Older adults are the largest group of wheelchair users yet there are no peer-reviewed studies on the national profile of older wheelchair users in Canada. We investigated the characteristics of wheelchair users in a national sample of community-dwelling older adults from the Canadian Study of Health and Aging (CSHA-2). Questions on the use of assistive technology were asked of 5395 Canadians (over 64), and 4.6 per cent reported using a wheelchair. Logistic regression was used to model the factors associated with wheelchair use. Controlling for age, gender, and cognitive impairment, older adults who reported greater dependence in basic self-care and instrumental activities of daily living were more likely to use a wheelchair. However, the effects of self-care dependence on wheelchair use varied by gender, with men more likely than women to use wheelchairs with increasing self-care dependence. The number of chronic health conditions and being unmarried also increased the odds of wheelchair use. This paper quantifies the risk of wheelchair use according to critical factors that can be used to project use and plan for services.

The data reported in this paper were collected as part of the Canadian Study of Health and Aging. The core study was funded by the Seniors' Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC[S]). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417–302[R]), Bayer Incorporated, and the British Columbia Health Research Foundation (projects no. 38[93-2] and no. 34[96-1]). The study was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada. Additional funds for the preparation of this manuscript were made available from the Opportunities Fund of the M-THAC Research Unit (from Medicare to Home and Community) at the University of Toronto, and from a post-doctoral fellowship awarded to the first author by the Social Sciences and Humanities Research Council of Canada.

While there is growing evidence of the increasing use of medicines by the elderly, research undertaken to critically examine differences among types of medicine users in this population is limited. Using population data, we examine the influence of social, demographic, and health-related factors on likelihood of being a non-user, a user of non-prescribed medicines only, or a user of prescription medicines only. We find some evidence of the rational use of drugs (i.e., those who are in better health are more likely to be non-users or to use non-prescribed medicines than those who are in poor health) and of rational explanations for reported use (i.e., being female is associated with less likelihood of non-use or exclusive use of non-prescription medicines than being male). Further analysis of the medicine-use patterns and decisions of elderly men and of those of elderly persons who are widowed or separated/divorced is warranted.

Previous studies report geographic variation in the use of home care services. In the province of Manitoba, home care is a core service that Manitoba' twelve regional health authorities (RHAs) are obligated to deliver. Manitoba' RHAs range from remote northern and rural southern regions to a major city, resulting in different challenges for delivering home care. Given this potential for inconsistent delivery and the previous findings of regional variation in other settings, the objective of this study was to measure and assess variation in the use of home care across Manitoba' RHAs. We used data from the Provincial Home Care Program' client registry, other health care administrative databases, and Vital Statistics. Home care use was measured using multiple indicators, including rates of population use, use after hospitalization, before entry to a long-term care facility, and before death. While some important differences emerged, overall we found comparable use of home care across Manitoba.

Evidence suggests that frailer older patients benefit from a continuum of care rather than the admit/discharge model of our health system. This study examined patient outcomes after discharge from a geriatric day hospital (GDH) to determine what proportion continues to do well, what proportion declines, how the two groups differ, and if factors predictive of deterioration can be identified. Using telephone survey and Goal Attainment Scaling methodologies, the goals of 151 patients discharged from a GDH between 6 and 18 months previously were examined to determine whether GDH achievements were maintained or lost. All but 5 patients improved between GDH admission and discharge; after discharge, 39 per cent deteriorated. The need for more support in the community was predictive of deterioration, probably reflecting patient frailty. Number of medical diagnoses or medications were not predictive. Frailer older patients tend not to maintain goals achieved in a GDH after discharge and may benefit from ongoing maintenance.

This paper draws a socio-demographic, physical, psychosocial, and behavioural profile of housebound older adults with arthritis and compares older adults with rheumatoid arthritis to those with osteoarthritis. Data from 125 housebound older adults with osteoarthritis (65%) or rheumatoid arthritis (35%) were compared to published samples and to population data using appropriate weighting. Respondents were mainly women, living alone, mean age 77 years (SD = 10.50). Symptoms of stiffness, fatigue, and pain intensity were moderate to severe, and a substantial proportion (51.4%) reported depression. Participants reported low levels of health behaviours such as exercise. Overall, older adults with rheumatoid arthritis were significantly younger, reported less pain and limitations, were more optimistic and satisfied with their social life, and had a higher self-efficacy than older adults with osteoarthritis. Home-based pain self-management programs should be constructed considering the unique profiles and needs of this population.

Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

We provide descriptive statistics for data collected via the Residential Care Facilities Survey (RCFS), from long-term care (LTC) facilities operating in Ontario between 1996 and 2002. The LTC sector in Ontario is dominated by large, proprietary for-profit facilities. The proportion of residents receiving extended care has increased from 53 per cent in 1996 to over 61 per cent in 2002. Government-owned facilities are significantly larger than both for-profit proprietary facilities and lay non-profit facilities. Religious and lay non-profit facilities provide care to more residents 85 years of age and older than do for-profit and government-owned facilities, while government-owned facilities provide care to a greater proportion of higher needs residents. Government-owned facilities have higher nursing intensity levels and higher direct care staffing levels than other ownership types, while for-profit facilities have significantly lower levels than other facility types. Non-profit operators have higher ratios of administrative to care staff than proprietary and government-owned facilities.

The purpose of this exploratory, phenomenological-hermeneutic study was to explore the experience of non-problem gambling by older adults. Twelve older gamblers were identified as non-problem gamblers using two gambling screens and participated in in-depth interviews about their experience of gambling. Two major themes emerged from the interviews: the attractions of gambling and methods to keep gambling in control. Older persons sought out gambling for a variety of reasons: social contact, the food and the excitement, chances to give to charity, chances to have an inexpensive holiday, and the need for a safe way to be “bad”. Participants also described a number of cognitive and behavioural strategies to keep their gambling from becoming a problem. The results of this small exploratory study suggest that gambling is a popular form of social entertainment for older persons, although the main attractions of gambling have little or nothing to do with gambling itself. Older persons also appear to possess numerous strategies to keep gambling from becoming a problem.

The effects of long-term hospitalizations can be severe, especially among older adults. In Manitoba, between fiscal years 1991/1992 and 1999/2000, 40 per cent of acute care hospital days were used by the 5 per cent of patients who had long stays, defined as stays of more than 30 days. These proportions were remarkably stable, despite major changes in the bed supply. Approximately two thirds of long-stay patients were aged 75 or older. Medical record review for a small sample of long-stay medical patients aged 75 or older revealed that 42 per cent of the days spent in hospital were spent either awaiting transfer to another level of care (home care, nursing home, or chronic care), or were due to in-hospital factors, such as awaiting consults, tests, or treatments. Hospital information systems and early discharge planning may help to alleviate lengthy discharge delays and result in better care for these patients.

Warfarin dosing for thromboprophylaxis in post-operative patients is time-consuming. Warfarin-dosing nomograms can be used in post-operative arthroplasty patients, but warfarin requirements are lower in frail older people. We modified an existing post-arthroplasty nomogram to a frail-friendly version and evaluated its performance in a frail elderly post-orthopaedic surgery on a geriatric rehabilitation ward to determine if it would improve quality indicators for oral anticoagulation. On a geriatric rehabilitation unit, post-operative orthopaedic patients were assigned to either physician-adjusted warfarin dosing or the nursing-administered nomogram. The proportion of days within target INR values was significantly higher in the nomogram group (77%, 95% CI 74% to 81%) compared to the physician-adjusted group (53%, 95% CI 46% to 60%), with no major bleeding or thromboembolic complications. The number of warfarin-related telephone calls to physicians was significantly reduced by tenfold. Use of a frail-friendly nomogram improved quality and efficiency of patient care on a geriatric rehabilitation unit.

Researchers in the fields of biology, religious studies, history, medical ethics, philosophy, and sociology offer a popularized interpretation of “what is death and dying.” This book is divided into three sections, each beginning with a relevant discussion on the contexts of the issue of death and dying. The work proposes three insights into the subject. First, the image of “the dead and the living,” as presented in art history, is revisited through the genetics and biology discourses that have recently challenged the traditional concepts of aging, as well as the very definition of “clinical” death. Second, the “experience of death” is based on new ideologies that reassess the solitude and individualistic nature of the dying and the necessity of reestablishing the links between the dying and the living, as reiterating the cultural norm. Finally, the “good death” establishes a virtual breach between two types of mythical figures – the heroes and the saints – and the relational singularity of palliative care.

Published by é ditions Autrement under the direction of Sophie Aurenche, this book examines euthanasia as a current subject of discussion in France. The January 2000 decision rendered by the Comité consultative national d'éthique (CCNE) accepting euthanasia in extenuating circumstances, and the passing of the March 2002 law on the rights of patients, including the right to a dignified death, have reopened the debate on the subject of euthanasia. No longer discussed only in the back rooms of the hospital or among those practising within the ethical and juridical spheres, euthanasia has emerged into the public domain. Journalist Sophie Aurenche has facilitated the debate by giving voice to speakers from a number of disciplines; each brings expertise and knowledge to the discussion and each examines the following question: is euthanasia a humanist duty or an inhumane practice? In the first section of the book, the texts address the question based on the meaning of the term euthanasia and its related concepts. The second half is dedicated to testimonies and reflections on the experience and practice of euthanasia. This book is a must for those interested in the study and repercussions of euthanasia and palliative care. The studies brought together in this volume as well as the realities they describe should be consulted in any future research on possible solutions envisioned on the issue of euthanasia.

Hospitalization is a sentinel event that leads to loss of independence for many seniors. This study of long-stay hospitalizations (more than 30 days) in seniors was undertaken to identify risk factors for not going home, to characterize patients with risk factors who did go home and to describe one year outcomes following home discharge. Using Manitoba's health care databases, the likelihood of death in hospital, discharge to a nursing home, and transfer to another hospital was determined for a set of risk factors in seniors with long-stay hospitalizations in Winnipeg's acute hospitals. Of the 17,984 long-stay hospitalizations during 1993–2000, 45 per cent were discharged home, 20 per cent died, and 30 per cent were discharged to a nursing home or another hospital. Seniors who received home care prior to hospitalization were more likely to be discharged to a nursing home or die in hospital than to go home. Stroke and cognitive impairment increased the likelihood of discharge to a nursing home. Seniors with neoplasms, multiple co-morbidities, and length-of-stay more than 120 days were more likely to die in hospital. Long-stay patients with risk factors who did go home had few co-morbidities. Within one year of home discharge, 20 per cent of seniors died, 5–15 per cent were admitted to a nursing home or long-term care institution, and 26–35 per cent of persons were re-hospitalized from home. A full 37 per cent experienced none of these outcomes. Our findings point to opportunities to improve discharge outcomes and plan support services for seniors.