The purpose of this paper is to introduce, define and test a theoretical model which explains elderly people's use of urban shopping centres as places for social exchange. We suggest that elderly people use shopping centres to satisfy social and leisure are individual or predisposing variables and environmental or encouraging variables which differentiate elderly people who engage in this activity. Using a secondary data analysis of a probability sample of 300 non-institutionalized elderly people in Montreal, we found that mallingering is an activity that 67 per cent of this sample do in three shopping centres in this city. Predisposing variables such as age, gender, education and feelings of loneliness, along with encouraging variables such as design and ambiance of the centre are related to this activity. Based on these findings, we suggest that this model contributes to our understanding of the leisure activities of non-institutionalized elderly people.

Long-term care spans a broad range of very diverse services and a pivotal location within the overall continuum of health and health care. Changes in one component of care affect and are affected by all other components as health care may be characterized as a dynamic series of interdependent processes and persons. The current state of Canadian health care, in general, and long-term care, in particular, demands the skilful juggling of universality and diversity to maximize both these characteristics without sacrificing either. In an atmosphere of reform and fiscal restructuring, the organizational, utilization and financing implications for this system on a tightrope are substantial. The challenges are of major proportions in maintaining a balance while securing a future system that is efficient, efficacious, equitable, effective and empowering.

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragiles) is an integrated service model based on community services, a multidisciplinary team, case management that retains clinical responsibility for all the health and social services required, and the capacity to mobilize resources as required and according to the care protocol. The SIPA demonstration project used an experimental design, with random allocation of the 1,230 participants from two areas of Montreal to an experimental and a control group. The costs of institutional services were $4,270 less for those in the SIPA group compared to the control group; the costs of community care were $3,394 more. The proportion of persons waiting in acute care hospitals for nursing home placement was twice as high in the control group as in the SIPA group. The costs of acute hospitalizations for persons in the SIPA group with ADL disabilities were at least $4,000 lower than those for persons in the control group. In conclusion, the SIPA trial showed that it is possible to undertake ambitious and rigorous demonstration projects in Canada. These results were obtained without an increase in the overall costs of health and social services, without reducing the quality of care, and without increasing the burden on elderly persons and their relatives.

Terror management theory (TMT) posits that cultural worldviews function to allay concerns about human mortality. Preliminary research with older adults has indicated that seniors do not respond to death reminders in the same way as their younger counterparts. The purpose of the current study was to test a developmentally relevant construct that may buffer death anxiety in later life. It was hypothesized that Erikson’s concept of generativity may encompass death-denying properties for older adults. One hundred and seventy-nine seniors were recruited to determine if subtle mortality salience inductions would lead participants to rate their own generativity as higher than after a blatant induction, or no induction, after controlling for pre-induction generativity. As expected, participants exposed to subtle death primes rated themselves as having higher levels of generativity than the other two groups after co-varying pre-induction generativity. Explanations are discussed in light of the literatures on TMT and generativity.

In this paper we investigate the geographical context in which employed caregivers provide assistance to their elderly relatives. Specifically, we examine the impact of the spatial arrangement of the employed caregiver's home, their workplace and the care recipient's home (the “locational triangle” alluded to in our title) on work-family balance. Analysis of data drawn from a national study of Work and Family conducted by the Canadian Aging Research Network (CARNET) indicates that the parameters of the locational triangle have discernable impacts on levels of perceived stress and interference and on the incidence of certain job effects and coping behaviours. The impacts of longer journey to work and increased distance from elderly relative(s) on stress and interference levels are seen to be bound up with the nature of family responsibilities. Location-based coping behaviours (considered or implemented in the six months leading up to the survey) are reported by 18 per cent of our sample of 595 employed caregivers, but are virtually confined to the home-elder axis of the location triangle. On the basis of our results, we advocate greater attention to the spatial context of work-family balance.

This review of the literature on the subject of health-related self-help and support groups for older adults begins by defining these two small group helping arrangements, and proceeds with a discussion of the extent of their utilization by older adults, barriers to participation, and ways of tailoring the groups to the needs and circumstances of older adults. The process and outcomes of these groups are also reviewed, and recommendations are offered regarding future research directions and ways of optimizing both the appeal and impact of these two types of mutual aid groups.

The purpose of this paper is to explore occupational health issues among employees of home care agencies. Results of a survey of 892 office and visiting employees of three not-for-profit home care agencies and focus group discussions show that employees of home care agencies experience high levels of stress, tiredness and exhaustion. This work-related stress is most acutely felt by those in managerial occupations, nurses and therapists. When compared to findings from the Canadian National Population Health Survey, employees of home care agencies are found to be significantly more likely than all working women to suffer from allergies, asthma, arthritis or rheumatism, back problems, high blood pressure, migraine headaches, and work-related injuries in the past year. Many employees of home care agencies suffer pain or discomfort in several body locations. Visiting employees of home care agencies suffer from sprains or strains, dislocations, fractures, and bruises as a result of lifting or moving clients, bending or straining, accidental falls, repetitive motion injuries, and motor vehicle accidents. Home care office staff suffer from repetitive strain injuries and respiratory illness. Implications for policy and research are discussed.

HIV/AIDS and aging is an important emerging topic with relevance to gerontology. Currently, little is known about the housing experiences of older adults within the context of HIV/AIDS. This article explores the issue and examines interview data concerning the housing experiences of 11 older adults (52 to 67 years old) living with HIV/AIDS in Ottawa, Ontario. Participants’ stories revealed concerns relating to three major themes: acceptance into retirement homes and long-term care communities, barriers to accessing subsidized housing services, and homelessness. Participants reported feeling that they lacked recognition and experienced confusion about their future housing prospects. These data suggest that a shift may be occurring in the housing needs of people aging with HIV/AIDS. This emerging population presents challenges to mainstream ideas of aging. We conclude that increased attention is needed in research, policy, and practice to address housing issues among this age group of people living with HIV/AIDS.

This study explored the efficacy of aerobic training (AT) in mitigating white matter hyperintensity (WMH) progression and whether these changes are sex dependent. This was an exploratory analysis of a randomized controlled trial assessing the effect of AT on cognition in people with vascular cognitive impairment. Participants were randomized to a 6 month AT or usual care (control [CON]) group. A subset completed magnetic resonance imaging to quantify WMH volume. Using an analysis of covariance model, we found a significant sex × group interaction (p = .03). Over the 6 month study, AT females demonstrated greater WMH progression than CON females (p = .05). Among males, there was no significant between-group difference (p = .31). Within the AT group, males demonstrated significantly less WMH progression than females (p = .01) at 6 months. Therefore, the effects of AT on WMH progression may vary by sex; that is, AT may curtail WMH progression in males but not females.

This article examines the extent and the meaning of solitude among the aged. A comprehensive study of the foreign, Canadian and Quebec literature was undertaken to prepare this document, but priority was given to the somewhat lesser known investigations originating from Quebec. First, the concepts most often utilized in discussing the phenomena under scrutiny were defined: solitude, social isolation and the feeling of loneliness. Then, the relative importance of each phenomenon was assessed, based on the available data. In order to fully understand the meaning of the facts observed, their causes were also examined. Finally, avenues for future research were proposed. This study suggests that solitude among the elderly is a more complex problem than believed. Even if the isolated and (or) lonely aged are in the minority, this does not mean that all their socio-affective needs are being met. These people spend long periods of time alone and this affects their lives. The problem as such is largely caused by the position the elderly occupy in the society and, in turn, this position probably influences their behaviour. However, gerontologists have scarcely studied this hypothesis. This article then highlights certain aspects of the solitude phenomenon which have so far been overlooked by gerontologists.

Specially designed outdoor spaces (SDOS) have been developed to improve the quality of life of people with dementia. However, few follow-up studies have been done to examine their use once implemented. The purpose of this study was to gain a better understanding of how SDOS are used and the objectives of their design fulfilled. A qualitative descriptive study was conducted of a SDOS 3 years after it was built to answer the following questions: How has the garden changed from the original design? What are the current patterns of use of the garden? What factors facilitate use of the garden? What are the barriers to use of the garden? Four main sources of data were used: landscape architectural drawings, non-participant observation, focus groups, and in-depth interviews. The results lend support to the theoretical principles of garden design in the literature. The garden was considered an important part of the service program. However, factors such as garden maintenance, organizational support, staff training, and accessibility may limit its impact.

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.

Drawing on the intergenerational stake hypothesis (Bengtson and Kuypers, 1971), this article explores intergenerational congruence and incongruence on filial obligation, and implications for social support, between older nisei (second generation) parents and adult sansei (third generation) children in Japanese Canadian families. Using data from semi-structured interviews with 100 parent–child dyads in British Columbia, congruence on close-ended responses to value statements (degree congruence) and the content congruence of open-ended responses are examined. The findings show the majority of parent-child dyads indicate overall (both degree and content) congruence in filial obligation, especially when a parent is female, widowed, and/or has poor/fair health status. We conclude that despite markedly different historical life course experiences and acculturation processes, both generations continue to regard filial obligation as important. These findings are discussed with respect to implications for social support exchanges given a continued valuation of filial obligation in Asian post-immigrant (North American-born) and immigrant families.

Client-responsive behaviours occur commonly among residents in long-term care (LTC) settings; direct-care staff, however, receive little education, support, or opportunities to discuss and collaborate on managing such behaviours. Our participatory action project introduced mental health huddles to support staff in discussing and managing client-responsive behaviours in long-term care. This research project engaged direct-care staff (e.g., personal support workers, registered practical nurses, housekeeping staff, and registered nurses) in learning how to use these huddles. Staff workers used huddles as a forum to stay informed, review work, problem solve, and develop person-centered action plans. Fifty-six huddles occurred over a 12-week period; two to seven direct-care staff participated in each huddle. Focus groups indicated improved staff collaboration, teamwork, support, and communication when discussing specific responsive behaviours. Huddles provided LTC staff with the opportunity to collaborate and discuss strategies to optimize resident care. Further research on how huddles affect resident care outcomes is needed.

Falls and fragility fractures are common, dangerous, and important public health challenges. They are best understood as geriatric syndromes with close relation to frailty and other aging-related health problems. They are associated with many risk factors, in all health domains – physical, psychological, social, and environmental. At a population level, the challenge is to improve the health and well-being of all older people to reduce the incidence of falls. At a clinical level, the challenge is to assess the individual risk factors and apply evidence-based individually tailored, multifactorial interventions. The most powerful component is strength-and-balance exercise training.

Feminist methodologies address the purpose and process of the research enterprise. They are not a particular set of techniques or procedures for gathering data. Rather they stem from the realization that it was the experiences of a very particular group of men, as both subject and object of enquiry, that defined social reality and the theories developed to explain our social worlds. This paper discusses some of the principles and approaches used by feminist researchers to explore the realities of women's lives. The author's research on home care workers, along with selected research in the field of aging, are used to illustrate the analysis and explore the implications of feminist methodologies for our understanding of aging in Canadian society.

Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Canada’s Truth and Reconciliation Commission Final Report (2015) highlighted the necessity of Indigenous self-determination in addressing the legacy of residential schools, yet Indigenous aging research remains dominated by Settlers. This Indigenist study by a Cree/Settler research team asked Indigenous Elders what is needed to support the wellness of the older adults in their communities. Elders shared that the healing of older survivors comes from reconnecting to the cultural knowledges that residential schools sought to eradicate. In resuming their traditional roles as transmitters of knowledge, older adults not only support their own healing, but also that of their whole communities. This understanding of the profoundly interrelational nature of Indigenous communities means that older adults’ wellness depends on first reclaiming their cultural identity and then on their roles as intergenerational transmitters of knowledge.

This study surveyed awareness of, and adherence to, six national fall prevention recommendations among community-dwelling older adults (n = 1050) in Ottawa. Although 76 per cent of respondents agreed falling is a concern and preventable, fewer perceived susceptibility to falling (63%). Respondents had high awareness that home modifications and physical activity can prevent falls. Reported modifications included grab bars (50%), night lights (44%), and raised toilet seats (19%). Half met aerobic activity recommendations; 38 per cent met strength recommendations. Respondents had lower awareness that an annual medication review, annual eye and physical examination, and daily vitamin D supplementation could reduce fall risk. However, reported annual medication review (79%) and eye examination (75%) was high. Nearly half met recommendations for vitamin D intake. These findings suggest a gap in knowledge of awareness and adherence to national recommendations, highlighting the ones that may require attention from those who work to prevent falls.