Drug-related illness (DRI) is a common problem in the elderly. Misuse of medications and inappropriate prescribing account for over half of all hospital admissions for DRI and both are potentially preventable. Physicians are the gatekeepers to prescription medication access and, in this role, they have the opportunity to prevent exposure to unnecessary and inappropriate medication and influence the use of medications by their elderly patients. Effective interventions to improve physician prescribing have been identified but they are costly to introduce, they require ongoing maintenance to maintain their effectiveness, they do not address the problems created by multiple prescribers or the challenges of keeping up-to-date on the growing number of new drugs that enter the market each year. Computer-based drug information networks and expert decision-making support systems are proposed as one means of providing (1) an accurate record for the prescribing physicians of drugs currently dispensed to their elderly patients, (2) a review of problems in existing and new prescriptions, and (3) an expert resource to select drug treatment. Canada is in an ideal situation to pioneer the development of these systems, but to do so, policies need to be put in place to address three problems. First, there is inadequate information available about the risks and benefits of drugs in the elderly because older sicker adults are often excluded in clinical trials of drug-effectiveness. Requirements for drug approval need to be amended so that sufficient evaluation of the risks and benefits of new drugs are carried out in the elderly. Second, computerization in the health care sector is central to the development of electronic decision-support systems in health care delivery. Future policy needs to be directed to the development of an effective infrastructure to facilitate the transition to an integrated computerized health sector. Third, the ethical and legal issues related to the access of prescription data through electronic networks need to be identified and clear guidelines for use of this new technology need to be developed.

The parallels between the funding of an individual pension plan and a paygo social security system are presented. In each plan, the total expected value of benefits can exceed the total expected value of contributions. For the individual pre-funded plan this is true because of the discount factor, δ, representing investment income earnings. For the paygo social security system, the analogous “discount” factor is denoted r, the total of real growth rates of the labour force and real productivity gains per worker, that is, real growth in wealth production. The paper then presents arguments to show that a fully-funded social security scheme is no more secure economically than a paygo scheme. Both schemes rely on the ability of the economy to create and transfer wealth. That is, security for social security does not lie in privatization. The paper also reviews the Reform Party's proposal for a “Super RRSP” replacement for social security and analyses its advantages and disadvantages.

A large body of evidence has demonstrated that normal human fibroblasts have a limited division potential in culture and underwent senescence, a process whereby cells became arrested in the G1 phase of the cell cycle and overexpressed a DNA synthesis inhibitor(s). Cyclin-dependent kinase two (Cdk2) is required for the promotion of the Gi-to-S phase transition in human cells. Senescent fibroblasts contain intact cyclin-Cdk2 complexes but cannot induce Cdk2 protein kinase activity in response to mitogen stimulation. Recently, we cloned p21Sdi1, a potent inhibitor of DNA synthesis and Cdk2 kinase activity, from a senescent cell cDNA library and demonstrated that it was expressed at significantly higher levels in senescent cells than actively proliferating cells. In contrast to actively dividing cells, mitogen-stimulated senescent cells do not down-regulate the expression of p21Sdi1 and do not express late G1 phase gene products that are required for entry into S phase. We suggest that the inability of mitogen-stimulated senescent cells to down-regulate p21Sdi1 levels contributes to the resulting lack of late Gi gene expression and failure to traverse the G1/S phase boundary.

This study's objective was to determine the extent of agreement between experienced Registered Nurses (RNs) and Registered Nursing Assistants (RNAs) in their use of pain indicators in assessing elderly nursing home residents for the presence of pain. Twenty-three pain indicators were judged appropriate by seasoned clinicians for assessment of pain in the elderly. Structured interviews with a card-sort technique were administered to 30 RNs and 30 RNAs from five nursing homes. Respondents were asked to rank the indicators in order of their perceived usefulness. Substantial agreement (Kappa=0.74, p<0.001) was found between the two groups. Personal characteristics of the two groups were not significantly different (p<.05). Clinical, educational and research implications are discussed.

This paper discusses seven major issues that will affect the development of gerontology education in response to manpower needs in aging in Canada. These issues concern the definitions of aging for educational and manpower policy, manpower forecasting, knowledge base in gerontology, gerontology as an academic field or as a professional field, development of education programs, employment opportunities, and factors in supply and demand. The author stresses the importance of creating baseline data about manpower needs and occupational settings and about the knowledge base of gerontology in Canada.

Some researchers have suggested that qualitative research is increasing in the gerontology field, but little systematic analysis has tested this assertion. Using the Canadian Journal on Aging/La Revue canadienne du vieillissement as a case study, we analysed articles reporting on original research from 1995 to 2012. One in four articles were qualitative, and results in three-year intervals show a clear increase in qualitative research findings during this 18-year time frame: (a) 1995–1997: 10 per cent; (b) 1998–2000: 19 per cent; (c) 2001–2003: 25 per cent; (d) 2004–2006: 25 per cent; (e) 2007–2009: 29 per cent; and (f) 2010–2012: 43 per cent. In all time intervals (with the exception of 2004–2006), French language articles were more likely to use a qualitative research design compared to English language articles. Topics, methodologies, and data collection strategies are also discussed.

Dance for older adults is increasingly being used to support health and well-being. While dance may be enjoyable for many, understanding its benefits for those with limited physical and cognitive abilities may provide further support for how dance may be used in these contexts. This was a study of Sharing Dance Older Adults, a dance program with remotely streamed sessions. Data were collected from 48 older adults who took part in the On Your Feet version of the program, and from 38 who took part in the In Your Seat version. Measures included interviews, physical fitness tests and surveys on mood, quality of life, and program satisfaction. Physical fitness significantly improved for both groups, unlike for mood, social well-being, or quality of life. This contrasts with qualitative findings, with participants reporting how the program enhanced their mood, social interactions, and quality of life.

Les difficultés cognitives consécutives aux troubles neurocognitifs majeurs (TNCM) engendrent des enjeux dans la réalisation d’activités de la vie quotidienne. Ce projet visait à identifier auprès des proches aidants et des intervenants des situations nécessitant des méthodes optimisant l’apprentissage pour faciliter l’engagement de personnes vivant avec un TNCM dans leurs activités de la vie quotidienne. Des entrevues individuelles semi-dirigées, d’une durée de 60 à 90 minutes, ont été menées auprès de proches aidants et d’intervenants. Les résultats montrent que les activités quotidiennes et domestiques sont notamment affectées par les difficultés à repérer ou à utiliser les objets, à garder en tête la tâche en cours, à mettre en séquences des étapes, à ne pas se laisser distraire par autre chose et à constater ses difficultés pour s’y adapter. Les proches aidants souhaitent du soutien dans l’application des méthodes optimisant l’apprentissage pour contribuer au maintien de l’autonomie des personnes vivant avec un TNCM.

Le Québec présente le taux de prescriptions d’antipsychotiques le plus élevé chez les personnes âgées de 65 ans et plus au Canada. La démarche « Optimiser les pratiques, les usages, les soins et les services – antipsychotiques » (OPUS-AP) vise à pallier cet enjeu. Étant donné ses premiers résultats prometteurs, notre étude visait à identifier les déterminants de son succès. Elle repose sur un devis d’étude de cas regroupant une analyse documentaire et 21 entrevues auprès d’acteurs clés impliqués dans l’implantation. Les résultats mettent en lumière cinq déterminants centraux : 1) une démarche intégrée, collaborative et probante; 2) des communications et des réseaux au service de la démarche; 3) un climat d’implantation favorable aux changements; 4) un engagement et une implication des parties prenantes; et 5) une stratégie d’application des connaissances intégrée et appuyée. Des défis et recommandations pour assurer la pérennisation et la mise à l’échelle d’OPUS-AP et inspirer des démarches similaires sont identifiés.

The Taiwan Government follows the policy of active aging to prevent frailty. However, the current services lack cultural safety toward the Indigenous peoples and would benefit from a broader perspective on what active aging may entail. In this research, we study local perceptions of active aging among older Indigenous Tayal taking part in a local day club. The study identifies two formal activities that foster active aging: (a) information meetings about health and illness and (b) physical activities. In addition, two informal activities highlighted by the participants themselves were identified as necessary for promoting healthy and active aging: Cisan and Malahang. While Cisan means “social care,” Malahang means “interrelational care practices.” In conclusion, we argue for the relevance of listening to Indigenous older adults’ voices to develop long-term care services adapted to their cultural values, linguistic competence, and cosmology.