Drawing on the literature on the extensive investment older adults make in volunteering, and on the findings of a study of 19 not-for-profit agencies that rely heavily on older adults to provide a variety of community services, this paper identifies several significant changes in the character of the clients who are served by these volunteers and in government health policies affecting the delivery of community services. The paper concludes with suggestions for research and policy development aimed to optimize the contribution which older volunteers make to society and reciprocally, the contribution that volunteering makes to the health and well-being of older adults.

Registered nurses (RNs) and licensed practical nurses (LPNs) provide the skilled component of nursing care in Canadian residential long-term care facilities, yet we know little about this important workforce. We surveyed 309 RNs and 448 LPNs from 91 nursing homes across Western Canada and report descriptively on their demographics and work and health-related outcomes. LPNs were significantly younger than RNs, worked more hours, and had less nursing experience. LPNs also experienced significantly more dementia-related responsive behaviours from residents compared to RNs. Younger LPNs and RNs reported significantly worse burnout (emotional exhaustion) and poorer mental health compared to older age groups. Significant differences in demographics and work- and health-related outcomes were also found within the LPN and RN samples by province, region, and owner-operator model. These findings can be used to inform important policy decisions and workplace planning to improve quality of work life for nurses in residential long-term care facilities.

As they near the end of life, long term care (LTC) residents often experience unmet needs and unnecessary hospital transfers, a reflection of suboptimal advance care planning (ACP). We applied the knowledge-to-action framework to identify shared barriers and solutions to ultimately improve the process of ACP and improve end-of-life care for LTC residents. We held a 1-day workshop for LTC residents, families, directors/administrators, ethicists, and clinicians from Manitoba, Alberta, and Ontario. The workshop aimed to identify: (1) shared understandings of ACP, (2) barriers to respecting resident wishes, and (3) solutions to better respect resident wishes. Plenary and group sessions were recorded and thematic analysis was performed. We identified four themes: (1) differing provincial frameworks, (2) shared challenges, (3) knowledge products, and 4) ongoing ACP. Theme 2 had four subthemes: (i) lacking clarity on substitute decision maker (SDM) identity, (ii) lacking clarity on the SDM role, (iii) failing to share sufficient information when residents formulate care wishes, and (iv) failing to communicate during a health crisis. These results have informed the development of a standardized ACP intervention currently being evaluated in a randomized trial in three Canadian provinces.

Availability of health professionals is fundamental to population health. Multiple trends contribute to provider shortages. Purpose: Develop and validate conceptual models of early and involuntary retirement among registered nurses (RNs) and allied health professionals (AHPs). Method: A review of retirement literature (n = 23 studies). Any factor reported as predictive of early or involuntary retirement was incorporated into a model. To achieve face validity, we conducted interviews with Canadian RNs/AHPs (n = 14). Results: The conceptual model of early retirement had eight categories (38 variables): workplace characteristics, socio-demographics, attitudes/beliefs, broader context, organizational factors, family, lifestyle/health, and work-related. The model of involuntary retirement had four categories (eight variables): broader context, socio-demographics, lifestyle/health, and family. Caregiving responsibilities (variable) was added based on interview data. Discussion: RNs/AHPs consider many factors when contemplating retirement; some are sensitive to intercession, which generates possibilities for extending the work lives of older RNs and AHPs.

The coronavirus disease (COVID-19) pandemic has had profound consequences on collective mental health and well-being, and yet, older adults appear better off than younger adults. The current study examined mental health impacts of the pandemic across adult age groups in a large sample (n = 5,320) of Canadians using multiple hierarchical regression analyses. Results suggest older adults are experiencing better mental health and more social connectedness relative to younger adults. Loneliness predicted negative mental health outcomes across all age groups, while the negative association between social support and mental health was only significant at average and high levels of loneliness in the 65–69 age group. Results point towards differential mental health impacts of the pandemic across adult age groups and indicate that loneliness and social support may be key intervention targets during the COVID-19 pandemic. Future research should further examine mechanisms of resiliency among older Canadian adults during the pandemic.

This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of wai in the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.

This paper examines friendship in later life, drawing upon data obtained from in-depth interviews conducted with a sample of 142 elderly women who were living in a small town in Atlantic Canada. The nature and meaning of friendship in later life is examined from the perspective of the elderly woman. The data indicate that most respondents have a substantial number of friends and differentiate between different types of friends: ‘friends’ and ‘close friends,’ ‘old friends’ and those acquired more recently. Focusing attention on the concepts of self-identity and reciprocity, an attempt is made to explain why older people might more highly value their old friends than those acquired more recently.

Although family scholars conceptualize caregiving in terms of networks of carers, little attention has been given to equity within these groups. Siblings comprise a prevalent caregiving network of members who feel responsible for parent care, expect to share these responsibilities with each other, and look to each other to evaluate the fairness of their sharing. In this paper, a multidisciplinary approach is used to examine sibling views of equity in relation to disputes over giving parent care and receiving parent assets. A literary perspective is offered through analysis of stepsibling tensions depicted in the novel Family Matters. Real life disputes among biological siblings that have been pursued through the courts are also examined. Issues arising from these examples are then analysed through the lens of legal doctrines of equity. Siblings evaluating fairness undertake careful comparisons of their respective relationships with parents in terms of biological links to parents and type and extent of influence in interactions with parents.

The movement away from institutional care to community living, along with improved nutrition and health care, has led to an increased lifespan for individuals with intellectual disabilities. In Canada, those who were born before 1945 represent the first significant group to grow old. Despite the increasing numbers of these individuals, relatively little is known about them, their life experiences, or their needs. They remain a largely invisible, undervalued, and often overlooked population, and are seldom the focus of new policy or program initiatives. This review of Canadian literature reports on issues related to the prevalence, life expectancy and early aging of individuals with intellectual disabilities, describes the impact of changes in social policy on their life experiences, outlines the needs and expectations of older adults and their families and, finally, suggests future directions for policy development and research in Canada.

Heart failure (HF) affects up to 20 per cent of residents in long-term care (LTC) and is associated with substantial morbidity, mortality, and health service utilization. Our study objective was to formulate recommendations on implementing HF care processes in LTC. A three-phase and iterative stakeholder consultation process, guided by expert panel input, was employed to develop recommendations on implementing care processes for HF in LTC. This article presents the results of the third phase, which consisted of a series of interdisciplinary workshops. We developed 17 recommendations. Key elements of these recommendations focus on improving interprofessional communication and improving HF-related knowledge among all LTC stakeholders. Engaging frontline staff, including personal support workers, was stated as an essential component of all recommendations. System-level recommendations include improving communication between LTC homes and acute care and other external health service providers, and developing facility-wide interventions to reduce dietary sodium intake and increase physical activity.

The principal objective of this study, the first of its kind to use this population, is to describe the factor analysis and validity of the Dyadic Adjustment Scale (EAD) among 895 French Canadian seniors living as couples. A confirmatory factor analysis was carried out using structural equation modeling. Results support Spanier’s hierarchical model questionnaire (1976). Results also indicate evidence of validity and reliability satisfactorily set aside for the Affective Expression subscale having a lower Cronbach alpha coefficient. The results also indicate strong validity of the scale according to indices of convergent and discriminant validity. Finally, a discussion is presented addressing considerations to be taken into account for using the questionnaire among older couples.

An increasing number of studies have documented the cognitive profile of individuals with mild cognitive impairment (MCI), but few studies have investigated the individuals’ psychological health and personality traits or how these factors interact with cognition. In the present study, 27 healthy older adults and 30 persons with MCI completed questionnaires covering psychological health, morale, personality, self-efficacy, and self-actualization. The results indicated that individuals with MCI are more depressed, anxious, hostile, and have lower morale than matched healthy older adults. Furthermore, our results show a positive association between the level of depression of MCI persons and the severity of their cognitive dysfunctions. In contrast, there were no group differences on measures of personality traits. Thus, while psychological distress is present in persons with MCI, those individuals are not characterized by differences in personality traits relative to older adults who experience no cognitive impairment.

Until recently, the health promotion movement has focussed primarily on individual responsibility for health behaviours rather than on broad social determinants of health. The movement has been targeted primarily at young rather than older persons, at men rather than women. There is an emerging call for a feminist approach to health promotion for aging women, an approach which would address the current gender, class, race, and age biases in health promotion practice, research, and policy. Feminist theories suggest that sexism limits women's health opportunities and subjects them to an array of situations including marginalization, powerlessness, and exploitation. The purpose of this paper is two-fold: to use a feminist analysis to critique health promotion, identifying gender, class, race, and age biases that influence older women's health, and to recommend changes in health promotion theory, research, practice, and education. Health promotion researchers, practitioners, and educators are challenged to work with older women to increase their visibility and empowerment, and to bring about a transformation of the society in which women age.

Ready-to-use modified-texture food (rMTF) products are commercially available and may have greater appeal than conventional in-house or commercial bulk modified-texture food (cMTF) products. A nine-month pilot study using a prospective interrupted time-series design where participants (n = 42) served as their own controls investigated the impact of cMTF + rMTF on weight goals, weight, food intake, and co-morbidity. Seventy-four per cent of participants achieved their weight goals at the end of six months on rMTF and, although insignificant, participants did have a trend towards weight gain while on rMTF (OR 3.5 p = .16). Main-plate food intake (grams) was not significantly different over time, but a downwards trajectory suggests decreased consumption that was compensated for by a significantly higher fat intake during the intervention period (p = .01). Increased co-morbidity and a decreasing volume of food consumed are common in older adults with dysphagia, and enhanced food products are needed to meet nutrient needs. Methodological issues encountered in this study can provide guidance for future work.

Using a case scenario involving a marginally competent elderly woman living alone at risk, we assessed the care decisions made by older adults (n = 82) and health care professionals (HCPs, n = 87), and identified differences in the values underlying the care decisions. Overall, participants did not place a high value on independence when they appraised the risk to the client as high and safety as low. Under these conditions, elderly respondents tended to be more paternalistic in their decisions about care, while HCPs tended to be more beneficent. If the values of HCPs differ from those of elderly people, how likely is it that the care provided to marginally competent elderly people will be congruent with their wishes? The care provided by HCPs might be improved by incorporating knowledge of the values and perspectives of other older adults.

Applying primary health care (PHC) team-based approaches to diagnosing and treating dementia is considered best practice. Unfortunately, those living in rural and remote areas often have limited access to dementia-specific PHC services. The purpose of this scoping review was to identify and understand PHC team-based approaches for dementia care in rural settings. A search strategy was employed which included only peer-reviewed journal articles that were published from 1997 to 2017. Four databases (Embase, Medline, PsycInfo, and CINAHL) were searched from March 2017 to May 2017. Among the 10 studies included there was a variation in the degree of collaboration and interaction among the care teams. Limited information existed about collaboration strategies among care teams. An adaptation of the socio-ecological model enabled us to categorize key factors influencing collaborative team-based approaches. Combined, these findings can be used to inform both future research and the development of a rural PHC dementia model.

The behavioural and emotional changes associated with Alzheimer's disease (AD) are compared for individuals with Down syndrome and AD and individuals with AD from the general population (AD-only). The primary caregivers of 30 people with Down syndrome and AD and 30 people with AD-only completed the BEHAVE-AD and the Apathy subscale of the CERAD. As well, behavioural observations at adult day programs were undertaken with selected participants (n = 26). The Down syndrome group experienced fewer delusions and had lower total scores on the BEHAVE-AD, indicating fewer problem behaviours overall. Day program observations suggested that the AD-only group were more likely to be sedentary and observe the activities of others, while the Down syndrome group were more physically active. Improving our understanding of the similarities and differences between these two groups may help facilitate the integration of individuals with Down syndrome into adult day programs for the general population.

The Canadian Longitudinal Study on Aging (CLSA) has progressed from a vision initiated by the Canadian Institutes of Health Research (CIHR) Institute of Aging in 2001 to a federally funded national research platform in 2008. The development of the CLSA protocol was enhanced through a series of international peer reviews, a multisectorial Steering Committee, and a CIHR Ethical, Legal, and Social Issues committee; each was essential to the excellence of the science and to making the CLSA relevant to multiple sectors. The CLSA research team, led by three co-principal investigators (Kirkland, Raina, and Wolfson), has developed a unique protocol focusing on aging from cell to society, designed to follow 50,000 people aged 45 to 85, for 20 years. A strategic partnership with Statistics Canada has been crucial to the development and launch of the CLSA. The CLSA will contribute to our understanding of transitions and trajectories within an aging population, and will differ from longitudinal studies of aging worldwide through the breadth of its scope, the early age of recruitment into the study (age 45), the ethno-cultural diversity of Canada’s population, and the potential to link collected data to health administrative data at the provincial level. The CIHR is a novel longitudinal population-based study that will be an unprecedented research resource underpinning multidisciplinary research and evidence-based decision making in aging in Canada.

Using variables derived from Attachment Theory, gender differences in several motivational and structural factors on the levels of care provided by adult offspring to their parents are explored. Data from the Winnipeg Parent Support Project on informal helpers who were sons and daughters between the ages of 30 and 64 (n = 79) were analysed. Consistent with previous research, adult daughters reported greater caregiving than sons. The structural variables of Employment, Marriage and Presence of Children did not emerge as significant predictors of caregiving involvement for sons or daughters. Considerable support was found for Attachment Theory. Perceived Parental Dependence, followed by Frequency of Visits, emerged as the strongest predictors of sons' and daughters' caregiving involvement. Perceived Parental Ability accounted for additional variation in daughters', but not sons', caregiving. No support was found for Exchange Theory; reciprocity did not predict caregiving involvement. Implications for understanding the helping behaviour of adult sons and daughters are discussed.

The challenge of this paper is to re-examine the demographics which underlie the re-write of social policy in an aging Canada, as related to gender, family and generation. Following a brief consideration of Canada's changes and challenges in comparison to those in the United States and selected European countries, the analytical construct, “life cycles of dependencies and responsibilities” is introduced and utilized to examine shifting bases of security among generations (with a focus on six cohorts), and in particular, the implications of possible changes to social policy for the elderly on women, the poor and other disadvantaged elders.