The aim of this study was to examine the psychometric properties of a French version of the Multifactorial Memory Questionnaire (MMQ) (Troyer & Rich, 2002). The MMQ, which is suited to clinical and research purposes, evaluates subjective memory functioning (i.e., affect related to memory abilities, frequency of problems remembering in different situations, and strategy use in everyday life). The questionnaire was administered to 294 French adult or elderly subjects (46–94 years old). The results allowed us to conclude that the French version of this scale is psychometrically sound. Indeed, the scores proved to be highly reliable (Cronbach's α for the subscales ranged from 0.79 to 0.88) and correlated in the expected directions with measures of other constructs (correlation coefficients ranged from −0.34 to 0.39). Convergent validity evidence for MMQ scores was provided by their statistically significant positive correlations (from 0.56 to 0.73) with several dimensions of the Metamemory in Adulthood scale (MIA) (i.e., the anxiety, change, capacity and strategy dimensions). However, the three-factor model found in the original version was not validated here. An exploratory factor analysis revealed that a four-factor solution offered the most interpretable pattern for the factor scores. Two of the dimensions proposed by Troyer and Rich (2002) were replicated: ability and contentment. The third subscale (strategy) was divided into two factors: internal strategies and external strategies.

We describe the age-specific outcomes for patients hospitalized with newly diagnosed congestive heart failure using administrative hospital abstracts from Alberta, Canada, from April 1, 1994, to March 31, 2000. Seniors (aged 65 years and older) constituted about 85 per cent of the 16,162 patients. Both co-morbidity and severity of illness tended to increase with age. The use of special care unit admissions, coronary artery diagnostic services (cardiac catheterization), and revascularization procedures (percutanenous transluminal coronary angioplasty/stenting, coronary artery bypass surgery) peaked in the 50-to 64-year age group and decreased with increasing age. Specialist/sub-specialist care, prescriptions of beta blockers and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers decreased with age in seniors. Adjusted in-hospital, 1-year mortality and crude, age-specific 5-year mortality were significantly greater in those 75 years and older. Outcomes and process of care in patients with newly diagnosed congestive heart failure were not uniformly distributed with age. The elderly had greater mortality but received less therapy.

In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated – with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage – in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.

This paper describes a new measure, the Worry Questionnaire for Nursing Home Residents (WQNHR), designed to assess the frequency of specific worries. It was administered to 67 residents. Psychometric evaluation showed an average item-to-total correlation of 0.20 (range = 0.15 to 0.58), an internal consistency estimate of 0.79, and a test-re-test reliability coefficient of 0.80. The WQNHR showed good convergent validity with other measures of worry obtained from residents, good discriminant validity with measures of health, but poor discriminant validity with self-ratings of depression. Psychometric results also indicated that the WQNHR performed better for residents with higher cognitive functioning. In addition, a collateral form (WQNHR-C) was administered to family or friends; however, it was not significantly correlated with the WQNHR. Overall, the WQNHR is a promising screening instrument for assessing worry in nursing home residents.

The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8 occupational therapists or physiotherapists. Three types of barriers were found: caregiver-related, patient-related and systems-related. Four themes for facilitating pain management were identified: (a) caregivers knowing the patient, (b) family support, (c) caregivers demonstrating understanding and compassion, and (d) teamwork by caregivers. Formal caregivers practising in long-term care institutions encounter a multitude of barriers that hinder the adequate assessment and treatment of pain, such as caregiver beliefs and knowledge and cognitive impairment in patients. Innovative strategies and strong political will are needed to overcome them.

The purpose of this study was to examine whether older age is associated with increasing loneliness in people aged 60 and over. Data came from TamELSA, a population-based prospective longitudinal study in Tampere, Finland. The follow-up time was 20 years. Loneliness was measured by a single question – “Do you feel lonely?“ – with the possible answers often, sometimes, or never. Cross-sectional analysis showed that the percentage of subjects feeling lonely increased toward older age groups, but in a multivariate analysis, only household composition and social participation were independently associated with loneliness. Longitudinal analysis showed that loneliness increased with higher age. Over a 10-year period, loneliness increased most in those who, at baseline, were married and living alone with their spouse. In conclusion, only a minority of older people continuously suffer from loneliness. Loneliness does increase with age, not because of age per se, but because of increasing disability and decreasing social integration.

Private, unregulated residential care facilities have become an increasingly important component of the continuum of housing and care for frail older adults in Canada. To date, this growing segment of the older population has received very little research attention. This study involved an in-depth examination of the functional/health profile, patterns of service use, and medical/care needs of a representative sample of 178 older adults in residential care facilities in the City of Ottawa. The results indicate great diversity in resident and facility profiles in this setting and confirm earlier impressions that special care units in the residential care sector have become increasingly close to being unlicensed pseudo-nursing homes. Despite the heavy burden of care, the evidence suggests that the care needs of the majority of residents are adequately met in the residential care environment. The results can inform future research, case finding, educational, and policy planning initiatives in this setting.

Loneliness is experienced in many cultures. To properly assess cross-cultural differences, attention should be paid to the level, determinants, and measurement of loneliness. However, cross-cultural studies have rarely taken into account more than one of these. Differences in the level of loneliness were hypothesized on the basis of national differences in partnership, kinship, and friendship, which were assumed to be related to cultural standards within a society. Differences were examined among married and widowed older adults aged 70 to 89 years living independently in the Netherlands (N = 1,847), Tuscany, Italy (N = 562), and Manitoba, Canada (N = 1,134). Loneliness was measured with an 11-item scale. The Manitobans were high on emotional loneliness and the Tuscans were high on social loneliness. Partner status excepted, the determinants were nearly the same across the three locations. Differential item functioning (DIF) related to the three locations was observed for most items. Interactions with gender and the availability of a partner relationship were observed.

This paper tests assumptions often made by policy makers and practitioners that networks of family, friends, and neighbours are able to provide sustained care to frail elderly Canadians. Using national survey data, we examined characteristics of the care networks of 1,104 seniors living with a long-term health problem. Care networks were found to vary considerably in size, relationship composition, gender composition, age composition, and proximity, and these network characteristics were found to help explain variations in the types and amounts of care received. As a result, network characteristics that might place seniors at risk of receiving inadequate care (including small size and higher proportions of non-kin, male, and geographically distant members) were identified. These risk factors appear to be poorly reflected in most existing policy.

In 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service requirements, access to home care and treatment services for which they had previously been ineligible. A review of the pilot showed that a large majority of clients preferred to remain at home, with support, rather than accept a long-term care placement, even when a bed became available. The pilot has helped reduce waiting times for nursing home beds and may have important implications for reducing costs and the demand for long-term care beds.

For the past 10 years, in long-term care systems, we have witnessed the accelerated deployment of casemix management systems. A casemix is formed by clusters, defined by individual characteristics that explain similar resource use. However, certain questions regarding the development of these systems must be raised. Moreover, none of these systems was developed in the context of an integrated care organization that can track the progress of a dependent elderly person through every kind of care arrangement available—from own home, through intermediate facility, to long-term care institution. This article emphasizes the necessity of being well informed about the features of existing systems, in order to choose or develop the system that best answers the goals of a particular health care system. Finally, it underlines important elements that should be considered in each step of the development of a casemix system in this context.

This article provides a commentary on a set of five other articles reporting European and Canadian studies of loneliness among seniors. It places those works involving Canadian, Dutch, Finnish, and Welsh samples in the larger context of research on loneliness; offers reflections on the methods and findings reported in the articles; and addresses the question, Is loneliness universal? Points of similarity in the articles are identified and possible ways of reconciling discrepant findings regarding age trends and gender differences are put forward. A discrepancy model of loneliness is used as a key framework for explaining several points, including why objective social isolation and loneliness don't always go together.

While the benefits of participating in care or medical decision making are widely reported, research on decision-making participation preferences usually reveals some portion of individuals who do not want to be involved. Data collected through structured, in-person interviews with 100 residents of six long-term care (LTC) facilities in Victoria, British Columbia, were used to examine participation preferences with respect to four types of care decisions (bedtimes, medication choice, room transfer, and advance directives), as well as predictors of these preferences. Residents with higher levels of formal education, a greater number of chronic conditions, and greater confidence about the worth of their input tend to prefer more active involvement in decision making. This research also suggests that predictors of preference for independent control over decision making (active involvement) differ from predictors of preference for joint or shared decision making. Implications for the empowerment of LTC facility residents and the meaning of decision-making involvement in these environments are discussed.