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.

In filial caregiving, women typically provide more care than men. The numerical predominance of female caregivers has been explained such that diversity among male caregivers has been overlooked. That is, “internalist” explanations, which emphasize the differing socialization experience of females and males, tend to homogenize each gender’s caregiving experience. “Externalist” explanations, which emphasize various factors that push or pull women and men into caregiving, reduce the actors involved to passive agents whose subjective understanding of caregiving over time is ignored. Both explanations divert attention from the diversity in male caregiving. This article presents qualitative data derived from interviews with 48 caregiving sons to provide evidence of that diversity. Some themes are common to both married and never-married male caregivers, yet there are also systematic differences between the two groups of caregivers. For example, caregiving for married sons was more limited; caregiving for never-married sons was a more central element in their lives.

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.

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.

Reminiscence is the process of thinking or telling about past experiences. The goal of this study was to investigate which functions young adults attribute to their own reminiscences, and to the reminiscences of older persons. The views of young adults on the reminiscences of older adults were also compared with the self-reports of older persons on their reminiscences. We used the Reminiscence Functions Scale (Webster, 1993,1997), which measures eight functions: Boredom Reduction, Death Preparation, Identity, Problem-Solving, Conversation, Intimacy Maintenance, Bitterness Revival, and Teach/Inform. Seventy-six undergraduate students reported on their own uses of reminiscences. A few weeks later, they gave their views regarding the functions for older persons on the same scale. Eighty-three adults over the age of 65 completed the scale regarding their own uses. Age-appropriate higher uses of the functions of Boredom Reduction, Identity and Problem-Solving characterized the young adults. Older adults most characteristically used reminiscence for Teach/ Inform, i.e. for transmission of life experiences. Compared to themselves, young adults believed that older adults reminisced more for practically all functions, which reflects the stereotypical view. When these beliefs were checked against the reports of older adults, it became clear that young adults overestimated almost all uses, especially Boredom Reduction, Death Preparation, and Teach/Inform. These findings reflect the prevalence of ageist assumptions regarding the uses of reminiscence by older persons.

In light of recent social pressures leading to a reimagining of the “Third Age” as a time of constant activity rather than repose and relaxation, this article explores the pressure on individuals to age “successfully” by engaging in physical activity in later life. Through semi-structured interviews with 15 retired or semi-retired gym-goers (eight women and seven men), the article examines how this call to increased activity impacts the ways active mid-life and older adults understand themselves and others. Drawing on Foucault’s understandings of the productive nature of power, we argue that those who perceive themselves as successfully heeding the call to active aging position themselves in contrast to inactive peers. Within a neoliberal framework, these participants self-identify as morally responsible citizens who, as a result of engagement in fitness activities, are authorized to survey and discipline the bodies of those “others” who will not or cannot engage in regular exercise.

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.

Little comparative research exists on health experiences and conditions of minority groups in Canada and the United States, despite both countries having a racially diverse population with a significant proportion of immigrants. This article explores race and immigrant disparities in health and health care access across the two countries. The study focus was on middle and old age given the change and increasing diversity in health and health care policy, such as Medicare. Logistic regression analysis of data from the 2002–2003 Joint Canada/United States Survey of Health shows that the joint effect of race and nativity on health outcomes – health differences between native and foreign-born Whites and non-Whites – is largely insignificant in Canada but considerable in the U.S. Non-White native and foreign-born Americans within both 45-to-64 and 65-and-over age groups experience significant disadvantage in health status and access to care, irrespective of health insurance coverage, demographic, socio-economic, and lifestyle factors.

We conducted a mixed-methods study – the focus of this article – to understand how workers in long-term care facilities experienced working conditions. We surveyed unionized care workers in Ontario (n = 917); we also surveyed workers in three Canadian provinces (n = 948) and four Scandinavian countries (n = 1,625). In post-survey focus groups, we presented respondents with survey questions and descriptive statistical findings, and asked them: “Does this reflect your experience?” Workers reported time pressures and the frequency of experiences of physical violence and unwanted sexual attention, as we explain. We discuss how iteratively mixing qualitative and quantitative methods to triangulate survey and focus group results led to expected data convergence and to unexpected data divergence that revealed a normalized culture of structural violence in long-term care facilities. We discuss how the finding of structural violence emerged and also the deeper meaning, context, and insights resulting from our combined methods.

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.

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.

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.

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.

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.

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 the 2000/2001 Canadian Community Health Survey (CCHS), this paper examines the health status of the older (aged 55+) immigrant population relative to that of non-immigrants in order to identify areas where their health statuses diverge. First, we compare the health status of older immigrants (foreign-born) aged 55 and over in Canada to the Canadian-born in terms of age and gender using multiple measures of health status including self-assessed health. Second, we identify the factors associated with health status using the determinants of health framework. In both cases, the key questions are whether differences in health status exist and whether they are explained primarily by socio-economic, socio-demographic, or lifestyle factors that may point to problems with the Canadian health care system. Findings indicate that there is a relative comparability in the health status of older immigrants, even after controlling for age.

Three Canadian research studies which used similar sampling strategies are examined. Data on their survey experiences are presented so as to assist those planning research to do so more efficiently. The response and completion rates of the three studies were quite similar, suggesting that some predictions might be made for similarly-designed future studies. The findings may give heart to those wondering whether their response and refusal rates are adequate or embarassing. Detailed reporting of survey research sampling experiences and adoption of a uniform terminology is called for.

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.

Recent research suggests that the single strongest predictor of burden among dementia caregivers is a measure of marital aggrandizement (Marital Conventionalization Scale). The current study corroborates the significant inverse relation between these constructs. In addition, there appears to be little association between this response style and more standard social desirability constructs (i.e. self-deception, impression management). Furthermore, the tendency to discount negative experience in one's marital history appears distinct from emotion- and problem-focussed coping as defined within Lazarus and Folkman's cognitive phenomenological model. The propensity to idealize one's spouse and marriage is discussed relative to the reconstructionist theory of memory and social exchange theory.