Research indicates that self-rated health is related to a variety of health-related outcomes, such as mortality and functional disability, even when controlling for more “objective” health measures. The present study extends previous research by prospectively examining the relation between self-rated health and health care use among a representative sample of elderly Canadians (N = 1,181) interviewed in 1991/92. Survey data were linked to administrative records of health care use. Self-rated health was positively related to the number of physician visits during the 12 months following the survey, as well as to the number of tests incurred (e.g., laboratory tests, X-rays), even when controlling for demographic variables, functional disability, morbidity, and prior health care use. Older adults who rated their health as “bad/poor” or “fair” were also more likely to be hospitalized than those who rated their health as “excellent”. These results highlight the importance of considering global measures of health when examining health care use.

This article presents some conclusions from a research program initiated in 1995 and aimed at analysing the early exit from the workforce of workers 45 years of age and older, especially through long-term unemployment. This early exit process is envisaged as a result of complex interactions between firms' policies and practices, public policies concerning retirement, workforce training and welfare, and individual workers participating in active social networks and able to develop strategies of resistance or adaptation. Research results show how the issue of early exit from the workforce is poorly recognized by firms and State policies as well. As a result, making individuals carry the responsibility for their own employability.

This paper presents the results of a study on the relationships between social participation and use of services. The hypotheses predicted that members of groups with high degrees of participation, cohesion, or participation and cohesion are likely to behave in a more homogeneous manner toward the use of services than members of groups having the opposite characteristics. The hypotheses were tested by doing multiple regressions on the number of service agencies contacted, preventive medical consultations and curative medical consultations. One of the hypotheses was corroborated by a major finding: being a member of a group with a high degree of participation and a high degree of cohesion remains positively correlated to curative medical consultations even when control variables like psychological well-being and perceived health have been considered. This result suggests that it could be possible to influence the use of services by older persons who are members of peer groups in dealing with the internal dynamics of these groups.

This paper explores the factors considered by Canadian court judges in 14 cases where the provincial legislation that obligates adult children to provide support for their parents was referred to. This exploration takes place within the context of intergenerational relationships with a focus on exchange between parents and adult children. Analysis revealed that the courts promote the obligation of family members to provide for one another according to the legislation and that the responsibility to provide this support is based on certain priorities. Nuclear family obligations come before those of the extended family. Of the factors considered by the court, this paper focusses on three: the eligibility of the parent, who is initiating the court proceedings, and the definition and prioritizing of responsibilities between parents and adult children.

Geriatric Medicine is a young specialty in Canada, having been formally recognized in 1981. The early years of research chiefly involved designing and describing programs of care. As the specialty matured, so too did the nature of research into the clinical problems of older adults. This article discusses research published by Canadian geriatricians since 1998, the date of a previous review. Two prominent areas of research are frailty and dementia. Several groups have studied the natural history of frailty, and designed techniques to better measure outcomes. Interventional trials are also gaining prominence, with the Systeme de services intégrés pour personnes agees en perte d'automonie (SIPA) and Mobile Geriatric Assessment Team (MGAT) being good examples. The Canadian Study of Health and Aging (CSHA) is one of the largest studies of dementia epidemiology ever conducted, and the upcoming third wave will provide new data on the outcomes of cognitive impairment not meeting criteria for dementia. Other areas of interest include pharmacoepidemiology, difficult clinical problems, advanced directives and bioethics. Canadian research in geriatrics will continue to develop, with the establishment of the Canadian Institutes of Health Research providing exciting new opportunities.

This study was carried out on a representative sample of elderly people living at home (n = 300), in intermediate faculties (n = 271) and nursing homes (n = 774) from metropolitan, urban and rural areas in the Province of Quebec (Canada) in order to: 1) determine the level of disabilities and resources involved in the care of elderly people living at home or in institutional settings; 2) estimate the costs (public, private, voluntary) of these resources; 3) compare the costs according to the level of disability; and 4) predict the costs associated with disabilities. Results show that there were significant differences but large overlap in the disability level, cognitive status and nursing care needed and received between participants from the three settings. The disability score explained 85 per cent of the variance in nursing care time and 55 per cent (home), 15 per cent (intermediate facilities) and 68 per cent (nursing homes) of the variance in the cost. Nursing care was responsible for most of the cost in all settings. The total societal cost of home care was greater than the cost of intermediate facilities for elderly participants with a disability score over 7.4 and greater even than the cost of nursing homes for a score over 38.7.

Nous avons examiné la sécurité du revenu subjective chez les Canadiens de 45 ans et plus à l'aide de données quantitatives. Nous avons étudié la relation entre les variables démographiques, socio-économiques et socio-psychologiques et la sécurité du revenu par le biais d'analyses multidimensionnelles, notamment la possibilité d'une insatisfaction à l'égard du revenu actuel ou prévu. Notre examen porte sur plusieurs résultats imprévus reliés aux effets de l'âge, de la situation maritale et du sexe sur la sécurité du revenu subjective. Cinq théories socio-psychologiques pourraient contribuer à l'explication de ces résultats: la théorie de l'aspiration, la théorie du groupe de référence, la théorie de l'équité, l'examen de la vie et la théorie de la socialisation et de l'identité. Bien que ces théories ne puissent être vérifiées en partant des données utilisées, elles fournissent une orientation de recherche éventuelle. Nous concluons que l'évaluation subjective du revenu adéquat ne doit pas constituer le fondement de l'établissement des politiques sociales de la redistribution du revenu.

The aim of this study was to develop a case-finding tool enabling the identification of residential care facilities that provide inadequate care to impaired older persons and assess its validity. This was done using data from a recent study that involved 88 homes for the aged located in the Eastern Townships of Quebec. For that study, facility managers were interviewed for information about themselves and their residence, while quality of care was assessed with the QUALCAEE Scale for each of 301 residents of the selected homes. Multivariate regression analyses helped develop a short questionnaire that can be completed during a telephone interview with the facility manager. With 85 per cent sensitivity and 65 per cent specificity in identifying homes delivering inadequate care, this case-finding questionnaire is simple, inexpensive and shows good evidence of validity.

This article focusses on the likelihood of senior centre participation, the frequency of attendance among participants, changes in use/non-use over a four-year period, and associated characteristics. The data are from a longitudinal study conducted in Winnipeg and eight smaller Manitoba communities, with 1,399 individuals aged 65 and older interviewed in 1991/92 and 956 re-interviewed in 1995. About one in five individuals attended a senior centre in the six months prior to the interview, with a wide range among participants in the number of visits. Only 8 per cent joined a senior centre and 13 per cent ceased their participation over the four years. The influence of socio-demographic characteristics, health status, and social integration varied depending on the measure of participation and according to place of residence. Social factors, such as living arrangement, tended to be more important than health status. Directions for future research are discussed.