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.

The rising cost of health care and changing demographic profiles have resulted in the relocation and redistribution of funding and services between rural and urban areas. Most econometric analyses of Canada’s health service use include broad controls by province and rural/urban status, but relatively little econometric work has focused on geographical variation in health service use. Using the Canadian Community Health Survey 2.1, we examined determinants of various measures of health services use by Canadians aged 55 or older across a range of urban and rural areas of residence. Our regression analysis showed that older residents in rural areas made fewer visits to a general practitioner, to a specialist, and to a dentist relative to urban residents. All else being equal, there are no significant differences in hospital nights or in unmet healthcare needs. These differences are significant after controlling for demographic characteristics, socioeconomic status, private health insurance, and health status.

We determined the after-tax income required to finance basic needs for Canadian elders living with different circumstances in terms of age, gender, city of residence, household size, homeowner or renter status, means of transportation, and health status. Using 2001 as our base year, we priced the typical expenses for food, shelter, medical, transportation, miscellaneous basic living items and home-based long-term care for elders living in five Canadian cities. This is the first Canadian study of basic living expenses tailored to elders instead of adults in general, prepared on an absolute rather than a relative basis. We also accounted for an individual’s unique life circumstances and established the varying effect that they have on the cost of basic expenses, particularly for home care. We found that the maximum Guaranteed Income Supplement and Old Age Security benefit did not meet the cost of basic needs for an elder living in poor circumstances.

Western societies are experiencing a dramatic growth in the population aged 75 and older. Changes in family composition raise questions about who will care for those who need assistance. We compared population projections to the year 2030 of those families aged 75 and older in Canada and France. Over the next 25 years, the pool of potential family carers, (i.e., spouses and children), will broaden from the effect of the baby boom and increased proportion of women with spouses. The populations most dependent on formal care, with no potential support from a child or a spouse, will increase more sharply in Canada (123%) than in France (34%) but at a slower rate than the total population. Policy and programs in both countries will need to prepare for a greater number of elderly spouses providing care and in Canada, at least, a significant increase in the number that will need to rely on formal services.

In filial caregiving, women typically provide more care than men. The numerical predominance of female caregivers has been explained such that diversity among male caregivers has been overlooked. That is, “internalist” explanations, which emphasize the differing socialization experience of females and males, tend to homogenize each gender’s caregiving experience. “Externalist” explanations, which emphasize various factors that push or pull women and men into caregiving, reduce the actors involved to passive agents whose subjective understanding of caregiving over time is ignored. Both explanations divert attention from the diversity in male caregiving. This article presents qualitative data derived from interviews with 48 caregiving sons to provide evidence of that diversity. Some themes are common to both married and never-married male caregivers, yet there are also systematic differences between the two groups of caregivers. For example, caregiving for married sons was more limited; caregiving for never-married sons was a more central element in their lives.

Drawing on the intergenerational stake hypothesis (Bengtson and Kuypers, 1971), this article explores intergenerational congruence and incongruence on filial obligation, and implications for social support, between older nisei (second generation) parents and adult sansei (third generation) children in Japanese Canadian families. Using data from semi-structured interviews with 100 parent–child dyads in British Columbia, congruence on close-ended responses to value statements (degree congruence) and the content congruence of open-ended responses are examined. The findings show the majority of parent-child dyads indicate overall (both degree and content) congruence in filial obligation, especially when a parent is female, widowed, and/or has poor/fair health status. We conclude that despite markedly different historical life course experiences and acculturation processes, both generations continue to regard filial obligation as important. These findings are discussed with respect to implications for social support exchanges given a continued valuation of filial obligation in Asian post-immigrant (North American-born) and immigrant families.

An estimated 36,000 home support workers assist older Canadians annually with daily activities, such as bathing, dressing, grooming, and light housework, yet home support workers’ day-to-day experiences are not well understood. Mahmood and Martin-Matthews (2008) have developed a model that locates the home support worker, elderly client, and family member at the intersection of the public and private spheres framed by their social, spatial, temporal, and organizational features. This study, funded by the Canadian Institutes of Health Research, examines and refines that model through an analysis of in-depth interviews with home support workers in British Columbia. Home support workers identify key issues in service delivery and discuss a range of creative solutions to complete their daily tasks efficiently, effectively, and respectfully. The study’s findings inform our understanding of home support workers’ job experiences; they also highlight those qualities that characterize exceptional workers in navigating the various domains of home support.

Immigrant care workers play an increasingly important role in home and long-term care in Canada, yet the full extent of their relations with older persons in those settings is relatively unknown. This article examines the role of immigrant care workers in both home and long-term care sectors, with a focus on relations with older clients and implications for quality of care. The data are derived from interviews with workers, employers, and older clients conducted in various home and long-term care services for older adults across three Canadian provinces: Ontario, British Columbia, and Quebec. Factors stemming from immigrant care workers’ ethnic/racial background, language barriers, and contextual factors such as staff shortage in different care settings for older adults complicate the relationship between immigrant care workers and their clients. In some cases, these factors diminish the quality of care. We point to some policy alternatives that our findings suggest should be considered.

This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported ≥ one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson’s disease), age ≥ 85 years, environmental hazards, previous slip or trip, and visual impairment.

This study determined the effects and costs of a multifactorial, interdisciplinary team approach to falls prevention. Randomized controlled trial of 109 older adults who are at risk for falls. This was a six-month multifactorial and evidence-based prevention strategy involving an interdisciplinary team. The primary outcome was number of falls during the six-month follow-up. At six months, no difference in the mean number of falls between groups. Subgroup analyses showed that the intervention effectively reduced falls in men (75–84 years old) with a fear of falling or negative fall history. Number of slips and trips was greatly reduced; and emotional health had a greater improvement in role functioning related to emotional health in the intervention group. Quality of life was improved, slips and trips were reduced, as were falls among males (75–84 years old) with a fear of falling or negative fall history.