Over the past 15 to 20 years there has been discussion and debate in the gerontological literature about the relative merits of self-report versus performance-based observational (PBO) measures of functional status. In 2001 the Aging in Manitoba Longitudinal Study had the opportunity to add a PBO measure of functional status and use it together with two self-report measures on a sub-sample of 138 participants. The PBO measure that was used was the Performance Assessment of Self-Care Skills, Version 3.1 (Home). Using ranks of the proportion of participants who were independent in nine different tasks, no significant correlations were found between the performance measure scores and either of the self-report measures. This finding suggests that using self-report data rather than performance data could lead program developers and policy makers to different conclusions about the extent of need for assistance among older adults.

The research presented here argues for the development of an evaluation tool for elderly persons' adjustment to a retirement home that more specifically measures the psychospatial adjustment of home residents. Elderly persons who enter a retirement home must undergo a process that requires them to first disappropriate their old objects and then reappropriate the new ones that furnish their rooms. The order in which this process occurs is as follows: first, objects from their former residence; second, objects acquired after entry into a home; and, third, objects belonging to the retirement home. After the existence of this process had been verified in a sample of 130 residents aged 67 to 98 years, it was demonstrated that the evaluation tool used in this study significantly correlates with the scale developed by Castonguay and Ferron (1999) that measures elderly persons' adjustment to their environments (EAPAR), as well as with the Geriatric Depression Scale (GDS), which evaluates levels of depression. In this study, this latter is an indicator of adjustment.

The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km 2) in the province of Saskatchewan. Long-term institutional care was provided in seven small (15 to 35 beds), publicly funded nursing homes, none of which had separate dementia special care units (SCUs). The Physical Environmental Assessment Protocol (PEAP) was used to evaluate the facilities on nine key dimensions of dementia care environments. Facilities were most supportive in provision of privacy and least supportive on maximizing awareness and orientation. Focus groups were conducted with registered nurses, nursing aides, and activity workers. Staff caregivers identified six special needs of residents with dementia that were difficult to meet in the nursing homes, two of which were related to the physical environment (safety and a calm, quiet environment) and four of which were related to the social environment (meaningful activity and one-to-one contact, opportunity to use remaining abilities, flexible policy, and knowledgeable caregivers who enjoy working with persons with dementia). Staff suggested separate dementia SCUs as one approach to managing dementia care but also identified challenges in creating dementia units in small rural facilities. Results provide support for conceptual models of dementia care settings that emphasize the interaction of organizational, social, and physical factors.

Five semi-structured interviews were conducted, using the psychological autopsy method, in order to document the causes of geriatric suicide and to describe the interaction among suicidal elderly persons, their personal and social environments, and health care professionals. The results of this study support our hypothesis that elderly persons view suicide as a means of alleviating the psychological suffering associated with the frustration they experience on account of their inability to satisfy their basic needs. Three types of basic needs that affect the suicidal tendency of elderly persons were identified: the need to self-actualize, the need to belong, and the need to feel safe. The results also show that the people who make up the social and personal environment of elderly persons have a limited role in the prevention of suicide. This is due to their unfamiliarity with the problems surrounding the fulfilment of the basic needs of the suicidal elderly. Furthermore, as revealed in the cases studied here, the intervention of the health care system has centred mainly on the use of medication as a treatment for symptoms of psychological distress. The health care system pays little attention to the dissonance associated with the frustration suicidal elderly persons experience on account of their inability to satisfy their basic needs. Finally, the outcome of this qualitative study suggests that understanding the basic needs of the elderly can be very useful in understanding geriatric suicide.

The Saskatchewan Mood Inventory (SMI) is a caregiver-focused assessment and research tool that was designed to enhance understanding of the emotional experiences of individuals with dementia and to identify relationships between level of cognitive impairment and family member ratings of pleasant and unpleasant emotional responses during daily activities. Family members were instructed to use the semi-structured written log to document prospectively the type and intensity of emotion expressed by the individual with dementia, to describe the associated emotion-evoking events or activities, and to monitor and record their own emotional reactions. Twenty-seven family caregivers recruited from Alzheimer support groups used the log consistently during a 2-week monitoring period to document an average of three emotion-evoking events per day. Average emotion ratings were more positive for individuals with moderate levels of dementia than for those with severe cognitive impairment, and caregivers' ratings of their family members' and their own emotional states were positively correlated. The event-reporting procedures produced narrative descriptions of emotion-evoking activities that were subsequently coded for content. Inter-rater reliability estimates were high. Event-category summaries are reported in association with positive, negative, and neutral emotional responses for individuals with moderate and severe levels of dementia. Level of impairment was related both to the relative frequency of positive and negative emotions and to the type of event category reported by caregivers.

In response to Canada's pressing need for effective evidence-based policy, services, and practices specific to seniors, national leaders representing all concerned stakeholders designed and implemented a National Consensus Process to promote spread, exchange, choice, and uptake of research evidence on social and health issues associated with an aging population. This article presents the innovative methods and evaluation of this three-year project, illuminating for all constituencies the challenges and opportunities associated with promoting seniors' independence through collaborative knowledge transfer efforts. A total of 198 organizations and 65 individuals were surveyed at baseline, throughout the intervention, immediately post-intervention, and one year post-intervention. Knowledge from 783 studies was spread to 63,387 people, 90 per cent of whom reported knowledge exchange. Over 50 per cent of stakeholders reported using the research evidence, although processes for facilitating knowledge choice did not achieve consensus. Significant knowledge uptake occurred in two of the four research theme areas.

This study was an implementation and community trial of a new falls-prevention program for seniors called Steady As You Go (SAYGO). The program, designed in the Capital Health region of Alberta, integrated the knowledge gained from successful falls-prevention research into a brief community intervention. SAYGO included a multifactorial, risk-abatement approach, as well as a cognitive-behavioural and environmental focus. The target population was relatively healthy and mobile, community-dwelling seniors. The randomized community trial was conducted in urban and rural areas in Alberta, with 660 seniors participating. Seniors who completed the program made significant reductions in eight of the nine risk factors addressed in the program. Over a 4-month follow-up period, the proportion of seniors who fell was lower in the treatment group (17%) than in the control group (23%). Among those seniors who had reported a fall in the previous year, a significantly lower proportion of those in the treatment group experienced a fall in the follow-up period (20%) as compared to those in the control group (35%).

Canadian health regions are required to set priorities and allocate resources within a limited funding envelope. Program budgeting and marginal analysis (PBMA) was piloted in continuing care in Claresholm, Alberta, with the aim of improving overall benefit from available resources. A marginal-analysis expert panel was used to assess options for continuing-care delivery. Inputs into the decision-making process included evidence from the literature, regional and provincial reports, program budgeting information, and local knowledge. Recommendations included implementing adult, day-and-night support programs and converting long-term beds to convalescent beds. Changes were funded through allocating provincial Broda funding and altering nursing assistant and physiotherapy activity. PBMA was demonstrated to be an effective framework in aiding decision makers with redesigning services in Claresholm. This case study is one of several which indicate PBMA to be a valuable aid to priority setting in health care service provision.

The Center for Epidemiologic Studies-Depression Scale (CES-D) is among the most widely used depression screening measures. Existing research suggests a higher-order factor structure of responses among older adults (factors labelled depressive affect, absence of well-being, somatic symptoms, and interpersonal affect, each loading upon a second-order depression factor). The current study extends this research to ascertain whether this structure is equivalent (or invariant) between the English and French versions of the CES-D. Findings suggest that the number and relative contribution of each factor is similar for both language groups. Furthermore, interpretation of CES-D items is statistically indistinguishable for 16 of 20 items within this randomly identified, national sample of caregivers of persons with dementia. Results of this study support the higher-order factor structure of this measure and provide data in support of the reliability of responses. Furthermore, findings support the use of the CES-D in cross-cultural and comparative research with English- and French-speaking adults.

Provincial government drug plans are the primary source of insurance for drugs taken by seniors in outpatient settings. The adequacy of this coverage has been called into question, given the increased clinical importance of pharma-ceuticals, shifts in the provision of health care from inpatient to outpatient settings, increased use of restrictive formularies, and reductions in provincial drug subsidies. To assess the adequacy of provincial coverage, we estimated what a typical single senior beneficiary of a provincial drug plan paid out-of-pocket in 1998 on prescription drugs covered by the public program, depending on his/her province of residence, level of drug consumption, and income. We compared provincial coverage for seniors with large drug costs. We also assessed provincial coverage of drugs that were introduced into the Canadian market between 1991 and 1998. The cost of drugs consumed by a senior in a given province and year was estimated by multiplying the average number of prescription drugs consumed by senior drug users by the average per-prescription costs. High drug consumption was defined as twice the average. We used the provincial drug cost sharing rules to estimate the senior's share of the total cost of drugs consumed. Mean out-of-pocket costs range from $42 to $1,302 per year, are lower for lower-income seniors, and increase with drug use, although the charge per drug decreases with the number used. There was up to a 12-fold variation among the provinces in the charges faced by seniors with similar incomes and drug use. All but one province limits costs to seniors with catastrophic drug costs, but there was 21-fold variation in the expenditure limits. The substantial variation in seniors' out-of-pocket drug costs raises questions about the distributive equity of drug subsidies in Canada. Recent evidence on the deleterious health effects of drug charges faced by seniors in Quebec and the fact that seniors in some other provinces face direct charges similar to those faced in Quebec raise the possibility of adverse consequences of drug charges in other provinces.

Bathrooms are a common location for falls among older adults. Bath grab bars can assist in promoting safe bath transfers. The aim of this study was to identify predictors of bathroom safety-device use among community-living seniors. A two-stage sampling strategy was used to select, first, a random sample of non-universal apartment buildings and a matched sample of universal buildings, from among non-profit apartment buildings in two Canadian regions; and second, a random sample of participants within each building. A total of 550 seniors participated in face-to-face interviews in their apartments. Participants within each building type presented with similar profiles. A logistic regression was used to identify predictors of grab-bar use among participants who had grab bars and entered the bathtub on a regular basis (n = 478). Significant predictors, in order of odds ratios, were bathing difficulties, ease of grab-bar use, living in buildings with policies supporting universal access to grab bars, having a history of falls, and reporting few psychosocial consequences of grab-bar use. Findings of this study emphasize the importance of promoting access as a key strategy for increasing use and have important implications for policy planning and falls-prevention initiatives.

The purpose of this study was an examination of the inter-rater reliability for a psychogeriatric population of the Global Assessment of Functioning (GAF), Axis V of the DSM-IV Classification System,. One-hundred-and-eight psychogeriatric patients, admitted to an acute-care psychiatric hospital, were rated on the GAF by three clinicians: a psychiatrist, a physician, and a psychologist. The psychologist also conducted a cognitive screening assessment at the time of admission, as well as a second rating of global functioning, which was carried out at the time of transfer/discharge from the admission unit. Results indicated good inter-rater reliability, with values ranging from 0.78 to 0.86. Comparisons were also made between the admission and transfer/discharge GAF scores. Implications for improving the inter-rater reliability of the GAF are discussed.

The transition from employment to retirement is changing dramatically in Canada and other industrialized societies, with a decreasing proportion of working life being spent in stable career progression. This study used a sample of 2,592 subjects, aged 45 to 64, from the 1994 General Social Survey of Canada (GSS): Cycle 9, to describe situations of later-life career disruption (LLCD) in older workers in Canada and to investigate the association between LLCD and self-rated health. Results showed that a large proportion of older Canadian workers had experienced such LLCD as job interruption and job loss. Experience of job loss and job interruption over the prior 5-year period was found to be significantly associated with poor self-rated health, after controlling for age, education, body mass index, and activity limitation. However, after excluding respondents whose LLCD was known to be due to poor health, job interruption and job loss were separately found not to be significantly associated with poor health. The complexity of the findings and the direction of causation between LLCD and self-rated health, as well as some methodology issues, are discussed. Areas of future research are indicated.