Burden among caregivers has consistently been recognized as a function of both subjective and objective variables. In addition to concrete role demands, caregivers' perceptions and appraisal strongly contribute to perceived burden. At present, however, the relative contribution of objective and subjective factors remains unclear. This question was addressed among 70 spousal caregivers recruited within a dementia assessment clinic. Subsequent to adjustment for socially desirable responding, both groupings of variables significantly contribute to the prediction of burden scores. These findings are discussed in the context of the hopelessness theory of depression. Demographic similarity between these caregivers and a corresponding sample of randomly derived spousal caregivers recruited as part of the Canadian Study of Health and Aging (CSHA) suggest the results of this study may be generalized with greater confidence.

An aging population and increasing rates of dementia point to the need for alternative strategies that allow individuals to age in place. This multiple case study explored, from an insider’s perspective, the role and meaning of music for individuals with dementia who are aging in place. Methods were semi-structured interviews, observations, and videos. The study’s central theme is connection, with three types of “connectors” – self, partner, and music – as subthemes. Connection to self involves present moment awareness, accessing memories, and self-expression. Connection to partner builds on self-connection and spending time together with music. Lastly, the connection to music builds on the previous two subthemes as well as the desire to keep things “normal”. This study provides insight into the growing body of interdisciplinary literature dedicated to dementia, music, aging in place, and contemplative practices, as well as implications for aging and caring for someone with dementia.

This study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.

The goal of this literature review is to identify key issues in the patterns of medical care utilization of services for seniors as a contribution to the National Consensus process on designing and delivering health care reforms which foster seniors' independence (Shapiro & Havens, 2000). A search strategy used to identify the relevant literature since 1985 focussing mainly on peer-reviewed journal articles is described and the results of the search strategy are summarized. Key articles are identified, analysed and synthesized based on Canadian and American evidence covering patterns of institutional care, physician use, ambulatory care and the determinants of utilization of these services.

This study presents on the initial development and validation of the Resilience Scale for Older Adults (RSOA). This new measure is based on a theoretical model of resilience grounded in qualitative research conducted with older adults. The scale consists of four resilience protective factors with 11 underlying facets. The Intrapersonal factor consists of Perseverance and Determination, Self-Efficacy and Independence, Purpose and Meaning, and Positive Perspective. The Interpersonal factor consists of Sense of Community, Family Support, and Friend/Neighbour Support. The Spiritual factor consists of Faith and Prayer, and the Experiential factor consists of Previous Adversity and Proactivity. The findings of three independent studies using older adult samples support the four-factor, 11-facet structure of the RSOA. Results also provide promising initial reliability and validity information, and analysis of gender invariance suggests that the factor structure is comparable across men and women. Implications for the applicability of the RSOA in research and clinical settings are discussed.

Many individuals have tube feeding implemented in the end stages of life. It is also common to have surrogates making life support decisions for others. When family members are placed in the role of decision-maker for an incompetent patient, what factors influence life support decisions? A case study and ethnomethodological inquiry provide an in-depth understanding of factors that influenced one daughter in her decision to have tube feeding implemented for her incompetent and severely debilitated mother. The decision was difficult and constituted a time of crisis. Unfortunately, the most influential factors in decision-making were: (a) urgency in the face of impending death, (b) lack of insight into the mother's values and preferences in relation to life support through tube feeding, (c) lack of knowledge over what tube feeding involved, and (d) the belief that tube feeding would not prolong her mother's life and suffering. Nine other, less influential, factors were also found. Improving the sensitivity of health care professionals to the agony of decision-making and to the decision-making process for life support are the major focuses of this paper.

A central question of social research is how experience is given voice in everyday life. Conventional methodologies provide technical answers: Issues of contextuality and the socially constructive and narrative features of method are not so much analytic and critical concerns as they are construed as procedural problems. This paper considers the question in aging research. Two sides of an analytic tension are addressed as they bear on method, one centred on voice and narrative and the other on the contextuality of experience. Observational and narrative material from qualitative studies of adults and elderly people is used to argue that a focus on ordinary, narrative practice usefully sustains the tension to provide the basis for a critical empiricism.

Tube feeding is a common, and frequently long-term, form of life support. Currently, no distinction is made between short-and long-term tube feeding; the latter being a replacement of the ability to eat on an ongoing, possibly permanent, basis. Little research has focussed on long-term feeding. Consequently, the implications and practices of long-term feeding remain undetermined. Hospital charts of ten accessible patients, who had long-term tube feeding were examined in order to answer pre-determined questions. Reporting includes: feeding solution types, tubes, and methods; medical diagnoses and functional reasons for tube feeding; changes in mental and physical conditions since initiation of tube feeding; involvement of nurses and others in tube feeding decisions, and decisions to continue tube feeding after initiation. Tube feeding was demonstrated to be capable of sustaining life over long periods of time. Despite improved nutrition, patients' overall levels of mental and physical capacity and self-care abilities were found unimproved. Maintenance of life may be the only goal of long-term tube feeding.

The aim of this study was to investigate the age differences in the rates and costs of broad categories of medical procedures (diagnostic, therapeutic and surgical) during the last year of life as well as hospitalization among the adult population of Quebec. The study is population-based and took into account 90 per cent of deaths occurring among the Quebec population (15 years and older) in 1991. The data were collected from the physician claim files of the Health Insurance Board. Costs were defined as physician payments for the procedures performed. The results showed that the rates of these procedures increase with age to reach a maximum in middle life and then decrease among the elderly. A similar trend was observed in the average cost of surgery and diagnostic procedures but the average cost of therapeutic procedures followed a constant decline with age. These data suggest that the oldest old do not seem to get more aggressive care at the end of life than younger decedents.

This article presents the results of a qualitative study on the contributions made by volunteers from a volunteer community organization to the home care of older adults living in a rural setting. In this study, the volunteer was considered as part of a social care system made up of a number of groups (the elderly themselves, those close to them, professional health providers, and volunteers). Results show that the lines delimiting the responsibilities of these various groups are neither clear nor precise. The place of the volunteer must take into account the nature of the participation of the other groups. How far the services offered by volunteers are used depends upon the characteristics that define their contributions and on the type of relationship they develop with a given older adult.

This article reports on two studies that describe the adaptation of Spielberger's State-Trait Anxiety Inventory (form Y) for people aged 65 and older. The aim of the first study is to assess the necessity to modify the format of the STAI for the aged. Verbal reports of 22 subjects suggest difficulties reading the items, respecting the instructions and using the Likert scale. Item-remainder correlations supported these observations. Therefore, the size of the text was doubled and the state or trait instructions, as well as the choices of the Likert scale, were repeated in each item. A second study is carried out to test if these modifications enhanced the understanding of the items, and simplified the use of the STAI-Y. Verbal report and internal consistency showed a significant improvement. Our results support the recommendation of other authors that adapting an instrument for the elderly necessitates important modifications.

Previous work on the association between total aluminum (Al) concentrations and a measure of cognitive impairment is extended by considering the associations between this measure of cognitive impairment, not only with total Al, but also with turbidity and DOC both of which also contain Al. The multivariate, but not bivariate, analyses show that the odds of showing indications of mental impairment increase with turbidity but decrease with DOC, and this effect is most pronounced at a medium pH. It is suggested that the two variables considered could account for some of the unexplained features of the association between Al concentrations and measures of cognitive impairment. The other associations, namely those with F, pH, source of drinking water (ground or surface) remain similar to those reported previously in this series of papers.

This article highlights the incidence of poverty amongst older persons in Canada by documenting the poverty rates among women and men from seven different ethnic groups representing both White ethnic and visible minority populations (Chinese, Aboriginal, Ukrainian, Jewish, Black, Greek and Italian ethnic ancestry). Special attention is placed on the incidence of poverty amongst older women and reasons for differential poverty rates among ethnic older women will be addressed. An attempt is made to link these issues with an agenda for gerontological research, policy and practice including addressing the need for improved services for this population.

Systematic, in-depth exploration of news media coverage of aggression and older adults remains sparse, with little attention to how and why particular frames manifest in coverage across differing settings and relationships. Frame analysis was used to analyze 141 English-language Canadian news media articles published between 2008 and 2019. Existing coverage tended towards stigmatizing, fear-inducing, and biomedical framings of aggression, yet also reflected and reinforced ambiguity, most notably around key differences between settings and relations of care. Mainstream news coverage reflects tensions in public understandings of aggression and older adults (e.g., as a medical or criminal issue), reinforced in particular ways because of the nature of news reporting. More nuanced coverage would advance understanding of differences among settings, relationships, and types of actions, and of the need for multifaceted prevention and policy responses based on these differences.

The goal of this study was to examine the reaction (anxiety, depression, and helplessness) and adaptive strategies (problem-solving and emotion-reducing) of community-dwelling elderly, confronted by one specific chronic stressor. We have conducted three face-to-face home interviews on a monthly basis with a follow-up interview seven months later. There were 237 psychotropic drug users and non-users, of high or low socio-economic status. Not only were low socio-economic psychotropic drug users more anxious about the targeted hassle of the week, but they also relied on and used more problem-solving strategies than non-drug users. It is suggested that psychotropic drug use be looked at as a strategy like any others rather than as passive behaviour when facing daily hassles. Moreover, using a high number of coping strategies is not synonymous with being good at coping with chronic stress. Various recommandations for clinical intervention are put forward.

Although many studies have been published over the past ten years on informal support of dependent elderly, few, if any, have examined the reticence of their caregivers to use formal support services. Further understanding of this phenomenon is required, for it questions the feasability of preventive measures for this population as well as the relationship between formal and informal support systems, considered optimal by government in their efforts to rationalize today's health care services. This article presents a conceptual framework enabling us to better understand the reasons why caregivers of the elderly seldom use formal support services, and discusses health, social and research implications.

The interest in preventive approaches to the health problems of older persons has increased substantially in recent years, partly in response to escalating health care costs. The present paper involves a critical examination of the potential usefulness of preventive home visits in the Canadian context in light of demonstration projects in other jurisdictions. The paper concludes with recommendations for Canadian research on the use of preventive home visits.

Des données ont été recueillies auprès de 47 grands-parents dont les enfants se sont remariés. Les rapports avec leurs petits enfants avant le divorce, entre les deux mariages et après le remariage ont été évalués à l'aide d'interviews et de questionnaires. La théorie des échanges sociaux a permis de comprendre les données. Les changements dans les visites entre grands-parents et petits enfants ont été conceptualisées comme des coûts assumés par les grands-parents dans leurs échanges avec les membres de la famille. L'analyse qualitative des données montre que le rôle de médiation de la génération des enfants des grands-parents, l'âge des petits enfants, la mobilité géographique et la possibilité pour les grands-parents de contribuer à la vie familiale sont associés aux coûts.

Part of Ontario’s strategy on Alzheimer’s disease and related dementias (ADRD) was to develop research priorities and recommend strategies for building research capacity. The process to achieve these objectives included an environmental scan, key informant interviews, surveys, and a consensus workshop; this process involved over 100 researchers, clinicians, persons with early dementia, and family caregivers. This article describes the process undertaken, key issues identified, and recommendations for research priorities and for building research capacity; and provides a strategic direction for dementia research in Ontario that is relevant for other jurisdictions. ADRD research in all aspects is required to advance knowledge of ADRD cause, care, and cure; gaps currently exist in understanding effective approaches to care and knowledge transfer. Capacity for high-calibre research hinges on maintaining attractive career paths for researchers, solid infrastructures, and strong partnerships. For research to inform policy and practice, better mechanisms are needed for knowledge exchange.

This study used administrative health data to describe emergency department (ED) visits by residents from assisted living and nursing home facilities in the Vancouver Coastal Health region, British Columbia. We compared ED visit rates, the distribution of visits per resident, and ED dispositions of the assisted living and nursing home populations over a 3-year period (2005–2008). There were 13,051 individuals in our study population. Visit rates (95% confidence interval) were 124.8 (118.1–131.7) and 64.1 (62.9–65.3) visits per 100 resident years in assisted living and nursing home facilities respectively. A smaller proportion of ED visits by assisted living residents resulted in hospital admission compared to nursing home residents (45% vs. 48%, p < .01). The ED visit rate among assisted living residents is significantly higher compared to that among nursing home residents. Future research is needed into the underlying causes for this finding.