Despite the extensive literature on the effects of relocation on the aged, most investigators have examined changes following relocation. Very little is known about the cognitions and emotions an older person experiences, or about the meaning of home during the pre-relocation period. The present study attempted to address these issues. Sixty-three older people awaiting relocation to age-segregated rent-subsidized apartment buildings were interviewed twice over a one year period: they received the PGC Multilevel Assessment Instrument as well as measures assessing coping strategies and their perceived meaning of home and relocation. Respondents did not demonstrate decrements on any domain of the PGC MAI over the year period; indeed, those who moved significantly increased their level of environmental satisfaction. Finally, participants reported dealing with stress by exercising personal control over, or actively manipulating, their environment; “home”, moreover, most often had meaning and importance because it was the place in which this personal control was optimized and ensured.

This study investigates novice and experienced student nurses’ attitudes about caring for patients across the lifespan. Students were also asked why they would enjoy or not enjoy caring for children and older adults. Both novice (n = 114) and advanced (n = 56) nursing students were relatively positive about caring for patients across the lifespan. However, novices were significantly more negative about working with older patients, particularly after experiencing a first clinical placement. In contrast, a significant quadratic effect was found for advanced students, indicating more negativity about working with both children and older adults. When giving reasons for why they would enjoy caring for older patients, novices were more likely than were advanced students to focus on stereotypical characteristics and on negative health outcomes of older adults as a group. Overall, results suggest that the attitudes driving career interests in nursing students change as training advances.

This paper reports on the results of analyses using administrative data from British Columbia for 10 years from fiscal 1987/1988 to 1996/1997, inclusive, to examine the comparative costs to government of long-term home care and residential care services. The analyses used administrative data for hospital care, physician care, drugs, and home care and residential long-term care. Direct comparisons for cost and utilization data were possible, as the same care-level classification system is used in BC for home care and residential care clients. Given significant changes in the type and/or level of care of clients over time, a full-time equivalent client strategy was used to maximize the accuracy of comparisons. The findings suggest that, in general, home care can be a lower-cost alternative to residential care for clients with similar care needs. The difference in costs between home care and residential care services narrows considerably for those who change their type and/or level of care, and home care was found to be more costly than long-term institutional care for home care clients who died. The findings from this study indicate that with the appropriate substitution for residential care services, in a planned and targeted manner, home care services can be a lower-cost alternative to residential long-term care in integrated systems of care delivery that include both sets of services.

Age-related dementias present a significant health concern in Canada, particularly for Indigenous communities, in which rates of dementia are estimated to be 34 per cent higher than in the general Canadian population. This article reports on a qualitative evidence synthesis of available literature concerning cultural understandings of dementia in Indigenous peoples in Canada. Key findings suggest that although exploration of this topic is on the rise in Canada, there remains a paucity of research on this topic, particularly among the Inuit and Métis. The synthesis of the literature found that dementia is viewed as a natural part of the life cycle by many Indigenous people; and although this presents significant challenges for caregivers, informal and community models of care are routinely practiced. This synthesis will be useful for health care providers and organizations that are searching for appropriate approaches to respond to the needs of Indigenous patients and families experiencing dementia.

Drawing from the health belief model, cues to action have been theorized to influence health behaviours; however, few studies have examined these constructs explicitly. This study investigated the relationship between information cues to action and exercise self-care. It was hypothesized that reading about illness information, knowing about services, and consulting with others about one's illness triggers exercise self-care. The sample consisted of 879 chronically ill adults aged 50 and over, drawn from the Vancouver North Shore Self-Care Study. It was found that the odds of exercising almost doubled for readers of information about illness (compared to non-readers), after controlling for socio-demographic factors, illness context, and illness efficacy. Furthermore, knowledge of services and consultations were shown to increase the odds of exercise self-care. These findings provide support for the salience of cues to action as a pivotal theoretical construct. The implications of these findings for health promotion programs targeting persons with chronic illnesses are discussed.

Previous papers reported on the associations between water quality and a measure of cognitive impairment, based on data of the Ontario Longitudinal Study of Aging (LSA). The present report summarizes the information on fluoride (F) and aluminum (Al) and provides additional information on the effects of pH. Specifically, our preliminary results suggest that a neutral pH, relatively low Al and relatively high F concentrations in drinking water decrease the odds of showing indications of cognitive impairment by a factor of about five, compared with other types of drinking water. The relevant chemical reaction is ascribed to an equilibrium involving Al complexes.

While the benefits of participating in care or medical decision making are widely reported, research on decision-making participation preferences usually reveals some portion of individuals who do not want to be involved. Data collected through structured, in-person interviews with 100 residents of six long-term care (LTC) facilities in Victoria, British Columbia, were used to examine participation preferences with respect to four types of care decisions (bedtimes, medication choice, room transfer, and advance directives), as well as predictors of these preferences. Residents with higher levels of formal education, a greater number of chronic conditions, and greater confidence about the worth of their input tend to prefer more active involvement in decision making. This research also suggests that predictors of preference for independent control over decision making (active involvement) differ from predictors of preference for joint or shared decision making. Implications for the empowerment of LTC facility residents and the meaning of decision-making involvement in these environments are discussed.

This paper argues that fear of aging can more precisely be recognized as a fear of disability and that fear of disability can be centrally understood as a fear of dependence. Accordingly, we are not likely to see old people being treated as important members of society until we see a change in attitudes towards disability. The argument is developed with reference to a consideration of attitudes toward and treatment of elders and people with disabilities, a consideration of the social construction of dependency, and an examination of statistics on the Canadian population of people with disabilities. The ubiquity of disability across all age groups means that there needs to be a re-conceptualization of disability as part of the human experience.

Older adults represent the highest proportion of gamblers (Ontario Lottery and Gaming Corporation [OLG], 2012). Unpartnered older adults may be more socially isolated and lonely (Dykstra & de Jong Gierveld, 2004), thus more likely to be at risk for problem gambling (McQuade & Gill, 2012). We examined whether gambling to socialize or from loneliness and going to the casino with friends/family mediate the relation between marital status and problem gambling. Data from a random sample of older adults at gambling venues across Southwestern Ontario indicated that gambling with family/friends and gambling due to loneliness mediated the relationship between marital status and problem gambling. Relative to those married, unpartnered older adults were less likely to gamble with family/friends, more likely to gamble due to loneliness, and had higher problem gambling. Prevention and treatment initiatives should examine ways to decrease loneliness and social isolation among older adults and offer alternative social activities.

Using data from a Canadian national sample, participation in three activities - going to public places, travel, and going on outings - in a sample of 4,258 respondents aged 55 and over is examined. OLS regression results indicate that the childless go to public places and travel as frequently as parents and go on outings more frequently than parents. Significant differences are also found for gender, marital status, health, and education. Logistic regression results indicate that the childless are more likely to seek companionship with friends and other relatives than are parents. However, gender and marital status are more often significant predictors of source of companionship than is parent status. We conclude that the childless negotiate unique social participation networks which ensure social participation outside the home.

Use of medical services by the elderly population is increasing. While rising numbers of elderly persons account for much of the overall increase, per capita increases in use of medical services within this group have been substantial. This phenomenon is commonly attributed to greater need due to the “aging” of the elderly population (i.e. an increased proportion of those 85 years of age and over) and to changing patterns of morbidity or to changing patterns of servicing the old and sick. Research to date suggests that the impact of the aging of the elderly population has been small. However, because the relationship between morbidity and rising utilization has not yet been studied, there is considerable debate about the extent to which increased “need” for care contributes to patterns of rising utilization. This research studied the impact of changes in numbers, demographics, and morbidity patterns of the elderly on per capita and aggregate consumption of ambulatory physician services at two points in time. Linked survey and physician claims data for representative samples of the elderly in 1971 and 1983 were used to study patterns of utilization of total ambulatory, consultative and non-consultative care by age and health status. The research found that per capita utilization of both consult and non-consult visits rose across all categories, with older individuals and those in poor health experiencing greater increases in utilization than younger and healthier individuals. At the aggregate level, a large percentage of the increase in utilization of medical services was related to increased numbers of elderly. Changes in ‘need’ attributable to aging of the elderly population and increased morbidity had only minor effects. At least 35 per cent of the increase in non-consult visits and 50 per cent of the increase in consult visits were not specifically related to changes in need of the elderly population and remain as unexplained changes in patterns of servicing individuals. While some of this increase was directed to individuals in poor health, the majority of increased servicing (32% of the increase in non-consultative visits and 58% of the increase in consultation visits) was directed to individuals in good health. Policy implications are discussed.

The purpose of the present research was to examine the perceptions of risk regarding falling held by older adults and their adult children. Using a focused ethnographic approach, older adults and adult children were interviewed in depth. Thematic analysis was conducted to identify themes within groups and to compare the perspectives of older adults and adult children. Findings highlighted differences in perceptions and approaches to action between older adults and their adult children. There were three approaches to action adopted by these families, which focused around whose actions were dominant: parents' actions, shared actions, and children's secret actions. The results emphasize the value placed on independence by older adults and the impact of multiple family relations taking action to prevent falls. The present study points to the importance of including multiple family perspectives in research concerning injury prevention for older adults.

This research examined the perspectives and experiences of First Nations community members regarding health and social support for elderly people living in 13 First Nations communities in northwestern Ontario. Surveys (n = 216) and focus groups (n = 70) were conducted in 2005 and 2006 with elderly Aboriginal people and their formal and informal caregivers. Results indicated a strong preference (69%) for helping people to age and die at home; however, barriers and challenges existed at the family, community, health system, and social policy levels. Barriers included a lack of family caregivers and shortage of health care providers and programs; changing community values; and limited access to provincial health services and culturally relevant and safe care, all of which hindered social policy and community empowerment. Enabling elderly people to age within First Nations communities will require multi-level and multi-sectoral system changes.

The formal sector's increasing recourse to families poses questions concerning the type and degree of participation that is expected of family caregivers and the conceptions that exist regarding them. This article examines different conceptions and their implications for practice, based on reflexions emanating from the authors' 15 years of empirical research on caregiving. A typology of practice approaches based on the various conceptions is presented including: the dependent adult approach, the caregiver as joint-client, the caregiver as resource and the caregiver as partner approach. Each of these approaches is based on a framework of beliefs, values and principles which shape policy and practice and have implications for how caregivers are perceived and served. The authors propose an alternative community-oriented approach which addresses the limitations of those which currently dominate homecare policy and practice.

Psychometric properties of the Beck Depression Inventory are questionable for elderly francophones. Consequently, the aim of this study is to assess the reliability and the validity of the French version of the BDI (Questionnaire de Dépression de Beck: Bourque & Beaudette, 1982) for this group. Six hundred and forty-three French-speaking elders from Quebec and New-Brunswick answered the BDI. The reliability coefficients showed satisfactory internal consistency (.85), split-half reliability (.76) and test-retest correlation (.74). A principal-components analysis yielded three factors (somatic complaints, negative view of the self, and helplessness) accounting for 46.9 per cent of the total variance. The choice of an optimal cut-off score and the use of the BDI with the elderly are also discussed in this study.

This paper focuses on ways that adult children and children-in-law mediate contact between grandmothers and grandchildren, following marriage breakdown and remarriage in the middle generation. A qualitative analysis of face-to-face contact between 110 grandmother-grandchild pairs was conducted. Findings showed that adult children have a more direct influence on visiting, by arranging or obstructing visits between grandmothers and grandchildren. The influence of first or second children-in-law was found to be more indirect. By preventing an estranged spouse from seeing his or her child, custodial children-in-law could also be preventing a grandmother's access to her grandchild, if she depended on her noncustodial child to bring the grandchild to see her when he or she exercised visiting rights. Children-in-law could also act as intermediaries through their absence as well as through their presence. These findings, as well as ways that grandparents can negotiate relationships with adult children and children-in-law, are discussed. Especially noted is the value of monitoring communication exchanges, maintaining friendly relationships with children-in-law and step-grandchildren, and acting as resources to the family.

Only competent persons can give informed consent to health care. Current approaches define competence in essentially cognitive terms, thereby ignoring the fact that someone may be cognitively competent yet lack the capacity to give a valid consent. I outline a more robust theory of competence that includes not only cognitive but also emotional and valuational parameters. I then distinguish competence from capacity, and indicate the role this distinction can usefully play in the extended and continuing care setting. I also show how this distinction is consistent with several recent Canadian legal decisions, and outline its usefulness in interpreting and applying relevant provincial statutes.

This grounded-theory study explored family members’ experiences supporting a relative’s move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members’ experiences accepting the need for, and timing of, their relative’s move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

As Canada's elderly population grows, an increasing number of seniors will require care as they face the end of life. Relatively little research attention, however, has been given to end-of-life issues, including those related to treatment and care for persons who are both old and dying. Families and health care providers have little direction and guidance to ensure an optimum quality of life for seniors prior to death and during the period of bereavement. This article presents an abbreviated summary of the literature regarding end-of-life issues and challenges for seniors who face a life threatening illness and are at, or near, the end of their lives. The article is also informed by a series of focus groups with elderly and other informal caregivers regarding the giving of help and getting support while caring for persons who are dying. It concludes with a response to this evidence by making a series of recommendations aimed at ensuring optimal end-of-life care for seniors who are dying and their families.

Previous research on activity patterns of the elderly has relied on survey and interview methods which have depended on special measures and the long term memory of the respondents. This paper examines the use of time budgets in studying changing activity patterns across the life span. The independent variables of interest in this analysu were age, sex, marital status, education, and whether or not the individual lives alone. The dependent variable was the activity patterns of the individual. Results indicate that only age, of the factors considered here, endured significance across all comparisons.