Hospitals may transfer seniors with a hip fracture to various rehabilitation settings. Knowing the relationship between hospital teaching status and post-acute rehabilitation setting may help evaluations of the transfer from acute care. The purpose of this study was to determine the relationship between hospital teaching status and rehabilitation destination following acute care in seniors with a hip fracture. Hospital separations were linked with home care records to identify hip fractures and hospital-based or home care rehabilitation (n = 806). Two logistic regression models determined the likelihood of transfer to any rehabilitation destination and to hospital-based versus home care rehabilitation. Teaching hospitals were no more likely than non-teaching hospitals to discharge patients to any rehabilitation (OR 1.20, 95% CI 0.88,1.65). However, among those referred to rehabilitation, the odds of discharge to hospital-based versus home care rehabilitation were almost four times greater for patients in teaching hospitals (OR 3.76, 95% CI 2.23, 6.37). The results are consistent with the availability of post-acute rehabilitation in the planning area. Future study of post-acute rehabilitation outcomes should consider hospital teaching status as an indicator of how hospital-based factors may affect the utilization of post-acute rehabilitation.

This article examines the struggle to win lifetime eligibility for selected home care benefits provided through the Veterans Independence Program (VIP) for veterans' widows in recognition of their years of unpaid caregiving – a policy change eventually implemented between 2003 and 2004. It explores how arguments on their behalf shifted from discourses of dependency, cost-saving, and compassion to ones of entitlement and commemoration between 1981 and 2004 as the large cohort of Second World War veterans and their wives moved towards the end of their lives. This policy victory for veterans' widows marked a historic shift in mandate for Veterans Affairs Canada and an important recognition by the state of unpaid caregiving as a form of national service. If Canadians are to learn from this example, however, it must be through seeing all caregiving labour – not just that of veterans' wives – as equally heroic and worthy of compensation.

Psychological treatment of depression in the elderly has recently benefited from the development of the cognitive approach. In particular, cognitive psychotherapy seems well adapted to and accepted by older people. In this article, we attempt to show the course of this type of psychotherapy in the case of a 79 year-old depressive woman in our Cognitive Therapy Unit for Elderly. We emphasize the therapeutical setting and the content of the sessions, the techniques used, the changes that occurred, and finally, the therapeutic alliance is described. Although some negative views about psychotherapy with older people are not totally abandoned, this vignette is a good illustration of the benefits for the patient and the highly enriching work for the therapist.

Des estimations ont été recueillies d'un groupe de 120 sous-graduées sur le rendement d'une parmi quatre cibles féminines (àgées de 24, 44, 64, ou 84 ans) sur le test Schaie-Thurstone Adult Mental Abilities, Form A (STAMAT; Schaie, 1985). Pour examiner l'importance de la familiarité avec une tàche dans la précision de son exécution, la moitié des répondantes ont été chargées de remplir le STAMAT elles-mêmes avant d'évaluer les scores pour leur cible; l'autre moitié a pu examiner le contenu du test mais n'a pas rempli le STAMAT avant de soumettre leurs estimations. Une comparaison entre les estimations et les normes du STAMAT a indiqué que la plupart étaient exactes; certaines étaient excessivement généreuses, surtout pour les cibles les plus àgées. De très faibles différences dans les estimations ont été décelées entre celles qui avaient été chargées de remplir le test et celles qui ne l'avaient pas été au préalable. Finalement, les résultats ont confirmé que les répondantes ont une opinion différente sur l'évaluation chronologique des habiletés cognitives.

As policy emerges from the interplay of economic, political, and social forces, determining whether research has made a difference to policy choices on aging issues is extremely difficult. Such a determination demands attention to the "black box" of the policy process, and the setting within which policy ultimately operates. This paper presents a Seniors' Independence Research Program as a case illustration of how research has made a difference to policy choices by stakeholder involvement throughout the research process. Strategies ensure stakeholder collaboration in policy issue search, filtration, definition, and prioritization; involvement in the design, implementation, and evaluation of health services models; and participation in achieving long-term evidence-based changes in policy and practice.

Cet article étudie le vieillissement de la main-d'oeuvre au sein des services publics de la Colombie-Britannique entre 1983 et 1991. Les inscrits aux fichiers annuels de rémunération du personnel du gouvernement ont été répartis selon l'âge, le sexe et la classification d'emploi des employés et par leur utilisation des programmes de maladie à court terme et d'invalidité prolongée. Des données sur la retraite sont également tirées des rapports annuels de la caisse de retraite des services publics. Ces données sont analysées en fonction des tendances en matière de retraite, du taux de rotation de la main-d'oeuvre et des tendances au plan de l'absentéisme. Les résultats révèlent une forte hausse au sein de la catégorie des travailleurs d'âge moyen et une faible augmentation du vieillissement de la main-d'oeuvre. L'embauche d'un plus grand nombre de travailleurs ayant atteint leur mi-carrière et d'un nombre inférieur de jeunes travailleurs conjuguée à des programmes de retraite anticipée ont causé une bulle dans la structure d'âge de la main-d'oeuvre, plutôt que son allongement, comme on peut observer au sein de l'ensemble de la population. Les auteurs discutent ensuite des conséquences à long terme et à court terme en regard de l'utilisation des ressources humaines.

Escalating medication prices are forcing drug benefit programs worldwide to change their payment policies. Physicians object that this intrudes on their long established authority to prescribe medications they judge best for their patients. This paper reports data from focus groups and a large random sample of seniors in British Columbia who were asked for their views towards Pharmacare's reference based pricing (RBP) policy. Seniors expressed the desire for physicians to be more knowledgeable and more involved in all aspects of medical care including policy changes. They have confidence in physicians as a credible source of information, but they also have as much confidence in pharmacists and almost as much in the Ministry of Health. Seniors overwhelmingly accept, and the majority support government's efforts with their cost-saving Pharmacare policies. Furthermore, those who know more about the policy are more likely to support it. The paper closes with a discussion of the feedback process with decision-makers.

In June 1993, the newly elected Progressive Conservative government of Alberta headed by Ralph Klein initiated a three-year deficit-elimination plan focussing exclusively on expenditure reductions. Despite the rapid implementation of this plan over the next three years, most Albertans did not find subsequent changes in government services and the shift of costs to the consumer to be consequential.Senior citizens, however, differ in a number of significant ways from the general population. Direct reductions in benefits, as well as cost-of-living increases and increases in other costs, combined to create a larger impact for seniors. A case study of one middle-income senior couple illustrates this point. This paper indicates that a more in-depth appraisal of the potential impact of social policy changes on vulnerable groups should be undertaken in other jurisdictions prior to the adoption of such fiscal-reform plans.

Causes of falls in older adults are common, multifactorial, and can lead to significant injury. This before-and-after study evaluated the benefits of a Fall Prevention Mobile Clinic (FPMC) in reducing the risk of falling in older adults in British Columbia, Canada. Four hundred seventy-six participants (average age of 83.6 years) enrolled in the study and were followed for 12 months after attending the FPMC. At 12-month follow-up, the mean percentage uptake of fall prevention recommendations was 48.8 per cent (SD = 25.7%), the Timed Up and Go mobility measure improved from a median of 19.04 seconds to 17.45 seconds and the number of participants falling decreased from 64.8 per cent (in the 12 months before attending the clinic) to 55.6 per cent (in the 12 months after attending the clinic) (p = .012). After attending the FPMC, participants acted on recommendations, improved mobility and decreased their risk of future falls.

Online delivery is new to the field of music therapy (MT). This research investigated older adults’ perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals’ suggestions for further development of VMT sessions, and (c) individuals’ personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

In long-term care (LTC) homes, the management of frail older residents’ pharmacotherapy may be challenging for health care teams. A new pharmaceutical care model highlighting the recently expanded scope of pharmacists’ practice in Quebec, Canada, was implemented in two LTC homes. This study aimed to evaluate health care providers’ experience and satisfaction with this new practice model. Twenty-three semi-structured interviews were performed and analyzed thematically. Positive results of the model have been identified, such as increased timeliness of interventions. Barriers were encountered, such as lack of clarity regarding roles, and suboptimal communication. The increased involvement of pharmacists was perceived as useful in the context of scarce medical resources. Although requiring time and adjustments from health care teams, the new model seems to contribute to the health care providers’ work satisfaction and to positively influence the timeliness and quality of care offered to LTC residents.

Dementia is a growing concern in Canada, affecting peoples’ health and raising the cost of care. Between June and October 2019, we conducted an environmental scan to identify primary care models, strategies, and resources for dementia care from 11 pre-selected countries and assess their impact on quality-of-life measures. Search strategies included a rapid scoping review, grey literature search, and discussions with stakeholders. Eighteen primary care-based models of dementia care were identified. Common factors include team-based care, centralized care/case coordination, individual treatment plans, a stepped-care approach, and support for care partners. Five provinces had released a dementia strategy. Evidence of positive outcomes supported primary care-based models for dementia care, although only one model demonstrated evidence of impact on quality of life. Although these findings are encouraging, further research is needed to identify primary care-based models of dementia care that demonstrably improve quality of life for people living with dementia and their care partners.

The objectives of this feasibility study were to measure the prevalence of nutrition risk in community-dwelling older adults (CDOA, ages ≥ 65 years) and explore the perspectives of CDOA of the acceptability, value, and effectiveness of nutrition risk screening in primary care and community settings. Using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)© eight-item tool (n = 276), results indicated that moderate and high nutrition risks affected 50 per cent and 8 per cent, respectively, of those screened. Interviewees (n = 16) agreed that screening is acceptable, important, and valuable (Theme One). Effectiveness was unclear, as only 3 of 16 respondents recalled being told their nutrition risk status. When articulating nutrition-related issues, a food security theme, expressed in the third person, was prominent (Theme Two). Screening for nutrition risk and receiving nutrition information in community-based settings are acceptable to CDOA and medically necessary, as evidenced by the high proportion of CDOA at moderate-high nutrition risk.

Different care settings in Quebec use levels of medical intervention forms, also called levels of care (LOC), to determine the code status of patients and to improve end-of-life care planning. It is not currently possible to know whether the levels of care in hospitals benefit patients and staff in facilitating the decision making process of treatment options and resuscitation measures. No study, to the best of the authors’ knowledge, has been published about LOC, particularly in Quebec and Canada. This literature review was undertaken on levels of care in order to clarify this topic. Relevant articles are discussed under different themes that are pertinent to LOC. The themes addressed in this article include care at the end of life, do-not-resuscitate orders, treatment withdrawal, and decision making at end of life.

As demographics and gender norms shift, more older men will be providing care for their wives living with dementia than ever before. Research on husbands as caregivers is limited and offers an incomplete picture of their role development and how they experience caregiving. This study examined husbands whose wives have dementia and how they provide care and construct their sense of self. Semi-structured interviews with 11 men aged 61–88 were conducted in Ontario, Canada. Data were analyzed using constant comparison analysis and a constructivist grounded theory (CGT) approach. Two categories were developed: Adapting to the Role of Caregiver and Staying a Husband. Caregiving as a husband for a wife living with dementia required revision of the role of husband to include that of caregiver by reimaging intimacy, being a protector in new ways, and finding new meanings to being a provider and the value of wealth.