The movement away from institutional care to community living, along with improved nutrition and health care, has led to an increased lifespan for individuals with intellectual disabilities. In Canada, those who were born before 1945 represent the first significant group to grow old. Despite the increasing numbers of these individuals, relatively little is known about them, their life experiences, or their needs. They remain a largely invisible, undervalued, and often overlooked population, and are seldom the focus of new policy or program initiatives. This review of Canadian literature reports on issues related to the prevalence, life expectancy and early aging of individuals with intellectual disabilities, describes the impact of changes in social policy on their life experiences, outlines the needs and expectations of older adults and their families and, finally, suggests future directions for policy development and research in Canada.

Quick Response Programs (QRP) have been instituted to contain hospital costs by reducing unnecessary hospital admissions through the prompt co-ordination of Home Care Services. No formal economic evaluation of the impact of this redirection of services has been conducted. This paper describes a randomized controlled trial designed to compare the costs and effects between comparable emergency department patients (ED) serviced by the QRP versus the usual department services. Patients were assessed at baseline and 10 days following discharge from the ED specifically for their health status, caregiver burden, satisfaction with health care services and expenditures. QRP was an acceptable alternative to ED services for a small percentage of patients and was not more expensive in total care costs although there was a shift in expenditures from hospital to Home Care services. Due to the small sample size the power to detect the clinically important differences in health status was 60 per cent.

The Alberta Assessment and Placement Instrument (AAPI), a multidimensionalassessment, is used to assess clients for continuing care in Alberta. We conducted a retrospective chart review to determine the validity of the AAPI items for use with long-term clients who are referred to Home Care. We were also interested in determining the status of clients one year after they were admitted to home care. The charts of 60 clients admitted to home care and 60 not admitted were randomly selected for the year 1992, the most recent year during which a duplication of all AAPI results was kept. The groups did not differ in demographic characteristics, measures of perceived need, number of medications, nutrition, cognitive status, psychosocial status, and use of formal and informal care providers as described in the AAPI. However, they differed significantly in medication management: those admitted to home care required more assistance with medication management than those not admitted. Therefore, use of the AAPI alone does not determine whether or not a client is admitted to home care. When the charts were followed one year after the initial administration of the AAPI, only 18 per cent of those admitted to home care remained on home care whereas 42 per cent of those not admitted to home care were now admitted. The admission of a client to home care was associated with an increased likelihood of being admitted to a long-term care institution (OR = 6.56) or being deceased (OR = 5.36) one year later.

The article presents the main results of research carried out in the autumn of 1995 on a sample of 309 senior citizens, living at home and residing in the CLSC La Source area, a suburb of Quebec. The purpose of this research was to gather information on the horizontal solidarity phenomenon among senior citizens. Three points of analysis have been used to define the concept of horizontal solidarity: individual help, community life and living together. The study presents a profile of senior citizens firmly rooted in their community, rather active and having frequent social contacts with their relatives. It emphasized the importance of the family in maintaining the existing solidarity, especially when the individual is not self-sufficient. The results of the research challenge the popular myth which stipulates that senior citizens represent, in the community, a passive, socially-withdrawn group.

The aim of this paper was (1) to document the extent to which elderly caregivers of persons with dementia engage in self-help/mutual aid activities such as groups and telephone support and (2) to document the extent to which non-users want to participate in this form of support. Caregivers aged 60 years of age and older were recruited from the Alzheimer's Society of Metropolitan Toronto Wandering Persons Registry. Data from telephone interviews (n = 84) from this multicultural sample showed that 21 per cent of subjects used support groups and 26 per cent of non attenders wanted to be part of a support group. Only 8 per cent of subjects utilized telephone support services yet 57 per cent of non-users wanted to use this service. We also report on other means of support such as use of computer networks and newsletters. The implications of this research for seniors will be discussed in light of these identified needs and barriers to participation.