Background: Decades of war and political instability have forced millions of Afghans to flee from their homes, resulting in one of the world's largest humanitarian crises. Many refugees have resettled in North America, particularly in Canada and the United States, where they have encountered numerous psychosocial and systemic barriers to adapting to their new environment. Objective: This scoping review aims to explore the settlement experiences of Afghan refugees in North America, synthesize existing evidence on integration challenges, and identify key gaps in the literature. Methods: Following Arksey and O’Malley's methodological framework, six electronic databases were searched for relevant literature published between 2014 and 2024, which focused on Afghan refugee settlement experiences in the North American context. Seventeen eligible studies were included in the final review. Results: Mental health emerged as the most studied topic, with Afghan refugees experiencing moderate to high rates of psychological distress, depression, and post-traumatic stress disorder. Key risk factors included female gender, older age, pre-migration trauma, financial constraints, and social isolation. Protective factors, such as, strong social support networks, English language proficiency, and gainful employment were associated with improved mental health outcomes. In spite of the generally positive healthcare experiences, Afghan refugees encountered language barriers, limited health literacy, transportation difficulties, and cultural misunderstandings with healthcare providers. Conclusion: Afghan refugees in North America face complex and intersecting barriers to health and healthcare access, and integration. Current literature by and large focuses on mental health, and there is an urgent need to expand research in other important areas of post-migration and (re)settlement.

The global population of older adults is growing rapidly, and refugees are now a significant proportion of the older adult population in Canada. Transnational healthcare practices (THPs)—seeking health information or services from the country of origin—may be an essential strategy used by refugee older adults in Canada, but few studies have explored this phenomenon. This is a protocol for a study, which is aimed at developing a comprehensive understanding of the role THPs play in the lives of older adults from three refugee groups (Afghan, Syrian and Ukrainian) (re)settled in the Greater Toronto Area (GTA), Canada. It will be informed by Constructivist Grounded Theory and will consist of three phases. Phase 1 will involve semi-structured individual interviews with Afghan, Syrian, and Ukrainian refugee older adults living in the GTA (n = 75–90) to explore their perspectives and experiences with various types of THP. Phase 2 will also involve semi-structured interviews with 75–90 refugee older adults from the three communities to examine the role of THP in stress, coping, and resilience in the context of health promotion, illness diagnosis, and disease management as well as the individual and contextual factors driving the use of THPs. Phase 3 will involve six focus groups (n = 36–48) with refugee older adults from these communities to explore what information, care, supports, technology, and services are needed to manage their health and illnesses locally. This project will advance knowledge in the areas of (re)settlement and integration, aging, local healthcare access, and THPs among refugee older adults in Canada. The findings will inform more effective integration policies and the delivery of efficient and equitable health information, care, support, technology, and services that address the healthcare needs of refugee older adults, enabling them to age well and age in place.

Aim: To identify types of walking programs and to determine the effects of these programs on menopausal symptoms. Background: Menopause is a naturally occurring phenomenon for women and can present with several physical and mental symptoms that are more severely experienced by some individuals. These experiences can be very distressing for women to deal with, especially because of their personal, social, and work lives. The substantial impact of menopausal symptoms directly calls for effective intervention. Specific to menopause, physical activity is a form of intervention that can decrease occurrences and severity of menopausal symptoms. Previous studies have reported the benefits of walking programs in reducing symptoms, yet it is unclear which specific ones are most effective in reducing menopausal symptoms, especially because of the time and efficacy barriers reported by menopausal women. Methods: A systematic review was conducted in nine databases for articles published since September 2011, to identify quantitative studies that evaluated walking programs in menopausal women. Two investigators independently screened articles, extracted data related to the type and the outcomes of walking programs, and assessed risk of bias. Effect sizes were calculated to quantify the effects of walking programs on menopausal symptoms. Findings: Six studies, including five randomized control trials (RCTs) and a one group pretest-post-test study, met all inclusion criteria. Amongst all programs (Pedometer-based programs, Nordic walking, walking training and SaBang Dolgi), pedometer-based walking presented the greatest improvement in outcomes. All studies reported improvement in post-intervention menopausal symptoms of depression, sleep quality and physiological markers, however depression saw the greatest reduction post interventions. Conclusions: Pedometer-based walking programs seem to be the most effective intervention for reduction of menopausal symptoms. Key words: menopause, walking, pedometer-based walking

African American (AA) women often experience earlier onset and more severe menopause symptoms, especially vasomotor symptoms (VMSs) like hot flashes, compared to other groups. However, limited research has examined the effectiveness and acceptability of menopause treatments in this population. This scoping review synthesized evidence on pharmacological (e.g., hormone replacement therapy [HRT], SSRIs, venlafaxine, nitroglycerin) and holistic (e.g., dietary changes, physical activity [PA], supplementation) approaches for managing menopause symptoms in AA women. Using Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was conducted, guided by the PCC framework. Four databases (CINAHL, PsycInfo, PubMed, Scopus) were searched for English-language studies (2010–2025) involving AA women aged 40–65. Eligible studies included RCTs and observational designs with ≥10% AA participants. Data were charted and synthesized descriptively. Fourteen U.S.-based studies (11–53% AA representation) were included. Pharmacological treatments—especially HRT and SSRIs—were effective for VMSs and mood symptoms. Holistic approaches showed mixed outcomes; PA and magnesium offered modest benefit, while phytoestrogens sometimes worsened memory. Race-specific results were rarely reported. Effective pharmacological options exist, but evidence tailored to AA women is lacking. Future research must ensure greater AA representation and culturally responsive approaches to menopause care.

Background: In Canada, 30 percent of the older adult population is foreign-born. Immigrant older adults are more likely to experience significant social isolation due to a variety of factors. However, limited research exists on the influence of specific factors. The objective of this study is to understand the economic factors that contribute to social isolation among older immigrants in the Greater Toronto Area (GTA), Canada. Methods: A qualitative interpretive description method was used. Following research ethics boards’ approval, semi-structured individual interviews were conducted with a total of 47 Arabic, Mandarin, and Punjabi-speaking older immigrants in the GTA. The interviews were conducted in their preferred language, audio-recorded, and translated (when needed) into English and transcribed. Thematic analysis of the data was informed by an ecosystemic framework. Results: Six themes were identified: (1) barriers to finding employment; (2) living a “hand-to-mouth life” due to limited income/pension; (3) housing costs that eliminate choices and options; (4) costs (and availability) of transportation as a barrier to getting around; (5) lack of “essential” healthcare coverage; and (6) costs of community programs that prevent “getting out of the house.” These economic factors at micro, meso, and macro levels of society intersected to create desperate situations that contributed to social isolation among older immigrants in the GTA. Conclusions/Implications: Addressing these economic factors is critical to immigrant older adults’ aging in place. Service providers must advocate for accessible physical and financial resources and services including affordable housing and transportation, old age security, and comprehensive healthcare coverage for older immigrants. Future research should focus on economic challenges faced by older adults across other immigrant communities in the GTA as well as in other cities, provinces, and territories.

Despite the increasing number of older Syrian refugees in Canada, little is known about how they manage their health care needs while contending with language barriers, cultural dissonance, and systemic inequities. This qualitative study explored how older Syrian refugees in the Greater Toronto Area (GTA) navigate healthcare across Canadian and transnational contexts. The study was guided by the transnational circulation of care framework and used an interpretive descriptive design. Following research ethics approval, 20 older Syrian refugees were interviewed by bilingual research assistants. In-depth individual interviews were conducted in Arabic and analyzed using reflexive thematic analysis. Four interrelated themes emerged: (1) Navigating a New System; (2) Living in Two Worlds; (3) Medication Portability, Herbal Practices, and Supplement Culture; and (4) Digital Health Across Borders. Findings demonstrate that older Syrian refugees actively construct hybrid care pathways that integrate biomedical, cultural, and transnational practices. These strategies reflect resilience and adaptability but also expose gaps in the healthcare system. The study underscores the need for culturally responsive and age-friendly healthcare practices that acknowledge transnational realities. By illuminating how care circulates across borders, this study provides actionable guidance for designing responsive health systems.