligible. The three top reasons why individuals were not eligible were: younger than 65 years, diagnosis of dementia, and not community-dwelling prior to/following the hip fracture. Of those who were eligible, the three most common reasons for nonparticipation were: English language barriers, inability to make contact with the older adult by telephone and/or mail, or declining the invitation to participate.

Conclusion: Recruiting for clinical trials can encounter some challenges, especially with vulnerable populations.

 

Sims-Gould, Joanie

Using falls video capture data as a knowledge translation and exchange strategy in long term care

Joanie Sims Gould 1, Vicky Scott4 ,1, Gina Gaspard3, Fabio Feldman3 ,2, Ryan Woolrych2, Andrew Sixsmith2, Heather McKay1, Stephen Robinovitch2 (1University of British Columbia, Vancouver, British Columbia, Canada, 2Simon Fraser University, Vancouver, British Columbia, Canada, 3Fraser Health Authority, British Columbia, Canada, 4Ministry of Health, British Columbia, Canada)

Falls are the number-one cause of injury in older adults, and are especially common in the long-term care (LTC) environment. In this presentation we highlight an end-of-grant knowledge translation project that involves the development and dissemination of a video-based training tool addressing the cause and prevention of falls in seniors. While applicable to a wide range of stakeholders, this interactive tool is designed specifically for training nurses, care aides, and physical therapists who work with older adults in LTC. The unique and powerful aspect of the tool is the inclusion of video footage of real-life falls (collected under our primary CIHR operating grant) in a set of "case studies" which focus on current knowledge and best practices related to issue such as fall risk screening, mobility and balance assessment, exercise, fall-related injuries (especially hip fracture and head trauma), environmental hazards, and hip protectors. In the last decade, knowledge translation and exchange (KTE) has become a cornerstone of successful and effective health research programs. As an essential first step to KTE, stakeholders and end users must be engaged in the research process. We describe the steps we undertook to engage stakeholders in the development and design of this unique KTE tool. We also highlight our dissemination and evaluation plan.



Robinovitch, Stephen

The Flooring for Injury Prevention (FLIP) Trial: Can Compliant Flooring Reduce Injuries Due to Falls in Long-Term Care?

Dawn C. Mackey 1, Chantelle Lachance1, Andrew C. Laing2, Stephen N. Robinovitch1, Fabio Feldman3 ,1
1Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada, 2Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada, 3Fraser Health Authority, Surrey, British Columbia, Canada

Falls are the leading cause of unintentional injury among older adults in Canada, including over 90% of hip and wrist fractures and a large percentage of head and spine injuries. Long-term care (LTC) is a particularly high-risk setting – approximately 60% of LTC residents will experience at least one fall each year, and 30% of falls in LTC cause injury. Despite these disturbing statistics, little attention has been directed to fall injury prevention in the LTC setting. A promising strategy for reducing fall-related injuries in LTC is to decrease the stiffness of the ground surface, and the subsequent force applied to the body parts at impact. Laboratory studies have demonstrated that purpose-designed compliant flooring can reduce the force applied to the hip during a fall by ~35 % and to the head by ~70%, without substantially impairing balance. However, no studies have tested the effect of compliant flooring on fall-related injuries in LTC. To address this gap, we will conduct a randomized controlled trial of flooring in resident rooms at a LTC facility in Abbotsford, British Columbia. The trial will (1) evaluate efficacy of compliant flooring relative to control flooring in reducing fall-related injuries; (2) determine cost-effectiveness of compliant flooring; and (3) assess perceptions about compliant flooring among staff, residents, and families. This symposium presentation will first review biomechanical evidence supporting the use of compliant flooring for injury prevention and then highlight the trial’s design, including stakeholder partnerships, ethics, blinding, randomization, renovation logistics, endpoint surveillance, and statistical power.

 

Hoppmann, Christiane

The role of pain, positive emotions, and self efficacy on daily life fluctuations in older adults’ patterns of physical activity

Tracey Ma1, Christiane Hoppmann 1, Peter Graf1, Karim Khan1 ,2, Jochen Phillipp Ziegelmann3, Maureen Ashe1 ,2
1University of British Columbia, Vancouver, British Columbia, Canada, 2The Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada, 3German Centre of Gerontology, Berlin, Germany

Although physical activity is known to reduce age-related health risks, older adults are the most inactive segment of the Canadian population. This study examined the role of pain, positive emotions, and self-efficacy in predicting daily physical activity as older adults engaged in their typical daily life routines. Data are based on 10-day time-sampling information from 143 community-dwelling older adults aged 65+ who provided self-efficacy ratings and who also completed 3 daily diaries about their current pain levels, emotional experiences, and minutes of physical activity. Participants also wore an accelerometer to objectively measure physical activity patterns. Multi-level models from the first 82 participants indicate that older adults with higher self-efficacy engaged in more physical activity than those with lower self-efficacy. Increased pain was accompanied by subsequent decreases in physical activity in the next five-hour interval. This effect was more pronounced in men as compared to women. Elevated positive emotions were neither associated with subsequent increases in physical activity, nor did they undo the effect of pain on physical activity. These findings are based on self-reported minutes spent in physical activity. Further analyses will consider both objective and subjective measures of physical activity controlling for functional capacity, baseline pain, current physical activity levels, and negative emotions using the full sample. Initial findings demonstrate the important role of psychological factors in predicting daily fluctuations in physical activity, thereby pointing to important daily life targets for health promotion. They further suggest that the underlying mechanisms may be gender-specific.

 

Ward Thompson, Catherine

How does the quality of the neighbourhood environment impact on older people's activity and quality of life? Evidence from a UK study

Catharine Ward Thompson (OPENspace Research Centre, Edinburgh, UK)

Maintaining independent mobility in later life is an important facet of quality of life and the role of the built environment in facilitating physical activity is well recognised. This presentation explores the concept of a supportive environment and use of Personal Projects as a framework to understand the idiosyncratic activities that are salient to individuals. We present results from a longitudinal study across several locations in the UK undertaken as part of the I'DGO TOO (Inclusive Design for Getting Outdoors 2) project (www.idgo.ac.uk). The interventions studied were changes to residential streets, designed to make streets more ‘liveable' by removing vehicular traffic and creating more shared space for local use. Residents aged 60+ living in intervention streets and in nearby control streets were surveyed in 2008 and, following the implementation of interventions, in 2010 and 2011. Data collected related to perceptions of the environment, activities undertaken, quality of life and self-rated health, and frequency of getting outdoors. Results suggest that, while there are some positive changes in perceptions of the environment and self-reported activity in intervention streets compared to control streets, positive effects on quality of life and health outcomes are less apparent. In conclusion, we identify the challenges and limitations of a study such as this, where the context of deprivation and the age of participants meant retention of study recruits was particularly difficult. These findings may help inform the design of age-friendly residential and neighbourhood environments by showing which aspects make a different to older people's everyday life.



Chudyk, Anna

A Framework for Community-Based Research Partnerships: An illustration from a built environment and mobility study conducted with older adults of low SES

Anna Chudyk, Lynsey Hamilton, Catherine Craven, Meghan Winters, Maureen Ashe, Heather McKay, Joanie Sims-Gould (Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada)

Low socio-economic status (SES) is associated with poorer health in older adults. However, older adults in low SES categories are often under-represented in the research literature. This is due, in part, to the challenge of first identifying and then recruiting this demographic as participants in research. .We use a case study approach to describe the steps we took to identify and recruit older adults of low SES as participants in a study that evaluates the role of the built environment on older adult mobility and health. We describe a central role for community partners (BC Housing in this instance) and examine some of the barriers and facilitators to working in partnership with community stakeholders. We present a framework with key practice and policy considerations that includes: strategies to address privacy policies of both partners in the research process, mechanisms to promote positive and transparent communication and the critical role of celebration. In conclusion, we offer practical suggestions to help strengthen community based built environment research partnerships and specifically initiatives that aim to address the specific needs of older adult populations in low socioeconomic strata.



Hanson, Heather 

Concept Mapping: Engaging Stakeholders to Unravel the Role of the Built and Social Environments on Older Adults' Mobility

Heather Hanson 1 ,2, Claire Schiller1 ,2, Joanie Sims-Gould1 ,2, Philippa Clarke3, Eileen Curran4, Meghan Donaldson1 ,2, Lynsey Hamilton1 ,2, Beverly Pitman5, Vicky Scott6 ,2, Meghan Winters1 ,7, Heather McKay1 ,2, Maureen Ashe1

1Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada, 2University of British Columbia, Vancouver, British Columbia, Canada, 3University of Michigan, Detroit, Michigan, USA, 4City of Vancouver, Vancouver, British Columbia, Canada, 5United Way of the Lower Mainland, Vancouver, British Columbia, Canada, 6British Columbia Ministry of Health Services, British Columbia, Canada, 7Simon Fraser University, Burnaby, British Columbia

Background: There is a complex interaction between older adults' mobility with their built and social environments. Emerging evidence highlights that street-level and community-level built environmental features, and social environment factors (social connections, social order etc.) may be the key to facilitate or inhibit older adults' non-motorized outdoor mobility and community participation.

Statement of Objectives: Therefore, the purpose of this in process study was to evaluate expert opinion regarding the association between elements of the built and social environments and older adults' outdoor mobility and community participation. Our specific objective for this study was to describe the process of concept mapping, and to demonstrate its utility to address our primary objective of understanding the contributing role of built and social environments to older adults' mobility.

Methods: We identified opinion leaders, community stakeholders, knowledge users and health researchers to take part in the concept mapping process. Based on brainstorming and synthesizing sessions, we will ascertain and synthesize key themes that encourage older adults' outdoor mobility and community participation.

Results: We will summarize the process and present a visual sample of our results to illustrate the integration of concepts and ideas across emerging themes.

Conclusion: Concept mapping is an effective visual representation of complex, interrelated ideas. This approach is highly accessible to stakeholders and adds depth to the existing peer-reviewed literature. We believe our results using this method, can be used effectively to engage and guide decision makers, practitioners and researchers regarding older adults' community participation.

 

Sims-Gould, Joanie

Engaging older adults in designing environments that enhance health & mobility

Joanie Sims-Gould 1 ,2, Meghan Winters1 ,3, Sarah Furst1 ,2, Catherine Craven1 ,2, Anna Chudyk1 ,2, Heather McKay1 ,2
1Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada, 2University of British Columbia, Vancouver, British Columbia, Canada, 3Simon Fraser University, Burnaby, British Columbia, Canada

Our research centers on a unique opportunity to capitalize on a "natural experiment" to better understand what constitutes healthy, mobility-focused community design. Our key partner, the City of Vancouver, is making a substantial investment in the built environment to develop a new greenway through downtown Vancouver, Canada. Our collective goal is to create an urban environment that prioritizes the mobility of pedestrians, adopting an age-friendly perspective. As a first stage in this research program we participated in and evaluated the City's process of developing community-informed design plans that aim to increase the mobility and liveability of the built environment along the Greenway. In a series of focus groups, individual conversations, and guided walking tours we spoke with over 50 older adults who live along (or use) the proposed route. Based on a content analysis of our notes from the consultations, we determined 4 key themes that reflect perceptions of older adults regarding key design features they deem necessary to enhance mobility along the greenway: (1) the current route is not a choice destination but could be; (2) benches are essential; (3) sidewalks must be smooth; (4) different (and strong) opinions about whether automobiles should be allowed along the route. We discuss the themes presented by older adults and the challenges the City of Vancouver must confront as they develop and modify their design plans to meet the needs of an older age demographic.

 

Hoppmann, Christiane

(O160) Emotional barriers to daily physical activity engagement in old age: The important role of fear of falling

Christiane Hoppmann 1 ,3, Peter Graf1, Karim Khan1 ,3, Jochen Ziegelmann2, Maureen Ashe1 ,3

1University of British Columbia, Vancouver, Canada, 2German Centre of Gerontology, Berlin, Germany, 3The Centre for Hip Health and Mobility, Vancouver, Canada

Although physical activity is known to reduce age-related health risks, older adults are the most inactive segment of the Canadian population. To date, limited attention has been paid to emotional factors such as fear of falling in reducing physical activity engagement in older adults. This study enrolled a community sample of 143 older adults aged 65 years and above. Participants were asked to provide self-ratings of fear of falling and to also wear an accelerometer for 10 days that objectively recorded daily physical activity patterns as they engaged in their typical daily life routines. First analyses using a subsample of participants indicate that fear of falling was negatively associated with time spent in moderate intensity physical activity even after controlling for functional capacity, age, and sex. This is important because it is the time spent in moderate to vigorous intensity physical activity that is emphasized in most physical activity guidelines due to their well-documented health benefits. Findings extend past work on health behaviors in old age by demonstrating that psychological barriers such as fear of falling may explain why many older adults do not engage in physical activity despite being functionally capable of doing so. It might thus be fruitful to target emotional barriers and build emotion-regulation skills when designing health behavior interventions with older adult samples.

 

Martin-Matthews, Anne 

Home Care Policy at the Point of Delivery and Receipt: Perspectives of Workers, Elderly Clients, Family Carers and Home Care Managers

Anne Martin-Matthews
University of British Columbia, Vancouver, Canada

This presentation will examine policy-relevant issues in the provision and receipt of home care services in Canada, focusing specifically on services delivered by non-professional or unregulated home support/personal care workers to community-dwelling elderly people. Three key policy issues emerged from a six-year, multi-phased program of research that included in-depth interviews with over 180 workers in British Columbia, Ontario and Nova Scotia, and with 83 elderly clients, 58 family carers and over 20 home care agency managers in BC. These issues are scope of services, scheduling of services, and the presumption of availability of family and friend carers. This presentation considers current policy and practice initiatives, and impediments to reform in these areas. Opportunities and challenges for home care to elderly people in Canada are considered in the broader context of demographic, economic, and social change.

 

Craven, Catherine 

(O205) Safety in the provision and receipt of home care: Testing a conceptual model of client and family perspectives

Catherine Craven, Joanie Sims-Gould, Anne Martin-Matthews (University of British Columbia, Vancouver, BC , Canada)

Older adults and their family members have identified the home as the ideal location to "age in place," and for many Canadians home support services facilitate this. The provision and receipt of home care, however, can pose safety hazards for those involved. The Nexus Home Care Project (2006-present) has collected data about home support services to older adults (http://nexushomecare.arts.ubc.ca). In-depth interviews with 82 clients and 56 family members in British Columbia identified complex and multifaceted safety concerns. A thematic analysis of verbatim transcripts was conducted. The analysis was guided by a conceptual model of intensifying and mitigating factors in safety in home care, which we developed using interviews with 118 community health workers (CHWs). Clients and family members discussed the nature and source of their safety concerns, including those that (a) precipitated the receipt of home care, (b) occur while CHWs are in the home, and (c) occur when workers are not present. Consistent did workers, clients and families discussed safety concerns that were physical, temporal, social and spatial in nature. Spatial concerns (including fire and fall hazards and the layout, cleanliness and equipment in the home) were most commonly identified. This emphasis on the spatial domain highlights the unique and often challenging nature of the home as the location of care. For family members, elder's cognitive conditions intensified their concerns, while the presence of the worker in the home was a mitigating factor. Findings highlight the ways in which the client, family and worker safety agendas are inextricably linked.

 

Hanson, Heather 

Opportunities for Change - Characterizing Social and Recreational opportunities in Assisted Living

Heather M. Hanson 1 ,2, Christiane Hoppmann1 ,3, Karen Condon4, Jane Davis5, Fabio Feldman5, Mavis Friesen4, Ming Leung5, Angela White1 ,2, Joanie Sims-Gould1, Maureen Ashe1 ,2 (1Centre for Hip Health and Mobility, Vancouver, BC, Canada, 2UBC Department of Family Practice, Vancouver, BC, Canada, 3UBC Department of Psychology, Vancouver, BC, Canada, 4Vancouver Coastal Health Authority, Vancouver, BC, Canada, 5Fraser Health Authority, Vancouver, BC, Canada)

Background: Participation in recreation programing provides opportunities for physical activity, social engagement, and community connectedness, which are important components of overall well-being. In British Columbia, Assisted Living (AL) sites are mandated to provide recreational opportunities for tenants. However, details of the activities are not well understood, as individual sites plan, deliver, and evaluate programming based on site characteristics and tenant needs. Therefore using an integrated knowledge translation (iKT) framework, we characterized social and recreational opportunities in AL across two provincial health authorities.

Methods: We used an iterative iKT process developed through a joint venture between colleagues at the local health authorities and an academic research centre. Based on monthly discussions and a review of available literature, three key phases were defined to answer the research question: what are the site-level characteristics, barriers, and enablers of recreation in AL? These included: i) AL activity calendar document review, ii) online survey of staff involved in the planning and/or delivery of recreational programming, and iii) adapted World Café symposia sessions with AL administrators and staff.

Results: Response rates were high across the three components, reflecting the engagement of AL staff. Key findings indicated a wide range of social and physical activity opportunities available to older adults living in AL. Staff recognize the importance of recreational activities and support in delivering recreation programing. Barriers were identified, including low attendance levels, particularly for physical activity programs.

Conclusions: Future interventions should focus on strategies that consider contextual factors to improve participation while respecting tenant autonomy.