This article focusses on the likelihood of senior centre participation, the frequency of attendance among participants, changes in use/non-use over a four-year period, and associated characteristics. The data are from a longitudinal study conducted in Winnipeg and eight smaller Manitoba communities, with 1,399 individuals aged 65 and older interviewed in 1991/92 and 956 re-interviewed in 1995. About one in five individuals attended a senior centre in the six months prior to the interview, with a wide range among participants in the number of visits. Only 8 per cent joined a senior centre and 13 per cent ceased their participation over the four years. The influence of socio-demographic characteristics, health status, and social integration varied depending on the measure of participation and according to place of residence. Social factors, such as living arrangement, tended to be more important than health status. Directions for future research are discussed.

As the population ages, interest is increasing in studying aging well. However, more refined means of examining predictors of biopsychosocial conceptualizations of successful aging (SA) are required. Existing evidence of the relationship between early-life education and later-life SA is unclear. The Successful Aging Index (SAI) was mapped onto the Cognitive Function and Aging Study (CFAS), a longitudinal population-based cohort (n = 1,141). SAI scores were examined using growth mixture modelling (GMM) to identify SA trajectories. Unadjusted and adjusted (age, sex, occupational status) ordinal logistic regressions were conducted to examine the association between trajectory membership and education level. GMM identified a three-class model, capturing high, moderate, and low functioning trajectories. Adjusted ordinal logistic regression models indicated that individuals in higher SAI classes were significantly more likely to have higher educational attainment than individuals in the lower SAI classes. These results provide evidence of a life course link between education and SA.

Although Canadian Medicare gives the population “reasonable” access” to all “medically necessary” physician and hospital services, long-term care is not formally subject to those conditions. In Ontario, long-term care involves a “patchwork quilt” of government, charitable, for-profit, and personally-provided services; an ongoing consultation has been under way in an attempt to rationalize service financing and provision. This paper reviews the series of policy proposals and the accompanying public consultation processes. It concludes that the emphasis on “community involvement” without a clear definition of “community” or the goals of participation has paradoxically increased the “scope of conflict,” increased frustration among stakeholders, and made policy action more difficult.

Spousal caregivers are the most vulnerable of all caregivers to the stresses associated with the caregiving role, yet they are the least likely of all caregivers to utilize formal support services. This low use of services is poorly understood. To develop insight into this issue, this qualitative study explored how spousal caregivers made sense of the personal experience of living with a memory-impaired partner. The goal was to better understand the interface between this personal experience and the use of formal support services. Information was gathered through the use of unstructured interviews with 14 spouses, most of whom had turned down available formal support services. Analysis of their transcripts revealed the availability of four discourses, or story-lines, for framing the experience. These included two competing story-lines which were used to structure individuals' caring activities and two other competing story-lines which provided the framework for judging one's personal competence within the experience. This paper examines these four discourses and highlights how each influences the meaning associated with the use of formal support services. This analysis makes visible the multiple and sometimes contradictory meanings that service use may have for spouses caring for a memory-impaired partner.

Preparing for the future housing needs of older adults is imperative in countries with an aging population, but little is known about these issues among vulnerable older adults. This study used a qualitative approach to identify key housing concerns in this group. A total of 84 vulnerable older adults including Aboriginal elders, those with various disabilities, and ethnic minorities participated in 10 focus groups. The Canadian Mortgage and Housing Corporation’s (CMHC’s) standards of core housing need provided a framework for data analysis, along with the identification of additional key housing themes across and within groups of vulnerable older adults. The results provide insight into preferred housing characteristics, regardless of housing form. Additionally, the results provide insight into how to support vulnerable older adults who choose to remain in their homes and communities and how to help ensure that appropriate housing is developed that meets the needs of this diverse population.

Restorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six “wait-list” facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.

Drawing on the intergenerational stake hypothesis (Bengtson and Kuypers, 1971), this article explores intergenerational congruence and incongruence on filial obligation, and implications for social support, between older nisei (second generation) parents and adult sansei (third generation) children in Japanese Canadian families. Using data from semi-structured interviews with 100 parent–child dyads in British Columbia, congruence on close-ended responses to value statements (degree congruence) and the content congruence of open-ended responses are examined. The findings show the majority of parent-child dyads indicate overall (both degree and content) congruence in filial obligation, especially when a parent is female, widowed, and/or has poor/fair health status. We conclude that despite markedly different historical life course experiences and acculturation processes, both generations continue to regard filial obligation as important. These findings are discussed with respect to implications for social support exchanges given a continued valuation of filial obligation in Asian post-immigrant (North American-born) and immigrant families.

This study advances the understanding of family caregiving by examining the relationship between adult children caregivers and their helpers. Specifically, it focuses on examining “who helps whom” and extends analyses beyond the dyadic focus of caregiving in later life. The focus on helping and caregiving addresses the variety of contributions and responsibilities involving not only the caregiver who was the target respondent in this research, but also others identified as helpers in the provision of care.

The data for this study are derived from the Work and Eldercare Research group of CARNET: The Canadian Aging Research Network. Secondary analysis of CARNET data focuses on data collected from 250 individuals with significant caregiving responsibilities for at least one older person. Findings extend Kahn & Antonucci's convoys of social support model (1981) and Cantor's model of social care (1991) by disentangling some of the dimensions of helping and caregiving, such as the distinction between direct and assistive help.

A sample of frail older adults (65 years and over) living at home or institutionalized (n = 664) with a significant functional limitation was used to document predisposing and facilitating factors of severe psychological distress among frail elderly adults. Our results indicated that 48.2 per cent of the older adults living at home presented severe psychological distress symptoms, compared to 34.3 per cent of elderly adults living in institutions. The probability of reporting a severe level of psychological distress was associated with the respondents' social support, cognitive and functional status. When the respondents' cognitive and functional status were controlled, no evidence of a significant association was found between the respondents' age, gender, marital status, education or income and the level of their psychological distress symptoms. Our results showed that 77.9 per cent of the respondents with severe psychological distress symptoms were still severely distressed 12 months after their first interview. Findings suggest that severe psychological distress represents an important challenge for practitioners in gerontology and geriatrics. It is suggested that other studies focusing on the consequences of psychological distress on older adults' quality of life, functional decline, institutionalization and mortality may help document the gravity of this symptomatology in the elderly population.

This survey assessed the extent of and satisfaction with collaboration between physicians and nurse practitioners (NPs) working in Ontario long-term care homes. Questionnaires, which included the Measure of Current Collaboration and Provider Satisfaction with Current Collaboration instruments, were mailed to NPs and physicians with whom the NP most frequently worked. The 14 matched-pairs of NPs and physicians reported similar levels of collaboration; however, physicians were significantly more satisfied with collaboration than were NPs (z = -2.67, p = 0.008). The majority of physicians (85%) and NPs (86%) indicated that collaboration was occurring, and 96 per cent of physicians and 79 per cent of NPs were satisfied with their collaboration. About one third of physicians reported that the NP had a negative effect on their income, but their satisfaction with collaboration did not differ from those who reported a positive effect. Overall, these physicians and NPs collaborate in delivering care and are satisfied with their collaboration.

Objectives: Are people 75 or over enabled to stay at home longer through annual assessments and referrals to health/social services than through assessments only or without assessments?

Design: randomized controlled trial

Participants: 520 people 75 or over living in their own homes

Intervention: Four annual RAI-HC computerized functional assessments. Intervention group 1: elders and primary caregivers received the results and were invited to take appropriate actions. Intervention group 2: elders and primary caregivers were offered referrals to health/social services.

Measurements/Outcomes: death, institutionalization, home care services, RAI-HC scores, self-rated health, perceived self-efficacy, caregiver burden

Results: By the end of the study, annual functional assessment and offers of referrals to health/social services led to a greater use of home care (6.3%) than did assessment alone (1.8%), but there were no significant differences in death rates, institutionalization, perceived self-efficacy, self-rated health status, or caregiver burden scores between groups.

Conclusion: We discovered that this was a group of healthy seniors. Multi-dimensional functional assessment is time- and labour-intensive and should be targeted at the minority of least self-reliant seniors.

Despite the fact that Meals-on-Wheels have both nutritional and social aspects, research on the social objectives of the service is lacking. This study set out to develop an understanding of the social objectives of Meals-on-Wheels and to explore the extent to which they are met by Ireland’s Meals-on-Wheels services. A literature review suggested that Meals-on-Wheels services can potentially meet three social objectives: (a) providing meals recipients with social contact, (b) helping to restimulate an interest in meals and regularising mealtimes, and (c) helping to develop acceptance of the service. Interviews were conducted with 66 meals recipients to explore these themes and augment them as necessary. Study results show that meals recipients derive limited social contact from the service; regularising mealtimes was not important to most recipients; and many were reluctant to accept the service. The three objectives are therefore minimally met within the Irish system at present.

Using data from the 2001 Census Public Use Microdata Files on Individuals, we examine the role of cultural preferences and economic constraints in elderly Canadians’ choice of living arrangements (living with one’s children and/or other relatives versus living independently). We find that members of ethnic groups holding familistic cultural values (Italian, Chinese, South Asian, and East Indian) are more likely than their individualistic counterparts (British, German, and Dutch) to live with kin. Economic disadvantage also entails a greater likelihood of living with kin. However, the relative importance of cultural preferences and economic constraints as determinants of living arrangements among the elderly depends on marital status. Among the married, cultural preferences explain a greater proportion of the variation in living arrangements; among the non-married, economic constraints do. This research contributes a more nuanced understanding of living arrangements among the elderly than its predecessors, which neglected the role of marital status.

The opening of a new Special Care Unit provided the opportunity to study the effect of reduced social density (fewer residents) and spatial density (more area per person) on the behaviour of residents with dementia. Two groups (N = 64) were observed at three periods spaced six months apart. As hypothesized, there was a greater improvement in Disruptive and Nondisruptive behaviour in the experimental group (move from high to low density) compared to the comparison group (constant high density). Findings suggest that unit density is an important determinant of behaviour in elderly residents with dementia.

In many countries one approach to supporting family-and-friend caregivers is direct financial or monetary support. Debates about the benefits and consequences of such policies pervade the literature. Building on the premise that values underlie public policy, the paper examines four policy paradoxes in the literature and uses selected examples from an international policy analysis to illustrate the underlying objectives and values upon which many of the policies were developed. These include the responsibility to care, economic or social objectives, gender equity, and the autonomy of care receivers. The authors conclude that policy makers need to be cautious about the unintended effects of financial support policy and develop a menu of policies and services to support caregivers. Future policy development in Canada must enable legitimate choice across the life course and ensure that neither the caregiver nor the care receiver will experience short- or long-term financial consequences of his or her choice.

Routinely-collected administrative data and Cox's proportional hazards models are used to compare outcomes of care while controlling for age, sex and dependency level. The results indicate that the overall quality of nursing home care in Manitoba is good but that residents in certain regions and in certain types of nursing homes have specific outcomes that are poorer than others. These outcome indicators must not be treated as definitive signs of poorer care but as “triggers” suggesting a need for a closer look because the methodology and outcomes used in this study are still in the experimental stage. The results also indicate that secondary data provide a relatively inexpensive starting point for evaluating outcomes of nursing home care.

Two challenges facing nursing-home care today are understanding the concept of quality of life as it relates to cognitively impaired residents and finding effective ways to ensure that it is achieved. Canadian director Allan King's documentary, Memory for Max, Claire, Ida and Company, filmed at Baycrest, captures a method for enhancing the quality of life of six cognitively impaired residents. While the film suggests an intervention model implemented by volunteers, there are challenges unique to institution-based programs (i.e., the recruitment and retention of volunteers). One of the challenges is the fear that volunteers may experience when interacting with the cognitively impaired. We conducted a pilot study of a model for training volunteers to provide friendly visiting and evaluated the impact on the participating residents. Observational accounts of volunteer–resident interactions and seven volunteer interviews were analysed and yielded several themes—(a) relationship building, (b) contribution of the environment, (c) preserving personhood, (d) resident-centred presence and the quality of the moment—and several themes related to the volunteers' role and their perceived impact on the residents. Discussed are the implications for volunteer programs in long-term health care settings.

Attitudes toward elder abuse differ with age, ethnicity, profession, and training. This article introduces a threshold model in order to reconcile findings on attitudinal differences within a unifying theoretical framework. The model assumes that individuals rate the abusiveness using consistent standards but different thresholds. Predictions from the model include consistency among individuals in their ratings of different behaviours (i.e., high relative consistency), but variation in the levels of rating (i.e., systematic departures from absolute consistency).

Samples of 339 seniors and 233 professionals rated 112 items representing a wide range of abuse severity. The findings suggested high relative consistency but systematic deviations from absolute consistency, with higher ratings (i.e., lower thresholds) by professionals than seniors, and by residents of smaller (rural) rather than larger (urban) communities. The implications of the threshold model include prevention through elder-abuse education and reporting practices.

Substance use patterns and predictors of substance use by women aged 65 and over were examined using data from the Canadian National Alcohol and Other Drugs Survey (1989). Use patterns were consistent with findings from previous surveys: that older women drink less alcohol, smoke less and use less illicit drugs than other age-gender groups. Also consistent with previous surveys, older women reported the highest rate of psychoactive prescription drug use of all groups. Bivariate analyses indicated significant relationships between some social and demographic variables and substance use. Drinking was associated with being single, younger, not religious, in better health, and smoking. Smoking was associated with being younger, not religious, in poorer health, having less social support, drinking, and use of psychoactive prescription drugs. Use of psychoactive prescription drugs (especially sleeping pills) tended to be associated with being widowed, older, less educated, more religious, in poorer health, experiencing higher stress, having lower income and less social support, smoking, and use of other psychoactive prescription drugs. When data were analysed using principal component analysis, two very consistent dimensions of substance use emerged for older women: greater religiosity associated with less drinking and smoking, and a dimension involving use of all types of psychoactive prescription drugs. These findings are discussed in terms of projected use patterns for future older women and the need for a better understanding of the social context of older women's substance use that involves light to moderate alcohol use but a higher rate of use of psychoactive prescription drugs than other age-gender groups.

This study was devised to determine the effectiveness of a pretherapy training procedure in enhancing group cognitive therapy for depressed older adults. Twenty-nine subjects were randomly assigned to a pretherapy training condition or an attention-placebo control condition. Subjects were 65 years of age or older, had a score of 14 or higher on the Beck Depression Inventory or on the Geriatric Depression Scale, and had no previous experience in psychotherapy. The pretherapy training procedure was based on Bandura's social cognitive theory and included verbal persuasion, vicarious experience, and performance accomplishment. The pretherapy training improved knowledge about psychotherapy and promoted the development of a problem-oriented focus in therapy. However it was unsuccessful in significantly reducing dropouts, increasing attendance, modifying role expectancies in the expected direction, and differentially affecting the outcome of cognitive therapy. For the experimental and control conditions taken together, 53.7 per cent of the subjects demonstrated clinically significant improvement at the end of therapy. Implications for research and clinical practice are discussed.