A provincial survey was undertaken in Ontario, Canada concerning the prevalence of the use of practice guidelines in chronic care and long-term care facilities and the opinions of staff about the clinical conditions or problems important for developing clinical practice guidelines and the factors that promote change in clinical practice. Five hundred and fifty surveys were sent out and 306 returned from two mailings. Forty per cent of the facilities were aware of evidence-based guidelines while only 21.6 per cent were using them. They were being used most in government-funded agencies, then in acute care facilities with chronic care beds and nursing homes and least in non-government funded agencies. The clinical problems which agencies felt were important for guideline development were behavioural problems, continence, feeding problems and problems with skin care. The results of this survey have implications for funding of these institutions as well as for identifying the situations where evidence is needed for future care and where it is presently available but not being utilized and understanding the reasons for this approach to practice.

Ensuring the delivery of comprehensive, high quality programs and services to seniors in Canada over the coming decades presents a significant challenge to policy makers and health care professionals. The goal of this study was to provide decision-makers with data on recent trends in the utilization of health services by seniors in Alberta. We compared recent trends in the utilization of acute hospital services (1992/93–1997/98), home care services (1994/95–1997/98), claims for physician consultations and procedures (1995/96–1997/98) and long-term facility care (1990–1996) for Albertans less than and over 65 years of age. We also assessed trends in the use of prescription drugs (1992/93–1997–98) by Albertans 65 years and older. Data for these analyses were obtained from Alberta Health and Wellness administrative databases and reports. Overall, the trends indicate fewer, though sicker, patients being cared for in institutions and more patients being cared for in the community. The receipt of prescription drugs obtained outside of facilities has also increased among seniors in recent years. The extent and appropriateness of substitution of community care for institutional care, the quality of that care, and whether health outcomes are better, worse, or unchanged, are important subjects for further study.

New approaches to residential continuing care for frail seniors include a shift toward more social care models that involve hiring multiskilled workers and expectations of family involvement as partners in care. Recall and stylized time-use methods were used to assess the types of tasks and amounts of service provided by family and staff caregivers in three models of care. Findings are that family members provide about 30 per cent of on-site services to residents. Family members spend most time in enhancing well-being, while staff spend most time in housework. Patterns of care differ across Adult Family Living, Assisted Living and Dementia Care settings. Sustainability of these patterns of care depends upon adequacy of staffing and reasonable expectations about family resources.

Échantillonnage des ménages de l'Ontario de la section de la santé de l'Enquête nationale sur la santé de la population de 1994–1995 a été relié à la base de données du Ontario Home Care Administrative System et l'on a exploré la relation entre les réponses des personnes interrogées et l'utilisation des soins à domicile dans les années qui ont suivi l'enquête dans le but d'évaluer les variables prédictives des soins à domicile. La prévalence de l'utilisation des soins à domicile chez les sujets de l'enquète s'élevait à 4,3 pour cent. Les facteur indépendants associés à une augmentation probable des soins à domicile étaient un age de 75 et plus, une contrainte des activités quotidiennes (AVQ) et des activités instrumentales de la vie quotidienne (AIVQ), une détérioration de la santé et l'utilisation antérieure de soins à domicile. Il faudra approfondir les travaux pour mieux comprendre les facteurs associés à l'utilisation des soins à domicile si l'on souhaite mieux définir le but et les objectifs des soins à domicile et contribuer à l'élaboration de modèles de financement de ces soins.

This study explored the determinants of self-rated health and happiness for elderly, institutionalized Canadians in the 1994/95 National Population Health Survey: Health Institutions. Separate ordinal logistic regression models were developed for self-rated health and happiness in a subsample of 780 elderly residents. The results indicate that older Canadians in institutions vary in their ratings of their health and happiness, and that demographic characteristics, illness-related factors, disability and social integration predict these variations. Both self-rated good health and happiness were consistently associated with being older, having fewer chronic diseases, fewer perceived memory difficulties and less pain. Whereas good health was associated with higher education and independence in ambulation, happiness was associated with greater grasping ability, more frequent attendance at group activities in the institution and the community and having a flexible schedule. These findings have important implications since many of the factors identified are potentially modifiable through rehabilitative and nursing interventions.

À l'aide de données provenant d'une cohorte de 1 352 personnes àgées demeurant dans la communauté et ayant visité l'urgence d'un centre hospitalier, nous avons étudié la prévalence (avant la visite à l'urgence) et l'incidence (pendant une période de suivi de six mois) de l'utilisation des services communautaires de santé ainsi que les facteurs reliés à l'utilisation de ces services. Les données ont été recueillies lors d'entrevues à l'urgence et au téléphone lors du suivi. Avant la visite à l'urgence, 59,8 pour cent des patients avaient au moins une incapacité en regard aux activités de la vie quotidienne (AVQ); 16,8 pour cent des patients ayant une incapacité recevaient des services communautaires. Parmi les patients qui ne recevaient pas ces services auparavant, 45,4 pour cent ont développé une nouvelle incapacité pour les AVQ pendant les trois mois suivant la visite à l'urgence; et 23,5 pour cent des patients avec une nouvelle incapacité ont commencé à recevoir des services communautaires. En contrôlant pour l'ampleur des besoms, les patients admis à l'hôpital se sont avérés être plus susceptibles de recevoir des services pendant la période de suivi que ceux ayant reçu leur congé de l'urgence. Il existe probablement de nombreux besoins non comblés pour les services communautaires dans cette population.

The growing population of seniors with disabilities experiences unmet support needs and loneliness. Although support deficiencies can be overcome by peers in support groups, most support groups are inaccessible to older adults with limited physical functioning. Accordingly, this project aimed to develop and test the impact of an accessible telephone support group intervention for seniors with disabilities. Six research questions guided the study. Four telephone support groups with five to six participants (n = 23) were created, each with a professional and a peer (senior) leader. The groups met once a week for 12 weeks. Qualitative analyses of the telephone transcripts and post-intervention interviews of participants and leaders revealed decreased support needs, diminished loneliness, and enhanced coping. Selection, training, and support of peer and professional leaders and member control of discussions were important ingredients of successful support groups.

Agitation in older persons is a major problem for the agitated individual and those around him/her. French-language measures of agitation with demonstrated validity and reliability are necessary for research and interventions in the French-speaking community. The goal of this study is to verify the reliability and validity of the “Inventaire d'agitation de Cohen-Mansfield” (IACM), a French version of the Cohen-Mansfield Agitation Inventory. The IACM measures the frequency of 29 agitated behaviours during a two-week period. Ninety-nine residents of a long-term care facility participated in this study. Results demonstrate the inter-rater reliability (r = .72), test-retest reliability (r = .72), internal consistency (Cronbach's alpha from .75 to .77), concurrent validity (r = .74) and construct validity (all r are significant, p < .05) of the IACM.

The purpose of this study was to establish the reliability and construct validity of the Consultation Expectations Scale for caregivers of elderly persons on the basis of Gerald Caplan's mental health consultation model. The reliability was determined by the Cronbach alpha coefficient ranging from .89 to .95 and the item-total correlation varying between .63 and .75. The content validity was demonstrated by an intra-class coefficient of .92 on all items evaluated by the judges. The internal consistency was determined by the correlations between the global scale and the subscales ranging from .67 to .91. The convergent validity relied on the positive and moderate correlations between the consultation expectations on the one hand and the need for support and psychological distress on the other. This scale demonstrated good psychometric qualities. Its utilisation should permit the consultants to keep the caregivers' point of view in mind, which will enable them to become more effective in their work.

This article is about the life story of a woman who has had a career as caregiver for 25 years. Its purpose is to present the main characteristics of her career as a support person who, since the beginning, has struggled every day to find ingenious ways to meet the challenges of caring for a dependent husband. A daily struggle in which love, learning and public, social and family solidarities all come together. Who is this woman? What motivated her to embark on a career as a caregiver? What does the reality of her many learning experiences reveal? What is her attitude towards the support she receives? These are some of the questions raised in this article. Beyond the answers it may provide, it sheds light on the experience and daily management of caregiving. At the same time, it contributes to a better understanding of the family logic of caring for a dependent person.

Anthropometric indices are commonly used in the assessment of nutritional status. This study examined data from elderly Canadian participants in the first phase of the Canadian Study of Health and Aging (CSHA-1). Height and weight were measured in 1,464 community-based individuals and 963 persons in institutions. Institution-dwelling participants weighed less than community-based participants (59.1 ± 13.8 kg. vs. 65.1 ± 14.1 kg.), were shorter (160.4 ± 10.1 cm vs. 162.6 ± 10 cm), and had lower body mass indices (BMIs) (23.3 ± 5.0 vs. 24.6 ± 4.5) (p < .001). Values were lower among women than men, and decreased progressively with age. Quebecers were shorter, with lower body weights compared to Canadians living elsewhere. Anthropometric indices declined by cognitive diagnosis, from normal, to “cognitively impaired, not demented” (CIND), to with dementia; participants with Alzheimer's dementia had the lowest body weights. Correlates of body weight differed for community and institution participants.

As the number of older adults residing in continuing care facilities increases, mental health professionals will provide more services and conduct more research in this setting. Mental health professionals working with continuing care residents will find themselves regularly challenged by ethical issues, particularly obtaining informed consent. Characteristics of the continuing care setting and residents make obtaining informed consent especially challenging. Mental health professionals must overcome these challenges in order to fulfill the following three requirements of informed consent: (1) the client is competent, (2) the client is provided with sufficient information, and (3) the client has not been coerced and/or the consent is voluntary. This article will examine the issues surrounding the fulfillment of these requirements in a continuing care facility, and will provide suggestions and guidelines that mental health professionals can utilize during the informed consent process.

This article is an essay, based on the attempted assessment ofresearch in the social sciences on aging in Canada and in Quebec during the last 20 years. It endeavours o t understand this area as based on institutional factors, including linguistic, cultural and political divisions between English Canada and Quebec, and the role of some major forces. Canadian research on aging is profoundly based on a social democratic vision of the role of the State that establishes the basic concept of citizenship, rights, liberties, justice and equality. It consequently contributes to maintaining the protective, redistributive, regulatory andcorrection ofinequalities that the State carries out through its social and fiscal policies. In the space of 20 years, the social sciences of aging in Canada have gone from a representation of aging characterized by decline, unavoidable physical and often psychic deterioration of capacities, impoverishment, and exclusion to a much more qualified vision of aging distinguished by the search for autonomy, adaptation, and growth in which seniors do not succumb passively to their condition but rather become responsible for their own development. At the same time, researchers, as well as experts and decision makers in the area ofaging, have turned progressively from an analysis of aging centred on social problems and the programs aimed to meet these problems, which encouraged the development of the state as provider, to an analysis of the forces and resources which seniors have or could obtain to rekindle family or community solidarities with the goal of maximum promotion of the autonomy of older persons.

Cataract surgery is one of the most frequent surgical procedures experienced by seniors. In Canada, substantial waiting lists for cataract surgery are common. This study systematically studied anxiety among older persons who were waiting for cataract surgery, and factors that may underlie anxiety in this population. Factors examined in relation to anxiety were age, sex, education, medical and ocular problems, previous cataract surgery, concern about wait, previous decisions to delay surgery, length of wait, visual functioning, visual acuity, worry about health, and coping strategies. A random sample (n = 50) of patients on a waiting list for cataract surgery took part in telephone interviews. Patients' ophthalmologists provided preoperative visual acuity. Over one-third of patients reported anxiety within the range reported for panic disorder patients and Beck Anxiety Inventory scores were well above reported norms for seniors. Increased anxiety was found among those with a general tendency to worry about their health, poorer visual functioning, and greater use of palliative coping strategies. The clinical implications of the findings are discussed. The results highlight the importance of assessing anxiety while elderly patients wait for surgery, designing interventions, and providing assistance to those patients found to have elevated levels of anxiety.

Les données sur l'utilisation des médecins de famille par les personnes âgées (65 ans et plus) de l'Enquête sur la santé en Ontario (1990) nous ont permis d'examiner les variables prédictives de leur utilisation selon les groupes d'âge et le sexe. À l'instar des études antérieures, les variables prédictives les plus importantes étaient le nombre de problèmes de santé et la perception de l'état de santé. Toutefois, en dépit des efforts en vue d'améliorer la force prédictive du modèle de comportement Andersen-Newman, ces variables n'ont expliqué que 29 pour cent de la variation de l'utilisation des médecins de famille lorsque le modèle a été appliqué aux personnes âgées interrogées dans le cadre de cette enquête. En outre, le niveau de variation expliqué est demeuré relativement bas lorsque des analyses ont été effectuées selon les groupes d'âge et le sexe. Bien que ce modèle de comportement soit le cadre conceptuel le plus fréquemment utilisé, la présente étude suggère qu'il n'est peut-être pas le plus approprié pour l'examen de l'utilisation des médecins de famille par les personnes âgées au Canada.

This research pertained to personal goals during retirement and especially to the influence of tenacity and flexibility on measures of psychological well-being. The participants (N = 147) had been retired for less than three years and were aged between 49 and 75 years (M = 58 years). The participants had to identify four personal goals and rate each of them along 15 dimensions. Psychological well-being was evaluated with scales of depression, self-esteem and life satisfaction. Regression analyses showed that flexibility in the presence of obstacles to the realization of goals accounts for 44 per cent of the variance in depression, 29 per cent of life satisfaction and 25 per cent of self-esteem. Tenacity had a more modest impact. Flexibility seems to be the strategy which is most useful in facing difficulties in the pursuit of goals during retirement.

In July 1996, major floods destroyed several houses occupied by pre-retirees (ages 50–59) and retirees (ages 60 and over). Faced with the task of relocating and rebuilding a new home, several of those older adults lived through difficult post-traumatic adaptation periods. The data collected during in-depth interviews with 31 aging people clearly show that the biopsychosocial health of pre-retirees and retirees, as well as their conception of home were greatly disturbed. The floods also had significant consequences on their behaviour, character and beliefs. A list of recommendations from the victims interviewed to individuals, workers and different government departments shows the need to take into account the emotional distress of victims in implementing emergency measures.