Hospitals may transfer seniors with a hip fracture to various rehabilitation settings. Knowing the relationship between hospital teaching status and post-acute rehabilitation setting may help evaluations of the transfer from acute care. The purpose of this study was to determine the relationship between hospital teaching status and rehabilitation destination following acute care in seniors with a hip fracture. Hospital separations were linked with home care records to identify hip fractures and hospital-based or home care rehabilitation (n = 806). Two logistic regression models determined the likelihood of transfer to any rehabilitation destination and to hospital-based versus home care rehabilitation. Teaching hospitals were no more likely than non-teaching hospitals to discharge patients to any rehabilitation (OR 1.20, 95% CI 0.88,1.65). However, among those referred to rehabilitation, the odds of discharge to hospital-based versus home care rehabilitation were almost four times greater for patients in teaching hospitals (OR 3.76, 95% CI 2.23, 6.37). The results are consistent with the availability of post-acute rehabilitation in the planning area. Future study of post-acute rehabilitation outcomes should consider hospital teaching status as an indicator of how hospital-based factors may affect the utilization of post-acute rehabilitation.

A sample of frail older adults (65 years and over) living at home or institutionalized (n = 664) with a significant functional limitation was used to document predisposing and facilitating factors of severe psychological distress among frail elderly adults. Our results indicated that 48.2 per cent of the older adults living at home presented severe psychological distress symptoms, compared to 34.3 per cent of elderly adults living in institutions. The probability of reporting a severe level of psychological distress was associated with the respondents' social support, cognitive and functional status. When the respondents' cognitive and functional status were controlled, no evidence of a significant association was found between the respondents' age, gender, marital status, education or income and the level of their psychological distress symptoms. Our results showed that 77.9 per cent of the respondents with severe psychological distress symptoms were still severely distressed 12 months after their first interview. Findings suggest that severe psychological distress represents an important challenge for practitioners in gerontology and geriatrics. It is suggested that other studies focusing on the consequences of psychological distress on older adults' quality of life, functional decline, institutionalization and mortality may help document the gravity of this symptomatology in the elderly population.

Although the experiences of formal and informal caregiving have been discussed and debated in the literature, more is assumed than is actually known (McDaniel & Gee, 1993). This qualitative study explored both informal and formal caregivers' perceptions of their own caregiving and the views of each other's caregiving. Information was collected through the use of in-depth interviews with 23 family caregivers and 15 nurses providing home care to older persons. Analysis of interview transcripts and field notes reveals that both informal and formal caregivers engage in all facets of caring work – physical, intellectual and emotional care – but that they carry out this work in varying degrees, and for different reasons. The reasons given for these differences, namely the nurses' professional knowledge and higher status designation, are key elements that define the boundaries between professional and family caregiving. However, it is apparent that, over time, this demarcation diminishes as family caregivers' knowledge and skill match those of health professionals. Study findings point to implications for future theory development and research.

The objective of this study was to explore the way in which relationships develop between family members and staff working in long-term care facilities. In-depth, qualitative interviews were conducted with 17 registered nurses. Data were analysed inductively using the constant comparative method. Findings showed that RNs perceive their relationships with families to develop in four stages: the “initial greeting,” sizing up,” “making a tentative decision,” and “reaching a final decision”. Several contextual factors were associated with the way in which relationships developed, including structural factors, family recognition of staff efforts, open communication, and professional identity. Findings suggest that relationships can best be understood from an interpretive perspective and that an analysis of family-staff relationships should consider the influence of social power.

This research broadens the understanding of the relationship between paid work and caregiving by including the contribution of the older “care recipient”. Using selected aspects of social exchange theory and a life course perspective, the importance of giving and receiving for caregivers and care recipients is explored through analyses of focus groups with employed women and interviews with their older mothers. The mothers and daughters focus on the time when they are most indebted to each other. The daughter's employment affects the type and value of contributions from care recipients. The mother's past assistance with housework and caring for children is greatly valued by the daughters. For care recipients, however, being reliant on a busy employee for their care has negative consequences. The mothers emphasize the current situation and under-estimate their past helping. Further research should consider the care recipient's perspective to obtain a broader understanding of the impact of the caregiver's employment in caregiving relationships.

One of the most influential applications of the concepts, methods and measures of social network analysis to the study of the social support transactions of older adults is the convoy model of social support. We draw on recent debates in network methodology to provide an assessment of the convoy model that explores the role of weak ties in the support networks of older adults. The social networks generated by the target diagram which operationalizes the convoy model display the structural and functional characteristics set out in its theoretical arguments. But not all of the ties constituting these networks are conduits of social support and, more importantly, these social networks do not include all supporting and supported others. The target diagram identifies core support networks; therefore, support flowing through weak ties is missed when it is used to set the boundaries of support networks. Expanding our picture of the support networks of older adults to take systematic account of weak ties and the emotional aid, instrumental assistance, and companionship that flow through them will enhance the effectiveness of support interventions that target older adults.

The intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

In both Canada and the United States, adult day services (ADS) are an integral component in the array of long-term care services available. We compared characteristics of programs and participant characteristics in Atlantic Canada, Maine, and Vermont. Directors of 47 ADS programs responded to a mailed survey. Individual ADS programs in each province and state exhibited unique program and participant characteristics. ADS programs in the two countries differed with respect to: affiliation, location, levels of government support, participant fees, organizational sponsorship, hours of operation, months of attendance, and hours attended per day. Participant characteristics that varied between the two countries were educational level, physical needs, and cognitive status. The results of this study provide new comparative information that can be used in guiding future research and program development of ADS.

Elderly adults often pose, or are perceived to pose, a risk to themselves or others. Others often also have the will, and sometimes the ability, to intervene in their lives: to take them from their homes, force medical treatment on them, and prevent them from spending their money as they see fit. Thus the question “To what extent, and for what purposes, can others interfere with the liberty of the individual?” takes on particular relevance for elderly adults. This is the question John Stuart Mill addressed in his essay On Liberty, and our aim is to adapt his theory of liberty to guide those who must make decisions about the old. We argue that individuals can be interfered with in their own interest and in the interest of others. It is apt to interfere in their own interest if and only if they are putting themselves at significant risk, are encumbered, i.e. are incompetent or subject to some other judgement-distorting condition, and interference will be: (a) effective, (b) not generative of evils greater than those it prevents, (c) the mildest possible to curb the evil, (d) not discriminatory, and (e), unless the interference has utility approaching absolute necessity, thought justified. It is apt to interfere in the interest of others if and only if they are putting others at significant risk and the same five conditions are satisfied. As we hope our adaptation of Mill's theory of liberty will have practical effect, we illustrate it with examples, relate it to the law in British Columbia, and state it in the form of a decision-tree.

Visual requirements for a simple walking task were evaluated for young and elderly persons to determine if, with normal aging, elderly subjects require more visual information. Ten young adults and 10 elderly people were asked to complete a simple walking task within predetermined pathway boundaries under two conditions of visual restriction. In the reactive condition, subjects automatically received a 200 ms flash of visual information at the halfway point of the walkway. For the predictive condition, subjects did not receive any visual information during the walking trial, but were equipped with an emergency button that would provide 200 ms of visual information whenever they needed it. For both experimental conditions, subjects received additional flashes of visual information if they stepped out of the walkway boundaries. Results showed that older persons stepped out of bounds more often in the reactive condition and gave themselves more visual cues than the younger subjects in the predictive condition. The relative importance of vision during locomotion seems to be higher in the elderly population when compared to young adults.

This paper presents a typology of older parents caring for adult offspring with lifelong disabilities, as well as barriers to residential planning from the perspectives of older parents caring for adult offspring with lifelong disabilities. Project participants included 54 older parents and one grandparent (all aged 60+). Information was collected via focus groups in six provinces across Canada. Transcripts were analysed using different analytical procedures, including pattern identification, clustering of conceptual groupings, identification of relationships between variables, constant comparisons, and theoretical memos. Older parents' reluctance to engage in the planning of future living options was found to be multi-factorial and linked to the macro- and micro-systems within which these families were embedded.