The vast majority of the 220,000 Canadians who die each year, principally of old age and progressive ill health, do not have access to specialized hospice or palliative care. Hospice and palliative care programs are unevenly distributed across Canada, with existing programs limited in capacity and services varying considerably across programs. End-of-life (EOL) care is defined as “The services that may be needed by dying persons and their families or friends in the last year of life, as well as bereavement services following death.” Although some health and social services may be available, most dying Canadians are in the difficult position of not having ready access to a full range of services that could ease their final days of life. Most are thus at risk of uncoordinated and potentially inadequate EOL care. Among all persons, dying persons are arguably the most vulnerable. The dying process is often difficult as a result of emotional and physical challenges. Although the loving support of family and friends for dying persons is irreplaceable, EOL care is an important public obligation. A synthesis research project was conducted to identify a best-practice EOL care model for Canada, one featuring coordinated or integrated EOL care. Through site visits, literature reviews, Web-based surveys, and a home care data analysis, four essential components for a best-practice integrated EOL care model for Canada were identified: (a) universality, (b) care coordination, (c) assured access to a broad range of basic and advanced EOL services, and (d) EOL care provision regardless of care setting. This model is offered as a guide for the development of EOL care services across Canada.

The purpose of the present research was to examine the perceptions of risk regarding falling held by older adults and their adult children. Using a focused ethnographic approach, older adults and adult children were interviewed in depth. Thematic analysis was conducted to identify themes within groups and to compare the perspectives of older adults and adult children. Findings highlighted differences in perceptions and approaches to action between older adults and their adult children. There were three approaches to action adopted by these families, which focused around whose actions were dominant: parents' actions, shared actions, and children's secret actions. The results emphasize the value placed on independence by older adults and the impact of multiple family relations taking action to prevent falls. The present study points to the importance of including multiple family perspectives in research concerning injury prevention for older adults.

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD).

Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population.

Methods: This study was guided by the research question: “What are the care needs and care priorities of senior citizens with end-stage COPD?” An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006.

Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others.

Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.

This study compares the normative expectations of 1315 Québécois survey-takers about the responsibilities of spouses and ex-spouses, on the one hand, and adult children and stepchildren, on the other hand, regarding the support they are to offer an elderly family member with incapacities. The comments of survey-takers in relation to fictional yet concrete scenario descriptions provided a basis with which to identify respondents' expectations along with the social factors surrounding these expectations. The results of this survey suggest that the nature and scale of support-related expectations vary according to the family tie with elderly relative. Expectations toward spouses are high and unmitigated, whereas expectations toward ex-spouses and adult stepchildren appear to be limited. Expectations toward adult children are more pronounced than those exhibited toward stepchildren. Where offspring are specifically concerned, expectations are strongly influenced by the given context; for this category of survey-taker, the demands of support should not interfere with their family life and career.

The demographic aging of the Registered Indian population suggests that the social, economic, and health conditions of older Registered Indians will be increasingly important for communities and policymakers. We have adapted the United Nations Development Program's Human Development Index using data from the Census of Canada and the Indian Register to measure whether improvements seen in the knowledge, standard of living, and health of the Registered Indian population between 1981 and 2001 are also observed among Registered Indians of older ages. The absolute levels of well-being of older Registered Indians were found to have improved, but gaps with other older Canadians had widened, particularly in terms of income and male life expectancy.

In North America, 40–50 per cent of older adults are actively involved as formal volunteers in providing diverse health and human services. We review empirical studies concerning older adults' motivations for volunteering, as well as the health and morale benefits they derive from this expression of altruism. Knowledge of the exact nature and amount of volunteer activity necessary to produce these effects is limited, and studies have yet to identify the behavioural and psychological mechanisms that are implicated. We propose that older adult volunteers may enjoy good health and longevity because being useful to others instills a sense of being needed and valued. We present several theoretical perspectives on the developmental significance of volunteering, discuss the challenges to volunteerism imposed by the baby boom cohort, and identify future research priorities.