This article presents a study that directly replicated the recently developed Balanced Time Perspective Scale (BTPS; J.D. Webster, 2011) and included middle-aged and older adults. Participants included 90 younger, 69 middle-aged, and 69 older adults who completed the BTPS and a measure of life satisfaction and happiness. A factor analysis replicated original findings with separate subscales for a past orientation and a future orientation obtaining simple structure (alphas = .94 and .95 respectively). A balanced time perspective predicted higher scores on both measures of well-being replicating the original J.D. Webster (2011) findings. A chi-square analysis indicated, as predicted, that the percentage of younger adults tended to be higher in the future-focused category, and the percentage of older adults tended to be higher in the past-focused category. Implications of a balanced time perspective on mental health over the life course are discussed.

This study explored various dimensions of generational relationships between older parents and their adult children using the second wave of SHARE (Survey of Health, Ageing and Retirement in Europe), comparing it to Dykstra’s and Fokkema’s (2011) analyses of the first wave. Results were further compared to the OASIS study (Old Age and Autonomy: The Role of Service Systems and Intergenerational Solidarity). The intergenerational solidarity model served as the main conceptual framework. Analyses yielded four family relationship types present in all countries, albeit with different frequencies. Around half of the respondents in the 11 countries were identified with close ties and flow of support. Four conclusions were drawn: (1) importance of personal resources; (2) cultural differences and meanings for families; (3) highlighting within-country difference; and (4) strength of intergenerational solidarity. The importance of understanding generational relationships in the current era with higher longevity and changing family structures is emphasized and explicated.

The literature on patient-physician interactions has largely ignored the perspectives of older adults with multiple morbidities. Featuring in-depth interview data from 16 men and 19 women with an average of six chronic conditions, this study focused on how participants perceived and experienced the care provided by their primary care physicians. Participants suggested that physicians caring for patients with multiple chronic conditions should be thorough, amenable to gate keeping, trustworthy, and open to different decision-making styles. However, many study participants perceived that they received inadequate care due to the personal failings of their physicians, constraints of medical consultations, and societal ageism. Consequently, many of the participants, especially the women, employed various strategies to maximize the care they received and manage their physicians’ impressions of them as worthy patients. Our findings suggest that elderly patients with multiple morbidities perceive that their health needs are not being adequately met.

Dementing illnesses, such as Alzheimer's disease, cause great changes in individuals – sometimes even leading us to say that they are “different persons”. Professional caregivers to these individuals may better understand them and their suffering (and thus provide more compassionate care), if they look at the illness in the context of the individual's life. Although their personhood has been threatened by dementia, appreciating the gestalt, or integrity of their lives may help preserve it. The clinical focus, which currently looks only at problems, should also assess the individual's remaining strengths, positive functions and characteristics. A case scenario helps to illustrate these suggestions. Some recommendations to researchers, clinicians and bioethicists for further study in this area are included.

Physical activity has been linked to positive health outcomes for frail seniors. However, our understanding of factors that influence the physical activity of residents in the long-term care (LTC) setting is limited. This article describes our work with focus groups, one component of a multi-component study that examined factors influencing the physical activity of LTC residents. Residents, significant others, and staff from nine LTC facilities participated in these focus groups. Analysis of group discussions revealed three themes reflecting factors that mitigate the provision of physical activity: (a) inadequate support for physical activity, (b) pervasive institutional routines, and (c) physical environment constraints. All participants considered physical activity important to health preservation. Individual, structural, and environmental factors affected the quantity and quality of physical activity accessed by residents. These findings confirm the need to develop practical strategies and ways to address modifiable barriers and embed physical activity into LTC systems of care.

This study explored qualitatively how residents of long-term care (LTC) facilities feel about and adapt to the care they receive. We interviewed and observed a purposeful selection of elderly residents in seven facilities purporting to provide person-centred care. Interpretative descriptions from 43 personal interviews with 23 participants answered the question: How do residents perceive the care rendered in LTC facilities purporting to offer person-centred care? Three themes emerged: (1) the caring environment; (2) preservation of dignity; and (3) maintenance of personal autonomy. Participants were sympathetic to the nursing staff’s workload, but felt distant from the staff. Participants gave examples of poor care and lack of empathy, human indignities, and violations of personal autonomy caused by institutional policies they felt inhibited their ability to receive care based on their preferences. Overall, they challenged the claims of person-centred care, but adapted to cope with an environment that threatened their dignity and autonomy.

This study involved the longitudinal trajectories of loneliness with aging and models the effects of relevant risk factors. Data came from the second to the sixth waves (2004/5 – 2012/13) of the English Longitudinal Studies of Ageing (ELSA). Respondents who participated in at least two waves and offered valid responses to the UCLA three-item loneliness scale were included (baseline n = 9,171). Although statistics describing the inter-wave changes confirmed the longitudinal stability of loneliness among older people, serious attention should be paid to the small percentage of older people who are “longitudinally lonely”. Self-reported health and relations with spouse and children were significant risk factors, and it was the change of closeness to spouse rather than the loss of spouse that most affected the change of loneliness scores. Future research should aim to identify personal and social events that make older people lonely over a long period of time.

This study was aimed at providing normative data for the Mini-Mental State Examination (MMSE). The norms were built from a sample (n = 2409) of community-dwelling French speaking residents from Québec aged 65 and older. The analyses indicated that socio-demographic variables such as education level, age, and gender of individuals influenced significantly the scores of older adults on the MMSE. More precisely, MMSE scores increased with education level and decreased with age. Moreover, women had significantly higher scores than men. On this basis, distinct tables of normative data were produced for women and men. In each table, the MMSE scores corresponding to percentiles 5, 10, 15 and 50 were identified according to four age categories and three education levels. Overall, the use of the present normative data by clinicians will improve their accuracy in detecting cognitive impairment in older adults from Québec.

Calls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

Falls represent 40 per cent of hospital accidents, and consequences range from none to serious injuries. The purpose of this study was to estimate the average hospital cost and length of stay (LOS) associated with serious injurious falls in an acute care hospital. We used data from risk management and case costing databases to identify cost associated with a serious injury after an in-hospital fall. Thirty-seven injured patients were matched with 2,113 controls by the most responsible medical diagnosis, age, and gender. Cost and LOS were compared using t-tests and multivariate regression. Average costs for seriously injured fallers and non-faller controls were CAD$44,203 and CAD$13,507, while LOS was 45 and 11 days respectively. Hospital cost for a seriously injured faller was $30,696 (95% CI: $25,158 – $36,781) greater than the cost for a non-faller. Hospital managers have a leading role in creating system-wide falls prevention programs and reducing hospital costs.

Nursing homes have become complex care environments where residents have significant needs and most have age-related dementia. Building on research by Hirdes et al. (2011), we describe a resident profile in a representative sample of 30 urban nursing homes in the prairie provinces using Resident Assessment Instrument – Minimum Data Set 2.0 data from 5,196 resident assessments completed between 1 October 2007 and 31 December 2011. Residents were chiefly over age 85, female, and with an age-related dementia. We compared facility support and related services and resident characteristics by province, owner-operator model, and number of facility units. We observed differences in support and related services by both unit count and province. We also found that public facilities tend to care for residents with more demanding characteristics: notably cognitive impairment, aggressive behaviours, and incontinence. No clear trends associating the number of units in a facility with resident characteristics were observed.

This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents’ perceptions of end-of-life comfort, sharing information about a fellow resident’s death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.

Senescence is a time of decline; yet many seniors remain active and engaged into very old age. How and why do some seniors live long and keep well? We report the responses to this question from a representative sample of 2,783 Canadian seniors.

Overall, seniors placed primary responsibility for their long lives on their own individual practices, citing keeping active and maintaining good nutrition as the major themes. Physical illness was less significant than the will to adapt to illness and avoid further physical decline as long as possible. Francophone and anglophone respondents differed in the frequency with which they mentioned many of the themes. Francophones focused on life quality and family, while anglophones focused on the self. Systematic gender differences were also identified. Many responses validate existing theories of successful aging, and indicate that Canadian seniors are well-informed, insightful participants in the process of growing old.

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff – disproportionately present in publicly owned facilities – were associated with lower transfer rates. A number of other facility organizational characteristics – unrelated to ownership – were also associated with transfer rates.

The primary purpose of the present investigation was to evaluate the effects of exercise on simple cognitive performance and on psychological well-being in persons over fifty years of age. A secondary purpose was to assess the relationship between a set of subject variables and drop-out from fitness programs. Twenty-nine new and 37 active volunteers from the St. John's 3F fitness club for persons over fifty years of age served as subjects. Initial assessment on fitness and psychological measures was carried out within three weeks of the start/restart of the program. A second testing took place six months later. Significant pre/post differences were obtained on measures of reaction time, flexibility, balance, extra program activity, and digit symbol performance. Group by pre/post effects also reached statistical significance for psychological well-being. These results suggest that the beneficial effects of exercise are not limited to physical fitness variables, but may extend to cognitive and personality processes.

This study aimed to identify factors affecting older adults' quality of life in urban environments and to compare older adults' and professionals' perspectives on the issue. Eleven focus groups were conducted (eight involving older adults, three involving professionals), each discussing a wide range of issues related to determinants of health and quality of life. The most salient themes were health and independence, financial security, social integration, health care services, housing, accessibility of community services, and decision-making power. Older adults' and professionals' comments strongly converged, with specific issues also raised by each. Older adults provided the richest and most in-depth data on intrapersonal factors, such as personal growth, personal qualities, and spirituality. Professionals discussed community environment issues in greater depth. Health promotion interventions to maximize older adults' quality of life are needed. These results contribute to building a knowledge base to guide such efforts, by identifying a variety of possible intervention sectors for future programs.

This research explores factors which differentiate non-institutionalized elderly persons living alone, living only with a spouse, and living with other persons (with or without a spouse present). Special attention is devoted to the measurement and investigation of several social norms and personal preferences. These factors are organized in terms of a decision-making framework developed from micro-economic and demographic theory. Choice of a living arrangement is seen as the product of underlying norms and preferences, a set of socio-demographic factors, and constraints on choice. This research relies on data from 454 personal interviews drawn from a stratified random sample of persons 65 and over living in private households in London, Ontario, Canada.

Data analysis indicates that the decision of whom to live with is complex and is influenced by a large group of variables. However, the most important factors are the social norms and personal preferences of the respondents. Of these, a preference for independence and privacy surfaces as the strongest predictor of living arrangements. Being able to do what one wants without outside interference in conjunction with a private living style tends to be viewed by older persons as very important household ‘goods’. The expected separateness of the elderly, age segregation or differentiation, and kinship obligations and ties were found to be influential social norms affecting living arrangement decisions. The analysis also suggests that the constraining effects of domestic competence, physical strength and mobility, and availability of kin for co-residence are also important. In addition, several socio-demographic variables including age, sex and ethnicity arise as significant predictors of living arrangements.

Early detection of dementia is essential to guide front-line health care practitioners in further clinical evaluations and treatments. There is a paucity of literature assessing the effectiveness of screening tools to predict the development of dementia, thus we conducted a systematic review to fill this gap. The purpose of the systematic review was to make recommendations to health care practitioners on which screening tool best predicts the development of dementia and is most feasible in the primary care setting. Ten databases were searched for relevant articles, yielding 751 papers. Of these, 12 met relevance criteria for inclusion. Screening tools were assessed for test accuracy, cognitive domain coverage, predictive ability, and feasibility. Four screening tools were recommended. Addenbrooke’s Cognitive Examination (ACE) was considered to be the ideal tool. A revised version of this tool is now used in clinical practice but the psychometric properties of the ACE-R remain to be established.

To determine if the post-operative experience of elderly and younger patients is different, data were collected from 41 elderly patients (65 years and older) and 249 younger patients (under 65 years). Pain and anxiety were assessed on days two and three post-operative. Anxiety was also measured pre-operatively. Amount of analgesic ordered and given, and time of last analgesic prior to pain assessment were recorded. Significant differences were found in the number of analgesics given, with the elderly receiving fewer analgesics. There were no significant differences in pain intensity levels. In both age categories patients were given less analgesic on the third post-operative day, regardless of pain intensity. The two groups chose almost, identical pain descriptors. In both groups strong associations were observed between post-operative anxiety and pain, but pre-operative anxiety seemed unrelated to post-operative pain levels. It was concluded that health care professionals manage pain similarly for both younger and elderly patients, but the elderly require less analgesic for pain control.

Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis explores the enactment of multiple roles for family members providing home-based palliative care to seniors with advanced cancer. Family members had multiple expectations to provide care but felt their expectations of services were unmet. The process of enacting multiple roles was depicted by three interrelated themes: balancing, re-prioritizing, and evolving. Positive and negative health responses resulted from attempts to minimize personal health while simultaneously maintaining health. “True” family-centred care was found to be lacking, but should be a goal of health professionals involved in end-of-life care.