Directly funded (DF) home care provides funding to home care recipients to coordinate their own care and supports, and is available across all Canadian provinces. Current research on DF home care focuses on the experiences of adults with disabilities self-directing their own care, but less is known about the experiences of family members managing services for adults 55 years of age and older. This article presents findings from a qualitative analysis of 24 semi-structured interviews with older adults and caregivers using the DF program in Manitoba, Canada, focusing on family manager experiences. We identify three themes in the interview data: (1) DF home care enhances choice and flexibility for older people and their caregivers, (2) choice and flexibility reduce caregiver strain, and (3) agency services reduce administrative burden. We discuss the importance of care relationships and the role of family managers. We recommend that traditional home care systems learn from DF, and that increased administrative support would reduce caregiver strain.

We aimed to determine protective factors distinguishing octogenarians with multiple sclerosis (MS) living at home from others their age and younger people with MS. Data from MS octogenarians (n = 23) and a matched group of MS young-old respondents (n = 61) were extracted from a Canadian MS aging survey. The MS groups were compared, along with a group of octogenarians from the general population, using national statistics. MS octogenarians lived with greater disability and higher prevalence of mood disorders but were more physically active than Canadian octogenarians without MS. MS octogenarians reported less stress and fatigue than the MS young-old group, and despite being more than a decade older, they reported similar levels of social support, financial flexibility, physical disability, and participation. Even when challenged by MS, maintenance of strong supports (social and financial), positive attitude, and participation in physical activity and life roles may contribute to aging in 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.

Data from the 1986/87 Health and Activity Limitation Survey (HALS) were used to examine the relationship between reported disabilities and institutionalization. Odds ratios obtained through logistic regression analyses were utilized to estimate the strength and direction of the associations between the various disabilities, age, gender, and institutionalization. An analysis of types and combinations of disabilities which are most strongly associated with institutionalization indicate that persons with disabilities regarding agility, mental functioning or speech have higher odds of institutionalization. The analyses of the relationship between number of disabilities and institutionalization suggest an exponential relationship, a greater rate of institutionalization with age and a higher rate for women than for men.

Past studies of aging and disability have been restricted to and by cross-sectional data. When cross-sectional surveys measure income, disability status and age at a common point in time, it is impossible to discern the process, and consequences, of a disability onset. In other words, it is not possible to examine the circumstances of the same individuals before, and after, the disability onset; nor whether effects differ according to the age at which the disability occurs. The present study uses a new panel data set, the Survey of Labour and Income Dynamics (SLID), to examine the prevalence of disability with respect to age, gender, and other socio-economic characteristics; however, its unique contribution is its investigation of disability onset, and the rates of entry into, and exit from, disability status by age group and gender. Further, we assess the financial circumstances of those who become disabled vis-à-vis a “control group”.

The Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of attempting to minimize excess disability while anticipating the progressive functional decline associated with AD. It is suggested that times of functional transition are times of decision making and opportunities for interdisciplinary collaboration to identify and minimize excess disability, for revision of goals and expectations, and for provision of support to patients and caregivers. The model also is applicable as a conceptual framework for education and research.

This paper argues that fear of aging can more precisely be recognized as a fear of disability and that fear of disability can be centrally understood as a fear of dependence. Accordingly, we are not likely to see old people being treated as important members of society until we see a change in attitudes towards disability. The argument is developed with reference to a consideration of attitudes toward and treatment of elders and people with disabilities, a consideration of the social construction of dependency, and an examination of statistics on the Canadian population of people with disabilities. The ubiquity of disability across all age groups means that there needs to be a re-conceptualization of disability as part of the human experience.

This research compared older adults' use of medical assistive devices (ADs) with their use of everyday ADs as a means of managing chronic physical disability. The study also examined whether predisposing, need, and enabling factors were associated with device use in three domains of activity: personal care / in-home mobility, household activities, and community mobility. Participants were 248 adults, aged 55 years and older, with a wide range of disability levels as a result of osteoarthritis. All participants were administered an in-depth, structured questionnaire, as part of a larger study examining older adults' independence and adaptation to chronic physical illness. The results revealed that respondents actively adapted to their disabilities and used a wide range of medical and everyday devices, with everyday devices being reported more than twice as often as medical ADs and the fewest devices overall being reported for community mobility. In general, medical devices were used when subjective and objective need for ADs was considerable. Everyday devices were reported earlier in the trajectory of the disease, at mild and moderate disability levels, and were associated with a broader pattern of adaptation that included planning to avoid problems, exercise, and pacing activities.

Older adults are the largest group of wheelchair users yet there are no peer-reviewed studies on the national profile of older wheelchair users in Canada. We investigated the characteristics of wheelchair users in a national sample of community-dwelling older adults from the Canadian Study of Health and Aging (CSHA-2). Questions on the use of assistive technology were asked of 5395 Canadians (over 64), and 4.6 per cent reported using a wheelchair. Logistic regression was used to model the factors associated with wheelchair use. Controlling for age, gender, and cognitive impairment, older adults who reported greater dependence in basic self-care and instrumental activities of daily living were more likely to use a wheelchair. However, the effects of self-care dependence on wheelchair use varied by gender, with men more likely than women to use wheelchairs with increasing self-care dependence. The number of chronic health conditions and being unmarried also increased the odds of wheelchair use. This paper quantifies the risk of wheelchair use according to critical factors that can be used to project use and plan for services.

The data reported in this paper were collected as part of the Canadian Study of Health and Aging. The core study was funded by the Seniors' Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC[S]). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417–302[R]), Bayer Incorporated, and the British Columbia Health Research Foundation (projects no. 38[93-2] and no. 34[96-1]). The study was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. Additional funds for the preparation of this manuscript were made available from the Opportunities Fund of the M-THAC Research Unit (from Medicare to Home and Community) at the University of Toronto, and from a post-doctoral fellowship awarded to the first author by the Social Sciences and Humanities Research Council of Canada.

While the physical correlates of knee osteoarthritis are well documented, less well documented are aspects of psychological functioning that may affect overall health and functional status. This paper describes the findings of a cross-sectional analysis that examined the strength of the relationship between selected psychological factors and the walking ability of adults with knee joint osteoarthritis. The variables assessed were pain, depression, levels of self-efficacy for pain and other-symptoms management, walking endurance, walking speed, and perceived exertion when walking. The sample, including 57 persons with unilateral and 43 persons with bilateral radiographic and symptomatic knee osteoarthritis, mean age, 69.9 ± 1 years, underwent standard assessment procedures on a single test occasion using several validated questionnaires and a series of walking tests on level ground. Bivariate and multiple regression analyses revealed that (a) higher pain and other-symptoms self-efficacy scores were associated with lower levels of pain (r = −0.29, −0.20.), perceived exertion during a walking task (r = −0.29, −0.31), and depression scores (r = −0.46, −0.54) (p < 0.001); (b) subjects with higher levels of self-efficacy for managing symptoms other than pain also recorded faster and fast speed walking velocities than those with lower self-efficacy scores (r = 0.30, 0.31) (p < 0.001); (c) self-efficacy for pain was the strongest predictor of pain intensity, and self-efficacy for symptom management was the strongest predictor of perceived exertion during walking, depression, and pain self-efficacy. Although no cause–effect relationship can be deduced from a cross-sectional analysis, these data imply that efforts to heighten self-efficacy for pain and other-symptoms management may influence the affective status, function, and effort-related perceptions of people with knee osteoarthritis quite significantly.