The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragiles) is an integrated service model based on community services, a multidisciplinary team, case management that retains clinical responsibility for all the health and social services required, and the capacity to mobilize resources as required and according to the care protocol. The SIPA demonstration project used an experimental design, with random allocation of the 1,230 participants from two areas of Montreal to an experimental and a control group. The costs of institutional services were $4,270 less for those in the SIPA group compared to the control group; the costs of community care were $3,394 more. The proportion of persons waiting in acute care hospitals for nursing home placement was twice as high in the control group as in the SIPA group. The costs of acute hospitalizations for persons in the SIPA group with ADL disabilities were at least $4,000 lower than those for persons in the control group. In conclusion, the SIPA trial showed that it is possible to undertake ambitious and rigorous demonstration projects in Canada. These results were obtained without an increase in the overall costs of health and social services, without reducing the quality of care, and without increasing the burden on elderly persons and their relatives.

This article identifies home care practitioners' perceptions of the responsibilities, difficulties, and needs for support of caregivers. It is based on a study undertaken in Quebec with 55 practitioners and 10 administrators from 10 CLSCs located in rural, urban, and metropolitan areas. The study had a qualitative, multiple-case design and used logs recording all contact with caregivers in the space of a week, followed by semi-structured interviews. Analysis reveals that practitioners tend to perceive the work of caregivers as mainly instrumental and clinical, ignoring the family relations that tie them to their relative. Although aware of the difficulties facing caregivers and the negative impacts of caregiving, a majority of practitioners have high expectations of caregiver participation in treatment plans, albeit as quasi-nurse's aides. Our analysis offers an explanation for this apparent contradiction by examining practitioners' values with regard to family responsibility for care.

Communication abilities are known to decline with age. In daily life, such abilities are frequently of the non-literal type, which require more cognitive resources to be processed. Since these resources tend to diminish with age, this study seeks to identify a possible effect of age on non-literal language abilities. Forty young and 40 older adults of two different education levels were compared on their non-literal and literal language abilities. Results suggest that age does not affect the processing of non-literal language but could affect some preliminary components of the task, thought to require more cognitive resources. This study does not provide direct evidence to suggest that elderly participants experience specific difficulties in processing non-literal language.

Although decisions related to driving are vital to well-being in later life, little is known about how aging drivers who do not experience a medical condition that requires driving cessation regulate their driving. This exploratory, qualitative study used focus groups with 79 such community-dwelling individuals to examine driving self-regulation from the perspective of pre-senior (aged 55–64) drivers, senior (aged 65 years or over) drivers, and senior ex-drivers. Themes resulting from inductive analysis addressed the importance of driving, mechanisms of self-monitoring and self-regulation, people who influenced decision making, and opinions regarding licensing regulations. A preliminary model of the process of self-regulation that highlights intrapersonal, interpersonal, and environmental influences on why, how, and when aging drivers adapt or cease driving is presented. The model identifies areas for future research to enhance understanding of this process, including the effectiveness of self-regulation. Findings suggest that increased public awareness of issues related to driving and aging could assist aging drivers, their families, and their family physicians in optimizing driving safety for this population. Since a near accident or accident was seen as the only factor that would lead many informants to stop driving and few informants planned for driving cessation, there is a need for interventions that help aging drivers make the transition to ex-driver in a timely and personally acceptable way.

A rapidly growing older population has led to changes in health care, including a community health movement with an emphasis on community collaboration, self-help, and capacity building. This study examined factors in the lives of older individuals that influenced their ability and willingness to participate in a health-related community-capacity-building project to help their frailer, older neighbours. Using cross-sectional survey methodology, 107 volunteers who lived in a high density seniors' apartment complex known for its high health service utilization were compared with a random sample of 74 non-volunteers from the same community. Factors associated with volunteer involvement included age, activity level, functional ability, life satisfaction and certain personality characteristics. The study suggests that, within a community, the “younger-old” may be able to support their frailer, older neighbours so that they can remain living in the community.

The purpose of this study was to examine changes in family involvement following a relative's move to a long-term care facility as well as factors associated with these changes. Qualitative data, using in-depth, active interviews were gathered from 35 family members at two points in time following a relative's move to a facility. Findings showed some changes in contact that were related to personal, social, institutional, and health conditions. Occasionally, new types of care were provided; more often care was rebalanced or expressed in alternative ways. The majority of participants did not view themselves as caregivers, a perception that remained stable over time. Consistent with continuity theory, families, in most cases, tended to seek ways to maintain consistency in their roles as family members and carers, particularly in the first year or so after placement. Nonetheless, facility staff should be aware of the factors that might influence changes over time in family caregiving roles and offer support to families dealing with these issues.

Whether the density of sarcoplasmic reticulum (SR) calcium release channels / ryanodine receptors in the heart declines with age is not clear. We investigated age-related changes in the density of «3H»-ryanodine receptors in crude ventricular homogenates, which contained all ligand binding sites in heart and in isolated junctional SR membranes. Experiments utilized young (120 days) and older adult (300 days) hamsters. «3H»-ryanodine binding site density did not change with age in crude homogenate preparations, although total heart protein concentration increased significantly with age. In contrast, the density of «3H»-ryanodine binding sites decreased markedly in heavy SR membranes purified from older hearts. These results show that demonstration of age-related changes in cardiac ryanodine receptor density depends upon the preparation used. Furthermore, the increase in total ventricular protein with age suggests that normalization of data by membrane protein should be used with caution in studies of aging heart.

According to the author, this book is an analysis of the underlying family dynamics in caring for an elderly relative. It is primarily for nonspecialists but is of definite interest to health professionals who work with families that are experiencing a situation of dependency. The ideas are presented as a dialogue between the author and a fictional character called “Autonome S'démène” (Independent and Struggling), who is herself a caregiver. This well-written book examines such relevant concepts as the family's hesitation to ask for or even accept an offer of services from the formal network for fear of being invaded by strangers.