Specially designed outdoor spaces (SDOS) have been developed to improve the quality of life of people with dementia. However, few follow-up studies have been done to examine their use once implemented. The purpose of this study was to gain a better understanding of how SDOS are used and the objectives of their design fulfilled. A qualitative descriptive study was conducted of a SDOS 3 years after it was built to answer the following questions: How has the garden changed from the original design? What are the current patterns of use of the garden? What factors facilitate use of the garden? What are the barriers to use of the garden? Four main sources of data were used: landscape architectural drawings, non-participant observation, focus groups, and in-depth interviews. The results lend support to the theoretical principles of garden design in the literature. The garden was considered an important part of the service program. However, factors such as garden maintenance, organizational support, staff training, and accessibility may limit its impact.

Older-adult community programs are significant partners in the identification of need and delivery of health care for seniors. At present there is no systematic screening for nutritional risk in Ontario, and the interest and resources of community programs to screen is unknown. From three Ontario organizational membership lists, 200 programs were randomly selected; 136 key informants completed and returned the survey. A diverse sample of programs was included. Most were providing some form of nutrition programming, with the most common being meal provision. Two thirds (67.7%) were collecting some form of nutrition information: 56.4 per cent had an assessment questionnaire with nutrition information, and 21.8 per cent had clients subjectively assess their own nutritional risk. Most providers were interested in the nutritional health of their clients, and over half were interested in formally screening for nutritional risk. Barriers to screening were also identified. It is clear that nutrition is an area of priority for community programs and that nutrition screening is desired. Barriers to ethical screening need to be addressed prior to implementation of a systematic screening program.

Elderly adults often pose, or are perceived to pose, a risk to themselves or others. Others often also have the will, and sometimes the ability, to intervene in their lives: to take them from their homes, force medical treatment on them, and prevent them from spending their money as they see fit. Thus the question “To what extent, and for what purposes, can others interfere with the liberty of the individual?” takes on particular relevance for elderly adults. This is the question John Stuart Mill addressed in his essay On Liberty, and our aim is to adapt his theory of liberty to guide those who must make decisions about the old. We argue that individuals can be interfered with in their own interest and in the interest of others. It is apt to interfere in their own interest if and only if they are putting themselves at significant risk, are encumbered, i.e. are incompetent or subject to some other judgement-distorting condition, and interference will be: (a) effective, (b) not generative of evils greater than those it prevents, (c) the mildest possible to curb the evil, (d) not discriminatory, and (e), unless the interference has utility approaching absolute necessity, thought justified. It is apt to interfere in the interest of others if and only if they are putting others at significant risk and the same five conditions are satisfied. As we hope our adaptation of Mill's theory of liberty will have practical effect, we illustrate it with examples, relate it to the law in British Columbia, and state it in the form of a decision-tree.

Based on the national Canadian Study of Health and Aging, the objective of this study was to determine the importance of socio-demographic and medical factors, cognitive and functional status as predictors of the development of urinary incontinence, and to estimate five-year incidence by sex and age group. Participants from the Canadian Study of Health and Aging who underwent a clinical examination in 1992 and were continent for urine at the time were followed up and their continence status was again determined in 1997. Multivariate logistic regression models with daily incontinence and daily or less than daily incontinence as the outcomes were developed separately for male (n = 306) and female (n = 520) survivors. Predictor variables were introduced in the following chunks: socio-demographic factors; cognitive status; functional status, diabetes and stroke. Five-year cumulative incidence of daily and less than daily incontinence by sex and age group was also estimated. Results indicated that the incidence of urinary incontinence was higher in women than in men, and increased by age in both men and women. Especially among men, those in institutions were much more likely to develop urinary incontinence than those in the community. Incontinence increased dramatically with severity of dementia, less so with physical immobility. Diabetes mellitus was related to the development incontinence in men but not in women, prior stroke was related to development of incontinence in both sexes. It is concluded that urinary incontinence is common in older persons, and enquiries about its presence should be part of routine medical and nursing assessment of older persons. Those who develop incontinence commonly have dementia and are physically impaired. The extent of assessment and management should be carefully tailored to each individual patient.

Visual requirements for a simple walking task were evaluated for young and elderly persons to determine if, with normal aging, elderly subjects require more visual information. Ten young adults and 10 elderly people were asked to complete a simple walking task within predetermined pathway boundaries under two conditions of visual restriction. In the reactive condition, subjects automatically received a 200 ms flash of visual information at the halfway point of the walkway. For the predictive condition, subjects did not receive any visual information during the walking trial, but were equipped with an emergency button that would provide 200 ms of visual information whenever they needed it. For both experimental conditions, subjects received additional flashes of visual information if they stepped out of the walkway boundaries. Results showed that older persons stepped out of bounds more often in the reactive condition and gave themselves more visual cues than the younger subjects in the predictive condition. The relative importance of vision during locomotion seems to be higher in the elderly population when compared to young adults.

Using data from 96 hours of semi-structured interviews with women aged 61 to 92, this paper explores the meanings that older women attribute to beauty and aging. The women in my study tend to equate physical attractiveness with youthfulness and slimness. However, they reject the extremes of thinness embodied in today's fashion models and actresses. Even as they disparage obese individuals, the women argue that thin older women appear scrawny. The women express a preference for more rounded female bodies than current beauty standards allow and emphasize the importance of inner beauty. While some women view their wrinkles negatively, others suggest that their facial creases are badges of honour. I argue that older women do not simply internalize beauty ideals to the detriment of their sense of self. Rather, older women resist and challenge current ideals of feminine attractiveness and suggest alternative beauty ideals and definitions of personal desirability.

This paper examines factors associated with falling among approximately 3,100 individuals aged 65 and older who were participants in the 1994 National Population Health Survey (NPHS). The intent of the NPHS is to monitor the health of Canadians and risk factors that affect their health. Several factors were identified as increasing the risk of falling, such as advanced age, being female, certain medical conditions, medication use and impaired mobility. The results from this survey, conducted on a national level, confirm the findings of many studies utilizing smaller samples within individual communities. Continuation of the NPHS will aid in offering longitudinal data with respect to falls, and allow for establishing a temporal order prior to the fall event, in order to provide more definitive evidence with respect to risk factors for falls.

This article discusses qualitative research conducted in minority Francophone communites in Ontario. The perceptions of and participation in physical activity by some thirty women are analysed with respect to sociological foundations and current views on aging. These views apply to individual responsibility for health; to the links between health, beauty, and aging; to participation in sports; to perceptions of masculinity and femininity; and, finally, to the obligation to remain physically active at all stages of life. The results of the study among women grouped into three age brackets reveal that, although these women have adopted a view of individual responsibility for health and the prevention of the harmful effects of aging through regular physical exercise, they may also be seen as subjects who find strategies in their daily lives to avoid falling prey to the pressures of health and beauty standards regarding aging, to face limitations, and to develop a healthy way of experiencing the aging process.

This paper presents a typology of older parents caring for adult offspring with lifelong disabilities, as well as barriers to residential planning from the perspectives of older parents caring for adult offspring with lifelong disabilities. Project participants included 54 older parents and one grandparent (all aged 60+). Information was collected via focus groups in six provinces across Canada. Transcripts were analysed using different analytical procedures, including pattern identification, clustering of conceptual groupings, identification of relationships between variables, constant comparisons, and theoretical memos. Older parents' reluctance to engage in the planning of future living options was found to be multi-factorial and linked to the macro- and micro-systems within which these families were embedded.

Past studies of aging and disability have been restricted to and by cross-sectional data. When cross-sectional surveys measure income, disability status and age at a common point in time, it is impossible to discern the process, and consequences, of a disability onset. In other words, it is not possible to examine the circumstances of the same individuals before, and after, the disability onset; nor whether effects differ according to the age at which the disability occurs. The present study uses a new panel data set, the Survey of Labour and Income Dynamics (SLID), to examine the prevalence of disability with respect to age, gender, and other socio-economic characteristics; however, its unique contribution is its investigation of disability onset, and the rates of entry into, and exit from, disability status by age group and gender. Further, we assess the financial circumstances of those who become disabled vis-à-vis a “control group”.

As Canada's elderly population grows, an increasing number of seniors will require care as they face the end of life. Relatively little research attention, however, has been given to end-of-life issues, including those related to treatment and care for persons who are both old and dying. Families and health care providers have little direction and guidance to ensure an optimum quality of life for seniors prior to death and during the period of bereavement. This article presents an abbreviated summary of the literature regarding end-of-life issues and challenges for seniors who face a life threatening illness and are at, or near, the end of their lives. The article is also informed by a series of focus groups with elderly and other informal caregivers regarding the giving of help and getting support while caring for persons who are dying. It concludes with a response to this evidence by making a series of recommendations aimed at ensuring optimal end-of-life care for seniors who are dying and their families.

As the demand for home care services increases, health care agencies should be able to predict the intake capacity of community-based long-term care (CBLTC) programs. Two hundred and thirty-seven clients entering a CBLTC program were assessed for activities of daily living (ADL) and cognitive and affective functioning and were then followed to monitor attrition and reasons why clients left the program. Compromised ADL functioning at baseline increased likelihood of death and institutionalization by 2 per cent each year. Over a 10-year period, reduced cognitive functioning at baseline increased the risk of death by 9 per cent and decreased the likelihood of leaving the program due to improvement by 18 per cent. Reduced affective functioning at baseline increased the risk of institutionalization during the course of the study by 3 per cent. Routine functional assessments with the elderly may help in the management of similar home care programs.