Ongoing major research projects led by YU-CARE members as well as past research projects on the following topics can be found below including: Care Work Studies, Cognitive Neuroscience Studies and Healthy Aging Promotion.
Virtual Reality
These projects evaluate Virtual Reality (VR) usability, safety, and clinical effectiveness for people with various health conditions and in different healthcare settings. Examples include people living with dementia, people with epilepsy, and those in the Intensive Care Unit (ICU).
These projects are also studying potential benefits of VR in alleviating hospital staff burnout, as well as, for nursing and allied health professional training.
Principal Investigator: Dr. Lora Appel
Imagining Age-Friendly ‘Communities within Communities’: International Promising Practices
Using two focci: understanding equity, aging and care work in international contexts, and identifying international promising practices and policies to support age- equity and age inclusion. This seven- year SSHRC Partnership Grant has four main themes of investigation: Policies and systems; Environments, designs, and technologies; Approaches to aging and care relationships; and Condition and equity. This project builds on the World Health Organization’s (WHO) ‘Age-Friendly Communities global initiative.
Principal Investigator: Dr. Tamara Daly
Assessing the Impact of DAy programs on individuals living with Dementia and their family/friend Caregivers (AIDA-DemCare): A prospective, cross-provincial cohort study
Most individuals with dementia and their family/friend caregivers want the person in need of care to remain at home for as long as possible. Health systems also want to reduce costly nursing home care. However, doing so safely and well may become challenging with increasing care needs. Day programs aim to maintain or improve older adults’ health and well-being. They also provide respite to caregivers. However, we lack robust, Canadian research on the effects of day programs on older adults living with dementia and their caregivers, especially those of equity-deserving groups with multiple, intersecting vulnerabilities. Partnering with key experts (those in need of care, their caregivers, advocates, day program staff/managers, and health system policymakers) throughout the study, we will address these important knowledge gaps.
Principal Investigator: Dr. Matthias Hoben
VR&R: Providing Respite to Caregivers by Managing Behavioural and Psychological Symptoms in People with Dementia Using Immersive VR-Therapy
Caregivers often describe respite as an internal experience where they can recuperate without removing themselves from a situation. Respite should be ongoing, flexible, and easily implemented and controlled by the caregiver. While home-based respite arguably removes barriers to receiving support for persons with disability and frailty (e.g., transportation, financing), it remains poorly understood how to best deliver effective respite programming. This gap in understanding disproportionately affects essential caregivers (mostly women) of people living with dementia (PwD) who experience high levels of burden. There has been a recent increase in interest in the therapeutic use of Virtual Reality (VR) with older adults, with a number of studies suggesting VR’s potential to manage BPSD and promote quality of life.
Principal Investigator: Dr. Lora Appel
Adult DAy Programs and their effects on individuals with Dementia and their Caregivers (ADAPT-DemCare): Developing program theories on the how and why
Most individuals with dementia and their family/friend caregivers want to receive care at home for as long as possible. Health systems also want to minimize costly nursing home care. However, when care needs become more complex, this may be difficult. Adult day programs aim to maintain or improve older adults’ health, wellbeing, social, physical and cognitive functioning, and independence. They also provide respite to caregivers and allow them to continue working a paid job. However, studies on the effects of day programs are inconclusive. Some suggest positive effects on individuals with dementia (i.e., fewer nursing home admissions, less acute/primary care use, slower physical/cognitive decline, better mental health), and better health and wellbeing of their caregivers. Other studies suggest no or even negative effects. Therefore, guided by a realist lens and partnering with experts (individuals with dementia, their caregivers and advocates, day program staff and managers, and healthcare policy makers), we will review the literature on adult day programs and develop program theories that explain how and why these settings lead to positive, negative, or no effects on individuals with dementia and their caregivers.
Principal Investigator: Dr. Matthias Hoben
Neurocognitive aging and decision-making
Every decision involves the choice to either exploit prior knowledge, towards a more predictable outcome; or to explore new sources of information, with less certain returns. This tension between exploitation and exploration is pervasive in everyday life. Do we return to the same vacation rental again next summer, or take that overseas trip? Do we watch our favourite cable news outlet or seek an alternative perspective? Do we rely on stereotypes or actively engage with unfamiliar others? We have shown that in young adults, decisions to explore versus exploit engage discrete brain regions. We have also hypothesized that an exploitation-bias emerges in later life, attributable to normal age-related brain and associated cognitive changes. Here we will directly test this exploitation-bias hypothesis using a series of decision-making tasks, combined with advanced structural and functional brain imaging, and blood-based biomarkers of Alzheimer’s disease pathology. If our hypotheses are supported, the studies proposed here will provide the first evidence that this fundamental aspect of decision-making, arguably the starting point of all goal-directed thought and action, differs between younger and older adults. These discoveries will enhance our understanding of decision-making biases in later life, ultimately informing surveillance and intervention strategies to optimize function and sustain functional independence in older adulthood.
Principal Investigator: Dr. Gary Turner
Retaining and Attracting Workers in Long-Term Care Homes: How System Dynamics Can Help
The COVID-19 pandemic has made clear the dire need to address underlying long-term care (LTC) workforce and workplace issues that affect resident quality of care and quality of life. These issues include insufficient funding, under-staffing, poor working conditions, complacency towards overburdened and undervalued staff, and lack of regulatory enforcement. These issues also contribute to poor job satisfaction among workers. In recent years, there have been policy changes to improve workforce and workplace conditions. But, some of these ‘fixes’ were later shown to be ineffective or even made the problem worse. These ‘fixes that fail’ are not an uncommon occurrence in complex systems like healthcare. The interconnectedness of factors, the nonlinearity of relationships (can’t draw a straight line between two variables), the feedback processes created in response to policy changes, and delayed reactions all make for a complex system that common quantitative tools used in policy design and evaluation, such as spreadsheet models and regression analysis, have difficulty handling. The proposed research uses novel engineering approaches, including group model building, to create a dynamic model of LTC job satisfaction.
Principal Investigators: Dr. Hannah Wong, Dr. Tamara Daly and Dr. Liane Ginsburg
Exploring Challenges in Identifying homebound Black older adults and understanding what strategies work: a comprehensive scoping review and qualitative case study in the Greater Toronto Area
Older adults who are homebound (HB) tend to stay at home for long periods (like one month), which can lead to declines in physical, mental, social, and emotional well-being. Factors like financial constraints, health issues, disabilities, and the support needed to go out or maintain social ties contribute to homebound status in older adults. These challenges are more common among black older adults due to differences in social and environmental conditions influenced by factors such as residential location, zoning rules, and land-use policies.
In this project, our goals are to:
a. Collect information on how, where, and when to find homebound Black older adults in the Greater Toronto Area (GTA) by working with various groups like Black individuals (older adults and family members), mail carriers in the Black community, community health and social care workers, and home meal delivery workers. – Through Interviews
b. Work together to come up with culturally sensitive ways to locate homebound Black older adults, talk about difficulties, and suggest solutions. – Through A full-Day Stakeholders Meeting
SSRCH Insight Development project and Black Seed Grant
July 2024 - June 2026
Principal Investigator: Dr. Michael Kalu
Bridging Mobility Gaps: Co-designing Culturally Appropriate Mobility AI-Powered Wearable (CAMAiW) Tool (prototypes) for Black, Indigenous, and People of Color (BIPOC) older adults
Wearable devices, like fitness trackers and watches, are helpful for older adults to move better. These devices check how well older adults move by looking at speed, distance, location and many other things. Our research shows that no tool combines all these things and considers people’s culture.
Our team is creating a unique tool called Culturally Appropriate Mobility AI-Powered Wearable Tool (CAMAiW) for older adults (55+) from Black, Indigenous, and People of Color (BIPOC) communities in three steps. CAMAiW will be a band with features like speed, distance, and how muscles work—all in one device.
Connected Minds Seed Grant
March 2024 - March 2026
Principal Investigator: Dr. Michael Kalu
Empowering Health Equity Through Prevention and Self-Management: Co-Designing Culturally Tailored Pre-Clinical & Diabetes Education for Black Older Adults in Peel
Diabetes is more prevalent in black population due to genetic dispositions, lifestyle factors, socio-economic disparities and limited access to healthcare. To date, strategies that have been used to prevent, and help older adults with diabetes with self-management have commonly used a European-centric approach “one-size-fits-all” approach, that is proven ineffective when it comes to education. It is of no surprise that uptake of these strategies have been low in ethnically diverse population, including Blacks, highlighting the need to co-design culturally-tailored self-management strategies to prevent or manage diabetes among black older adults.
The Novo Nordisk Network for Healthy Populations
2024 Network Catalyst Grant
NPA: Dr. Kristina Kokorelias & Dr. Michael Kalu
Care Work Studies
What’s Past is Prologue:
Comparing Long-term Care Workers and Working Conditions Between Canada and Nordic Countries 10 Years Later
In 2006, our team was funded by CIHR to conduct the Long-term Care Workers’ Survey (LTC-WS) to better understand the work of Canada’s highly gendered LTC labour force and to compare conditions here with the Nordic countries. This groundbreaking survey was conducted in three Canadian provinces (Ontario, Manitoba, Nova Scotia) as well as Sweden, Norway, Denmark and Finland, and later in Germany and Japan. It advanced knowledge about work in LTC facilities in Canada and internationally, highlighting issues surrounding gender, work and care. The results underlined challenges related to staffing, models of care and workers’ exposure to violence in LTC facilities in Canada.
Today, Canada’s long-term care (LTC) workforce is undergoing major shifts in demographics, working conditions and work organization, involving new challenges and opportunities. Our team has been funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) to provide fresh comparative insight into the nature of contemporary work in LTC. Led by Dr. Tamara Daly, a CIHR Research Chair in Gender, Work and Health, this four year mixed-method project brings together a multi-disciplinary team of experts and partners representing LTC workers across the country. It focuses on exploring the current nature of work in LTC five Canadian provinces: British Columbia, Alberta, Manitoba, Ontario and Nova Scotia.
A new, expanded survey for LTC workers is currently underway, as are complementary surveys for informal caregivers, paid companions, and managers in LTC facilities to build on the work started with the Invisible Women Study. Survey results, together with findings from ethnographic observation, focus groups and interviews, will improve understanding of work, working conditions, and work organization. In collaboration with our Nordic colleagues, who are also conducting a revised survey for LTC workers, we will extend and expand current understandings of different forms of work in different jurisdictions. In examining a wide spectrum of formal and informal work in LTC settings, this project will provide urgently needed insights into recent changes as well as key challenges and opportunities for the future in this important sector.
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Re-imagining Long-term Residential Care
Long-term residential care is where many of our most vulnerable members live and, in spite of moves towards aging in place, where many will continue to live in the future. It is also a workplace for thousands of paid and unpaid providers, most of whom are women and many of whom are from racialized communities. It is a barometer of values and practices; a signal of economic, cultural and social perspectives. It raises issues well beyond specific services and practices; issues such as human and social rights, the role of the state, responsibilities of individuals and families, work organization and skills; and notions of care. Yet too often it is characterized as failure; failure of the family to care, failure of the health care system to cure and failure of the individual to live independently, perhaps explaining why it has received so little research and policy attention. Instead of focusing mainly on failures, this project identifies promising practices for conceptualizing and organizing long-term care, learning from and with other countries. What approaches to care, to work organization, to accountability, to financing and ownership offer the most promising practices when the goal is to treat both providers and residents with dignity and respect, to understand care as a relationship and to take differences and equity into account? What contexts and conditions support these practices, allowing residents and providers to flourish? These are questions for the social sciences and humanities, as well as for those who deliver, those who organize and those who need care.
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Invisible Women: Gender and the Shifting Division of Labour in Long-term Residential Care
How does growth in the number of private duty carers coupled with the care work performed by unpaid students, volunteers and family members in long-term residential care facilities impact the organization of care? The study is specifically interested in how occupational health and safety and the division of labour are affected by the informal care provided by people other than those employed at the facility. It is mostly women who are employed in long-term residential care. Recent health human resources research does recognize that women are the overwhelming majority of paid providers but consideration of gender in relation to paid health care work is not common, as is evident when reviewing the 2010 health systems trends report from the Ontario Ministry of Health and Long-Term Care. While we have little information on the gendered dimensions of paid work in long term residential care, we have next to no information about the other paid and unpaid carers in facilities, nor is this informal care acknowledged in research or in policy. Addressing this gap is of vital importance because of the implications for our understanding of facility care, of the safety of the space and of the people who live and work there. We will survey all nursing homes and retirement homes in Ontario, and conduct interviews and detailed observations of units in 5 facilities in Toronto and with selected residents and their carers in each of the 5 facilities to elicit answers to several important overarching questions: 1. How has the division of labour shifted for facility employees due to the work performed by informal carers (i.e. paid private duty carers, students, volunteers and family members)? 2. In what ways are workloads and occupational health and safety in the facilities affected by the care performed by these other carers? 3. Finally, how do we understand the amount of time available for care (e.g. staff intensity) when we account for work performed by other carers?
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Validating a response format to facilitate responding in older adults
This study evaluates if a response tree maintains the psychometric properties in, and improves older hospitalized adults' responding to, several standardized surveys measuring symptoms of orthostatic hypotension, fatigue, and sleep quality. The results will: 1) provide data validating the use of the revised scales; and, 2) have implications for how other self-report scales are designed for use with older hospitalized adults. These are important considerations since the data generated from such surveys are used all the time for evaluation, accountability and quality improvement purposes (e.g. Hospital Report Card and Patient Satisfaction Surveys).
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Systematic review of acute hospital geriatric intervention units
Specialized geriatric services have been designed to prevent the complications of hospitalization for acutely ill older adults with complex chronic disease. In this review we are examining all of the information that has been written about these services. We are describing the activities that are delivered in each service, and we are evaluating which services are best at preventing complications for older adults.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Nurse and organizational readiness to deliver best elder care: The key to Ontario’s ability to design and implement Senior Friendly Hospital plans
Many provincial health authorities committed to developing Senior Friendly Hospitals after improved outcomes were identified when older adults received services based on the Acute Care for Elders (ACE) model of service delivery. The ACE model speaks to the unique and central role of nurses, yet little is known about nurses’ capacity to provide best elder care. The goal of this project is to better understand nurses’ needs to provide best elder care. The project will examine the relationships between organizational (team collaboration, geriatric resources, and leadership support) and nurse (skill and knowledge in geriatric nursing and patient & family centred-care, and ACE role agreement) characteristics, nurse outcomes (role clarity, job satisfaction and turnover intentions), and nurses’ perspectives on best elder care. We will ask up to 3615 nurses to complete relevant surveys, and up to 80 nurses participate in focus groups to further our understanding of their needs and to identify strategies to help nurses provide best elder care. This project is critical to the success of Senior Friendly Hospital initiatives. It will provide information that decision-makers in provincial health authorities can use to enhance nurses’ ability to ensure that older adults have good health and discharge outcomes during hospitalization.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Cognitive Neuroscience Studies
Healthy Brain Aging Project
Investigating how functional and structural brain changes relate to cognitive and social functioning, and how these changes are impacted by modifiable lifestyle factors (e.g. diet, physical activity levels). Gary Turner and Nathan Spreng (Cornell University).
Attention and Balance Project
Investigating how attention capacity impacts balance control and, ultimately falls risk, in older adults. Will Gage and Gary Turner.
For more information about this project, please contact: Dr. G Turner (grturner@yorku.ca).
Healthy Aging Promotion
Seniors Adding Life to Years (SALTY)
Seniors – Adding Life To Years (SALTY) is a four-year study on quality of life among people in late life who are living in residential long-term care settings, their caregivers and supporters.
The project, involving decision makers, clinicians, care providers, including family and friends care, is being conducted in Ontario, British Columbia, Alberta and Nova Scotia, led by Professor Janice Keefe at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging.
The SALTY research program is organized in 4 streams that address interrelated themes in late life care. Diverse members of the SALTY team are engaged in (1) monitoring care practices, (2) mapping approaches to care relationships, (3) evaluating innovative practices and (4) examining policy contexts.
Seniors – Adding Life To Years (SALTY) is a four-year study on quality of life among people in late life who are living in residential long-term care settings, their caregivers and supporters.
The project, involving decision makers, clinicians, care providers, including family and friends care, is being conducted in Ontario, British Columbia, Alberta and Nova Scotia, led by Professor Janice Keefe at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging.
The SALTY research program is organized in 4 streams that address interrelated themes in late life care. Diverse members of the SALTY team are engaged in (1) monitoring care practices, (2) mapping approaches to care relationships, (3) evaluating innovative practices and (4) examining policy contexts.
York U Faculty of Health Professor Tamara Daly will co-lead stream two “approaches to care relationships” with Professor Ivy Bourgeault of University of Ottawa and Dr. Katie Aubrecht of Mount Saint Vincent. This research is mapping the social and relational dimensions of quality of life and quality of care in LTC facilities, providing fresh insight into the relationships that “add life to years” and the implications for improving late life care for Canadians, focusing on programs, practices and policies being used in residential long-term care facilities across British Columbia, Alberta, Ontario and Nova Scotia. Stream two will be housed at the York University Centre for Aging Research and Education.
This project is funded by the Canadian Institutes for Health Research, the Nova Scotia Health Research Foundation, the Michael Smith Foundation for Health Research and the Alzheimer Society of Canada.
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Imagining Age-Friendly: Communities within Communities
This brand new 7-year Social Sciences and Humanities Research Council funded project builds on the World Health Organization’s (WHO) “Age-Friendly Communities” global initiative. Our conceptualization of promising practices in aging assumes that they “add life to years”, rejecting so-called apocalyptic notions of population aging.
The age-friendly strategy operates mostly at the city-community level with a one-size-fits-all approach. Our attention to “communities within communities” across 12 cities in Canada and around the world guides us to account for differences. Addressing critical knowledge gaps identified by WHO, we will investigate how culture and gender matter in creating age-friendly cities. Our goal is to enhance the effectiveness of age-friendly practices in light of demographic shifts associated with both population aging and diversity. We ask: how can age-friendliness support conditions in which all senior citizens not only maintain healthy active lives, but can participate and create meaning in later life?
Attention to gender draws us to investigate how inequalities and differences between and among women, men and non-binary people play out in seniors’ lives and policy assumptions. Our approach to culture assumes diversities due to global migrations; imperatives for Truth and Reconciliation with indigenous peoples; intra-cultural gender roles; and rich community cultures among people with disabilities and LGBTIQ2S groups, which affect what it means to grow old with dignity and respect. We will investigate what makes age-friendly communities promising places with “promising practices” for women, men and non-binary people; those living in poverty; LGBTIQ2S, ethno-racial, indigenous, disability and Dementia communities; families who require specific supports and services; and those who support seniors, especially migrants and domestic carers, who are aging on the job. We recognize that seniors are a mobile population, moving across neighbourhoods and the globe for many reasons, from fleeing persecution to downsizing.
The strategies to conduct the research include organizing researchers and students to work within and across four themes, each co-led by teams of researchers addressing specific sub-questions.
For more information about this project, please contact Dr. Tamara Daly (dalyt@yorku.ca).
The Cardiovascular Health Awareness Program (CHAP)
This important project applies more than a decade’s worth of work done as part of the Cardiovascular Health Awareness Program (CHAP) to the goal of reducing the impact of cardiovascular disease for York region’s South Asian community. Through a series of studies, CHAP has been shown to be an acceptable intervention to reduce participants’ blood pressure, encourage lifestyle changes and to optimize drug regimens. The project aims to extend its proven successes by adapting its material and approaches to the York Region South Asian Community, to assess the voluntary model of program delivery, and to identify gender and ethno-specific impacts of the program.
Research Question & Objectives
The main research questions are:
- What adaptation strategies to the Cardiovascular Health Awareness Program (CHAP) should be put in place in order to successfully prevent and manage chronic disease among the South Asian community?
- How can we address gender and ethno-specific impacts?
- What are the best strategies to optimize the recruitment, retention and health promotion role of peer health educators among the South Asian Community?
For more information about this project, please contact: Dr. Tamara Daly (dalyt@yorku.ca).
Limited physical activity and bed rest in seniors with complex chronic disease
This grant focuses on identifying research priorities to prevent decreased mobility in older persons with CCD following an acute illness episode. The meetings will be conducted in two phases. In Phase 1 we will identify research priorities to prevent decreased mobility following an acute illness episode in this population. In Phase II, we will develop a research action plan which jointly addresses gaps in the knowledge and stakeholder information needs, and forge new partnerships for the future projects. Outcomes include: an action plan outlining future research initiatives which are relevant to stakeholders' information needs and represent a gap in evidence in this area.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).
Phase 1 of an early rehabilitation intervention for older adults with complex chronic disease
Intense physical activity is often undesirable and unacceptable to older adults experiencing an acute illness or exacerbation of a chronic condition. Yet, inactivity in the form of bed rest is has many known adverse health consequences. To address this issue, we are developing 2 low intensity exercise programs with input from older adults. We are evaluating older hospitalized adults opinions about the programs. The results will be used to refine the interventions, clarify patient characteristics on which to tailor the interventions and define the required resources prior to testing their effects in a future clinical trial.
For more information about this project, please contact: Dr. Mary Fox (maryfox@yorku.ca).