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This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were collected in 1991/1992. Place of residence was categorized as "urban/small-town zone" or "predominantly rural area". A 5-year follow-up determined subsequent home care use. Urban residents were more likely to receive home care than those in small-town zones or predominantly rural areas. Characteristics associated with use differed according to place of residence, with the exception of baseline physical functioning and changes in physical functioning that consistently emerged as significant. Directions for future research are discussed. (Contains 2 tables.)

This study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Co-residence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole. (Contains 1 note and 7 tables.) [Abstract provided in both French and English.]

Objective: We sought to determine whether adults aged 65 years or older living in rural areas who are without depressive symptoms have a lower risk of developing depressive symptoms over 5 years than their urban counterparts, and to determine the factors that predict the development of depressive symptoms in older adults in rural and urban areas. Methods: We conducted a secondary analysis of an existing data set, the Manitoba Study of Health and Aging (MSHA.) We studied a population-based random sample of 807 people without depressive symptoms or cognitive impairment who were residing in Manitoba communities in 1991/92 and 5 years later in 1996/97. We defined "rural" as a census subdivision with a population of less than 20 000, and "urban" as a population of 20 000 or greater. The MSHA investigators measured depressive symptoms using the Center for Epidemiologic Studies Depression scale, using the standard cut-point of 16 or more. Participants reported their age, sex, education, self-rated health, and functional status at the time of their first interview. Results: Of adults aged 65 years or older living in urban areas, 13.3% developed depressive symptoms, versus 8.9% of those living in rural regions (p = 0.047). In multivariate analyses, a rural residence was not associated with the development of depressive symptoms. In rural areas, factors predicting depressive symptoms were female sex and poor self-rated health at the time of the first interview. Conclusion: A rural residence is only weakly protective for the development of depressive symptoms over 5 years, and this association was not seen after we accounted for potential confounding variables. As well, these results underscore the strong association between poor health and depressive symptoms. Objectif : Nous avons cherche a determiner si des adultes de 65 ans ou plus vivant en milieu rural et n'ayant pas de symptomes depressifs risquent moins d'avoir des symptomes depressifs en cinq ans que leurs homologues urbains et a determiner les facteurs predicteurs de l'apparition de symptomes depressifs chez les adultes ages en regions rurale et urbaine. Methodes : Nous avons procede a une analyse secondaire d'un ensemble de donnees existantes tirees de l'etude sur la sante et le vieillissement au Manitoba (ESVM). Nous avons etudie un echantillon aleatoire representatif de 807 personnes qui ne presentaient aucun symptome depressif ni deficit de la cognition et qui habitaient des communautes du Manitoba en 1991-1992 et cinq ans plus tard en 1996-1997. Nous avons defini "rural" comme une subdivision de recensement comptant moins de 20 000 habitants et "urbain" comme une subdivision en comptant 20 000 ou plus. Les chercheurs de l'ESVM ont mesure les symptomes depressifs au moyen de l'echelle de la depression du Centre d'etudes epidemiologiques et utilise le point de demarcation habituel de 16 ou plus. Les participants ont indique leur age, sexe, scolarisation, etat de sante autoevalue et etat fonctionnel au moment de leur premiere entrevue. Resultats : Parmi les adultes de 65 ans ou plus vivant en milieu urbain, 13,3 % ont eu des symptomes depressifs par rapport a 8,9 % de ceux qui vivaient en region rurale (p = 0,047). Des analyses a variables multiples ont revele qu'il n'y avait pas de lien entre la residence en milieu rural et l'apparition de symptomes depressifs. En milieu rural, les facteurs predicteurs des symptomes depressifs etaient le sexe feminin et un etat de sante autoevalue mediocre au moment de la premiere entrevue. Conclusion : Le fait d'habiter en milieu rural protege faiblement contre l'apparition de symptomes depressifs en cinq ans et on n'a pas constate ce lien apres avoir tenu compte de variables confusionnelles possibles. En outre, ces resultats soulignent le lien solide qui existe entre le mauvais etat de sante et les symptomes depressifs., INTRODUCTION Depressive symptoms are a concern for older adults, and have been shown to predict death, (1) admission to a nursing home (2) and functional decline. (3) Since the urbanization [...]

Research has shown that the level of activity of the residents of a city's neighbourhood is related to the availability of activity-related resources. This study aimed to characterise the housing environment in which many older adults live by exploring what activity-related resources were available in senior apartment buildings in one Canadian city, Winnipeg. Of 195 senior apartment buildings in the city, 190 were surveyed to examine whether variation in the buildings' activity resources was related to neighbourhood characteristics, particularly socio-economic status. Resources were classified as those for physical activities (e.g. exercise classes), social activities (e.g. card games), and services (e.g. a grocery-store shuttle). The neighbourhood characteristics were taken from census data and included socio-economic and socio-demographic measures. The apartment buildings varied considerably in the resources available, and a positive relationship was found between neighbourhood income and physical and social activity programmes and services. Lower residential stability and a higher percentage of residents living alone were also related to the buildings' resource-richness, and senior apartment buildings with limited activity-related resources clustered in disadvantaged neighbourhoods. How senior apartments are resourced should be examined in relation to the neighbourhood in which they are located. KEY WORDS--environment, housing, activity participation, socio-economic status.

Background. Concerns have been raised over transfers into acute care hospitals at the end of life. The objective of this study was to examine (a) the extent of and (b) factors related to hospitalization in the last 180 days before death among long-term care (LTC) residents. Methods. The study included all LTC residents from 60 facilities in the province of Manitoba, Canada, who died in 2003/04 (N = 2,379), with data derived from administrative health care records. Multilevel regression analyses were conducted to examine the relationship between resident and facility characteristics and the following: location of death (in hospital vs the LTC facility): whether individuals were hospitalized in the last 180 days before death; and number of hospital days in the last 180 days. Results. Overall, 19.1% of LTC residents died in hospital; however, 40.7% were hospitalized at least once in the last 6 months before death. Several resident characteristics (age, trajectory group, and level of care) were related to the outcome measures. Living in a not-for-profit LTC facility decreased the odds of dying in hospital (adjusted odds ratio [OR] = 0.589; 95% confidence interval [CI] = 0.402-0.863) or being hospitalized (adjusted OR = 0.647: 95% CI = 0.452-0.926). Conclusions. Hospitalization at the end of life is common among LTC residents, and the likelihood of hospital transfers is increased for residents who are younger, have organ failure, lower care level needs, as well as among those who live in for-profit facilities. Particular emphasis should, therefore, be placed on targeting these groups to determine the appropriateness of hospital admission and possible ways of reducing transfers. Key Words: End-of-life care--Hospital use--Long-term care--Administrative data Multilevel models.

Although several authors have speculated about the type of relationship between informal and formal care, relatively little empirical work directly examines the interface between the two support systems. This paper examines the correlates of using neither system, only one system and several combinations of both systems. It explores the characteristics of those who do and do not make complementary use of both systems and under what circumstances the two systems are complementary. Multivariate analyses are performed, using logistic regression analyses, to examine the correlates of the different sources of support. Analyses demonstrate that those who utilize the formal care system do so while retaining care from the informal network. Use of the formal system in conjunction with informal care appears to take place in two instances: when seniors are in need and critical elements of their informal network are lacking, or when they have an intact informal support network, but their health needs are extremely high. In both of these instances the formal system enter to assist the informal network. The data point to the complementarity of the two care systems, not in terms of task specificity, but rather, in terms of a sharing of overall task load.

Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)

Examined tenant resource coordinator (TRC) within elderly persons' housing unit to link social and health services with housing as type of supportive housing. Findings suggest that TRC functions to convey information about services to tenants and vice versa. TRC fulfills role of facilitator between community services and housing. (Author/NB)

Intermediate housing options are limited in North America, despite a recognized need for such resources. When questioned, seniors overwhelmingly prefer to live as independently as possible with help from community support services. The least preferred option is moving in with children. Supportive housing fills the gap for people who are not totally independent, but not completely dependent either. Issues to consider in developing such housing include cost, provision of services, and use of services. Such housing was built in Canada in response to these needs. Supportive services were overseen by a residential coordinator. Interviews with tenants on two occasions (before and after the coordinator was put on staff) concerned their feelings about other tenants and living conditions, as well their knowledge and use of services available. The results indicated that the tenants were relatively well-educated in these areas after a residence coordinator was provided, but not before. Attitudes toward living in the buildings and about other tenants did not change over time. This study highlights the importance of the role of the coordinator as a means of connecting the systems of health care and housing for maximal use by the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)

This paper examines changes in life satisfaction among participants of Adult Day Care (ADC) in Manitoba, Canada, and their informal caregivers (where applicable). ADC participants (N = 112) and their informal caregivers (N = 34) were interviewed at two points in time. Data analyses reveal that, during attendance at the program, the life satisfaction of both the participant and the informal caregiver tend to improve. Attempts to predict which participants are most likely to improve, remain stable, or deteriorate in life satisfaction were largely unsuccessful. A smaller group of participants in Winnipeg programs were matched on age, sex, functional disability and illness with two control groups. Analyses reveal improvements in life satisfaction among ADC participants appear to be program effects. [ABSTRACT FROM PUBLISHER]

Examined was the effect of Adult Day Care (ADC) in the Province of Manitoba on utilization of health care practitioner (primarily physician) and inpatient hospital services. Data were from three separate ADC studies, one of which contained two control groups. When ADC was first operative, participation had no effect on use of the other services. When operative for some time, however, there may be dramatic decreases in hospital inpatient stays, but this was a less conclusive finding and warrants further research. [ABSTRACT FROM PUBLISHER]

This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba ( n = 855) were collected in 1991/1992. Place of residence was categorized as urban/small-town zone or predominantly rural area . A 5-year follow-up determined subsequent home care use. Urban residents were more likely to receive home care than those in small-town zones or predominantly rural areas. Characteristics associated with use differed according to place of residence, with the exception of baseline physical functioning and changes in physical functioning that consistently emerged as significant. Directions for future research are discussed.