The Functional Independence Measure (FIM) was developed to assess the burden of care of persons receiving rehabilitation services in regard to self-care activities and social and cognitive skills. Until now, no study has evaluated the validity of the FIM with the elderly without distinction of diagnosis. The purpose of this study was to examine the MIF's factorial structure using a principal components analysis. As a secondary goal, the predictive validity and the internal consistency of the instrument were also examined. Data collected from 120 subjects generated a solution consisting of three factors accounting for 67.6 per cent of the total variance. The first factor (46.6%) represents the handicap concept, the second factor (14.7%) measures disability and the third factor (6.3%) represents disability with a major component of physical involvement of lower extremities. The results of this analysis confirm the multidimensional structure of the FIM and reveal the possibility of a third factor for the elderly. With this population, internal consistency of the instrument, obtained from admission and discharge data, is estimated at 0.92 and 0.96 with Cronbach's alpha. Total FIM score at discharge as well as items related to the handicap factor as measured on admission allow us to correctly predict place of discharge in a proportion of 72.9 per cent of the cases. These results indicate that the FIM bears an interesting potential for measuring rehabilitation outcomes for the elderly.

The move towards early retirement as witnessed over the last few years in Europe comes from social assistance mechanisms, other than old age security and is not due to a simple earlier retirement age.

Two systems have been used primarily to help older workers. These are disability and employment insurance. “Early retirement” mechanisms have also helped these active or unemployed workers retire, by means of allocating resources.

The social security structure in European countries has remained essentially unchanged with the risks and logistics of management inextricably intertwined. Moreover, these new forms of transition between activity and retirement reveal the reorganization underway in all matters related to aging workers. One of the implications of the massive movement towards early retirement has been that the tripartite life course in which important social stages within the life course are marked by milestones (e.g. school age, retirement age …) is disappearing. It is gradually being replaced with new flexibility for managing the end of the life course. This type of evolution would require us to rethink the social protection system in the sense of reducing the distinct ternary division in the life course. In this perspective, the very concepts of retirement and social transfers for definitive inactivity are no longer relevant.

The purpose of this paper is to report research findings from a study of the nature of the relationship between informal and formal care of the elderly. There are several explanations for the link between informal and formal care: the task specific model, the compensatory model, the substitution model, the supplementary model, and the complementary model (which combines both the compensatory and supplementary functions of formal care). These explanations were evaluated using data from the 1985 General Social Survey for those aged 65 and older who have functional disabilities. Data were analysed using logistic regression analysis. The findings show support for the complementary function of formal care. The data indicate that formal care compensates for the absence of a spouse or child and, in a minority of cases, supplements work of the spouse or child caregiver for personal care tasks and to a lesser extent housework. Of these two, the compensatory effect of formal care appears to be more prevalent than the supplemental effect.

Intergenerational transfers are the essence of societal continuity, and yet not at all well conceptualized or analysed. Intergenerational transfers are also at the core of the welfare state concept of redistribution of resources and hence, of current social policy changes/challenges. In making a difference to policy choices and in linking research to policy, attention to intergenerational transfers focusses on the fundamental policy questions of guiding belief systems, family (or private) transfers versus public transfers among generations, and issues of intergenerational and cohort equity in the short and longer terms. This paper has four objectives: (1) Situating intergenerational transfers in socio-historical, international comparative, and current social policy contexts; (2) Developing a typology of intergenerational transfers that could provide the basis for answering thus far unanswerable key policy questions, such as whether the situations of seniors into future generations will be like those of seniors today; (3) Encouraging the collection of more complete and integrated data on intergenerational transfers in Canada, which would provide for more informed policy choices; and (4) Enumerating key policy questions that emerge from research and remain to be addressed. From analysis of what is known about intergenerational transfers and what remains to be known, an agenda for an information system, for future research and for addressing policy questions is outlined.

The brain undergoes many changes in chemistry and structure during normal aging. For example, it dries and shrinks. Neurons are lost from some regions and there is also neuronal atrophy and loss of synaptic branching. The extent of such losses remains controversial for all but a few subcortical regions of the brain. Decreases in glucose metabolism and in some pre-and post-synaptic neurotransmitter indices have also been reported. Many systems, however, remain entirely unexplored. The evidence to date also indicates that there is great regional specificity in the effects, and that humans show considerable variability between individuals. Of interest is the fact that some of the changes most clearly demonstrated in normal aging - such as loss of dopaminergic neurons of the substantia nigra and cholinergic neurons of the medial basal forebrain - also occur in a much accentuated form in neurodegenerative diseases such as Parkinson's disease and Alzheimer disease. The small loss of these systems in normal aging may account for the shuffling gait, stooped posture and memory loss in the elderly. A phenomenon seen in neurodegenerative diseases, but not in normal aging, is the appearance of chronic inflammation in the brain. The suggestion that the progress of such diseases might be slowed by treatment with anti-inflammatory agents has, in the case of Alzheimer disease, gained some support from 19 epidemiological studies and one very small clinical trial. Clearly more detailed clinical trials are required, and caution must be used because of the undesirable side effects of currently available anti-inflammatory agents.

As previous research has shown central nicotinic receptors to (a) be asymmetrical, (b) decline with age, and (c) be more abundant in smokers, quantified EEG indices of hemispheric asymmetry were employed to assess whether smoker/non-smoker status affected the aging brain and whether the aging brain demonstrated an altered response to acute smoking/nicotine. Forty healthy volunteers participated, including 20 young (18–39 years) and 20 elderly (64–81 years) adults. Half of the subjects in each age category were lifelong non-smokers and half were cigarette smokers with average smoking histories of 9.3 and 52.0 years for young and elderly respectively. Inter-hemispheric theta and alpha asymmetry indices illustrated greater left hemisphere power (relative to right) in elderly adults, while the reverse trend was seen in young adults. Smokers and non-smokers both showed similar aging trends but differed with respect to their presence in frontal and posterior regions. Intra-hemispheric asymmetry indices, particularly with alpha activity, illustrated a reduced anterior-posterior gradient of power distribution in the elderly. Acute smoking increased slow (delta) and fast (beta) inter-hemispheric indices but only in elderly smokers. Smoking also altered the intra-hemispheric balance of slow wave activity in both age groups of smokers. The results are discussed in relation to normal and pathological aging.

This paper examines the effect of cohort heterogeneity upon the potential needs for assistance in ADL and IADL of an aging population. Variables that are important predictors of the differentiating pattern of perceived needs in the older population are subject to on-going changes as a result of cohort differentiation and cohort succession in the older ages. For those reasons, a forecasting methodology involving three phases has been developed: an identification phase of the key explanatory variables, a demographic-projection phase of socio-demographic variables identified as key variables and a phase in which risk-factor probabilities are applied to the demographic-projection output to determine the overall impact of the population change. The use of logistic regression is shown as the best strategy to determine risk-factor probabilities. This method is applied to measure the assistance needed in ADL and IADL by disabled elderly persons in Québec. The results point to the need to consider changes in intra-cohort heterogeneity between new cohorts entering the older population and old ones leaving it.

The purpose of this study was to investigate the phenomenon of spousal caregiving following the institutionalization of elderly husbands. Theoretically, the study was informed by the interpretive perspective in sociology and the concept of career. Methodologically, the study employed a longitudinal and prospective design and combined quantitative and qualitative approaches. The data were drawn from a larger study designed to explore the transition to quasi-widowhood. This article reports on one aspect of spousal caregiving following the admission of husbands to a long term care setting, i.e. the performance of tasks. In this study, wives carried out a substantial number and wide variety of tasks related to personal, instrumental, relational and recreational care. They viewed visiting as their most important task but also highly valued providing companionship, love and support, doing little things for their husbands and monitoring their health and well-being. Typically, wives carried out tasks they viewed as falling within their domain of responsibility. Task performance occurred within a context of meaning that served to explain, in part, their continued involvement in caregiving following the admission of husbands to a long term care setting. Implications of this study point to the need for collaboration in caregiving between wives and staff, to support and enhance the quality of care provided by elderly wives who are coping with the institutionalization of their husbands.

The challenge of this paper is to re-examine the demographics which underlie the re-write of social policy in an aging Canada, as related to gender, family and generation. Following a brief consideration of Canada's changes and challenges in comparison to those in the United States and selected European countries, the analytical construct, “life cycles of dependencies and responsibilities” is introduced and utilized to examine shifting bases of security among generations (with a focus on six cohorts), and in particular, the implications of possible changes to social policy for the elderly on women, the poor and other disadvantaged elders.

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another.

The baby boom generation is now well into middle age, and over the next few decades will reach old age. As the boom generation grows old the costs of maintaining existing social support systems will rise, and the ability or willingness to sustain those systems has been called into question. In this paper we discuss a number of issues related broadly to population aging in Canada and the associated social “costs,” including the costs of public services. We conclude that while population-related cost increases should be expected, and reallocations of resources required, the overall increases should be of manageable proportions.

Data from the Manitoba Study of Health and Aging were used to compare the utilization and direct costs of formal community care services among the elderly diagnosed as persons with no cognitive impairment, with cognitive impairment/no dementia and with dementia. The results of the analyses indicate that, in addition to living arrangement and limitation on basic and instrumental activities of daily living, mental function diagnosis is an independent predictor of community care use. A diagnosis of dementia increases the likelihood of community care use over those with unimpaired mental functioning, whereas cognitive impairment without dementia does not. The three diagnostic groups differ in the type of services used. Standardization by age, sex and the other variables which significantly affect the need for community care can help a program improve its ability to project realistic cost estimates.

Available research supports the therapeutic usefulness of cognitive therapy for depressed older adults. Few studies have addressed the issue of response prediction. This research investigates the associations between several pre-intervention characteristics of subjects and therapy outcomes in the context of a group intervention. The characteristics under study were severity of depressive symptommatology, endogenous depression profile, subjective health status, perceived social support, and frequency of cognitive depressive symptoms representing a negative view of oneself. A more severe depressive symptomatology and a more negative health perception were associated with a less favourable outcome of therapy. Although the majority of endogenous patients benefitted from the intervention, only a minority reached the level of symptom remission at the end of treatment. A more pronounced cluster of symptoms characterized by negative thoughts about oneself tended to be associated with a worse outcome. Perceived social support was unrelated to therapy outcome.

In times of health reform, fiscal restraint and population aging, it becomes increasingly imperative to understand what must be done to better link research and policy in the health area. In this paper, the major determinants of healthy aging are discussed in terms of current conceptual frameworks of health, measurement, methodologies, and data sources. In order to maximize the benefit for the health of current and future Canadian seniors, policy recommendations are made to Statistics Canada, Health Canada, and the Seniors Independence Research Program (SIRP) which cover a range of issues related to measurement and data sources, health services, health status, economic status, and education.

Financial compensation for family members who provide informal care to elderly kin has frequently been discussed but rarely implemented in Canada. One exception is the Nova Scotia Home Life Support Program, which financially compensates family members for the care of the elderly. This study explores differences among caregivers who receive formal services, specifically, financial compensation or home help services. Financially compensated caregivers tend to be younger females who live in non-urban areas and co-reside with the care receiver. In comparison to caregivers who receive home help services, these paid caregivers report a reduction in financial worry but have greater involvement in the care of the elderly and higher levels of time dependence burden. Before implementing financial compensation policies, research which specifically investigates the effect of these programs on caregivers is needed.

Researchers and policy-makers interested in the needs of the frail elderly in community and institutional settings have had limited success in forming policy based on empirical evidence. The reasons for this have included a variety of organizational and political considerations (e.g., lack of effective communication mechanisms), conceptual and methodological issues (e.g., problems with reliability and validity of existing data sources) and limitations in knowledge (e.g., lack of longitudinal data across health care sectors). The Minimum Data Set (MDS) series of instruments may prove useful in dealing with these difficulties. The MDS instruments have multiple uses for different audiences (e.g., care provision, funding and quality improvement). Extensive international testing has shown the MDS to be valid and reliable, and translations are available in 11 different languages. As implementation of the MDS begins in Canada, a number of new concerns will need to be addressed (e.g., confidentiality and access to data).

A critical ethnography of the process of discharge decision-making for elderly patients was conducted to examine the nature of the process over the total course of patients' hospital stays. The focus was on describing the timing and conditions of decision-making, the related activities of professionals, professionals' perceptions of the process, and the effects of the process on those involved and on the hospital organization. Data analysis demonstrated that the process is not intricately linked with patients' clinical progress, that often inaccurate assumptions about the importance of patient-related clinical and social factors and organizational parameters underlie decisions, and that professionals' perceptions of the process are shaped by organizational imperatives. In the current process, resources are used inefficiently and humanitarian and ethical consequences arise for participants. The analysis supports attempts to achieve greater congruence between the discharge decision process and the patient's clinical progress so that the fiscal and humanitarian goals of the hospital can be achieved.

A review of the literature shows that only a weak connection exists between objective memory tests and self-evaluation memory questionnaires. The object of the present study was to explore which of the mnemonic, affective or psychosocial factors influence subjective evaluation of the memory function. This study is composed of a self-evaluation memory questionnaire, an ecologic-type objective memory evaluation, two affective state measures, anxiety and depression, and an inventory of life events. Sixty elderly persons took part in the study. They were divided into two groups, with attribution to a group depending on whether or not they considered themselves to have problems with memory Results supported the hypothesis that subjective and objective evaluations of memory comprise different components. Contrary to an objective test, self-evaluation of memory is strongly related to affect rather than being a perfect representation of actual mnemonic ability and this in spite of the ecological character of the memory test.

Until recently, the health promotion movement has focussed primarily on individual responsibility for health behaviours rather than on broad social determinants of health. The movement has been targeted primarily at young rather than older persons, at men rather than women. There is an emerging call for a feminist approach to health promotion for aging women, an approach which would address the current gender, class, race, and age biases in health promotion practice, research, and policy. Feminist theories suggest that sexism limits women's health opportunities and subjects them to an array of situations including marginalization, powerlessness, and exploitation. The purpose of this paper is two-fold: to use a feminist analysis to critique health promotion, identifying gender, class, race, and age biases that influence older women's health, and to recommend changes in health promotion theory, research, practice, and education. Health promotion researchers, practitioners, and educators are challenged to work with older women to increase their visibility and empowerment, and to bring about a transformation of the society in which women age.

The parallels between the funding of an individual pension plan and a paygo social security system are presented. In each plan, the total expected value of benefits can exceed the total expected value of contributions. For the individual pre-funded plan this is true because of the discount factor, δ, representing investment income earnings. For the paygo social security system, the analogous “discount” factor is denoted r, the total of real growth rates of the labour force and real productivity gains per worker, that is, real growth in wealth production. The paper then presents arguments to show that a fully-funded social security scheme is no more secure economically than a paygo scheme. Both schemes rely on the ability of the economy to create and transfer wealth. That is, security for social security does not lie in privatization. The paper also reviews the Reform Party's proposal for a “Super RRSP” replacement for social security and analyses its advantages and disadvantages.