This study draws on the life histories of heterosexual childless individuals who have never married, to explore the more subtle ways that age norms affect the subjective experience of singlehood. Specifically, it examines whether or not it is appropriate to speak of transitions in the experience of singlehood. The data clearly reveal the experience of a transition to singlehood. This transition is represented by a change in self-attributed status that occurs over time and is associated with a cultural timetable for marriage. It marks the experience of “becoming single” that occurs when an individual identifies more with singlehood than with marriage. Moreover, I explore the ways in which singlehood is a gendered experience. The results from this study affirm the applicability of life course theory to the lives of single persons and serve to broaden the definition of the concept “transition” to include those not obviously marked by normative events.

High divorce rates over the past 40 years have affected multiple generations and have long-term consequences for family relationships. This article applies a life course perspective as it explores the reverberation of relationship dissolution beyond the nuclear family. Qualitative data from a study involving 86 adults from 10 three-generation families illustrate the extensive reach of divorce across time and generations. An intensive analysis of two families reveals six key areas of negotiation following divorce: relationship dissolution itself; balancing work and family obligations; inlaw ties; parent-child ties; sibling ties; and intimate relationships. Multiple voices from three generations demonstrate the complexity of family relationships over time and the reverberation of individual life course transitions throughout family networks. Applying the concept of ambivalence highlights variations among social groups in the ongoing renegotiation of relationships and situations that follows the dissolution of long-term unions.

To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using linked administrative databases to determine the incremental use of health services by elderly Ontarians with dementia. Overall, study results demonstrated that individuals with dementia used services in a pattern similar to non-demented persons, albeit at a higher level. Exceptions were women's use of hospital and home care services, where the most elderly women received significantly fewer services. Thus, the study provided important insight regarding the relative levels of health services used by demented Ontarians. Research in this area will become increasingly important as the population ages and the settings integral to dementia care and management shift and evolve.

From a “successful aging” perspective, the subjective feeling of well-being is as important as “objective” health. Physical exercise is seen as being an effective way of staying healthy, but its link with well-being in a normal aging population remains largely unexplored. Based on two randomized surveys of the aging population, conducted in 1979 and 1994, respectively, with questionnaires including retrospective questions on activities and health, two cohorts of young-old (aged 64–74) were selected (cohort 1, born 1905–1914, N = 949; cohort 2, born 1920–1929, N = 602) and split into four groups, corresponding to their exercising trajectories (long-term exercisers LE, new exercisers NE, quitters Q, sedentary S). The link between the four trajectories and two indicators of well-being (self-rated health, self-assessed depression scale) was examined by means of regression analyses. In both cohorts, the LE group had a higher level of well-being than the Q and the S. The study also throws light on the case of the quitters (Q), who showed the lowest level of well-being. Scant research has hitherto been done on the causes and repercussions of abandoning exercise.

This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age > 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group of individuals. Specifically, we took advantage of a natural experiment to compare the responses of a group of 59 ice storm victims to those of 55 matched controls living outside the ice storm area. Data on disability, pain, self-reported health, helplessness, depression, and independence were assessed prior to the ice storm and approximately 17 months later. Older adults who reported greater helplessness and lost independence prior to the storm reported significantly greater ice storm stress and rumination and were more likely to report that the storm affected their condition. In addition, participants exposed to the ice storm reported significant changes in disability and pain nearly a year and a half later, compared to matched controls. These results suggest that older adults with chronic physical illness may be particularly vulnerable when faced with additional stressful events.

Few studies have integrated the concept of empowerment in their analysis of the interaction between formal services and informal caregivers. This study was conducted among 32 female informal caregivers living in a district served by a Montreal local community service centre (CLSC). It was designed to identify those aspects of formal services that either empowered caregivers or increased their powerlessness. Three major issues were identified: norms applicable to care giving; access to and control over resources and services; and power relationships with practitioners. Depending on their context and their perception of their role as a caregiver, caregivers reported that their recourse to services was either an empowering experience or one that increased their powerlessness.

This study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Coresidence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole.

Information on the characteristics of seniors who use supplements is lacking. A convenience sample of community-living seniors (n = 128) was recruited from 10 sites to identify factors associated with supplement use (vitamin-mineral and/or herbal preparations). Data on nutritional variables, health history, and supplement use were collected with an interview-administered questionnaire. A Propensity to Use Supplements scale was developed and was associated with increased use of herbal supplements. At the bivariate level, few characteristics distinguished users and non-users. Multivariate modelling revealed the Propensity scale and a low Body Mass Index to be factors related to the total number of supplements used. When individual scale items were examined at the bivariate level, food supply concerns, health beliefs, and a proactive role in one's own health were associated with increased supplement use. Initial results suggest seniors' attitudes towards supplements may be an important factor contributing to their decision to use supplements. Further work is required in a more diverse, randomly selected, older Canadian population.

We studied the relationship between caregivers' personal and social resources and facilitation of adherence by elderly care recipients to a prescribed health regimen. Adherence facilitation was measured among 240 caregivers on a 45-item instrument constructed for this research. The facilitation score was regressed on caregivers' role-specific self-concept (e.g., caregiver competence), informal social network support, utilization of the informal network as a lay referral system, formal network support, and reported health status of the care recipient. Background variables and health beliefs were considered as control variables. The resource variable best correlated with adherence facilitation was the personal resource of caregiver competence — perception of oneself as a good caregiver — followed by two social resources: support of the professional health care provider and the presence of a lay referral system (R2 = 0.37). Thus, although the care recipient is the beneficiary of adherence facilitation, the caregiving characteristics of the caregiver appear to affect its extent.

The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

We evaluated an enhanced role in comprehensive geriatric assessment for community-nurse case managers. Following practicum education in geriatric assessment, two community-nurse case managers conducted assessments of frail older clients and served as a resource for their case-manager teams. Impacts on their colleagues' assessment skills were investigated in a non-randomized, controlled trial. Intervention-group case managers had higher confidence in assessing and managing the health and social concerns of older persons, greater use of standard assessment tools, and higher case-study assessment scores, than did control-group case managers. Case managers reported that interaction with the enhanced-role case managers had enhanced their skills and benefited clients; family physicians reported that improved patient outcomes had resulted from the assessment information received. Community case managers with enhanced training in geriatric assessment can have a valuable clinical and educational role. Issues include resource implications and integrating the enhanced role into home care operations.