This article explores how dementia care is provided to First Nations communities in southwestern Ontario. Data were collected through in-depth interviews with health care providers and analysed using a constructivist grounded-theory methodology. Two interrelated frameworks for understanding dementia care were identified: a care delivery framework and a knowledge framework. The care delivery framework identified care goals, care elements being provided, care barriers, and strategies and solutions to deliver care and overcome barriers. The knowledge framework defined four groups of knowledge stakeholders: persons with dementia, informal care providers, formal care providers, and the First Nations community. It identified the knowledge each stakeholder held or needed and processes of sharing – or failing to share – knowledge in dementia care. Several barriers, many created by a lack of knowledge, negatively impacted dementia care. However, health care professionals had effective strategies for providing care, designed to overcome barriers and which encompassed elements of knowledge sharing.

Nous avons cherché à identifier l’ampleur et les facteurs prédictifs de l’évolution longitudinale de l’aide financière aux parents des descendants adultes et des réseaux de transferts pendant une période de deux ans. Les analyses s’appuyent sur les données regroupées de l’Étude de la Santé et de la Retraite (1994–2000), utilisant les familles dans lesquelles les descendants adultes ont au moins un, mais pas plus de quatre frères et sœurs, qui ont fourni un soutien financier aux parents pendant deux ans. Certains changements dans le réseau d’aide surviennent dans environ 40 pour cent de ces familles au cours de la période de deux ans. Quand le changement se produit, il s’agit le plus souvent de la cessation du soutien par un enfant, suivie par l’addition d’un nouvel enfant au réseau, alors que l’échange de soutien aux enfants est relativement rare. Le changement reflète la capacité de la progéniture avant tout à fournir des soins et le fardeau créé par les besoins des parents. Cependant, la taille et la composition du réseau adulte-enfant et du groupe de soutien initial jouaient un rôle important aussi bien. Les résultats soulignent le caractère dynamique et systémique des réseaux financiers intergénérationnels.

The aging population and the epidemic of chronic diseases requires an accompanying finance reform of long-term care that will become increasingly dominant. Many countries have faced this situation and have set up a separate public funding for such care on the basis of a universal insurance covering both home care and institutions. Canada and Quebec must adopt such autonomy insurance and create a separate fund financed partly by a more judicious use of current budgets and tax credits, and also by a significant investment in home care. An autonomy support benefit could be allocated in kind to fund public services and by contract to pay for services delivered by private, voluntary, and social economy agencies. This benefit would be established following a standardized assessment of functional autonomy achieved by the case manager who will manage the services and control their quality.

This study examined the cost-effectiveness of a multifactorial falls prevention program and estimated the trade-off between the extra costs of such a program and the additional reduction of unintentional falls. Cost-effectiveness was evaluated using the traditional incremental cost-effectiveness ratio (ICER) and the net benefit regression framework (NBRF). Using the NBRF, decision making was formalized by incorporating values of willingness to pay (WTP) a priori. The results failed to provide evidence that a multifactorial falls prevention program was cost-effective. Participant adherence to recommendations ranged from low (41.3%), to moderate (21.1%), to high (37.6%). A future challenge is to understand more clearly the relationship between the community-dwelling older adult, potentially modifiable risks for falls, adherence to multifactorial risk factor recommendations, costs, and resulting effects of falls prevention practices. Future economic evaluations of falls prevention interventions remain necessary and should consider the NBRF so that regression tools can facilitate cost-effectiveness analysis.

Based on data from the 2002 General Social Survey, this research presents a global portrait of unmet needs for home care services among Canadians aged 65 and over. It shows that 26.8% of seniors need assistance, accounting for approximately 1,024,000 individuals. Among these, just over 180,000 (17.7%) had at least one unmet need. In nearly half the cases, elderly with unmet needs receive insufficient support for 2 activities or more. Furthermore, house cleaning, house maintenance and outdoor work are the three activities with the highest prevalence of unmet needs. Finally, the younger seniors, those who require assistance for 3 or 4 activities and those living in Quebec and British Columbia are most likely to have unmet needs.

Falls represent 40 per cent of hospital accidents, and consequences range from none to serious injuries. The purpose of this study was to estimate the average hospital cost and length of stay (LOS) associated with serious injurious falls in an acute care hospital. We used data from risk management and case costing databases to identify cost associated with a serious injury after an in-hospital fall. Thirty-seven injured patients were matched with 2,113 controls by the most responsible medical diagnosis, age, and gender. Cost and LOS were compared using t-tests and multivariate regression. Average costs for seriously injured fallers and non-faller controls were CAD$44,203 and CAD$13,507, while LOS was 45 and 11 days respectively. Hospital cost for a seriously injured faller was $30,696 (95% CI: $25,158 – $36,781) greater than the cost for a non-faller. Hospital managers have a leading role in creating system-wide falls prevention programs and reducing hospital costs.

Cette étude compare la consommation d’alcool des Canadiens âgés de 55 ans et plus entre les années 1990 et 2000 et vérifie si les différences persistent lorsque la composition sociodémographique des échantillons est prise en compte. Les analyses incluent des sous-échantillons de répondants âgés de 55 à 74 ans provenant des enquêtes CADS de 1994 (1 071 hommes/1 446 femmes) et GENACIS de 2004 (1 494 hommes/2 176 femmes). Des ANOVA univariées font ressortir des taux de buveurs et de consommation excessive significativement plus élevés en 2004, mais aucune différence dans les profils de consommation. Des régressions montrent que la composition sociodémographique n’annule pas les différences observées. Le contexte social/environnemental plus favorable à l’alcool en 2004 expliquerait potentiellement les taux de buveurs plus élevés. Davantage de recherche sera nécessaire afin de préciser les effets de l’âge, de la cohorte et de la période sur la consommation d’alcool des Canadiens âgés.

In this study we examined the longitudinal relationships between five dimensions of social support and psychological distress to determine whether (1) social support was related to subsequent psychological distress levels; or (2) if distress levels were related to subsequent social support levels; or (3) if distress and support had a reciprocal (bi-directional) relationship across time. Using bivariate autoregressive cross-lagged models, we analysed data from 2,564 older adults. We found support for the reciprocal relationship between affectionate support and distress. Higher psychological distress was related to subsequently higher levels of positive social interaction, and significantly related to subsequently higher emotional/informational support. No significant relationship was found between tangible and structural support and psychological distress. This study demonstrates that different types of support are associated in correspondingly different ways with psychological distress, and that psychological distress may be important in predicting levels of social support two years later.

This grounded-theory study explored family members’ experiences supporting a relative’s move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members’ experiences accepting the need for, and timing of, their relative’s move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

Although some studies have confirmed positive associations between social engagement and well-being in later life, this study aimed to understand why some seniors cannot be engaged. The authors analyzed the lived experiences of 89 seniors in three rural communities in Canada, from semi-structured interviews and using the constant comparison method. Five factors make choices for social engagement in later life unequal among older adults who differ by gender, class, age, and health status. Profound engagement in care work, compulsory altruism, personal resources, objectively perceived and subjectively available engagement opportunities, and ageist barriers around paid work constrain choices for seniors who lack privilege in the context of a market economy, particularly for low-income older women. To avoid stigmatizing vulnerable older persons, societal barriers to meaningful activities must be addressed – for example, through provision of income security or by reversing inter- and intragenerational ageism in access to the labor market.

The oncoming retirement of baby boomers has governments worried. Will individual baby boomers demonstrate the ability to prepare financially for their retirement? Well-being in retirement depends largely on financial preparedness during working life. Those baby boomers who are the most vulnerable at the end of their working lives are more likely to become vulnerable during retirement. This study looks at the income of the first baby boomers, those born between 1946 and 1956, aged 50 to 60, according to the 2006 Canadian census. First we establish the socio-economic categories for which members are most financially vulnerable. Then, we estimate how many baby boomers are vulnerable and to what extent. This study’s preferred approach is an interprovincial comparison between Quebec and Ontario, used to analyze individual aspects of baby boomers’ financial positions.

This study examined hope in long-term care residents with cancer from the perspectives of both residents and health care providers (HCPs). Clinical data established that the prevalence of a cancer diagnosis in the study facility (15%) was similar to other estimates in the literature. Eight experienced HCPs were interviewed. Ten residents with a cancer diagnosis were interviewed, and they completed the Herth Hope Index (HHI). Dimensions of hope and contextual factors that shape hope emerged as themes for both HCPs and residents, but reflected their different perspectives. HCPs identified hope as integral to care. HHI scores were high, indicating residents were generally hopeful. The study findings suggest that for the small but complex subgroup of long-term care (LTC) residents who have a diagnosis of cancer, hope is not lost, but rather it is relevant, nuanced, and possible to attain.

Aging is associated with increased intestinal inflammation and elevated risk of chronic diseases including inflammatory bowel diseases and colon cancer; many epidemiologic studies show that regular exercise reduces risk. This study examined the effects of long-term voluntary exercise on inflammatory mediators expressed in the intestine of older (15–16 months), healthy C57BL/6 mice. Animals were assigned to four months of freewheel running (WR; n = 20) or to a “sedentary” no wheel running (NWR; n = 20) control group. Intestinal lymphocytes were harvested and analysed for expression of (1) pro-inflammatory (TNF-α, IL-1β) and pleiotropic (IL-6) cytokines, and (2) pro-(caspase-3/-7) and anti-(Bcl-2) apoptotic proteins. Training was confirmed by skeletal muscle enzyme activity; stress was assessed by plasma 8-iso-PGF2α and corticosterone. The WR mice had a lower expression of TNF-α, caspase-7, and 8-isoprostanes (p < .05) compared to sedentary controls, suggesting that long-term exercise may “protect” the bowel by reducing inflammatory cytokine and apoptotic protein expression.

Early detection of dementia is essential to guide front-line health care practitioners in further clinical evaluations and treatments. There is a paucity of literature assessing the effectiveness of screening tools to predict the development of dementia, thus we conducted a systematic review to fill this gap. The purpose of the systematic review was to make recommendations to health care practitioners on which screening tool best predicts the development of dementia and is most feasible in the primary care setting. Ten databases were searched for relevant articles, yielding 751 papers. Of these, 12 met relevance criteria for inclusion. Screening tools were assessed for test accuracy, cognitive domain coverage, predictive ability, and feasibility. Four screening tools were recommended. Addenbrooke’s Cognitive Examination (ACE) was considered to be the ideal tool. A revised version of this tool is now used in clinical practice but the psychometric properties of the ACE-R remain to be established.

We explored contextual features shaping end-of-life (EOL) care in residential care facilities by drawing on the perspectives of 11 resident care aides (RCAs) in one Western Canadian urban centre. RCAs characterized EOL care as “providing comfort”, including physical and emotional comfort. Concerns with time and workload challenges dominated accounts and generated guilt, sadness, and frustration. RCAs tried to “find the time” by taking it from themselves or other residents, and by relying on the commitment of co-workers and on families. Findings emphasize the importance of the RCA role (particularly in emotional comfort), yet call for attention to interpretations of what is involved in this work, and to definitions of scopes of practice and training requirements. Findings reiterate the importance, among Canadian RCAs, of appropriate workloads to facilitate quality EOL care, and raise concerns about how time constraints shape EOL care practice and the meanings infusing this practice.

HIV/AIDS and aging is an important emerging topic with relevance to gerontology. Currently, little is known about the housing experiences of older adults within the context of HIV/AIDS. This article explores the issue and examines interview data concerning the housing experiences of 11 older adults (52 to 67 years old) living with HIV/AIDS in Ottawa, Ontario. Participants’ stories revealed concerns relating to three major themes: acceptance into retirement homes and long-term care communities, barriers to accessing subsidized housing services, and homelessness. Participants reported feeling that they lacked recognition and experienced confusion about their future housing prospects. These data suggest that a shift may be occurring in the housing needs of people aging with HIV/AIDS. This emerging population presents challenges to mainstream ideas of aging. We conclude that increased attention is needed in research, policy, and practice to address housing issues among this age group of people living with HIV/AIDS.

ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Little is known about how persons with dementia and their care partners respond to mealtime changes that occur throughout the dementia journey. By interviewing 27 persons living with dementia and their 28 care partners, we explored the meaning and experience of change surrounding mealtimes. Participants adjusted to mealtime change by adapting to an evolving life, as a result of a dynamic process of becoming aware of change, attaching meaning to change, and responding to change. Seminal events compounded by a sense of things being different triggered awareness of mealtime changes. Meaning was attached to mealtime changes, observed through emotions experienced and diverse strategies developed to support mealtime values. Responding to change ranged from resisting, to being in a holding pattern, to transforming and adapting. Understanding how individuals and families adjust to mealtime changes, and the strategies they develop, provides critical insights for supporting families throughout the dementia journey.

We analysed a prospective cohort study to determine (1) if self-rated health (SRH) predicts mortality in older adults with and without depressive symptoms, and (2) to determine if there is an interaction between SRH and depressive symptoms on mortality. We followed 1,751 community-dwelling adults aged 65 and older over five years. Measurements included age, gender, education, the Center for Epidemiological Studies-Depression (CES-D), SRH, the Modified Mini-Mental State Examination (3MS), and the Older Americans Resource Survey (OARS). Our outcome measure was time to death. Analyses were conducted in those with, and those without, depressive symptoms. We constructed Cox regression models with an interaction term for the CES-D and SRH. The hazard ratio (HR) for mortality was 1.63 for those with depressive symptoms; it was 1.68 for those without. No significant interaction was found between depressive symptoms and SRH for mortality.

D’ici à 2038, le nombre d’heures de soins non rémunérées aux aînés offert par les membres de la famille devraient tripler. Les membres des familles sont souvent suppliés d’aider dans le processus parce que vivre avec la démence peut inhiber la capacité pour prendre une décision. Cette étude ethnographique a soumis les relations au sein de soins de la démence à domicile à un examen critique par le biais des entrevues face-à-face et les observations des participants des clients, des aidants naturels et des prestataires de soins à domicile. Les résultats ont révélé comment les décisions sont imposées dans le contexte du système de soins à domicile formels, et ont mis en évidence trois thèmes: (1) L’accommodation de la compétence/incompétence, comme définie cliniquement; (2) La prise de décisions inopportunes; et (3) Le renforcement de l’exclusion des déments dans la prise de décision. Ces thèmes illuminent la façon dont les valeurs culturelles (la compétence), les croyances (l’immuabilité du système) et les pratiques (le réglage des décisions) dans le système de soins à domicile sont finalement déterministes dans la prise de décisions pour les déments et leurs aidants. Afin d’optimiser la santé des déments qui se font soignés à domicile, il faut accorder d’attention supplémentaire aux pratiques collaboratives et inclusives des membres des familles.