Increasing emphasis is being placed on the need to have older adults, their families and formal service providers work together collaboratively or “in partnerships” to provide long-term care, both in community and residential care settings. There is therefore a need to determine how such relationships are currently structured. This paper systematically reviews the results of studies published from 1985 through 1998 on relationships involving self-, informal and formal care within these settings. The findings suggest that formal services are not used to displace or substitute for informal care but rather, that formal services tend to be used to supplement and complement the care provided by the informal network. This is true both in community and residential care settings. Exactly how these partnerships are structured and the relationships between self-care and both informal and formal systems of care are less clear. The findings point to a need to refocus attention away from the creation of partnerships and protecting against unnecessary substitution, towards broader concerns with supporting the partnerships that already exist.

Critical, language-based analytic approaches offer tools to explore how we use language to construct identities, roles and relationships, to represent realities, and to challenge or support existing social orders. In this paper we use language-based analyses to explore the issue of work and eldercare. We identify the epistemologies, mechanics and insights of three language-based approaches: functional grammar, discourse analysis, and deconstruction. The texts analysed are drawn from depth interviews with male and female managerial level employees in Southern Ontario who provide care for aging relatives. Analyses target (1) managers' reactions to the “eldercare” label and (2) how managers balance work commitments and caregiving commitments. We focus on managers because their role in eldercare has received little attention in either the organizational or the gerontological literature; and yet they may be in a position to effect institutional change.

Fostering independence amongst people over 65 years of age, over 80 per cent of whom have medical conditions, presents many challenges to policy personnel, program planners, and service providers, as physical, social, and psychological dimensions of independence must all be considered. This paper presents a systematic literature review and synthesis of 65 rigorous, comprehensive research papers selected from 238 published studies on care delivery approaches relevant to promoting the independence of older persons. This evidence suggests the merits of exercise and health promotion programs for all seniors, and in-home geriatric health care management and fall prevention programs for frail older persons. Findings also indicate the need for more attention to policy on assistive devices, and the need for more research on the effectiveness of public health programming, on strategies to enhance preventive medical care, and onpsychosocial factors which affect seniors' self-efficacy.

The prevalence, risk factors, and medical conditions associated with seeing and hearing disabilities were examined among Canadian adults aged 55 years and older. A probability sample of respondents from the 1986 and 1991 Canadian Census were selected to complete the 1986 and 1991 Health and Activity Limitations Survey (HALS). Seniors, 65 years and older, were more likely than 55–64 year olds to experience a sensory disability. Men were more likely than women to report having hearing disabilities, while women were more likely to report seeing disabilities than men. Increased age and lower total household incomes were associated with a greater likelihood of having a sensory disability. Cataracts and deafness were reported most often as the cause of seeing and hearing ADL restrictions in both age groups. Sensory disabilities are prevalent conditions among older adults. Public health initiatives should focus on hearing and seeing disabilities particularly among seniors, women, and the lower income level population.

Patients and professionals have difficulty communicating with one another about prescriptions and alternative therapies. The aim of this research was to investigate and contrast 714 seniors and health-professionals' perceptions and communication about the above mentioned health products. First, intensive face-to-face, ethnographic interviews with health professionals and seniors were conducted to elicit relevant issues of concern. Second, focus groups were used to evaluate the issues and wording of question probes developed initially. Third, a survey established associations and predictive validity of variables found in the first two phases. Highlights from the emergent themes include different perceptions of (a) the value and usage of alternative therapies, (b) information adequacy about prescriptions and alternative therapies, and (c) communication about prescription misuses and alternative therapy use. Seniors and professionals suggested insights for improving clinical practice.

Drawing from life course theory, this article examines gender differences in formal assistance among functionally dependent Dutch older persons within five distinct marital history groups – first-married, never-married, divorced (not remarried), widowed (not remarried) and the remarried. Hierarchical logistic regression analyses are performed for each of the marital history groups to test hypotheses regarding the interrelationships among gender and three sets of variables: 1) measures of age and functional health; 2) measures of socio-economic status; and 3) measures of the social network. The results indicate gendered patterns of formal help use among the first-married, never-married and widowed. Consistent with other studies, older first-married women are approximately three times more likely to receive formal help than are men, a difference that remains robust after statistically controlling for other factors, including frailty of spouse. However, we also find that never-married women are about one-third as likely to use formal help than are never-married men, which may be reflective of different preferences regarding formal service use. Among the widowed, we find that men with poorer functional health are more likely to receive formal help than are their female counterparts, suggesting contrasting patterns of help-seeking behaviour and social vulnerability. Additional differences are observed among the marital history groups in terms of the other independent variables, which are also interpreted from a life course perspective.

We establish the potential for outcomes evaluation of a long-term care population-based dataset. Data come from the Health Care Financing Administration's case-mix and quality demonstration project including all Medicare/ Medicaid certified homes of five U.S. states during 1992–1994. Using the Minimum Data Set, we identified nearly 70,000 residents over 65 years of age with congestive heart failure. We provide a preliminary analysis of pharmacotherapy of congestive heart failure and its effects on decline in physical functioning. Functional outcome, expressed as the rate of ADL decline, was improved for patients on combination therapy relative to those on digoxin or ACE-inhibitors alone. The availability of a population-based data set provides a means of evaluating current policies and practices.

This article examines to what extent the presence or absence, adequacy or inadequacy of formal services impacts on the work trajectory of caregivers to elderly relatives. The article is based on a qualitative study with 20 employed caregivers' whose elderly relatives received homecare services from one of two Montreal CLSCs: Results reveal the key role played by formal services in caregivers' attempts to juggle caregiving demands with those of their employment. They illustrate how the presence or the insufficiency of these services, their adequacy or inadequacy, combined with the other accommodations which caregivers put into place, can be determinants in caregivers' decisions to continue working and in their capacity to function well in the work place.

Most care of older, ailing or disabled people within the home is carried out by a spouse. This paper examines late life marriage and the gendered consequences of caring for older married people in England. Qualitative interview data are analysed to contrast the sense of autonomy of older men and women while caring for a spouse and after widowhood. By encouraging older people to reflect retrospectively on the meaning of their caring roles, we illuminate the process of adjusting to transitions after long-term marriage. The research data indicate that gendered roles and expectations are crucial in understanding the mainly negative experience of older women as carers, in contrast to the more positive experience of older men.

This research investigated the prevalence of depression among the elderly Chinese in Canada. The respondents totalled 96 randomly selected elderly Chinese living in Calgary. A 15-item Chinese version of the Geriatric Depression Scale was used as the depression measure. Results show that among the respondents, 9.4 per cent were mildly depressed and 11.5 per cent were moderately to severely depressed. The overall prevalence rate of depression in the elderly Chinese is higher than that of the general elderly population in Canada, but lower than that of the elderly Chinese in the United States. Findings from regression analysis show that having more illnesses, having lived in Canada longer, not knowing English, being younger in age, and having poor physical health are the significant predictors of depression in the elderly Chinese. The results indicate the mental health needs of this group of ethnic elderly. Other research and practice implications of the findings are also discussed in the paper.

The goal of this literature review is to identify key issues in the patterns of medical care utilization of services for seniors as a contribution to the National Consensus process on designing and delivering health care reforms which foster seniors' independence (Shapiro & Havens, 2000). A search strategy used to identify the relevant literature since 1985 focussing mainly on peer-reviewed journal articles is described and the results of the search strategy are summarized. Key articles are identified, analysed and synthesized based on Canadian and American evidence covering patterns of institutional care, physician use, ambulatory care and the determinants of utilization of these services.

Prior to the past decade, much research examining outcomes of home care programs, including efforts at delaying institutional placement, maintaining function, and supporting independence, was atheoretical in character. Outcomes hoped for were often unobserved. New policy developments require comprehensive assessment of need and aggregation of this assessment information. As more and more patients leave hospitals with complex clinical problems and extensive rehabilitative goals there has been a corresponding explosion of home care services. Social care models, while they still exist, are becoming a smaller component of the overall home care market. In this changing environment, questions are now being asked concerning the appropriateness of the care programs in home care and other post-acute care settings. There are also concerns that need to be addressed about movement of clients between post-acute settings. In this paper, we describe a set of proposed functional, behavioural, and social outcome measures that are germane to evaluating the efficacy of programmatic efforts within the post-acute continuum. Data were collected with a standardized data collection instrument, the Resident Assessment Instrument for Home Care (RAI-HC). We provide data summarizing these proposed outcomes and evidence of known groups validity in a cross-national sample of home care clients. Data highlight the differing characteristics of clients across these agencies and provide evidence that this standardized data collection instrument can capture data that is reliable and valid for describing populations and evaluating program effectiveness.

This paper investigates socio-demographic, family structure and other factors that predict men's filial care involvement. The concepts guiding this investigation are related to family obligations or motivations to provide care — commitment to care, legitimate excuses, and caring by default. Data for this research come the Work and Eldercare Research Group of CARNET: The Canadian Aging Research Network. This work is based on a sample of 772 men who provide assistance to older parents or parents-in-law. Overall, findings demonstrate the value of the conceptual framework for explaining variations in men's care. For example, distance constraints and the commitment of young children, appear to be legitimate reasons for less care involvement. Further, living nearby and being without siblings may “default” men into being more involved in care. This research recognizes men's filial care as a more complex issue than a ‘gender difference’ focus on caregiving has allowed.

Increasing expenditures for prescription drugs have placed seniors in the spotlight of health reforms because they are the main users of prescription drugs. Substantial improvements could be made in the utilization of prescription drugs that would enhance the benefits of therapy, and minimize adverse effects, particularly for seniors. A variety of problems have been documented, including the over- and under-use of drug therapy, prescribing errors, treatment compliance, and cost-ineffective prescribing. Health care system policies, selected physician and hospital-based pharmacist interventions, and decision-aids and compliance aids have been shown to be effective for components of the problem. Integration of key policies and interventions into a comprehensive solution for optimal drug use is needed. This will include: (1) revision of policies guiding the relationship between the drug industry and health sector, (2) regulations requiring adequate drug testing in seniors for drug approval, (3) a Consumer Health Institute to provide a central objective resource for patient information and decision support systems, (4) integrated clinical information systems to support prescribing, dispensing and drug and disease management systems for pharmacists and primary care physicians, and (5) reforms in medical training and licensure.

If many efforts have been undertaken by the scientific community in the last years to better understand the interactions between seniors and their informal support network, understanding of their reciprocal relations remain incomplete. In a context of “young” and “old,” where the later group is becoming larger, coexist longer because of increased life expectancy, and where the redistribution of public resources seems to favour seniors, the private inter-generation solidarity takes on considerable importance. These solidarities are especially expressed by helping each other, and this varies depending on the actors involved. This article attempts to describe the orientation and the content of the reciprocal relationships of seniors and to identify the principal determinants of such relations in Quebec. The data come from the Survey of Aging and Independence study undertaken by Statistics Canada in 1991. The results show that about two out of five seniors have this type of relationship and most often with their spouse. For individuals who no longer have a spouse, children, and particularly a daughter become privileged partners. This study also shows that exchanges of help with friends and/or neighbours prove to be essential when seniors live alone. These actors could even become essential in the future for the upholding of the autonomy of these “grandpa-boomers” who are less well surrounded in later life in terms of descendants than the seniors of today. Finally, very old men with small incomes, living alone in an urban setting and with few or no surviving children are the least likely to experience reciprocity with their entourage.

The nursing home case-mix classification system, Resource Utilization Groups Version III (RUG-III), has been tested and refined for long-term home care clients. The study sample included 804 individuals seeking home care through the Michigan Care Management Program or the Home and Community Based Waiver for the Elderly and Disabled. Clients were classified, and RUG-III models were derived using the Minimum Data Set for Home Care (MDS-HC). A refined home care model, RUG-III/HC, was developed incorporating Instrumental Activities of Daily Living (IADLs) to the nursing home RUG-III classification. The model explained 33.7 per cent of the variance of per diem cost, using cost weighted formal and informal care as the dependent variable. Resource use within groups was relatively homogeneous. The case-mix index (CMI) of weighted formal and informal care time spanned an eight-fold range. Further analysis is suggested regarding the inclusion of informal care as a cost in case-mix classification for long-term home care clients.