This article explores how dementia care is provided to First Nations communities in southwestern Ontario. Data were collected through in-depth interviews with health care providers and analysed using a constructivist grounded-theory methodology. Two interrelated frameworks for understanding dementia care were identified: a care delivery framework and a knowledge framework. The care delivery framework identified care goals, care elements being provided, care barriers, and strategies and solutions to deliver care and overcome barriers. The knowledge framework defined four groups of knowledge stakeholders: persons with dementia, informal care providers, formal care providers, and the First Nations community. It identified the knowledge each stakeholder held or needed and processes of sharing – or failing to share – knowledge in dementia care. Several barriers, many created by a lack of knowledge, negatively impacted dementia care. However, health care professionals had effective strategies for providing care, designed to overcome barriers and which encompassed elements of knowledge sharing.

Based on data from the 2002 General Social Survey, this research presents a global portrait of unmet needs for home care services among Canadians aged 65 and over. It shows that 26.8% of seniors need assistance, accounting for approximately 1,024,000 individuals. Among these, just over 180,000 (17.7%) had at least one unmet need. In nearly half the cases, elderly with unmet needs receive insufficient support for 2 activities or more. Furthermore, house cleaning, house maintenance and outdoor work are the three activities with the highest prevalence of unmet needs. Finally, the younger seniors, those who require assistance for 3 or 4 activities and those living in Quebec and British Columbia are most likely to have unmet needs.

This study examined hope in long-term care residents with cancer from the perspectives of both residents and health care providers (HCPs). Clinical data established that the prevalence of a cancer diagnosis in the study facility (15%) was similar to other estimates in the literature. Eight experienced HCPs were interviewed. Ten residents with a cancer diagnosis were interviewed, and they completed the Herth Hope Index (HHI). Dimensions of hope and contextual factors that shape hope emerged as themes for both HCPs and residents, but reflected their different perspectives. HCPs identified hope as integral to care. HHI scores were high, indicating residents were generally hopeful. The study findings suggest that for the small but complex subgroup of long-term care (LTC) residents who have a diagnosis of cancer, hope is not lost, but rather it is relevant, nuanced, and possible to attain.

Early detection of dementia is essential to guide front-line health care practitioners in further clinical evaluations and treatments. There is a paucity of literature assessing the effectiveness of screening tools to predict the development of dementia, thus we conducted a systematic review to fill this gap. The purpose of the systematic review was to make recommendations to health care practitioners on which screening tool best predicts the development of dementia and is most feasible in the primary care setting. Ten databases were searched for relevant articles, yielding 751 papers. Of these, 12 met relevance criteria for inclusion. Screening tools were assessed for test accuracy, cognitive domain coverage, predictive ability, and feasibility. Four screening tools were recommended. Addenbrooke’s Cognitive Examination (ACE) was considered to be the ideal tool. A revised version of this tool is now used in clinical practice but the psychometric properties of the ACE-R remain to be established.

ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Osteoarthritis (OA) in older adults is a prevalent chronic condition associated with substantial pain and disability. Oral analgesic use is a central component of symptom management. Medication use in this population, however, is complex and must balance the need for symptom control with drug safety concerns. Our study focus was to illustrate and discuss the variability in the medications used to manage OA-related symptoms. We analysed data from a sample of community-dwelling persons aged 55 and older with hip or knee arthritis to examine social and medical factors associated with reported variation in OA drugs. A key finding is that drug types used by OA patients vary by age and gender, independent of disease, and medical and social context. Possible explanations related to patient and professional preferences are considered.

Ready-to-use modified-texture food (rMTF) products are commercially available and may have greater appeal than conventional in-house or commercial bulk modified-texture food (cMTF) products. A nine-month pilot study using a prospective interrupted time-series design where participants (n = 42) served as their own controls investigated the impact of cMTF + rMTF on weight goals, weight, food intake, and co-morbidity. Seventy-four per cent of participants achieved their weight goals at the end of six months on rMTF and, although insignificant, participants did have a trend towards weight gain while on rMTF (OR 3.5 p = .16). Main-plate food intake (grams) was not significantly different over time, but a downwards trajectory suggests decreased consumption that was compensated for by a significantly higher fat intake during the intervention period (p = .01). Increased co-morbidity and a decreasing volume of food consumed are common in older adults with dysphagia, and enhanced food products are needed to meet nutrient needs. Methodological issues encountered in this study can provide guidance for future work.

This study examined the relationship between medical advice to engage in physical activity with type of demand required by physical activity and demographic variables. A cross-sectional study was developed, featuring a questionnaire on physicians’ advice, and type of demand. The questionnaire was completed by a probability and nationwide sample of older adults in Spain (n = 933, M = 74.1, range 65–93), randomly selected using multistage sampling. More physically active older adults have, more often than the less active, received physicians’ advice to engage in physical activity. There is a significant relationship between medical advice and type of demand (p < .01) and age (p < .05). However, no relationship was found between physician medical advice and gender, social class, or income. Physicians can effectively promote physical activity among sedentary older adults through appropriate advice. Consequently, health authorities should promote physicians’ advising older patients to pursue physical activity.

Non-institutionalized dependent older adults present high morbidity and mortality, demand care from their families, and consume primary health care resources. To expand knowledge about this group, we conducted a population-based one-year prospective cohort study of 130 non-institutionalized dependent older persons (age 60 and older), stratified according to baseline mobility: independent walking (group A), use of walking aids (group B), and bedridden or confined to a wheelchair (group C). The outcomes analysed were death, hospitalization, and mobility disability. Total mortality was 8.5 per cent (p = .05). Overall hospitalization rate was 34.6 per cent; the main causes were stroke and pneumonia. After one year, there was a decline in the proportion of subjects classified as independent walking (57% vs. 43%; p = .03). We conclude that there was a high rate of mortality and hospitalization in this group of dependent older people, and an increase in disability after a one-year follow-up.