Although many studies have been published over the past ten years on informal support of dependent elderly, few, if any, have examined the reticence of their caregivers to use formal support services. Further understanding of this phenomenon is required, for it questions the feasability of preventive measures for this population as well as the relationship between formal and informal support systems, considered optimal by government in their efforts to rationalize today's health care services. This article presents a conceptual framework enabling us to better understand the reasons why caregivers of the elderly seldom use formal support services, and discusses health, social and research implications.

This paper presents the results of a study on the relationships between social participation and use of services. The hypotheses predicted that members of groups with high degrees of participation, cohesion, or participation and cohesion are likely to behave in a more homogeneous manner toward the use of services than members of groups having the opposite characteristics. The hypotheses were tested by doing multiple regressions on the number of service agencies contacted, preventive medical consultations and curative medical consultations. One of the hypotheses was corroborated by a major finding: being a member of a group with a high degree of participation and a high degree of cohesion remains positively correlated to curative medical consultations even when control variables like psychological well-being and perceived health have been considered. This result suggests that it could be possible to influence the use of services by older persons who are members of peer groups in dealing with the internal dynamics of these groups.

This article focusses on the likelihood of senior centre participation, the frequency of attendance among participants, changes in use/non-use over a four-year period, and associated characteristics. The data are from a longitudinal study conducted in Winnipeg and eight smaller Manitoba communities, with 1,399 individuals aged 65 and older interviewed in 1991/92 and 956 re-interviewed in 1995. About one in five individuals attended a senior centre in the six months prior to the interview, with a wide range among participants in the number of visits. Only 8 per cent joined a senior centre and 13 per cent ceased their participation over the four years. The influence of socio-demographic characteristics, health status, and social integration varied depending on the measure of participation and according to place of residence. Social factors, such as living arrangement, tended to be more important than health status. Directions for future research are discussed.

Administrative home care data from the Manitoba Support Services Payroll (MSSP) system for fiscal years 1995/1996 to 1998/1999 were utilized to study home care client characteristics and changes in home care use over time. Patterns in home care access and use after hospitalization, before admission to a nursing home, and before death were examined. The study found that the majority of home care clients were female, aged 65 and over, and not married. The proportion of Manitobans using home care increased slowly, but significantly, over the 4 years. The greatest increases were found among the older age groups. The average number of days that clients received home care before death or before admission to a nursing home was stable over time, while a significant increase over time in home care use after hospitalization was experienced. These findings can be useful to regional health authorities for planning and budgeting.

Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined 4.8 per cent, and specialist-to-population ratios declined 10.0 per cent. Among the general population, FP visit rates declined 3 per cent. Among older adults, physician visit rates increased 2.3 per cent, FP visit rates increased 10.9 per cent, and specialist visit rates declined 15.7 per cent. By comparison, we document declines in FP use by those younger than 5 years (25.5%) and those 6 to 19 years of age (18.6%). Increases in FP and declines in specialist use occurred primarily among those aged 65 to 84 years. By 2000/2001 older adults accounted for 25 per cent of all FP encounters. Gains in FP use among older adults was less attributable to the presence of more seniors and more related to the fact that a higher proportion of them are visiting a FP each year and, potentially, substituting primary for secondary care.

Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP-to-population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the volume of care received and provided over the period, contribute to this paradox. Given the relationship between age and FP use in fiscal year 1991/1992, an aging population should have been associated with a 2 per cent increase in visits by 2000/2001. Likewise, given the relationship between FP age and workloads in 1991/1992, an aging workforce should have been associated with a 12 per cent increase in service provision a decade later. Yet visit rates and average FP workloads remained unchanged. There was an increase in age-specific rates of FP use among older adults and a decline in rates among the young, and an increase in age-specific workloads such that older FPs provided many more services than their predecessors (30%) and younger FPs provided many fewer (20%). In terms of impact on future requirements for FPs, both changes in age-specific rates of use, and changes in age-specific patterns of FP productivity, trump population aging as key drivers.