Following previous studies on the associations between aluminium (Al) water concentrations and relatively high risks of a measure of mental impairment, the role of silica (SiO2) as a possible confounding variable is investigated. The bivariate associations show that the lowest odds, representing an approximation of relative risks, are observed at “mild” SiO2 concentrations. Multivariate analyses indicate that, if interaction terms are included, the odds comparing higher and lower SiO2 concentrations are different than if an interaction term is not included. There are also indications that at relatively high Al levels, high SiO2 concentrations lower the odds, consistent with previous suggestions by Birchall. The implication is that when investigating the role of Al in the etiology of various measures of mental impairment, it is important to consider the effects of other water constituents, and also the different chemical forms of Al present in treated water. The desirability of additional work is stressed, preferably using more definitive outcomes than indications of mental impairment.

Previous studies in this series of papers investigated the associations between aluminum (Al) water concentrations and relatively high risks of a measure of mental impairment and also various possible other drinking water characteristics, particularly pH, turbidity, fluoride and silica. The results were based on one measure of mental impairment, which would not be expected to give the same results as the more definitive endpoint (outcome variable) of a record of Alzheimer's Disease (AD) as the underlying cause of death on a death certificate. The present paper therefore investigates the relevant associations, based both on the measure of mental impairment and on death certificates in which AD and presenile dementia are listed as the underlying causes of death. As expected, the associations were not identical, but they were similar. More specifically, Al water concentrations were strongly associated with the recording of AD on death certificates, as were pH, fluoride, and silica concentrations. The implications of these results are discussed, and it is suggested that the evidence is sufficiently strong for methods of water purification to be modified, at least on a trial basis, because of the likelihood that this will reduce the incidence of AD.

A self-administered mailed questionnaire was sent to a stratified random sample of medical administrators in Ontario homes for the aged (HFAs) and nursing homes (NHs) in 1991 in order to explore the types and extent of medical-administrative activities undertaken by these physicians, and their perceptions of skills, attitudes and knowledge that were important in carrying out their roles. Three key findings emerged from the survey. First, considerable variation exists in the extent of medical administrative activities undertaken within each of the two facility types and, in some cases, across the two facility types. Second, there were few activities which ≥75 per cent of medical administrators reported undertaking on all occasions and many activities which ≥25 per cent of physicians reported not undertaking on any occasion. Third, in general, medical administrators did not express values congruent with adoption of a broader management role in facility administration, financing, and planning activities. Research and policy implications for the evolving role of medical administrators in NHs and HFAs are discussed.

Craik (1986) has proposed that age-related deficits on memory tasks are proportional to the extent to which these tasks require the use of self-initiated operations. Because the number of required self-initiated operations vary among traditional episodic memory tasks, these tasks should display a gradation of age-related deficits. The objective of this study was to test this hypothesis. A secondary analysis (i.e. based on the results of previous studies) was performed on 22 studies in which verbal stimuli were used as targets on more than one episodic memory task. Of the 24 comparisons provided by the studies, 21 supported the gradation concept. This result suggests that the self-initiated operation hypothesis is valid.

The objective of this study was to attempt to develop an index of assessment items important to most, if not all, mental capacity determinations. A group process, judgmental method was used. Three separate panels of multidisciplinary experts were assembled to define relevant assessment items and to assign importance weights to the items. All three panels generated a list of assessment items, but panelists refused to assign importance weights. Four items were identified by all three panels, six were identified by two panels, and three were identified by one panel only. A composite list of mental capacity assessment items was generated, but the study failed to generate a standardized assessment instrument.

The value that the elderly put on being autonomous is an intrinsic characteristic of the aging population that can have a decisive influence on their motivation to maintain or recover their autonomy. This study was designed to examine the importance that elderly people who have lost their autonomy put on the ability to perform themselves five activities of daily living: eating, washing, dressing, eliminating and moving around. It also explores the influence of age, sex, place of residence, level of physical autonomy, feeling of well-being and socio-economic status on the value put on autonomy. A non-probabilistic sample of 68 elderly subjects was interviewed and the value put on autonomy was evaluated using two instruments: Osgood, Suci and Tannenbaum's differential semantic, and Torrance's time trade-off technique. The results suggest that the subjects consider physical autonomy very important. Educational level and the degree of physical autonomy were the main factors linked to importance. However, no link with age or place of residence (institution vs. home) was found.

Using event history data from the 1990 Canadian Family and Friends Survey, this study examines several factors that influence the likelihood of remarriage for women and men whose first marriages ended in widowhood. Our results suggest that large sex differences in remarriage exist, with ever-widowed men having appreciably higher rates than ever-widowed women. Remarriage rates are shown to vary by indicators of lifecycle and by socio-economic status. The implications of these results are discussed.

Discontinuity of grandparent-grandchild relationships has been largely overlooked in social science research, despite the fact that the salience of the grandparent grandchild attachment bond is the subject of considerable discussion. This article reports the results of an exploratory study of grandparent-grandchild contact loss, by means of a survey of the core membership of five “grandparent rights” groups across Canada. As reflected in the particular concerns of this membership, there are four primary circumstances associated with grandparent loss of contact with grandchildren: parental divorce, conflict with both parents, death of adult child, and stepparent adoption following remarriage. Grandparents whose adult children are noncustodial parents (mostly paternal grandparents) are at high risk for contactloss, and adult children-in-law appear to be the primary mediators in the ongoing grandparent-grandchild relationship. Disrupted grandchild access is seen as having profound negative consequences for grandparents, and this has important implications for socio-legal policy and therapeutic practice.

Routinely-collected administrative data and Cox's proportional hazards models are used to compare outcomes of care while controlling for age, sex and dependency level. The results indicate that the overall quality of nursing home care in Manitoba is good but that residents in certain regions and in certain types of nursing homes have specific outcomes that are poorer than others. These outcome indicators must not be treated as definitive signs of poorer care but as “triggers” suggesting a need for a closer look because the methodology and outcomes used in this study are still in the experimental stage. The results also indicate that secondary data provide a relatively inexpensive starting point for evaluating outcomes of nursing home care.

Substance use patterns and predictors of substance use by women aged 65 and over were examined using data from the Canadian National Alcohol and Other Drugs Survey (1989). Use patterns were consistent with findings from previous surveys: that older women drink less alcohol, smoke less and use less illicit drugs than other age-gender groups. Also consistent with previous surveys, older women reported the highest rate of psychoactive prescription drug use of all groups. Bivariate analyses indicated significant relationships between some social and demographic variables and substance use. Drinking was associated with being single, younger, not religious, in better health, and smoking. Smoking was associated with being younger, not religious, in poorer health, having less social support, drinking, and use of psychoactive prescription drugs. Use of psychoactive prescription drugs (especially sleeping pills) tended to be associated with being widowed, older, less educated, more religious, in poorer health, experiencing higher stress, having lower income and less social support, smoking, and use of other psychoactive prescription drugs. When data were analysed using principal component analysis, two very consistent dimensions of substance use emerged for older women: greater religiosity associated with less drinking and smoking, and a dimension involving use of all types of psychoactive prescription drugs. These findings are discussed in terms of projected use patterns for future older women and the need for a better understanding of the social context of older women's substance use that involves light to moderate alcohol use but a higher rate of use of psychoactive prescription drugs than other age-gender groups.