A qualitative study, within a life course perspective, explored the transition into marriage for mid- to later-life same-sex couples. Twenty individuals (representing 11 couples) were interviewed – 12 lesbians, seven gay men, and one bisexual man. At the time of their marriages, participants were between 42 and 72 years old (average age: 54) and had been with their partners from six months to 19 years (average: 7.5 years). Three processes highlighted the ways in which these same-sex couples’ experiences of deciding to marry were influenced by their life course experiences. First, individuals had to integrate marriage into their psyches (integration). Second, they had to consider why they would marry their specific partner (rationale). Third, the study participants demonstrated how their experiences of wedding planning and their wedding characteristics were imbued with intentionality as a result of lifetime experiences of homophobia and/or heterosexism (intentionality).

Research on dementia care continues to develop, yet little attention has been given to the dementia experience in rural, northern communities. This study explored the dementia journey through the viewpoints of health service providers, caregivers, community members, and people living with dementia. The findings highlight the complexity of dementia awareness and understanding. Sound awareness and knowledge of dementia itself, the community services available, as well as of the perspectives of individuals living with dementia and care partners specifically in rural, northern Ontario are fundamental to quality care and support of individuals with dementia. Practical service implications and the need for greater developments with respect to the awareness and understanding of dementia in rural, northern communities are discussed.

This paper reports the development of a psychological assessment instrument for evaluating the deteriorated elderly patient. The instrument provides information on patient function in eight areas including communication abilities, cognitive status and mood. Analyses were undertaken to determine the psychometric properties of each component of the instrument. Examination of the means and standard deviations indicated that the full range was used for each scale. Examination of interrater reliability yielded values ranging from .92 to .99. Several indices that may be of use in evaluating the significance of change in test scores are also presented. Suggestions are also made for the application of this instrument in both clinical and research settings.

This study examined whether Canada's public pensions (Old Age Security and Canada Pension Plan) provided adequate income for seniors living in Nova Scotia in 2005 to afford a basic nutritious diet. Monthly incomes were compared to essential monthly expenses for four household scenarios: (a) married couple, 80 years and 78 years, in urban Nova Scotia; (b) single male, 77 years in rural Nova Scotia; (c) a couple, 70 years and 65 years, in rural Nova Scotia; (d) widowed female, 85 years, in urban Nova Scotia. The monthly food costs for the four households were CAN$313.32, $193.83, $316.71, and $150.89, respectively. Results showed that both single-member households lacked the necessary funds for a nutritious diet, while living with a partner seemed to protect against inadequate financial resources. These findings illustrate the need to improve Canada's retirement systems to ensure all seniors have adequate financial resources to meet their basic needs—including nutritious food—prevent chronic disease, and ultimately improve quality of life.

Equitable access to and utilization of health services is a primary goal for many health care systems, particularly in countries with universal publicly funded systems. Despite concerns regarding potentially adverse implications of the 1990s’ health care policy and other reforms, whether and how income inequalities in service utilization changed remains unclear. This study addressed the impact of income on physician and hospital utilization from 1992–2002 among adults aged 50 and older in British Columbia. Those with lower incomes were found less likely to access general practitioner and specialist services but more likely to access hospital services. Income-related disparities in physician care increased over time; hospital care declined. Volume of GP and hospital care was inversely associated with income; these differences increased regarding GP services only. Findings of declines in hospital-care access, accompanied by increasing income-related disparities in physician-services access, show that inequities are increasing within Canada’s health care system.

Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.

Self-determination theory (Deci & Ryan, 1985a) has recently been applied to the motivation behind daily activities in old age (Vallerand & O'Connor, 1989). According to this theory, a primary determinant of motivation is the degree of self-determination in the living environment: actual opportunities for self-determination are assumed to affect the experience of self-determination, which in turn affects motivation. This prediction was tested among 129 residents from 11 nursing homes. Both actual opportunities for autonomy and experienced autonomy were associated with motivational styles. Furthermore, the effects of the objective environment on motivation were mediated by perceptions of the environment. The results provide suggestive support for a causal sequence that has proven difficult to establish in previous research.

We investigated whether convenience sampling is a suitable method to generate a sample of older drivers representative of the older-Canadian driver population. Using equivalence testing, we compared a large convenience sample of older drivers (Candrive II prospective cohort study) to a similarly aged population of older Canadian drivers. The Candrive sample consists of 928 community-dwelling older drivers from seven metropolitan areas of Canada. The population data was obtained from the Canadian Community Health Survey – Healthy Aging (CCHS-HA), which is a representative sample of older Canadians. The data for drivers aged 70 and older were extracted from the CCHS-HA database, for a total of 3,899 older Canadian drivers. Two samples were demonstrated as equivalent on socio-demographic, health, and driving variables that we compared, but not on driving frequency. We conclude that convenience sampling used in the Candrive study created a fairly representative sample of Canadian older drivers, with a few exceptions.

Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants had thought about, discussed, or formalized their end-of-life preferences), and considered, as well, whether relations existed among the three outcomes. Canadian region of residence, female gender, and more years of education predicted having thought about preferences; region of residence, female gender, and lack of cognitive impairment predicted discussion of preferences; and region of residence and not being married predicted whether formal documents were in place. Ontario residents were most likely to have thought about, discussed, and formalized their preferences, whereas Atlantic residents were least likely to. Finally, having thought about preferences was associated with discussion, and having thought about and having discussed preferences were each associated with formalization of preferences. These findings are in keeping with the position that Advance Directives (AD) execution is a multi-stage process. A better understanding of this process may prove useful for the development of interventions to promote planning for end-of-life care.

Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.

To date, attention to the environmental production of disability among older adults with age-related vision loss (ARVL) has been limited. This critical ethnographic study aimed to reveal the ways in which environmental barriers produced and perpetuated disability for 10 older adults with ARVL. A modified version of Carspecken’s five-stage approach for critical ethnography was adopted with three methods of data collection used, including a narrative interview, a participant observation session, and a semi-structured, in-depth interview. Findings revealed how disability is shaped for older adults with ARVL when they encounter environmental features that are embedded within an ageist and disablist society. These findings are illustrated via presenting analysis of three commonly discussed activities: shopping, eating, and community mobility. Our discussion suggests that addressing the environmental production of disability requires inclusive social policy, advocacy, and a focus on education in order to develop and sustain age and low-vision-friendly environments.

This article examines the process which allows caregivers to combine employment and eldercare. Using an interactionist approach, the authors present the factors which determine this process, based on a qualitative study with 25 caregivers. The article proposes that the effects of eldercare on employment are the result of the degree to which caregivers manage to maintain balance between different life spheres: personal and social life, family life, caregiving and employment. This balance is achieved by a complex process of co-ordination, negotiation, and mediation which the authors call “juggling work” and which itself is determined by a series of factors, conditions and contextual elements.

This study identified factors that influenced physical activity (PA) participation among older adults from rural settings in Nova Scotia Canada and explored how the rural context may influence PA participation and promotion. Data were collected via individual semistructured interviews with 20 older adults (Mage = 77.5 years) from rural areas of Cape Breton and subjected to thematic analysis procedures (Braun & Clarke, 2006). Four themes representing factors that influence the prioritization of PA were identified: (1) historical context of activity, work, and productivity; (2) already busy with day-to-day activities; (3) being/staying on the go; and (4) cautionary approach. These findings suggest that PA promotion should be contextually salient, and highlight the need for a shared understanding between rural older adults and PA promoters regarding what constitutes being “physically active”. Effective promotion of PA among rural older adults may require a shift away from contemporary methods of PA promotion.

The aging population and the epidemic of chronic diseases requires an accompanying finance reform of long-term care that will become increasingly dominant. Many countries have faced this situation and have set up a separate public funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec must adopt such autonomy insurance and create a separate fund financed partly by a more judicious use of current budgets and tax credits, and also by a significant investment in home care. An autonomy support benefit could be allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social economy agencies. This benefit would be established following a standardized assessment of functional autonomy achieved by the case manager who will manage the services and control their quality.

While a substantial body of literature has emerged on the relationships between stress, social support and well-being in community-based older persons, few studies have examined institutionalized populations. The present study used data from pilot studies of the MDS 2.0 in three hospitals, along with supplementary surveys related to psychological well-being. It was found that patients with higher social engagement scores tended to have higher levels of well-being, and this effect was greatest among those with more stable physical health. Pain was an important predictor of lower well-being. Since the MDS 2.0 provides a comprehensive approach to identifying and responding to social, psychological and physical problems in institutionalized older persons, it can have an important impact on well-being when used to support decision making and clinical intervention.

The aim of this exploratory study was to better understand interpersonal communication between frail elders and caregivers in the context of long-term care giving. In addition, in light of the Communication Accommodation Theory, the goal was to determine the extent to which communication can be a transmitter of ageism, particularly of implicit ageism. A total of 26 semi-structured interviews were conducted among elders and caregivers of a Quebec long-term care facility. Results suggest a close convergence between the perception of seniors and caregivers in regards to a quasi total absence of daily communication and moreover, in regards to the highly instrumental nature of this same communication. Finally, results of the content analysis also suggest that implicit ageism is indeed reflected in interpersonal communication between frail elders and caregivers.

The prevalence, risk factors, and medical conditions associated with seeing and hearing disabilities were examined among Canadian adults aged 55 years and older. A probability sample of respondents from the 1986 and 1991 Canadian Census were selected to complete the 1986 and 1991 Health and Activity Limitations Survey (HALS). Seniors, 65 years and older, were more likely than 55–64 year olds to experience a sensory disability. Men were more likely than women to report having hearing disabilities, while women were more likely to report seeing disabilities than men. Increased age and lower total household incomes were associated with a greater likelihood of having a sensory disability. Cataracts and deafness were reported most often as the cause of seeing and hearing ADL restrictions in both age groups. Sensory disabilities are prevalent conditions among older adults. Public health initiatives should focus on hearing and seeing disabilities particularly among seniors, women, and the lower income level population.

This study examined how intergenerational exchanges with sons and daughters predicted older parents’ likelihood of co-residing with a son prior to death in a rural area of China’s Anhui Province. Our investigation drew on theories of contingent co-residence, modernization, and social exchange, conceptualizing co-residence as having practical and symbolic importance in rural Chinese culture. The sample included 470 older parents, reported as deceased during 2001–2009, and their posthumous informants. We used logistic regression to assess intergenerational support and cohesion as predictors of co-residence with a son just prior to death. Older parents who provided instrumental support to, and received instrumental support from, sons and had better emotional relationships with sons were more likely than their counterparts to co-reside with a son at the end of life. Living with sons demonstrates filial piety for older parents at the end of life, but its realization is sensitive to intergenerational transactions.

Despite evidence of increasing diversification of family structures, little is known regarding implications of marital and parental status for access to social support in later life. Using data from Statistics Canada’s 2007 General Social Survey, this study assessed the impact of marital and parental status intersections on social support among adults aged 60 and older (n = 11,503). Two-stage probit regression models indicated that among those who were currently married or separated/divorced, childless individuals were more likely to report instrumental (domestic, transportation) and emotional support from people outside the household. Conversely, among never-married or widowed older adults, being childless was associated with reduced domestic support but without differences in other support domains. Findings suggest that marital and parental status intersections are not uniformly positive, neutral, or negative regarding implications for extra-household social support. Future work should address complexities of these relationships in order to better understand rapidly changing family structures.