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.

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.

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.

To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using linked administrative databases to determine the incremental use of health services by elderly Ontarians with dementia. Overall, study results demonstrated that individuals with dementia used services in a pattern similar to non-demented persons, albeit at a higher level. Exceptions were women's use of hospital and home care services, where the most elderly women received significantly fewer services. Thus, the study provided important insight regarding the relative levels of health services used by demented Ontarians. Research in this area will become increasingly important as the population ages and the settings integral to dementia care and management shift and evolve.

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.

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.

The purpose of this study was to identify the self-report physical activity (PA) tool best suited for assessment of PA in community-dwelling older adults with multiple chronic conditions (MCC). PA can positively influence physical and psychological health in this population. Although self-report PA tools exist, little is known about the psychometric properties and feasibility of using these tools in older adults with MCC. A systematic literature review from 2000 to 2018 was conducted of studies reporting on the psychometric properties and feasibility of 18 self-report PA tools for community-dwelling older adults (≥ 65 years) to determine the suitability of these tools for use in older adults with MCC. Based on an assessment of the available evidence for the psychometric properties and feasibility of 18 different self-report PA tools, the Physical Activity Assessment Scale for the Elderly (PASE) is recommended as the best-suited self-report PA tool for older adults with MCC.

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.

Canadian older adults with complex health problems are often considered ineligible for traditional rehabilitation programs but may benefit from slow stream rehabilitation (SSR). This scoping review summarizes the literature related to SSR for older adults, within single-payer health care systems. Methods: Peer-reviewed and grey-literature documents relevant to older adults in SSR were systematically reviewed. Results: 1,445 documents were screened independently by two reviewers [Cohen Kappa value of 0.78 (CI = 0.73, 0.83)], and included 18 documents. SSR programs were found to be multidisciplinary with a mean duration ranging from 30 to 141.2 days. SSR participants were more likely to be female, with a mean age range of 72–82 years, multiple co-morbidities and mild-to-moderate cognitive impairments. SSR participants demonstrated improvements in physical and functional measures. Discussion: SSR programs have the potential to be an integral part of the continuum of care for older adults with complex medical histories.

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.

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.

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.

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.

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.

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.

Currently, many immigrants are disqualified from Canada’s public pension scheme because of residency requirements. In addition, decades of low income and labour market exclusion prohibit many Canadian immigrants from building adequate private pension savings throughout their working life. Together, these factors present serious concerns for immigrant seniors’ economic well-being. Using Canadian census data spanning a twenty-year period (1991–2011), we find that income from personal savings plans and investments has declined sharply for both native-born and immigrant Canadians, with recent immigrant cohorts faring worst. However, since 1991, native-born and immigrant men living in Canada for 40-plus years had major gains in private employer pensions (Registered Pension Plans; [RPPs]). Yet RPP income for all other immigrant cohorts remained stable or declined during these decades. Thus, the data demonstrate a worrisome growing private savings gap between native-born men and all others in Canada, with newer immigrants and women faring worst.

A central question of social research is how experience is given voice in everyday life. Conventional methodologies provide technical answers: Issues of contextuality and the socially constructive and narrative features of method are not so much analytic and critical concerns as they are construed as procedural problems. This paper considers the question in aging research. Two sides of an analytic tension are addressed as they bear on method, one centred on voice and narrative and the other on the contextuality of experience. Observational and narrative material from qualitative studies of adults and elderly people is used to argue that a focus on ordinary, narrative practice usefully sustains the tension to provide the basis for a critical empiricism.

This article reports on two studies that describe the adaptation of Spielberger's State-Trait Anxiety Inventory (form Y) for people aged 65 and older. The aim of the first study is to assess the necessity to modify the format of the STAI for the aged. Verbal reports of 22 subjects suggest difficulties reading the items, respecting the instructions and using the Likert scale. Item-remainder correlations supported these observations. Therefore, the size of the text was doubled and the state or trait instructions, as well as the choices of the Likert scale, were repeated in each item. A second study is carried out to test if these modifications enhanced the understanding of the items, and simplified the use of the STAI-Y. Verbal report and internal consistency showed a significant improvement. Our results support the recommendation of other authors that adapting an instrument for the elderly necessitates important modifications.

The goal of this literature review is to identify key issues in the patterns of medical care utilization of services for seniors as a contribution to the National Consensus process on designing and delivering health care reforms which foster seniors' independence (Shapiro & Havens, 2000). A search strategy used to identify the relevant literature since 1985 focussing mainly on peer-reviewed journal articles is described and the results of the search strategy are summarized. Key articles are identified, analysed and synthesized based on Canadian and American evidence covering patterns of institutional care, physician use, ambulatory care and the determinants of utilization of these services.

Tube feeding is a common, and frequently long-term, form of life support. Currently, no distinction is made between short-and long-term tube feeding; the latter being a replacement of the ability to eat on an ongoing, possibly permanent, basis. Little research has focussed on long-term feeding. Consequently, the implications and practices of long-term feeding remain undetermined. Hospital charts of ten accessible patients, who had long-term tube feeding were examined in order to answer pre-determined questions. Reporting includes: feeding solution types, tubes, and methods; medical diagnoses and functional reasons for tube feeding; changes in mental and physical conditions since initiation of tube feeding; involvement of nurses and others in tube feeding decisions, and decisions to continue tube feeding after initiation. Tube feeding was demonstrated to be capable of sustaining life over long periods of time. Despite improved nutrition, patients' overall levels of mental and physical capacity and self-care abilities were found unimproved. Maintenance of life may be the only goal of long-term tube feeding.