This paper is concerned with questions relating to demographic change (population growth and aging) and its implications for operating a publicly funded health care system in a Canadian setting. It provides an assessment of how prospective population changes alone would affect the share of health care costs in total national income in Canada over the next several decades; it provides also an analysis of how actual patterns of hospital service provision changed in Ontario over the last decade in response to budgetary restrictions in a period of rising demand for services. Finally, a case is made for viewing health care as an integrated system; a description is provided of a set of computer-based models that have been developed to facilitate analysis of the health care system, and illustrative projections are discussed.

The aim of this research was to study the relationship between aging and decision-making. Specifically, it deals with managers' views on the hypothetical effects of age and experience on decision behaviour. Do the numerous beliefs and stereotypes related to the supposed effects of aging (i.e. agism) affect the decision-making process and its results? Are younger managers more creative, quicker or more audacious than older managers? Are the experienced managers more skilled, cautious or pragmatic than the less experienced ones? Given the fact that mean age of managers in many contemporary public organizations is rising, further information is needed on how this trend will affect the behaviour and state of mind of public managers who make daily decisions bearing important economic and social consequences. To investigate these questions, interviews were conducted with managers employed by Quebec's public service. These interviews were aimed at collecting data about the way managers themselves perceive the effects of aging on decision behaviour. Results indicated that managers do not readily link age and decision behaviour. However, the relationship between experience and decision behaviour is perceived as comparatively strong. The relevancy of further research on the effects of experience on decision behaviour and, more generally, on the effects of experience on working abilities is discussed.

This research presents risk factors for abuse and neglect among older adults who accessed health and social service organizations in London, Ontario, 1991. The paper reviews four theoretical perspectives on elder abuse and neglect: the situational model, social exchange theory, symbolic interactionism and a feminist model. Risk factors for physical abuse, chronic verbal abuse, material abuse and neglect were identified for each theoretical model. Each set of risk factors was regressed on each type of abuse in order to determine the efficacy of the theoretical models. The data suggest that the risk factors associated with the situational and feminist model(s) provide the best fit in terms of physical abuse; the symbolic interaction model explains the most variance in chronic verbal abuse; both the symbolic interaction and feminist models explain about the same amount of variance in neglect; and none of the theoretical models adequately explains the variance in material abuse.

While multi-method research is currently provoking much interest, there is little reflection on the legitimacy of this kind of research and on the conditions for achieving high quality research. This article first describes the scientific and socio-political contexts from which this movement towards multi-method research has emerged. It then goes on to discuss why comparative analysis is central to the triangulation of methods and why the notion of triangulation itself requires an external point of reference. It is suggested that the reason why we produce only half-hearted or even illigitimate comparisons is because the reference points are hidden. For multi-method research to be of high quality it must clearly externalize valid inferences at each moment in the spiral of knowledge, identify its analytical logic and establish its internal reference points. (This article is the result of joint research and the respective positions of the authors are reflected in the way in which the article is presented.)

Claims that the health care system is about to be engulfed in a “wave of grey” have become commonplace. Recent cost escalation is commonly attributed to the aging of the population, and there is no shortage of dire warnings about the cost implications of the even more dramatic aging, and costs, still to come. These claims have been largely unsubstantiated. Yet they persist for a number of reasons. First, over long periods of time, the effects of demographic trends can be (and probably will be) quite substantial. But these effects move like glaciers, not avalanches. Second, the effects of aging populations on some types of services which cater differentially to seniors will be much more dramatic; observers of those sub-sectors (such as long-term care) tend to extrapolate that sector-specific experience to health care generally. Third, at the “coal-face,” health care providers are seeing their practices become ever more dominated by seniors. They mistake this increased “presence” of patients aged 65 and over in their practices as evidence of the effects of demographic changes. In this paper we discuss each of these sources of error about the effects of aging population on health care costs. We focus primarily on the confusion between changes in patterns of care for particular age groups, and changes in overall levels of care. Quite extensive empirical evidence has been collected over the past decade from analyses of British Columbia data bases, and these findings are not unique, in Canada, or beyond. The common finding of this body of research is that population aging has accounted for very little of the increase in health care costs over the past three decades, in Canada or elsewhere. Health care utilization has increased dramatically among seniors. But this has had less to do with the fact that there are more of them, than with the fact that the health care system is doing much more to (and for) them than was the case even a decade ago. This suggests that the appropriate care of elderly people should be a central issue for health care policy and management, but that demographic issues are, in the short run at least, largely a red herring.

Previous studies in this series of papers investigated the associations between aluminum (Al) water concentrations and relatively high risks of a measure of mental impairment and also various possible other drinking water characteristics, particularly pH, turbidity, fluoride and silica. The results were based on one measure of mental impairment, which would not be expected to give the same results as the more definitive endpoint (outcome variable) of a record of Alzheimer's Disease (AD) as the underlying cause of death on a death certificate. The present paper therefore investigates the relevant associations, based both on the measure of mental impairment and on death certificates in which AD and presenile dementia are listed as the underlying causes of death. As expected, the associations were not identical, but they were similar. More specifically, Al water concentrations were strongly associated with the recording of AD on death certificates, as were pH, fluoride, and silica concentrations. The implications of these results are discussed, and it is suggested that the evidence is sufficiently strong for methods of water purification to be modified, at least on a trial basis, because of the likelihood that this will reduce the incidence of AD.

This study explored the validity of the Caregiver Abuse Screen (CASE) as a brief measure of abuse/neglect of seniors. A group of abusive caregivers from the community was compared with two contrasting groups of non-abusive caregivers. The CASE distinguished between the abusive and each non-abusive group, while the non-abusive groups did not differ from each other. Higher CASE scores coincided with higher scores on abuse/aggression measures from independent sources; with caregiver personality traits; with appraisals of poorer caregiver/care-receiver relationships and more care-receiver problem behaviours, poorer caregiver health, more caregiver depression and less social support. Findings were interpreted as supporting the CASE's validity as an initial abuse screen for use with caregivers.

Cet article étudie le vieillissement de la main-d'oeuvre au sein des services publics de la Colombie-Britannique entre 1983 et 1991. Les inscrits aux fichiers annuels de rémunération du personnel du gouvernement ont été répartis selon l'âge, le sexe et la classification d'emploi des employés et par leur utilisation des programmes de maladie à court terme et d'invalidité prolongée. Des données sur la retraite sont également tirées des rapports annuels de la caisse de retraite des services publics. Ces données sont analysées en fonction des tendances en matière de retraite, du taux de rotation de la main-d'oeuvre et des tendances au plan de l'absentéisme. Les résultats révèlent une forte hausse au sein de la catégorie des travailleurs d'âge moyen et une faible augmentation du vieillissement de la main-d'oeuvre. L'embauche d'un plus grand nombre de travailleurs ayant atteint leur mi-carrière et d'un nombre inférieur de jeunes travailleurs conjuguée à des programmes de retraite anticipée ont causé une bulle dans la structure d'âge de la main-d'oeuvre, plutôt que son allongement, comme on peut observer au sein de l'ensemble de la population. Les auteurs discutent ensuite des conséquences à long terme et à court terme en regard de l'utilisation des ressources humaines.

The debate regarding paradigms and investigation methods is at least partially responsible for the fragmentation of gerontologocial knowledge. First, the article presents arguments in favour of methodological pluralism as a research designed to facilitate the integration of knowledge and innovation. The main goal of methodological pluralism is to reconcile different approaches by combining a number of observation and data-collection scenarios within the same study. After presenting the arguments in favour of methodological pluralism and identifying the integration methods that can be applied to study results already obtained, the author proposes a taxonomy of multiple research strategies that may be utilized in the same study. He specifically discusses: pseudo-triangulation, parallel and sequential triangulation, composite methods, mixed methods and the multi-method approach.

A self-administered mailed questionnaire was sent to a stratified random sample of medical administrators in Ontario homes for the aged (HFAs) and nursing homes (NHs) in 1991 in order to explore the types and extent of medical-administrative activities undertaken by these physicians, and their perceptions of skills, attitudes and knowledge that were important in carrying out their roles. Three key findings emerged from the survey. First, considerable variation exists in the extent of medical administrative activities undertaken within each of the two facility types and, in some cases, across the two facility types. Second, there were few activities which ≥75 per cent of medical administrators reported undertaking on all occasions and many activities which ≥25 per cent of physicians reported not undertaking on any occasion. Third, in general, medical administrators did not express values congruent with adoption of a broader management role in facility administration, financing, and planning activities. Research and policy implications for the evolving role of medical administrators in NHs and HFAs are discussed.

This research examined individual differences in attitudes about elder abuse and other concerns in contemporary social morality. Study 1 was part of a larger investigation intended to identify examples of elder abuse through a survey of 572 seniors and practioners. Using a series of construct validation filters, a unifactorial Elder Abuse Attitude Test (EAAT) was developed that measures individual differences in evaluating examples of elder abuse. The EAAT contains 13 items and had an internal consistency exceeding 9. Study 2 included the EAAT in a survey of attitudes about wider social issues. Data on the EAAT, 31 survey items, and indexes of extremity and agreement set were analysed for 257 respondents. Zero-order and factor analysis showed relationships of the EAAT with extremity set and items stating that society should provide fiscal and other resources towards the prevention and remediation of child, spousal, and elder abuse. Attitude extremity was uncorrelated with four other attitude factors. We conclude that people more prone to attitude extremity have stronger convictions about the responsibility of society to attenuate abusive situations.

Social Models of aging deal with changes over the life course. Using a loose definition of model, this paper reviews models under the following classification: Allocation models; Construction of the Life Course models; Personality and Socialization models; and Negotiation models. Differences between and within these models are explored, with particular reference to the issue of determinism and the conceptualization of social structure. The life course perspective is recognized as hegemonic in contemporary theorizing about aging, but it is seen as itself embracing diverse models.

L'objectif de la présente étude était de déterminer si les embêtements, les évaluations cognitives et les stratégies d'adaptation contribuent au développement de la détresse psychologique chez les veuves âgées. Cent huit femmes âgées (M = 69.17 ans), veuves en moyenne depuis 18.54 mois, ont participé à l'étude sur une base volontaire. Les analyses de régression multiple ont démontré que le facteur Santé de l'Échelle des Embêtements pour Personnes âgées, une Menace à l'estime de soi de l'Évaluation Primaire et la stratégie Echappement-évitement de l'échelle des Façons de Composer avec une Situation Stressante contribuent à expliquer 65 pour cent de la variance de la détresse psychologique telle que mesurée par l'Inventaire Bref des Symptômes. Les coefficients standardisés ont indiqué que la Santé était la variable la plus importante pour prédire le niveau de détresse. Les implications méthodologiques ainsi que des suggestions de projets futurs sont abordées.

Use of medical services by the elderly population is increasing. While rising numbers of elderly persons account for much of the overall increase, per capita increases in use of medical services within this group have been substantial. This phenomenon is commonly attributed to greater need due to the “aging” of the elderly population (i.e. an increased proportion of those 85 years of age and over) and to changing patterns of morbidity or to changing patterns of servicing the old and sick. Research to date suggests that the impact of the aging of the elderly population has been small. However, because the relationship between morbidity and rising utilization has not yet been studied, there is considerable debate about the extent to which increased “need” for care contributes to patterns of rising utilization. This research studied the impact of changes in numbers, demographics, and morbidity patterns of the elderly on per capita and aggregate consumption of ambulatory physician services at two points in time. Linked survey and physician claims data for representative samples of the elderly in 1971 and 1983 were used to study patterns of utilization of total ambulatory, consultative and non-consultative care by age and health status. The research found that per capita utilization of both consult and non-consult visits rose across all categories, with older individuals and those in poor health experiencing greater increases in utilization than younger and healthier individuals. At the aggregate level, a large percentage of the increase in utilization of medical services was related to increased numbers of elderly. Changes in ‘need’ attributable to aging of the elderly population and increased morbidity had only minor effects. At least 35 per cent of the increase in non-consult visits and 50 per cent of the increase in consult visits were not specifically related to changes in need of the elderly population and remain as unexplained changes in patterns of servicing individuals. While some of this increase was directed to individuals in poor health, the majority of increased servicing (32% of the increase in non-consultative visits and 58% of the increase in consultation visits) was directed to individuals in good health. Policy implications are discussed.

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.

Long-term care spans a broad range of very diverse services and a pivotal location within the overall continuum of health and health care. Changes in one component of care affect and are affected by all other components as health care may be characterized as a dynamic series of interdependent processes and persons. The current state of Canadian health care, in general, and long-term care, in particular, demands the skilful juggling of universality and diversity to maximize both these characteristics without sacrificing either. In an atmosphere of reform and fiscal restructuring, the organizational, utilization and financing implications for this system on a tightrope are substantial. The challenges are of major proportions in maintaining a balance while securing a future system that is efficient, efficacious, equitable, effective and empowering.

Des mécanismes moléculaires liant le cancer à la sénescence cellulaire sont présentement explorés. Les télomères (l'extrémité des chromosomes) raccourcissent à chaque division cellulaire et il a été proposé que ce raccourcissement soit l'horloge moléculaire qui déclenche le processus de la sénescence cellulaire. La re-expression de la télomérase, une enzyme qui aide à maintenir la longueur des télomères et à prévenir leur raccourcissement, est un événement fréquemment observé dans les cellules tumorales. Cette re-expression est probablement essentielle à la formation et à la croissance soutenue de la majorité des cancers.

The headings of Table 2 in Judith G. Chipperfield's article p. 442 in Vol. 13 no.4 were incorrectly positioned. A corrected version is printed below.