The objective of this study was to explore the way in which relationships develop between family members and staff working in long-term care facilities. In-depth, qualitative interviews were conducted with 17 registered nurses. Data were analysed inductively using the constant comparative method. Findings showed that RNs perceive their relationships with families to develop in four stages: the “initial greeting,” sizing up,” “making a tentative decision,” and “reaching a final decision”. Several contextual factors were associated with the way in which relationships developed, including structural factors, family recognition of staff efforts, open communication, and professional identity. Findings suggest that relationships can best be understood from an interpretive perspective and that an analysis of family-staff relationships should consider the influence of social power.

This study examines the stages of change in exercise as a form of coping with chronic illness, among a panel of older adults managing arthritis, cardiovascular disease, or hypertension. Hypotheses connected to socio-demographic, exercise-history, cognitive, and illness contexts are explored in order to advance applications of the Transtheoretical Model for exercise self-care. A random sample of 735 individuals aged 51 to 95, who completed interviews at time 1 (1995–96) and time 2 (1996–97), were drawn from the Vancouver North Shore Self Care Study. Bivariate and hierarchical logistic regression analyses were performed on the data. The descriptive analyses supported two patterns: first, older persons with a chronic illness exhibited a propensity either to remain in or move into the extreme exercise stages (pre-contemplation or maintenance) in a non-sequential manner; second, elements of the illness context were primary determinants of stage of exercise change. Illness type, illness duration, activity restriction, and co-morbidity exhibited associations with exercise-stage change in the multivariate analysis. The findings have a number of direct implications for tailoring health promotion programs targetting older adults, especially those who use exercise as a form of self-care.

The purpose of this qualitative study was to learn more about the relationships that families develop with staff who work in the facilities in which their relatives live. Data were collected through participant observation in two long-term care facilities and through personal interviews with 61 family members. Five types of relationships emerged from the data, including relationships that were “collegial,” “professional,” “friendship,” “distant,” and “tense”. Several factors appeared to be associated with positive relationships developed between families and staff, including contact with purpose, shared experiences, and issues of trust. Families also reported a number of benefits from developing positive relationships with staff.

This article discusses a longitudinal study of caregivers (n = 195) from a representative sample of caregivers pf Spanish, ADL-disabled persons, aged 65 and over carried out to assess the role of social support and religiosity in the development of depression. Depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. One year later, 119 of the caregivers were contacted again. Stability of depression over 1 year was observed in most participants. Poor physical health and low self-esteem, as well as incontinence in the care recipients, were significant predictors of the development of depressive symptoms. Social support had a differential effect on the development of depression, depending on how much assistance with activities of daily living the caregivers had to provide. Religiosity seemed to have no effect. Depression in caregivers is related more to their health and psychosocial resources than to the amount of care they provide. Poor health status, low self-esteem, and lack of emotional support may be useful indicators in identifying caregivers at high risk for depression.

This paper examines use of alternative therapies to manage a chronic illness among older adults with at least one of three major conditions: arthritis, heart disease, and hypertension. Drawing from developments in the health utilization literature, a focus is placed on the illness context, predisposing factors, and several factors deemed to enable persons to use complementary medicine. The baseline data (n = 879) from the 1995–96 North Shore Self-Care Study conducted in Vancouver, Canada were used for this study. Two dependent variables were analysed using logistic regression techniques – the first is based on a comprehensive question about using alternative therapies (such as herbal remedies, acupuncture, massage therapy, etc.) to manage a chronic condition; and the second uses a more specific question pertaining to meditation or praying. The results from the first analysis show that being younger, suffering from arthritis compared to hypertension, comorbidity, taking fewer medications, lower income, reading on the chronic condition, and the interaction between reading and illness self-efficacy are associated with trying alternative therapies. The findings for the second analysis show that being female, being younger, and not married, as well as reporting a more serious condition, illness duration and the interaction between having moderate levels of mutual aid and number of confidants result in a greater likelihood of trying meditation/prayer. Implications of these results are discussed in terms of their theoretical import, and their relevance for the degree to which unconventional and conventional medicine are complementary.

With a view to reducing the exhaustion experienced by informal caregivers and thus encourage the frail elderly to remain at home, a new free respite care program, which offers to house the frail elderly one week per month, was evaluated using an array of multiple cases. Ajzen and Madden's (1986) theory of reasoned action was used as a model to explain the effect of the program on the caregivers' intention to resort to permanent accommodation. Fourteen informal caregivers took part in the program evaluation process. An analysis of the reports of the meetings of the program's Implementation Committee revealed that human and material resources had been used as established in the initial plan. Seven subjects completed the 12 months planned for evaluating the program and were able to continue with the program thereafter. An analysis of the data, using graphic representations and pre-experimental and experimental phase medians, did not reveal any decrease in the perceived burden and in the intention to resort to accommodation in subjects who had completed the program evaluation process. Those who dropped out did so in part because of the high level of perceived burden and the caregivers' intention to resort to accommodation prior to entering the program. Unstructured telephone interviews with the caregivers suggest, moreover, that an elderly person's loss of autonomy, a good financial situation, and the caregiver's decreased feeling of guilt at the idea of housing his/her relative are important determining factors in the caregiver's decision to use permanent accommodation.

This research compared older adults' use of medical assistive devices (ADs) with their use of everyday ADs as a means of managing chronic physical disability. The study also examined whether predisposing, need, and enabling factors were associated with device use in three domains of activity: personal care / in-home mobility, household activities, and community mobility. Participants were 248 adults, aged 55 years and older, with a wide range of disability levels as a result of osteoarthritis. All participants were administered an in-depth, structured questionnaire, as part of a larger study examining older adults' independence and adaptation to chronic physical illness. The results revealed that respondents actively adapted to their disabilities and used a wide range of medical and everyday devices, with everyday devices being reported more than twice as often as medical ADs and the fewest devices overall being reported for community mobility. In general, medical devices were used when subjective and objective need for ADs was considerable. Everyday devices were reported earlier in the trajectory of the disease, at mild and moderate disability levels, and were associated with a broader pattern of adaptation that included planning to avoid problems, exercise, and pacing activities.

This research broadens the understanding of the relationship between paid work and caregiving by including the contribution of the older “care recipient”. Using selected aspects of social exchange theory and a life course perspective, the importance of giving and receiving for caregivers and care recipients is explored through analyses of focus groups with employed women and interviews with their older mothers. The mothers and daughters focus on the time when they are most indebted to each other. The daughter's employment affects the type and value of contributions from care recipients. The mother's past assistance with housework and caring for children is greatly valued by the daughters. For care recipients, however, being reliant on a busy employee for their care has negative consequences. The mothers emphasize the current situation and under-estimate their past helping. Further research should consider the care recipient's perspective to obtain a broader understanding of the impact of the caregiver's employment in caregiving relationships.

Variations in health and medication use exist across cultures. Medication use among Chinese-Canadian older persons is complicated by many factors including combined use of Western and traditional Chinese medicines (TCM). There is little research on health, psycho-social and cultural determinants of medication use in the Chinese. A cross-sectional census study of community-based Chinese-Canadian older persons in the Kitchener/Waterloo area was conducted using the Minimum Data Set for Home Care and a supplementary questionnaire for cultural issues. The response rate was 89.1 per cent with 106 participants using face-to-face assessments. Socio-demographic and cultural variables were summarized. The multivariate logistic model for TCM use included pain symptoms and being hospitalized, and a curvilinear association between TCM use and health beliefs. For combined medicine use, living with a child, pain symptoms, hospitalization, and social isolation problems were the main effects. Living with a child, physical health problems and number of diseases were associated with Western medicine use. Health, psycho-social and cultural factors were significant determinants for medication use. Education programs for both Chinese-Canadian older persons and health care providers are necessary to understand the appropriate use of Western and TCM treatments.

The goodness-of-fit hypothesis contends that distress results due to incongruence between choice of coping strategies and perceived ability to change stressful stimuli. Goal-directed or active coping responses are believed to be most efficacious when the individual believes s/he can change or control perceived threats (i.e., problem-focused coping). Instances in which stressors must be accepted, however, would dictate reliance upon strategies to regulate distress (i.e., emotion-focused coping). Inconsistent support for this facet of Lazarus and Folkman's cognitive phenomenological model was obtained in this study of spouses of suspected dementia patients. The distinction between emotion- and problem-focused coping appears less germane than overall coping efforts relative to perceived control and caregiver burden. In addition, perceived ability to control dementia-related stressors appears to be somewhat independent of coping by caregivers. These findings are discussed in terms of the unique and chronic demands faced by spouses of persons with dementia.

One of the most influential applications of the concepts, methods and measures of social network analysis to the study of the social support transactions of older adults is the convoy model of social support. We draw on recent debates in network methodology to provide an assessment of the convoy model that explores the role of weak ties in the support networks of older adults. The social networks generated by the target diagram which operationalizes the convoy model display the structural and functional characteristics set out in its theoretical arguments. But not all of the ties constituting these networks are conduits of social support and, more importantly, these social networks do not include all supporting and supported others. The target diagram identifies core support networks; therefore, support flowing through weak ties is missed when it is used to set the boundaries of support networks. Expanding our picture of the support networks of older adults to take systematic account of weak ties and the emotional aid, instrumental assistance, and companionship that flow through them will enhance the effectiveness of support interventions that target older adults.

Although aging is normally associated with declines in motor performance, recent evidence suggests that older adults suffer no loss in some measures of bimanual coordination relative to younger adults. Two hypotheses for this finding were compared in the present research. One hypothesis was based on the assumption that these coordination patterns are automatic and relatively impervious to the effects of aging. An alternative explanation is that older adults maintain this level of bimanual coordination at a cost of increased attention demand. These hypotheses were tested in an experiment in which bimanual coordination patterns (in-phase and anti-phase) were paced at two metronome frequencies (1 and 2 Hz), either alone or together, with serial performance of an attention-demanding task (adding 3s to a two-digit number at a 1 Hz pace). The results of the study provided some support for both hypotheses. The automaticity view was supported only for the coordination patterns at the 1 Hz metronome frequency. Support for an attention allocation hypothesis was shown in the observed-movement frequency data, as older adults tended to sacrifice movement frequency at the 2 Hz metronome pace in order to maintain performance in the movement and counting tasks. These findings are discussed relative to recent accounts of the role of automaticity in the absence of age-related differences in the performance of cognitive tasks.

This study aimed at (a) developing a restraint reduction program, (b) describing its implementation in long-term care units, and (c) examining its effects on care staff's perceptions of and knowledge about the use of restraints. The program was composed of three parts: consciousness-raising meetings, staff education, and clinical follow-up. The study was a randomized, controlled clinical trial with eight intervention care units (five nursing homes) and 11 controls (five additional nursing homes). Care staff was surveyed at two time intervals over a 7-month period (pre- and post-test intervention; intervention care units: N = 171 [T0] and N = 158 [T1]; controls: N = 181 [T0] and N = 166 [T1]). The implementation of the program was successful and results showed significant changes in care staff perceptions of and knowledge about the use of restraints.

The intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

Many of the limitations experienced by community-dwelling older women are related to mobility within their communities. This qualitative study explored community mobility from the perspective of older, community-dwelling women in Winnipeg, Manitoba. Semi-structured interviews were completed with 23 older women (mean age 75.9 years) identified through an existing database. In addition to travels to conduct instrumental activities of daily living and participate in social and recreational activities, the women in the study described trips to fulfil social obligations (e.g., attending funerals, visiting sick friends) and emphasized the importance of these trips. The women's travels through the city were influenced by their perception of risk and the strategies they employed to minimize or avoid risk during the day, in the evening, and during bad weather. Autonomous community mobility provided the women with a sense of independence and control. The findings have potential implications for health care providers and community programmers who work to maintain older women in the community.

Until now, family caregivers have been involved very little in the processes of assessing the quality of care delivered to a hospitalized relative. This study is the second phase of a broader research project whose aim is to develop measurement scales intended for elderly patients and their caregivers on their perceptions of the quality of services delivered in Geriatric Assessment Units. More specifically, the goal of this phase of the research is to document the criteria that caregivers use to judge the quality of these services: these criteria should constitute the content of the measurement scale that is intended for them. Four focus groups, bringing together 21 caregivers, allowed for the identification of 31 criteria of quality. These criteria have been classified according to six dimensions of quality: information, communication, attitude of staff, technical quality, continuity, and physical resources. The study highlights the dual concerns of participants: the well-being of the patient and support for caregivers. It shows that caregivers consider themselves to be clients of geriatric services.

In both Canada and the United States, adult day services (ADS) are an integral component in the array of long-term care services available. We compared characteristics of programs and participant characteristics in Atlantic Canada, Maine, and Vermont. Directors of 47 ADS programs responded to a mailed survey. Individual ADS programs in each province and state exhibited unique program and participant characteristics. ADS programs in the two countries differed with respect to: affiliation, location, levels of government support, participant fees, organizational sponsorship, hours of operation, months of attendance, and hours attended per day. Participant characteristics that varied between the two countries were educational level, physical needs, and cognitive status. The results of this study provide new comparative information that can be used in guiding future research and program development of ADS.

Attitudes toward elder abuse differ with age, ethnicity, profession, and training. This article introduces a threshold model in order to reconcile findings on attitudinal differences within a unifying theoretical framework. The model assumes that individuals rate the abusiveness using consistent standards but different thresholds. Predictions from the model include consistency among individuals in their ratings of different behaviours (i.e., high relative consistency), but variation in the levels of rating (i.e., systematic departures from absolute consistency).

Samples of 339 seniors and 233 professionals rated 112 items representing a wide range of abuse severity. The findings suggested high relative consistency but systematic deviations from absolute consistency, with higher ratings (i.e., lower thresholds) by professionals than seniors, and by residents of smaller (rural) rather than larger (urban) communities. The implications of the threshold model include prevention through elder-abuse education and reporting practices.

Drawing on a qualitative study of families' experience with Alzheimer's disease, this paper examines family members' reaction to identity transformation or loss of self in the afflicted loved one, using a symbolic interactionist perspective. The findings show that family members find this aspect of the disease emotionally stressful. Refusing to let go of what remains of the loved one's former self, they employ a number of strategies in an effort to protect her/his social and self-identity. These strategies include concealing information, medicalizing inappropriate behaviour, fostering independence, managing appearance, and perceiving selectively.

The aim of the present investigation was to determine whether differences in the strength of original information influence adult age differences in susceptibility to misinformation. One-half of the younger and older adults watched a slide sequence once (one-trial learning) that depicted a theft, whereas the remaining participants viewed the slide sequence repeatedly to ensure that all critical details were encoded (criterion learning). Three weeks later and immediately prior to final testing, participants were asked questions that contained misleading information. As expected, the degree of initial learning influenced age differences in misinformation reporting. That is, when event memory was poorer for older than younger adults (in the criterion learning condition), older adults were more susceptible to misinformation than younger adults. However, when memory of the event was poor (in the one-trial learning condition), the younger adults reported more misled details than the older adults, possibly because the younger adults had better memory for the misleading information. Therefore, strength of initial memory influences the extent and direction of adult suggestibility and helps explain the discrepancy found across studies in this area.