Maintaining the integrity of home care.

The arguments and model put forward by MacAdam are laudable, but fall short. The proposal would create a home-care system that is a support system for medical care, thus fulfilling only one of the three functions of home care. The emphasis in the model on expanding professional services addresses the demands for increases in intensive post-acute care. However, the support of chronic long-term care and of health promotion and disease prevention would not be strengthened and, indeed, would lead to the already visible demise of traditional chronic long-term care as evident throughout recent health reform. It would ensure that a preventive function is not developed.

Dimensions of care for dementia sufferers in long-term care institutions: are they related to outcomes?

OBJECTIVES: This study empirically examined whether dimensions of care cluster in special care units (SCUs) compared with non-SCUs. The relationship between SCU status plus separate measures of the dimensions of care and outcomes for dementia sufferers was then investigated. METHODS: Data were drawn from the Intermediate Care Facility Project. The sample (N = 510) included residents with dementia, aged 65 and older, in intermediate care facilities throughout the province of British Columbia. Canada. Longitudinal data included 6 outcomes: cognitive function, behavioral problems of agitation and social skills, physical functioning, and quality of life measured through affect and expressive language skills. Separate multiple linear regression equations were estimated, relating each of these outcomes to 5 dimensions of care: preadmission and admission procedures. staff training and education, nonuse of physical and chemical restraints, flexible care routines and resident-relevant activities, and the environment. RESULTS: The results showed there is virtually no clustering of dimensions along SCU/non-SCU lines. Neither SCU status nor the individual dimensions were highly predictive of outcomes. Residents' affect at t1 emerged as a characteristic that was significantly correlated with other outcomes. DISCUSSION: This Canadian research can be added to the few but growing number of rigorous studies that suggest SCUs are not homogeneous and do not necessarily provide better care than non-SCUs. Moreover, it raises questions about the benefits of "best practice" dimensions of care, regardless of SCU status.

Receptivity to new technology among older adults.

PURPOSE: Both absolute and relative increases in the older adult population are occurring concurrently with the growth of high technology. Technological devices offer sophisticated solutions to some of the problems associated with ageing. This study borrows from the health utilization literature in order to develop and test a model for understanding receptivity to specific technological products by older adults. RESULTS: Receptivity is directly influenced by predispositional, need and social support factors, as well as by one's level of concern for problems that could be alleviated through the use of technology. Hierarchical regression equations reveal that this latter variable, concern, has the strongest influence on receptivity, while need factors display strong indirect effects. Those with unsatisfactory contact with others are also more receptive, suggesting that the lack of social support acts as a need factor. Contrary to past research, women are more receptive to technology than men. CONCLUSIONS: The results indicate that new technology geared toward enhancing the quality of life of seniors in their homes would be welcomed by many.

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.

Health care service use by Chinese seniors in British Columbia, Canada.

This paper assesses whether the same factors are predictive of health service utilization among this ethnic group as is true of the general population of seniors. The data suggest that the health of Chinese elders is just as bad as other seniors, and their utilization is very similar. They have a strong preference for Western over Chinese medicine and for Western trained doctors over Chinese practitioners, and use services with Chinese staff, probably because of language. Similarly, the predictors of service use are strikingly similar to predictors revealed in utilization studies throughout the industrialized world. Ability to speak English, immigration history, and country of origin are unrelated to the use of these services. However, approximately half of Chinese seniors also engage in traditional Chinese care. Religious beliefs and a preference for traditional Chinese medicine are strongly predictive of the use of traditional care. It would appear that distinctive culture is related to the use of traditional care, but not the use of the western health care system.

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.

The impact of cognitively impaired patients and shift on nursing assistant stress.

This study compared the stress experienced by nursing assistants (NAs) under four work conditions: high or low proportion of cognitively impaired patients and day or other shift. Five standard measures of caregiver stress served as the dependent variables in this study; burden, reaction to patient behaviors, workload, and two measures of burnout. A 2x2 multivariate analysis of variance found an interaction effect of type and shift on the stress measures. Univariate tests found that Burden and Depersonalization accounted for this effect. A further multivariate analysis of simple main effects found significant differences for each independent variable within each level of the other independent variable. Univariate analysis found that NAs who care for cognitively impaired patients on the day shift show significantly higher scores on specific stress measures. The article concludes with a discussion of how institutions can respond to the stresses faced by NAs who care for cognitively impaired patients.

Home care research: what does it tell us?

This article assesses the applied relevance of research on home care, reviewing the literature on predictors of use of home care services, the experience of receiving home care, and efficacy studies. Research to date informs us rather conclusively that functioning is a major predictor of use throughout the industrialized world, but does not inform us of the structural factors impacting on home care. Studies on the experience of home care, to date, have focused on program implementation issues, rather than more macro policy issues. Finally, efficacy studies by and large have not concluded that home care is less costly or necessarily better for the quality of life of seniors when compared with institutional care. This has led to questions about the raison d'être of home care. We do not have longitudinal research assessing the long-term preventive effects of home care.

Nursing assistant burnout and the cognitively impaired elderly.

This article employs the cognitive appraisal model to examine the experience of burnout in a random sample of nursing assistants (N = 245). The three subscales of Maslach's Burnout Inventory--Emotional Exhaustion, Personal Accomplishment, Depersonalization--serve as the dependent variables in this study. The study found that both stressor and appraisal variables influence feelings of burnout. The stressor variable, frequency of disturbing patient behaviors, best explained feelings of reduced Personal Accomplishment. The appraisal variable, reaction to patient behaviors, best explained Emotional Exhaustion and contributed to the explanation of reduced Personal Accomplishment. Age, minutes spent giving physical care, appraisal of work tasks, and reaction to patient behavior, explained Depersonalization. The study found support for the cognitive appraisal model in that appraisal played an important role in determining burnout. The article concludes with some suggestions for relief of nursing assistant burnout.

Implications of shifting health care policy for caregiving in Canada.

The health care system in Canada, like other industrialized countries, is undergoing a questioning and a change unlike any it has seen for many decades. This article begins with a brief description of the Canadian health care system, then discusses the shifts taking place in health care policy, the assumptions behind these shifts, and the choices that are being made. The current debate draws on knowledge about seniors and their caregivers. The shifts also have implications for caregiving, and these are examined. It is concluded that the new vision of an appropriate health care system that is emerging provides opportunity for greater recognition of and participation by caregivers. At the same time, however, it holds the danger that the burden of care will be shifted even more to their shoulders. It is not yet clear which direction it is going to take.

The role of support in alleviating stress among nursing assistants.

This paper provides a direct test of the buffering hypothesis that the negative effects of stressors (measured as burden, burnout, and perceived job pressure) on nursing assistants working in long-term care institutions are moderated by social support (at work and external to work). The buffering hypothesis was not confirmed, though some support for a main effects view was found. Social support at work, specifically training to work with residents with cognitive impairment, and support from family and friends can assist nursing assistants in dealing with burnout and perceived job pressure. However, major steps in alleviating burden, burnout, and perceived job pressure must be to decrease or change the workload and provide rewards on the job.

Living arrangements and sources of caregiving.

This study examined both the prevalence of different types of caregivers (in terms of the relation to the individual), and whether living with someone is more important for caregiving than the relation of an elder to an individual. Caregiving is examined in terms of IADL and emotional support. Analyses are conducted using three separate random samples of those who are married and living with a spouse, those who live alone, and those who live with nonspousal others in Winnipeg, Manitoba, Canada. The results confirm previous research pointing out that married people tend to receive assistance from their spouse. Among nonmarrieds, children are named most frequently as the primary caregiver. After children, however, those who live alone tend to receive assistance from friends, and those who live with nonspousal others receive assistance from siblings. The data further document the importance of the structural characteristic of living with someone, rather than marital status, for assistance with IADL.

Social isolation and well-being.

We examined 10 common indicators of social isolation and assessed which, if any, are related to subjective well-being among elderly individuals. The quantitative measures (no daily contact and minimal weekly contact), no children, having no children plus being unmarried, and having no children plus living alone, were unrelated to either global happiness or life satisfaction. The combined indicators of living alone and being unmarried as well as single indicators of having no companions or having no confidants were related at the bivariate level to both measures of well-being. When controlling for demographic, economic, and health factors, having no confidants and no companions were significantly and independently related to subjective well-being. These findings suggest that practitioners who seek information on living arrangements or marital status as proxy measures of lower psychological well-being are utilizing the wrong predictors.

Self-care in health and in illness.

This paper focuses on self-care, both expectations and actual behaviours, as health behaviour and as illness behaviour among a random sample of elderly individuals living in the community in a Canadian city (n = 743). The conceptualization of both health and illness behaviour follows Mechanic's (1,2) definition of illness behaviour as selective, interpretive, and evaluative. The data reveal a gap between intentions and behaviours, with elderly individuals de-emphasizing the importance of self-care and overemphasizing the importance of professional contact in their intentions compared with their behaviours. Further, self-care as health and as illness behaviour are uncorrelated with one another. Virtually all individuals engage in some health maintenance behaviours. Approximately two-thirds engage in self-care or do nothing as an initial response to common ailments. While different correlates emerge for each, health beliefs are significantly related, irrespective of whether it is health or illness behaviour.

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.

Professional and business role orientations among practicing pharmacists.

This paper examines business and professional role orientations among practicing pharmacists. Data from pharmacists in six urban centres in Canada are examined, focusing on three questions: the co-existence of these two role orientations, the factors related to each and the relevance for actual practice behaviors. The data analyses show a lack of correlation between business and professional role orientations and their co-existence in some instances, the particular importance of work setting and current position for role orientation and beneficial practice behaviors related to high professional orientations.

What is reasonable is true. Life satisfaction and functional disability among day hospital participants.

Among the several kinds of health care programs enabling the elderly to maintain community residence is the geriatric day hospital. An investigation was undertaken, utilizing structured interviews, to determine what factors influenced life satisfaction and functional disability among the elderly attending three day hospitals in Winnipeg, Canada. Findings indicate that the major predictors of functional disability include perceived health, Canadian ethnicity and differential services. Those for life satisfaction (activity, socio-economic status and health) were similar to those cited for elderly generally in the population.