The association of institutional relocation and mortality among elderly patients has been the subject of considerable debate, in part, because of equivocal findings in the literature. However, much of the research in this area is limited by small sample sizes, use of arbitrary follow-up periods and crude statistical methods. The present analyses are based on six years of mortality data in a chronic care hospital that experienced a mass relocation of patients to a new facility. After adjusting for age, gender and length of stay before follow-up, the odds ratio for mortality associated with relocation was 1.53.

This paper examines friendship in later life, drawing upon data obtained from in-depth interviews conducted with a sample of 142 elderly women who were living in a small town in Atlantic Canada. The nature and meaning of friendship in later life is examined from the perspective of the elderly woman. The data indicate that most respondents have a substantial number of friends and differentiate between different types of friends: ‘friends’ and ‘close friends,’ ‘old friends’ and those acquired more recently. Focusing attention on the concepts of self-identity and reciprocity, an attempt is made to explain why older people might more highly value their old friends than those acquired more recently.

Given the lack of research in clinically depressed elders, and drawing on an integrative perspective, this study examined predictions of three prominent psychological models of depression (cognitive, learned helplessness, and psychodynamic theory) in a sample of elderly depressed patients. The hypothesized specificity to depression and stability of representative psychological characteristics were evaluated by comparing levels of 25 clinically depressed elders, 20 nondepressed psychiatric controls and 28 nondepressed medical controls, at hospitalization (Tl), discharge (T2) and five months later (T3). Also, the relative contribution of theory-based variables to depression severity at discharge and at follow-up was explored. While elderly depressed patients showed, overall, significantly higher levels of maladaptive cognitions, biased attributions, and selected depressogenic personality traits than medical controls, these variables did not discriminate among depressives and psychiatric controls, with the exception of negative automatic thinking, and pessimistic attributions in females. Positive attributional style and hedonism did not discriminate among subject groups. Support was found for the stability, in the depressed group, of purportedly traitlike characteristics through hospitalization to follow-up. Multiple regression analyses indicated that initial symptomatology level was the strongest predictor of both discharge and follow-up depression severity, whereas selected variables from each theoretical model contributed marginally, depending on the time of assessment.

Long-term care in Canada is situated within a universally accessible publicly insured program. The Government of Canada establishes certain minimum standards for health care as the basis for the federal share in funding health programs, although the programs themselves are administered provincially. Examples are drawn from the Province of Manitoba. While the dependency ratio has been decreasing due to a slower increase in the number of persons under 17 years of age, the percent of the population over 65 years continues to increase. Population projections forecast that by the year 2031, one-quarter of the population of Canada will be over 65 years of age. Expenditures on health care doubled from 1981 to 1990 for both Manitoba and Canada. The policy response to ever-increasing costs of delivering health care to an aging population has been to seek alternative methods of delivery. Specifically, the long-term care bed-to-population ratio has been reduced and the authors anticipate continued modest increases in the use of community care.

Data from the 1990 Canadian General Social Survey on Friends and Family were used to examine the relationship between ethnicity and patterns and characteristics of friendship in later life. Ethnicity (i.e. British, French, European – the most prevalent ethnic groups amongst Canadian seniors – and a “Multi-Ethnic” category) is examined in relation to the number of friends reported, satisfaction with friendships, and the geographic proximity to and frequency of contact with the closest identified friend, with attention also given to the factors of age, gender, and marital status. Although results indicate differences for both gender and marital status, ethnicity emerged as the most consistent predictor. Specifically, the French have fewer friends, they live closer to them and are in more frequent contact. The British live further from their friends, who are more numerous. The British and the French did not differ from each other in terms of satisfaction with friendship. The European and the Multi-Ethnic groups were similar across the comparisons made. These results are interpreted in the context of social support access and underscore the importance of including ethnicity in studies of aging and social relations.

This research evaluates a mediational model of work-family conflict among employees with caregiving responsibilities for older relatives. In a survey of employees from eight organizations, 396 women and 316 men completed measures assessing their eldercare involvement, the extent to which their family responsibilities interfered with work (FIW), the extent to which their work interfered with family (WIF), job satisfaction, job costs (e.g., missed meetings), and absenteeism. Eldercare involvement was significantly associated with FIW for women but not for men. Among women, FIW was related to job dissatisfaction and absenteeism; among men, it was related to job costs and absenteeism. WIF was unrelated to eldercare, but was associated with FIW and job costs for both women and men. It also was associated with job satisfaction for men. The findings of the current study suggest that eldercare responsibilities impact on the workplace indirectly by arousing conflict between family and work.

The process of aging is under genetic control. The traditional view derived from evolutionary biology is that aging is a polygenic trait, controlled by a large number of genes, each with a small additive effect. An alternative point of view is presented here, which suggests that there may be only a few master genes that control aging. These could include protective genes that ensure accuracy of protein synthesis and protect against free radical damage, as well as genetic control switches that initiate or delay the aging process. As genetic technology advances and the human genome is mapped, our understanding of genes that control aging and age-related diseases may advance to the point that gene therapy becomes possible.

In this paper we investigate the geographical context in which employed caregivers provide assistance to their elderly relatives. Specifically, we examine the impact of the spatial arrangement of the employed caregiver's home, their workplace and the care recipient's home (the “locational triangle” alluded to in our title) on work-family balance. Analysis of data drawn from a national study of Work and Family conducted by the Canadian Aging Research Network (CARNET) indicates that the parameters of the locational triangle have discernable impacts on levels of perceived stress and interference and on the incidence of certain job effects and coping behaviours. The impacts of longer journey to work and increased distance from elderly relative(s) on stress and interference levels are seen to be bound up with the nature of family responsibilities. Location-based coping behaviours (considered or implemented in the six months leading up to the survey) are reported by 18 per cent of our sample of 595 employed caregivers, but are virtually confined to the home-elder axis of the location triangle. On the basis of our results, we advocate greater attention to the spatial context of work-family balance.

During the 1960s and 1970s, The Netherlands had one of the youngest populations in Western Europe. In fact, a significant increase in the proportion of elderly in the population will not begin until after the year 2010. Despite this relatively late aging of the population, the Dutch government developed a policy on aging at an early stage, with particular attention to institutional care for the elderly. This move resulted in a high proportion of elderly living in institutions. In 1982, 3 per cent of the 65 + population lived in nursing homes and 9 per cent in homes for the elderly. These care institutions are organized on a non-profit basis and financed through direct or indirect taxation. Their population can be characterized as “frail elderly”. However, homes for the elderly were originally considered to be housing facilities for the elderly. The costs related to institutional care increased considerably in the 1960s and 1970s, but through procedures like specific planning criteria and assessing the need for admission into a home for the elderly, the government has attempted to contain the costs. Until the end of the 1980s, these attempts had not been very successful. One of the more successful means of containing costs seems to be the stipulation of community long-term care.

The present study examined the ability of the Aging Sexuality Knowledge and Attitude Scale (ASKAS) to assess individuals' attitudes toward elderly sexuality. The instrument's primary assumption, that individuals' attitudes toward elderly sexuality are one dimensional, was challenged. Four hundred and fifty-eight college students, with a mean age of 27 (s.d. = 8.67), completed the attitude subscale of the ASKAS, responded to a series of elderly sexuality attitude items constructed by the authors, and provided self-report information regarding a number of demographic and personality variables. A factor analysis of all attitude items revealed a two factor solution in which items loading on the first factor appeared to represent more restrictive (i.e. less permissive) attitudes toward elderly sexuality, whereas items loading on the second factor appeared to represent more empathic attitudes. The validity of this bivariate attitude structure appears to be supported by the differentially predictive nature of a number of subject variables including religiosity, death anxiety, salience of elderly sexuality, and age. The discovery of this underlying, two factor attitude solution also is used to interpret previously discrepant findings regarding health care providers' attitudes toward elderly sexuality.

Using routine data, surveys, and data from a local area study, this article describes the long-term care sector in Norway. Some comparisons with Denmark and Sweden are also presented. Typical for the Scandinavian solution is tax-financed formal care, provided as a highly decentralized public service. In Norway, three stages of development have been identified since 1955: establishing a basic structure of long-term care (LTC) (1955–70), expansion (1970–80), and reorganization (1980–90). The current Norwegian system is characterized by well-staffed, small institutional units integrated with home care. The turn-over rate in nursing homes is high. Most admissions and live discharges constitute an interchange with the home-care system. Although Norway occupies an intermediate position between Denmark and Sweden, there is now a strong tendency of convergence among these three LTC systems.

Objective: To compare demographic and functional characteristics of elderly users and non-users of home care services in urban Nova Scotia (n = 533) and Newfoundland (n = 449) using a cross sectional study design.

Results: More Nova Scotians (24%) than Newfoundlanders (11%) received home care services. In both provinces, most ADL-dependent people do not receive home care services, and most home care users are not ADL dependent. In Newfoundland, home care users were more likely to be ADL dependent and to have dementia; this was not the case in Nova Scotia. In Nova Scotia being over age 85 without a supporter in the same residence, not being married, and having an IADL limitation significantly increased the likelihood of home care use. IADL impaired subjects in Newfoundland were also more likely to receive home care.

Conclusions: If home care is to substitute for institutional care, existing home care programs must be prepared to adapt to a new type of user.

This paper examines, first of all, the levels of satisfaction of wives with the care of their institutionalized elderly husbands and changes in satisfaction over the nine months following the husband's admission to a long-term care facility. Secondly, the paper examines the relationships between satisfaction with care and: (a) the husband's care requirements prior to admission, and (b) wives' physical and psychosocial health following admission. Data are taken from a longitudinal study of wives' responses to the institutionalization of elderly husbands. The subsample in this paper consists of 46 wives who remained in the study nine months after the husband's admission. Wives reported fairly high levels of satisfaction. Changes did not occur over time in overall satisfaction, satisfaction with the arrangements for husband's care, or satisfaction with time for information. A significant decline over time was found, however, with respect to satisfaction with the facility. Pre-admission factors (husbands' need for assistance and wives' perceived burden) showed little relationship to wives' subsequent satisfaction with care. As well, wives' physical health was unrelated to satisfaction. In contrast, wives with better psychosocial health (as indicated by morale, affect, depressive symptoms and social interaction) tended to be more satisfied with care.

Human diploid fibroblasts undergo a limited number of population doublings in vitro and are used widely as a model of cellular aging. Despite growing evidence that cellular aging occurs as a result of altered gene expression, little is known about the activity of transcription factors in aging cells. Here we report that the dramatic reduction in the expression of the transcription factor FOS during cellular aging appears to be due to the inability of another transcription factor, serum response factor (SRF), to bind to its cognate site termed the serum response element (SRE) that is found upstream of several genes including the human c-fos gene. In contrast, the activities of proteins binding to the RNA polymerase “core” element TATA and to the cAMP response element (CRE) were maintained in senescing human fibroblasts. We present evidence that hyperphosphorylation of SRF is responsible for the decreased binding activity seen in late passage cells, as proposed previously for the FOS protein.

In contrast to the negative images which attend old women in many social and statistical reports, literary gerontology provides a framework which allows us to see old women as complex and integrated figures. Canadian literature offers numerous examples of powerful old women who defy reductive stereotypes. Literary grandmothers, particularly when they appear in pairs, force a recognition of the integrating and mediating powers of old women. This paper discusses four Canadian novels in which pairs of grandmothers can be seen to supply a structural matrix which orders and supports the growth and development of future generations. Through the old women in these novels we may recognize the tradition of the mythic Great Mother in whose image we recognize the full power of our witches, wise women and ordinary old grandmothers.

The goal of this study was to examine the reaction (anxiety, depression, and helplessness) and adaptive strategies (problem-solving and emotion-reducing) of community-dwelling elderly, confronted by one specific chronic stressor. We have conducted three face-to-face home interviews on a monthly basis with a follow-up interview seven months later. There were 237 psychotropic drug users and non-users, of high or low socio-economic status. Not only were low socio-economic psychotropic drug users more anxious about the targeted hassle of the week, but they also relied on and used more problem-solving strategies than non-drug users. It is suggested that psychotropic drug use be looked at as a strategy like any others rather than as passive behaviour when facing daily hassles. Moreover, using a high number of coping strategies is not synonymous with being good at coping with chronic stress. Various recommandations for clinical intervention are put forward.

An analysis is made concerning the relation of different factors to client transfer between levels of care in an area-based system of long-term care for the elderly and the disabled. Special emphasis is given to the transfer from non-institutional to institutional care. The analysis uses data collected through the application of the ASIM monitoring system from 1985 to 1991 in the municipality of Solna, Sweden. Factors analysed include age, sex, marital status, co-habitation, accessibility of housing, informal social support and different aspects of disability. Multivariate analysis regarding factors related to institutionalization — i.e. transfer from domiciliary care or sheltered housing to residential home or long-term hospital care/nursing home — showed level of disability, staff assessment of appropriate level of care and age to be the most significant factors. Dementia was the strongest individual disability factor with functional disability and incontinence also having some influence on the probability of transfer. Deficiencies in the social environment in terms of living alone, inadequate housing accessibility or lack of social support did not show up — presumably because they were adequately compensated for by the public home help services

According to the free radical theory, aging is caused by the damaging effects of oxygen radicals. These agents are produced continuously and they become toxic when their intra-cellular levels become elevated. Although well-known for the damage they cause, recent studies indicate that free radicals may also have a beneficial side regulating some of the processes within a cell. With aging, however, it seems that the ability to control endogenous concentrations declines, and rising levels become progressively more harmful. In addition to the primary changes, the effects of free radical damage should also be examined at the secondary level. Because of its importance in regulating homeostatic mechanisms, it is possible that in this regard the hypothalamus may play a crucial role in the aging process. Progressive loss of function in this centre may lead to systemic changes which cause widespread disruption throughout the organism.

Major milestones in the evolution of nursing home care in the United States between 1960 and 1985 were the introduction of Medicaid and Medicare (resulting in a rapid growth in beds), national health planning (slowing the growth of beds), and prospective payment system for hospitals (shifting the case mix to a more disabled population). Critical policy concerns for nursing home care in the mid-1980s were the appropriate mix of public and private expenditures, impoverishment of some elderly persons as a result of long stays, improvement of the quality of care, and the funding bias toward institutional longterm care. Policy changes in the past few years have addressed quality by requiring a standard assessment linked to a care plan, although quality remains a major issue. Recent policies creating home care and community-based care programs may signal a shift away from institutional care. The issues of impoverishment and of the appropriate mix of expenditures are unresolved. Nursing homes certified by Medicaid and Medicare differed from those not certified in providing more services, having more nursing staff, and having more residents with disability and behaviour problems. Between 1985 and 1994, there were some significant changes in sources of funding for national nursing home expenditures. Out-of-pocket expenditures dropped, while government expenditures rose, with the increase occurring in the federal-government share.