Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants had thought about, discussed, or formalized their end-of-life preferences), and considered, as well, whether relations existed among the three outcomes. Canadian region of residence, female gender, and more years of education predicted having thought about preferences; region of residence, female gender, and lack of cognitive impairment predicted discussion of preferences; and region of residence and not being married predicted whether formal documents were in place. Ontario residents were most likely to have thought about, discussed, and formalized their preferences, whereas Atlantic residents were least likely to. Finally, having thought about preferences was associated with discussion, and having thought about and having discussed preferences were each associated with formalization of preferences. These findings are in keeping with the position that Advance Directives (AD) execution is a multi-stage process. A better understanding of this process may prove useful for the development of interventions to promote planning for end-of-life care.

Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider–client interactions have the potential to undermine relationship building. While the former has been documented, how seniors perceive relationship building within the home has received little attention. The purpose of this study was to explore seniors' perspectives on relationship building with in-home providers, focusing particularly on the facilitators of and barriers to this experience. Applying interpretive phenomenology, in-depth interviews were conducted with a purposeful sample of senior clients and an immersion/crystallization analysis strategy was used to elicit the findings. Findings revealed that seniors perceived relationship building as a dynamic process that encompassed facilitators and barriers at both individual and contextual levels. The interpretive findings afford several insights into building provider–client relationships within the in-home context.

While American literature on sustaining restraint reduction is relatively robust, there is a lack of research published on the same issue in Canadian continuing care (CC) settings. Statistics from Canada's largest publicly funded and operated CC organization have revealed telling patterns in mechanical restraint use. Over a 4-year study period during a campaign to reduce mechanical restraint use, the organizational prevalence dropped from 24.68 per cent to 16.01 per cent. There was substantial variability in restraint prevalence among the organization's 11 centres (range: 0–39.86% of residents restrained) and all but 1 was able to achieve mechanical restraint reduction. Specific facilitators to achieving and sustaining restraint reduction are identified, including small facility size, provision of specialized care (e.g., Alzheimer's disease), and an on-site champion. Specific barriers, such as large facility size and an off-site champion are also discussed.

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

This article looks at how The Simpsons' representations of aging, considered ageist and stereotypical by some, can be viewed as a positive look at the elderly that attempts to subvert the same stereotypes that it seemingly employs. The Baby Boom cohort is now seen as an attractive economic group, and as they continue their journey through the life cycle, they are drawing increased attention. A current scholarship exists that investigates the ways that the “aged” are seen, catered to, advertised at, seemingly marginalized, and represented in the larger context of the mass media. Relying primarily on the theoretical musings of Frederic Jameson and Linda Hutcheon, the article constructs a bridge that places The Simpsons squarely within a postmodern aesthetic and, using this rubric, shows how the inherent political nature of parodic irony can help to create an inversion of meaning.

This study examined whether Canada's public pensions (Old Age Security and Canada Pension Plan) provided adequate income for seniors living in Nova Scotia in 2005 to afford a basic nutritious diet. Monthly incomes were compared to essential monthly expenses for four household scenarios: (a) married couple, 80 years and 78 years, in urban Nova Scotia; (b) single male, 77 years in rural Nova Scotia; (c) a couple, 70 years and 65 years, in rural Nova Scotia; (d) widowed female, 85 years, in urban Nova Scotia. The monthly food costs for the four households were CAN$313.32, $193.83, $316.71, and $150.89, respectively. Results showed that both single-member households lacked the necessary funds for a nutritious diet, while living with a partner seemed to protect against inadequate financial resources. These findings illustrate the need to improve Canada's retirement systems to ensure all seniors have adequate financial resources to meet their basic needs—including nutritious food—prevent chronic disease, and ultimately improve quality of life.

The purpose of this study was to assess the feasibility and benefits (fitness and quality of life) of an 8-week mall-walking program. A total of 52 participants (n = 39at post-testing) took part in the pilot project (mean age = 66.4; range 46–83 years), with an overall attendance rate of 62.4 per cent. Participants self-selected pace, time, and frequency. Fitness measures, physical activity behaviour, and quality of life were assessed pre- and post-program. Results indicate a significant improvement in physical activity behaviour and most fitness indices. No quality-of-life changes were found, likely due to the above-norm values at baseline. Overall, this pilot project supports the feasibility of and positive health improvements associated with a mall-walking program. Such programs should be considered as part of health-promotion programs, especially for the aging population.

This article uses the concept of continuity of care to examine the implications of health-system restructuring for workers and staff in the BC home support system. Home support primarily serves frail seniors living in poverty and has the potential to provide assistance with tasks like bathing, dressing, and toileting, as well as offer social support and relational care to isolated clients. Through presentation of qualitative data from focus groups and interviews with home support workers and clients in the Greater Vancouver area, we demonstrate how the casualization and intensification of work in a context of increasing client acuity levels has diminished both continuity and quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, and compromised quality.

The purpose of this exploratory study was to examine the experiences of older adults with dementia while they were in long-term care and while they were in a summer-camp setting. Participant observation and interviews took place in both settings to gain an understanding of the experiences of seven residents of the long-term care facility. In the participants' experiences in the two contrasting environments, two types of relationships were evident—functional and supportive. Differing strategies were employed by residents within these two types of relationships. Notably, in supportive relationships, participants used humour and reminiscing in ways that reflected the depth of the relationship. At summer camp, in a more open and less constrained environment, relationships were dramatically altered and included elements of equality; personal interactions; and attention, reciprocity, and trust.

The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative data, including all individuals aged 65 years and older living in a British Columbia NH facility between April 1996 and March 1999. Hospitalization rates of NH residents were compared to estimated rates for community-dwelling seniors, using age- and sex-adjusted standardized incidence ratios (SIRs): SIR = 2.81 (95%CI: 2.71, 2.91) for femoral fractures, 1.96 (1.88, 2.04) for pneumonia, 0.73 (0.70, 0.76) for other heart disease, and 1.01 (0.99, 1.02) for all causes. NH residents have disproportionately higher rates of hospitalization for femoral fractures and pneumonia, with NH residents accounting for approximately one quarter of all femoral fracture hospitalizations of BC seniors.