Sixty-five has long been used to define the beginning of “old age”. Yet it is clear that the definition is arbitrary, and with continuing reductions in mortality and morbidity rates it will become increasingly inappropriate as time passes. We consider how the definition might be modified to reflect changes in life table probabilities, and how the future numbers and proportions in “old age” would be affected. In a similar manner, we consider also the redefinition of the “oldest old” from a current definition of 85 and over.

This article discusses a longitudinal study of caregivers (n = 195) from a representative sample of caregivers pf Spanish, ADL-disabled persons, aged 65 and over carried out to assess the role of social support and religiosity in the development of depression. Depressive symptomatology was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. One year later, 119 of the caregivers were contacted again. Stability of depression over 1 year was observed in most participants. Poor physical health and low self-esteem, as well as incontinence in the care recipients, were significant predictors of the development of depressive symptoms. Social support had a differential effect on the development of depression, depending on how much assistance with activities of daily living the caregivers had to provide. Religiosity seemed to have no effect. Depression in caregivers is related more to their health and psychosocial resources than to the amount of care they provide. Poor health status, low self-esteem, and lack of emotional support may be useful indicators in identifying caregivers at high risk for depression.

With a view to reducing the exhaustion experienced by informal caregivers and thus encourage the frail elderly to remain at home, a new free respite care program, which offers to house the frail elderly one week per month, was evaluated using an array of multiple cases. Ajzen and Madden's (1986) theory of reasoned action was used as a model to explain the effect of the program on the caregivers' intention to resort to permanent accommodation. Fourteen informal caregivers took part in the program evaluation process. An analysis of the reports of the meetings of the program's Implementation Committee revealed that human and material resources had been used as established in the initial plan. Seven subjects completed the 12 months planned for evaluating the program and were able to continue with the program thereafter. An analysis of the data, using graphic representations and pre-experimental and experimental phase medians, did not reveal any decrease in the perceived burden and in the intention to resort to accommodation in subjects who had completed the program evaluation process. Those who dropped out did so in part because of the high level of perceived burden and the caregivers' intention to resort to accommodation prior to entering the program. Unstructured telephone interviews with the caregivers suggest, moreover, that an elderly person's loss of autonomy, a good financial situation, and the caregiver's decreased feeling of guilt at the idea of housing his/her relative are important determining factors in the caregiver's decision to use permanent accommodation.

The goodness-of-fit hypothesis contends that distress results due to incongruence between choice of coping strategies and perceived ability to change stressful stimuli. Goal-directed or active coping responses are believed to be most efficacious when the individual believes s/he can change or control perceived threats (i.e., problem-focused coping). Instances in which stressors must be accepted, however, would dictate reliance upon strategies to regulate distress (i.e., emotion-focused coping). Inconsistent support for this facet of Lazarus and Folkman's cognitive phenomenological model was obtained in this study of spouses of suspected dementia patients. The distinction between emotion- and problem-focused coping appears less germane than overall coping efforts relative to perceived control and caregiver burden. In addition, perceived ability to control dementia-related stressors appears to be somewhat independent of coping by caregivers. These findings are discussed in terms of the unique and chronic demands faced by spouses of persons with dementia.

Until now, family caregivers have been involved very little in the processes of assessing the quality of care delivered to a hospitalized relative. This study is the second phase of a broader research project whose aim is to develop measurement scales intended for elderly patients and their caregivers on their perceptions of the quality of services delivered in Geriatric Assessment Units. More specifically, the goal of this phase of the research is to document the criteria that caregivers use to judge the quality of these services: these criteria should constitute the content of the measurement scale that is intended for them. Four focus groups, bringing together 21 caregivers, allowed for the identification of 31 criteria of quality. These criteria have been classified according to six dimensions of quality: information, communication, attitude of staff, technical quality, continuity, and physical resources. The study highlights the dual concerns of participants: the well-being of the patient and support for caregivers. It shows that caregivers consider themselves to be clients of geriatric services.

Drawing on a qualitative study of families' experience with Alzheimer's disease, this paper examines family members' reaction to identity transformation or loss of self in the afflicted loved one, using a symbolic interactionist perspective. The findings show that family members find this aspect of the disease emotionally stressful. Refusing to let go of what remains of the loved one's former self, they employ a number of strategies in an effort to protect her/his social and self-identity. These strategies include concealing information, medicalizing inappropriate behaviour, fostering independence, managing appearance, and perceiving selectively.

Specially designed outdoor spaces (SDOS) have been developed to improve the quality of life of people with dementia. However, few follow-up studies have been done to examine their use once implemented. The purpose of this study was to gain a better understanding of how SDOS are used and the objectives of their design fulfilled. A qualitative descriptive study was conducted of a SDOS 3 years after it was built to answer the following questions: How has the garden changed from the original design? What are the current patterns of use of the garden? What factors facilitate use of the garden? What are the barriers to use of the garden? Four main sources of data were used: landscape architectural drawings, non-participant observation, focus groups, and in-depth interviews. The results lend support to the theoretical principles of garden design in the literature. The garden was considered an important part of the service program. However, factors such as garden maintenance, organizational support, staff training, and accessibility may limit its impact.

Using data from 96 hours of semi-structured interviews with women aged 61 to 92, this paper explores the meanings that older women attribute to beauty and aging. The women in my study tend to equate physical attractiveness with youthfulness and slimness. However, they reject the extremes of thinness embodied in today's fashion models and actresses. Even as they disparage obese individuals, the women argue that thin older women appear scrawny. The women express a preference for more rounded female bodies than current beauty standards allow and emphasize the importance of inner beauty. While some women view their wrinkles negatively, others suggest that their facial creases are badges of honour. I argue that older women do not simply internalize beauty ideals to the detriment of their sense of self. Rather, older women resist and challenge current ideals of feminine attractiveness and suggest alternative beauty ideals and definitions of personal desirability.

This article discusses qualitative research conducted in minority Francophone communites in Ontario. The perceptions of and participation in physical activity by some thirty women are analysed with respect to sociological foundations and current views on aging. These views apply to individual responsibility for health; to the links between health, beauty, and aging; to participation in sports; to perceptions of masculinity and femininity; and, finally, to the obligation to remain physically active at all stages of life. The results of the study among women grouped into three age brackets reveal that, although these women have adopted a view of individual responsibility for health and the prevention of the harmful effects of aging through regular physical exercise, they may also be seen as subjects who find strategies in their daily lives to avoid falling prey to the pressures of health and beauty standards regarding aging, to face limitations, and to develop a healthy way of experiencing the aging process.

As the demand for home care services increases, health care agencies should be able to predict the intake capacity of community-based long-term care (CBLTC) programs. Two hundred and thirty-seven clients entering a CBLTC program were assessed for activities of daily living (ADL) and cognitive and affective functioning and were then followed to monitor attrition and reasons why clients left the program. Compromised ADL functioning at baseline increased likelihood of death and institutionalization by 2 per cent each year. Over a 10-year period, reduced cognitive functioning at baseline increased the risk of death by 9 per cent and decreased the likelihood of leaving the program due to improvement by 18 per cent. Reduced affective functioning at baseline increased the risk of institutionalization during the course of the study by 3 per cent. Routine functional assessments with the elderly may help in the management of similar home care programs.

This book is based on a doctoral thesis (itself comprised of four published articles and a conclusion) defended by Mario Paquet in 1998. The subject is the reluctance (réticence) of caregivers to use formal support services. The value of this book lies in its elucidating the challenge faced by professionals as they try to comprehend family dynamics from the standpoint of caregivers rather than from their own institutional perspective. Despite this positive contribution, the book has two major limitations. The first concerns the methodology chosen for examining family dynamics. Although the author situates himself within the paradigm of the actor and a constructivist epistemology, for less than convincing reasons, the majority of the data is derived from interviews with key informants (e.g., professionals) rather than with caregivers themselves. The author is thus compelled to discern the logic of one actor vis-à-vis another from the perspective of the latter. The second reservation pertains to use of the term ‘réticence’ to describe the hesitancy of caregivers to use formal services. To conceptualize non-use as réticence, which must be overcome to prevent caregiver burnout, reflects the perspective of professional service providers. This book may be of interest to newcomers to the field of caregiving but of less interest to those familiar with the literature in this area.