This study aimed at identifying the factors associated with caregivers' use of three community services (day care centre, attendant care at home and home help), and those associated with caregivers' nonuse of these services due to a perceived barrier. The sample consisted of primary caregivers (n = 265) cohabiting with a demented relative. Using polychotomous nominal logistic regression analyses, a group of users and of nonusers perceiving a barrier was contrasted with a group of nonusers reporting no need for these services. Across the three services, under high relatives' needs (high ADL impairments or frequent dysfunctional behaviours), caregivers with high psychological distress, compared to those with low psychological distress, were more likely to be nonusers reporting no need for a service than to be users or nonusers due to a barrier, suggesting that psychological distress may impede service utilization, despite a relative's high needs. Vulnerability factors (caring for a relative with frequent dysfunctional behaviours or experiencing high psychological distress and caring for a relative with low ADL impairments) were associated with the use of day care centre or attendant care. These factors were also associated with nonuse due to a barrier, meaning that some caregivers with the same characteristics of vulnerability did not draw on these two services. In addition, caregivers with less informal support who were caring for a relative with high ADL impairments were more likely to be nonusers perceiving a barrier to attendant care.

The aging of the population is expected to result in substantial increases in the costs of maintaining health care and pension programs, and that is a source of widespread concern. However, a proper assessment requires that attention be given to all categories of government expenditure, including education and others associated with younger age groups, and not just those associated with the older population. It requires also that privately provided goods and services be considered, since their costs must be charged against the same national income as publicly provided ones. Beyond that, it is important to recognize that population change affects not only the demand side of the economy, but also the supply side — the economy's productive capacity. An important conclusion is that while other influences will no doubt play a role, demographic effects by themselves are likely to cause government expenditure (all categories, all levels of government combined) to increase by no more than the rate of growth of the population, and by less than the rate of growth of the gross domestic product. Taking public and private costs together, and assigning appropriate weights to different age groups, the overall “dependency ratio” can be expected to remain at its current low level for another decade and a half or two decades, and then to rise as the baby boom generation retires in large numbers. However, the projected future ratio never reaches the levels of the 1950s and 1960s. Although the overall “burden” of population aging is manageable, major adjustments will be required in the coming decades, especially in the area of federal/provincial cost sharing. For the most part, though, the effects of population aging are predictable, slow, and some time off.

I revisit trends in the level and distribution of income among Canadian seniors in the context of what is arguably the major source of change in these trends since the end of the seventies: the maturation of Canada's public and private earnings-related pension systems. The expanded role of earnings related pensions in the 1980s and 1990s is largely the result of changes that occurred in the 1950s and 1960s. The Canada and Quebec Pension Plans (C/QPP) were implemented in 1966 and the first cohort to receive full C/QPP benefits turned 65 in 1976. Cohorts retiring after this period were also the beneficiaries of the expansion of private occupational pensions that took place between the 1950s and the 1970s. I rely on a detailed decomposition of income by source to show that the maturation of these earnings-related programs produced not only a substantial increase in average real incomes but also a substantial reduction in income inequality among older persons, due mainly to higher C/QPP benefits. Rising real incomes went disproportionately to lower income seniors contributing to the well-known decline in low-income rates among older persons.

Although previous research has examined the various correlates of self-rated health, little attention has been paid to how position in the social structure influences this important measure of health. Drawing upon the social structure and personality perspective, I examine whether the relationship between socio-economic status (income adequacy and education) and self-rated health is mediated by financial stress, self-esteem, mastery, social support, smoking, alcohol consumption and physical activity, using data from the 1994 National Population Health Survey. Results show that almost one-third of the relationship can be explained by the mediating effect of these variables. Income adequacy and education, however, remain significantly related to self-rated health net of these variables. Further research with a broader array of variables related to social position is required to specify the mechanisms connecting socio-economic status and perceived health.

This review and synthesis of the literature on the topic of self-care among older adults defines the construct in terms of preventive behaviours and responses to illness that are performed by lay people on their own behalf. After placing self-care in a historical context, theoretical perspectives and key findings concerning its incidence, correlates, and barriers are reviewed. This is followed by a review of the process and outcomes of interventions designed to promote self-care. The paper concludes with recommendations for future research, policy, and practice.

This study examines the relationship between ethnicity and the provision of assistance to older relatives. A sample of employed Canadians (N = 2,753), a subsample of the CARNET Work and Family Survey, is used to explore how ethnicity influences the amount of assistance provided to older relatives. Findings from our study suggest that Asians, East Indians, and Southern Europeans provide higher levels ofhelp than British respondents. Final obligation affects the amount of help provided but plays a similar role within each ethnic group. However, structural factors — in particular, living arrangement and age — are stronger predictors of the level of involvement in helping older relatives than are cultural factors of filial obligation and belonging to a particular ethnic group.

Antidepressant use was examined with samples from long-term care facilities in Toronto (Canada), Sapporo and Naie (Japan), Reykjavik (Iceland) and Prague (Czech Republic). Only in Iceland did the majority of residents with depression receive an antidepressant. Rates of depression and antidepressant use were uniformly low in Japan, and there was a great discrepancy between diagnosed depression and behavioural signs of depression in the Czech Republic. In all countries, about half the recipients of antidepressants have no clear indication of depression present. For some countries, antidepressant use was lower among residents who were female, older and more disabled. Depression is clearly under-diagnosed in the Czech Republic, but low rates of depression in Japan are somewhat more difficult to interpret. Given the widespread consensus that depression is under-detected and under treated, these results suggest that responses to depression could be improved through instruments like the MDS.

A survey of service providers was undertaken to identify issues regarding the provision of service to aging adults with developmental disabilities (DD). Seventy-five questionnaires were sent to 38 agencies involved in the support of older adults with and without disabilities. Forty-four or 59 per cent of surveys were returned. Results suggested that service providers did not feel adequately trained to address many of the needs of aging adults with DD. Respondents requested additional training in dealing with such issues as the health and medical concerns of older adults with DD, and recreational and retirement planning for aging clients with DD. Service providers also required assistance from professionals such as psychologists and medical personnel who were knowledgeable about aging and/or DD. Results were consistent with previous surveys in finding that training for service providers and medical/health care support were key issues. The information reported here updates and extends our knowledge of the needs of those involved in the support of aging adults with DD in the Canadian service sector and details the specific types of information and support required. Preliminary recommendations for modifications to service delivery, policy, and educational programs, are offered.

Cross-sectional data (n = 6,487) from four Nordic countries, Denmark, Finland, Iceland and Sweden, were utilized to determine the prevalence of daily pain and its association with disability in institutional long-term care. Every resident in each of the participating institutions was assessed with Minimum Data Set version 1.0. The sample was representative of institutional long-term care in Copenhagen and Reykjavik. In addition, the data collected from Stockholm and Helsinki provided substantial information on the residents in these capitals. The results showed that 22–24 per cent of the residents experienced daily observable pain and this was most evident in the most disabled subjects. In addition to disability and female gender, diseases or conditions independently associated with pain were terminal prognosis, osteoporosis, pneumonia, arthritis, depression, anaemia, peripheral vascular disease, cancer and cardiac heart failure. The association between pain and severe cognitive impairment was negative. The results strongly indicate that daily pain in long-term care has a complex association with disability, the latter acting together with underlying diseases as a source and/or result of pain. Thus, a vicious circle between pain and disability can be anticipated.

The new Quebec Civil Code came into effect on January 1,1994. This text enacted among other things the new provisions for consent to experimentation. In this article, we summarize these provisions and highlight the necessity of excluding from the majority of research protocols, people unable to consent without legal representative. Thanks to the database of a recent study, we then show that this provision can render certain gerontological studies invalid. This leads us to recommend that the Civil Code be amended in a way to allow impaired persons who are not legally represented to participate in studies that do not pose any serious risk to their health.

This exploratory survey aimed at determining the spatial and territorial factors used by elderly people when entering an old people's home and illustrating how these variables could be referred to two spatial and territorial appropriation processes. One hundred and two residents were asked to describe their rooms and to fill in a life satisfaction rating scale adapted by Blais, Vallerand, Pelletier and Brière (1989). The findings highlighted two distinct appropriation processes, that is to say a spatial appropriation-disappropriation process and a territorial disappropriation-reappropriation one. The respective predictors of these two processes are on the one hand the life satisfaction ratio, age and sex; and on the other hand the representation the elderly person has of his/her own autonomy as well as the evaluation of the gap between the elderly person's satisfaction with his/her past and present life.

This review of the literature on the subject of health-related self-help and support groups for older adults begins by defining these two small group helping arrangements, and proceeds with a discussion of the extent of their utilization by older adults, barriers to participation, and ways of tailoring the groups to the needs and circumstances of older adults. The process and outcomes of these groups are also reviewed, and recommendations are offered regarding future research directions and ways of optimizing both the appeal and impact of these two types of mutual aid groups.

A study ofolder adults in Israel (n = 170) examined the relationship of activity level and social network characteristics to respondents' subjective well-being, controlling for background socio-demographic characteristics and extent of physical disability. Factor analysis derived three activity factors corresponding to formal, informal and solitary activity. A hierarchical regression procedure revealed that physical disability accounted for 40 per cent of the variance in the well-being measure. Extent of informal activity explained another 3 percent of the variance, but was outweighed in the final model by the addition of a social network factor – degree of network supportiveness (R2 =.48). The findings suggest that it is the social network aspect of activity that makes a difference in older persons' subjective well-being, rather than the effect of activity per se.

This study investigates the effects of chronic use of benzodiazepines (BZ) as hypnotics on the neuropsychological performance of older adults with insomnia. Twenty-one older persons who had used BZ on a chronic basis (average duration = 21.7 years) for their sleep difficulties were enrolled in a medication withdrawal program. A neuropsychological evaluation was conducted before and after the taper program. A control group composed of older adults not using BZs and without sleep complaints were also evaluated for comparative purpose. The results showed that prolonged use of BZ produces mild and selective impairments of cognitive and psychomotor performance. However, BZ users subjectively evaluated their own performance much more negatively than good sleepers. The results are discussed in terms of a possible amplification of performance deficits among insomnia patients and also as a tolerance to adverse effects that develops with prolonged utilization of BZ.

Data from the Quebec Health Survey (QHS) were used to examine the influence of physical health status on responses to the somatic and affective-cognitive components ofthe QHS psychological distress inventory (PDI) in three age groups (n = 600): 18–39 years, 40–64 years and 65 years and over. A structural equation modelling strategy using LISKEL VIII was employed to test an explanatory model of the association between physical health and both components of the PDI. The model included sex, perceived life stress, social support, and marital status as covariates. Results showed that the affective-cognitive component of distress was the main explanatory factor in the somatic symptom index. Results also indicated that physical health directly affects responses to the somatic component of the PDI. However, the same effect of physical health on responses to somatic symptoms was found in all three age groups. Findings lead to the conclusion that using a psychological distress measure that includes somatic items, like the PDI, will result in a small overestimation of psychological distress in older adults and younger age groups as well. However, somatic items do not introduce a differential bias in the estimation of respondents' psychological distress status according to age.

While a substantial body of literature has emerged on the relationships between stress, social support and well-being in community-based older persons, few studies have examined institutionalized populations. The present study used data from pilot studies of the MDS 2.0 in three hospitals, along with supplementary surveys related to psychological well-being. It was found that patients with higher social engagement scores tended to have higher levels of well-being, and this effect was greatest among those with more stable physical health. Pain was an important predictor of lower well-being. Since the MDS 2.0 provides a comprehensive approach to identifying and responding to social, psychological and physical problems in institutionalized older persons, it can have an important impact on well-being when used to support decision making and clinical intervention.

Increasing emphasis is being placed on the need to have older adults, their families and formal service providers work together collaboratively or “in partnerships” to provide long-term care, both in community and residential care settings. There is therefore a need to determine how such relationships are currently structured. This paper systematically reviews the results of studies published from 1985 through 1998 on relationships involving self-, informal and formal care within these settings. The findings suggest that formal services are not used to displace or substitute for informal care but rather, that formal services tend to be used to supplement and complement the care provided by the informal network. This is true both in community and residential care settings. Exactly how these partnerships are structured and the relationships between self-care and both informal and formal systems of care are less clear. The findings point to a need to refocus attention away from the creation of partnerships and protecting against unnecessary substitution, towards broader concerns with supporting the partnerships that already exist.