Data from the Canadian Labour Force Survey (1997) reveal that relatively few mid-life women offer ill health as a reason for leaving their job or downshifting to part-time employment, implying that the role of ill health may be inconsequential in effecting changing patterns in mid-life women's labour force activity. In contrast, interviews with 30 mid-life women (aged 40 to 54 years) illustrate that, although they do not offer illness as their main reason for leaving their job or working part-time, health is a determining factor. This research also maps the complex relationship between work and ill health, showing that stressful working conditions (due to funding cuts and policy changes) affected the mental and physical health of this group of mid-life women, which, in turn, influenced their decision to change their labour force activity. The author concludes that policy makers must recognize that ill health may be under-reported among mid-life women in large surveys and that research is needed that specifically examines women's working conditions as they relate to health. Such research should not be based solely on large surveys but must also include qualitative studies that capture women's experiences.

Due to increasing life expectancy over time, persons who live into their nineties, known as nonagenarians, are an important and growing segment of the Canadian population. In 2001, there were 130,325 nonagenarians (compared to 3,795 centenarians), and it is estimated that they will top 400,000 by 2026. This paper provides a health profile and an exploratory analysis of selected social determinants of health for community-living nonagenarians, using the 2001 Canadian Community Health Survey (Statistics Canada, 2003). Perceived health, a selection of prevalent chronic illnesses, and several health behaviours are examined. One dominant pattern is the tendency for male nonagenarians to be in better health than their female counterparts. This finding is consistent with research on centenarians and is discussed in terms of a mortality selection effect. Other key findings include the strength of sense of belonging, income, and physical activity as potential social determinants of health, connected to particular dimensions of health status.

Early differential diagnosis of dementia is becoming increasingly important as new pharmacologic therapies are developed, as these treatments are not equally effective for all types of dementia. Early detection and differential diagnosis also facilitates informed family decision making and timely access to appropriate services. Information about gait characteristics is informative in the diagnostic process and may have important implications for discriminating among dementia subtypes. The aim of this review paper is to summarize existing research examining the relationships between gait and dementia, including gait classification systems and assessment tools, gait patterns characteristic of different dementias (Alzheimer's disease, vascular dementia, dementia with Lewy Bodies, and fronto-temporal dementia), and the utility of gait analysis in early-stage diagnosis. The paper concludes with implications for future research.

Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n = 29) and volunteers (n = 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS© inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (≥80%) for most items but was higher among volunteers than between volunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

Research has shown that mothers often differentiate among their adult children in terms of closeness and support; however, studies have not addressed why some mothers report preferences among children and others do not. To distinguish between mothers who do and do not report favouring some of their adult children, we used data from a within-family study in which 553 older mothers were interviewed about each of their children. Almost all of the mothers reported differentiating among their children regarding emotional closeness, confiding, or preference among caregivers. Multivariate analyses revealed that mothers' values and mother-child value similarity predicted which mothers differentiated among their children regarding closeness and confiding, whereas mothers' and children's demographic characteristics predicted which mothers differentiated regarding preferred caregivers. Black mothers were less likely than white mothers to differentiate when seeking a confidant; however, race played no role in mothers' likelihood of differentiating regarding emotional closeness or help during illness. Taken together, these findings indicate that differentiating among adult children is common; further, family-level predictors of mothers' differentiating mirror the patterns shown in dyad-level analyses of mothers' favouritism.

This study examined the relationships between culture and the health status of older Chinese in Canada. Data were collected through face-to-face interviews with a cross-sectional, randomly selected sample of 2,272 older Chinese between 55 and 101 years of age in seven Canadian cities. Health status was assessed by the number of chronic illnesses, by limitations in ADL and IADL, and by information on the Medical Outcome Study Short Form SF-36. Although cultural variables explained only a small proportion of variance in health status, having a stronger level of identification with traditional Chinese health beliefs was significant in predicting physical health, number of illnesses, and limitations on IADL. Other cultural variables, including religion, country of origin, and length of residence in Canada, were also significant in predicting some health variables. Interventions to improve health should focus on strategies to enhance cultural compatibility between users and the health delivery system.

We investigated whether frailty, defined as the accumulation of multiple, interacting illnesses, impairments and disabilities, is associated with psychiatric illness in older adults. Five-thousand-six-hundred-and-seventy-six community dwellers without dementia were identified within the Canadian Study of Health and Aging, and self-reported psychiatric illness was compared by levels of frailty (defined by an index of deficits that excluded mental illnesses). People with psychiatric illness (12.6% of those surveyed, who chiefly reported depression) had a higher mean frailty index value than those who did not. Older age was not associated with higher odds of psychiatric illness. Taking sex, frailty, and education into account, the odds of psychiatric illness decreased with each increasing year of age (OR 0.95; 95% CI, 0.94–0.97). Frailty was associated with psychiatric illness; for each additional deficit-defining frailty, odds of psychiatric illness increased (OR 1.23; 95% CI, 1.19–1.26). Similarly, psychiatric illness was associated with much higher odds of being among the most frail. These findings lend support to a multidimensional conceptualization of frailty. Our data also suggest that health care professionals who work with older adults with psychiatric illness should expect frailty to be common, and that those working with frail seniors should consider the possible co-existence of depression and psychiatric illness.

For many years there has been an underlying pathology within the literature about families with children and adults with intellectual disabilities (Helff & Glidden, 1998). This literature has emphasized stress and burden, incapacity and dependency, leading to negative stereotyping of families in this context. Over the last 2 decades research has led to some important reconceptualizations of how families approach their caring, affording an improved understanding of how they deploy strengths and resources, and who benefits. This paper reviews this thinking, arguing that it provides a suitable context for understanding the scope and form of family caregiving contributions that are less visible, and therefore less recognized. An attempt is therefore made to chart invisible contributions. It is suggested that invisible contributions have implications for thinking about human and social capital (Putnam, 2000) as well as for practice in supporting families.

Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as “the need for personalization of service”. Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

This study advances the understanding of family caregiving by examining the relationship between adult children caregivers and their helpers. Specifically, it focuses on examining “who helps whom” and extends analyses beyond the dyadic focus of caregiving in later life. The focus on helping and caregiving addresses the variety of contributions and responsibilities involving not only the caregiver who was the target respondent in this research, but also others identified as helpers in the provision of care.

The data for this study are derived from the Work and Eldercare Research group of CARNET: The Canadian Aging Research Network. Secondary analysis of CARNET data focuses on data collected from 250 individuals with significant caregiving responsibilities for at least one older person. Findings extend Kahn & Antonucci's convoys of social support model (1981) and Cantor's model of social care (1991) by disentangling some of the dimensions of helping and caregiving, such as the distinction between direct and assistive help.

This article presents the results of a qualitative study on the contributions made by volunteers from a volunteer community organization to the home care of older adults living in a rural setting. In this study, the volunteer was considered as part of a social care system made up of a number of groups (the elderly themselves, those close to them, professional health providers, and volunteers). Results show that the lines delimiting the responsibilities of these various groups are neither clear nor precise. The place of the volunteer must take into account the nature of the participation of the other groups. How far the services offered by volunteers are used depends upon the characteristics that define their contributions and on the type of relationship they develop with a given older adult.

The Functional Transitions Model (FTM) integrates the theoretical notions of progressive functional decline associated with Alzheimer's disease (AD), excess disability, and transitions occurring intermittently along the trajectory of functional decline. Application of the Functional Transitions Model to clinical practice encompasses the paradox of attempting to minimize excess disability while anticipating the progressive functional decline associated with AD. It is suggested that times of functional transition are times of decision making and opportunities for interdisciplinary collaboration to identify and minimize excess disability, for revision of goals and expectations, and for provision of support to patients and caregivers. The model also is applicable as a conceptual framework for education and research.

The Canadian population is aging and becoming more ethnically diverse. This paper focuses on South Asian immigrant seniors and examines differences in housing and living arrangements among seniors who immigrated at different life stages. We interviewed a convenience sample of 161 immigrant seniors of South Asian descent in Edmonton, Alberta, to assess type of living arrangement, type of housing and dwelling density (measured in persons per room), activity in the neighbourhood, and means of transportation. Overall, those seniors who came to Canada before the end of mid-life were more likely than those who came at an older age to drive a car and, if married, to live in a one- or two-generation family. Women were more likely than men to be widowed, have poorer English-language skills, or live with a three-generation family if unmarried, and less likely to drive a car. Most respondents were satisfied with their living arrangements, housing, and perceived safety at home and in their neighbourhood. Theoretical implications are discussed.

This study examines the decision of institutionalizing an elderly parent suffering from cognitive impairments and the various people involved in this process: the elderly person, the informal caregiver, certain family members and health and social service professionals. Based on a qualitative analysis of interviews conducted with 16 elderly people and their family networks, this study reveals the importance of considering the point of view of everyone involved. The results show that one of the main reasons behind the decision to institutionalize an elderly person is the appearance of disturbing behaviours related to his or her cognitive impairments. Diverse strategies used by family members and health and social service professionals in order to bring about the institutionalization of an elderly person when he or she is opposed to it are presented as well as the ethical dilemmas this raises. We conclude with a presentation of research and intervention recommendations.