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Background The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear. Methods Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort. Results Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60. Limitations Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts. Conclusions Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

Background Loneliness and social isolation are prevalent public health concerns among community-dwelling older adults. One approach that is becoming an increasingly popular method of reducing levels of loneliness and social isolation among older adults is through technology-driven solutions. This protocol outlines a research trajectory whereby a scoping review will be initiated in order to illustrate and map the existing technological approaches that have been utilized to diminish levels of loneliness and social isolation among community-dwelling older adults aged 60 years or older. We will address the question: what are the most common and less used technological approaches to reduce loneliness and social isolation among community-dwelling older adults? Methods A scoping review of Academic Search Premier, AGEline, Global Health, MEDLINE, PsycINFO, and Web of Science databases will take place using our search terms including the following: loneliness, social isolation, older adults, elderly, Aged, Aged 80 and over, program, evaluation, trial, intervention, technology, computer, information and communication technology, internet, and robot. The initial electronic search will be supplemented by reviewing the reference lists and review articles to identify any missing studies. To meet study inclusion criteria, intervention studies had to pertain to community-dwelling adults aged 60 years or older, include technological interventions, include loneliness and/or social isolation as outcome variables, and be written in the English language. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results. Discussion The information gleaned in this scoping review will be essential to understand the degree to which technological interventions influence social isolation and loneliness among older adults and identify gaps for further research.

Self-reported health is a common measure predictive of morbidity and mortality among adults. Many factors are known to be associated with self-reported health including the number of chronic conditions (i.e., multimorbidity). While the association between self-reported health and morbidity and mortality has been well-established, the factors that shape the relationship with self-reported health (e.g., modify and mediate) are poorly understood. Further, it is unknown why some older adults, despite having high numbers of chronic conditions, continue to rate their health positively. This is known as the well-being paradox. This mixed methods research study was designed to address these knowledge gaps. The objectives of the proposed research are to (1) determine what factors shape the relationship between multimorbidity and self-reported health and how they do so; (2) describe the ways that older adults define and perceive their individual health; and (3) explain the well-being paradox. Informed by a multimorbidity resilience framework, the quantitative component of research will analyze Canadian Longitudinal Study on Aging data while the qualitative component will collect and analyze interview data from 12 to 20 community-dwelling older adults using a case study design. Findings from this study have the potential to inform and advance future health intervention programs or services aimed at improving health-related quality of life for community-dwelling older adults.

Objectives To understand the experience of Metro Vancouver’s Homelessness Partnering Strategy-funded Housing First program and how it is functioning from the perspective of a representative sample of providers and clients who deliver and receive HF services. Methods Thirty-four clients and providers who currently or formerly delivered HF in Metro Vancouver participated in one-on-one interviews (n = 26) or focus groups (n = 8) between March and April 2017 and data were thematically analyzed. Results Strengths of the HF program included: the ability to transition persons from the street into housing with individualized service supports and, in certain cases, with 12-month rent subsidies, household goods, and connection to community resources. Identified program weaknesses were: eligibility criteria, limited rent subsidy funds, limited provider capacity, and workload burden. Suggested opportunities to improve HF were: streamlining federal and provincial reporting and rent subsidy systems and building friendly landlord networks. Potential threats to HF described were: limited affordable housing, stigma and discrimination toward clients, inadequate income assistance, and limited opportunity for cross-sector collaboration. Conclusions The delivery of HF in regions that have limited affordable housing presents unique challenges. Recommendations are provided to improve HF practice and policy in these contexts.

Objective:Recently, there has been a growing interest in examining forms of illness-related resilience. This study examines associations between lifestyle behavioral factors and multimorbidity resilience (MR) among older adults.Methods:Using baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 6,771 Canadian adults aged 65 or older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: cardiovascular/metabolic, osteo-related, and mental health. Associations were explored using hierarchical linear regression modeling, controlling for sociodemographic, social/environmental, and illness context covariates.Results:Among older adults with two or more illnesses, as well as the cardiovascular/metabolic and osteo-related illness clusters, having a non-obese body mass, being a non-smoker, satisfaction with quality of sleep, having a good appetite, and not skipping meals are associated with MR. However, the mental-health cluster resulted in different behavioral lifestyle associations, where MR was not associated with obesity, smoking, or appetite, but inactivity demonstrated moderate positive associations with MR.Discussion:While there are similar patterns of lifestyle behaviors across multimorbidity and multimorbidity clusters involving physiological chronic illnesses, those associated with mental health are distinct. The results have implications for healthy aging among persons coping with multimorbidity.

The care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual’s systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.

This chapter describes the development and application of a theoretical model of multimorbidity resilience, and a measure-multimorbidity resilience index specifically aimed for use in population health surveys. The Lifecourse Model of Multimorbidity Resilience (LMMR) links resources embedded in multi-level domains and elaborates key processes that occur during disruption and reintegration along a life trajectory. It furthers our understanding of resilience processes underlying the outcomes of wellness, recovery, and growth/development among older persons facing multimorbidity. In addition, a multimorbidity resilience index comprising functional, social, and psychological domains capturing both adversity and adaptation is described. The results of criterion validation of the index based on health care utilization and health status outcomes is presented, and offers support for this measure. Further confirmatory research is needed for both the LMMR and the multimorbidity resilience index using other known population health data sets. This relevance of multimorbidity resilience has been increased during the COVID-19 pandemic and beyond. Research is also warranted using different populations and sub-populations as well as clinical settings.

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.

Background Multimorbidity is recognized as a major public health issue that increases with age and affects approximately two-thirds of older people in Canada, the US, Australia and many European countries. This study develops and tests a three domain (functional, social and psychological) multimorbidity resilience composite index based on a previously developed lifecourse model of multimorbidity resilience, incorporating measures of adversity and positive adaptation. The criterion validity of the measure is demonstrated by means of an analysis of key outcome variables drawn from the literature. Methods We used the baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Associations of functional, social, psychological as well as total resilience with two health utilization and three illness context outcome variables were examined using logistic regression analyses, adjusted for age, gender, marital status, income, education, region, and number of chronic conditions. Results The sample included all 6771 Canadian adults aged 65 or older (mean age 73.0, 57% women) who reported two or more of 27 possible chronic conditions. Total resilience was associated with: perceived health (OR = 1.68, CI 1.59–1.77); sleep quality (OR = 1.34, CI 1.30–1.38); perceived pain (OR = 0.80, CI 0.77–0.83); hospital overnight stays (OR = 0.87, CI 0.83–0.91); and emergency department visits (OR = 0.90, CI 0.87–0.94)., after adjusting for socio-demographic factors, and number of chronic conditions. These associations were similar for the unadjusted models, as well as for the functional, social and psychological resilience sub-indices. Conclusions Combining components of adversity and positive adaptation within functional, social and psychological domains produces a measure of multimorbidity resilience that is associated with more positive health outcomes. Several implications of a composite multimorbidity resilience measure for clinical practice are identified. This measure can be replicated using measures found in other secondary health data sets. Future validation using longitudinal data is warranted. Electronic supplementary material The online version of this article (10.1186/s12877-018-0851-y) contains supplementary material, which is available to authorized users.

Background Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research. Methods A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy “resilience” AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term “resilience” must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results. Discussion The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research. Electronic supplementary material The online version of this article (10.1186/s13643-019-0950-7) contains supplementary material, which is available to authorized users.

The purpose of this article is to advance a Lifecourse Model of Multimorbidity Resilience. It focuses on the ways in which individuals face adversities associated with multimorbidity and regain a sense of wellness through a complex, dynamic phenomenon termed resilience. A comprehensive review of 112 publications (between 1995 and 2015) was conducted using several comprehensive electronic data bases. Two independent researchers extracted and synthesized resilience literature with specific applications to chronic illness. The article outlines five stages of theoretical development of resilience, synthesizes these with the aging and chronic illness literature, builds a rationale for a lifecourse approach to resilience, and applies the model to multimorbidity. Cultivating and maintaining resilience is fundamental to functioning and quality of life for those with multimorbidity. We found that there are a number of gaps in both basic and applied research that need to be filled to advance knowledge and practice based on resilience approaches.

ObjectivesWe aimed to develop and internally validate a measure of multimorbidity burden using data from the Canadian Longitudinal Study on Aging (CLSA).DesignData from 40 264 CLSA participants (52% men) aged 45–85 years (a mean of 63 years) were analysed. We used logistic regression models to predict overnight hospitalisation in the last 12 months in the development dataset (random two-thirds of the total) and used these to construct 10 multimorbidity indices (5 models, each treated with and without an age interaction term). Thirty-five chronic conditions were considered for inclusion in these models, in addition to age and sex. We assessed predictive and convergent validity for these 10 different multimorbidity indices in the validation dataset (remaining one-third of the total).ResultsThe absolute count of chronic conditions plus an interaction with age, displayed strong calibration properties, outperforming other candidate indices. Discrimination was modest for all of the indices that we internally validated, with C-statistics ranging from 0.66 to 0.68. The indices showed weak correlations (ie, convergent validity) with satisfaction with life, functional disability and mental health (absolute Pearson’s correlation coefficients ranging from 0.11 to 0.30) but generally moderate correlations with self-rated general health (0.32–0.45).ConclusionsWe investigated alternative methods to measure the multimorbidity burden of individuals, tailored to the CLSA. Our findings show that an absolute count of conditions, along with an age interaction term, has the strongest calibration for overnight hospitalisation in the last 12 months. The utility of an age interaction term in measuring multimorbidity burden may be applicable to the study of chronic disease in cohorts other than the CLSA.

This paper attempts to elucidate the dynamics and inherent tensions of population aging as it relates to age-period-cohort changes in health status and health care utilization, and attainable system-level transformations. Using the Canadian context, we specifically address three interlocking problems: 1) the paradox of increasing life expectancy with compression of morbidity, concurrent with the rise in the prevalence of chronic illnesses and comorbidity; 2) the complex interactive relationship between baby boomer health status change and temporal improvements in health care efficiency; and 3) the disconnect between health care system efficiency and increasing demands, including patient expectations and end-of-life decision-making. These issues are investigated using interdisciplinary evidence, and applying a set of assumptions to scientific forecasting of modern health care system transformations over the next 20 years, the period in which population aging will peak. Two extreme scenarios positioned at opposite ends of a continuum are advanced that differ on the timing and extensiveness of policy reform versus system-level inertia.

Background Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines. Methods An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older. Results A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults. Conclusion Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.

This exploratory study addresses whether there are similar or different risks and protective factors associated with spousal abuse among mid-age adults (persons aged 45-59) and old-age adults (persons aged 60 and over). The risk and protective factors of abuse are compared across these two age groups and situated within a life course framework. Cross-sectional data from the 1999 and 2004 General Social Surveys are merged to address the research questions. Overall, it was found that there are as many differences as there are similarities in risk/protective factors connected to individual, relationship, and community environments. The findings are discussed in terms of program development and future research.

Background We examine the population impact on functional disability and social participation of physical and mental chronic conditions individually and in combination. Methods Cross-sectional, population-based data from community-dwelling people aged 45 years and over living in the 10 Canadian provinces in 2008–2009 were used to estimate the population attributable risk (PAR) for functional disability in basic (ADL) and instrumental (IADL) activities of daily living and social participation restrictions for individual and combinations of chronic conditions, stratified by age and gender, after adjusting for confounding variables. Results Five chronic conditions (arthritis, depression, diabetes, heart disease and eye disease) made the largest contributions to ADL-related and IADL-related functional disability and social participation restrictions, with variation in magnitude and ranking by age and gender. While arthritis was consistently associated with higher PARs across gender and most age groups, depression, alone and in combination with the physical chronic conditions, was associated with ADL and IADL disability as well as social participation restrictions in the younger age groups, especially among women. Compared to women, the combinations of conditions associated with higher PARs in men more often included heart disease and diabetes. Conclusions Our findings suggest that in community-dwelling middle-aged and older adults, the impact of combinations of mental and physical chronic conditions on functional disability and social participation restriction is substantial and differed by gender and age. Recognising the differences in the drivers of PAR by gender and age group will ultimately increase the efficiency of clinical and public health interventions.

This article applies and builds upon the network leadership models introduced by Provan and Kenis to the case of the British Columbia Network for Aging Research (BCNAR). We specify a particular type of shared leadership model and term this a Targeted Shared Leadership (TSL) model based on the governance structure of BCNAR. Key features include six coleaders who are selected on the basis of representation of five major universities (typically in its gerontology center) situated in the five provincial health authorities in British Columbia. Several network characteristics are introduced and then applied to BCNAR to assess effectiveness of the leadership structure. Innovations in research grant capacity support, communication, mentorship and training of new gerontologists, and knowledge translation are used to specify the effectiveness of the leadership structural dynamics of BCNAR. Potential applications of this shared leadership model for other networks are discussed.

Chappell and Hollander provide support for a set of policy directives formulated for an aging population. An integrated continuum of care model is the fulcrum of the policy prescription, given evidence-based support for its cost-effectiveness; improved quality of care and quality of life; and the success of similar models found in Denmark, Japan and other countries. This commentary addresses the underlying assumptions of these policy recommendations, identifies the major barriers to their implementation and suggests solutions. Improving our understanding of the dynamics of population aging as it relates to health and healthcare use is a necessary requirement to reaching the aims set out by the authors.

This exploratory study investigated administrator and facility-related predictors of quality of care in long-term care facilities. Quality was measured using several unmet standards of care identified in the last inspection report of the Ontario Ministry of Health and Long-Term Care (2007). Supplemental data were gathered from surveys mailed to all 602 long-term care administrators in Ontario, Canada, 302 of whom completed the questionnaire. Multiple regression analyses were conducted to test sets of hypotheses linking characteristics of administrators and those of the long-term care facility to quality of care. Education and experience as an administrator in a participant's current position had a moderate positive influence on quality of care; however, negative associations were found between administrator salary and effort devoted to resident care problems and quality of care. In addition, smaller facilities, being located in less populated communities, and administrators with a nursing background signi...

RÉSUMÉLes Canadiens vivent plus longtemps et les personnes plus âgées composent une part croissante de la population (14% en 2006, projeté d’atteindre 20% d’ici 2021). L’Étude longitudinale canadienne sur le vieillissement (ÉLCV) est une étude longitudinale nationale portant sur le développement adulte et le vieillissement qui recrutera 50 000 Canadien(ne)s âgé(e)s de 45 à 85 ans et qui les suivra pendant au moins 20 ans. Tous les participants fourniront un ensemble d’informations communes sur plusieurs aspects de la santé et du vieillissement, et 30 000 passeront un examen approfondi couplé au don de spécimens biologiques (sang et urine). L’ÉLCV deviendra une source de données riches pour l’étude d’inter-relations complexes entre les facteurs biologiques, physiques, psychosociaux et sociaux qui affectent le vieillissement en santé.

In this study, we tested the efficacy of a low-intensity lifestyle intervention aimed at reducing the risk of cardiovascular disease among mid-life individuals.We conducted a randomized controlled trial in which participants were randomly assigned either to receive a health report card with counselling (from a Telehealth nurse) on smoking, exercise, nutrition and stress or to receive usual care. The patients were divided into 2 groups on the basis of risk: the primary prevention group, with a Framingham risk score of 10% or higher (intervention, n = 157; control, n = 158), and the secondary prevention group, who had a diagnosis of coronary artery disease (intervention, n = 153; control, n = 143). The primary outcome was a change in the Framingham global risk score between baseline and 1-year follow-up. Data were analyzed separately for the 2 prevention groups using an intention-to-treat analysis controlling for covariates.Within the primary prevention group, there were statistically significant changes for the treatment group relative to the controls, from baseline to year 1, in Framingham score (intervention, -3.10 [95% confidence interval (CI) -3.98 to -2.22]; control, -1.30 [95% CI -2.18 to -0.42]; p0.01) and scores for total cholesterol (intervention, -0.41 [95% CI -0.59 to -0.23]; control, -0.14 [95% CI -0.32 to 0.04]; p0.05), systolic blood pressure (intervention, -7.49 [95% CI -9.97 to -5.01]; control, -3.58 [95% CI -6.08 to -1.08]; p0.05), nutrition level (intervention, 0.30 [95% CI 0.13 to 0.47]; control, -0.05 [95% CI -0.22 to 0.12]; p0.01), and health confidence (intervention, 0.20 [95% CI 0.09 to 0.31]; control, 0.04 [95% CI -0.07 to 0.15]; p0.05), with adjustment for covariates. No significant changes in outcome variables were found for the secondary prevention group.We found evidence for the efficacy of an intervention addressing multiple risk factors for primary prevention at 1 year using Framingham risk score report cards and telephone counselling. (Requirement for clinical trial registration waived [enrolment completed before requirement became applicable].).

Background Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system. Methods Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use. Results Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6. Conclusions To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

Background: There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM. Objectives: This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM. Methods: Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey. Results: The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care. Discussion: Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.

Aging is commonly associated with an increase in chronic disease and disability, affecting access to transportation. This study examines factors that contribute to the decision to use Handy Dart transportation (a handicap-specialized service) among 869 elderly, chronically ill residents of a metropolitan region in British Columbia. Drawing on Chappell’s complementary model of support, the authors hypothesized that informal social support will be positively associated with specialized transportation service use. The authors employ the Andersen-Newman model of health use to help organize the other expected predictors. Results of logistic regression analysis revealed that the presence of regular social support, a positive attitude about Handy Dart helpfulness, being retired, disability because of arthritis, and perceived ill health were the strongest predictors of use. Age, gender, marital status, knowledge, and number of comorbid illnesses did not predict use of the service. The results are discussed within the context of changing needs for specialized transportation services.

Objective: The purpose of this investigation is to examine correlates and predictors of self-care activities for persons diagnosed with arthritis both cross-sectionally and longitudinally. Method: Data from telephone surveys conducted with 313 older ( M = 68.8, SD = 8.93) individuals, chosen from a larger sample, who reported professionally diagnosed arthritis, were used. Results: A total of 10 of the 11 self-care activities changed significantly during the 1-year interval, with 9 showing increased participation. Results from hierarchical regressions showed that all three blocks of predictors explained significant portions of variance, with gender and perceived importance of general health significantly predicting self-care activities at Time 1, at Time 2, and longitudinally. Discussion: These results highlight the influence of demographic, health status, and health belief variables on self-care both cross-sectionally and longitudinally. Future work should focus on the mediating effects of these and other variables to better understand the processes by which individuals engage in self-care behavior.

This paper examines use of alternative therapies to manage a chronic illness among older adults with at least one of three major conditions: arthritis, heart disease, and hypertension. Drawing from developments in the health utilization literature, a focus is placed on the illness context, predisposing factors, and several factors deemed to enable persons to use complementary medicine. The baseline data (n = 879) from the 1995–96 North Shore Self-Care Study conducted in Vancouver, Canada were used for this study. Two dependent variables were analysed using logistic regression techniques – the first is based on a comprehensive question about using alternative therapies (such as herbal remedies, acupuncture, massage therapy, etc.) to manage a chronic condition; and the second uses a more specific question pertaining to meditation or praying. The results from the first analysis show that being younger, suffering from arthritis compared to hypertension, comorbidity, taking fewer medications, lower income, reading on the chronic condition, and the interaction between reading and illness self-efficacy are associated with trying alternative therapies. The findings for the second analysis show that being female, being younger, and not married, as well as reporting a more serious condition, illness duration and the interaction between having moderate levels of mutual aid and number of confidants result in a greater likelihood of trying meditation/prayer. Implications of these results are discussed in terms of their theoretical import, and their relevance for the degree to which unconventional and conventional medicine are complementary.

Background Multimorbidity has been recognized as a major public health issue, negatively affecting health-related quality of life, including physical, functional, mental, emotional, and social domains, as well as increasing health care utilization. This exploratory study examines selected health outcomes associated with multimorbidity across older age groups/cohorts and gender, comparing Canada and Australia. Methods Data were drawn from the 2008/09 Canadian Community Health Survey and the 2009 Australian HILDA survey. Seven major chronic conditions were identical across the two data sets, and were combined into an additive measure of multimorbidity. OLS and logistic regression models were performed within age group (45-54, 55-64, 65-74, 75+) and gender to estimate associations between multimorbidity and several health-related outcomes, including: loneliness, life satisfaction, perceived health, mobility restriction, and hospital stays, adjusting for marital status, education and foreign born status. Results Overall, country-level differences were identified for perceptions of loneliness, life satisfaction, and perceived health. Australians tended to experience a greater risk of loneliness and lower self-rated health in the face of multimorbidity than Canadians, especially among older men. Canadians tended to experience lower life satisfaction associated with multimorbidity than Australians. No country-level differences were identified for associations between multimorbidity and hospital stays or mobility limitations. Conclusions The associations between multimorbidity and health are similar between the two countries but are variable depending on population, age group/cohort, and gender. The strongest country-level associations are for indicators of health-related quality of life, rather than health care or mobility limitation outcomes.

This study examines the influence of transportation dependence and fulfillment of transportation needs on well-being based on a community sample ( N = 174). The majority (54.4%) of transportation-dependent participants had unfulfilled transportation needs, whereas this was the case for very few (7.1%) of those independent of transportation support. Regression analyses revealed that the transportation needs variable was statistically significant, whereas the transportation dependence factor was not. In terms of the prioritization of environmental components, elderly dependent on transportation support placed higher importance on housing than on neighborhood or community elements compared to more mobile seniors. Participants with unmet transportation needs were more likely to depend solely on family to provide transportation, whereas participants with fulfilled transportation needs were more likely to include friends or neighbors for providing transportation support. Results suggest that prioritization of needs enables seniors to maintain positive wellbeing despite experiencing functional limitations or being dependent on transportation services.

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.

Reflecting a world-wide trend toward avoidance of institutionahzation and the fostering of aging in place in the community, a range of housing alternatives has been developed for older persons in Canada. This paper examines: (1) current patterns of housing and living arrangements of older Canadians; (2) philosophies that have dominated policy and production of housing for seniors for the last 30 years; and (3) seniors' preferences and utilization rates of various options. Data sources include the 1991 census and two cross-Canada studies, one urban and one rural, in which seniors were asked about their housing and related support service needs, usage patterns and preferences. The paper concludes with a discussion of emerging trends blending shelter and services and of policy gaps that need to be addressed in meeting the future housing needs of older Canadians.

This paper investigates gender differences in the timing of ischemic heart disease (IHD) mortality among white Americans. Three age‐at‐death groupings are examined, using a model incorporating three types of independent variables: lifestyle, socioeconomic status, and biology/heredity. Logistic regression techniques are used to analyze National Mortality Follow‐back Survey data. Three hypotheses drawn from the literature are tested: (1) that IHD mortality risks will vary by gender and across the life course; (2) that the independent variables will exert a lower mortality risk for women than for men at all ages of death; and (3) that differential risks by gender will be larger for younger age‐at‐death groups. Findings support the first and third hypotheses. The importance of research on gender differentials in age at IHD mortality in relation to parental heart‐attack mortality, smoking and spousal smoking, occupation, and fertility is highlighted.

PURPOSE: Faced with an aging driving population, interest is increasing in the use of restricted licenses or "graduated delicensing" for older drivers to allow them to safely retain a driver's license. The primary purpose of this study was to determine whether restricted licenses are successful at mitigating number of crashes per year and whether they can extend the period of crash-free driving for aging adults. DESIGN AND METHODS: Using a cohort study design, licensing and insurance claims crash records of all drivers aged 66 years and older in British Columbia were examined for the years 1999-2006. Nonparametric and Cox proportional hazards survival analyses were used to compare restricted vs. unrestricted drivers and to estimate crash risks. RESULTS: The risk of causing a crash for restricted drivers was 89% (or 11% lower risk) compared with unrestricted drivers after controlling forage and gender.[corrected]. The most common restriction was a combination of daylight driving only plus a speed maximum of 80 km/hr. Restricted drivers retained a driver's license for a longer period of time than unrestricted drivers and continued to drive crash free longer than unrestricted drivers. There was no difference in severity of collisions, and results suggest a high level of compliance with daylight-only restrictions. IMPLICATIONS: These findings suggest that driving restrictions may be effective for prolonging the crash-free driving of some aging drivers, thus supporting their continued independence and delaying institutionalization. Further studies are needed to determine which drivers are most likely to benefit from restricted licenses. Language: en

This paper focuses on the use of the Internet for health information and behaviour change. Specifically, it examines and reviews the current trends and issues connected to baby boomers in Canada using the Internet for accessing health information. We explore their opportunities and limitations as a target generation for e-health; considerations in serving diverse populations; issues of health literacy; e-health tool design and motivational impact; barriers to reaching offline boomers and strategies to reduce these barriers; and review several common e-health tools. The unique characteristics of this generation, including their high internet utilization rates and desire for health information make them a prime target for e-health tools.

1. Overall, care staff members displayed positive attitudes toward resident monitoring technologies, especially staff members working in facilities with more of this technology. 2. It is necessary to place nurses and other front-line health care workers in the center of the policymaking process that determines the technological versus human composition of any long-term care facility. 3. The ethnicity of the health care worker, and to a lesser extent their age and education, are more important than the job status in determining attitudes toward monitoring technology. 4. Comprehensive evaluations of technology used in care facilities should include the overall value of the technology, its impact on a facility's liability, its effect on the quality of care on residents, and whether use of the devices in question is ethical.

This study empirically tests several hypotheses derived from the social network perspective on marijuana use. In so doing, it demonstrates the importance of friendship networks as agents which affect drug taking. The results indicate that the normative expectations of one' friends are important influences on the individual. Other hypotheses that predict sex differences in marijuana use are also tested and confirmed. This study demonstrates how the social network perspective can be used to explain sex differences in the use of marijuana. The sex structure of friendship groups accounts for sex differences in use-abstinence and in the level of consumption among smokers. Implications of these results are discussed with particular reference to the generalizability of the social network perspective.