The majority of elderly individuals do not engage in any form of regular physical activity. This lack of participation is thought to be due to a number of factors ranging from entrenched patterns of inactivity to myths and fears concerning the safety and suitability of exercise for this age group. The following review critically examines the research in the area in order to assess the elderly's capacity for exercise and the benefits accruing from exercise. Endurance training studies are contrasted with rhythmic exercise programs in terms of documented benefits, screening procedures and attrition rates. The lower-intensity exercise programs attract a more representative group of senior participants and appear to overcome many of the barriers to increased involvement in physical activity. Implications of the research findings for both program planning and broader educational efforts are discussed.

For many years there has been an underlying pathology within the literature about families with children and adults with intellectual disabilities (Helff & Glidden, 1998). This literature has emphasized stress and burden, incapacity and dependency, leading to negative stereotyping of families in this context. Over the last 2 decades research has led to some important reconceptualizations of how families approach their caring, affording an improved understanding of how they deploy strengths and resources, and who benefits. This paper reviews this thinking, arguing that it provides a suitable context for understanding the scope and form of family caregiving contributions that are less visible, and therefore less recognized. An attempt is therefore made to chart invisible contributions. It is suggested that invisible contributions have implications for thinking about human and social capital (Putnam, 2000) as well as for practice in supporting families.

The objectives of this study were to assess the prevalence of fear of falling (FOF) among patients over age 60 with dizziness, falls, or syncope; and to analyze risk factors associated with FOF, including data from the tilt table test. This study included 200 older patients referred to a geriatric outpatient clinic specializing in dizziness, falls, and syncope. The primary outcome measure was the proportion of patients who experienced FOF (yes vs. no) and whether FOF restricted leaving home alone or performing activities of daily living. FOF occurred in 50 per cent of patients in this population. Among these, 44 per cent gave up going out alone and 10 per cent stopped doing basic activities of daily living. Beyond age 75, FOF was associated with recurrent dizziness, depression, and symptoms on standing, but not prior falls.

Although the experiences of formal and informal caregiving have been discussed and debated in the literature, more is assumed than is actually known (McDaniel & Gee, 1993). This qualitative study explored both informal and formal caregivers' perceptions of their own caregiving and the views of each other's caregiving. Information was collected through the use of in-depth interviews with 23 family caregivers and 15 nurses providing home care to older persons. Analysis of interview transcripts and field notes reveals that both informal and formal caregivers engage in all facets of caring work – physical, intellectual and emotional care – but that they carry out this work in varying degrees, and for different reasons. The reasons given for these differences, namely the nurses' professional knowledge and higher status designation, are key elements that define the boundaries between professional and family caregiving. However, it is apparent that, over time, this demarcation diminishes as family caregivers' knowledge and skill match those of health professionals. Study findings point to implications for future theory development and research.

We searched nine electronic databases for randomized controlled trials (RCTs) about care at the end of life and found 23 RCTs. We assessed their quality using the criteria of the Cochrane Collaboration. The RCTs researched three themes: (a) the effect of providing palliative care through dedicated community teams on quality of life, on the management of symptoms, on satisfaction with care, on the duration of the palliative period, and on place of death; (b) the effects of specific palliative care interventions—advanced planning of care for the end of life, patient-held records, providing quality-of-life data to patients and physicians, grief education for relatives, palliative care education for nurses, and palliative care for patients with dementia; and (c) the costs of palliative compared to conventional care. We identify difficulties in conducting research on palliative care and solutions and discuss future possible research themes.

Through a review of the literature, this article explores the debate between the traditional perspective that conceives it as natural that families take care of their elderly members when frail or in need and an emerging critique of this view. The critique exposes the invisible divisions of caring work between men and women and between public and private arenas, and challenges the comfortable imagery of ‘family care.’ The implications of this analysis for the future are considered, both for constructive changes in social policies and for the reformulation of assumptions on which research and practice with the frail elderly and their families are based.

The field of psychogerontology is data rich, but theory poor. It will be argued that a constructivist view of science in terms of models or metaphors encourages the development of theories in the field of aging. Historically, there are three psychological models: Age, aging and the aged. The psychology of the aged is concerned with the thematic study of the problematic and non-problematic elderly. The psychology of age focuses on age differences and compares groups of people of different ages. The psychology of aging studies some typicalness of change of average functioning over time. Recent psychological models of aging emphasize degree of variability, rather than average functioning. Primary, secondary and tertiary aging patterns are presented in terms of a differential psychology of aging. A theoretical explanation of the differential aging process will be given in terms of gerodynamics, which lays the foundation of the new branching model of aging.

This study examined whether off-target verbosity should be conceptualized as a distinct process from high levels of talkativeness in every day social situations. The relationship of age to these speech styles was also determined. The responses of 125 community-based elderly adults to a life-history interview were independently rated by two research assistants for the frequency and extent of off-target verbosity. The participant's activities in daily life, including talkativeness, were independently rated by the participants themselves, 125 similar-aged peers and 10 professional workers acquainted with the participants. Confirmatory factor analysis supported a model postulating off-target verbosity and talkativeness as two largely independent latent factors. Age was associated with the verbosity factor. The results were interpreted as indicating that off-target verbosity cannot be explained by the same processes that underlie social talkativeness. Possible mechanisms of the verbosity factor were discussed.

The deterioration of the cholinergic system in aging is hypothesized to contribute to age-related declines in attention. We investigated potential age differences in performance on the Attention Network Test (ANT) and intra-individual variability in speed (RT-IIV) on go/no-go and choice reaction time tasks in young and healthy older adults. We also asked whether short-latency afferent inhibition (SAI), a neurophysiological marker of central cholinergic activity obtained via transcranial magnetic stimulation, might be correlated with performance. Older adults were slower on the ANT and exhibited greater RT-IIV than young adults on the multiple choice RT task, but there were no age differences on the ANT network scores (alerting, orienting, and executive control). SAI was diminished in older adults, but it was not significantly correlated with performance. It may only be in cases of severe cholinergic dysfunction that relations with attention emerge. Other brain mechanisms may also be stronger predictors of functions relating to attention.

The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a “managed competition” delivery model. The second is the Ministry of Health and Long-Term Care's privileging of “health care” over “social care” through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

Involuntary weight loss (IWL) is common in the North American elderly population and affects as many as 60 per cent of nursing home residents, representing a threat to health and function. Investigation into nutrient provision in a long-term care (LTC) centre showed that mean total energy exposure over the 5-week menu cycle differed significantly between regular and puréed diet orders, with lower mean levels of exposure to all three macronutrients on a puréed diet order. There is sufficient evidence that current LTC menus may provide fewer nutrients in those receiving puréed diets that further investigation in this area is warranted.

This paper provides an exploratory analysis of ethnocultural diversity and intergenerational support, examining factors that shape the attitudes of young adults toward sharing a home with an elderly parent. Data are drawn from a random sample of 565 young adults aged 19 to 35 living in the Greater Vancouver Regional District, whose primary ethnic identity is as members of one of three groups: British-, Chinese-, and Indo-Canadian. Utilizing a comparative, cross-cultural approach and logistic regression procedures, the study found the likelihood of young adults' expressing favourable attitudes to caregiving to be influenced by several factors associated with collectivistic systems of caregiving. Noteworthy is the finding that, after controlling for ethnocultural and socio-demographic factors, the best predictor of co-residence attitudes is the quality of a child's relationship with her/his mother. Findings are discussed with regard to their implications for intergenerational relations and support for aging families.

The Center for Epidemiologic Studies-Depression Scale (CES-D) is among the most widely used depression screening measures. Existing research suggests a higher-order factor structure of responses among older adults (factors labelled depressive affect, absence of well-being, somatic symptoms, and interpersonal affect, each loading upon a second-order depression factor). The current study extends this research to ascertain whether this structure is equivalent (or invariant) between the English and French versions of the CES-D. Findings suggest that the number and relative contribution of each factor is similar for both language groups. Furthermore, interpretation of CES-D items is statistically indistinguishable for 16 of 20 items within this randomly identified, national sample of caregivers of persons with dementia. Results of this study support the higher-order factor structure of this measure and provide data in support of the reliability of responses. Furthermore, findings support the use of the CES-D in cross-cultural and comparative research with English- and French-speaking adults.

This paper identifies some factors associated with changes in face-to-face contact between grandmothers and grandchildren following a child's marriage breakdown. A qualitative analysis showed that geographic mobility, the appeal of a grandmother's home, employment status of the adult child, and the absence of the child-in-law were related to increases in visiting. Unresolved conflict and difficulties re-negotiating post-breakdown relationships were related to decreases in visiting. These findings as well as implications for service delivery are discussed.

A critical ethnography of the process of discharge decision-making for elderly patients was conducted to examine the nature of the process over the total course of patients' hospital stays. The focus was on describing the timing and conditions of decision-making, the related activities of professionals, professionals' perceptions of the process, and the effects of the process on those involved and on the hospital organization. Data analysis demonstrated that the process is not intricately linked with patients' clinical progress, that often inaccurate assumptions about the importance of patient-related clinical and social factors and organizational parameters underlie decisions, and that professionals' perceptions of the process are shaped by organizational imperatives. In the current process, resources are used inefficiently and humanitarian and ethical consequences arise for participants. The analysis supports attempts to achieve greater congruence between the discharge decision process and the patient's clinical progress so that the fiscal and humanitarian goals of the hospital can be achieved.

Fostering independence amongst people over 65 years of age, over 80 per cent of whom have medical conditions, presents many challenges to policy personnel, program planners, and service providers, as physical, social, and psychological dimensions of independence must all be considered. This paper presents a systematic literature review and synthesis of 65 rigorous, comprehensive research papers selected from 238 published studies on care delivery approaches relevant to promoting the independence of older persons. This evidence suggests the merits of exercise and health promotion programs for all seniors, and in-home geriatric health care management and fall prevention programs for frail older persons. Findings also indicate the need for more attention to policy on assistive devices, and the need for more research on the effectiveness of public health programming, on strategies to enhance preventive medical care, and onpsychosocial factors which affect seniors' self-efficacy.

The relationship between ADL self-assessments and physical ability was investigated using data compiled on 128 exercise class participants. Compared with community dwelling respondents, institutionalized seniors were not only less accurate in their subjective ADL estimates, but consistently underestimated their capabilities over comparable ranges of the objective physical scale. Seniors appear to make errors estimating their functional capabilities with respect to daily activities they no longer perform and that may be restricted for reasons of institutional convenience.

Cross-sectional data (n = 6,487) from four Nordic countries, Denmark, Finland, Iceland and Sweden, were utilized to determine the prevalence of daily pain and its association with disability in institutional long-term care. Every resident in each of the participating institutions was assessed with Minimum Data Set version 1.0. The sample was representative of institutional long-term care in Copenhagen and Reykjavik. In addition, the data collected from Stockholm and Helsinki provided substantial information on the residents in these capitals. The results showed that 22–24 per cent of the residents experienced daily observable pain and this was most evident in the most disabled subjects. In addition to disability and female gender, diseases or conditions independently associated with pain were terminal prognosis, osteoporosis, pneumonia, arthritis, depression, anaemia, peripheral vascular disease, cancer and cardiac heart failure. The association between pain and severe cognitive impairment was negative. The results strongly indicate that daily pain in long-term care has a complex association with disability, the latter acting together with underlying diseases as a source and/or result of pain. Thus, a vicious circle between pain and disability can be anticipated.

The goal of the Canadian Longitudinal Study on Aging (CLSA) is to recruit 50,000 participants aged 45 to 85 years of age and follow them for at least 20 years. The sampling and recruitment processes for a study of this scope and magnitude present important challenges. Statistics Canada was approached to collaborate with the CLSA with the goal of determining whether the Canadian Community Health Survey (CCHS) could be used as a recruitment vehicle for the CLSA. In this pilot study conducted in 2004, it was determined that 63.8 per cent and 75.8 per cent of the respondents agreed to share their contact information and their survey responses with the CLSA, respectively. The most commonly reported concerns were confidentiality/privacy issues, lack of interest, and commitment issues. This pilot study identified some challenges to the use of the CCHS as a recruitment vehicle for the CLSA.

Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts – in rural aging, rural palliative care, and navigation – as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.