The literature on age-friendly communities is predominantly focused on a model of urban aging, thereby failing to reflect the diversity of rural communities. In this article, we address that gap by focusing on the concept of community in a rural context and asking what makes a good fit between older people and their environment. We do this through (a) autobiographical and biographical accounts of two very different geographical living environments: bucolic and bypassed communities; and through (b) analysis of the different needs and resources of two groups of people: marginalized and community-active older adults, who live in those two different rural communities. We argue that the original 2007 World Health Organization definition of age friendly should be reconceptualized to explicitly accommodate different community needs and resources, to be more inclusive as well as more interactive and dynamic, incorporating changes that have occurred over time in people and place.

Recent discourses on aging emphasize the value of older people’s social participation. How participation is defined in policy, however, may not correspond with seniors’ realities. This article reports on the results of a critical discourse analysis conducted on aging policy in Quebec between 2005 and 2011. Results indicate that participation definitions can be problematic recommendations, standards, and expectations. Over time, participation increasingly came to be defined as productivity. The participation context also changed from collective responsibility to community adjustment and personal choice. Finally, policy texts reflected a polarization between activity and a loss of autonomy that linked participation with health status. Results suggest that, although innovative in the Canadian context, articulation of participation in Quebec’s recent policies on aging lacks the politics from which to discuss difference, otherness, and access to participative opportunities. The case of older people’s aging with disabilities illustrates the challenges of the new participatory agenda.

Des niveaux moins élevés de participation sociale et d’épisodes de marche représentent deux facteurs pouvant contribuer à la dépression chez les personnes âgées, mais les recherches antérieures ne sont pas concluantes à ce sujet. L’objectif de cette étude transversale est de quantifier les associations entre la dépression et l’effet combiné de la participation sociale et de la marche dans un échantillon de personnes âgées vivant au Canada (n = 549). Des analyses de régressions linéaires et logistiques ont été effectuées pour examiner si la participation sociale et la marche prédisent la dépression indépendamment des caractéristiques individuelles. Dans les modèles finaux, les résultats suggèrent que les individus qui ne prennent pas de marches présentent davantage de symptômes dépressifs ou une possible dépression (l’association entre la participation sociale et la dépression devient non significative dans les modèles ajustés). La présente étude souligne le rôle central des habitudes de vie telle la marche pour la santé mentale des aînés.

Nursing homes have become complex care environments where residents have significant needs and most have age-related dementia. Building on research by Hirdes et al. (2011), we describe a resident profile in a representative sample of 30 urban nursing homes in the prairie provinces using Resident Assessment Instrument – Minimum Data Set 2.0 data from 5,196 resident assessments completed between 1 October 2007 and 31 December 2011. Residents were chiefly over age 85, female, and with an age-related dementia. We compared facility support and related services and resident characteristics by province, owner-operator model, and number of facility units. We observed differences in support and related services by both unit count and province. We also found that public facilities tend to care for residents with more demanding characteristics: notably cognitive impairment, aggressive behaviours, and incontinence. No clear trends associating the number of units in a facility with resident characteristics were observed.

Cette étude a examiné un échantillon de 228 personnes âgées en réhabilitation après chirurgie pour remplacement d’une articulation; elle a porté sur la relation entre une adaptation proactive, l’humeur et les résultats psychologiques et fonctionnels. Faire face proactivement c’est une façon de réagir qui est axée sur les objectifs et nécessite qu’on affront les facteurs qui incitent le stress comme un défi plutôt qu’une menace. Selon notre hypothèse, les personnes âgées qui adoptent des stratégies proactives d’adaptation subiraient une amélioration du fonctionnement physique et psychologique apres la réadaptation et connaîtraient une humeur positive. Le modèle proposé a trouvé du support, par lequel une expérience de vigueur a été trouvé à la médiation de l’effet d’une adaptation proactive sur les résultats. Les implications théoriques et pratiques des résultats de recherche sont discutées dans le contexte des interventions qui encourageraient les personnes âgées à faire face proactivement.

A qualitative study, within a life course perspective, explored the transition into marriage for mid- to later-life same-sex couples. Twenty individuals (representing 11 couples) were interviewed – 12 lesbians, seven gay men, and one bisexual man. At the time of their marriages, participants were between 42 and 72 years old (average age: 54) and had been with their partners from six months to 19 years (average: 7.5 years). Three processes highlighted the ways in which these same-sex couples’ experiences of deciding to marry were influenced by their life course experiences. First, individuals had to integrate marriage into their psyches (integration). Second, they had to consider why they would marry their specific partner (rationale). Third, the study participants demonstrated how their experiences of wedding planning and their wedding characteristics were imbued with intentionality as a result of lifetime experiences of homophobia and/or heterosexism (intentionality).

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.

We validated seven chronic disease ascertainment algorithms for use in the Canadian Longitudinal Study on Aging. The algorithms pertained to diabetes mellitus type 2, parkinsonism, chronic airflow obstruction (CAO), hand osteoarthritis (OA), hip OA, knee OA, and ischemic heart disease. Our target recruitment was 20 cases and controls per disease; some cases were controls for unrelated diseases. Participants completed interviewer-administered disease symptom and medication use questionnaires. Diabetes cases and controls underwent fasting glucose testing; CAO cases and controls underwent spirometry testing. For each disease, the appropriate algorithm was used to classify participants’ disease status (positive or negative for disease). We also calculated sensitivity and specificity using physician diagnosis as the reference standard. The final sample involved 176 participants recruited in three Canadian cities between 2009 and 2011. Most estimated sensitivities and specificities were 80 per cent or more, indicating that the seven algorithms correctly identified individuals with the target disease.

Few studies of older individuals have directly assessed secondary control beliefs, previously defined by Morling and Evered in 2006 as a combination of psychological adjustment and acceptance. We classified older adults (n = 223, M age = 85 years, 62% women) into three categories of secondary control beliefs: psychological adjustment only, psychological adjustment and acceptance, and neither psychological adjustment nor acceptance. Relative to individuals who emphasized beliefs about psychological adjustment only, those who emphasized a combination of secondary control beliefs (including both psychological adjustment and acceptance), reported more frequent positive emotions, greater life satisfaction, and less severe chronic conditions. Our findings have implications in both theoretical and applied contexts. Theoretically, our findings extend contemporary thinking on secondary control. In applied contexts, they suggest ways of thinking that could enhance well-being in the very old.

Rates of HIV (human immunodeficiency virus) and sexual-risk behaviour for those aged 50 and over in the United States are highest and increasing in Florida, where many Canadian “snowbirds” winter. This pilot study examined the sexual-risk behaviour and predictors of HIV testing in a convenience sample of Canadian snowbirds who winter in Florida (n = 265). Multivariate logistic regression analyses revealed that the odds of testing were increased for the unmarried, those aged 50–64, those who had talked to a doctor about sexual-risk behaviour since age 50, and those who agreed that sex was important in their lives. Dating males were more likely to test than non-dating males. Dating females were not more likely to test than non-dating females; and males who dated were 13.6 times more likely to test than females who dated. Further research will improve understanding of Canadian snowbirds’ sexual interactions and HIV-testing behaviour.

Cognitive aging is a heterogeneous reality among the senior population. Studies have recently identified certain factors that may contribute to maintaining the cognitive health of seniors. To date, these research studies have primarily focused on individual determinants, namely: health conditions and lifestyle habits. A review of the literature was conducted in order to explore the socio-environmental factors that may influence the cognitive vitality of seniors. This review demonstrates that studies that have examined this potential link are very rare. Only the type and socioeconomic level of the neighbourhood of the residence, as well as the size of the social network, were identified as influential factors. However, studies have shown that the environment could modulate certain lifestyle habits which, in turn, can influence cognition. This article uses an ecological approach to illustrate individual and socio-environmental targets for the promotion of the cognitive health of seniors.

Contexte : La consommation de benzodiazépines est une pratique courante chez les personnes aînées. Cette consommation peut entraîner un problème de dépendance dont les critères du Manuel diagnostic et statistique des troubles mentaux, 4e édition révisée (DSM-IV-TR) ne s’appliqueraient pas toujours à la situation de l’aîné. Cette recherche vise à examiner l’association entre le sentiment de dépendance aux benzodiazépines et l’utilisation des services de santé par les aînés. Un objectif secondaire consiste à décrire l’utilisation des benzodiazépines chez les aînés vivant dans la communauté.

Méthode : Les données proviennent d’une enquête menée au Québec en 2005-2006 auprès d’un échantillon représentatif de 707 francophones âgés de 65 ans et plus vivant dans la communauté. Le sentiment de dépendance aux benzodiazépines a été évalué par une variable composite intégrant deux questions inspirées du DSM-IV-TR. L’utilisation des services de santé a été mesurée par l’incidence cumulée des consultations auprès des professionnels de la santé au cours d’une période de 12 mois.

Résultats : Les aînés ont consommé au total 745 benzodiazépines parmi lesquelles 117 (16,5 %) avaient une longue demi-vie d’élimination. La proportion d’aînés qui ont rapporté un sentiment de dépendance aux benzodiazépines a été estimée à 35,1 %. Ces aînés n’ont pas significativement davantage utilisé les services de santé pour leurs problèmes de dépendance aux benzodiazépines.

Conclusion : Les résultats de cette étude suggèrent que l’utilisation des benzodiazépines chez les aînés au Québec est loin d’être optimale. Par ailleurs, le besoin ressenti de dépendance ne constitue pas un facteur suffisant pour amener les aînés à utiliser les services de santé pour la prise en charge d’un problème de dépendance. Il existe donc un besoin de recherche afin de mieux cerner les barrières associées à l’utilisation des services de santé par les aînés dépendants aux benzodiazépines.

This article discusses the First Nations sample of a larger study on dementia care decisions and knowledge sharing. The purpose is to enhance understanding of the process of knowledge sharing among health care practitioners (HCPs), care partners, and persons with dementia (PWDs) within a rural First Nations community. A constructivist grounded theory methodology was used. Nineteen interviews were conducted at three points in time with two dementia care networks that included two PWDs, three care partners, and two HCPs. A sharing dementia care knowledge model was conceived, with the PWDs and their care partners at the centre. Knowledge sharing in the model was represented by three broad themes: (1) developing trusting relationships, (2) accessing and adapting the information, and (3) applying the information. Culturally sensitive approaches were essential to developing trusting relationships. Once developed, knowledge sharing through accessing, adapting, and applying the information was possible.

Using data collected by the Ontario HIV Treatment Network Cohort Study, the primary goal of this study was to describe the socio-demographic characteristics of a sample of older people (age 50 and over) from Ontario (n = 1,129) living with HIV/AIDS (PHAs). The secondary goal was to compare four sub-samples of older PHAs: women (10.6%), heterosexual men (16.7%), gay men (65.8%), and bisexual men (6.9%). These groups differed significantly by age, education, income, nationality, race, and time spent living with HIV. Compared to other groups, gay and bisexual men (GBM) reported lower HIV stigma, disclosure stigma, negative self-image stigma, and concern with public attitude stigma. GBM also reported higher mental health quality of life, lower depression scores, and lower maladaptive coping scores. These findings suggest that services for older PHAs, including training for HIV and gerontological providers, may need to cater to the specific needs of these sub-populations.

This study sought to determine (1) if measures of social position are associated with frailty; (2) if any observed association between social position and frailty is a threshold or gradient effect; and (3) if any observed association is independent of possible confounders. Data were drawn from a sample of 1,751 community-dwelling adults, aged 65 and older, living in the Canadian province of Manitoba in 1991. Education, self-reported income adequacy, and self-reported income satisfaction were used as measures of social position. Frailty was graded based on functional loss, cognition, and urinary incontinence. Multivariate regression analyses revealed, after adjusting for possible confounding factors, that all measures of social position were strongly associated with frailty in a gradient, rather than a threshold, manner. We conclude that social gradients for frailty are present in older adults, although a causal mechanism is not yet clear.

The association of health and disability factors on the perception of involuntary retirement in Canada was investigated with a multivariate logistic regression analysis of the 2006 Participation and Activity Limitation Survey data. The study investigated the role that choice or control plays in the decision to retire. Study participants were adults, with disabilities, aged 45 to 74 and who retired during the period 2001–2006. The analysis revealed that health at the time of retirement was not significantly associated with the perception of involuntary retirement, whereas disability characteristics were strongly associated with the type of retirement when health and other characteristics were controlled. Further, persons with disabilities who had to permanently retire because of their condition were eight times more likely to retire involuntarily than those whose conditions did not force involuntary retirement, suggesting the importance that control over the retirement decision has on the perception of involuntary retirement.

The accelerated aging of the Canadian population is a recognized fact and leads to an increasing number of seniors with cognitive impairments (Curateur public du Québec, 2010a). This has a definite impact on health professionals who have to assess their competency to live independently and manage their finances. This decision, which has important consequences for the person, must be based on an objective and rigorous assessment. The purpose of this paper is to analyse the available tools, both in the scientific literature and in clinical settings, to better document the various components to assess seniors’ competency to live independently and manage their finances. The goal is to help practitioners who work with older people with cognitive impairments to accurately assess their ability to manage themselves and their property. A review of the relevant literature and training available, as well as three group consultations, showed that there is no consensus about the tools used to assess the capacity to take care of oneself and one’s property. Additional studies are thus needed to fill the gap in knowledge about specific tools used to assess competency.

The objective of this article is to understand coordination as it unfolds in case management practices in the context of integrated care networks devoted to frail elderly individuals. More specifically, we describe practical coordination processes. We conducted a qualitative exploratory study using an embedded case study design. Our study covers three health and social service centers in Québec. We noted that coordination produces convention in case management practices through a process of bringing together different types of compromise in home care situations where multidimensionality appears to be more or less important. We constructed four different types of compromise-producing convention with regard to coordination in case management practices: compromise at the interface, scheduling compromise, compromise of opportunity, and compromising change.

This article sets out to analyze how older women understand grandmotherhood. In-depth interviews were conducted with 25 elderly women from Quebec with diverse lives (widowed, married, single, with or without children) drawn from three generations (65–74 years, 75–84 years, 85 years and over) according to principles of qualitative analysis using grounded theory. Based on a constructivist approach, results highlight the evolution of images of grandmotherhood offering the benefit of emotional, playful and comforting roles. This analysis also reveals multiple ways of being a grandmother and commitments that vary according to three principal factors: (1) the personality and life trajectory of the grandmothers; (2) the family situation and role of crisis in the family; and (3) the degree of intimacy with grandchildren. There follows a discussion on the place and role of the family in the lives of older women today.

This article describes British Columbia’s regulatory model for assisted living and used time series analysis to examine individuals’ use of health care services before and after moving to assisted living. The 4,219 assisted living residents studied were older and predominantly female, with 73 per cent having one or more major chronic conditions. Use of health care services tended to increase before the move to assisted living, drop at the time of the move (most notably for general practitioners, medical specialists, and acute care), and remain low for the 12-month follow-up period. These apparent positive effects are not trivial; the cohort of 1,894 assisted living residents used 18,000 fewer acute care days in the year after, compared to the year before, their move. Future research should address whether and how assisted living affects longer-term pathways of care for older adults and ultimately their function and quality of life.