Denise Cloutier - Academia.edu (original) (raw)

Papers by Denise Cloutier

Research Partnerships and Knowledge Mobilization, 2020

Canadian Food Studies / La Revue canadienne des études sur l'alimentation

Long before the exacerbating effects of COVID-19, household food insecurity (HFI) has been a pers... more Long before the exacerbating effects of COVID-19, household food insecurity (HFI) has been a persistent yet hidden problem in wealthy nations such as Canada, where it has been perpetuated in part through dominant discourses and practices. In this critique of HFI-related frameworks, we suggest that discourses organized around the production and (re)distribution of food, rather than income inequality, have misdirected household food insecurity reduction activities away from the central issue of poverty, even inadvertently enabling the ongoing neoliberal “rollback” of safety net functions. Unlike most scholarship that focuses on the politics of food systems, or health research that insufficiently politicizes poverty, this analysis emphasizes the role of politics in income discourses. In spite of their contradictions, food-provisioning- and income-based discourses are potentially complementary in their shared recognition of the right to food. Operating from the perspective of political ...

Rural and Remote Health, 2021

Introduction: Understanding rural-urban differences, and understanding levels of life satisfactio... more Introduction: Understanding rural-urban differences, and understanding levels of life satisfaction in rural populations, is important in planning social and healthcare services for rural populations. The objectives of this study were to determine patterns of life satisfaction in Canadian rural populations aged 45-85 years, to determine rural-urban differences in life satisfaction across a rural-urban continuum after accounting for potential confounding factors and to determine if related social and health factors of life satisfaction differ in rural and urban populations. Methods: A secondary analysis was conducted using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging. A cross-sectional sample from the baseline wave of the tracking cohort was used, which was intended to be as generalizable as possible to the Canadian population. Four geographic areas were compared on a rural-urban continuum: rural, mixed (indicating some rural, but could also include some peri-urban areas), peri-urban, and urban. Life satisfaction was measured using the Satisfaction with Life Scale and dichotomized as satisfied versus dissatisfied. Other factors considered were province of residence, age, sex, education, marital status, living arrangement, household income, and chronic conditions. These factors were self-reported. Bivariate analyses using χ tests were conducted for categorical variables. Logistic regression models were constructed with the outcome of life satisfaction, after which a series of models were constructed, adjusting for province of residence, age, and sex, for sociodemographic factors, and for health-related factors. To report on differences in the factors associated with life satisfaction in the different areas, logistic regression models were constructed, including main effects for the variable of interest, for the variable rurality, and for the interaction term between these two variables. Results: Individuals living in rural areas were more satisfied with life than their urban counterparts (odds ratio (OR)=1.23; 95% confidence interval (CI): 1.13-1.35), even after accounting for the effect of confounding sociodemographic and health-related factors (OR=1.32, 95%CI: 1.19-1.45). Those living in mixed (OR=1.30, 95%CI: 1.14-1.49) and peri-urban (OR=1.21, 95%CI: 1.07-1.36) areas also reported being more satisfied than those living in urban areas. In addition, a positive association was found between life satisfaction and age, as well as between life satisfaction and being female. A strong graded association was noted between income and life satisfaction. Most chronic conditions were associated with lower life satisfaction. Finally, no major interaction was noted between rurality and each of the previously mentioned different factors associated with life satisfaction. Conclusion: Rural-urban differences in life satisfaction were found, with higher levels of life satisfaction in rural populations compared to urban populations. Preventing and treating common chronic illness, and also reducing inequalities in income, may prove useful to improving life satisfaction in both rural and urban areas. Studies of life satisfaction should consider rurality as a potential confounding factor in analyses of life satisfaction within and across societies.

American Journal of Alzheimer's Disease & Other Dementiasr, 2013

Limited research explores the experience of individuals with dementia in acute care geriatric psy... more Limited research explores the experience of individuals with dementia in acute care geriatric psychiatry units. This observational case study examines the influence of the physical environment on behavior (wandering, pacing, door testing, congregation and seclusions) among residents in a traditional geriatric psychiatry unit who were then relocated to a purpose-built acute care unit. Purpose-built environments should be well suited to the needs of residents with dementia. Observed trends revealed differences in spatial behaviors in the pre- and post- environments attributable to the physical environment. Person-centred modifications to the current environment including concerted efforts to know residents are meaningful in fostering quality of life. Color coded environments (rooms vs dining areas etc.) to improve wayfinding and opportunities to personalize rooms that address the `hominess' of the setting also have potential. Future research could also seek the opinions of staff a...

Canadian Journal on Aging / La Revue canadienne du vieillissement, 2013

International Journal of Indigenous Health, 2020

This paper presents the first phase of a community engagement project that explores (re)connectin... more This paper presents the first phase of a community engagement project that explores (re)connecting to coming-of-age teachings grounded in Indigenous ways of knowing and doing for urban Indigenous youth in foster or away-from-home care. An intergenerational group of urban Indigenous Knowledge Holders in and around Victoria, British Columbia, Canada came together to discuss what a culturally appropriate coming of age could look like for urban Indigenous youth in care and how delegated Indigenous child and family service organizations could be involved. Four questions were discussed, and the conversations were recorded and subsequently themed. The event reflected the community’s commitment to supporting youth in their coming-of-age journey. Delegated organizations, in addition to acting as legal guardians for the youth, are cultural resources for the community and help connect youth to culture in their ancestral/home and urban communities. Communities work to ensure that youth have acc...

Journal of Community Practice, 2020

ABSTRACT Working from an asset-based perspective, this exploratory, qualitative study examined lo... more ABSTRACT Working from an asset-based perspective, this exploratory, qualitative study examined local community strengths and capacities to support healthy aging in a rural community in Western Canada. The research team consisted of academic leads and a project coordinator from a Canadian university, collaborating partners from the health authority, representatives from local and regional municipal leadership, and an Advisory Committee comprising local municipal leaders, seniors’ advocates, business owners, health care professionals and other community stakeholders. The findings from this study underscore five equally critical and overlapping areas of recommendations: Networking and Cross-Community Collaborations; Communications; Health and Social Care Initiatives; Transportation; and Housing.

Innovation in Aging, 2017

Local food system planning was identifi ed in the late 1990s as an emerging and important urban p... more Local food system planning was identifi ed in the late 1990s as an emerging and important urban planning object. Since then, little attention has been placed on identifying a robust and comprehensive understanding of the roles and tools local government can use in addressing their local food systems. Th e emerging literature identifi es problems with the dominant productionist agricultural system, addresses conceptual issues and often advances normative arguments in support of developing and supporting local food systems, but attention to the practical actions needed to address this issue on the ground have been limited. Th is paper provides an overview of the reported risks (such as water shortages, climate change, peak oil) associated with our dominant food systems, addresses the lack of attention to the importance of sub-scales within 'local' and defi nition of 'local food,' and it identifi es the main reasons for considering local food systems as part of addressi...

Innovation in Aging

Across North America, a growing number of older adults have a core housing need and lack access t... more Across North America, a growing number of older adults have a core housing need and lack access to affordable, suitable or adequate housing. Although federal, state/provincial and local backdrops vary across Canadian and American contexts, seniors’ housing providers in both countries face similar challenges and must develop innovative policy and program responses to help older adults age in place. We hosted an international seniors’ housing conference to create a platform for cross-national collaboration among multidisciplinary seniors housing experts. This event offered an opportunity to exchange best practices, emerging research, and policy solutions, and establish a set of shared priorities for advancing seniors housing that were applicable to two nations with different social systems. This paper will reflect on the exchange of knowledge and best practices related to housing preservation, eviction prevention, and access to supports during COVID-19, and the lessons learned fosteri...

Journal of women & aging, 2021

The growing issue of housing affordability is an increasing challenge worldwide as the financiali... more The growing issue of housing affordability is an increasing challenge worldwide as the financialization of housing markets undermines housing as a basic human right. One of the most vulnerable segments of the population affected by rising housing costs are older, low-income, females. Drawing on qualitative interviews with older women, we explore lived experiences of housing insecurity using a feminist political ecology perspective. Our findings reveal substantial challenges as well as creative solutions being employed by these women to stay in place. We conclude that more targeted and age- and gender-inclusive housing policies, programs, supports and services are critically needed.

BMJ Open

ObjectivesPrevious studies on depression in rural areas have yielded conflicting results. Feature... more ObjectivesPrevious studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural–urban disparities in depressive symptoms between those living in rural and urban areas of Canada.DesignWe conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population—the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020.Participants21 241 adults aged 45–85.MeasuresRurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease sta...

The Journal of Rural Health

PURPOSE To document the prevalence of functional impairment in middle-aged and older adults from ... more PURPOSE To document the prevalence of functional impairment in middle-aged and older adults from rural regions and to determine urban-rural differences. METHODS We have conducted a secondary analysis using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross-sectional sample from the baseline wave of the "tracking cohort." The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into "Urban," "Peri-urban," "Mixed" (areas with both rural and urban areas), and "Rural," and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates. FINDINGS No differences were found in functional status between those living in rural, mixed, peri-urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health-related factors. There were no rural-urban differences in any of the individual items on the OARS scales. CONCLUSIONS We found no rural-urban differences in functional status.

Social Science & Medicine

The end-of-life context is imbued with emotions, with death and dying transforming everyday place... more The end-of-life context is imbued with emotions, with death and dying transforming everyday places, like long-term care facilities, into entirely new emotional topographies that can evoke profound effects on those who live and work within these settings. Despite their significant role, healthcare providers' emotions and their interconnections with 'place' have received relatively little attention from researchers, including geographers of care and caregiving. This secondary thematic analysis attempts to address this notable gap by exploring the emotional geographies of healthcare providers caring for dying residents in four long-term care facilities in western Canada. By drawing upon interview and focus group data with administrators (n = 12) and direct care provider (n = 80) participants, findings reveal that experiences of caring for dying residents were often charged with negative emotions (e.g., distress, frustration, grief). These emotions were not only influenced by social and physical aspects of 'place', but the temporal process of caring for a dying resident, which included: (1) Identifying a resident as in need of a palliative approach to care; (2) Actively dying; and (3) Following a resident's death. Findings indicate that providers' emotions shifted in scale at each of these temporal phases, ranging from association with the facility as a whole to the micro-scale of the body. Broader structural forces that influence the physical and social place of long-term care facilities were also found to shape experiences of emotional labor among staff. With an increasing number of deaths occurring within long-term care facilities throughout the Global North, such findings contribute critical experiential knowledge that can inform policy and programs on ways to help combat staff burnout, facilitate worker satisfaction, and foster resilience among long-term care providers, ensuring they receive the necessary supports to continue fulfilling this valuable caring role.

Canadian Journal of Rural Medicine

Objective: The objective is to determine the use of health-care services (physician visits, emerg... more Objective: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a rural to urban spectrum. Methods: We conducted a secondary analysis of cross-sectional data from a population-based prospective cohort study, the Canadian Longitudinal Study on Aging (CLSA). Participants included community-dwelling adults aged 45–85 years old from the tracking cohort of the CLSA (n = 21,241). Rurality was classified based on definitions from the CLSA sampling frame and similar to the 2006 census. Main outcome measures included self-reported family physician and specialist visits, emergency department visits and hospitalisations within the previous 12 months. Results were compared for four geographic areas on a rural-urban continuum. Univariate and bivariate analyses were performed on data from the 'tracking cohort' of the CLSA, Chi-square tests were used for categorical variables. Logistic regression models were created for the main outcome measures. Results: Participants in rural and mixed rural and urban areas were less likely to have seen a family physician or a specialist physician compared to urban areas. Those living in rural and peri-urban areas were more likely to visit an emergency department compared to urban areas. These differences persisted after adjusting for sociodemographic and health-related variables. There were no significant rural-urban differences in hospitalisations. Conclusion: Rural-urban differences were found in visits to family physicians, specialists and emergency departments.

International Journal of Aging Research

Providing quality of care (QoC) to older adults in residential care settings is an ongoing challe... more Providing quality of care (QoC) to older adults in residential care settings is an ongoing challenge given the increasingly complex needs of this population and the escalating economic constraints within which health authorities operate. While the implementation of the residential care delivery model in a Western Canadian health authority has contributed to some improvements in QoC, it has also highlighted key challenges that are both interpersonal and organizational in nature; specifically, gaps in leadership, teamwork, mentorship, and communication, as well as staffing mix, staffing consistency, resident complexity, and competing policy and program initiatives and directives. The implementation of a major change in care delivery impacts residents, families, and staff and may, in turn, impact their perceptions of change in QoC. When evaluating a model, therefore, it is important to examine both qualitative and quantitative outcomes: stories from those most affected in their everyday lives and trends in QoC indicator data.

Progress in Planning

Abstract Local Food Systems (LFS) are a relatively new concept in planning. While there is a grow... more Abstract Local Food Systems (LFS) are a relatively new concept in planning. While there is a growing interest in making transformative change in LFS, the area lacks a solid theoretical foundation to address how change processes in food systems occur. In this study, a classic Glaserian grounded theory methodology was used to investigate LFS planning. The primary goal was the development of theory grounded in the experience of practitioners, elected officials, and members of the public all having some level of experience with LFS initiatives. The data are drawn from interviews with 29 elected officials, public stakeholders, and planning staff working in five communities with LFS planning initiatives. In addition, 10 member checking interviews were conducted to determine the fit and relevance of the findings to the experience of participants in LFS planning. The emergent theory of ‘Transformative Incrementalism’ (TI), was developed from this research to describe the social processes underlying planning initiatives to achieve transformative change in LFS. Consistent with grounded theory principles, the core category identified in the theory was Power, while Values, Praxis, and Outcomes were other main themes. TI suggests that change is achieved through a long process of incremental efforts by actors within the public, political, and bureaucratic groups to achieve convergence and align values and beliefs over time.

The Gerontologist

Purpose of the Study: Janus, the two-faced, Roman god of beginnings and transitions is used as a ... more Purpose of the Study: Janus, the two-faced, Roman god of beginnings and transitions is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (1) How do our quantitative data map onto our mothers' experiences; and (2) What lessons do our mothers' experiences offer for the care of older women with dementia? Design and Methods: Informed by a life course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care. Results: Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be: widowed, and living alone in suburban areas. Upon entry into residential care, they exhibit greater frailty in terms of ADLs, cognition, aggression and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the: public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families. Implications: A life course perspective, and qualitative and quantitative data facilitate understanding the care journeyshealth and service trajectories of older women with dementia.