In situations where care-receivers cannot respond to questions about their functional status, caregiver proxies are often substituted. Yet studies addressing caregiver-care-receiver agreement remain limited in scope, focusing primarily on cognitive functioning and caregiver relationship. This study broadens the range of research in this area by examining caregiver and care-receiver reports of individual IADL and AADL items by gender of care-receiver. As well, the degree to which the care-receiver's age and mental and physical health status influence agreement are investigated. Data for this study come from a sample of 388 Manitoba older adults aged 65 and over. Results (using Cohen's kappa) suggest less agreement on the presence of disability for men than for women, particularly among those aged 75–84. Differences by health status were also revealed. The implications of the findings for assessments of functioning are considered.

Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined 4.8 per cent, and specialist-to-population ratios declined 10.0 per cent. Among the general population, FP visit rates declined 3 per cent. Among older adults, physician visit rates increased 2.3 per cent, FP visit rates increased 10.9 per cent, and specialist visit rates declined 15.7 per cent. By comparison, we document declines in FP use by those younger than 5 years (25.5%) and those 6 to 19 years of age (18.6%). Increases in FP and declines in specialist use occurred primarily among those aged 65 to 84 years. By 2000/2001 older adults accounted for 25 per cent of all FP encounters. Gains in FP use among older adults was less attributable to the presence of more seniors and more related to the fact that a higher proportion of them are visiting a FP each year and, potentially, substituting primary for secondary care.

Purpose: To assess the prevalence and strength of association of risk factors for falling in Canadian veterans of World War II and Korea and their caregivers.

Methods: Questionnaires were sent to addresses of 3,000 Canadian veterans (response rate = 70%). Risk factors for falls and the frequency of falls and injurious falls in the past 12 months were collected.

Results: Veterans had more risk factors than did caregivers, and more had fallen in the past year (39.8% vs. 29.7%). Risk factors in the logistic model for veterans included lower extremity disability (odds ratio = 1.98, 95% confidence interval 1.5–2.6); lower extremity weakness (OR 1.75, 95% CI 1.3–2.3); worse memory than peers (OR 1.67, 95% CI 1.1–2.5); one or more visits to the family doctor in the past month (OR 1.53, 95% CI 1.2–2.0); and worse memory than 5 years ago (OR 1.36, 95% CI 1.0–1.8).

Conclusions: Veterans appear more frail and prone to falling than their caregivers.

Implementing generationally appropriate activities for persons with dementia is a challenging task. Horticulture therapy (HT) addresses this challenge through the use of plants to facilitate holistic outcomes. Utilizing the model of environmental press, the current study sought to analyse adult day service (ADS) participants' responses to HT as compared to traditional activities.

HT activities were conducted once a week for a half an hour at four different ADS programs over the course of 9 weeks. Observational data were collected during HT and traditional ADS activities using a modified dementia care mapping (DCM) technique. Observers coded predominant behavioural and affectual responses for each participant.

HT activities facilitated higher levels of productive engagement and positive affect and lower levels of non-engagement than did traditional ADS activities. Therefore, HT offers dementia-care staff a viable activity alternative that is well received by clients and inclusive of all interested persons, despite cognitive limitations.

Aging well is new, again. The recent interest is part of a 50-year period of research. Contradictory conceptualizations of aging well create an opportunity to consider assumptions that underlie the concept. In this paper, through the construction of an aging-well, theorizing narrative, an underlying assumption is identified in past aging-well conceptual frameworks: to age well is to achieve self-integration in relation to particular sets of resources or forms of engagement. The narrative relates how more recent aging-well theorizing is being shaped by a growing interest in later-life meaning-making. Evidence is presented of a contemporary shift toward describing aging well as the negotiation of the co-construction and reconstruction of multiple selves in an ongoing, open-ended process of meaning-making amid later-life events and transitions. The paper concludes with implications for future research.

Numerous studies suggest that the clinical presentation of Alzheimer's disease (AD) is varied and that AD is thus a heterogeneous disorder. Evidence of this inter-individual variability has had an important impact on the approaches to the cognitive rehabilitation of AD, particularly in the early stages of the disease. Research has shown that, despite variable cognitive profiles, many preserved capabilities are observed in the first stages of AD and that the disease does not affect all cognitive functions globally. These preserved capabilities make it possible to apply cognitive interventions. However, numerous methodological difficulties are encountered in evaluating the effectiveness of these interventions, many of which are related to the heterogeneity of the deficits. The purpose of this article is to discuss this heterogeneity and its impact on methodological characteristics, especially participant selection and research design.

The purpose of this feminist narrative study was to examine the experiences of women in four different health professions (nursing, medicine, physiotherapy, and social work) who provided care to elderly relatives. Although caring is a central and common feature of the personal and professional lives of many women (Baines, Evans, & Neysmith, 1991; Baines, 2004), the separation of professional, paid caregiving from family, unpaid caregiving among health care providers is problematic. Study findings suggest that female health professionals who assume familial responsibilities continually negotiate the boundaries between their professional and personal caring work. Despite the use of a variety of strategies for managing their double-duty caregiving demands, many women experienced a dramatic blurring or erosion of these boundaries, resulting in feelings of isolation, tension, and extreme physical and mental exhaustion. These findings suggest that women who are double-duty caregivers, especially those with limited time, finances, or other tangible supports, may experience poor health, which warrants further study.

This study aimed to identify factors affecting older adults' quality of life in urban environments and to compare older adults' and professionals' perspectives on the issue. Eleven focus groups were conducted (eight involving older adults, three involving professionals), each discussing a wide range of issues related to determinants of health and quality of life. The most salient themes were health and independence, financial security, social integration, health care services, housing, accessibility of community services, and decision-making power. Older adults' and professionals' comments strongly converged, with specific issues also raised by each. Older adults provided the richest and most in-depth data on intrapersonal factors, such as personal growth, personal qualities, and spirituality. Professionals discussed community environment issues in greater depth. Health promotion interventions to maximize older adults' quality of life are needed. These results contribute to building a knowledge base to guide such efforts, by identifying a variety of possible intervention sectors for future programs.

This work seeks to identify factors that facilitate or diminish care-providers' propensity to improve continence care in long-term care (LTC) settings. We conducted a cross-sectional qualitative study using focus group methodology in four long-term care institutions in Montreal, QC. Forty-two nurses, nursing assistants, and orderlies caring for incontinent elderly residents were asked how they perceived urinary incontinence (UI), how it was being managed, and what factors enabled or hindered continence care in their institution. Content analysis was used. Facilitating and inhibiting elements of three individual/internal factors (beliefs about UI, attitudes towards the elderly, and knowledge about UI) and five institutional/external factors (workload demands, type of patient, environmental support, co-worker support, and attributes of UI interventions) emerged as important determinants of care-providers' propensity to manage UI. To be successful, continence programs must target multidimensional elements that take into account personal, systems, and organizational level factors.

Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP-to-population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.

Differences occur in the demographic, health, and social network contexts of men and women, all of which are associated with successful aging. The objectives of this study were to determine whether differences exist in satisfaction in specific domains, in general life satisfaction and in the paths for life satisfaction for men and women. A secondary data analysis was conducted on selected variables from the Aging in the Community data set (Béland et al., 1998). The responses of 958 older Canadian francophone adults were examined. There were no differences in general or domain life satisfaction between women and men. Path analyses revealed good model fit for separate models for both male and female samples. For men, life satisfaction is explained positively by age, income, and perceived control, and negatively by recall errors, illness, and functional limitations. For women, life satisfaction is explained positively by age, education, income, social support, perceived control, and physical activity, and negatively by illness and functional limitations. The results suggest that social support had direct positive effects on life satisfaction but reduced perceived control for women. As hypothesized, although there are similarities in paths to life satisfaction for older men and women, the path models indicated that there are also important differences.

Cataract surgery is the highest-volume surgical procedure in Canada, with over 200,000 performed annually, mostly (85%) on persons aged 65 or older. Concerns have been raised about wait times to access this procedure. This study explores the relationship between waiting times for cataract surgery in Manitoba and a variety of characteristics, including age, sex, socio-economic status, region of residence, health status, surgeon, and surgeon's caseload. The study included 6,114 individuals who had first-eye cataract surgery between November 1, 1998, and March 31, 2000, in Winnipeg, MB. Significant predictors of variation in wait times were age, sex, having a hospitalization while waiting, and surgeon. The model explained 32.5 per cent of the variance in wait times; specific surgeon independently explained 29.5 per cent of the variance. Median waiting times varied widely by surgeon, ranging from 61 to 399 days. Differences in surgeons' expected wait times should be available to patients and referring clinicians.

Drawing from the health belief model, cues to action have been theorized to influence health behaviours; however, few studies have examined these constructs explicitly. This study investigated the relationship between information cues to action and exercise self-care. It was hypothesized that reading about illness information, knowing about services, and consulting with others about one's illness triggers exercise self-care. The sample consisted of 879 chronically ill adults aged 50 and over, drawn from the Vancouver North Shore Self-Care Study. It was found that the odds of exercising almost doubled for readers of information about illness (compared to non-readers), after controlling for socio-demographic factors, illness context, and illness efficacy. Furthermore, knowledge of services and consultations were shown to increase the odds of exercise self-care. These findings provide support for the salience of cues to action as a pivotal theoretical construct. The implications of these findings for health promotion programs targeting persons with chronic illnesses are discussed.

This paper examines the growing demographic phenomenon of grandparent–adult grandchild relationships from the perspectives of both generations. Drawing on qualitative life-history interviews (n = 37), this research explores the subjective meanings of the relationship, as well as the experiences of being grandparents and adult grandchildren. Despite tremendous diversity in grandparent–adult grandchild relationships, including differences among and between generations, both groups in this study view one another positively and conceptualize their ties as personally and existentially meaningful. They classify their relationships as a distinct family tie centred on unconditional love, mutual support, respect, and obligation. A number of individuals also discuss their grandparent–adult grandchild relationships as friendships, involving mutual trust, shared confidences, and personal choice. Overall, this research suggests that grandparent-grandchild relationships often grow more profound and meaningful as grandparents and grandchildren age, move through the life course, and experience life events.

While an association between UI and psychological distress among older adults has been established in the literature, the mechanisms underlying this relationship remain less clear. Using a sample of 4,689 older adults from the Canadian Community Health Survey (1.1), we test the potential mediating and moderating effects of four dimensions of social support on the UI–distress relationship. Incontinent older adults are significantly more likely to report higher levels of distress than continent adults. Although we do not find support for a mediating effect of any of the dimensions of social support, we do report a significant interaction between one dimension of social support (tangible support) and UI. A buffering effect of tangible support is evident for continent – but not incontinent – respondents. These findings emphasize the need to assess the types of social support and the context in which they operate.

Only competent persons can give informed consent to health care. Current approaches define competence in essentially cognitive terms, thereby ignoring the fact that someone may be cognitively competent yet lack the capacity to give a valid consent. I outline a more robust theory of competence that includes not only cognitive but also emotional and valuational parameters. I then distinguish competence from capacity, and indicate the role this distinction can usefully play in the extended and continuing care setting. I also show how this distinction is consistent with several recent Canadian legal decisions, and outline its usefulness in interpreting and applying relevant provincial statutes.

Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were examined. The study found that the majority of home care clients were female, aged 65 and over, and not married. The proportion of Manitobans using home care increased slowly, but significantly, over the 4 years. The greatest increases were found among the older age groups. The average number of days that clients received home care before death or before admission to a nursing home was stable over time, while a significant increase over time in home care use after hospitalization was experienced. These findings can be useful to regional health authorities for planning and budgeting.

The present study was conducted to expand research showing that older adults' expectations that they will recall particular medication instructions do not coincide with their actual ability to do so. Seventy-one younger-old adults (M = 68.10 years, range = 57–74) and 62 older-old adults (M = 80.31 years, range = 75–89) made judgements about the likelihood of their recalling medication instructions and about their confidence in their recall. The results indicate that older-old adults recall fewer instructions than do younger-old adults and that both groups overestimate their ability to recall the instructions. This research suggests that problems remembering to take medication may be due, in part, to older adults' overestimating the ease with which they will remember medication instructions.

In this study, we examine trends in the patterns of time use of seniors in Canada since the 1980s. In particular, we ask whether today's seniors devote more, or less, time to productive activities than 20 years ago. Our inquiry is motivated by the claims that today's seniors are not engaged in ‘active aging.’ This study uses data from a series of time-use surveys carried out in Canada since 1981 to empirically test the validity of this claim. Our results suggest that some shift towards active aging has taken place in Canada since the 1980s; however, this shift involves a complex pattern of reallocation of time that varies by gender and age.

The behavioural and emotional changes associated with Alzheimer's disease (AD) are compared for individuals with Down syndrome and AD and individuals with AD from the general population (AD-only). The primary caregivers of 30 people with Down syndrome and AD and 30 people with AD-only completed the BEHAVE-AD and the Apathy subscale of the CERAD. As well, behavioural observations at adult day programs were undertaken with selected participants (n = 26). The Down syndrome group experienced fewer delusions and had lower total scores on the BEHAVE-AD, indicating fewer problem behaviours overall. Day program observations suggested that the AD-only group were more likely to be sedentary and observe the activities of others, while the Down syndrome group were more physically active. Improving our understanding of the similarities and differences between these two groups may help facilitate the integration of individuals with Down syndrome into adult day programs for the general population.