Patients and professionals have difficulty communicating with one another about prescriptions and alternative therapies. The aim of this research was to investigate and contrast 714 seniors and health-professionals' perceptions and communication about the above mentioned health products. First, intensive face-to-face, ethnographic interviews with health professionals and seniors were conducted to elicit relevant issues of concern. Second, focus groups were used to evaluate the issues and wording of question probes developed initially. Third, a survey established associations and predictive validity of variables found in the first two phases. Highlights from the emergent themes include different perceptions of (a) the value and usage of alternative therapies, (b) information adequacy about prescriptions and alternative therapies, and (c) communication about prescription misuses and alternative therapy use. Seniors and professionals suggested insights for improving clinical practice.

The effects of long-term hospitalizations can be severe, especially among older adults. In Manitoba, between fiscal years 1991/1992 and 1999/2000, 40 per cent of acute care hospital days were used by the 5 per cent of patients who had long stays, defined as stays of more than 30 days. These proportions were remarkably stable, despite major changes in the bed supply. Approximately two thirds of long-stay patients were aged 75 or older. Medical record review for a small sample of long-stay medical patients aged 75 or older revealed that 42 per cent of the days spent in hospital were spent either awaiting transfer to another level of care (home care, nursing home, or chronic care), or were due to in-hospital factors, such as awaiting consults, tests, or treatments. Hospital information systems and early discharge planning may help to alleviate lengthy discharge delays and result in better care for these patients.

The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

The Canadian population is aging and becoming more ethnically diverse. This paper focuses on South Asian immigrant seniors and examines differences in housing and living arrangements among seniors who immigrated at different life stages. We interviewed a convenience sample of 161 immigrant seniors of South Asian descent in Edmonton, Alberta, to assess type of living arrangement, type of housing and dwelling density (measured in persons per room), activity in the neighbourhood, and means of transportation. Overall, those seniors who came to Canada before the end of mid-life were more likely than those who came at an older age to drive a car and, if married, to live in a one- or two-generation family. Women were more likely than men to be widowed, have poorer English-language skills, or live with a three-generation family if unmarried, and less likely to drive a car. Most respondents were satisfied with their living arrangements, housing, and perceived safety at home and in their neighbourhood. Theoretical implications are discussed.

The Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) are self-reported scales used internationally to assess anxiety symptoms in older adults. In this study, we conducted the first critical comprehensive review of these scales’ psychometric properties. We rated the quality of 31 relevant studies with the COSMIN checklist. Both the GAI and GAI-SF showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with generalized anxiety measures; lowest with instruments relating to somatic symptoms. We detected substantial overlap with depression measures. While there was no consensus on the GAI’s factorial structure, we found the short version to be unidimensional. Although we found good sensitivity and specificity for detecting anxiety, cut-off scores varied. The GAI and GAI-SF are relevant instruments showing satisfactory psychometric properties; to broaden their use, however, some psychometric properties warrant closer examination. This review calls attention to weaknesses in the methodological quality of the studies.

Group-exercise instructors are a vital social determinant of exercise enjoyment, attendance, and adherence. Instructors also affect the degree to which physical cultures are socially inclusive. In order to elucidate the roles that instructors play in affecting these outcomes, we conducted a scoping review. Scoping reviews are a preliminary method for assessing the breadth and depth of existing literature in order to identify key themes and gaps therein. Based on Arksey and O’Malley’s (2005) framework, we identified 52 articles and book chapters, 33 of which were older-adult specific, using a university search engine that simultaneously searches multiple databases. We conceptually mapped the literature, which revealed instructors’ vital roles as: (1) constructors of group social cohesion, (2) cultural intermediaries, (3) competent practitioners, (4) leaders and communicators, and (5) educators. Of these, the instructor’s educative role lacks empirical attention. We conclude with implications for future research, practice, and policy.

Evidence is accumulating to suggest that peoples' perceptions of their own memories are important for understanding memory functioning in later life. This paper reviews two questionnaires designed to measure such perceptions, and identifies several research questions requiring further study. In general, memory perceptions appear to be multidimensional and involve belief and affective components as well as knowledge components. In addition, the relationship between memory perceptions and memory performance appears to differ as a function of age and type of task. Salient issues for future research include the extent to which older adults' memory perceptions show systematic state-like fluctuations over time, and the extent to which these perceptions represent an accurate picture of individuals' memory abilities.

Cost-effective methods have been developed to help busy emergency department (ED) staff cope with the growing number of older patients, including quick screening and assessment tools to identify those at high risk and note their specific needs. This survey, from a sample of key informants from all EDs (n=111) in the province of Quebec (participation rate of 88.2%), investigated the implementation of these tools and barriers to implementation. Questionnaires (administered either by telephone or by self-completion) included characteristics of the ED, characteristics of the respondent, use of tools, and method of implementation. Barriers to the implementation of these tools included lack of resources for screening and follow-up, misunderstandings of the difference between screening and assessment tools, and need for adaptation of the tools to the local context. Education of staff and pre-implementation adaptation and testing are needed for successful implementation.

This article describes British Columbia’s regulatory model for assisted living and used time series analysis to examine individuals’ use of health care services before and after moving to assisted living. The 4,219 assisted living residents studied were older and predominantly female, with 73 per cent having one or more major chronic conditions. Use of health care services tended to increase before the move to assisted living, drop at the time of the move (most notably for general practitioners, medical specialists, and acute care), and remain low for the 12-month follow-up period. These apparent positive effects are not trivial; the cohort of 1,894 assisted living residents used 18,000 fewer acute care days in the year after, compared to the year before, their move. Future research should address whether and how assisted living affects longer-term pathways of care for older adults and ultimately their function and quality of life.

The purpose of this study was to assess the feasibility and benefits (fitness and quality of life) of an 8-week mall-walking program. A total of 52 participants (n = 39at post-testing) took part in the pilot project (mean age = 66.4; range 46–83 years), with an overall attendance rate of 62.4 per cent. Participants self-selected pace, time, and frequency. Fitness measures, physical activity behaviour, and quality of life were assessed pre- and post-program. Results indicate a significant improvement in physical activity behaviour and most fitness indices. No quality-of-life changes were found, likely due to the above-norm values at baseline. Overall, this pilot project supports the feasibility of and positive health improvements associated with a mall-walking program. Such programs should be considered as part of health-promotion programs, especially for the aging population.

This paper explores similarities and differences in the way caring work is experienced by kin, homemakers and volunteers. Under the conceptual umbrella of working conditions, issues of work milieu, isolation, communication, feedback, autonomy, motivation and choice are compared across these three groups of care providers. Although the functional capacities of the elderly persons receiving care were quite similiar, the circumstances that surrounded the performance of caring were quite different. The paper argues that the context within which care is provided will be critical in future policy discussions. It is suggested that the specific task content of providing care may be of secondary importance to understanding the context within which care providers carry out these activities.

Canada's demographic situation in the future will differ substantially from what we have known in the past. Unless there is an early return to high fertility the average age of both the population and the labour force will increase substantially, while the overall dependency ratio will be low by historical standards. Our analysis suggests that up to about 2010 population change will have less of an impact on the real (i.e., constant—price) level of aggregate government expenditures than on the size of the real gross national product However, we can anticipate compositional changes in government expenditures as a result of population change: very large increases in the real social security costs, lesser (but still large) increases in health costs, and a reduction in education costs. Finally, a relatively large portion of the aggregate expenditure increases will be at the federal government level.

This study focused on issues of concern to and service needs of older parents caring for an adult son or daughter with an acquired brain injury (ABI) in Ontario. Three issues were identified as particularly challenging: diagnosis of the brain injury, parents’ feelings about the cause of the brain injury, and planning for long-term accommodation for their family member with a brain injury. The most frequently cited services needed for the person with ABI were social and/or recreational activities, day programs, and residential placement. The most frequently cited services needed by parents were parent education and support groups. The information gathered provides a base for further research in other sectors. Implications of these initial findings for clinical practice and policy and program development are discussed.

The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens.

The purpose of this study was to better understand adjustment and life satisfaction in later life. In particular, it examined the contribution of leisure participation and motivation toward leisure in older people’s adjustment to their nursing homes and their satisfaction with life.. Study results underlined the contribution of participation in leisure activities both to the adaptation of an elderly person to his residence and to life satisfaction. In terms of adaptation to the residence, participation in recreational activities exhibited this mediational sequence: leisure participation → self-determined motivation for leisure → adjustment to nursing homes. This suggests that leisure participation has an indirect effect on older people’s adaptability. Various practical implications of this research emerge for the development of future recreational programs in nursing homes to promote seniors’ adaptation.

This article explores potential differences in yoga practice between middle-and older-aged adults. A health belief – life course model frames this research, and a mixed-methods analytic strategy is employed to examine life course pathways into yoga and motivations to practice, as well as perceived barriers and health benefits. For the quantitative analyses, a convenience sample of 452 participants was collected using an online questionnaire. For the qualitative analyses, face-to-face interviews were conducted with a sub-set of 20 participants. Unique differences between the age groups (both current age and age when started yoga) as well as by gender were found for selected pathways, reasons/motivations, and barriers to engage in yoga as well as for perceived health benefits. In addition, results underscore the importance of informational cues and social linkages that affect how individuals adopt and experience yoga. Implications for health promotion programs that target older adults are discussed.

This paper offers an exploratory investigation of spatial aspects of the shopping patterns of elderly downtown residents. Attention is explicitly focused on their usage fields, transport modes, and shopping context. The shopping behaviour of the elderly is evaluated with reference to that of a baseline group of non-elderly consumers. The data are obtained from a questionnaire/interview survey of random samples of elderly and non-elderly apartment dwellers in the central area of Winnipeg. The findings indicate that the elderly's shopping trips are largely restricted to the central business district. In contrast, the non-elderly exhibit more extensive movement patterns, particularly when purchasing relatively expensive items. These differences appear to be related to the higher level of transport deprivation among elderly persons, although some are able to compensate for their limited mobility by travelling as bus or automobile passengers.

The right of the individual to participate in her life-prolonging treatment decisions, either as a decision maker or by having her treatment wishes used as a decision-making criterion, is the result of an evolution in legal guidelines over the last two decades. Although necessary, these legal guidelines are however not sufficient to assure the individual's opportunity to participate. For the chronically ill older adult residing in a health care institution, the opportunity to participate in decisions concerning life-prolonging treatments implicitly depends on the effective communication among three key actors (the individual, her physician, and her proxy). The necessity of this communication has important implications for clinical practice and future empirical research.

This study draws on the life histories of heterosexual childless individuals who have never married, to explore the more subtle ways that age norms affect the subjective experience of singlehood. Specifically, it examines whether or not it is appropriate to speak of transitions in the experience of singlehood. The data clearly reveal the experience of a transition to singlehood. This transition is represented by a change in self-attributed status that occurs over time and is associated with a cultural timetable for marriage. It marks the experience of “becoming single” that occurs when an individual identifies more with singlehood than with marriage. Moreover, I explore the ways in which singlehood is a gendered experience. The results from this study affirm the applicability of life course theory to the lives of single persons and serve to broaden the definition of the concept “transition” to include those not obviously marked by normative events.

Une des clés au succès de l’Étude longitudinale canadienne sur le vieillissement (ÉLCV) sera de tirer profit des sources de données secondaires, en particulier données relatives à l’utilisation des soins de santé (USS). Pour examiner les aspects pratiques, méthodologiques et éthiques d’accéder à des données sur l’USS, des entrevues qualitatives individuelles ont été réalisés auprès de 53 administrateurs de données et commissaires/ombudsman à la protection de la vie privée à travers le Canada. Les participants de l’étude ont indiqué que d’obtenir la permission d’accéder à des données sur l’USS est généralement possible; cependant, ils ont noté que ce processus sera complexe et long, exigeant des travaux préparatoires considérables et méticuleux afin de s’assurer que la documentation soit appropriée et que le tout soit conforme aux variations juridiques ainsi qu’aux lignes, législatives et politiques.