Canadians are living longer, and older persons are making up a larger share of the population (14% in 2006, projected to rise to 20% by 2021). The Canadian Longitudinal Study on Aging (CLSA) is a national longitudinal study of adult development and aging that will recruit 50,000 Canadians aged 45 to 85 years of age and follow them for at least 20 years. All participants will provide a common set of information concerning many aspects of health and aging, and 30,000 will undergo an additional in-depth examination coupled with the donation of biological specimens (blood and urine). The CLSA will become a rich data source for the study of the complex interrelationship among the biological, physical, psychosocial, and societal factors that affect healthy aging.

Zarit Burden Interview (ZBI) is the most widely used instrument for assessing the burden experienced by the caregivers of persons with dementia. As part of the Canadian Study of Health and Aging, the 22-item ZBI was administered to a representative sample of 312 informal caregivers of community-dwelling subjects with dementia. The mean score was 22.4 out of 88 (sd: 16.2) and the median score was 18.5, which is far lower than those reported in previous studies using this instrument with convenience samples. There was no significant difference in the burden score according to the age, gender, living arrangement, marital status or employment status of the caregiver. The ZBI score was more strongly correlated to the depressive mood of the caregivers (r = 0.59) and the behaviour problems of the care recipients (r = 0.64) than their cognitive (r = 0.32) and functional (r = 0.31) status. Following a factor analysis, a 12-item short version of the instrument is proposed with two factors: personal strain (3 items) and role strain (9 items).

Patient falls are a serious problem, contributing to the morbidity and mortality of the elderly patient. This study reports on the development of the Morse Fall Scale. The scale consists of six scored items and discriminant analysis correctly classifies 80.5% of the patients. Validation of the scale by computer modeling was conducted. Data were randomly split and that analysis procedure repeated. Variables were obtained and weighted using half of these data, and these weights were tested on the remaining data. Similar results were obtained. Sensitivity of the scale was 78% and the positive predictive value, 10.3%. Conversely, specificity was 83% and the negative predictive value, 99.3%. Interrater reliability scores were r=.96. A prospective study in three clinical areas showed that the scale is sensitive to different patient conditions and to length of stay. Thus, the scale permits identification of the patient at risk of falling so that prevention strategies may be targeted to those individuals.

The Fraboni Scale of Ageism (FSA) is introduced in this study with reports of its factor structure, internal consistency reliability, and its relationship to The Acceptance of Others Scale, The Facts on Aging Quiz, and The Marlowe-Crowne Social Desirability Scale (N = 231). The FSA construct is derived from Butler's (1978) definition of ageism, and is intended to measure the affective component of attitude to supplement the cognitive aspect measured by other instruments. The FSA was found to have adequate construct validity and high internal reliability. Relationships to the other constructs measured supported the uniqueness of the FSA and revealed a lack of influence from social desirability. Sex was found to account for some variance in FSA scores.

On the political and policy front, interest has increased in making communities more “age-friendly”, an ongoing trend since the World Health Organization launched its global Age-Friendly Cities project. We conceptualize age-friendly communities by building on the WHO framework and applying an ecological perspective. We thereby aim to make explicit key assumptions of the interplay between the person and the environment to advance research or policy decisions in this area. Ecological premises (e.g., there must be a fit between the older adult and environmental conditions) suggest the need for a holistic and interdisciplinary research approach. Such an approach is needed because age-friendly domains (the physical environment, housing, the social environment, opportunities for participation, informal and formal community supports and health services, transportation, communication, and information) cannot be treated in isolation from intrapersonal factors, such as age, gender, income, and functional status, and other levels of influence, including the policy environment.

In this study, Weiss's (1973) theorizing about the sources of emotional and social loneliness is elaborated – with notions about the asymmetric gratifications derived from marriage, about the conflicting loyalties that result from remarriage, and about selection into marriage – in order to reach an understanding of gender differences in loneliness, both in and outside of marriage. First and subsequent marriages are considered, as well as marital disruptions and never marrying. The data (N = 3737) are from the 1992 Dutch survey on older adults' living arrangements and social networks (NESTOR-LSN). Marital-history differences emerge, not only for emotional loneliness, but also (and contrary to Weiss's theoretical conceptualizations) for social loneliness. The marital-history differences in emotional and social loneliness are greater among men than women. For men, the marriage bond appears not only to be more central to emotional well-being than is the case for women but also to play a pivotal role in their involvement with others. Marital history offers the best explanation for differences in emotional loneliness among men, but social embeddedness characteristics also account for differences in emotional loneliness among women. Apparently, whereas men are more likely to find an intimate attachment in marriage, women also find protection from emotional loneliness in other close ties. The marital-history differences in social loneliness are largely mediated by social embeddedness characteristics, partly in different ways for men and women. Involvement in activities outside the home serves as the context for sociability for men, whereas parenthood plays a more important role in women's social engagements.

Worldwide, falls among older people are a public health concern because of their frequency and adverse consequences in terms of morbidity, mortality, and quality of life, as well as their impact on health system services and costs. This epidemiological review outlines the public health burden of falls and fall-related injuries and the impact of population aging. The magnitude of the problem is described in terms of the classification of falls and measurement of outcomes, including fall incidence rates across settings, sociodemographic determinants, international trends, and costs of falls and fall-related injuries. Finally, public health approaches to minimize falls risk and consequent demand on health care resources are suggested.

Relatively little is known about the factors in Canada which lead to osteoporosis and its concomitant fractures. The Canadian Multicentre Osteoporosis Study (CaMos) is a prospective cohort study which will estimate the incidence and prevalence of declining bone mass and fractures. The impact of osteoporosis in Canada will be assessed, including regional variation and the effect of various risk factors. The study will provide information for developing prevention programs. The cohort has been drawn from a random population-based sample of non-institutionalized men and women 25 years old or more and living within 50 km. of nine cities in Canada. Through telephone interviews 9,423 participants have been recruited. All answered an extensive questionnaire, and had physical measurements related to bone quality taken. This paper details the CaMos baseline and five-year follow-up protocol.

The purpose of this study was to examine whether older age is associated with increasing loneliness in people aged 60 and over. Data came from TamELSA, a population-based prospective longitudinal study in Tampere, Finland. The follow-up time was 20 years. Loneliness was measured by a single question – “Do you feel lonely?“ – with the possible answers often, sometimes, or never. Cross-sectional analysis showed that the percentage of subjects feeling lonely increased toward older age groups, but in a multivariate analysis, only household composition and social participation were independently associated with loneliness. Longitudinal analysis showed that loneliness increased with higher age. Over a 10-year period, loneliness increased most in those who, at baseline, were married and living alone with their spouse. In conclusion, only a minority of older people continuously suffer from loneliness. Loneliness does increase with age, not because of age per se, but because of increasing disability and decreasing social integration.

Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.

This article provides an introduction to the special volume on research related to issues of social isolation and loneliness for older people. It discusses some key concepts and provides a brief overview of the articles included in the volume.

The Bangor Longitudinal Study of Ageing (BLSA), conducted in rural Wales from 1979 to 1999, followed a cohort of survivors from more than 500 people over 20 years. Using both quantitative and qualitative data from the study, the factors associated with increases and decreases in loneliness and social isolation were identified. The study was based on a population sample and survivors were followed up every 4 years. From 1983 to 1987, 30 people aged 75 and over in 1979 were studied intensively. The customary measure of loneliness was used, as well as an aggregate measure devised by the research team. Social isolation was similarly measured, using an aggregate measure. Respondents were assessed as demonstrating low, moderate, or high levels of loneliness or isolation. Subsequently, statistical models of loneliness and social isolation were developed. Some respondents were assessed as not experiencing social isolation or loneliness during the study. Others showed changes in levels. In this article, the data are explored, seeking factors associated with changes in social isolation and loneliness. Outcome measures of these two variables of interest are compared with items from the aggregate measures and other identifiable intervening variables. The article discusses which change variables contribute most to levels of isolation and loneliness and result in different combinations of these two outcomes. Implications for policy and practice are discussed.

This review evaluates the quality of available administrative data in the Canadian provinces, emphasizing the information needed to create integrated systems. We explicitly compare approaches to quality measurement, indicating where record linkage can and cannot substitute for more expensive record re-abstraction. Forty-nine original studies evaluating Canadian administrative data (registries, hospital abstracts, physician claims, and prescription drugs) are summarized in a structured manner. Registries, hospital abstracts, and physician files appear to be generally of satisfactory quality, though much work remains to be done. Data quality did not vary systematically among provinces. Primary data collection to check place of residence and longitudinal follow-up in provincial registries is needed. Promising initial checks of pharmaceutical data should be expanded. Because record linkage studies were “conservative” in reporting reliability, the reduction of time-consuming record re-abstraction appears feasible in many cases. Finally, expanding the scope of administrative data to study health, as well as health care, seems possible for some chronic conditions. The research potential of the information-rich environments being created highlights the importance of data quality.

This article presents the results of a study into stereotyping by managers of their older workers and the influence of these stereotypes on the inclination of managers to keep their older workers in employment. The data for the study were gathered among 796 managers. Through principal components analysis, 15 opinions about older workers were reduced to three dimensions of stereotypes. The first dimension deals with the productivity of older staff; the other two dimensions have to do with their reliability and their adaptability. These stereotypical ideas about older workers influence managers' attitudes toward the retirement of their employees. The analyses show that, besides organizational factors, psychological mechanisms also explain why people view older workers through stereotypes. Managers who are older and in more frequent contact with older employees tend to hold more positive views.

This paper describes patterns of caring for people aged 65 or over with dementia in Canada, and the relationship this has with the well-being of caregivers. Data were drawn from a representative sample of elderly people, selected from the community and from institutions in the ten provinces of Canada as part of the Canadian Study of Health and Aging (CSHA). Interviews were held with the caregivers of people diagnosed with dementia, and with a comparison group of caregivers for non-demented persons. About half of all people with dementia in Canada are living in the community, and our results show that over 98 per cent of them have a caregiver. The caregivers in 94 per cent of these cases are unpaid family members, relatives or friends: the spouse in 37 per cent of cases and a daughter in 29 per cent. Caregivers rarely use community support services. Among those caring for someone in the community, those caring for a person with dementia are more likely to experience chronic health problems and depressive symptoms than are those caring for a non-demented elderly person. Those caring for a person in the community are much more likely to feel burdened than those whose loved one is in an institution, even though those who are institutionalized are more likely to suffer from severe dementia. These national figures support many of the findings reported from smaller, localized studies. The findings suggest that long-term care institutions are serving a role for Canada's seniors, particularly for the most demented, and that caregivers often provide care for loved ones even when suffering from chronic health conditions, depression, and burden themselves.

In this article, we examine the existing sociocultural research and theory concerned with the aging body. In particular, we review the body image and embodiment literatures and discuss what is known about how older adults perceive and experience their aging bodies. We analyse how body image is shaped by age, culture, ethnicity, gender, health status, sexual preference, and social class. Additionally, we critically elucidate the embodiment literature as it pertains to illness experiences, sexuality, the everyday management of the aging body, appearance work, and embodied identity. By outlining the key findings, theoretical debates, and substantive discrepancies within the body image and embodiment research and theory, we identify gaps in the literature and forecast future, much-needed avenues of investigation.

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.

An aging population is best served by social, personal, and health support focused on maintaining and maximizing personal independence. The Internet affords numerous opportunities for individuals of all ages to communicate, access information, and engage in recreational activities. A community-based sample of 122 adults over 60 years of age completed a questionnaire which assessed three clusters of characteristics: (a) frequency and patterns of Internet use, (b) well-being (loneliness, life satisfaction, self-efficacy, social support, and depression), and (c) demographics (age, income, education). Significant correlations emerged between the three clusters of measured variables. Controlling for demographic differences, Internet use and self-efficacy remained significantly related. Among the sample of older adults, individuals who used the Internet more had higher perceptions of self-efficacy than those who used the Internet rarely or not at all.

Since the prevalence of many chronic health conditions increases with age, we might anticipate that as the population ages the proportion with one or more such conditions, and the cost of treatment, would rise. How much would the overall prevalence of chronic conditions increase in a quarter century if age-specific rates of prevalence did not change? How much would the requirements for health care resources increase? How much difference would it make to those requirements if people had fewer chronic conditions? The overall prevalence rates for almost all conditions associated mostly with old age would rise by more than 25 per cent, and health care requirements would grow more rapidly than the population – more than twice as rapidly in the case of hospital stays – if the rates for each age group remained constant. Even modest reductions in the average number of conditions at each age could result in substantial savings.

Because the concept of retirement is prominent in both popular thinking and academic studies, it would be helpful if the notion were analytically sound, could be measured with precision, and would make possible comparisons of patterns of retirement over time and among different populations. This paper reviews and assesses the many concepts and measures that have been proposed, summarizing them in groupings that reflect non-participation or reduced participation in the labour force, receipt of pension income, end-of-career employment, self-assessed retirement, or combinations of those characteristics. It concludes that there is no agreed measure and that no one measure dominates. Instead, new proposed measures continue to take account of additional refinements as new data sets become available, thereby further restricting possible comparisons. The confusing array of definitions reflects the practical problem that underlies the concept of retirement: It is an essentially negative notion, a notion of what people are not doing – namely, that they are not working. A more positive approach would be to focus, instead, on what people are doing, including especially their involvement in non-market activities that are socially productive, even if those activities do not contribute to national income as conventionally measured.