Resource Utilization Groups III (RUG-III) is a case-mix system developed in the United States for categorization of nursing home residents and the financing of residential care services. In Hong Kong, RUG-III is based on several board groups of residents. The aim of this study was to examine the reliability and validity of the RUG-III in Hong Kong nursing homes. A cross-sectional survey was conducted in seven residential facilities operated by one agency. Residents (N=1,127) were assessed by the Minimum Data Set (MDS) and nursing as well as auxiliary staff care times were recorded within 2 weeks before or after the completion of MDS assessment. Forty-five out 1,127 residents were re-interviewed by an independent assessor to assess the inter-rater reliability. The inter-rater reliability of MDS assessment was excellent (κ=0.76) and the original RUG-III accounted for about 30 per cent of nursing staff time. Results provide preliminary evidence to support that RUG-III is a reliable and valid case-mix system for Hong Kong nursing homes, but future studies must be explored to reduce the variance of resource use explained by this case-mix system.

In response to the contradictions appearing between, on the one hand, government promotion of family caregiving for elderly parents and, on the other, the rise of autonomist values (as documented in the literature), we surveyed a number of elderly people living with disabilities about the kind of assistance they would like to receive. The present qualitative, thematic analysis is based on the accounts given by 19 elderly people who receive assistance. The findings show that the position of elderly people with respect to their desire to receive (or not receive) substantial assistance from their family rests on a set of values, wishes, and/or fears – including, particularly, adherence to the value of autonomy, the desire to respect freedom (one's own as well as that of others), adherence to norms of familial duty, attachment to one's home, the value placed on solitude and privacy, and the degree of emotional closeness between the elderly and their children. Access to quality formal services also stands out as a factor enabling elderly people to actualize the desire for care which they elicited within the framework of this analysis.

The vast majority of the 220,000 Canadians who die each year, principally of old age and progressive ill health, do not have access to specialized hospice or palliative care. Hospice and palliative care programs are unevenly distributed across Canada, with existing programs limited in capacity and services varying considerably across programs. End-of-life (EOL) care is defined as “The services that may be needed by dying persons and their families or friends in the last year of life, as well as bereavement services following death.” Although some health and social services may be available, most dying Canadians are in the difficult position of not having ready access to a full range of services that could ease their final days of life. Most are thus at risk of uncoordinated and potentially inadequate EOL care. Among all persons, dying persons are arguably the most vulnerable. The dying process is often difficult as a result of emotional and physical challenges. Although the loving support of family and friends for dying persons is irreplaceable, EOL care is an important public obligation. A synthesis research project was conducted to identify a best-practice EOL care model for Canada, one featuring coordinated or integrated EOL care. Through site visits, literature reviews, Web-based surveys, and a home care data analysis, four essential components for a best-practice integrated EOL care model for Canada were identified: (a) universality, (b) care coordination, (c) assured access to a broad range of basic and advanced EOL services, and (d) EOL care provision regardless of care setting. This model is offered as a guide for the development of EOL care services across Canada.

Sign comprehension is critical for effective driving, responses to warnings, and way-finding. Signs that are poorly comprehended by older people increase accident risk and may compromise independence. This study sought to determine whether iconic sign comprehension suffers in healthy aging and in the presence of cognitive impairment. Additionally, we examined whether the addition of text to iconic signage would increase comprehension in older adults. In Experiment 1, young adults, healthy older adults, and older adults with varying levels of cognitive impairment were asked the meaning of 65 signs used for driving, warnings, and way-finding. Healthy older adults were generally good at sign comprehension but had difficulty with way-finding signs. Older adults with cognitive impairment had poorer sign comprehension overall and particular difficulty with way-finding icons and signs that had icons only. In Experiment 2, healthy older adults were asked the meaning of signs containing icons only, or icons and text. A significant improvement in comprehension was found when text was added. An important implication of this work is that the assessment of sign comprehension needs to involve a broad and heterogeneous sample of older adults reflecting the range of perceptual and cognitive abilities represented in the population.

Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA–family relationships in complex continuing care (CCC). In-depth individual interviews with eight HCAs and a follow-up focus group with HCAs from three CCC facilities were analysed. Building relationships with families entailed “being there for them and their relatives”, while maintaining relationships involved “dealing with disappointments”. Factors influencing building and maintaining HCA–family relationships included “having supportive team members”, “having resources available”, and “functioning within care-team hierarchies”. The findings highlight the importance of minimizing the unit and organizational factors that disrupt HCA–family relationships.

Innovations in information and communication technologies are changing society, but only 1 in 15 Canadian seniors used a computer at the turn of the millennium (Statistics Canada, 2000). Furthermore, about 1 in 5 Canadian seniors has difficulty hearing, seeing, or communicating. The primary goal of the study was to investigate the relationship between hearing impairment and the use of information and communication technologies by older adults. A questionnaire about use of technologies was administered to 135 older adults and hearing was measured using audiometry. Hearing was found to be related to the extent of use of communication technologies, especially newer and more specialized technologies. Those with hearing loss who did not use a hearing aid did not use other technologies as much as peers with good hearing or hearing-aid users. Overall, the extent of and ability to use information and communication technologies was greater for the study sample than in previous findings for a national sample; however, the patterns of usage of various technologies and the factors influencing use were similar in the two samples. Recommendations are made for future research, health education programs, and universal design.

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.

The purpose of the present research was to examine the perceptions of risk regarding falling held by older adults and their adult children. Using a focused ethnographic approach, older adults and adult children were interviewed in depth. Thematic analysis was conducted to identify themes within groups and to compare the perspectives of older adults and adult children. Findings highlighted differences in perceptions and approaches to action between older adults and their adult children. There were three approaches to action adopted by these families, which focused around whose actions were dominant: parents' actions, shared actions, and children's secret actions. The results emphasize the value placed on independence by older adults and the impact of multiple family relations taking action to prevent falls. The present study points to the importance of including multiple family perspectives in research concerning injury prevention for older adults.

Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD).

Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out their lives in the community. Little is known about the care needs of this significant population.

Methods: This study was guided by the research question: “What are the care needs and care priorities of senior citizens with end-stage COPD?” An ethnographic qualitative approach was used to address this question. Twelve community-dwelling seniors living in a Canadian city and diagnosed with advanced COPD were interviewed three times in their homes over an eight-month period in 2006.

Findings: Three themes emerged, each with concrete care needs: (a) self-reliance and independence through adaptation, (b) stable health through maintenance, and (c) living with constraints. The predominant theme was that all participants wanted to maintain their independence. This required considerable adaptation, as well as assistance from others.

Conclusions: Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants had thought about, discussed, or formalized their end-of-life preferences), and considered, as well, whether relations existed among the three outcomes. Canadian region of residence, female gender, and more years of education predicted having thought about preferences; region of residence, female gender, and lack of cognitive impairment predicted discussion of preferences; and region of residence and not being married predicted whether formal documents were in place. Ontario residents were most likely to have thought about, discussed, and formalized their preferences, whereas Atlantic residents were least likely to. Finally, having thought about preferences was associated with discussion, and having thought about and having discussed preferences were each associated with formalization of preferences. These findings are in keeping with the position that Advance Directives (AD) execution is a multi-stage process. A better understanding of this process may prove useful for the development of interventions to promote planning for end-of-life care.

These two studies are designed to evaluate the reactions of male nurses aged 45 years and older toward ageism. The goal of the first study is to test the prestigious work domain model of psychological disengagement resulting from a previous study conducted among female nurses. This model has been confirmed through path analyses conducted on a sample of 236 male nurse technicians; by the same token, it has been shown to apply in the case of lower-status employees working in a prestigious field. In particular, the more a male nurse aged 45 and older experiences relative personal deprivation, the more he discredits feedback from his co-workers and superiors; such discrediting, in turn, leads to devaluation of the domain of work, which in turn lowers self-esteem. The goal of the second study is three-fold, namely: (a) testing the disengagement model among 419 male nurse clinicians; (b) extending this model through the addition of ageist communication as a variable triggering personal relative deprivation; and (c) constructing a scale of ageist communication. Path analyses have again confirmed that the way a domain is appreciated influences the negative impact that devaluation can produce on self-esteem, regardless of the gender or status of the employee working in that field. In addition, these results demonstrate the central role played by communication in the workplace as a vehicle of ageism and as a precursor of ageing employees' discomfort. The discussion covers the implications of ageing employees' reactions toward ageism as well as the consequences of depreciatory language and exclusionary communication practices in the workplace.

People frequently express comparative optimism; that is, they believe they are less likely than average to experience negative events. The aim of the present study is, first, to observe whether people of more than 65 years are still optimists when they evaluate driving-related risks; and second, to test the assumption that older drivers show less optimism when they compare themselves with average-age drivers than when they compare themselves with same-age drivers. Our results reveal that drivers of more than 65 years do, indeed, express comparative optimism, but, contrary to our expectation, only in a limited number of cases does the age of the comparison target appear to have an effect. These results are particularly discussed in terms of self-image enhancement.