This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age > 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group of individuals. Specifically, we took advantage of a natural experiment to compare the responses of a group of 59 ice storm victims to those of 55 matched controls living outside the ice storm area. Data on disability, pain, self-reported health, helplessness, depression, and independence were assessed prior to the ice storm and approximately 17 months later. Older adults who reported greater helplessness and lost independence prior to the storm reported significantly greater ice storm stress and rumination and were more likely to report that the storm affected their condition. In addition, participants exposed to the ice storm reported significant changes in disability and pain nearly a year and a half later, compared to matched controls. These results suggest that older adults with chronic physical illness may be particularly vulnerable when faced with additional stressful events.

This study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Coresidence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole.

The objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km 2) in the province of Saskatchewan. Long-term institutional care was provided in seven small (15 to 35 beds), publicly funded nursing homes, none of which had separate dementia special care units (SCUs). The Physical Environmental Assessment Protocol (PEAP) was used to evaluate the facilities on nine key dimensions of dementia care environments. Facilities were most supportive in provision of privacy and least supportive on maximizing awareness and orientation. Focus groups were conducted with registered nurses, nursing aides, and activity workers. Staff caregivers identified six special needs of residents with dementia that were difficult to meet in the nursing homes, two of which were related to the physical environment (safety and a calm, quiet environment) and four of which were related to the social environment (meaningful activity and one-to-one contact, opportunity to use remaining abilities, flexible policy, and knowledgeable caregivers who enjoy working with persons with dementia). Staff suggested separate dementia SCUs as one approach to managing dementia care but also identified challenges in creating dementia units in small rural facilities. Results provide support for conceptual models of dementia care settings that emphasize the interaction of organizational, social, and physical factors.

The Saskatchewan Mood Inventory (SMI) is a caregiver-focused assessment and research tool that was designed to enhance understanding of the emotional experiences of individuals with dementia and to identify relationships between level of cognitive impairment and family member ratings of pleasant and unpleasant emotional responses during daily activities. Family members were instructed to use the semi-structured written log to document prospectively the type and intensity of emotion expressed by the individual with dementia, to describe the associated emotion-evoking events or activities, and to monitor and record their own emotional reactions. Twenty-seven family caregivers recruited from Alzheimer support groups used the log consistently during a 2-week monitoring period to document an average of three emotion-evoking events per day. Average emotion ratings were more positive for individuals with moderate levels of dementia than for those with severe cognitive impairment, and caregivers' ratings of their family members' and their own emotional states were positively correlated. The event-reporting procedures produced narrative descriptions of emotion-evoking activities that were subsequently coded for content. Inter-rater reliability estimates were high. Event-category summaries are reported in association with positive, negative, and neutral emotional responses for individuals with moderate and severe levels of dementia. Level of impairment was related both to the relative frequency of positive and negative emotions and to the type of event category reported by caregivers.

Canadian health regions are required to set priorities and allocate resources within a limited funding envelope. Program budgeting and marginal analysis (PBMA) was piloted in continuing care in Claresholm, Alberta, with the aim of improving overall benefit from available resources. A marginal-analysis expert panel was used to assess options for continuing-care delivery. Inputs into the decision-making process included evidence from the literature, regional and provincial reports, program budgeting information, and local knowledge. Recommendations included implementing adult, day-and-night support programs and converting long-term beds to convalescent beds. Changes were funded through allocating provincial Broda funding and altering nursing assistant and physiotherapy activity. PBMA was demonstrated to be an effective framework in aiding decision makers with redesigning services in Claresholm. This case study is one of several which indicate PBMA to be a valuable aid to priority setting in health care service provision.

The Center for Epidemiologic Studies-Depression Scale (CES-D) is among the most widely used depression screening measures. Existing research suggests a higher-order factor structure of responses among older adults (factors labelled depressive affect, absence of well-being, somatic symptoms, and interpersonal affect, each loading upon a second-order depression factor). The current study extends this research to ascertain whether this structure is equivalent (or invariant) between the English and French versions of the CES-D. Findings suggest that the number and relative contribution of each factor is similar for both language groups. Furthermore, interpretation of CES-D items is statistically indistinguishable for 16 of 20 items within this randomly identified, national sample of caregivers of persons with dementia. Results of this study support the higher-order factor structure of this measure and provide data in support of the reliability of responses. Furthermore, findings support the use of the CES-D in cross-cultural and comparative research with English- and French-speaking adults.