The aim of this study was to better understand care protocol implementation, including the influence of organizational-contextual factors on implementation approaches, in long-term care homes operating in Ontario. We surveyed directors of care employed in all 547 Ontario LTC homes, and combined survey data with secondary organizational data on rural/urban location, nursing home size, chain membership, type of ownership, and accreditation status. Motivations for the use/selection of care protocols in nursing homes primarily derived from beliefs in continuous improvement and in evidence-based care. Protocol selection was largely participative, involving management and staff. External information sources were important for protocol implementation, and in-service education was the chief means of training and educating staff. Significant differences in approaches to implementation were evident in association with differences in ownership. Three key success factors for implementation were identified: contextualizing the practice change, adequately resourcing for implementation, and demonstrating connections between practice change and outcomes.

This article examines to what extent the presence or absence, adequacy or inadequacy of formal services impacts on the work trajectory of caregivers to elderly relatives. The article is based on a qualitative study with 20 employed caregivers' whose elderly relatives received homecare services from one of two Montreal CLSCs: Results reveal the key role played by formal services in caregivers' attempts to juggle caregiving demands with those of their employment. They illustrate how the presence or the insufficiency of these services, their adequacy or inadequacy, combined with the other accommodations which caregivers put into place, can be determinants in caregivers' decisions to continue working and in their capacity to function well in the work place.

This study examined six- and 12-month levels of adherence to physical activity, functional changes, and psychosocial determinants of physical activity in 176 older adults who participated in the “Get Fit for Active Living (GFAL)” pilot program. Functional and psychosocial measures were conducted in person at six months; psychosocial measures and physical activity participation were assessed by telephone interview at 12 months. Ninety-five per cent were retained in the study at the six-month follow-up, and 88 per cent at 12 months. The self-reported adherence rate to exercise at 12 months was 66 per cent. The main reason for continued exercise participation was to maintain health (45%). Reasons for nonadherence were illness (38%) and lack of motivation (32%). Results identify factors associated with positive behaviour change that health promoters can utilize when targeting the older adult population. The GFAL project results can serve as a model for sustainable, community-based older-adult exercise programs.

Following the program I’m Taking Charge of My Arthritis!, study participants reported fewer functional limitations, less helplessness, and better coping effectiveness than did controls. This study examined the maintenance of these effects and the role of social reinforcement in maintaining benefits eight months post-intervention. The study collected information (1) at baseline (n=125); (2) two months later, before randomization (pre-intervention); (3) two months post-randomization (post-intervention 1); and (4) ten months post-randomization (post-intervention 2) (n=80). We conducted a randomized controlled trial comparing three groups: a control group, intervention group without social reinforcement, and intervention group with social reinforcement after the program. A multilevel analysis revealed that intervention participants with social reinforcement following the program continued to report significantly fewer functional limitations and greater coping effectiveness compared to intervention group participants without social reinforcement. This research provides preliminary evidence for the value of additional contact with frail housebound seniors post-intervention for maintaining the intervention benefits.

The association of health and disability factors on the perception of involuntary retirement in Canada was investigated with a multivariate logistic regression analysis of the 2006 Participation and Activity Limitation Survey data. The study investigated the role that choice or control plays in the decision to retire. Study participants were adults, with disabilities, aged 45 to 74 and who retired during the period 2001–2006. The analysis revealed that health at the time of retirement was not significantly associated with the perception of involuntary retirement, whereas disability characteristics were strongly associated with the type of retirement when health and other characteristics were controlled. Further, persons with disabilities who had to permanently retire because of their condition were eight times more likely to retire involuntarily than those whose conditions did not force involuntary retirement, suggesting the importance that control over the retirement decision has on the perception of involuntary retirement.

Every public-policy problem can be defined in terms of its empirical (“facts”) and normative (“values”) dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of “narrative frame” analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure – including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process.

Currently, many immigrants are disqualified from Canada’s public pension scheme because of residency requirements. In addition, decades of low income and labour market exclusion prohibit many Canadian immigrants from building adequate private pension savings throughout their working life. Together, these factors present serious concerns for immigrant seniors’ economic well-being. Using Canadian census data spanning a twenty-year period (1991–2011), we find that income from personal savings plans and investments has declined sharply for both native-born and immigrant Canadians, with recent immigrant cohorts faring worst. However, since 1991, native-born and immigrant men living in Canada for 40-plus years had major gains in private employer pensions (Registered Pension Plans; [RPPs]). Yet RPP income for all other immigrant cohorts remained stable or declined during these decades. Thus, the data demonstrate a worrisome growing private savings gap between native-born men and all others in Canada, with newer immigrants and women faring worst.

Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.

Families of adults with an intellectual disability (ID) face post-parent transition when they can no longer assume their son’s or daughter’s care. This exploratory study aims to assess the perceptions of 12 mothers (Mage = 65.1; years, SD: 11) sharing a household with an adult with an ID (Mage = 36.9; SD: 11.4)): benefits and constraints of cohabitation, residence transition planning, perceptions and emotions about the future. The results of a questionnaire completed in an interview indicate that several mothers can envision siblings becoming potential caregivers for the future and that the transition generates emotions relating to their son’s or daughter’s welfare. However, participants’ planning of the transition is not advanced in most cases.

Over the last several decades there have been changes in how paid and unpaid labour is divided between men and women: The rate of women's participation in the labour force women has increased as has men's participation in household labour. Although a plethora of research has addressed these changes by analysing couple and individual data, few have examined them within the context of multi-generational families. Using a case study analysis of a three-generation family, this paper shows that gender, class, social context, and family background influence how paid and unpaid work is divided within families. The case study shows that the social context of a given time conditions the options women and men have available to them in negotiating the balance of work and family responsibilities. Yet within this context, family background also matters. Negative childhood experiences were an impetus for adult children negotiating patterns of paid and unpaid labour that were different from those of their parents.

Private, unregulated residential care facilities have become an increasingly important component of the continuum of housing and care for frail older adults in Canada. To date, this growing segment of the older population has received very little research attention. This study involved an in-depth examination of the functional/health profile, patterns of service use, and medical/care needs of a representative sample of 178 older adults in residential care facilities in the City of Ottawa. The results indicate great diversity in resident and facility profiles in this setting and confirm earlier impressions that special care units in the residential care sector have become increasingly close to being unlicensed pseudo-nursing homes. Despite the heavy burden of care, the evidence suggests that the care needs of the majority of residents are adequately met in the residential care environment. The results can inform future research, case finding, educational, and policy planning initiatives in this setting.

Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

The purpose of this study was to determine the extent to which functional ability was associated with dietary intake in community-living seniors with some activity limitation. In this cross-sectional survey, 145 seniors were recruited from 15 recreation, day programs or seniors' apartment complexes. Dietary intake was assessed with a food frequency questionnaire and evaluated for adequacy with a Diet Score. An Activity Score was derived from 15 questions on basic and instrumental activities of daily living. Demographic, health, psychosocial, functional and behavioural factors that could influence diet intake were measured with standardized, validated scales. Diet Score was significantly and positively associated with income, hearing, education, satisfaction with use of time, number of medications and age. Activity Score, the belief that health affects activity level, shopping behaviour and smoking were negatively and significantly associated with Diet Score. Many factors influence the dietary intake of seniors, including extent of functional limitations. This analysis suggests that the most dependent seniors living in the community consume better diets than those seniors with few limitations; this finding is probably a result of informal and formal support services for these functionally dependent seniors.

Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.

This article looks at how The Simpsons' representations of aging, considered ageist and stereotypical by some, can be viewed as a positive look at the elderly that attempts to subvert the same stereotypes that it seemingly employs. The Baby Boom cohort is now seen as an attractive economic group, and as they continue their journey through the life cycle, they are drawing increased attention. A current scholarship exists that investigates the ways that the “aged” are seen, catered to, advertised at, seemingly marginalized, and represented in the larger context of the mass media. Relying primarily on the theoretical musings of Frederic Jameson and Linda Hutcheon, the article constructs a bridge that places The Simpsons squarely within a postmodern aesthetic and, using this rubric, shows how the inherent political nature of parodic irony can help to create an inversion of meaning.

The prevention and management of dementia in Canada is at a crossroads. Despite the low diagnosis rates, the number of persons living with dementia continues to increase. Yet, Canada’s health care policies have resulted in more people living with dementia living at home, and with most of their care being provided by family, friends, and significant others. This Policy Note provides an overview of a joint submission from the Canadian Gerontological Nursing Association (CGNA) and the Registered Nurses’ Association of Ontario (RNAO) to the Standing Senate Committee on Social Affairs, Science, and Technology. This article outlines the background and recommendations in five key areas of dementia care in Canada: health system resources, education and training of health providers, housing, care partners, and the integration of health and social supports. Based on these five key areas, a number of health and social policy interventions are discussed.

The health promotion literature for young adults is not generalizable to the elderly, and different outcomes are likely to motivate changes in health practices within the two populations. Main and interactive effects of smoking, alcohol consumption, obesity and physical activity on older Canadians' quality of life are examined with 1991 GSS data. Quality of life is operationalized with psychological well-being and subjective health indicators. Two dichotomous outcomes are used for each dimension, where one outcome is relatively sensitive in detecting impaired quality of life and the other relatively specific. Smoking was consistently associated with negative outcomes, but there was little evidence of adverse effects for alcohol consumption. Physical activity effects were most pronounced comparing sedentary and moderately active individuals. Body mass index showed curvilinear associations with impaired quality of life and interactions with smoking and activity level in separate models.

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons’ access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

The measurement of psychological constructs depends upon clear definitions and demonstrated relationships among items, scales, and relevant theories. In this study, we examined these relationships for the measurement of affect as reflected in the popular Bradburn Affect Balance Scale (ABS). Results of confirmatory analyses of data from 187 older Canadian adults (Mean age, 69.7 years) showed that a two-dimensional structure fitted the item data much better than the unidimensional, bipolar model suggested by the original scoring key. The two dimensions showed parallel patterns of correlations with two measures of morale and with a measure of social desirability, but these patterns differed from that of the conventional unidimensional ABS score. Results suggested that the ABS should be used with caution and with scoring for two distinguishable dimensions.

The study identified the types of help provided by 27 adult children to their hospitalized chronically ill parents. The investigation further examined the child's helping behavior in relation to stress and strain, as well as dependence of the parent on the child. The results demonstrated that despite profound stress and strain felt by children, they still provided a range of helping behaviors within the formal caregiving structures of the acute care hospital. Dependence was a weak indicator of the adult child's helping behavior, while stress was a stronger indicator.