Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.

We investigated the self-report hypertension variables in the CSHA, recorded in the screening questionnaire and the Self-Administered Risk Factor (SARF) questionnaire. The two questions showed high agreement (phi coefficient 0.83). Each was modestly but significantly associated with other simultaneous reports of heart disease and stroke, and with subsequent mortality. Only the SARF asked questions about treatment; controlling for treatment effects, five-year survival was longest among those with no hypertension and no treatment (mean survival time 1,645 days; 95% CI 1,632 to 1,658), and shortest for those with no reported hypertension who were receiving “antihypertensive” medications presumably prescribed for other cardiovascular disease (mean survival time 1,496 days; 95% CI 1,457 to 1,535). The SARF questions incorporating high blood pressure and treatment appear preferable to assess the risks associated with hypertension.

Lack of social support is an important risk factor for disability, psychiatric illness, cognitive impairment, institutionalization, and mortality. Social networks are also important for the caregiving and emotional support that elderly people need to allow them to function well in the community. This article details the development and validation of an index of the instrumental support available to older community residents in the Canadian Study of Health and Aging (CSHA). Preliminary item review, internal consistency, and exploratory factor analysis were carried out on a random half of the sample. The second half of the sample was used for cross validation; internal consistency, exploratory factor analysis, and item response theory analysis were carried out. The final scale had six items; alpha internal consistency was 0.76 and IRT reliability was 0.85. A one-factor solution was most easily interpretable. IRT analyses showed that the scale was homogeneous and that most items were highly discriminating. The instrumental support scale also had a high correlation with size of social network; it was related to marital status and gender, and predicted institutionalization between the two phases of the study.

Most older adults have multiple chronic diseases. Consideration of these conditions can improve the performance of statistical models in epidemiological analyses. The Chronic Disease Score (CDS) is a measure of comorbidity derived from medication usage, which may have some advantages over measures derived from other sources. The calculation of the CDS from data contained in the Canadian Study of Health and Aging (CSHA) is described. This measure can be used to estimate comorbidity within the CSHA database.

The Canadian Study of Health and Aging produced an estimate of the incidence of dementia among elderly Canadians by following up, after 5 years, the undemented found in an initial prevalence survey. Initial and follow-up estimates could be biased by false-negative error in the screening tool used for subjects living in the community, and by erroneous classification of subjects who died in the interim. Here, we use a deterministic model to quantify those possible biases. We conclude that, using the estimates of the errors from control samples, the incidence among community subjects would be overestimated by 15%, and the incidence among the institutional subjects would be underestimated by 37%. The overall incidence would be underestimated by 14%. Most of the bias can be attributed to inaccuracies in the classification of deaths.

The Canadian Study of Health and Aging (CSHA) was a cohort study that included 528 Nova Scotian community-dwelling participants. Linkage of CSHA and provincial Medical Services Insurance (MSI) data enabled examination of health care utilization in this subsample. This article discusses methodological and ethical issues of database linkage and explores variation in the use of health services by demographic variables and health status. Utilization over 24 months following baseline was extracted from MSI's physician claims, hospital discharge abstracts, and Pharmacare claims databases. Twenty-nine subjects refused consent for access to their MSI file; health card numbers for three others could not be retrieved. A significant difference in healthcare use by age and self-rated health was revealed. Linkage of population-based data with provincial administrative health care databases has the potential to guide health care planning and resource allocation. This process must include steps to ensure protection of confidentiality. Standard practices for linkage consent and routine follow-up should be adopted. The Canadian Study of Health and Aging (CSHA) began in 1991-92 to explore dementia, frailty, and adverse health outcomes (Canadian Study of Health and Aging Working Group, 1994). The original CSHA proposal included linkage to provincial administrative health care databases by the individual CSHA study centers to enhance information on health care utilization and outcomes of study participants. In Nova Scotia, the Medical Services Insurance (MSI) administration, which drew the sampling frame for the original CSHA, did not retain the list of corresponding health card numbers. Furthermore, consent for this access was not asked of participants at the time of the first interview. The objectives of this study reported here were to examine the feasibility and ethical considerations of linking data from the CSHA to MSI utilization data, and to explore variation in health services use by demographic and health status characteristics in the Nova Scotia community cohort.

The first wave of the Canadian Study of Health and Aging (CSHA) constituted a large health survey of a representative sample of elderly Canadians. Other Canadian surveys from the same era provided equivalent figures, and the present report compares the results of 6 surveys on a variety of health indicators. Agreement was close on self-reported chronic health conditions, adequate for several indicators of functional limitation, but was lower for overall self-ratings of the impact of health problems on day-to-day life. Using the CSHA data to compare alternative operational definitions of frailty, a definition based on ADL limitations appeared to offer an underestimate; addition of IADL questions or cognitive limitations provided figures that appeared more plausible. Survey estimates of chronic health conditions appear consistent, as are estimates of certain ADL disabilities. Care must be taken with interpreting more subjective reports, while prevalence of frailty varies considerably according to the definition used.

The Canadian Study of Health and Aging (CSHA) and the National Population Health Survey (NPHS) collected data on the prevalence of dementia in differing fashions. The CSHA used a two-stage method with objective testing and expert judgment, and the NPHS used self-report and proxy data. The present report compares estimates of prevalence and the methodology for ascertainment in the two surveys. The more detailed approach of the CSHA offers the more valid means of estimating prevalence and providing data on subtypes, and can be used in natural history studies. The NPHS measures, including a self/proxy report of diagnosed dementia and a derived cognitive measure, are not sufficiently valid for useful inferences to be made. However, the NPHS method can be improved through supplementation with data on functional disability, providing age group-specific point estimates closer to the CSHA's estimates of cognitive impairment and dementia from the community sample. Future waves of the NPHS may wish to include objective cognitive function measures as a cost-efficient and more accurate method of estimating the prevalence of the dementia syndrome without attempting to estimate the prevalence of particular causes of that syndrome.