Verbally agitated behaviours are among the behavioural symptoms of dementia most commonly encountered in long-term care facilities. These behaviours may be related to unmet needs that cannot be expressed adequately because of cognitive impairment. The objective of this preliminary study is to assess an intervention, based on the needs of social attention, sensory stimulation, and comfort, for managing verbally agitated behaviours in long-term care demented patients. A multiple baseline case study design was used, with two participants.

The current study examines constructs that contribute to the well-being of an international sample of older married adults. A convenience sample of 208 participants was recruited through an Internet site as well as more traditional means such as newspaper advertisements and contact with community groups. The resulting structural equation model provides further support for the revised theory of cognitive adaptation. Within this model, the direct and indirect contributions of personality, marital satisfaction, and cognitive adaptation are examined in relation to well-being. Contrary to previous findings, personality appears to have an indirect effect upon both marital satisfaction and well-being. Cognitive adaptation, in contrast, has both a direct and indirect effect upon the well-being of older adults. Limitations of use of the Internet as a vehicle for data collection are considered as well as directions for future study.

Over the last several decades there have been changes in how paid and unpaid labour is divided between men and women: The rate of women's participation in the labour force women has increased as has men's participation in household labour. Although a plethora of research has addressed these changes by analysing couple and individual data, few have examined them within the context of multi-generational families. Using a case study analysis of a three-generation family, this paper shows that gender, class, social context, and family background influence how paid and unpaid work is divided within families. The case study shows that the social context of a given time conditions the options women and men have available to them in negotiating the balance of work and family responsibilities. Yet within this context, family background also matters. Negative childhood experiences were an impetus for adult children negotiating patterns of paid and unpaid labour that were different from those of their parents.

The purpose of this study was to provide an empirical measure of bedroom personalization and a descriptive characterization of the types of items included in a personalized space. The study compared the extent of personalization in three types of bedrooms, varying as to their homelike quality (private-homelike, private-institutional, and ward-institutional). A measure of the relative degree of personalization was obtained by recording the number of personal items for each room and dividing the number of items per room by each room's available vertical and horizontal surface area. The degree of personalization was found to be significantly greater in private-homelike rooms than in private-institutional or ward-institutional rooms. This study provides the first demonstration that personalization of a resident's bedroom can be quantified and opens the way for studies of factors contributing to the effect (e.g., facility regulations, family, and staff attitudes) and empirical studies of presumed consequences (e.g., resident satisfaction and improved functioning).

In Quebec, benzodiazepines are some of the most extensively used drugs by the elderly. The goal of this study was to identify factors associated with short- and long-term benzodiazepine use among 2,039 elderly persons having participated in the Quebec Health Survey conducted in 1998. Results of the multivariate, multinomial logistic regression showed that a higher number of chronic health problems, a higher number of physicians visited and general practitioners consulted were associated with short- and long-term use of benzodiazepines. Factors specifically associated with long-term use were female gender (OR=1.84) and the presence of benzodiazepine users in the household (OR=1.90). In this study, we were unable to show a difference between the two groups of users with regards to the risk factors studied. This result leads us to conclude that prevention of long-term use must be aimed at all new benzodiazepine users.

Restorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six “wait-list” facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.

In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.

Age-related macular degeneration (ARMD) is a frequent cause of vision loss among people over age of 60. It is an aging process involving a progressive degradation of the central retina. It does not induce total blindness, since it does not affect the peripheral vision. Nonetheless, it makes difficult to read, drive, and perform all daily activities requiring fine details perception. Low-vision care consists in inducing an eccentric fixation so that relevant visual targets impact an unaffected retinal locus. It is necessary but not sufficient to enhance visual extraction. The present work aims to draw the attention of low-vision professionals to the necessity of developing new re-education tools. Beyond the perceptual re-education linked to an optimization of visual information extraction, a cognitive re-education should also be provided in order to enhance the interpretation processes. Indeed, the spatial-frequency properties of the visual world no longer match patient perceptual habits. The visually impaired person has to learn again to use these new sensory data in an optimal way. Contextual information can be a precious help in this learning process. An experimental study involving young people provides elements for another method of low-vision care, in terms of visual cognitive re-education.

Trends in the health status of the entire senior population aged 65 years or older in Manitoba were examined over a 14-year period (1985–1999) using administrative data (about 150,000 individuals). Significant health gains were apparent for a number of important indicators, including acute myocardial infarction, stroke, cancer, and hip fractures, although some of these gains were restricted to urban areas. Improvements in these health indicators are significant, as they can have major implications for individuals' need for health services and ability to live independently. In contrast, chronic diseases were on the rise, with the prevalence of diabetes, hypertension, and dementia increasing substantially over the 14-year period. These trends suggest a need for a policy emphasis on prevention, such as reducing the prevalence of obesity, which is one risk factor for diabetes. Moreover, having sufficient care options in place for the growing number of individuals with dementia is an issue that will have to be addressed.

Most literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC) environments from the perspective of staff were found in the literature. A qualitative study that draws on a grounded theory approach was conducted to explore staff-family relationships in CCC, and the findings presented in this article illuminate the unit manager's role. Data were collected through in-depth interviews with nine unit managers and a follow-up focus group with five unit managers who work in three CCC facilities. Three categories reflecting the unit manager's role with family members of clients in CCC settings were derived: establishing supportive entry; building and preserving relationships; and closing the loop. Implications of the findings for practice and future research are presented.

This paper describes a process of identifying best practice guidelines for non-pharmacological management for individuals with dementia and disseminating them to a group of frontline practitioners in specialized geriatric services. Our dissemination plan involved early participation of practitioners, development of a chart summarizing five guidelines showing commonalities, contrasts, and gaps in the guidelines, and their interpretation, colour-coded for the strength of the evidence on which they were based. Two sequential workshops were held in which recommendations for action were developed. Outcomes of the process included a resource manual, a network of practitioners, and action recommendations based upon survey data. An early follow-up evaluation showed increased adoption of guidelines.

This paper examines 16-year trends in the utilization of hospital and physician services by Manitobans aged 75 and more, using data from the Manitoba Population Health Research Data Repository. Trends are examined across five measures of hospital services (separations, short-stay days, long-stay days, cataract surgeries, and hip/knee replacements) and two measures of physician care (overall visit rate, and proportion having seven or more visits). Results show changes in the utilization of these services among older adults living in Manitoba over time, with the extent of change varying with the service under consideration, age, and location of residence. Previously large utilization differentials are shown to be shrinking; for example, cataract surgery rates across regions and physician visit rates by age. For other services, such as the rates of hip or knee replacement surgery, the differences across regions are increasing. Findings indicate that global generalizations about the impact of older adults on the health care system are subject to question, as regional differences and differences between age groups (75–84, 85+) can be significant.

This article presents the results of a study into stereotyping by managers of their older workers and the influence of these stereotypes on the inclination of managers to keep their older workers in employment. The data for the study were gathered among 796 managers. Through principal components analysis, 15 opinions about older workers were reduced to three dimensions of stereotypes. The first dimension deals with the productivity of older staff; the other two dimensions have to do with their reliability and their adaptability. These stereotypical ideas about older workers influence managers' attitudes toward the retirement of their employees. The analyses show that, besides organizational factors, psychological mechanisms also explain why people view older workers through stereotypes. Managers who are older and in more frequent contact with older employees tend to hold more positive views.