The right of the individual to participate in her life-prolonging treatment decisions, either as a decision maker or by having her treatment wishes used as a decision-making criterion, is the result of an evolution in legal guidelines over the last two decades. Although necessary, these legal guidelines are however not sufficient to assure the individual's opportunity to participate. For the chronically ill older adult residing in a health care institution, the opportunity to participate in decisions concerning life-prolonging treatments implicitly depends on the effective communication among three key actors (the individual, her physician, and her proxy). The necessity of this communication has important implications for clinical practice and future empirical research.

Determining the appropriate intensity of investigation and treatment for individual elderly patients in long-term care settings can present a significant challenge to physicians, especially when patients are incompetent to decide for themselves. However, respecting established intervention levels may represent an even greater challenge, given the realities of coverage by on-call physicians. This paper describes a new Intervention Level Scale for competent as well as incompetent long-term care elderly, and its validation as a communication tool between attending and on-call physicians. Specifically studied were (a) concordance of interventions, (b) whether prior knowledge of an intervention level by an on-call physician was considered useful, (c) applicability of the scale in different institutions and (d) necessity of physician training for optimal use. The scale's uniqueness resides in the fact that it is based on personal values of life, rather than institutional resources, and it incorporates directives on family contact.

Older persons living in Residential and extended care centres (RECC) have to cope with various Stressors associated with institutional life. While some residents cope successfully, a large proportion of this population presents difficulties in adjustment. Knowledge about the role of coping strategies in the adjustment process to nursing home Stressors is limited to strategies used in the first few months following admission to RECC. The goal of this exploratory study was to determine how various coping strategies are related to depressive symptoms, anxiety and well-being of 90 residents living in RECC for more than three months. Individual interviews were used to collect the data. Significant correlations were observed between measures of psychological adaptation and the strategies of escape-avoidance and seeking social support. These results confirm than certain coping strategies are associated with adaptation to life in RECC.

Using census data, this study investigates change in the residential segregation of persons age 65 years and over from younger persons in Canadian census metropolitan areas (CMAs) between 1981 and 1991. In each CMA, age-segregation is first evaluated in terms of inner city-suburban population distributions, and then according to the degree of segregation across census tracts expressed by the Index of Dissimilarity. Although the CMAs typically had moderate segregation levels in both 1981 and 1991, there were consistent trends toward (i) increasing proportions of the elderly living in suburban areas, and (ii) declining degrees of age-segregation across census tracts. It is proposed that these trends are partly attributable to the aging in place of suburban residents. Correlation and regression analyses indicate that in 1991 lower degrees of segregation were associated with CMAs which had relatively high percentages of both older dwellings and elderly population. The policy implications of the results are discussed.

Population aging has become a subject of widespread popular and academic interest. In providing an assessment of the extent of aging that is in prospect, this paper makes available a number of projections of the age-sex distribution of the Canadian population for the 45-year period 1996 to 2041 and comparisons with the previous 45-year period. The projections combine assumptions relating to fertility, mortality, and migration so as to produce future populations characterized as “medium,” “old,” “young,” “high immigration” and “low immigration”. Supplementary calculations include growth rates, for both the total population and selected age groups, and various types of dependency ratios, including ones with a range of age-differentiated weights. It is concluded that substantial aging of the Canadian population appears virtually certain but, based on the demographic evidence, the “dependency burden” is likely to remain below the peak levels attained during the baby boom.