Burden among caregivers has consistently been recognized as a function of both subjective and objective variables. In addition to concrete role demands, caregivers' perceptions and appraisal strongly contribute to perceived burden. At present, however, the relative contribution of objective and subjective factors remains unclear. This question was addressed among 70 spousal caregivers recruited within a dementia assessment clinic. Subsequent to adjustment for socially desirable responding, both groupings of variables significantly contribute to the prediction of burden scores. These findings are discussed in the context of the hopelessness theory of depression. Demographic similarity between these caregivers and a corresponding sample of randomly derived spousal caregivers recruited as part of the Canadian Study of Health and Aging (CSHA) suggest the results of this study may be generalized with greater confidence.

A comparative analysis of injury mortality in 24 developed countries during the period 1985–1989 shows the importance of this cause of death among the elderly. One out of four men and one out of two women who dies from injury is aged 65 and over. There is an over-representation of the elderly among injury-related deaths and the risk of death is still increasing after age 65. Some differences can be noted for the elderly as compared to other age groups: a lower male excess mortality ratio and a much larger proportion of violent deaths related to accidental falls. Among developed countries, a wide scope of variations exists in age groups and cause-specific patterns. Hierarchical clustering is used to obtain different aggregations of countries, based on the level, the structure and the causes of violent mortality. Although the classification of countries varies according to a chosen criteria, we often find aggregations of countries belonging to the geographical area.

Although many studies have been published over the past ten years on informal support of dependent elderly, few, if any, have examined the reticence of their caregivers to use formal support services. Further understanding of this phenomenon is required, for it questions the feasability of preventive measures for this population as well as the relationship between formal and informal support systems, considered optimal by government in their efforts to rationalize today's health care services. This article presents a conceptual framework enabling us to better understand the reasons why caregivers of the elderly seldom use formal support services, and discusses health, social and research implications.

In 1985 there were about 5.5 million functionally disabled elderly persons (65 +) in the United States (U.S.) living in the community and an additional 1.3 million in nursing homes. By 2020, these figures are expected to almost double to 10.1 million and 2.5 million respectively. The long-term care system (LTC) in the U.S. is large and complex. Fundamentally, it consists of: (a) informal care, provided voluntarily by one's family, friends, neighbours, and community organizations; (b) home and community based care, covering formal (paid) services provided in one's own home or other community based settings; and (c) nursing homes, which provide specialized medical, nursing, and social services in an institutional setting. Home and community based care includes a variety of services and financing streams, including (a) Medicare home health care, (b) Medicaid home health services, (c) Medicaid home- and community-based services, (d) programs and services under the Older Americans Act, (e) state sponsored social services funded by the Social Services Block Grant, (f) Supplemental Security Income payments, and (g) a range of supportive housing arrangements. Data on the LTC system are available from several key sources: national surveys, administrative records, inventories, state and local data systems, and demonstration programs. The LTC system remains decentralized. The frail elderly want dignity and independence in the latter years, plus access to needed services and an acceptable quality of life. In policy terms, their caregivers and the taxpaying public continue to struggle to find the appropriate mix of public and private support to meet the needs of the LTC population.

Considerable research on osteoporosis has recently focused on the prevention of bone loss in the later years. Researchers and clinicians are now able to accurately measure the effects of therapies and preventive strategies on the skeleton. It has been suggested that regular physical activity will be one of the valuable strategies in maintaining bone density and preventing osteoporosis. This paper will review the quantitative techniques available for bone density assessment and provide an overview of the recent cross-sectional and longitudinal studies related to the potential benefits of physical activity on the aging skeleton.

The health promotion literature for young adults is not generalizable to the elderly, and different outcomes are likely to motivate changes in health practices within the two populations. Main and interactive effects of smoking, alcohol consumption, obesity and physical activity on older Canadians' quality of life are examined with 1991 GSS data. Quality of life is operationalized with psychological well-being and subjective health indicators. Two dichotomous outcomes are used for each dimension, where one outcome is relatively sensitive in detecting impaired quality of life and the other relatively specific. Smoking was consistently associated with negative outcomes, but there was little evidence of adverse effects for alcohol consumption. Physical activity effects were most pronounced comparing sedentary and moderately active individuals. Body mass index showed curvilinear associations with impaired quality of life and interactions with smoking and activity level in separate models.

One thousand, four hundred and six seniors were asked about their consumer spending preferences. While some could name a product spending preference, others could not. This study examines the characteristics that best distinguish those elders who are uninterested in spending on consumer products from those who choose product specific preferences. Discriminant function analyses show that age best distinguishes the non-interested group from the others, supporting a previous report by Walker and Schwenk (1991). Income and health status most reliably separate those whose most important spending priority is a recreational product from those most interested in basic needs or housing products. Those whose spending priority is a housing item tend to be home-owners who have lived in their residences for long periods of time. The results confirm that the heterogeneity among seniors documented in other areas (such as health and social characteristics) extends to their consumption preferences. The diversity in spending preferences can be understood in terms of a desire to enhance quality of life.

The elements of a conceptual scheme for long-term care (LTC) were developed based on two lines of thought. The first, more practical, borrows from planning. The second, which is more theoretical, reflects sociological action theories. Planning is defined as an action that targets the development of a plan. Using values, desires, resources and constraints as a starting point, operational objectives are defined and means chosen. Planning focuses on four themes: (1) establishment of priorities, (2) setting up organizations in the form of agencies, (3) choosing objectives and (4) defining resources. These four themes are analyzed in turn, with each producing four elements defining a total of 16 themes, dilemmas, problems or issues specific to LTC. The relationships between these elements, which are by definition prescriptive, form the core of our proposal for an LTC planning model.

Planning of long-term care (LTC) focusses on four themes: (1) developing priorities to reflect values; (2) setting up human service organizations governed by a set of rules and procedures; (3) choosing objectives to which participants and organizations are committed; (4) mobilizing resources. A conceptual scheme for LTC planning could draw on each of these four structural elements. But they might prove to be a set of separate concepts only linked to each other intuitively, unless they are linked through action processes. The total number of reciprocal relationships between the four planning elements is 12. We have therefore identified 12 different action processes to be examined whenever LTC planning is undertaken. These processes allow information from the four structural elements to circulate between them. For example, priority, organization and objectives are sources of information when choosing criteria for the allocation of resources. Thus the processes form bridges between the planning elements. These bridges must be used whenever planning is undertaken in order to ensure that all the elements are given equal weight. Whichever planning element is used as a starting point for LTC planning, the process knits the structural elements together into a whole. Using our conceptual scheme as a guide, planners can cover the whole field of LTC that it represents.

The Fit (Falls Intervention Trials) Project was a randomized clinical trial of a program designed to reduce falls and their sequela among older people. The sample consisted of 100 persons who were age 60 and over, who lived in the Capital Region District (Victoria, B.C.) and who had experienced a fall in the preceding three months. The intervention consisted of a comprehensive risk assessment, individualized feedback about identified risks and a motivational video and booklet entitled “Head Over Heels”. Outcome measures included fall incidence, falls self-efficacy, fear of falling, social functioning, health service utilization and quality of life. While there were no statistically significant differences between the intervention and control groups on the key study variables, there were improvements in both groups between the beginning of the study and the six-month follow-up assessment. The paper discusses possible reasons for these findings and their implications for further research.

A large body of evidence has demonstrated that normal human fibroblasts have a limited division potential in culture and underwent senescence, a process whereby cells became arrested in the G1 phase of the cell cycle and overexpressed a DNA synthesis inhibitor(s). Cyclin-dependent kinase two (Cdk2) is required for the promotion of the Gi-to-S phase transition in human cells. Senescent fibroblasts contain intact cyclin-Cdk2 complexes but cannot induce Cdk2 protein kinase activity in response to mitogen stimulation. Recently, we cloned p21Sdi1, a potent inhibitor of DNA synthesis and Cdk2 kinase activity, from a senescent cell cDNA library and demonstrated that it was expressed at significantly higher levels in senescent cells than actively proliferating cells. In contrast to actively dividing cells, mitogen-stimulated senescent cells do not down-regulate the expression of p21Sdi1 and do not express late G1 phase gene products that are required for entry into S phase. We suggest that the inability of mitogen-stimulated senescent cells to down-regulate p21Sdi1 levels contributes to the resulting lack of late Gi gene expression and failure to traverse the G1/S phase boundary.

The elements of a conceptual scheme for long-term care (LTC) were developed based on two lines of thought. The first, more practical, borrows from planning. The second, which is more theoretical, reflects sociological action theories. Planning is defined as an action that targets the development of a plan. Using values, desires, resources and constraints as a starting point, operational objectives are defined and means chosen. Planning focuses on four themes: (1) establishment of priorities, (2) setting up organizations in the form of agencies, (3) choosing objectives and (4) defining resources. These four themes are analyzed in turn, with each producing four elements defining a total of 16 themes, dilemmas, problems or issues specific to LTC. The relationships between these elements, which are by definition prescriptive, form the core of our proposal for an LTC planning model.

The pattern of transfers of clients between different levels of care in an area-based system of long-term care for elderly and disabled people is described and analysed using data collected through a monitoring system, called ASIM, from 1985–1991 in the Municipality of Solna, Sweden. Transfers between levels of care occurred in both directions but the frequency of downward transfers was small compared to the number of upward transfers – especially for sheltered housing and residential homes. For all levels of care there were great variations in disability among the entering clients, suggesting non-systematic assessment procedures in connection with admission. An analysis of changes over time in the pattern of transfers illustrated the interdependence of the different levels of care. Reduced resources in long-term hospital care resulted in a near blocking of transfers from the residential homes and increased average disability for the admitted patients in general.

The General Well-Being Schedule (GWB) is a questionnaire that is frequently used in large-scale epidemiological surveys to evaluate the psychological health of a given population. In spite of its popularity, it appears that no validation study has been done on a French version of the instrument. The present study proposes a French version of the GWB and establishes its psychometric qualities based on a sample of 369 subjects, 179 of whom are bilingual. The subjects were recruited through notices placed in the different francophone and anglophone media. The questionnaires were mailed to the subjects. First, the results show a very strong correlation between the translated version and the original version of the questionnaire (r = 0.88, p < 0.0001). The internal consistency of the French version is estimated at 0.92 and its test-retest reliability at 0.82 (95% CI: 0.71–0.89). Correlations between the total score on the general well-being scale and measures of depression and anxiety are over 0.70. Principal component analysis applied to the French and English versions of the questionnaire suggests the presence of a main factor which accounts for 50 per cent of the variance. This study provides a French version of the GWB that may justifiably be considered reliable and valid. Validation of the questionnaire should be pursued by establishing normative values for the elderly francophone population and by studying its responsiveness.