Drawing on the literature on the extensive investment older adults make in volunteering, and on the findings of a study of 19 not-for-profit agencies that rely heavily on older adults to provide a variety of community services, this paper identifies several significant changes in the character of the clients who are served by these volunteers and in government health policies affecting the delivery of community services. The paper concludes with suggestions for research and policy development aimed to optimize the contribution which older volunteers make to society and reciprocally, the contribution that volunteering makes to the health and well-being of older adults.

Health care cuts and restructuring are shifting the site of acute care from hospitals to homes and prompting provincial governments to introduce varying forms of mixed economies in home care. Typically, such arrangements seek to drive down public costs and to reposition service users as “consumers” of market-modelled care. Drawing on an ongoing study of frail elderly women and women with disabilities receiving home care in Ontario, this paper explores the significance for service users of these economic and political objectives. Rather than feeling like consumers free to exercise choice and demand quality in the mixed economy of home care, they experienced their positioning within it as insecure and subordinate and its supply as unpredictable and meagre. The implications of these findings for fashioning secure and equitable public responses to elderly and disabled citizens who need assistance at home over the long term are discussed.

The formal sector's increasing recourse to families poses questions concerning the type and degree of participation that is expected of family caregivers and the conceptions that exist regarding them. This article examines different conceptions and their implications for practice, based on reflexions emanating from the authors' 15 years of empirical research on caregiving. A typology of practice approaches based on the various conceptions is presented including: the dependent adult approach, the caregiver as joint-client, the caregiver as resource and the caregiver as partner approach. Each of these approaches is based on a framework of beliefs, values and principles which shape policy and practice and have implications for how caregivers are perceived and served. The authors propose an alternative community-oriented approach which addresses the limitations of those which currently dominate homecare policy and practice.

The purpose of this qualitative study was to learn more about the relationships that families develop with staff who work in the facilities in which their relatives live. Data were collected through participant observation in two long-term care facilities and through personal interviews with 61 family members. Five types of relationships emerged from the data, including relationships that were “collegial,” “professional,” “friendship,” “distant,” and “tense”. Several factors appeared to be associated with positive relationships developed between families and staff, including contact with purpose, shared experiences, and issues of trust. Families also reported a number of benefits from developing positive relationships with staff.

This paper examines use of alternative therapies to manage a chronic illness among older adults with at least one of three major conditions: arthritis, heart disease, and hypertension. Drawing from developments in the health utilization literature, a focus is placed on the illness context, predisposing factors, and several factors deemed to enable persons to use complementary medicine. The baseline data (n = 879) from the 1995–96 North Shore Self-Care Study conducted in Vancouver, Canada were used for this study. Two dependent variables were analysed using logistic regression techniques – the first is based on a comprehensive question about using alternative therapies (such as herbal remedies, acupuncture, massage therapy, etc.) to manage a chronic condition; and the second uses a more specific question pertaining to meditation or praying. The results from the first analysis show that being younger, suffering from arthritis compared to hypertension, comorbidity, taking fewer medications, lower income, reading on the chronic condition, and the interaction between reading and illness self-efficacy are associated with trying alternative therapies. The findings for the second analysis show that being female, being younger, and not married, as well as reporting a more serious condition, illness duration and the interaction between having moderate levels of mutual aid and number of confidants result in a greater likelihood of trying meditation/prayer. Implications of these results are discussed in terms of their theoretical import, and their relevance for the degree to which unconventional and conventional medicine are complementary.

Variations in health and medication use exist across cultures. Medication use among Chinese-Canadian older persons is complicated by many factors including combined use of Western and traditional Chinese medicines (TCM). There is little research on health, psycho-social and cultural determinants of medication use in the Chinese. A cross-sectional census study of community-based Chinese-Canadian older persons in the Kitchener/Waterloo area was conducted using the Minimum Data Set for Home Care and a supplementary questionnaire for cultural issues. The response rate was 89.1 per cent with 106 participants using face-to-face assessments. Socio-demographic and cultural variables were summarized. The multivariate logistic model for TCM use included pain symptoms and being hospitalized, and a curvilinear association between TCM use and health beliefs. For combined medicine use, living with a child, pain symptoms, hospitalization, and social isolation problems were the main effects. Living with a child, physical health problems and number of diseases were associated with Western medicine use. Health, psycho-social and cultural factors were significant determinants for medication use. Education programs for both Chinese-Canadian older persons and health care providers are necessary to understand the appropriate use of Western and TCM treatments.

Many of the limitations experienced by community-dwelling older women are related to mobility within their communities. This qualitative study explored community mobility from the perspective of older, community-dwelling women in Winnipeg, Manitoba. Semi-structured interviews were completed with 23 older women (mean age 75.9 years) identified through an existing database. In addition to travels to conduct instrumental activities of daily living and participate in social and recreational activities, the women in the study described trips to fulfil social obligations (e.g., attending funerals, visiting sick friends) and emphasized the importance of these trips. The women's travels through the city were influenced by their perception of risk and the strategies they employed to minimize or avoid risk during the day, in the evening, and during bad weather. Autonomous community mobility provided the women with a sense of independence and control. The findings have potential implications for health care providers and community programmers who work to maintain older women in the community.

The aim of the present investigation was to determine whether differences in the strength of original information influence adult age differences in susceptibility to misinformation. One-half of the younger and older adults watched a slide sequence once (one-trial learning) that depicted a theft, whereas the remaining participants viewed the slide sequence repeatedly to ensure that all critical details were encoded (criterion learning). Three weeks later and immediately prior to final testing, participants were asked questions that contained misleading information. As expected, the degree of initial learning influenced age differences in misinformation reporting. That is, when event memory was poorer for older than younger adults (in the criterion learning condition), older adults were more susceptible to misinformation than younger adults. However, when memory of the event was poor (in the one-trial learning condition), the younger adults reported more misled details than the older adults, possibly because the younger adults had better memory for the misleading information. Therefore, strength of initial memory influences the extent and direction of adult suggestibility and helps explain the discrepancy found across studies in this area.

Based on the national Canadian Study of Health and Aging, the objective of this study was to determine the importance of socio-demographic and medical factors, cognitive and functional status as predictors of the development of urinary incontinence, and to estimate five-year incidence by sex and age group. Participants from the Canadian Study of Health and Aging who underwent a clinical examination in 1992 and were continent for urine at the time were followed up and their continence status was again determined in 1997. Multivariate logistic regression models with daily incontinence and daily or less than daily incontinence as the outcomes were developed separately for male (n = 306) and female (n = 520) survivors. Predictor variables were introduced in the following chunks: socio-demographic factors; cognitive status; functional status, diabetes and stroke. Five-year cumulative incidence of daily and less than daily incontinence by sex and age group was also estimated. Results indicated that the incidence of urinary incontinence was higher in women than in men, and increased by age in both men and women. Especially among men, those in institutions were much more likely to develop urinary incontinence than those in the community. Incontinence increased dramatically with severity of dementia, less so with physical immobility. Diabetes mellitus was related to the development incontinence in men but not in women, prior stroke was related to development of incontinence in both sexes. It is concluded that urinary incontinence is common in older persons, and enquiries about its presence should be part of routine medical and nursing assessment of older persons. Those who develop incontinence commonly have dementia and are physically impaired. The extent of assessment and management should be carefully tailored to each individual patient.

This paper examines factors associated with falling among approximately 3,100 individuals aged 65 and older who were participants in the 1994 National Population Health Survey (NPHS). The intent of the NPHS is to monitor the health of Canadians and risk factors that affect their health. Several factors were identified as increasing the risk of falling, such as advanced age, being female, certain medical conditions, medication use and impaired mobility. The results from this survey, conducted on a national level, confirm the findings of many studies utilizing smaller samples within individual communities. Continuation of the NPHS will aid in offering longitudinal data with respect to falls, and allow for establishing a temporal order prior to the fall event, in order to provide more definitive evidence with respect to risk factors for falls.

Past studies of aging and disability have been restricted to and by cross-sectional data. When cross-sectional surveys measure income, disability status and age at a common point in time, it is impossible to discern the process, and consequences, of a disability onset. In other words, it is not possible to examine the circumstances of the same individuals before, and after, the disability onset; nor whether effects differ according to the age at which the disability occurs. The present study uses a new panel data set, the Survey of Labour and Income Dynamics (SLID), to examine the prevalence of disability with respect to age, gender, and other socio-economic characteristics; however, its unique contribution is its investigation of disability onset, and the rates of entry into, and exit from, disability status by age group and gender. Further, we assess the financial circumstances of those who become disabled vis-à-vis a “control group”.

As Canada's elderly population grows, an increasing number of seniors will require care as they face the end of life. Relatively little research attention, however, has been given to end-of-life issues, including those related to treatment and care for persons who are both old and dying. Families and health care providers have little direction and guidance to ensure an optimum quality of life for seniors prior to death and during the period of bereavement. This article presents an abbreviated summary of the literature regarding end-of-life issues and challenges for seniors who face a life threatening illness and are at, or near, the end of their lives. The article is also informed by a series of focus groups with elderly and other informal caregivers regarding the giving of help and getting support while caring for persons who are dying. It concludes with a response to this evidence by making a series of recommendations aimed at ensuring optimal end-of-life care for seniors who are dying and their families.