Based on self-determination theory, this study examined the relationship between leisure activities, motivation, and adjustment to institutional living by older adults who live in nursing homes. We hypothesized that motivational profiles with higher levels of self-determined motivation represent the optimal profiles regarding participation in leisure activities, adaptation to nursing home living, and satisfaction with life. Participants completed questionnaires assessing motivation, leisure activity participation, life satisfaction, and adaptation to the nursing home. Results showed a relationship between the latter three factors. A latent profile analysis based on the different forms of motivation indicated four distinct profiles. Although no differences were found between the high self-determined profile (high self-determined motivation and low non-self-determined motivation) and the additive profile (high self-determined motivation and non-self-determined motivation), participants with a moderate profile and a low self-determined profile reported the lowest levels in leisure activity participation, adaptation to the nursing home, and satisfaction with life.

Aspects of existentialism relevant to existence and death anxiety (DA) are discussed. Included are the “thrownness” of existence, being-with-others, the motivational influence of inevitable death, the search for meaning, making the most of existence by taking responsibility for one’s own life, and coping with existential isolation. The attempted separation of DA from object anxiety is a significant difficulty. The correlations among age, gender, and DA are variable. Personality and role-oriented problems in the transition to retirement are discussed along with Erikson’s notion of “generativity” as an expression of the energy and purpose of mid-life. Furthermore, methodological and linguistic problems in DA research are considered. The article suggests qualitative methodologies as an interpersonal means of exploring DA within the contexts of psychotherapy and counselling.

Shortly after the COVID-19 pandemic was declared, strict visitor restrictions were issued for long-term care facilities (LTCFs). A year later, restrictions are still in place and they continue to impact family members who have limited or no in-person contact with their relative in LTCFs. The goal of this qualitative longitudinal focused ethnography was to understand the experience of family members who have a relative in a LTCF where visiting has been restricted during the pandemic. Seventeen family members participated in two interviews that were 6 months apart. Data analysis highlighted five key drivers, defined as the workforce, communication deficits, characteristics of care, public health directives, and autonomy of relative which in turn resulted in three main themes: psychological distress, surveillance, and visiting challenges. This study provides a glimpse into the difficult experiences of families with a relative residing in a LTCF in the province of New Brunswick.

Growing demand for beds in government-subsidized long-term care (LTC) homes in Ontario is causing long waitlists, which must be absorbed by other residential alternatives, including unsubsidized retirement homes. This study compares Ontario’s LTC homes and retirement homes for care services provided, funding regimes, and implications of differential funding for seniors. Descriptive data for both types of homes were collected from public and proprietary sources regarding service offerings, availability, costs, and funding. Overlaps exist in the services of both LTC and retirement homes, particularly at higher levels of care. Although both sectors charge residents for accommodation, most care costs in LTC homes are publicly funded, whereas residents in retirement homes generally cover these expenses personally. Given waitlists in Ontario’s LTC homes, many seniors must find residential care elsewhere, including in retirement homes. Several policy alternatives exist that may serve to improve equity of access to seniors’ residential care.

This study examined how front-line home and community-care (H&CC) case managers view the role of informal caregivers, and the factors that contribute to H&CC managers’ resource allocation decisions. The study research used two methods of data collection: (a) secondary analysis of the results from balance of care (BoC) simulations conducted in nine regions of Ontario, and (b) in-depth follow-up interviews with participating BoC case managers. Results suggest that case managers unanimously agree that the unit of care in the H&CC sector is not confined to the individual, as in acute care, but encompasses both the individual and the caregiver. We found, however, considerable variation in the mix and volume of H&CC services recommended by case managers. We conclude that variability in decision making may reflect the lack of regulations, best practices, and accountability guidelines in the H&CC sector.

This study examined a cohort of 227 older drivers and investigated the relationship between performance on the electronic Driver Observation Schedule (eDOS) driving task and: (1) driver characteristics; (2) functional abilities; (3) perceptions of driving comfort and abilities; and (4) self-reported driving restrictions. Participants (male: 70%; age: M = 81.53 years, SD = 3.37 years) completed a series of functional ability measures and scales on perceived driving comfort, abilities, and driving restrictions from the Year 2 Candrive/Ozcandrive assessment protocol, along with an eDOS driving task. Observations of participants’ driving behaviours during the driving task were recorded for intersection negotiation, lane-changing, merging, low-speed maneuvers, and maneuver-free driving. eDOS driving task scores were high (M = 94.74; SD = 5.70) and significantly related to participants’ perceived driving abilities, reported frequency of driving in challenging situations, and number of driving restrictions. Future analyses will explore potential changes in driving task scores over time.

The Échelle d'adaptation de la personne âgée à sa résidence (ÉAPÂK) aims at identifying the elderly people experiencing difficulties of adjustment to their nursing homes. The validation of this scale was carried out on 37 women aged 65 to 97 living in a nursing home for three months and more. Participants answered ÉAPÂR twice at a one-week interval, The Échelle de dépression gériatrique, the Activités de la vie quotidienne section of the OAES and the Échelle de désirabilité sociale Marlowe-Crowne Form C were also administered in order to complete the validation process. The scale showed a test-retest reliability of 0.65 (p < 0.01), an internal consistency of a = 0.69 at time 1 and a construct validity with the Échelle de dépression gériatrique of -0.41 (p < 0.05). ÉAPÂR therefore does contribute to the identification of elderly women experiencing adjustment difficulties.

Sixty-five has long been used to define the beginning of “old age”. Yet it is clear that the definition is arbitrary, and with continuing reductions in mortality and morbidity rates it will become increasingly inappropriate as time passes. We consider how the definition might be modified to reflect changes in life table probabilities, and how the future numbers and proportions in “old age” would be affected. In a similar manner, we consider also the redefinition of the “oldest old” from a current definition of 85 and over.

Using event history data from the 1990 Canadian Family and Friends Survey, this study examines several factors that influence the likelihood of remarriage for women and men whose first marriages ended in widowhood. Our results suggest that large sex differences in remarriage exist, with ever-widowed men having appreciably higher rates than ever-widowed women. Remarriage rates are shown to vary by indicators of lifecycle and by socio-economic status. The implications of these results are discussed.

Several writers have suggested that there is an inverted U-curve of status or prestige across the lifespan in Western society. The old and the young are apparently accorded less status than persons in midlife, and women are seen as having less status than men.

In this study of 198 older individuals (mean age 67), the same inverted U-curve was found, but gender differences were very small. Much less extreme status ratings were given by this older sample than by the earlier samples of young adults. Also, status ratings were again mostly unaffected by respondents' characteristics such as age, sex, marital status, or social class. Older adults, therefore, seem to accept the broad cultural views of age stratification, but are slightly more egalitarian than the young.

This study assessed changes in older peoples' levels of perceived respect between the 1970s and the 1980s using data from the Aging in Manitoba Study. A longitudinal analysis was conducted for Manitobans, age 65 and over, who were interviewed in the mid 1970s and subsequently reinterviewed in the early 1980s. Changes in perceived respect scores for those who survived into the 1980s, and who provided ratings at both interviews (n = 776), were assessed in a repeated measures ANOVA. Significant increases were found in the mean level of respect for some ethnic groups, namely for the British, French, and German. A subsequent analysis indicated that the reported improvements in perceived respect could not be explained by participation in the study. These results may suggest that over the decade, the social climate of the elderly population in Manitoba has improved, at least for some ethnic groups.

This systematic overview summarizes the published literature reflecting the effectiveness of services or models of care for persons with dementia living in their homes, in specialized institutional care or assisted living centres/congregate homes. A detailed search for literature found studies evaluating respite care, day programs, counselling, congregate living, and special care units in institutions and there is some evidence of the effectiveness of these programs. No scientifically rigorous effectiveness studies, specific for persons with dementia, were found for hospice care, case management or psychogeriatric outreach mental health programs. First and foremost, more research is needed that examines the effectiveness of different programs for specific persons and their caregivers with different characteristics and the measurement of family expenditures as well as costs of programs.

This mixed-methods study identified the personal and workplace characteristics that drive the job satisfaction of home support workers (HSWs) providing assistance to elderly clients. Data were based on a standardized measure of job satisfaction, along with in-depth qualitative interviews with 176 home support workers from three Canadian provincial jurisdictions (British Columbia, n = 108; Ontario, n = 28; Nova Scotia, n = 40). We anticipated that variability in demographic profiles between the three groups of workers and different job descriptions would be associated with differences in perceived job satisfaction. This was not the case. Results from the qualitative analysis highlight key areas that contributed to job satisfaction. These are job (scheduling, travel, and safety), economic (income security), and organizational (communication, support, and respect) factors. Given these findings, we recommend improvements to workplace communication, increased travel time allowance between clients, and wage parity with equivalent positions in long-term care facilities.

Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA–family relationships in complex continuing care (CCC). In-depth individual interviews with eight HCAs and a follow-up focus group with HCAs from three CCC facilities were analysed. Building relationships with families entailed “being there for them and their relatives”, while maintaining relationships involved “dealing with disappointments”. Factors influencing building and maintaining HCA–family relationships included “having supportive team members”, “having resources available”, and “functioning within care-team hierarchies”. The findings highlight the importance of minimizing the unit and organizational factors that disrupt HCA–family relationships.

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.

Previous studies in this series of papers investigated the associations between aluminum (Al) water concentrations and relatively high risks of a measure of mental impairment and also various possible other drinking water characteristics, particularly pH, turbidity, fluoride and silica. The results were based on one measure of mental impairment, which would not be expected to give the same results as the more definitive endpoint (outcome variable) of a record of Alzheimer's Disease (AD) as the underlying cause of death on a death certificate. The present paper therefore investigates the relevant associations, based both on the measure of mental impairment and on death certificates in which AD and presenile dementia are listed as the underlying causes of death. As expected, the associations were not identical, but they were similar. More specifically, Al water concentrations were strongly associated with the recording of AD on death certificates, as were pH, fluoride, and silica concentrations. The implications of these results are discussed, and it is suggested that the evidence is sufficiently strong for methods of water purification to be modified, at least on a trial basis, because of the likelihood that this will reduce the incidence of AD.

There is increasing recognition that using assistive devices can support healthy aging. Minimizing discomfort and loss of function and increasing independence can have a substantial impact physically, psychologically, and financially on persons with functional impairments and resulting activity limitations, as well as on caregivers and communities. However, it remains unclear who uses assistive devices and how device use can influence social participation. The current analysis used CLSA baseline data from 51,338 older adults between the ages of 45 and 85. Measures of socio-demographic, health, and social characteristics were analyzed by sex and age groups. Weighted cross-tabulations were used to report correlations between independent variables and assistive device use for hearing, vision, and mobility. We found that assistive device use was higher among those who were of older age, had less education, were widowed, had lower income, and had poorer health. Assistive devices were used differently according to sex and social participation, providing insight into assistive device use for the well-being of older adults and their families.

This research pertained to personal goals during retirement and especially to the influence of tenacity and flexibility on measures of psychological well-being. The participants (N = 147) had been retired for less than three years and were aged between 49 and 75 years (M = 58 years). The participants had to identify four personal goals and rate each of them along 15 dimensions. Psychological well-being was evaluated with scales of depression, self-esteem and life satisfaction. Regression analyses showed that flexibility in the presence of obstacles to the realization of goals accounts for 44 per cent of the variance in depression, 29 per cent of life satisfaction and 25 per cent of self-esteem. Tenacity had a more modest impact. Flexibility seems to be the strategy which is most useful in facing difficulties in the pursuit of goals during retirement.

Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First – Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.

The purpose of this study was to investigate the phenomenon of spousal caregiving following the institutionalization of elderly husbands. Theoretically, the study was informed by the interpretive perspective in sociology and the concept of career. Methodologically, the study employed a longitudinal and prospective design and combined quantitative and qualitative approaches. The data were drawn from a larger study designed to explore the transition to quasi-widowhood. This article reports on one aspect of spousal caregiving following the admission of husbands to a long term care setting, i.e. the performance of tasks. In this study, wives carried out a substantial number and wide variety of tasks related to personal, instrumental, relational and recreational care. They viewed visiting as their most important task but also highly valued providing companionship, love and support, doing little things for their husbands and monitoring their health and well-being. Typically, wives carried out tasks they viewed as falling within their domain of responsibility. Task performance occurred within a context of meaning that served to explain, in part, their continued involvement in caregiving following the admission of husbands to a long term care setting. Implications of this study point to the need for collaboration in caregiving between wives and staff, to support and enhance the quality of care provided by elderly wives who are coping with the institutionalization of their husbands.