The current study examines constructs that contribute to the well-being of an international sample of older married adults. A convenience sample of 208 participants was recruited through an Internet site as well as more traditional means such as newspaper advertisements and contact with community groups. The resulting structural equation model provides further support for the revised theory of cognitive adaptation. Within this model, the direct and indirect contributions of personality, marital satisfaction, and cognitive adaptation are examined in relation to well-being. Contrary to previous findings, personality appears to have an indirect effect upon both marital satisfaction and well-being. Cognitive adaptation, in contrast, has both a direct and indirect effect upon the well-being of older adults. Limitations of use of the Internet as a vehicle for data collection are considered as well as directions for future study.

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.

In Canada, provincial and territorial laws address circumstances in which a substitute decision-maker may be appointed for an adult deemed legally incapable of making decisions in one or more areas of life. We searched for provincial and territorial laws that explicitly address substitute decision-making about research participation, and found significant differences among Canadian jurisdictions. In some provinces and territories there is no direct statutory guidance on the issue. Differences among jurisdictions that address substitute decision-making about research in legislation include whether judicial intervention is required to authorize the substitute decision-maker, whether any advance directive in place must explicitly authorize the decision about research in order for a proxy to consent, and how risk and benefit thresholds beyond which substitute consent to research is prohibited are articulated. It is imperative that government, researchers, and the Canadian public revisit the principles underpinning substitute decision-making about research in light of national and international norms, in order to lend clarity and consistency to this area of law and research practice.

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.

Purpose: To assess the prevalence and strength of association of risk factors for falling in Canadian veterans of World War II and Korea and their caregivers.

Methods: Questionnaires were sent to addresses of 3,000 Canadian veterans (response rate = 70%). Risk factors for falls and the frequency of falls and injurious falls in the past 12 months were collected.

Results: Veterans had more risk factors than did caregivers, and more had fallen in the past year (39.8% vs. 29.7%). Risk factors in the logistic model for veterans included lower extremity disability (odds ratio = 1.98, 95% confidence interval 1.5–2.6); lower extremity weakness (OR 1.75, 95% CI 1.3–2.3); worse memory than peers (OR 1.67, 95% CI 1.1–2.5); one or more visits to the family doctor in the past month (OR 1.53, 95% CI 1.2–2.0); and worse memory than 5 years ago (OR 1.36, 95% CI 1.0–1.8).

Conclusions: Veterans appear more frail and prone to falling than their caregivers.

Numerous studies suggest that the clinical presentation of Alzheimer's disease (AD) is varied and that AD is thus a heterogeneous disorder. Evidence of this inter-individual variability has had an important impact on the approaches to the cognitive rehabilitation of AD, particularly in the early stages of the disease. Research has shown that, despite variable cognitive profiles, many preserved capabilities are observed in the first stages of AD and that the disease does not affect all cognitive functions globally. These preserved capabilities make it possible to apply cognitive interventions. However, numerous methodological difficulties are encountered in evaluating the effectiveness of these interventions, many of which are related to the heterogeneity of the deficits. The purpose of this article is to discuss this heterogeneity and its impact on methodological characteristics, especially participant selection and research design.

While an association between UI and psychological distress among older adults has been established in the literature, the mechanisms underlying this relationship remain less clear. Using a sample of 4,689 older adults from the Canadian Community Health Survey (1.1), we test the potential mediating and moderating effects of four dimensions of social support on the UI–distress relationship. Incontinent older adults are significantly more likely to report higher levels of distress than continent adults. Although we do not find support for a mediating effect of any of the dimensions of social support, we do report a significant interaction between one dimension of social support (tangible support) and UI. A buffering effect of tangible support is evident for continent – but not incontinent – respondents. These findings emphasize the need to assess the types of social support and the context in which they operate.

Only competent persons can give informed consent to health care. Current approaches define competence in essentially cognitive terms, thereby ignoring the fact that someone may be cognitively competent yet lack the capacity to give a valid consent. I outline a more robust theory of competence that includes not only cognitive but also emotional and valuational parameters. I then distinguish competence from capacity, and indicate the role this distinction can usefully play in the extended and continuing care setting. I also show how this distinction is consistent with several recent Canadian legal decisions, and outline its usefulness in interpreting and applying relevant provincial statutes.

Evidence suggests that frailer older patients benefit from a continuum of care rather than the admit/discharge model of our health system. This study examined patient outcomes after discharge from a geriatric day hospital (GDH) to determine what proportion continues to do well, what proportion declines, how the two groups differ, and if factors predictive of deterioration can be identified. Using telephone survey and Goal Attainment Scaling methodologies, the goals of 151 patients discharged from a GDH between 6 and 18 months previously were examined to determine whether GDH achievements were maintained or lost. All but 5 patients improved between GDH admission and discharge; after discharge, 39 per cent deteriorated. The need for more support in the community was predictive of deterioration, probably reflecting patient frailty. Number of medical diagnoses or medications were not predictive. Frailer older patients tend not to maintain goals achieved in a GDH after discharge and may benefit from ongoing maintenance.

Researchers in the fields of biology, religious studies, history, medical ethics, philosophy, and sociology offer a popularized interpretation of “what is death and dying.” This book is divided into three sections, each beginning with a relevant discussion on the contexts of the issue of death and dying. The work proposes three insights into the subject. First, the image of “the dead and the living,” as presented in art history, is revisited through the genetics and biology discourses that have recently challenged the traditional concepts of aging, as well as the very definition of “clinical” death. Second, the “experience of death” is based on new ideologies that reassess the solitude and individualistic nature of the dying and the necessity of reestablishing the links between the dying and the living, as reiterating the cultural norm. Finally, the “good death” establishes a virtual breach between two types of mythical figures – the heroes and the saints – and the relational singularity of palliative care.