The challenge of this paper is to re-examine the demographics which underlie the re-write of social policy in an aging Canada, as related to gender, family and generation. Following a brief consideration of Canada's changes and challenges in comparison to those in the United States and selected European countries, the analytical construct, “life cycles of dependencies and responsibilities” is introduced and utilized to examine shifting bases of security among generations (with a focus on six cohorts), and in particular, the implications of possible changes to social policy for the elderly on women, the poor and other disadvantaged elders.

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another.

An ongoing, structured, low-intensity exercise program designed to foster physical, social and cognitive functioning was evaluated in 128 seniors ranging in age from 55 to 101 years. The sample included individuals residing in the general community, seniors' apartment complexes and institutional care facilities. Participation in other exercises was found to increase since joining the program. The program appeared to be providing an opportunity for social interaction among participants, and the exercises appeared to be mentally stimulating. Implications for program modifications, including building in self-monitoring procedures, are discussed.

This research, taking into account sex and previous occupational level, examines the influence of retirement on three dependent variables: loneliness, depression, and life satisfaction. One hundred and six men and women, aged 65 and receiving governmental pensions (Régie des rentes du Québec) completed on two occasions (with a one year interval) the Échelle de solitude de l'Université Laval, the Questionnaire de dépression de Beck and the Échelle de satisfaction de vie. The resulte indicate that there is no significant difference between Time 1 and Time 2 of evaluation on the three questionnaires (temporal view). However, from a cross-sectional perspective, newly retired men and professionals may be more lonely, less satisfied with their life and more depressed. The results are discussed in the light of Atchley's (1976b) model.

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.

Today more men work in the long-term care sector, but men are still in the minority. Little is known about men’s experiences in care work, and the dilemmas and opportunities they face because of their gender. This article focuses on men care workers’ integration into the organization and flow of nursing home work as perceived by these workers and staff members. Using a rapid ethnography method in two Ontario nursing homes, we found work organization affected interpretations of gender and race, and that workers’ scope for discretion affected the integration and acceptance of men as care workers. In a nursing home with a rigid work organization and little worker discretion, women workers perceived men workers as a problem, whereas at a nursing home with a more flexible work organization that stressed relational care, both women and men workers perceived men workers as a resource in the organization.

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.

This longitudinal mixed-method study examined the types of help provided by caregivers to optimize participation of older adults with cognitive deficits post-stroke (care recipients), and how these types of help varied with caregiver’s burden. Twelve family caregivers of care recipients post-stroke completed a burden questionnaire and semi-structured interviews one month, three months, and six months following care recipient’s discharge home from acute care, rehabilitation, or day hospital. Care recipients completed cognitive tests and a social participation questionnaire. Types of help caregivers provided differed according to the amount of daily living support, degree of concern for care recipient’s well-being, and impact on caregivers’ social life. Interestingly, types of help fostering care recipient’s social participation, self-esteem, and abilities were unrelated to a negative impact on caregivers’ social life. Understanding how different types of help relate to caregiver burden could improve the types of help to optimize care recipients’ social participation without overburdening caregivers.

The Canadian Longitudinal Study on Aging (CLSA) has progressed from a vision initiated by the Canadian Institutes of Health Research (CIHR) Institute of Aging in 2001 to a federally funded national research platform in 2008. The development of the CLSA protocol was enhanced through a series of international peer reviews, a multisectorial Steering Committee, and a CIHR Ethical, Legal, and Social Issues committee; each was essential to the excellence of the science and to making the CLSA relevant to multiple sectors. The CLSA research team, led by three co-principal investigators (Kirkland, Raina, and Wolfson), has developed a unique protocol focusing on aging from cell to society, designed to follow 50,000 people aged 45 to 85, for 20 years. A strategic partnership with Statistics Canada has been crucial to the development and launch of the CLSA. The CLSA will contribute to our understanding of transitions and trajectories within an aging population, and will differ from longitudinal studies of aging worldwide through the breadth of its scope, the early age of recruitment into the study (age 45), the ethno-cultural diversity of Canada’s population, and the potential to link collected data to health administrative data at the provincial level. The CIHR is a novel longitudinal population-based study that will be an unprecedented research resource underpinning multidisciplinary research and evidence-based decision making in aging in Canada.

This paper examines gender differences in helping networks for three different illness situations (common ailments, hypothetical short-term health emergencies, and functional disability) among participants attending day hospitals and senior centres in Winnipeg, Manitoba. The findings show that women are more likely than men to receive assistance from family members other than a spouse and to receive assistance from friends as well. Gender emerged as a significant correlate of who helped, even when controlling for availability of that person, extent of the illness, other health factors, and social network characteristics.

Burden among caregivers has consistently been recognized as a function of both subjective and objective variables. In addition to concrete role demands, caregivers' perceptions and appraisal strongly contribute to perceived burden. At present, however, the relative contribution of objective and subjective factors remains unclear. This question was addressed among 70 spousal caregivers recruited within a dementia assessment clinic. Subsequent to adjustment for socially desirable responding, both groupings of variables significantly contribute to the prediction of burden scores. These findings are discussed in the context of the hopelessness theory of depression. Demographic similarity between these caregivers and a corresponding sample of randomly derived spousal caregivers recruited as part of the Canadian Study of Health and Aging (CSHA) suggest the results of this study may be generalized with greater confidence.

This article examines the living situations and access to social support for community-dwelling people between the ages of 50 and 65, and who have lived with significant physical impairment for more than 15 years. Data were gathered through in-depth, semi-structured interviews with eight men and women. Findings suggest that coping with long-term impairment may be a lonely experience when the individual lacks a strong network of family and/or friends to offer emotional support. Participants felt their experiences of aging with significant long-term impairment were improved when they shared thoughts, feelings, and problems with others. Findings also show the significance of gender regarding access to social support and point towards the importance of using subjective understanding when ascertaining the level of social support available to individuals. More generally, findings underscore the broader point that individuals aging with impairments are immersed in and wish to maintain reciprocal relationships.

Cultural adaptation is important to assess; however, most acculturation measures are unidimensional with little psychometric data for older immigrants. This study assessed a bidimensional measure, the Vancouver Index of Acculturation (VIA; Ryder, Alden, & Paulhus, 2000), among 149 (mean age: 73.92 years) Chinese Canadians. Internal consistencies were .84 and .83 for the Mainstream and Heritage subscales respectively, and they were orthogonal. Convergent and discriminant validity were demonstrated by predicted correlations between the VIA subscales and age at immigration, years in Canada, English fluency, and the Belief in Chinese Culture and Values Scale (BCCV; Lai & Chau, 2007). The VIA accounted for significantly more variance in language ability than the BCCV, above and beyond acculturation proxies. Exploratory factor analysis replicated the two-factor structure reported by Ryder et al. (2000). A confirmatory factor analysis indicated poor fit. This study supports a bidimensional model of cultural adaptation among older Chinese Canadians.

Women experience a rapid rise in the incidence of wrist fracture after age 50. Accordingly, this study aimed to (1) determine the internal and environmental fall-related circumstances resulting in a wrist fracture, and (2) examine the relationship of functional status to these circumstances. Women aged 50 to 94 years reported on the nature of the injury (n = 99) and underwent testing for physical activity status, balance, strength, and mobility (n = 72). The majority of falls causing wrist fracture occurred outdoors, during winter months, as a result of a slip or trip while walking. Half of these falls resulted in other injuries including head, neck, and spine injuries. Faster walking speed, lower grip strength, and higher balance confidence were significantly associated with outdoor versus indoor falls and slips and trips versus other causes. This study provides insights into potential screening and preventive measures for fall-related wrist fractures in women.

Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.

The potential role of physical activity in the primary, secondary, tertiary and quarternary treatment of disease is examined with particular reference to the health care needs of the elderly. Areas requiring further research are stressed. On present evidence, it would appear likely that enhanced physical activity could make a useful contribution to the containment of health care expenditures; however, it still has to be established how far the gains of physical condition and resultant improvements of health status that are seen in younger individuals could be realized by the various categories of geriatric patient.

A survey on abuse of the elderly was mailed to 174 Canadian and American professionals who were identified as persons likely to be involved with cases of elder abuse. Neglect was the most commonly reported type of abuse, followed by financial and psychological abuse. Physical abuse constituted the smallest number of cases. While various family relationships were reported, middle-aged sons were the most common abusers, while older mothers were most frequently the victim. Regardless of the legislative approach taken, laws were reported to be generally effective. Greatest concerns were expressed regarding the lack of funds to administer and provide services to abused seniors.

An aging population and increasing rates of dementia point to the need for alternative strategies that allow individuals to age in place. This multiple case study explored, from an insider’s perspective, the role and meaning of music for individuals with dementia who are aging in place. Methods were semi-structured interviews, observations, and videos. The study’s central theme is connection, with three types of “connectors” – self, partner, and music – as subthemes. Connection to self involves present moment awareness, accessing memories, and self-expression. Connection to partner builds on self-connection and spending time together with music. Lastly, the connection to music builds on the previous two subthemes as well as the desire to keep things “normal”. This study provides insight into the growing body of interdisciplinary literature dedicated to dementia, music, aging in place, and contemplative practices, as well as implications for aging and caring for someone with dementia.

This study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.

Falls in residential long-term care (LTC) facilities continue to be a leading cause of injury for residents and cost for the health care system. Interdisciplinary clinical teams are responsible for assessing risk levels for their residents and developing appropriate care plans and interventions in response. This study compares the predictive accuracy of three separate fall risk assessment tools: the interRAI Falls Clinical Assessment Protocol (CAP), derived from the LTC Facility (LTCF) or Minimum Data Set (MDS) 2.0 assessments; the Scott Fall Risk Screen; and a modified Fall Risk Tool that was implemented as part of a provincial Fall Reduction Strategy in Nova Scotia. To conduct this retrospective cohort study, secondary data were collected from 1,553 LTC residents with interRAI assessments completed between March 1, 2015 and September 29, 2016, across Nova Scotia and New Brunswick. For each resident, data were collected regarding the three fall risk assessments, along with fall incident data for use in sensitivity, specificity, and logistic regression analyses. This study found that although all three tools had limitations with sensitivity or specificity thresholds, the interRAI Falls CAP delivered the highest accuracy with a c-statistic of 0.673, compared with the Scott Fall Risk Screen at 0.529 and the modified Fall Risk Tool at 0.609. When diseases that have been established to be a risk factor for falls were added to the model, the overall accuracy of the interRAI Falls CAP combined with those covariates increased to 0.749. These results suggest that the best practice guidelines for fall risk assessment be revisited, and that the interRAI Falls CAP could potentially be updated to include certain diseases and controls for optimal predictive ability.