This study investigated the speed of short-term memory scanning in two groups of patients: patients with Parkinson's disease (PD) (primarily subcortical pathology) and patients with a presumptive diagnosis of dementia of the Alzheimer type (DAT) (primarily cortical pathology). Non-demented PD patients (M age = 58.3), mildly demented DAT patients (M age = 67.0), and normal control (NC) subjects (M age = 58.9) were compared to one another in order to determine whether the presence of slowed scanning differentiates subcortical from cortical pathology. The three groups did not differ significantly on the memory scanning task. Slowed scanning speed does appear to occur in some patients with PD, however. This may relate to age, duration of disease, or an interaction between these two. Despite normal scanning speed, most DAT patients required highly structured instructions to be able to carry out the item-recognition task, and many remainedunable to perform this task even with additional instructions.

This paper examines the economic well-being of women who become divorced or separated in mid- or later life, using 1994 data from Statistics Canada's Survey of Labour and Income Dynamics. Economic well-being is measured by adjusted economic family total money income, before-tax low-income cut-offs, and ownership of dwelling. Women and men aged 65 and over still in their first marriages are compared with women and men, aged 65 and over, who were divorced or separated at age 45 or older. Results show that women who become divorced or separated in mid- or later life are more likely to have low income than married persons and men who become divorced or separated in mid- or later life. Persons who divorce or separate in mid- or later life are less likely than married persons to live in a dwelling that is owned by a member of the household. Regression analyses show that receiving pension income and receiving earnings are positively associated with income for women who become divorced or separated in mid- or later life. Implications for the Canadian legal and retirement income systems are discussed.

Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

Cataract surgery is one of the most frequent surgical procedures experienced by seniors. In Canada, substantial waiting lists for cataract surgery are common. This study systematically studied anxiety among older persons who were waiting for cataract surgery, and factors that may underlie anxiety in this population. Factors examined in relation to anxiety were age, sex, education, medical and ocular problems, previous cataract surgery, concern about wait, previous decisions to delay surgery, length of wait, visual functioning, visual acuity, worry about health, and coping strategies. A random sample (n = 50) of patients on a waiting list for cataract surgery took part in telephone interviews. Patients' ophthalmologists provided preoperative visual acuity. Over one-third of patients reported anxiety within the range reported for panic disorder patients and Beck Anxiety Inventory scores were well above reported norms for seniors. Increased anxiety was found among those with a general tendency to worry about their health, poorer visual functioning, and greater use of palliative coping strategies. The clinical implications of the findings are discussed. The results highlight the importance of assessing anxiety while elderly patients wait for surgery, designing interventions, and providing assistance to those patients found to have elevated levels of anxiety.

Few studies of older individuals have directly assessed secondary control beliefs, previously defined by Morling and Evered in 2006 as a combination of psychological adjustment and acceptance. We classified older adults (n = 223, M age = 85 years, 62% women) into three categories of secondary control beliefs: psychological adjustment only, psychological adjustment and acceptance, and neither psychological adjustment nor acceptance. Relative to individuals who emphasized beliefs about psychological adjustment only, those who emphasized a combination of secondary control beliefs (including both psychological adjustment and acceptance), reported more frequent positive emotions, greater life satisfaction, and less severe chronic conditions. Our findings have implications in both theoretical and applied contexts. Theoretically, our findings extend contemporary thinking on secondary control. In applied contexts, they suggest ways of thinking that could enhance well-being in the very old.

The advancement of computer systems has led to the existence of large and detailed existing computerized data sets, many of which contain useful information for studying the elderly and the aging process. This paper identifies several types of existing large data bases and provides examples of each. Strengths and weaknesses of working with existing data are discussed and strategies for conducting secondary data analysis of large data sets are outlined. Existing data sets represent large investments in the collection of individual data and have great potential to provide answers to important questions in the field of aging research.

Our objective was to evaluate the efficacy of recombinant human growth hormone (GH) on bone mineral density (BMD) in persons age 50 and older, with normal pituitary function, with or at risk for developing osteoporosis. We systematically reviewed randomized clinical trials (RCTs), searching six databases, and conducted meta-analyses to examine GH effects on BMD of the lumbar spine and femoral neck. Data for fracture incidence, bone metabolism biomarkers, and adverse events were also extracted and analysed. Thirteen RCTs met the eligibility criteria. Pooled effect sizes suggested no significant GH effect on BMD. Pooled effect sizes were largest, but nonsignificant, when compared to placebo. GH had a significant effect on several bone metabolism biomarkers. A significantly higher rate of adverse events was observed in the GH groups. Meta-analysis of RCTs suggests that GH treatment for persons with or at risk for developing osteoporosis results in very small, nonsignificant increases in BMD.

Existing research on the health care utilization patterns of older Canadians suggests that income does not usually restrict an individual’s access to care. However, the role that income plays in influencing access to health services by older adults living in rural areas is relatively unknown. This article examines the relationship between income and health service utilization among older adults in rural and urban areas of British Columbia. Data were drawn from Statistics Canada’s Canadian Community Health Survey, Cycle 3.1. Multivariate regression techniques were employed to examine the influence of relative income on accessibility for 3,424 persons aged 65 and over. Results suggest that (1) relative income does not influence access to health care services; and (2) this is true for both urban and rural older adults. The most important and consistent predictors of access in all cases were those that measured health care need.

The recent introduction of new adult guardianship legislation in British Columbia, Ontario, Manitoba and the Northwest Territories signals the arrival of the third wave of guardianship law reform in Canada since the mid 1970s. The first wave appeared in Alberta in the form of the Dependent Adults Act which was replicated, in part, in Saskatchewan. The second wave affected only the Atlantic provinces and consisted of new adult protection legislation aimed primarily (but not solely) at cases of elder abuse or neglect. The third wave of reform involves, amongst other things, the enactment of omnibus adult guardianship statutes that include adult protection provisions. Some potential problems are examined including an untenable fusion of guardianship and protection procedures; an excessive reliance upon potentially expensive and fiscally vulnerable advocacy services; and an increase in abuse and neglect as a result of the removal of various “paternalistic” safeguards.

Public libraries are community hubs that can both create opportunities and address challenges often associated with later life and population aging. Using a thematic analysis of 18 in-depth interviews with public librarians, this study investigates common practices and challenges experienced while developing programs for older adults. This analysis is augmented by an environmental scan of older-adult programming offered in member libraries of the Canadian Urban Library Council (CULC). Results indicate that public librarians leverage community partnerships and staff training to develop programs that foster digital, financial, language, and health literacy and create opportunities for both intergenerational and peer social connection. At the same time, they face challenges related to limited space, budgets, and staff capacity, difficulty meeting the extensive and often conflicting interests of various groups within the library, and marketing programming to older adults. Findings indicate that public libraries may be key players in mitigating challenges often associated with having an aging population, and indeed highlight the many benefits of valuing and providing services to this population.

This paper examines changes in functional ability and mental functioning among participants (aged 50 and over) of Adult Day Care programs in Manitoba, Canada. It compares those who improve, remain stable, and deteriorate on each of these two dimensions in terms of their condition at time 1, a host of demographic factors, subjective and social factors, characteristics of their participation in the program, and diseases as coded from their medical claims records. In doing so it explores whether or not it is possible to identify who will benefit while in the program. The results provide only a potential answer to the question, but do suggest that the ADC program is performing an important social function which is related to improved functional ability, especially among those living alone and with fewer relatives. For mental health, the findings suggest the program works in conjunction with the existing marital relationship, benefiting most those still married. Research efforts are ongoing.

Chemical dependency in the elderly has been recognized as a serious problem since the early 1960s. Few practitioners however, have developed intervention or treatment programs for this age group. The Elders Health Program, a research demonstration project, established the fact that the problem of enabling behaviours had to be addressed. Active family and professional enablers became significant factors influencing the design of intervention and treatment programs.

This paper describes a process of identifying best practice guidelines for non-pharmacological management for individuals with dementia and disseminating them to a group of frontline practitioners in specialized geriatric services. Our dissemination plan involved early participation of practitioners, development of a chart summarizing five guidelines showing commonalities, contrasts, and gaps in the guidelines, and their interpretation, colour-coded for the strength of the evidence on which they were based. Two sequential workshops were held in which recommendations for action were developed. Outcomes of the process included a resource manual, a network of practitioners, and action recommendations based upon survey data. An early follow-up evaluation showed increased adoption of guidelines.

Geriatric consultation programs have been developed to service elderly patients in a number of acute care hospitals. Evaluation studies examining their utility have shown variable results. Suggested explanations for these inconsistent findings include differing study designs, various service delivery strategies, differing outcome measurements, and site-specific factors. The evidence suggests that the critical variable may well be the methods utilized in patient recruitment. Further work is required in a number of areas such as: (1) development of optimal targeting strategies, (2) determination of appropriate service composition and function, (3) study of how these programs interact with other components of a comprehensive geriatric program, (4) documentation of the long-term (1 year) impact on assessed patients, and (5) evaluation of the institutional impacts of these programs.

A provincial survey was undertaken in Ontario, Canada concerning the prevalence of the use of practice guidelines in chronic care and long-term care facilities and the opinions of staff about the clinical conditions or problems important for developing clinical practice guidelines and the factors that promote change in clinical practice. Five hundred and fifty surveys were sent out and 306 returned from two mailings. Forty per cent of the facilities were aware of evidence-based guidelines while only 21.6 per cent were using them. They were being used most in government-funded agencies, then in acute care facilities with chronic care beds and nursing homes and least in non-government funded agencies. The clinical problems which agencies felt were important for guideline development were behavioural problems, continence, feeding problems and problems with skin care. The results of this survey have implications for funding of these institutions as well as for identifying the situations where evidence is needed for future care and where it is presently available but not being utilized and understanding the reasons for this approach to practice.

Variations in health and medication use exist across cultures. Medication use among Chinese-Canadian older persons is complicated by many factors including combined use of Western and traditional Chinese medicines (TCM). There is little research on health, psycho-social and cultural determinants of medication use in the Chinese. A cross-sectional census study of community-based Chinese-Canadian older persons in the Kitchener/Waterloo area was conducted using the Minimum Data Set for Home Care and a supplementary questionnaire for cultural issues. The response rate was 89.1 per cent with 106 participants using face-to-face assessments. Socio-demographic and cultural variables were summarized. The multivariate logistic model for TCM use included pain symptoms and being hospitalized, and a curvilinear association between TCM use and health beliefs. For combined medicine use, living with a child, pain symptoms, hospitalization, and social isolation problems were the main effects. Living with a child, physical health problems and number of diseases were associated with Western medicine use. Health, psycho-social and cultural factors were significant determinants for medication use. Education programs for both Chinese-Canadian older persons and health care providers are necessary to understand the appropriate use of Western and TCM treatments.

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization’s guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic’s persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents’ quality of life, while ensuring the well-being of staff and residents’ families.

Theories of adult development and aging suggest that older adults turn towards religion and spirituality (R/S) to increase meaning and purpose in life, and to assist in coping with adverse experience. We sought to examine the relationship between R/S and positive mental health and mental illness (i.e., psychological distress) in adulthood, and to determine the potential moderating role of age. Data from the 2012 Canadian Community Health Survey – Mental Health (CCHS-MH), a national population health study, were used. A multivariable linear regression model revealed a significant R/S by age interaction for positive mental health (p = 0.001). Although R/S was associated with positive mental health among all participants, there was a stronger relationship between R/S and positive mental health for older adults. No statistically significant relationship between R/S and psychological distress was observed. Findings highlight the importance of R/S to positive mental health across the adult lifespan. The differential relationships among R/S, positive mental health, and mental illness underscore the utility of using the dual-continua of mental health and mental illness in order to understand their respective determinants.