Home-care utilization within the year of death: trends, predictors and changes in access equity during a period of health policy reform in British Columbia, Canada.

Healthcare policy reforms enacted through the 1990s explicitly endorsed expanded community care and enhanced equitable access to care. We examine end-of-life home-care service utilization during this time period. We are interested in trends in and predictors of utilization influencing receipt of service or total service use. This is a population-based, retrospective study of home-care utilization by adults 50 years of age and older in British Columbia, Canada, who died in the last 6 months of each year from 1991 to 2000 (n = 98,327). Data were drawn from the British Columbia Linked Health Data resource; we examined both receipt and extent of care, using logistic and standard regression models. Independent variables included year of death, age, gender, area of residence and income quintile. Year of death was not significantly associated with receipt of home care in general. However, the odds of receiving home support services declined significantly over time, while annual home support hours increased. In contrast, receipt of home nursing increased, while annual home nursing visits did not change. Social factors frequently emerged as significant predictors of both receipt and extent of care. However, we found only limited evidence for interactions between these factors and year of death acting as determinants of receipt or extent of service. Results suggest that end-of-life home care services did not expand, but instead were reallocated and intensified over the 1990s. As well, there was little evidence to suggest enhanced equity in access to care.

In the middle: parental caregiving in the context of other roles.

OBJECTIVES: Parental caregiving has been conceptualized as both a source of role strain and of role enhancement. To assess support for each of these perspectives, this article examines the relationship between concurrent multiple roles (as spouse, parent, and employed worker) and the perceived stress and physical and emotional ill health of parental caregivers. METHODS: Multivariate regression analyses (OLS) are conducted using data drawn from a Canadian probability sample of 687 caregivers to parents and parents-in-law. RESULTS: Although the vast majority of parental caregivers are confronted with multiple roles, only weak and inconsistent relationships are evident between particular roles or combinations of roles and caregivers' perceptions of stress and physical and emotional health. DISCUSSION: Little support is found for either a role strain or role enhancement hypothesis. Inconsistencies in the findings point to a need to go beyond simplified expectations of either role strain or role enhancement and examine the meanings assigned to particular roles and the contexts within which they are enacted.

Evaluating support services to seniors. A discussion of collaborative research.

The difficulties involved in attempting to turn collaboration into partnership are revealed in this article about the relationship between research funders and researchers, specifically government funders and university researchers. Some discussion revolves around the relationships between researchers and among the researchers, practitioners, and consumers. This article also discusses collaborative research relationships by using the evaluation of a support program to seniors as an illustration. Also addressed are how the research revealed the success of the program and the frustrations encountered when government would not act on the findings.

Marital instability after midlife.

"Divorce in later life has been shown to produce dramatic declines in the economic, psychological, and physical well-being of marital partners. This study examines the prevalence and determinants of marital disruption after midlife using Becker's theory of marital instability. Using recent Canadian national data, the marital outcomes of women and men who were married as of age 40 are tracked across the remaining years of the marriage. Cox proportional hazard regression models indicate stabilizing effects of the duration of the marriage, the age at first marriage, the presence of young children, as well as of remarriage for middle-aged and older persons. Other significant risk factors include education, heterogamous marital status, premarital cohabitation, number of siblings, and region."

Employer-based health insurance and seniors: the case of Bermuda.

This article examines the importance of economic factors in physician and other health service utilization among older adults living in Bermuda. Using data drawn from a national survey of 500 Bermudian elders, the findings reveal economic factors to be unrelated to the use of physician services directly, but to be significant determinants of the use of other health services. Need plus non-need factors are related to the use of both physician and other health services. The employer-based system does seem to provide universal access, but factors in addition to need influence the receipt of care.

Health, social support, and the utilization of health services among older adults.

This study examined the role of social support in relation to health status and health service utilization. The analyses draw on data from interviews with a stratified random sample of 1,284 noninstitutionalized adults aged 60 and over living in the province of Manitoba, Canada. The findings reveal differences depending upon the type of support (instrumental, emotional) and type of service (medical, hospital, home care) involved. Significant interactions are found between dimensions of support and of health status, suggesting the differential importance of social support across levels of health-related need.

Cognitive impairment, caregiver burden, and the utilization of home health services.

This study addresses the relationship between caregiver burden and the use of home health services among older adults with cognitive impairment. Analyses draw on data from personal interviews conducted with 327 older adults with cognitive impairment and living in the community of their primary caregivers. Using the Andersen-Newman framework, the results of ordinary least squares and logistic regression analyses reveal that caregiver burden and formal home health service use are only weakly related. Possible explanations for the findings are discussed.

Gender differences in disability, assistance, and subjective well-being in later life.

This study focused on gender differences in functional disability among older adults, their reliance on personal assistance and technical aids, and relationships among the use of these sources of assistance, functional disability, and subjective feelings of well-being. The analyses employ data from interviews conducted with 1,406 community-dwelling elders living in Manitoba, Canada. The results reveal (a) greater disability and somewhat greater use of personal assistance among women, and (b) differences between men and women in relationships between both personal and technical resources and subjective feelings of well-being across levels of functional disability.

Receipt of assistance by elderly people: hierarchical selection and task specificity.

We studied the relative importance of family members, friends, neighbors, and others in the support networks of elderly people. A hierarchical compensatory model contends that kin, particularly spouse and children, are of primary importance, followed by friends and neighbors and formal organizations in a well-ordered hierarchical selection process. In contrast, a task specificity model emphasizes differences in the ability of particular groups to offer various forms of support. Data drawn from interviews with 1,284 elderly respondents in Winnipeg, Manitoba offer limited support for the hierarchical compensatory model.

Ethnicity and informal supports among older adults.

This article examines patterns of ethnic variability in informal familial and extrafamilial sources of social support. Data derived from a stratified random sample of people age 65 and over residing in Winnipeg, Manitoba, Canada are used to compare five different ethnic groups in terms of various aspects of support (including availability, interactions, satisfaction, exchanges of assistance and support, and confidant relationships). The analyses reveal similarities as well as differences among the groups. The implications of the findings are discussed in terms of attempts to conceptualize patterns of ethnic variability in informal networks on the basis of distinctions between "traditional" extended family and lineal authority structures, and more "modern" nuclear family and collateral authority structures.