This study examined how patients experience transitions to community from hospitals, inclusive of daily living problems and medical concerns. Analysing qualitative data from interviews with 36 individuals including 17 high-risk older adults with multiple chronic health conditions recently discharged from hospital, and 19 family members who provided the patients with ongoing care, we asked (1) What are the challenges that patients experience in transitioning home from the hospital, and (2) What are the system and policy solutions that can address the challenges these patients experience? Our findings reveal both short- and long-term challenges associated with transitions back home. Short-term challenges include preparing the dwelling for the patient and understanding the organization of care at home. Long-term challenges are associated with practical and emotional concerns. Reflecting on our findings, we suggest that patients’ social needs may be equally important to their medical needs during post-discharge recovery, and we discuss implications for policy.

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 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.

Homelessness among older people is a growing concern across Canada and is expected to rise with demographic change (Crane & Warnes, 2010; Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). Yet current knowledge, policies, and practices on homelessness largely focus on younger populations. Likewise, research and policies on aging typically overlook homelessness. Responses to homelessness among older people must address complex needs related to health, income security, and housing. Based on a comprehensive literature review, this article outlines the existing and needed research with regards to homelessness among older people. We clarify the intersections of aging and homelessness; review the relevant statistics, including estimated prevalence; discuss pathways and variations in experience; and identify gaps in knowledge. We conclude with a call for an inclusive research agenda that will help build policies and practices to reduce and ultimately to eliminate homelessness among older people in Canada.

Narrative approaches in the field of aging are receiving increasing attention by theorists and practitioners alike. This article draws on recent thinking in narrative gerontology to look at three aspects of aging on which a narrative perspective can shed further light. In relation to the temporal aspects, the notion of storytime is examined. Concerning its poetical aspects, the article considers the stages, styles, genres, contexts, and selves of self-storying. Under spiritual aspects, the topics of meaning and identity are explored. A discussion of these aspects may be seen to converge on the theme of wisdom and the possibility of wisdom environments.

Efforts to address the “paradox of autonomy in long-term care” attempt to salvage an ethic of autonomy by redefining the central concept, and then applying it to the long-term care environment. Such attempts are critiqued, and an alternative ethic of dignity for long-term care is developed. Autonomy, it is argued, is crucial to certain aspects of dignity, but should not be confused with the whole of it. Indeed, long after the capacity for autonomy has diminished or vanished, basic dignity continues to exert normative force.

The purpose of this research was to examine the characteristics of older Canadians with dementia (compared to those without dementia), their use of health care services, and the impact of place (rural/urban) on use of services. Andersen and Newman's Behavioural Model of Health Services Use (1973) guided the study. A cross-sectional design used data from the Canadian Community Health Survey (CCHS) Cycle 1.1 (N=49,995 older Canadians; those with dementia =313). Results indicated that among Canadian females between the ages of 50 and 64, those with dementia were more likely than those without dementia to live in rural areas. Among females 80 years of age and over, those with dementia had higher levels of education and income than those without dementia. In addition, a higher proportion of white than of visible minority Canadians was afflicted with dementia. The results further suggest that Canadians with dementia primarily required support services and that they were more likely than persons without dementia to report that their health care needs were unmet. It is recommended that publicly funded national home care programs be expanded to ensure that the supportive services needed by this population are available.

This qualitative study describes expectations, concerns, and needs regarding long-term care (LTC) homes and home care services of 12 older lesbian and gay couples living in Canada. Our findings reflect four major themes: discrimination, identity, expenditure of energy, and nuanced care. Discrimination involved concerns about covert discrimination; loss of social buffers as one ages; and diminished ability to advocate for oneself and one’s partner. Identity involved anticipated risk over disclosing one’s sexual identity; the importance of being identified within a coupled relationship; and the importance of access to reference groups of other gay seniors. We conclude that partners were burdened by the emotional effort expended to hide parts of their identity, assess their environments for discrimination, and to placate others. Nuanced care involved a mutual level of comfort experienced by participants and their health care providers. These themes inform understandings of LTC homes and home care services for lesbian and gay older couples.

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.

This study describes the mental health experiences of older adults living with HIV in Ottawa. Eleven participants aged 52 to 67 completed in-depth personal interviews. Mental health concerns pervaded the lives of these older adults. We identified three central themes common to the participants’ stories: uncertainty, stigma, and resilience. For some of these participants, uncertainty impacting mental health centred on unexpected survival; interpretation of one’s symptoms; and medical uncertainty. Participants’ experiences of stigma included discrimination in health care interactions; misinformation; feeling stigmatized due to aspects of their physical appearance; compounded stigma; and anticipated stigma. Participants reported using several coping strategies, which we frame as individual approaches to resilience. These strategies include reducing the space that HIV takes up in one’s life; making lifestyle changes to accommodate one’s illness; and engaging with social support. These findings inform understandings of services for people aging with HIV who may experience mental health concerns.

The growth of research knowledge on culturally diverse family caregivers for the aging population lags behind the increase of culturally diverse populations in Canada. This study examines the effects of culture, as manifested through cultural variables, on the caregiving burden of family caregivers in a Chinese-Canadian community. A random sample of 339 Chinese-Canadian caregivers for elderly relatives completed a telephone survey. Results of hierarchical stepwise multiple regression analysis reported the predicting effects of culture-related variables on caregiving burden. The findings indicated that being an immigrant, having a Western or non-Western religion as compared to having no religion, and having a lower level of filial piety, predicted a higher level of caregiving burden. Chinese tradition does not exempt the caregivers from being burdened. Policies and practices should address the needs of family caregivers according to the intra-cultural variations identified in this study.

The authors conducted a systematic review of studies examining correlations between assessments of function obtained using self-report and those obtained using performance-based measures for community-dwelling older adults.

Inadequate public transportation was recognized as a barrier to social participation, especially for older adults in rural communities and with mobility issues. Older adults will not benefit from opportunities to engage with their community and maintain social networks if they are unable to access them. The purpose of this scoping review was to make recommendations for further research and to summarize areas for improvement identified in the literature that will aid in the development of public transportation initiatives that can better address social isolation for older adults (≥ 55 years of age). Nineteen articles met the inclusion criteria, identifying themes of access to rural public transportation, issues with public transportation, and mobility. In practice, older adults need to prepare for driving cessation and mobility transitions; sound policy requires input to tailor transportation initiatives to an aging population, and future research should explore older adults’ transportation needs and potential solutions in urban and rural communities.

Age (18–81 years), sex, and personality (Extraversion, Neuroticism, Openness to Experience) variables were used as predictors of four dimensions of reminiscence behaviour. Contrary to theoretical assumptions, age did not predict reminiscence frequency. Neither were there age differences in terms of emotional tone or philosophical content of reminiscence. Memory remoteness, however, was predicted by age. Personality traits, in contrast, were significant predictors for all four reminiscence dimensions. Finally, sex predicted reminiscence frequency. The results are discussed from a lifespan perspective.

Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument’s psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents’ QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff’s being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research.

Implementing generationally appropriate activities for persons with dementia is a challenging task. Horticulture therapy (HT) addresses this challenge through the use of plants to facilitate holistic outcomes. Utilizing the model of environmental press, the current study sought to analyse adult day service (ADS) participants' responses to HT as compared to traditional activities.

HT activities were conducted once a week for a half an hour at four different ADS programs over the course of 9 weeks. Observational data were collected during HT and traditional ADS activities using a modified dementia care mapping (DCM) technique. Observers coded predominant behavioural and affectual responses for each participant.

HT activities facilitated higher levels of productive engagement and positive affect and lower levels of non-engagement than did traditional ADS activities. Therefore, HT offers dementia-care staff a viable activity alternative that is well received by clients and inclusive of all interested persons, despite cognitive limitations.

Social inclusion is an important factor in promoting optimum health and wellness for older adults. Community-engaged arts (CEA) have been promoted as a means to support social inclusion for this population, but little empirical evidence has been reported. The objective of this study was to explore the role of a CEA program in the social inclusion of older, community-dwelling adults. Sixteen hours of participant observation, nine interviews, and document analyses were conducted with 20 older adults participating in the Arts, Health and Seniors (AHS) Program in Vancouver. Results indicated that the program supported seniors’ capacity to connect to community in new ways by helping them forge connections beyond the seniors centre. Participants also developed a stronger sense of community through collaboration as a group, working together on the arts project towards a final demonstration to the larger community. The results suggest that CEA programs contribute to social inclusion for older people.

The Internet is an important resource for health information, among younger and older people alike. Unfortunately, there are limitations associated with online health information. Research is needed on the quality of information found online and on whether users are being critical consumers of the information they find. Also, there is a need for research investigating online use among adults aged 65 and over – a rapidly growing demographic of Internet users. The current study presents important descriptive data about the search patterns of older adults seeking online health information, the types of health topics they research, and whether they consider credibility issues when retrieving online health information. A comparison is also made between search strategies used in printed text and hypertext environments. The results, which have implications with respect to credibility issues, highlight the need to increase awareness about critical searching skills among older adult Internet users.

Most care of older, ailing or disabled people within the home is carried out by a spouse. This paper examines late life marriage and the gendered consequences of caring for older married people in England. Qualitative interview data are analysed to contrast the sense of autonomy of older men and women while caring for a spouse and after widowhood. By encouraging older people to reflect retrospectively on the meaning of their caring roles, we illuminate the process of adjusting to transitions after long-term marriage. The research data indicate that gendered roles and expectations are crucial in understanding the mainly negative experience of older women as carers, in contrast to the more positive experience of older men.

The Aging in Manitoba (AIM) project includes nearly 9,000 seniors who have been interviewed. Three independent cross-sectional samples (i.e. 1971, 1976, 1983) were subsequently followed (1983–1984, 1990), producing cross-sectional and longitudinal data. A major goal of this paper was to examine non-response over time and representativeness of the panel of AIM survivors. This involved analysis of non-response, calculations of completion/response rates, and comparisons of demographic variables across the AIM sample and the broader Manitoba and Canadian populations. Non-response was very low (4.6% in 1983–1984, 5.0% in 1990) and did not appear to be dependent on such factors as location, gender, education level, or nationality descent. The 95.0 per cent completion rate compares favourably with other longitudinal studies, demonstrating the value of employing rigorous tracking procedures. These findings suggest that attempts to minimize bias and selective attrition in the AIM study have been successful.