The advancement of computer systems has led to the existence of large and detailed existing computerized data sets, many of which contain useful information for studying the elderly and the aging process. This paper identifies several types of existing large data bases and provides examples of each. Strengths and weaknesses of working with existing data are discussed and strategies for conducting secondary data analysis of large data sets are outlined. Existing data sets represent large investments in the collection of individual data and have great potential to provide answers to important questions in the field of aging research.

Discontinuity of grandparent-grandchild relationships has been largely overlooked in social science research, despite the fact that the salience of the grandparent grandchild attachment bond is the subject of considerable discussion. This article reports the results of an exploratory study of grandparent-grandchild contact loss, by means of a survey of the core membership of five “grandparent rights” groups across Canada. As reflected in the particular concerns of this membership, there are four primary circumstances associated with grandparent loss of contact with grandchildren: parental divorce, conflict with both parents, death of adult child, and stepparent adoption following remarriage. Grandparents whose adult children are noncustodial parents (mostly paternal grandparents) are at high risk for contactloss, and adult children-in-law appear to be the primary mediators in the ongoing grandparent-grandchild relationship. Disrupted grandchild access is seen as having profound negative consequences for grandparents, and this has important implications for socio-legal policy and therapeutic practice.

In “Mauvais traitements des personnes âgees: Statégies de changement” are contained the analyses and reflections of 27 different authors. They address four separate areas of the issue: practice, policies, education and research. The authors went about writing this book with the intention of assessing what is known to date, indicating how the situation appears to have evolved and providing certain recommendations in the hope of putting an end to this complex, disturbing problem. Very recent works which, for the most part, were written by the same authors are described in this book. However, few studies which have been conducted on a regional or local level, or even in a university milieu, have been mentioned. Despite the quality of this work, once again there is a noticeable lack of precise terminology used in reference to mistreatment. Nevertheless, this document does paint an excellent picture of the issue and presents recommendations which can be extremely useful in developing policies, protocol and programs aimed at the prevention of mistreatment with regard to seniors, either in a family or institutional environment.

La plupart des recherches sur les relations entre générations au sein de families âgées ont principalement porté sur les parents frêles et leurs enfants d'êge adulte. Cette étude a pour but d'examiner les engagements entre générations et les liens entre les parents et leurs enfants qui géraient communément une ferme. Le point de mire théorique de l'étude était les intérêts de chacune des générations. Nous prédisions que les enjeux autour des intérêts devaient être cruciaux en raison de l'interdépendance des générations et du patrimoine familial à maintenir. Une échelle d'intérêts familiaux et agricoles a été élaborée, et les niveaux d'intérêt de ces deux secteurs ont été examinés en fonction de la génération et du sexe. Les différences entre générations, moins importantes que prédites, sont dues au rôle des belles-filles, lesquelles habitaient à l'extérieur de la maison de ferme.

The last “great pension debate” in Canada came to an end in the early 1980s but is now about to resume. The terms of debate have changed significantly, however. As a contribution to the debate, this paper aims to identify emergent positions and the new social, economic and political conditions to which they are a response. “Conservative” strategies have emphasized privatization of the pension function and greater emphasis on providing income-tested benefits to the low income elderly. New “progressive” alternatives have advocated a redesign of the welfare state to allow for a more flexible model of retirement and the economic life course more generally. Each is a response to real changes in the fiscal capacities of governments, the conditions for successful economic performance and the distribution of economic risk among age groups. The empirical core of the paper uses data from the Survey of Consumer Finances to show how the age distribution of economic well-being has changed since the the 1960s when the current welfare state was designed. Our aim is not to resolve the debate but to set it in context and identify the main assumptions and models underlying alternative strategies for reform.

Cet article fait un bilan critique des écrits relatifs à l'évaluation de groupes de soutien pour aidants naturels, une intervention de plus en plus répandue dans les organismes publics et communautaires. Après avoir situé le contexte des groupes de soutien, l'article décrit rapidement les types de groupe de soutien évalués, les types de recherches évaluatives, les principaux résultats et limites de ces évaluations. Il ressort que les études se sont principalement intéressées aux groupes de soutien de courte durée, visant à offrir de l'information et du soutien émotif, ainsi qu'à développer de nouvelles habiletés. Les évaluations cherchent principalement à mesurer les effets des groupes sur les conséquences du stress en utilisant des devis de type expérimental et des mesures standardisées. Très peu d'importance est accordée à l'évaluation d'implantation. La majorité des études conclut à l'absence d'effet. Trois pistes de recherche sont proposées soient: l'analyse de différents types de groupes de soutien, la multiplication des approches théoriques et disciplinaires accordant plus d'attention aux dynamiques de groupe et aux dimensions sociales et, enfin, le recours à un éventail plus large de méthodes.

Calls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

Routinely-collected administrative data and Cox's proportional hazards models are used to compare outcomes of care while controlling for age, sex and dependency level. The results indicate that the overall quality of nursing home care in Manitoba is good but that residents in certain regions and in certain types of nursing homes have specific outcomes that are poorer than others. These outcome indicators must not be treated as definitive signs of poorer care but as “triggers” suggesting a need for a closer look because the methodology and outcomes used in this study are still in the experimental stage. The results also indicate that secondary data provide a relatively inexpensive starting point for evaluating outcomes of nursing home care.

Research measures can be integrated into routine care if they are useful to care providers. Measures will be useful if they facilitate the processes of care, and if the outcomes which they measure reflect outcomes of importance to the patient. Many current measures suffer from being unwieldy for routine use, or not adequately measuring relevant outcomes. In the care of the frail elderly, who have complex needs, these challenges are particularly difficult. The techniques of Comprehensive Geriatric Assessment and Goal Attainment Scaling (GAS) are proposed as means of embracing the complexity of the needs of the frail elderly, and measuring the effectiveness of specialized interventions. GAS appears to meet the current definition of a Health-Related Quality of Life measure, suggesting that its routine use provides advantages both as a management process and as an outcome measure.

Model building in epidemiological-ecologic research on aging is hampered by the prevailing paradigm of standard empiricism, lack of knowledge about the biological origins and causes of aging and problems in differentiating the aging process from age-related diseases and disabilities. Consequently, the identification of associations or causal relations between risk factors, aging, diseases and disabilities suffers from a number of conceptual and methodological problems which sometimes can lead to research results which are absurd in the context of real life despite their formal correctness. The benefit of building theoretical models arises out of the necessity to construct an empirically sensible order of events which renders the research object intelligible. It is suggested that in the multifactorial epidemiological-ecologic aging research it might be useful to adopt and empirically test the concept of the “effective causal complex” instead of continuing, in many cases fruitless, attempts to define the effects of single risk factors on the associations between aging, physiological damage and disease and disability outcomes.

Substance use patterns and predictors of substance use by women aged 65 and over were examined using data from the Canadian National Alcohol and Other Drugs Survey (1989). Use patterns were consistent with findings from previous surveys: that older women drink less alcohol, smoke less and use less illicit drugs than other age-gender groups. Also consistent with previous surveys, older women reported the highest rate of psychoactive prescription drug use of all groups. Bivariate analyses indicated significant relationships between some social and demographic variables and substance use. Drinking was associated with being single, younger, not religious, in better health, and smoking. Smoking was associated with being younger, not religious, in poorer health, having less social support, drinking, and use of psychoactive prescription drugs. Use of psychoactive prescription drugs (especially sleeping pills) tended to be associated with being widowed, older, less educated, more religious, in poorer health, experiencing higher stress, having lower income and less social support, smoking, and use of other psychoactive prescription drugs. When data were analysed using principal component analysis, two very consistent dimensions of substance use emerged for older women: greater religiosity associated with less drinking and smoking, and a dimension involving use of all types of psychoactive prescription drugs. These findings are discussed in terms of projected use patterns for future older women and the need for a better understanding of the social context of older women's substance use that involves light to moderate alcohol use but a higher rate of use of psychoactive prescription drugs than other age-gender groups.

This paper examines the question of whether the costs of ambulatory medical care (AMCC) in a universal health care system, such as that in Quebec, are related to household income. Questionnaires completed by 32,000 respondents for the Enquête Santé-Québec, 1987 (ESQ87) were matched with records in the Quebec Medicare system (La Régie d'Assurance-maladie du Québec, RAMQ). Approximately 90 per cent of the individuals were matched. Respondents living in remote regions were excluded from the study since a major portion of medical care in these regions is not reimbursed through fee for service; visits to physicians not on fee for service are not recorded in RAMQ files. At the individual level, the costs of ambulatory medical care over a two-year period decreased slightly with income, but at the household level, costs increased for those with higher incomes since the number of individuals in the households increased with income. These associations disappeared when the age of the respondents was taken into account. State of health is directly related to costs of care. Among health risks, availability of social support decreases costs of AMCC for both children and adults, while unemployment increases costs for adults only. Education of parents is linked with higher levels of costs for children, but AMCC decreases with increased education of adults. Finally, costs are lower for children in larger families compared with those in smaller families. To conclude, income does not affect costs of AMCC in Quebec, although variables associated with income, such as education, unemployment and family size, do have definite effects on costs. The absence of a link between psychological distress and costs for the elderly is a matter of concern since it confirms the difficulty the elderly experience in accessing psychiatric care.

This book reports on a survey conducted in Chicago, in 1988, among homeless seniors and elderly whose housing situations were considered to be precarious. The first part of this work establishes the socio-economic context which resulted in the development of this problem among the homeless, while the second part deals with the results of the survey and the third tackles the problem of the gradual disappearance of affordable housing – e.g., the single-room occupancy (S.R.O.) hotel. Through this book we learn that the decrease in the number of affordable housing units, such as public housing, during the '80s plays a central role in the emergence of the phenomenon of homelessness among the elderly. It should be remembered that Canada became partly familiar with this situation as of January 1994, with the removal of federal funding for the construction of new social-housing units. In addition, the results of the survey informs us that homeless seniors are often without shelter on a temporary basis. This can be attributed to specific episodes in their lives resulting primarily from situations like an eviction, a fire in a previous dwelling, loss of social support or a sudden decrease in revenue (robbery, loss of a spouse). Housing Risks and Homelessness Among the Urban Elderly is a simple book that sheds light on a fringe phenomenon which, as yet, is not well-known.

The intuitive notion of action research — planning with individuals to try something out, studying what happens when the change is implemented, making appropriate revisions, and then trying it again — appeals to researchers interested in using the practical knowledge of the people they study, simultaneously allowing them to develop strong personal connections. This paper provides an overview of action research methods and their potential use in applied social research on aging and the elderly. The first section defines terms and gives examples of action research. The second section reviews work in this field, and the final section presents four questions for gerontologists to consider.

This book provides a summary of the various possibilities available on the American market to house the elderly: 13 major solutions are put forth, ranging from a retirement community, to inverted mortgages to social housing, all analysed in great detail. The 11 chapters, which include the proposed housing solutions, are all divided in the same manner: presentation of the solution, general characteristics, clients reached, principal advantages and disadvantages. Unfortunately, after some time, this type of chapter construction serves to reduce your interest in reading the book. However, the author does prove that he took great pains in classifying housing solutions and in searching for pertinent documentation. This work should help anyone who is not familiar with this subject to take stock of the situation. Nevertheless, it does not offer any perspective for the future, since the author endeavours to give prominence to the main inconveniences of the proposed solutions, thus offsetting the few known advantages of the latter. In the end, you find yourself wondering what can actually be done and suggested to this clientele, since unfortunately nothing substantial has been proposed.