Many individuals have tube feeding implemented in the end stages of life. It is also common to have surrogates making life support decisions for others. When family members are placed in the role of decision-maker for an incompetent patient, what factors influence life support decisions? A case study and ethnomethodological inquiry provide an in-depth understanding of factors that influenced one daughter in her decision to have tube feeding implemented for her incompetent and severely debilitated mother. The decision was difficult and constituted a time of crisis. Unfortunately, the most influential factors in decision-making were: (a) urgency in the face of impending death, (b) lack of insight into the mother's values and preferences in relation to life support through tube feeding, (c) lack of knowledge over what tube feeding involved, and (d) the belief that tube feeding would not prolong her mother's life and suffering. Nine other, less influential, factors were also found. Improving the sensitivity of health care professionals to the agony of decision-making and to the decision-making process for life support are the major focuses of this paper.

This research evaluates the time competence of the aged in relation to sex, age, living environment, activities, health, and socio-economic status. One hundred and sixty subjects answered a socio-demographic questionnaire. Level of time competence was evaluated by the time competence subscale of the Personal Orientation Inventory (POI) (Shostrom, 1966) and by the estimate of an interval of 40 seconds (Newman, 1972, 1976). Analysis of variance shows that level of time competence varies according to age, satisfaction in the number of activities, subjective assessment of health and living environment. These results show the possible importance of objective health in the evaluation of the time competence. In fact, subjects from the 65–75 age group living in institutions show more physical deterioration than the other subjects and less time competence. For the older subjects, time competence does not differ according to the life environment. It would therefore be important, in further studies, to take this variable into account. These results and those of earlier studies reveal that the personnel have to take into account the rate of activities imposed on the beneficiaries by their health condition when developing programs of activities because time competence also varies according to satisfaction with the number of activities. The results also cast a doubt on the sensitivity of the estimate of this particular time competence measure requiring an interval of 40 seconds.

Caregivers of demented patients are under significant stress along with physical, psychological or social problems. Standardized and validated instruments are required for measuring consequences of caregiving or efficacy of support interventions. Reliability of French translation of these instruments has to be verified in order to confirm their psychometric properties. The goal of the present study is to assess reliability of the French translation of three instruments designed for evaluation of caregivers of demented patients. The Zarit's Burden Interview (BI) is a 22-items scale measuring the subjective burden of the caregiver. The Revised Memory and Behavior Problems Checklist (RMBPC), a 53 item scale, measures frequency of memory and behaviour problems of demented patients and the caregiver's reaction to these problems, which is another mean of burden assessment. The Alzheimer's Disease Knowledge Test (ADKT) assesses knowledge of caregivers about demented diseases and resources available using 20 multiple choice questions. A reliability study was conducted on a sample of 40 caregivers. The caregivers were questioned twice, the second time after one (N = 26) or eight (N = 14) weeks. The BI internal consistency (Cronbach alpha) yielded a coefficient of 0.85 and test-retest reliability (intra-class correlation coefficient) was 0.89. The RMBPC's Cronbach Alpha was 0.93 for frequency and 0.94 for reaction. Intra-class correlation coefficients were 0.77 (frequency) and 0.90 (reaction) for RMBPC and 0.71 for ADKT.

Statistics concerning the aging of Quebec's population raise the question of the changes in the lifestyle of elderly people. What do these people do? What trends are emerging in the ways in which they occupy themselves? Are there constraints to the practice of some activities? To answer these questions, we have prepared a summary of many documents collected during a research project on the leisure activities of Quebec's elderly. These documents show that Quebec's elderly are in a better financial position today, retire earlier from work and are more active than their predecessors. Rates of participation in most physical, cultural and educational activities, in volunteer work and the proportion of elderly people who travel have increased during the 1980s. Thus, it seems that leisure is now a fundamental dimension of the life of these people. But elderly people cannot do all the activities they would like because of constraints which limit or prohibit them. If these constraints were eliminated, elderly people would be more active. Researchers should therefore continue to study changes affecting the pattern of activities of elderly people and at the same time, social practitioners should help them to remain active as long as possible.

A census was taken on 26 long-term care facilities in the Ottawa-Carleton Region comprising 3, 825 residents to estimate the point prevalence of cognitive impairment or dementia. Nurses familiar with the residents identified those who had either memory impairment or dementia (according to DSM III criteria). A validation of the data obtained through the census was carried out on a stratified, random sample of residents. The long-term care facilities were stratified by level of care and by size. From each of the three strata, 11 facilities were randomly selected then a 10 per cent random sample with replacement (411 residents) was determined. The validation survey consisted of interviewing residents using two screening instruments, interviewing the nurse using two behavioural instruments and a chart audit. On the census the prevalence for cognitive impairment in the surveyed group was 67 per cent compared to 61 per cent for the whole resident population. The sensitivity and specificity for cognitive impairment was calculated at 84 and 70 per cent respectively. The prevalence of dementia in the surveyed group was 61 per cent compared to a census estimate of 52 per cent for the whole resident population. The overall sensitivity of the census for dementia was 95 per cent and the specificity was 83 per cent. The results indicated that a census undertaken with standardized definitions, by knowledgeable staff directly involved with patient care is a reasonably effective method for estimating the prevalence of persons with dementia in long-term care facilities.

The goal of the study was to investigate the issue of informed consent for mental capacity. Seventeen clients referred to the Competency Clinic at the Baycrest Centre for Geriatric Care were interviewed after the assessment had been completed. Their responses to questions regarding the reasons for and possible consequences of the assessment indicated a range of understanding and of capacity to give informed consent. The results are discussed in terms of the appropriateness of having a fairly low threshold for informed consent in situations where other capacities are already in question.

Based on a hypothesis that the cause of Alzheimer's Disease (AD) is multifactorial, we explored the possible links between the geographical distribution of 102 subjects diagnosed as “definite,” “probable” or “possible” cases at the onset of the disease and the social ecology of the Chicoutimi-Jonquière (CJ) urban area in the Saguenay region of Québec. We were also interested in the level of education of the 74 “definite” and “probable” cases. The use of factor analysis (principal components) and cluster analysis (Ward method) made it possible for us to identify socioeconomic zones and homogeneous social areas in CJ. The first results indicate that on the one hand, the male/female ratio of the cases differs statistically from that of the at-risk age group in the general population. The disease affects more women than men. On the other hand, there is significant social differentiation in CJ. Nevertheless, the 102 subjects are randomly distributed among the three socio-economic zones as well as among the eight social areas. Analysis of the geographical distribution of “definite” and “probable” cases also suggests a random distribution. The random nature of the distribution of subjects is confirmed by a very strong correspondence between the distribution of cases observed when counting them by enumeration area or census tract and Poisson's theoretical distribution. There was a significant difference between the subjects' level of education and that of the 65 years old and over in the reference population. A more in-depth case-control study might shed more light on this aspect.

The book is a vigorous analysis for the defense of the several programs constiting the American Welfare State. It certainly represents one of the strongest and most meaningful counter critic of the conservative critics of social programs during the last 15 years. The book belongs to an ongoing political analysis current which stresses that, for a nation, in order to compete within the new world economic order, public policies have to be extensively developed and supported, especially in the field of manpower training, universal health services and fair pension levels for retired persons. Consequently, the politics of less and less State intervention clearly runs counter to the ability of a nation to address the challenges posed by a worldwide economy.

There has been a long-running debate over the welfare state between its opponents and protagonists for decades, not only in the United States, but in all advanced western democracies. The authors of this publication simultaneously defend the positive effects of the welfare state and offer an analysis of the reasons for the suspicion of public opinion on the subject. But the debate over the welfare state crisis can best be analysed, in light ofF. Ewald's work, not as an avatar, but as representing an episode in the system's very means of reproduction.