Many patients, particularly older patients, interact with multiple providers while accessing health care services in a variety of different settings over extended periods of time. Understanding older patients’ experiences of their journeys through the health system is critical to improving service integration and quality of care. In this study, we have summarized the experiences of four patients living with chronic obstructive pulmonary disease as they interacted with the health care system over a three-month period following hospital discharge. Guided by case study methodology, we gathered data through semi-structured interviews and patient logs. Three overarching themes – social support, system navigation, and access – emerged from the data. Attending to provider-patient and provider-provider communication, and to patient social support and self-care needs, could improve integration and care outcomes. Achieving what patients perceive as an integrated and effective system will require time and commitment.

Community-dwelling seniors increasingly require physical assistance to perform the activities of daily living (ADL). To examine the possible association of this need with psychological distress, we conducted a prospective cohort study of community-dwelling people age 75 and older in Montreal, Canada. We report the results for women only (n = 530). Multivariable linear regression was used to examine the association between met and unmet need in instrumental ADL (IADL) and personal ADL (PADL) with concomitant psychological distress. Unmet IADL need was associated with elevated psychological distress [β = 0.42 (95% CI: 0.26, 0.60)], as was met IADL need [β = 0.19 (95% CI: 0.06, 0.33)], but not met and unmet PADL need. The full model explained 32.8 per cent of the total variance in psychological distress. Receiving assistance to meet IADL needs is associated with elevated psychological distress. Not receiving assistance, however, is associated with even greater distress.

This study used van Dijk’s critical-discourse approach to explore the current societal discourse on hope and to explore the hope of older terminally ill cancer patients, their significant others and primary nurse. Forty-three newspaper articles dealing with hope and cancer were collected and analyzed to explore how hope is socially constructed by print media. Individual face-to-face, qualitative, open-ended interviews were conducted with three triads, each consisting of an older palliative cancer patient, a significant other, and a primary nurse. The predominant discourse of hope and cancer in the newspaper articles was considered ageist, conveying the message that only one legitimate hope existed for persons with cancer: hope for a cure. The study findings suggested that this message caused confusion and distress for the patients, significant others, and their primary nurses because their own discourses of hope were focused on comfort, peace, and maintaining relationships at the end of life.

This study reports on a population of Anglophone Canadian seasonal migrants to Florida. Surveys were mailed to 4,500 subscribers to Canada News, a Florida-based weekly paper, and were completed by 61% of the respondents. The descriptive profile reveals younger-old, healthy, married, home owners of moderate income who stay in Fionda for six months, but communicate regularly with their Canadian family. They utilize no social services in Florida, are satisfied with life and with their Florida health care experiences, but take various precautionary health care measures prior to leaving Canada. Their Florida visits will continue, moderated more by the exchange rate than health concerns. These data will be discussed relative to policy issues for Florida and Canada.

Cet article explore la satisfaction de la vie de 81 personnes âgées, sélectionnées au hasard (58 femmes et 23 hommes; âge moyen 76), d'origine chinoise et provenant de l'ouest du Canada. La variable dépendante, la satisfaction de la vie, a été mesurée en utilisant le «Life Satisfaction Index-A (LSI-A)» et une mesure globale à une seule question. Les résultats ont indiqué que la plupart des personnes âgées, immigrants d'origine chinoise faisant partie de cette étude, étaient plutôt satisfaites de leur vie et ont obtenu des résultats élevés en utilisant la mesure LSI-A. Niveau d'activité, santé psychologique, supports sociaux, amour propre, et le sens d'être en charge d'eux-mêmes étaient significativement associés avec les deux mesures de satisfaction. L'analyse de regression multiple révèle que la santé psychologique, le soutien social et le sens d'être en charge d'eux-mêmes étaient les meilleurs prédicteurs. Concernant la satisfaction de la vie, tant pour hommes que pour les femmes, il n'y avait pour ainsi dire aucune différence. D'autres analyses ont examinés les corrélate de la satisfaction de la vie des répondants des deux sexes. Les moyens d'améliorer la satisfaction de la vie de cette minorité ethnique sont le point d'intérêt de la discussion.

This article uses the concept of continuity of care to examine the implications of health-system restructuring for workers and staff in the BC home support system. Home support primarily serves frail seniors living in poverty and has the potential to provide assistance with tasks like bathing, dressing, and toileting, as well as offer social support and relational care to isolated clients. Through presentation of qualitative data from focus groups and interviews with home support workers and clients in the Greater Vancouver area, we demonstrate how the casualization and intensification of work in a context of increasing client acuity levels has diminished both continuity and quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, and compromised quality.

This study aimed at identifying the factors associated with caregivers' use of three community services (day care centre, attendant care at home and home help), and those associated with caregivers' nonuse of these services due to a perceived barrier. The sample consisted of primary caregivers (n = 265) cohabiting with a demented relative. Using polychotomous nominal logistic regression analyses, a group of users and of nonusers perceiving a barrier was contrasted with a group of nonusers reporting no need for these services. Across the three services, under high relatives' needs (high ADL impairments or frequent dysfunctional behaviours), caregivers with high psychological distress, compared to those with low psychological distress, were more likely to be nonusers reporting no need for a service than to be users or nonusers due to a barrier, suggesting that psychological distress may impede service utilization, despite a relative's high needs. Vulnerability factors (caring for a relative with frequent dysfunctional behaviours or experiencing high psychological distress and caring for a relative with low ADL impairments) were associated with the use of day care centre or attendant care. These factors were also associated with nonuse due to a barrier, meaning that some caregivers with the same characteristics of vulnerability did not draw on these two services. In addition, caregivers with less informal support who were caring for a relative with high ADL impairments were more likely to be nonusers perceiving a barrier to attendant care.

An aging population and immigration-based population growth necessitate research, practice, and policy focusing on the mental health of older immigrants in Canada, especially, because their mental health appears to deteriorate over time. This review focuses on: What is known about the social determinants of mental health for older immigrants in Canada and what are the barriers they face in accessing mental health services? Findings reveal that: (1) the key social determinants of mental health are culture, health services and gender; (2) older immigrants use fewer mental health services than their Canadian-born counterparts due to cultural beliefs, lack of culturally and linguistically-appropriate services, financial difficulties, and ageism; and (3) regardless of the subcategories within this population, older immigrants experience mental health inequities. The research evidence provides a clear message that addressing mental health service gaps for older immigrants should be a policy and practice priority for Canada’s health care system.

The purpose of this exploratory, phenomenological-hermeneutic study was to explore the experience of non-problem gambling by older adults. Twelve older gamblers were identified as non-problem gamblers using two gambling screens and participated in in-depth interviews about their experience of gambling. Two major themes emerged from the interviews: the attractions of gambling and methods to keep gambling in control. Older persons sought out gambling for a variety of reasons: social contact, the food and the excitement, chances to give to charity, chances to have an inexpensive holiday, and the need for a safe way to be “bad”. Participants also described a number of cognitive and behavioural strategies to keep their gambling from becoming a problem. The results of this small exploratory study suggest that gambling is a popular form of social entertainment for older persons, although the main attractions of gambling have little or nothing to do with gambling itself. Older persons also appear to possess numerous strategies to keep gambling from becoming a problem.

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD).

Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population.

Methods: This study was guided by the research question: “What are the care needs and care priorities of senior citizens with end-stage COPD?” An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006.

Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others.

Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

Pregraduate students (N = 144) used a modified version of the Treatment Evaluation Inventory (TEI; Kazdin, 1980a) to rate the acceptability of one of three treatments for depression (cognitive therapy, cognitive bibliotherapy, and antidepressant medication) for one of three cases of a depressed elderly person (mild, moderate or severe symptoms). Factorial analysis of the modified version of the TEI revealed two factors (treatment acceptability and negative aspects) which accounted for 72.8 per cent of the total variance. The modified TEI was shown to possess good concurrent validity as well as good internal consistency and test-retest reliability. Subjects rated all treatments as equally acceptable, and treatments were judged more acceptable for mild to moderate symptoms.

The legalization of medical assistance in dying (MAID) in Canada has presented an opportunity for physicians, policy makers, and patients to rethink end-of-life care. This article reviews the key features of the Alberta MAID framework and puts it in the context of other provinces and their MAID programs. We also compared policies and MAID practices in different provinces/territories of Canada. In addition, we used the Alberta MAID database to provide the current state of patient demographics and access to MAID services in Alberta in 2017–2018. Significant differences were identified between provincial/territorial MAID program processes and practices. Alberta, Ontario, and Quebec have more comprehensive frameworks. Alberta has dedicated resources to the support of MAID. The median age of those who received MAID service in Alberta from July 2017 to April 2018 was 70 years; a higher proportion were males (55%) and the majority included patients with a cancer diagnosis (70%). Approximately 39 per cent of MAID events happened in a hospital setting, and 38 per cent occurred in patients’ homes. We have presented some recommendations on MAID program development, implementation, and review based on Alberta’s experience with MAID over the past two years.

The present investigation represents a re-validation of the Memorial University of Newfoundland Scale of Happiness (MUNSH) and its Negative (NAS) and Positive Affect (PAS) subscales in an institutionalized sample of elderly urban residents. Self-ratings of happiness (AVHT) and judges' ratings (JR) were used as criterion measures. Correlations between MUNSH scales and AVHT ranged from 0.75 to 0.86, while those between MUNSH scales and JR fell between 0.37 and 0.55. The findings indicate that the MUNSH is as valid for residents of large urban centres as for the smaller centres in which it was initially developed.

This paper investigates several dimensions of the informal support network and well-being among widows and widowers. Using subsets of two random samples of older people living in Winnipeg, Manitoba collected in 1980, one group who were using home care services and another who were not. widowed men and women are contrasted on a number of support network variables, three indicators of well-being, and several socio-demographic and health-related variables. While significant differences arise in length of widowhood, functional ability and some components of the support network, no gender differences are found for the measures of well-being for either sample, even after introducing control variables. Implications for future research and practice are discussed.

This mixed-methods study evaluated the effect of a community-engaged arts program on the physical, emotional, and social well-being of seniors. Weekly workshops were offered over a three-year period at community centers where artists worked with four groups of seniors to produce a collective art piece or performance for public presentation. Participants completed pre- and post- questionnaires, and group interviews were conducted at the program’s end. Paired t-test analyses indicated that seniors experienced improvement in perceived overall health, experience of pain, and sense of community. Interpretive descriptive analysis of the group interviews revealed six themes that informed understanding : (1) providing structure and discipline; (2) facilitating coping; (3) requiring hard work and effort; (4) bringing out one’s artistic side; (5) promoting social involvement; and (6) making a contribution. These results are consistent with previous research and contribute to further understanding of how community-engaged arts can benefit the well-being of older people.

Within a neoliberal policy context that shifts responsibility for health and well-being from the state to families and individuals, Canadian home care strategies tend to present family members as “partners in care”. Drawing on an interpretive grounded theory study that involved 34 qualitative interviews, this article examines older people’s experiences at the intersections of formal home care and family/friend care arrangements, against the backdrop of policies that emphasize partnerships with family. The core concept derived from the interviews was reconciling tensions between care needs and concerns about burdening others, in the context of available home and community care. Four processes are identified, which illustrate how access to financial and social resources may lead to opportunities and constraints in experiences of care. Findings underscore the emotional and practical challenges that older people may encounter vis-à-vis policy discourses that encourage family responsibility for care. Implications for policy and practice are discussed.

L'objectif principal de cette recherche était de déterminer si les embêtements de la vie quotidienne sont plus fortement reliés au bien-être physique et psychologique chez les personnes âgées que les événements majeurs. Les modèles de prédiction du bien-être physique et psychologique ont été déterminés en fonction de la contribution des embêtements et des événements majeurs ainsi que d'autres variables incluant l'évaluation subjective de la santé. Deux cents personnes âgées ont rapporté les événements majeurs des trois dernières années et les embêtements survenus au cours du dernier mois. Les sujets ont également évalué leur état de santé et le degré d'incapacité dans les activités quotidiennes conséquente à chacune de leurs maladies chroniques. Des analyses de régression multiple par étapes ont montré que (1) l'évaluation subjective de la santé, l'incapacité dans les activités quotidiennes et la fréquence des embêtements sont reliées au bien-être physique et que (2) le bien-être psychologique est associé à la fréquence des embêtements, l'âge et l'incapacité dans les activités de la vie quotidienne. La fréquence des événements majeurs récents ne contribue pas significativement à l'un ou l'autre des modèles. Des résultats similaires ont été obtenus selon que l'Échelle des Embêtements ou seulement les items de cette échelle qui ne correspondent pas à des symptômes étaient utilisés dans les analyses de régression. Les résultats suggèrent que la fréquence des embêtements est plus fortement reliée au bien-être chez les personnes âgées que la fréquence des événements majeurs.

This study assessed the reliability and validity of the Activities Checklist (Reid & Ziegler, 1981) as well as its utility for predicting cognitive functioning in the elderly. Data were drawn from two longitudinal projects where elderly subjects had been tested on two occasions approximately five years apart. Test-retest reliabilities were .54 and .43 for the larger (N = 158) and smaller (N = 76) samples respectively. Validity was demonstrated by an age shift towards more passive activities and by positive correlations with education, occupational status, health and well-being. Weighted versions of activity scores were not superior to unweighted versions as predictors of cognitive functioning. For both samples activity levels significantly predicted performance on some cognitive measures. It was concluded that the Activities Checklist is a potentially useful instrument to employ in the study of individual differences in cognitive aging.

There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults’ perceptions of the term “frail”, and the implications of being classified as “frail”. The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.

Despite the extensive literature on the effects of relocation on the aged, most investigators have examined changes following relocation. Very little is known about the cognitions and emotions an older person experiences, or about the meaning of home during the pre-relocation period. The present study attempted to address these issues. Sixty-three older people awaiting relocation to age-segregated rent-subsidized apartment buildings were interviewed twice over a one year period: they received the PGC Multilevel Assessment Instrument as well as measures assessing coping strategies and their perceived meaning of home and relocation. Respondents did not demonstrate decrements on any domain of the PGC MAI over the year period; indeed, those who moved significantly increased their level of environmental satisfaction. Finally, participants reported dealing with stress by exercising personal control over, or actively manipulating, their environment; “home”, moreover, most often had meaning and importance because it was the place in which this personal control was optimized and ensured.