Provincial government drug plans are the primary source of insurance for drugs taken by seniors in outpatient settings. The adequacy of this coverage has been called into question, given the increased clinical importance of pharma-ceuticals, shifts in the provision of health care from inpatient to outpatient settings, increased use of restrictive formularies, and reductions in provincial drug subsidies. To assess the adequacy of provincial coverage, we estimated what a typical single senior beneficiary of a provincial drug plan paid out-of-pocket in 1998 on prescription drugs covered by the public program, depending on his/her province of residence, level of drug consumption, and income. We compared provincial coverage for seniors with large drug costs. We also assessed provincial coverage of drugs that were introduced into the Canadian market between 1991 and 1998. The cost of drugs consumed by a senior in a given province and year was estimated by multiplying the average number of prescription drugs consumed by senior drug users by the average per-prescription costs. High drug consumption was defined as twice the average. We used the provincial drug cost sharing rules to estimate the senior's share of the total cost of drugs consumed. Mean out-of-pocket costs range from $42 to $1,302 per year, are lower for lower-income seniors, and increase with drug use, although the charge per drug decreases with the number used. There was up to a 12-fold variation among the provinces in the charges faced by seniors with similar incomes and drug use. All but one province limits costs to seniors with catastrophic drug costs, but there was 21-fold variation in the expenditure limits. The substantial variation in seniors' out-of-pocket drug costs raises questions about the distributive equity of drug subsidies in Canada. Recent evidence on the deleterious health effects of drug charges faced by seniors in Quebec and the fact that seniors in some other provinces face direct charges similar to those faced in Quebec raise the possibility of adverse consequences of drug charges in other provinces.

The transition from employment to retirement is changing dramatically in Canada and other industrialized societies, with a decreasing proportion of working life being spent in stable career progression. This study used a sample of 2,592 subjects, aged 45 to 64, from the 1994 General Social Survey of Canada (GSS): Cycle 9, to describe situations of later-life career disruption (LLCD) in older workers in Canada and to investigate the association between LLCD and self-rated health. Results showed that a large proportion of older Canadian workers had experienced such LLCD as job interruption and job loss. Experience of job loss and job interruption over the prior 5-year period was found to be significantly associated with poor self-rated health, after controlling for age, education, body mass index, and activity limitation. However, after excluding respondents whose LLCD was known to be due to poor health, job interruption and job loss were separately found not to be significantly associated with poor health. The complexity of the findings and the direction of causation between LLCD and self-rated health, as well as some methodology issues, are discussed. Areas of future research are indicated.

This paper argues that fear of aging can more precisely be recognized as a fear of disability and that fear of disability can be centrally understood as a fear of dependence. Accordingly, we are not likely to see old people being treated as important members of society until we see a change in attitudes towards disability. The argument is developed with reference to a consideration of attitudes toward and treatment of elders and people with disabilities, a consideration of the social construction of dependency, and an examination of statistics on the Canadian population of people with disabilities. The ubiquity of disability across all age groups means that there needs to be a re-conceptualization of disability as part of the human experience.

This paper provides an exploratory analysis of ethnocultural diversity and intergenerational support, examining factors that shape the attitudes of young adults toward sharing a home with an elderly parent. Data are drawn from a random sample of 565 young adults aged 19 to 35 living in the Greater Vancouver Regional District, whose primary ethnic identity is as members of one of three groups: British-, Chinese-, and Indo-Canadian. Utilizing a comparative, cross-cultural approach and logistic regression procedures, the study found the likelihood of young adults' expressing favourable attitudes to caregiving to be influenced by several factors associated with collectivistic systems of caregiving. Noteworthy is the finding that, after controlling for ethnocultural and socio-demographic factors, the best predictor of co-residence attitudes is the quality of a child's relationship with her/his mother. Findings are discussed with regard to their implications for intergenerational relations and support for aging families.

The purpose of this research was to study the influence of spousal support in the pursuit of retirement goals on retirement satisfaction and marital satisfaction. The 100 retirees had to evaluate the support they received from their spouse for the realization of their personal projects. Regression analyses demonstrated that availability of spousal support, capacity to realize one's projects and spousal support to these projects accounted for 36% of the variance of retirement satisfaction and for 71% of the variance of marital satisfaction. Spousal support in the realization of retirement projects is an important element to consider in the evaluation of retirement and marital satisfaction.

This paper presents psychometric data on a new, three-dimensional measure of self-efficacy for caregivers of older adults. Based on a sample of family caregivers of persons with dementia and a longitudinal study design (Time 1: N = 134; Time 2: N = 103), the RIS Eldercare Self-Efficacy Scale assesses relational self-efficacy, instrumental self-efficacy, and self-soothing efficacy. These three dimensions show strong internal consistency and moderate test-retest reliability. Their construct validity is demonstrated by their zero-order correlations with a set of standardized indicators of the caregivers' health and morale, personality characteristics, and personal resources. Multivariate analyses suggest that the three dimensions are more strongly trait- than state-linked. Use of this measure as a clinical screening tool and in intervention research is discussed.

The goal of this study is to describe gender-specific care situations based on interviews and case studies with key caregivers. Eight main themes emerged; namely, the action of taking a certain degree of additional responsibility, the perception of the process of illness, the care received from the formal and informal networks, the effects of assuming care on the male or female caregiver's social life, the quality of care given, the caregiver's own health, the costs associated with caregiving and the survival strategies adopted by male and female caregivers. Recommendations were proposed by interviewees and the findings point to the conclusion that changes to the health and social services network have affected women and men informal caregivers. Women enjoyed limited informal support, and it would appear that informal caregiving has consequences that affect the health, mental well-being, social life, and economic autonomy of women. These case studies will contribute to a systematic gender-based analysis during the development of programs and policies directed towards formal and informal caregivers.

While there are 157,000 designated continuing care (CC) beds in Canada – beds that are only used by a rather distinct group of individuals – no comprehensive description of the CC resident population exists. An analysis of 1974–1997 Statistics Canada mortality data and 1992/93–1996/97 Alberta hospital utilization data was undertaken to provide a description of one segment of this population, those at the end of life. Statistics Canada data indicate that only a small (<3%) proportion of deaths take place each year in CC facilities, with these persons 84.5 years of age on average, and most often female (62.5%), widowed (61.9%), and Canadian born (61.8%). The primary cause of death/diagnosis varied considerably, as it did for CC residents in Alberta who were transferred to acute care hospitals before dying there. The average hospital stay for transferred persons was 14.0 days in length, with these hospitalizations normally characterized by few diagnostic tests or treatments (mean=0.9).