Data from the Survey on Ageing and Independence are employed to test the relationship between stress, integration in close family and friend networks, and well-being with a particular emphasis on parent status. The dependent variables used in this analysis are, whether individuals have a close family member or a close friend, the number of reported close relatives and friends, life stress, and the affect balance scale. It is hypothesized that the zero order relationship often found between parent status and well-being may be due to (1) a fundamental difference in the social support experiences of older parents and older childless individuals, (2) different levels of stress among these groups, or (3) the potential of friends to be of greater importance in assuring well-being in older age than family. Results show that childless persons are less likely than parents to have at least one close family member and they have fewer close relatives. No parent status differences are found regarding the likelihood of having a close friend or in the number of close friends individuals have. Compared to parents, childless individuals experience less life stress and similar levels of well-being. Finally, the nature of the stress-support-well-being relationship appears to be the same regardless of parent status.

This paper is concerned with questions relating to demographic change (population growth and aging) and its implications for operating a publicly funded health care system in a Canadian setting. It provides an assessment of how prospective population changes alone would affect the share of health care costs in total national income in Canada over the next several decades; it provides also an analysis of how actual patterns of hospital service provision changed in Ontario over the last decade in response to budgetary restrictions in a period of rising demand for services. Finally, a case is made for viewing health care as an integrated system; a description is provided of a set of computer-based models that have been developed to facilitate analysis of the health care system, and illustrative projections are discussed.

I revisit trends in the level and distribution of income among Canadian seniors in the context of what is arguably the major source of change in these trends since the end of the seventies: the maturation of Canada's public and private earnings-related pension systems. The expanded role of earnings related pensions in the 1980s and 1990s is largely the result of changes that occurred in the 1950s and 1960s. The Canada and Quebec Pension Plans (C/QPP) were implemented in 1966 and the first cohort to receive full C/QPP benefits turned 65 in 1976. Cohorts retiring after this period were also the beneficiaries of the expansion of private occupational pensions that took place between the 1950s and the 1970s. I rely on a detailed decomposition of income by source to show that the maturation of these earnings-related programs produced not only a substantial increase in average real incomes but also a substantial reduction in income inequality among older persons, due mainly to higher C/QPP benefits. Rising real incomes went disproportionately to lower income seniors contributing to the well-known decline in low-income rates among older persons.

Purpose: The study purposes were twofold: (1) to explore barriers to pain management and those associated with implementing a pain management program in long-term care (LTC); and (2) to develop an interprofessional approach to improve pain management in LTC.

Methods: A case study approach included both qualitative and quantitative components. We collected data at two LTC sites using seven focus groups for the licensed nurses, unregulated care providers and physicians, and 10 interviews with other health care provider groups, administration, and residents. We reviewed documents and administered a short survey to study participants to assess perceptions of barriers to pain management.

Results: The findings revealed barriers to effective LTC pain management at the resident/family, health care provider, and system levels. We then developed a six-tiered model with proposed interventions to address these barriers.

Conclusions: This model can guide the development of innovative approaches to improving pain management in LTC settings.

Cet article fait un bilan critique des écrits relatifs à l'évaluation de groupes de soutien pour aidants naturels, une intervention de plus en plus répandue dans les organismes publics et communautaires. Après avoir situé le contexte des groupes de soutien, l'article décrit rapidement les types de groupe de soutien évalués, les types de recherches évaluatives, les principaux résultats et limites de ces évaluations. Il ressort que les études se sont principalement intéressées aux groupes de soutien de courte durée, visant à offrir de l'information et du soutien émotif, ainsi qu'à développer de nouvelles habiletés. Les évaluations cherchent principalement à mesurer les effets des groupes sur les conséquences du stress en utilisant des devis de type expérimental et des mesures standardisées. Très peu d'importance est accordée à l'évaluation d'implantation. La majorité des études conclut à l'absence d'effet. Trois pistes de recherche sont proposées soient: l'analyse de différents types de groupes de soutien, la multiplication des approches théoriques et disciplinaires accordant plus d'attention aux dynamiques de groupe et aux dimensions sociales et, enfin, le recours à un éventail plus large de méthodes.

Older adults are the largest group of wheelchair users yet there are no peer-reviewed studies on the national profile of older wheelchair users in Canada. We investigated the characteristics of wheelchair users in a national sample of community-dwelling older adults from the Canadian Study of Health and Aging (CSHA-2). Questions on the use of assistive technology were asked of 5395 Canadians (over 64), and 4.6 per cent reported using a wheelchair. Logistic regression was used to model the factors associated with wheelchair use. Controlling for age, gender, and cognitive impairment, older adults who reported greater dependence in basic self-care and instrumental activities of daily living were more likely to use a wheelchair. However, the effects of self-care dependence on wheelchair use varied by gender, with men more likely than women to use wheelchairs with increasing self-care dependence. The number of chronic health conditions and being unmarried also increased the odds of wheelchair use. This paper quantifies the risk of wheelchair use according to critical factors that can be used to project use and plan for services.

The data reported in this paper were collected as part of the Canadian Study of Health and Aging. The core study was funded by the Seniors' Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC[S]). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417–302[R]), Bayer Incorporated, and the British Columbia Health Research Foundation (projects no. 38[93-2] and no. 34[96-1]). The study was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. Additional funds for the preparation of this manuscript were made available from the Opportunities Fund of the M-THAC Research Unit (from Medicare to Home and Community) at the University of Toronto, and from a post-doctoral fellowship awarded to the first author by the Social Sciences and Humanities Research Council of Canada.

It is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.

A shift in emphasis from institutions to community poses important challenges for providers and policy makers, key among them being the challenge of providing asufficient volume of high quality community-based services to meet consumer needs. This challenge is particularly evident in community-based long-term care (LTC) due to the complexity and diversity of the field, the vulnerability of the population served, and the current wave of demand for services generated by hospital downsizing. The most recent reform of long-term care in Ontario is of particular interest in this context because, as suggested by the provincial government's maxim “highest quality, best price,” it promises cost-efficiency while maintaining or improving quality. To do this it employs a “managed competition” model in which for-profit and not-for-profit providers compete for service contracts under the auspices of local Community Care Access Centres (CCACs) run by volunteer boards. In this paper we draw on the comments of senior government officials and representatives of provider organizations, as well as published documents, to highlight issues and problems posed by the province's latest reform. We argue that, particularly under conditions of capped budgets and increasing demands, the managed competition process may result in the subordination of service quality and consumer choice to pressures for cost-containment.

Sign comprehension is critical for effective driving, responses to warnings, and way-finding. Signs that are poorly comprehended by older people increase accident risk and may compromise independence. This study sought to determine whether iconic sign comprehension suffers in healthy aging and in the presence of cognitive impairment. Additionally, we examined whether the addition of text to iconic signage would increase comprehension in older adults. In Experiment 1, young adults, healthy older adults, and older adults with varying levels of cognitive impairment were asked the meaning of 65 signs used for driving, warnings, and way-finding. Healthy older adults were generally good at sign comprehension but had difficulty with way-finding signs. Older adults with cognitive impairment had poorer sign comprehension overall and particular difficulty with way-finding icons and signs that had icons only. In Experiment 2, healthy older adults were asked the meaning of signs containing icons only, or icons and text. A significant improvement in comprehension was found when text was added. An important implication of this work is that the assessment of sign comprehension needs to involve a broad and heterogeneous sample of older adults reflecting the range of perceptual and cognitive abilities represented in the population.

The General Well-Being Schedule (GWB) is a questionnaire that is frequently used in large-scale epidemiological surveys to evaluate the psychological health of a given population. In spite of its popularity, it appears that no validation study has been done on a French version of the instrument. The present study proposes a French version of the GWB and establishes its psychometric qualities based on a sample of 369 subjects, 179 of whom are bilingual. The subjects were recruited through notices placed in the different francophone and anglophone media. The questionnaires were mailed to the subjects. First, the results show a very strong correlation between the translated version and the original version of the questionnaire (r = 0.88, p < 0.0001). The internal consistency of the French version is estimated at 0.92 and its test-retest reliability at 0.82 (95% CI: 0.71–0.89). Correlations between the total score on the general well-being scale and measures of depression and anxiety are over 0.70. Principal component analysis applied to the French and English versions of the questionnaire suggests the presence of a main factor which accounts for 50 per cent of the variance. This study provides a French version of the GWB that may justifiably be considered reliable and valid. Validation of the questionnaire should be pursued by establishing normative values for the elderly francophone population and by studying its responsiveness.

The interactional environment of institutionalized elders has been described as communication-impaired due to the lack of opportunities for ordinary adult-to-adult conversation. Patronizing speech from caregivers is one form of constraining communication that may frustrate elders within institutions. In this study, 256 adults (randomly assigned to one of 16 experimental conditions) evaluated either a patronizing conversation between a nurse and an elderly woman in a nursing home or a more neutral version of the same conversation. In a complex between-subjects design based on Communication Accommodation Theory, we examined the possible influences on the evaluation of patronizing speech of three manipulations: resident alertness, personal situational topic, and privacy of setting for the conversation. Across all contexts, the nurse using a patronizing speech style was viewed as less respectful and less nurturant than the nurse using the neutral style. The resident was considered less satisfied with the patronizing conversation. The situational topic manipulation yielded main effects for these same variables, with the nurse criticizing a resident about a personal issue being viewed as less respectful and nurturant than the nurse raising a safety issue. Moreover, the resident addressed about a personal issue was rated as less competent than the resident addressed about a safety issue. Situational topic interacted with speech style on only one measure, while resident alertness and privacy had no impact on the negative connotations of patronizing speech.

Using data collected by the Ontario HIV Treatment Network Cohort Study, the primary goal of this study was to describe the socio-demographic characteristics of a sample of older people (age 50 and over) from Ontario (n = 1,129) living with HIV/AIDS (PHAs). The secondary goal was to compare four sub-samples of older PHAs: women (10.6%), heterosexual men (16.7%), gay men (65.8%), and bisexual men (6.9%). These groups differed significantly by age, education, income, nationality, race, and time spent living with HIV. Compared to other groups, gay and bisexual men (GBM) reported lower HIV stigma, disclosure stigma, negative self-image stigma, and concern with public attitude stigma. GBM also reported higher mental health quality of life, lower depression scores, and lower maladaptive coping scores. These findings suggest that services for older PHAs, including training for HIV and gerontological providers, may need to cater to the specific needs of these sub-populations.

Demographic and social trends lead to a variety of micro-level and internal structural contexts that influence caregiving in families with older members. The results of macro-level changes have received little focused attention in the aging literature, where much of the caregiving research has addressed issues within the context of traditional family structure. Yet the conventional nuclear family model is increasingly uncommon as new, pluralistic models of family life are emerging in contemporary society. The majority of elder care is provided by relatives, albeit with varying patterns of involvement and responsibility across family structures. Both conventional and pluralistic families face challenges in meeting the care needs of their oldest members, leaving some older adults at risk of having unmet needs. Additional research on family risk and resilience related to the care of older relatives is warranted, particularly with respect to pluralistic models of family life.

The purpose of this exploratory study was to examine the experiences of older adults with dementia while they were in long-term care and while they were in a summer-camp setting. Participant observation and interviews took place in both settings to gain an understanding of the experiences of seven residents of the long-term care facility. In the participants' experiences in the two contrasting environments, two types of relationships were evident—functional and supportive. Differing strategies were employed by residents within these two types of relationships. Notably, in supportive relationships, participants used humour and reminiscing in ways that reflected the depth of the relationship. At summer camp, in a more open and less constrained environment, relationships were dramatically altered and included elements of equality; personal interactions; and attention, reciprocity, and trust.

De nombreuses recherches concluent que les aidants naturels de personnes âgées en perte d'autonomie éprouvent un fardeau associé à leur situation. Les principaux facteurs influençant ce fardeau sont ici passés en revue et regroupés en quatre catégories: variables liées aux tâches effectuées par l'aidant, caractéristiques de la personne âgée, caractéristiques de l'aidant et variables interactionnelles caractérisant la relation entre l'aidant et l'aidé. L'article présente les résultats d'une recherche conduite auprès d'un échantillon représentatif des aidants québécois de personnes âgées en perte d'autonomie (n = 294). Selon cette analyse, le degré d'assistance fournie, l'aide pour les activités de la vie quotidienne et l'interaction avec les professionnels du réseau de soins formel sont associés au fardeau ressenti. De plus, le degré d'autonomie et l'état de santé de la personne aidée, de même que l'âge de l'aidant influencent le fardeau. Les variables interactionnelles influençant le fardeau sont: la proximité du lien de parenté entre l'aidant et l'aidé, le degré de responsabilité assumée par l'aidant, la cohabitation, ainsi que l'assistance fournie par les autres membres du réseau personnel. Ces résultats appuient plusieurs conclusions des travaux antérieurs, suggérant ainsi que les principaux facteurs associés au fardeau pourraient être similaires, peu importe le pattern ou le contexte de la situation aidant/aidé au plan de la culture (l'échantillon est québécois), du statut de l'aidant (principal ou secondaire) et du degré ou du type d'incapacité de l'aidé. Les résultats de cette recherche sont finalement discutés dans la perspective des tendances sociales à venir et des implications concrètes qu'ils soulèvent pour la planification des services sociaux et de santé.

Elderly people from ethnic minority groups often experience different barriers in accessing health services. Studies have typically focused on combined groups of elderly immigrants or on large ethno-cultural minorities such as the Chinese in Canada, or African-Americans and Hispanics in the U.S. This study aimed to examine the types and factor structure of barriers to using health services experienced by aging South Asian immigrants in Calgary, Alberta, Canada. A telephone survey was used to collect data from a random sample of South Asian immigrants aged 55 years and older. Principal component analysis revealed four major types of barriers: cultural incompatibility, personal attitudes, administrative problems in delivery, and circumstantial challenges.

In this study we examine the impact of parent status and marital status on (1) the foundations of social support networks and (2) who one turns to if help is required with activities of daily living. Data are taken from structured interviews with 678 community-dwelling persons aged 55 and over in London, Canada. This sample overrepresents the childless, single (never married), and divorced, thus ensuring adequate numbers in each category for data analysis. Our findings indicate that marital status is more influential than parent status regarding differences in the foundations of social support. However, for more specific forms of assistance, the divorced and single are more likely than the married, and the childless are more likely than parents to rely on formal support and paid help and less likely to rely on family. As well, for both marital and parent status, there are significant interactions with gender.

Des niveaux moins élevés de participation sociale et d’épisodes de marche représentent deux facteurs pouvant contribuer à la dépression chez les personnes âgées, mais les recherches antérieures ne sont pas concluantes à ce sujet. L’objectif de cette étude transversale est de quantifier les associations entre la dépression et l’effet combiné de la participation sociale et de la marche dans un échantillon de personnes âgées vivant au Canada (n = 549). Des analyses de régressions linéaires et logistiques ont été effectuées pour examiner si la participation sociale et la marche prédisent la dépression indépendamment des caractéristiques individuelles. Dans les modèles finaux, les résultats suggèrent que les individus qui ne prennent pas de marches présentent davantage de symptômes dépressifs ou une possible dépression (l’association entre la participation sociale et la dépression devient non significative dans les modèles ajustés). La présente étude souligne le rôle central des habitudes de vie telle la marche pour la santé mentale des aînés.

This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported ≥ one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson’s disease), age ≥ 85 years, environmental hazards, previous slip or trip, and visual impairment.

This study investigated the relationships among gender role and self-reported health functioning in a sample of community dwelling older adults. One hundred and two (55 female, 47 male) participants were recruited through seniors’ associations in Windsor, Ontario. Analyses of variance were conducted separately by gender to compare the self-rated physical health functioning, wellness, and life satisfaction of participants differing on classification of their gender role. For older women classified as androgynous, gender role exhibited significant effects on general wellness and life satisfaction, but not on self-reported physical health functioning. In support of Bem’s androgyny model of optimal adjustment, post-hoc analyses revealed that women who rated themselves as androgynous reported better overall wellness levels than their peers. Older men’s self-reported physical health functioning and general wellness did not differ significantly by gender role. Limitations and implications are discussed.