Research on rural aging has developed considerably since publication of the book Aging in Rural Canada (Butterworths, 1991). The purpose of this article is twofold: to provide a retrospective on issues in rural aging from this book, and to review Canadian literature on rural aging since its publication. The review highlights new directions in conceptual definitions of rural, and in issues of social engagement, independence, family and social networks, and rural services and health. Two main research lenses are evident. The marginalization lens focuses on rural seniors with health problems, but has not included those marginalized by poverty or gender. The aging-well lens focuses on contributions and engagement, but has omitted research on social relationships and quality of family interaction. The report includes a call for interrogation about interaction between people and place, and for understanding issues of rural diversity and processes of rural aging.

Immigrant care workers play an increasingly important role in home and long-term care in Canada, yet the full extent of their relations with older persons in those settings is relatively unknown. This article examines the role of immigrant care workers in both home and long-term care sectors, with a focus on relations with older clients and implications for quality of care. The data are derived from interviews with workers, employers, and older clients conducted in various home and long-term care services for older adults across three Canadian provinces: Ontario, British Columbia, and Quebec. Factors stemming from immigrant care workers’ ethnic/racial background, language barriers, and contextual factors such as staff shortage in different care settings for older adults complicate the relationship between immigrant care workers and their clients. In some cases, these factors diminish the quality of care. We point to some policy alternatives that our findings suggest should be considered.

Aging well is new, again. The recent interest is part of a 50-year period of research. Contradictory conceptualizations of aging well create an opportunity to consider assumptions that underlie the concept. In this paper, through the construction of an aging-well, theorizing narrative, an underlying assumption is identified in past aging-well conceptual frameworks: to age well is to achieve self-integration in relation to particular sets of resources or forms of engagement. The narrative relates how more recent aging-well theorizing is being shaped by a growing interest in later-life meaning-making. Evidence is presented of a contemporary shift toward describing aging well as the negotiation of the co-construction and reconstruction of multiple selves in an ongoing, open-ended process of meaning-making amid later-life events and transitions. The paper concludes with implications for future research.

This paper tests assumptions often made by policy makers and practitioners that networks of family, friends, and neighbours are able to provide sustained care to frail elderly Canadians. Using national survey data, we examined characteristics of the care networks of 1,104 seniors living with a long-term health problem. Care networks were found to vary considerably in size, relationship composition, gender composition, age composition, and proximity, and these network characteristics were found to help explain variations in the types and amounts of care received. As a result, network characteristics that might place seniors at risk of receiving inadequate care (including small size and higher proportions of non-kin, male, and geographically distant members) were identified. These risk factors appear to be poorly reflected in most existing policy.

This research uses data from the Manitoba Longitudinal Study on Aging and multiple logistic regression analysis to assess the impact of twenty-eight sociodemographic and health status variables on nursing home admission. The results indicate that 1) all the short-term predictors continue to be significantly associated with facility bed use in the long run, suggesting that the high risk elderly can be identified relatively early; 2) the key sociodemographic characteristics are better predictors of admission than health and physical functioning characteristics; and 3) time itself appears to change the relationship of the study variables to admission.

This paper reviews the different concepts and measures of positive aspects of caregiving that have been used in previous studies. It describes the use of a simple measure of “enjoyable aspects of caregiving” used in a large longitudinal Canadian study of dementia care in the community. The measure attained significant test-retest reliability and significantly correlated with caregiver burden and health. It also predicted caregiver desire to institutionalize the care recipient at three different time periods but not actual institutionalization. The paper calls for greater use of measures related to positive aspects of caregiving and a better understanding of how these measures relate to one another and to outcomes.

Rates of sexual activity have been found to decline over the life course, as individuals experience marital transitions and the loss of partners, health problems, and decreased sexual interest. This article compares and contrasts earlier- and later-life sexual experiences and examines the changing meanings that older women ascribe to sexuality over the life course. Qualitative data from a study involving 24 women aged 52 to 90 who were remarried after age 50 illuminate a shift, as individuals age, from an emphasis on the importance of sexual intercourse and passion to a greater valuing of companionship, cuddling, affection, and intimacy. Situating the discussion in the context of changing cultural norms and sexual scripts, the article investigates the impact of health conditions on the women's sexual relationships as well as the women's tendency to have later-life sexual experiences more positive than were their earlier sexual experiences.

How do older workers keep up and adapt to a changing workplace after age 55? In exploring that question, this study specifically examined how age-related changes affect workers, how older workers deal with a loss of resources, how they engage in life management, and why some are more successful than others. An in-depth analysis was undertaken using 32 semi-structured interviews conducted with workers aged 55 to 64. Findings revealed that older workers use various strategies to adapt to a change in resources, and that these strategies help them cope and maintain their functioning in the workplace. Because older workers require different types of employer support, this study offers an understanding of how employers can provide that support to encourage older workers to remain in the workforce longer. Several avenues for future research are suggested, including an exploration of the role played by internal sources of support.

This study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls (n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group (n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients (n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant (p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

In response to the anticipated pressures of population aging, national governments and supranational bodies such as the Organisation for Economic Co-operation and Development (OECD) and the European Union (EU) have promoted policies to encourage the labour force participation of older workers. The recent elimination of mandatory retirement in Ontario is an example of such a policy, and others include changes to national pension systems and changes to disability and employment insurance programs, active labour-market policies, and the promotion of phased or gradual retirement. This paper reviews the different policy approaches taken in the six countries included in the Workforce Aging in the New Economy (WANE) project, placing Canadian policy approaches in relation to those taken in Australia, Germany, the Netherlands, the United Kingdom, and the United States. From the life course perspective, the policy approaches discussed here do not consider the heterogeneity of older workers' life courses or the related domains of health and family. As well, the changes made thus far do not appear likely to lead to increased labour force participation by older workers, and some may leave older workers at greater risk of low income and low-wage work.

This research evaluates a mediational model of work-family conflict among employees with caregiving responsibilities for older relatives. In a survey of employees from eight organizations, 396 women and 316 men completed measures assessing their eldercare involvement, the extent to which their family responsibilities interfered with work (FIW), the extent to which their work interfered with family (WIF), job satisfaction, job costs (e.g., missed meetings), and absenteeism. Eldercare involvement was significantly associated with FIW for women but not for men. Among women, FIW was related to job dissatisfaction and absenteeism; among men, it was related to job costs and absenteeism. WIF was unrelated to eldercare, but was associated with FIW and job costs for both women and men. It also was associated with job satisfaction for men. The findings of the current study suggest that eldercare responsibilities impact on the workplace indirectly by arousing conflict between family and work.

This article reviews the international English-language literature on social support and caregiving in gerontology since the early 1990s. The literature has grown, but consensus on the terms’ meaning and measurement is lacking. Interest is ongoing in practical help, in benefits of social support, and in demands and negative outcomes for caregivers, with growing but less emphasis on more theoretical questions, on negative outcomes from the receipt of support, and on positive consequences of providing care. Nevertheless, social support is duly recognized as a social determinant of health and receiving attention at policy levels – both are significant shifts from two decades ago and add to the interest this area will receive from researchers in coming decades. There remain many unanswered questions regarding the changing societal context, but it is clear that the social support of others – throughout our lives including old age – will continue in the future, albeit in ever-changing forms.

This paper examines the growing demographic phenomenon of grandparent–adult grandchild relationships from the perspectives of both generations. Drawing on qualitative life-history interviews (n = 37), this research explores the subjective meanings of the relationship, as well as the experiences of being grandparents and adult grandchildren. Despite tremendous diversity in grandparent–adult grandchild relationships, including differences among and between generations, both groups in this study view one another positively and conceptualize their ties as personally and existentially meaningful. They classify their relationships as a distinct family tie centred on unconditional love, mutual support, respect, and obligation. A number of individuals also discuss their grandparent–adult grandchild relationships as friendships, involving mutual trust, shared confidences, and personal choice. Overall, this research suggests that grandparent-grandchild relationships often grow more profound and meaningful as grandparents and grandchildren age, move through the life course, and experience life events.

Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.

The purpose of this paper is to report research findings from a study of the nature of the relationship between informal and formal care of the elderly. There are several explanations for the link between informal and formal care: the task specific model, the compensatory model, the substitution model, the supplementary model, and the complementary model (which combines both the compensatory and supplementary functions of formal care). These explanations were evaluated using data from the 1985 General Social Survey for those aged 65 and older who have functional disabilities. Data were analysed using logistic regression analysis. The findings show support for the complementary function of formal care. The data indicate that formal care compensates for the absence of a spouse or child and, in a minority of cases, supplements work of the spouse or child caregiver for personal care tasks and to a lesser extent housework. Of these two, the compensatory effect of formal care appears to be more prevalent than the supplemental effect.

The People’s Republic of China has the largest population of older persons of any country in the world. It is a nation that has experienced enormous economic, social, and demographic changes over the past three and a half decades. Traditionally, the family was the main social support for older persons; this changed somewhat under early socialism, but in recent years, the importance of family support has been reasserted. However, over this time, the family’s ability to support its older members has been considerably altered and arguably weakened. This article reviews four key issues (population change, the hukou system, economic reform, general features surrounding modernization) that have gradually changed families’ capacity to provide support for older members. Research foci and public policy directions are considered under which the state might take some responsibilities from the family, support capacity to care, and improve the quality and quantity of support for older citizens.

This study compared the correlates of burden for spouse and adult child caregivers at two points in time and assessed whether correlates at T1 predicted burden at T2. The sample consisted of 878 caregivers to older adults throughout British Columbia who were prescribed cholinesterase inhibitors. Burden was measured six months after the older adult was prescribed the medication and one year later (n = 759). Findings suggest that adult children experience more burden than spouses at both T1 and T2 with adult children but not spouses decreasing their burden over time. Correlates of T1 burden explained significant amounts of variance, revealing differential correlates for the two groups and the importance of caregiver characteristics over patient characteristics. Burden at T2 is explained mostly by T2 factors, plus T1 burden, suggesting the importance of relatively immediate factors for direct effects on caregiver burden. Indirect effects operated through T1 burden.

This study determined the effects and costs of a multifactorial, interdisciplinary team approach to falls prevention. Randomized controlled trial of 109 older adults who are at risk for falls. This was a six-month multifactorial and evidence-based prevention strategy involving an interdisciplinary team. The primary outcome was number of falls during the six-month follow-up. At six months, no difference in the mean number of falls between groups. Subgroup analyses showed that the intervention effectively reduced falls in men (75–84 years old) with a fear of falling or negative fall history. Number of slips and trips was greatly reduced; and emotional health had a greater improvement in role functioning related to emotional health in the intervention group. Quality of life was improved, slips and trips were reduced, as were falls among males (75–84 years old) with a fear of falling or negative fall history.

This study explored informal family caregiver experiences in supporting care transitions between hospital and home for medically complex older adults. Using a qualitative, grounded-theory approach, in-depth semi-structured interviews were conducted with community and resource case managers, as well as with informal caregivers of older hip-fracture and stroke patients, and of those recovering from hip replacement surgery. Six properties characterizing caregiver needs in successfully transitioning care between hospital and home were integrated into a theory addressing both a transitional care timeline and the emotional journey. The six properties were (1) assessment of unique family situation; (2) practical information, education, and training; (3) involvement in planning process; (4) agreement between formal and informal caregivers; (5) time to make arrangements in personal life; and (6) emotional readiness. This work will support research and clinical efforts to develop more well-informed and relevant interventions to most appropriately support patients and families during transitional care.

Unregulated care aides provide most of the direct care to nursing home residents. We previously reported the first demographic profile of care aides in Western Canada through the Translating Research in Elder Care (TREC) longitudinal research program (2007–2022) in applied health services. Here we describe demographic, health, and work life characteristics of aides from 91 nursing homes in Western Canada. Demographics and work life varied significantly across health regions and facility owner-operator models. Our longitudinal cohort of aides from Alberta and Winnipeg had higher emotional exhaustion (a negative attribute), professional efficacy (a positive attribute), and experience of dementia-related responsive behaviours from residents. Overall, results indicate little improvement or worsening of care aide health and quality of work life. Coupled with limited provincial or national initiatives for workforce planning and training of these workers, this signals a long-term care system ill-prepared to care effectively for Canada’s aging population.