Determining the appropriate intensity of investigation and treatment for individual elderly patients in long-term care settings can present a significant challenge to physicians, especially when patients are incompetent to decide for themselves. However, respecting established intervention levels may represent an even greater challenge, given the realities of coverage by on-call physicians. This paper describes a new Intervention Level Scale for competent as well as incompetent long-term care elderly, and its validation as a communication tool between attending and on-call physicians. Specifically studied were (a) concordance of interventions, (b) whether prior knowledge of an intervention level by an on-call physician was considered useful, (c) applicability of the scale in different institutions and (d) necessity of physician training for optimal use. The scale's uniqueness resides in the fact that it is based on personal values of life, rather than institutional resources, and it incorporates directives on family contact.

The Alberta Assessment and Placement Instrument (AAPI), a multidimensionalassessment, is used to assess clients for continuing care in Alberta. We conducted a retrospective chart review to determine the validity of the AAPI items for use with long-term clients who are referred to Home Care. We were also interested in determining the status of clients one year after they were admitted to home care. The charts of 60 clients admitted to home care and 60 not admitted were randomly selected for the year 1992, the most recent year during which a duplication of all AAPI results was kept. The groups did not differ in demographic characteristics, measures of perceived need, number of medications, nutrition, cognitive status, psychosocial status, and use of formal and informal care providers as described in the AAPI. However, they differed significantly in medication management: those admitted to home care required more assistance with medication management than those not admitted. Therefore, use of the AAPI alone does not determine whether or not a client is admitted to home care. When the charts were followed one year after the initial administration of the AAPI, only 18 per cent of those admitted to home care remained on home care whereas 42 per cent of those not admitted to home care were now admitted. The admission of a client to home care was associated with an increased likelihood of being admitted to a long-term care institution (OR = 6.56) or being deceased (OR = 5.36) one year later.

This article highlights the incidence of poverty amongst older persons in Canada by documenting the poverty rates among women and men from seven different ethnic groups representing both White ethnic and visible minority populations (Chinese, Aboriginal, Ukrainian, Jewish, Black, Greek and Italian ethnic ancestry). Special attention is placed on the incidence of poverty amongst older women and reasons for differential poverty rates among ethnic older women will be addressed. An attempt is made to link these issues with an agenda for gerontological research, policy and practice including addressing the need for improved services for this population.

Recent research suggests that the single strongest predictor of burden among dementia caregivers is a measure of marital aggrandizement (Marital Conventionalization Scale). The current study corroborates the significant inverse relation between these constructs. In addition, there appears to be little association between this response style and more standard social desirability constructs (i.e. self-deception, impression management). Furthermore, the tendency to discount negative experience in one's marital history appears distinct from emotion- and problem-focussed coping as defined within Lazarus and Folkman's cognitive phenomenological model. The propensity to idealize one's spouse and marriage is discussed relative to the reconstructionist theory of memory and social exchange theory.

The article presents the main results of research carried out in the autumn of 1995 on a sample of 309 senior citizens, living at home and residing in the CLSC La Source area, a suburb of Quebec. The purpose of this research was to gather information on the horizontal solidarity phenomenon among senior citizens. Three points of analysis have been used to define the concept of horizontal solidarity: individual help, community life and living together. The study presents a profile of senior citizens firmly rooted in their community, rather active and having frequent social contacts with their relatives. It emphasized the importance of the family in maintaining the existing solidarity, especially when the individual is not self-sufficient. The results of the research challenge the popular myth which stipulates that senior citizens represent, in the community, a passive, socially-withdrawn group.

The aim of this study was to investigate the age differences in the rates and costs of broad categories of medical procedures (diagnostic, therapeutic and surgical) during the last year of life as well as hospitalization among the adult population of Quebec. The study is population-based and took into account 90 per cent of deaths occurring among the Quebec population (15 years and older) in 1991. The data were collected from the physician claim files of the Health Insurance Board. Costs were defined as physician payments for the procedures performed. The results showed that the rates of these procedures increase with age to reach a maximum in middle life and then decrease among the elderly. A similar trend was observed in the average cost of surgery and diagnostic procedures but the average cost of therapeutic procedures followed a constant decline with age. These data suggest that the oldest old do not seem to get more aggressive care at the end of life than younger decedents.

This study compared the diagnostic performance of the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS) in correctly identifying depressed and nondepressed older people who are nursing home residents without cognitive disorders. At the usual cut-off scores of 10 and 11, sensitivity was 96.30 per cent for the BDI and 88.89 per cent for the GDS, while their specificity rates were 46.15 and 56.41 per cent respectively. Using Receiver Operating Characteristics (ROC) curves, the results obtained using these scales were compared with the diagnosis of psychiatric disorder according to the DSM-III-R. Contrary to the hypothesis, no difference was found between the area under the ROC for the BDI (Az = .87; SD = .04) and for the GDS (Az = .85; SD = .05). The exclusion of the somatic items, or the somatic factor, did not change the diagnostic performance of the BDI. Indices of temporal stability, concurrent validity and agreement with clinical diagnoses also confirmed the reliability and validity of these two scales for older people living in nursing homes.

Older persons living in Residential and extended care centres (RECC) have to cope with various Stressors associated with institutional life. While some residents cope successfully, a large proportion of this population presents difficulties in adjustment. Knowledge about the role of coping strategies in the adjustment process to nursing home Stressors is limited to strategies used in the first few months following admission to RECC. The goal of this exploratory study was to determine how various coping strategies are related to depressive symptoms, anxiety and well-being of 90 residents living in RECC for more than three months. Individual interviews were used to collect the data. Significant correlations were observed between measures of psychological adaptation and the strategies of escape-avoidance and seeking social support. These results confirm than certain coping strategies are associated with adaptation to life in RECC.

Pregraduate students (N = 144) used a modified version of the Treatment Evaluation Inventory (TEI; Kazdin, 1980a) to rate the acceptability of one of three treatments for depression (cognitive therapy, cognitive bibliotherapy, and antidepressant medication) for one of three cases of a depressed elderly person (mild, moderate or severe symptoms). Factorial analysis of the modified version of the TEI revealed two factors (treatment acceptability and negative aspects) which accounted for 72.8 per cent of the total variance. The modified TEI was shown to possess good concurrent validity as well as good internal consistency and test-retest reliability. Subjects rated all treatments as equally acceptable, and treatments were judged more acceptable for mild to moderate symptoms.

Using census data, this study investigates change in the residential segregation of persons age 65 years and over from younger persons in Canadian census metropolitan areas (CMAs) between 1981 and 1991. In each CMA, age-segregation is first evaluated in terms of inner city-suburban population distributions, and then according to the degree of segregation across census tracts expressed by the Index of Dissimilarity. Although the CMAs typically had moderate segregation levels in both 1981 and 1991, there were consistent trends toward (i) increasing proportions of the elderly living in suburban areas, and (ii) declining degrees of age-segregation across census tracts. It is proposed that these trends are partly attributable to the aging in place of suburban residents. Correlation and regression analyses indicate that in 1991 lower degrees of segregation were associated with CMAs which had relatively high percentages of both older dwellings and elderly population. The policy implications of the results are discussed.

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.

The aim of this paper was (1) to document the extent to which elderly caregivers of persons with dementia engage in self-help/mutual aid activities such as groups and telephone support and (2) to document the extent to which non-users want to participate in this form of support. Caregivers aged 60 years of age and older were recruited from the Alzheimer's Society of Metropolitan Toronto Wandering Persons Registry. Data from telephone interviews (n = 84) from this multicultural sample showed that 21 per cent of subjects used support groups and 26 per cent of non attenders wanted to be part of a support group. Only 8 per cent of subjects utilized telephone support services yet 57 per cent of non-users wanted to use this service. We also report on other means of support such as use of computer networks and newsletters. The implications of this research for seniors will be discussed in light of these identified needs and barriers to participation.

Population aging has become a subject of widespread popular and academic interest. In providing an assessment of the extent of aging that is in prospect, this paper makes available a number of projections of the age-sex distribution of the Canadian population for the 45-year period 1996 to 2041 and comparisons with the previous 45-year period. The projections combine assumptions relating to fertility, mortality, and migration so as to produce future populations characterized as “medium,” “old,” “young,” “high immigration” and “low immigration”. Supplementary calculations include growth rates, for both the total population and selected age groups, and various types of dependency ratios, including ones with a range of age-differentiated weights. It is concluded that substantial aging of the Canadian population appears virtually certain but, based on the demographic evidence, the “dependency burden” is likely to remain below the peak levels attained during the baby boom.

This study investigated the relationships among several aspects of cognitive functioning and the outcome of self-medication training in hospitalized elderly patients. Data from 53 geriatric patients who received rehabilitation treatment at the SCO Hospital in Ottawa, Canada between 1992 and 1997 were collected, on an archival basis. Patients began a graduated self-medication program after undergoing a neuropsychological evaluation. Performance scores from five different aspects of cognition were regressed on the self-medication training outcome measures. Findings revealed that aspects of cognitive functioning were significantly related to the outcome of self-medication training. Thus, psychometric measures of cognition can be useful in predicting which patients are most likely to benefit from a self-medication program, or alternatively, those who would require a modified program to be able to learn. The clinical implications of these results are discussed.

Developmentally grounded research on norms for social exchange in adult relationships is equivocal, and rife with theoretical and methodological inconsistencies. We examined the applicability of three theoretical perspectives to specific relationships differing in self-perceived closeness in three groups of adults. Participants were first year (n = 37, MAge = 19.1 years) and fourth year (n = 42, MAge = 22.1 years) undergraduates, and retired teachers (n = 42, MAge = 66.8 years). We find considerable similarity among the three age groups on exchange norms and reciprocity expectations, despite considerable differences in sources of supportive relationships. Results indicate greatest support for exchange based upon need over either equity or social exchange perspectives, with this being especially true for very close relationships. Older adults report relationships operating to a greater extent on expectations for long-term over short-term reciprocity than young adults. Findings highlight the importance of considering intra-individual variation in exchange norms and expectations for reciprocity.

Although there are reports that the State-Trait Anxiety Inventory (STAI) should be adapted to older adults, the standard version of the instrument is consistently used with this population. Bouchard, Gauthier, Ivers and Paradis (1996) have adapted a French version of the STAI for a population of older adults and found one item with extremely low item-remainder correlation. In Study 1 (N = 57), alternative formulations of item 24 were assessed to examine if the low item-remainder correlation was related to problems in translation that could become apparent in a sample of older adults. Study 2 (N= 188) was conducted in order to replicate the findings of Study 1 and assess the factor structure of the instrument. In Study 3, 46 older adults completed the instrument on two occasions with a 35-day interval to assess test-retest reliability. Our results suggest that: (a) item 24 should be removed from the trait anxiety scale and be replaced by the mean of the other anxiety-present items; (b) the instrument has a four-factor structure similar to what is found with the standard version of the STAI in nonelderly samples; and (c) both subscales are highly stable.