This study examined the socioeconomic pathways linking partnership status to physical functioning, assessed using objective measures of late life physical functioning, including peak flow and grip strength. Using Wave 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we ran multilevel models to examine the relationship between partnership status and physical function in late life, adjusting for social-network characteristics, socioeconomic factors, and health behaviours. We found a robust relationship between partnership status and physical function. Incorporating social-network characteristics, socioeconomic factors, and health behaviours showed independent robust relationships with physical function. Co-variates attenuated the impact of cohabitation, separation, and widowhood on physical function; robust effects were found for singlehood and divorce. Sex-segregated analyses suggest that associations between cohabitation, singlehood, divorce, and widowhood were larger for men than for women. Results suggest that social ties are important to improved physical function.

This paper deals with the lack of interest shown by family medicine residents in Quebec (Canada) in home follow-up or monitoring of the elderly. By collecting and analyzing data from sixteen family medicine residents before and after their first experience of home follow-up, and from four medical supervisors, we found that residents experience a rapid loss of interest in this practice over a very short period. We show that this lack of interest stems first from the difficulty of applying the principle of patient-centered care, wherein medical interventions must meet the needs of the elderly in their entirety. Secondly, residents complain that they have to deal with many administrative tasks. They call for implementation of professional features to better integrate services such as case management.

The present study was conducted to determine whether anxiety among community-dwelling elders is associated with cognitive decline over a period of one year as well as to verify whether there are sex differences in the association between anxiety and cognitive decline. Participants (n=1942) were community-dwelling adults aged 65–96 years assessed at study entry (T0) and one year later (T1). Anxiety was identified with a semi-structured interview and cognitive functioning was assessed using the Mini-Mental State Examination. Results revealed that the presence of a clinically significant anxiety disorder did not predict cognitive decline in men and women. Subclinical anxiety symptoms predicted cognitive decline in women only. Moreover, for men, the presence of symptoms from at least two anxiety disorders predicted cognitive decline. For women, cognitive decline was predicted by the presence of symptoms from one anxiety disorder only. Overall, the results illustrate the role of anxiety in cognitive decline in community-dwelling older adults.

Medial temporal lobe (MTL)/memory and frontal lobe (FL)/executive functions indexes are used to measure changes related to cognitive aging. These indexes are based on composite scores of neuropsychological tests validated in English-speaking populations, and their use in aging research is growing in popularity. This study aimed at validating the MTL/memory and FL/executive functions indexes in French-speaking adults. Ninety-eight healthy participants (32 young and 66 older adults) were tested on eight neuropsychological tests, three associated with MTL/memory functions and five associated with FL/executive functions. Factor analysis indicated that residual scores independent of age and associated with MTL/memory functions grouped under one factor, and residual scores associated with FL/executive functions grouped under another factor. Bootstrapping analysis with 1,000 resamples confirmed stability for seven neuropsychological tests. This study provides the first validation of the MTL/memory and FL/executive functions composite scores in French-speaking adults, which may be used to assess cognitive changes in aging research.

The implementation in Ontario of 15 primary-care–based interprofessional memory clinics represented a unique model of team-based case management aimed at increasing capacity for dementia care at the primary-care level. Each clinic tracked referrals; in a subset of clinics, charts were audited by geriatricians, clinic members were interviewed, and patients, caregivers, and referring physicians completed satisfaction surveys. Across all clinics, 582 patients were assessed, and 8.9 per cent were referred to a specialist. Patients and caregivers were very satisfied with the care received, as were referring family physicians, who reported increased capacity to manage dementia. Geriatricians’ chart audits revealed a high level of agreement with diagnosis and management. This study demonstrated acceptability, feasibility, and preliminary effectiveness of the primary-care memory clinic model. Led by specially trained family physicians, it provided timely access to high-quality collaborative dementia care, impacting health service utilization by more-efficient use of scarce geriatric specialist resources.

Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical and organizational environments. RCF owners across Quebec were invited to complete a questionnaire that described the setting’s physical and organizational environment. Different combinations of cluster analysis methods and statistical parameters were used to identify plausible classifications. The final choice was made by an expert committee. Overall, 552 owners returned the questionnaire. Three plausible classifications were submitted to the committee. The selected classification included five clusters that differed with regard to admission criteria, services offered and recreational activities. This classification could help health professionals select the RCF that best responds to older adults’ needs.

Many hospitalized older patients are functionally dependent and, during their hospitalization, employ paid caregivers to perform various tasks. This study examined nurses’ attitudes regarding the tasks these care workers should or should not be allowed to perform in providing care during hospitalization, and the factors underlying nurses’ attitudes towards these paid carers. The study involved interviews of five key informants such as head nurses and medical directors in two general hospitals and surveys of 265 nurses in internal medicine and geriatric wards. Although no formal policies or guidelines existed with respect to the tasks that paid carers perform, most nurses believed that paid carers caregivers should be allowed to perform certain tasks except for those involving professional nursing. Hospital and nurses’ characteristics were significant in explaining nurses’ attitudes towards paid carers’ involvement with older care recipients. The study results indicate a need for explicit policies and practice guidelines for paid carers of older patients during hospitalization.

Despite evidence of increasing diversification of family structures, little is known regarding implications of marital and parental status for access to social support in later life. Using data from Statistics Canada’s 2007 General Social Survey, this study assessed the impact of marital and parental status intersections on social support among adults aged 60 and older (n = 11,503). Two-stage probit regression models indicated that among those who were currently married or separated/divorced, childless individuals were more likely to report instrumental (domestic, transportation) and emotional support from people outside the household. Conversely, among never-married or widowed older adults, being childless was associated with reduced domestic support but without differences in other support domains. Findings suggest that marital and parental status intersections are not uniformly positive, neutral, or negative regarding implications for extra-household social support. Future work should address complexities of these relationships in order to better understand rapidly changing family structures.

This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of wai in the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.

This study examined correlates of caregiving at the end of life provided by adult children to their older parents and the role of gender of adult children in family caregiving in rural China. Data came from five waves of the Longitudinal Study of Rural Elder’s Well-Being in Anhui Province, China, over 12 years and from a post-mortality survey. Hierarchical linear modeling was used. Findings demonstrated that the birth order of adult children, prior geographic distance, and prior intergenerational support exchange were significantly associated with family caregiving at the end of life. Eldest children, compared to other siblings, provided the most end-of-life caregiving to their parents. Children cohabitating with older parents before death provided the most caregiving, compared to other siblings. Adult children who had previously exchanged instrumental support with older parents before death, especially sons, tended to provide the most caregiving, compared with that by others, at end of life.

Heart failure (HF) is common among long-term care (LTC) residents, and may account for 40 per cent of acute-care transfers. Canadian Cardiovascular Society HF guidelines endorse standard therapies; yet LTC residents are less likely to receive treatment. This qualitative study employed focus groups to explore perceptions, from 18 physicians and nurse practitioners in three Ontario homes, on HF care practices and challenges. For example, participants reported challenges with HF diagnostic skills and procedural knowledge. They also identified the need for interprofessional collaboration and role clarification to improve HF care and outcomes. To address these challenges, multimodal interventions and bedside teaching are required. Leadership was viewed as essential to improve HF care. Several concerns arose regarding knowledge gaps and clinical deficits among primary-care providers who manage heart failure in LTC residents. Multimodal, clinically focused educational and interprofessional solutions are needed to improve HF care in long-term care.

This study sought to ascertain whether occupational noise-induced hearing loss (NIHL) increased the risk of falls requiring hospitalization among retired workers. The study population consisted of males (age ≥ 65) with an average occupational noise exposure of 30.6 years and whose mean bilateral hearing loss was 42.2 dB HL at 3, 4, and 6 kHz. Seventy-two retired workers admitted to hospitals after a fall were matched with 216 controls from the same industrial sectors. Conditional logistic regression models were used to estimate the risk (odds ratio; [OR]) of falls leading to hospitalization by NIHL categories. Results showed a relationship between severe NIHL (≥ 52.5 dB HL) and the occurrence of a fall (OR: 1.97, CI95%: 1.001–3.876). Reducing falls among seniors fosters the maintenance of their autonomy. There is a definite need to acquire knowledge about harmful effects of occupational noise to support the prevention of NIHL and ensure healthier workplaces.

Population aging is the population issue of the XXI century and many indices are used to measure its level and pace. In Science (2010), Sanderson and Scherbov suggested improvements to the measure of elderly dependency ratio. They identified several limitations to the use of chronological age as the main variable and proposed a new index, the Adult Disability Dependency Ratio, defined as the number of adults at least 20 years old with disabilities divided by the number of similarly aged adults without disabilities. They used the Sullivan prevalence-based method by multiplying derived disability rates to macro population projections. They showed results for several ECE and OECD countries; results for Canada (see online annex, available at https://www.sciencemag.org/content/329/5997/1287/suppl/DC1) were derived using coefficients of Italy. However, disability is a complex multidimensional process (see Carrière, Keefe, Légaré, Lin, & Rowe, 2007; Légaré and Décarie, 2011), and microsimulation can take into account its implied complexity. Our results for Canada, presented here, exceed those in Science to show how more-sophisticated projections of disabled older adults can improve the analysis. We used LifePaths, a Statistics Canada’s microsimulation model, to provide a perspective of the phenomena unobtainable with prevalence-based methods.

This mixed-methods study evaluated the effect of a community-engaged arts program on the physical, emotional, and social well-being of seniors. Weekly workshops were offered over a three-year period at community centers where artists worked with four groups of seniors to produce a collective art piece or performance for public presentation. Participants completed pre- and post- questionnaires, and group interviews were conducted at the program’s end. Paired t-test analyses indicated that seniors experienced improvement in perceived overall health, experience of pain, and sense of community. Interpretive descriptive analysis of the group interviews revealed six themes that informed understanding : (1) providing structure and discipline; (2) facilitating coping; (3) requiring hard work and effort; (4) bringing out one’s artistic side; (5) promoting social involvement; and (6) making a contribution. These results are consistent with previous research and contribute to further understanding of how community-engaged arts can benefit the well-being of older people.

The purpose of this study was to explore the self-perceived influences among older adults in deciding whether to take or not take the seasonal influenza vaccine. Thirty-one receivers and six non-receivers (aged 67–91) participated in six focus groups in London, Ontario. The focus group meetings lasted approximately 60 minutes, were digitally audio-recorded, and transcribed verbatim. Inductive content analysis was performed to analyse the transcripts. The major facilitators of taking the vaccine were recommendations by, and trust in, health professionals, and a belief in vaccine efficacy. The major barriers were a fear of adverse reactions and the belief in resilience of an older adult. The Canadian Public Health Agency and allied health professionals should educate older adults in accurate influenza symptoms, vaccine efficacy, and populations at risk for contracting influenza. Focus should be given on correcting misconceptions about adverse events.

This study compared the correlates of burden for spouse and adult child caregivers at two points in time and assessed whether correlates at T1 predicted burden at T2. The sample consisted of 878 caregivers to older adults throughout British Columbia who were prescribed cholinesterase inhibitors. Burden was measured six months after the older adult was prescribed the medication and one year later (n = 759). Findings suggest that adult children experience more burden than spouses at both T1 and T2 with adult children but not spouses decreasing their burden over time. Correlates of T1 burden explained significant amounts of variance, revealing differential correlates for the two groups and the importance of caregiver characteristics over patient characteristics. Burden at T2 is explained mostly by T2 factors, plus T1 burden, suggesting the importance of relatively immediate factors for direct effects on caregiver burden. Indirect effects operated through T1 burden.

Care for older people is a complex phenomenon, and is an area of pressing policy concern. Bringing together literature on care from social gerontology and economics, we report the findings of a mixed-methods project exploring networks of informal caring. Using quantitative data from the British Household Panel Survey (official survey of British households), together with qualitative interviews with older people and informal carers, we describe differences in formal care networks, and the factors and decision-making processes that have contributed to the formation of the networks. A network approach to care permits both quantitative and qualitative study, and the approach can be used to explore many important questions.