Abstracts / Résumés

001

HEALTHY AGING: FROM GENES TO SOCIETY

Norah Keating, (norah.keating@ualberta.ca)

The late 20C shift from a disease to a health-oriented model of aging has been accompanied by a new empirical work on determinants of aging well. This work is being conducted across the broad set of disciplines that comprise gerontology and from a number of theoretical perspectives. The purpose of this symposium is to provide a forum for the presentation of some of the newest research and conceptual thinking on healthy aging.

In his presentation on genomic approaches to understanding the biology of aging, Riabowol presents insights into the mechanisms of biological aging associated with longevity. In particular, identification of alleles of genes maintained in centenarians (and therefore associated with longevity and healthy aging) may aid in identification of "longevity assurance" genes that could be used in the future to improve the quality and length of life.

Buckley, Denton, Robb and Spencer consider the role of income as a determinant of perceived health status of older Canadians. They draw on recently available Canadian longitudinal survey files including Statistics Canada's Survey of Labour and Income Dynamics (SLID), and the National Population Health Survey (NPHS), to explore this link across time and across the Canadian population.

In their report on older adults in socially deprived urban neighbourhoods, Scharf, Phillipson, Smith and Kingston focus on issues of reduced access to important life chances that people and localities to the mainstream of society. They discuss how social exclusion can affect health/quality of life and discuss how social policy might be developed toward enhancing quality of life of older people living in deprived urban areas.

Fast, Dosman, Chapman & Keating present findings from an empirical test of a new theoretical model of aging well. The model posits that the outcome of aging well is reflected in life satisfaction and happiness and is a function of the relationships among the constructs of productive and social engagement, material resources, and cognitive, physical and spiritual well being. The model is tested using a sample of older adults from Statistics Canada's 1998 General Social Survey on time use.

002

PRIMARY- AND SECONDARY-CONTROL ENHANCING STRATEGY USE BY OLDER INDIVIDUALS

Jennifer Jonah, 159 Roseberry Street, Winnipeg, MB R3J 1T1 (umvolkjs@cc.umanitoba.ca), Tel: (204) 783-3325; Judith Chipperfield, Nancy Newall, Audrey Swift

Previous research on the control-enhancing strategies used by older individuals has examined the use of specific primary- and secondary-control enhancing strategies among men and women (e.g. Chipperfield et al., 1999). The present study examined the use of these strategies and the correspondence between strategy use as identified by two methods. Strategy use was assessed among community-dwelling seniors (aged 72 to 99) using closed- and open-ended questions to identify pre-defined and participant-generated strategy use. Our Evaluation of the pre-defined strategies found that overall, women reported more secondary-control enhancing strategy use than men (t = - 3.105, p = 0.003) while primary-control enhancing strategy use did not differ by gender (t = - 0.795, ns). Strategy use did not differ by age for primary, or secondary control (t = .022, ns, and t = -.773, ns). Analyses of the qualitative data on participant-generated strategies (n = 296) revealed that some participant-generated strategies matched our pre-defined strategies, particularly those involving help-seeking. The majority (61.1%) of the participant-generated strategies, however, did not match the pre-defined strategies; for example participants reported distracting themselves, or contemplating and talking about the problem as methods of regaining a sense of control. This indicates that researchers may need to broaden their scope when studying the use of these strategies.

003

PERCEIVED EXPECTATIONS OF REHABILITATION SUCCESS: RELATIONSHIP TO PRIMARY AND SECONDARY CONTROL BELIEFS IN OLDER ADULTS

Leah Weinberg, School of Medical Rehabilitation, University of Manitoba, T258 - 770 Bannatyne Ave., Winnipeg, MB R3E 0W3 (weinbrg@cc.umanitoba.ca), Tel: (204) 787-1099, Fax: (204) 789-3927

Recent research suggests that perceived primary and secondary control beliefs (Rothbaum et al, 1982) both contribute to positive health outcomes for older adults (Chipperfield et al, 1999). Secondary control, by adjusting cognitive processes, may counterbalance primary control losses in health situations where primary control is chronically threatened. However, the role of primary and secondary control is a neglected area of research in rehabilitation of the elderly. This study, using a sample of geriatric day hospital clients (n=106), explored the relationship between perceived expectations of success in achieving rehabilitation goals, and both primary control beliefs, and two secondary control dimensions. Secondary control measures included vicarious control (i.e., alignment with powerful others) and illusory control (i.e., chance/luck control). Results show that clients expectations of rehabilitation success were significantly, positively correlated to both primary and vicarious control (i.e., beliefs in personal control, doctor control, and day hospital staff control of future health and future functional ability). However, expectations of rehabilitation success were not related to chance/luck or illusory control. These results suggest that primary (personal control) and secondary control beliefs (i.e., control by powerful others) may have important implications in achieving rehabilitation success for older adults.

004

INTERPRETIVE CONTROL, SUCCESSFUL COPING, AND LIFE SATISFACTION IN OLDER INDIVIDUALS

Audrey Swift, Judith Chipperfield, 130 Lansdowne Avenue, Winnipeg, MB R2W 0G3 (audrey_swift@hotmail.com) Tel: (204) 582-2750, Fax: (204) 261-4802

Rothbaum, et al.'s (1982) conception of interpretive secondary control has previously been defined as a cognitive process in which individuals may partially restore perceptions of control by reinterpreting negative situations and events to find positive meaning and value in them. In light of the importance of perceived control in potentially alleviating stress and perhaps reducing resultant health care utilization (Chipperfield and Greenslade, 1999) the role of interpretive control (IC) beliefs was examined in 179 community-living older individuals. In particular, we asked whether IC beliefs predicted success at coping with stress, and whether successful coping subsequently predicted improved life satisfaction. A gender by IC interaction emerged on perceived coping success (t=2.26, p<.05) in which finding benefit in negative situations/events was more strongly related to coping for men, relative to women. In addition, coping success positively predicted life satisfaction (t=3.59, p<.001), and this relationship also appeared to be stronger for men as suggested by a marginally significant gender by coping success interaction (t=-1.91, p=.06). Potential implications of these findings may include interventions aimed at increasing interpretive control beliefs to facilitate successful stress coping, which may culminate in decreased stress-related health service utilization and improved quality of life in the elderly.

005

GENDER DIFFERENCES IN SECONDARY CONTROL AND EMOTION IN OLDER INDIVIDUALS

Audrey Swift, Judith Chipperfield, 130 Lansdowne Avenue, Winnipeg, MB R2W 0G3 (audrey_swift@hotmail.com) Tel: (204) 582-2750, Fax: (204) 261-4802

Primary and secondary control may have implications for well-being that are differentially mediated by gender (Chipperfield, Perry, & Hladkyj, 2001). However, few studies have considered this using Rothbaum, Weisz, and Snyder's (1982) four types of secondary control. The present study of 353 community-dwelling individuals found levels of illusory and interpretive control to be higher in women relative to men (F=14.97, p<.001 and F=4.52, p<.05, respectively). This supports previous findings in which women used more secondary control relative to men (Chipperfield, Perry, & Menec, 1999). Further, a gender by illusory control interaction emerged on positive emotion in which the relationship appeared stronger in men than in women (t=2.06, p<.05). Similarly, a gender by vicarious control interaction emerged on negative emotion in which the relationship appeared stronger in men than in women (t=-3.20, p<.01). Taken together these results suggest that although women may use secondary control relatively more than men, perhaps the subjective well-being of the men who DO use it is affected comparatively more than that of their female counterparts. In light of previous research suggesting links between emotions and physical health (Chipperfield, Perry, & Weiner, 2001), these results may have implications for interventions geared at using secondary control to improve emotional and subsequently physical well-being in older individuals.

006

POSTURAL STABILITY IN THE ELDERLY: EMPIRICAL CONFIRMATION OF A THEORETICAL MODEL

Hélène Corriveau, Réjean Hébert, François Prince, Marie-France Dubois, Centre de recherche sur le vieillissement, 1036 rue Belvédère sud, Sherbrooke, QC, J1H 4C4 (hcorrive@courrier.usherb.ca) Tel: (819) 821-1150 ext 2427, Fax: (819) 829-7141

Background: A systems approach that considers the influence of multiple body systems on maintaining upright balance has been proposed to explain postural stability. The present study investigated if physiological factors related to specific body systems can explain postural stability.

Methods: The data from seventy-five elderly were analysed: 46 healthy elderly and 29 subjects with disabilities following a stroke or diabetic peripheral neuropathy. The biomechanical variable "COP-COM" which represents the distance between the centre of pressure (COP) and the centre of mass (COM) used to measure the postural stability. Measurements were made in quiet stance, eyes open (EO) and eyes closed (EC) conditions. Three systems were considered as possible predictors of the COP-COM amplitude: sensory (somatosensory and vision), musculoskeletal and central processor. A confirmatory analysis was done using structural equation modelling.

Results: In the A/P direction with EO, the muscle strength explained 23,74 % of the COP-COM amplitude; with EC, 51.75 % of the variance of the COP-COM amplitude was explained by somatosensory system. In the M/L direction, the strength explained 40.73 % and 28.75 % in the EO and EC respectively.

Conclusions: The results of this study highlight the role of peripheral somatosensory input and muscle strength in the maintenance of postural stability during quiet stance in the elderly. Furthermore, the indirect action of the different systems on the COP-COM amplitude found in the different models supports the systems theory.

007

EXPLORING A CAUTIONARY CONTROL ORIENTATION

Nancy Newall, Judith Chipperfield, Audrey Swift, Jennifer Jonah, 2-892B Dorchester, Winnipeg, MB R3M 0R8 (n_newall@umanitoba.ca) Tel: (204) 284-4567

Control orientations refer to beliefs individuals have regarding control over important life events. The objective of this study was to examine what it means to have a cautionary-control (CC) orientation, defined as a belief that it is best not to expect to have control over important events. It is hypothesized that this orientation represents an avoidance of primary control or a form of helplessness, however, it is possible that it represents a type of secondary control (e.g. acceptance of personal limitations). Community-living older adults (N=353) were asked how strongly they agreed or disagreed with the statement that it is better not to expect to have control over important life events. A substantial proportion of older adults (18%) agreed with the statement thus indicating a CC orientation. Content analysis of participants' reasons for a CC orientation suggest that a CC orientation may reflect a form of helplessness. Moreover, correlational analyses showed that a CC orientation was negatively related to a primary control orientation (defined as a belief that it is best to try to influence important life events), but was not significantly related to a secondary control orientation (defined as a belief that when a person is unable to influence events they should "take it in stride").

008

UN VIRAGE À L'UNITÉ PROTHÉTIQUE

Josée Ouellette, Jacques Yves Desautels, c/o Murielle Mondou, CHSLD Biermans-Triest, Unité 1, 4900 boul. Lapointe,

Montréal, QC, H1K 4W9 (murielle.mondou.btri@ssss.gouv.qc.ca)

Tel: (514)353-1227 poste 5170, Fax: (514) 353-9587

Les personnes âgées sont souvent atteintes de plusieurs problèmes médicaux et de diverses pathologies qui nécessitent une médication variée. Une personne âgée admise en centre d’hébergement de soins de longue durée qui présente un problème d’adaptation s’expose davantage à une plus grande consommation de médicaments. Pour lutter contre cette surconsommation et pour conserver une qualité de vie et une autonomie à ces personnes, les infirmières de l’unité prothétique de la Résidence Triest du CHSLD Biermans-Triest avec le pharmacien ont instauré progressivement le suivi pharmaco médico-nursing pour trente-cinq (35) résidents.

Une rencontre composée d’une infirmière, infirmière auxiliaire, pharmacien et médecin est prévue une fois semaine et au cours de laquelle se font une analyse et une réévaluation du profil pharmacologique de résidents préalablement sélectionnés.

L’infirmière prépare et anime la rencontre. Elle identifie les besoins de santé du résident, fait part à l’équipe des comportements observés à l’unité, des réactions et des réponses aux médicaments.

Le pharmacien supervise la consommation de médicaments en constituant un dossier pour chacun des résidents et transmet les données pertinentes aux autres professionnels.

Cette rencontre de suivi permet d’encourager et d’inciter les médecins à suivre des normes de prescriptions et à discuter avec les autres membres de l’équipe sur la nécessité de donner tel médicament ou de poursuivre tel traitement.

Nous avons pu constater que ces rencontres ont eu comme résultats de :

• Cesser les traitements devenus désuets

• Diminuer la consommation de médicaments

• Prévenir et/ou diminuer les effets secondaires ou réactions nuisibles (agitation, tremblements, anxiété, dyskinésie, apathie)

• Diminuer la consommation de médication prn

• Avoir un meilleur suivi quant à la durée du traitement et la posologie

• Augmenter les connaissances des professionnels

• Développer une équipe harmonieuse et efficace

• Diminuer les appels au médecin pour problèmes de comportement

• Augmenter les interventions non pharmacologiques

Les résultats globaux de ces rencontres sont très positifs.

Toutefois, nous insistons pour rappeler que certains préalables doivent être présents lors du déroulement de cette démarche tels : des croyances positives à l’égard de ce processus chez les professionnels, une motivation de ces derniers à réaliser ce suivi et une grande stabilité de la présence infirmière.

009

ÉVALUATION DES RELATIONS ENTRE LES TROUBLES D’ÉQUILIBRE ET LES FONCTIONS EXECUTIVES CHEZ LES SUJETS ÂGES

Paola Campana, Nicole Moreau Stephanie Caillé, Institut universitaire de gériatrie de Montréal, 4565 Queen Mary, Montreal, QC H3W 3W5 (p_campana@hotmail.com), Tel: (514) 340-3518, Fax: (514) 340-2826

INTRODUCTION

En l’absence de troubles au niveau des systèmes somato-sensoriels, on peut néanmoins observer des atteintes de l’équilibre chez certaines personnes âgées. Dans ces cas, les atteintes cognitives pourraient expliquer les difficultés notées au niveau de l’équilibre. Ces difficultés se situeraient en outre au niveau de l’attention et des fonctions exécutives.

OBJECTIF

L’objectif général du présent projet de recherche, lequel est de nature exploratoire, est d’évaluer les relations entre l’équilibre et certaines fonctions exécutives.

POPULATION ET INSTRUMENTS DE MÉSURE

Les sujets sont des patients (n=30) âgés de 65 ans et plus, recrutés au programme de courte durée gériatrique, au printemps 2001.

L’évaluation de l’équilibre et de la mobilité est réalisée à l’aide des activités suivantes: Échelle de Berg, test Timed Up and Go, vitesse du transfert rythmique de poids et du contrôle de la direction par moyen du Balance Master.

L’évaluation des fonctions exécutives est effectuée à l’aide d’épreuves neuropsychologiques standardisées suivantes: empan numérique à l’endroit et à rebours, Stroop, Tour de Londres, Trail Making A et B.

RÉSULTATS PRÉLIMINAIRES ET CONCLUSION

Les résultats préliminaires suggèrent que les difficultés au niveau de l’équilibre, observées chez des sujets âgés sans atteinte des systèmes somato-sensoriels, peuvent être associées à une atteinte des fonctions exécutives et notamment de l’inhibition et de la planification.

010

MELATONIN -- AN EARLY MARKER FOR PATHOLOGICAL BRAIN AGING?

Alexander G. MacCordick, N.P.Vasavan Nair, George Schwartz, N.M.K. Ng Ying Kin, Sophie Briere, Sonia Lupien, Joseph X. Thavundayil. Douglas Hospital Research Centre and Department of Psychiatry, McGill University, 6875 Lasalle Blvd., Verdun, QC., Canada, H4H 1R3 (vasavan.nair@douglas.mcgill.ca) Tel: (514) 762-3035, Fax: (514) 762-3020

One hundred and thirty two healthy elderly subjects participated in an ongoing, longitudinal study on normal brain aging. Annual evaluations include a complete physical and neurological examination and neuropsychological tests (language, memory, executive functions). Blood samples collected at hourly intervals over a 24-hour-period were assayed for melatonin. The circadian secretion of melatonin was evaluated. Twenty subjects developed clinically significant episodic memory deficit (EMD group). Serum melatonin concentrations of these subjects were found to be below the lower limit of the 95% confidence interval (CI) of the complementary group of subjects without memory deficit (n=112), during the time of night when melatonin levels were usually the highest (i.e., at 1:00, 2:00 and 3:00 a.m.). The mean individual peak level of melatonin secretion in the EMD group was 14% lower than the normal group’s CI lower limit. In addition, the cosinor acrophase was advanced 46 minutes ahead of the lower limit. In conclusion, these results indicate that subjects with memory deficits show reduced melatonin secretion.

011

THE PERSPECTIVE OF FAMILIES REGARDING DECISION-MAKING FOR LATE-STAGE ALZHEIMER'S DISEASE: THE CENTRALITY OF QUALITY OF LIFE

Chantal Caron, Marcel Arcand, Jennifer Griffith, Joseé Roy, Centre de recherche sur le vieillissement, Institut universitaire de gériatrie de Sherbrooke, 1036, rue Belvédère sud, Sherbrooke, QC J1H 4C4 (chantal.caron@courrier.usherb.ca), Tel: (819) 821-1170 poste 2214, Fax: (819) 829-7141

Family caregivers are often called upon to make treatment decisions when a loved one suffering from Alzheimer's disease reaches the end of his or her life. Making treatment decisions is a complex process and it can be difficult for families to determine the most appropriate care for the patient. Very few studies have explored the perspective of family caregivers with regards to treatment choices once the patient can no longer participate in the decision making. The aims of this qualitative study are to examine the concerns of caregivers around the care of a loved one in late-stage dementia as well as to explore how end-of-life care decisions are made. The method used was the grounded theory design. Data was collected from in-depth interviews with twenty-two caregivers and analysed using the constant comparison method, resulting in a theory of decision-making. Among the numerous dimensions of this theory, the patient's quality of life emerged as a central determinant for caregivers in deciding appropriate care. Quality of life is described and its relationship to other dimensions of the decision-making process are revealed. The results highlight the importance of including family caregivers' experience in working toward caregiver/medical team consensus around care decisions at end-of-life.

012

THE PARADOX OF DOING WHAT IS BEST: PERCEPTIONS DRIVING NURSING STAFF'S DECISIONS TO USE RESTRAINTS IN A COMPLEX CONTINUING CARE/REHABILITATION HOSPITAL

Vera Parkin, Chantale LeClerc, The Riverdale Hospital, 14 St. Matthews Road, Room 203 Hastings Bldng, Toronto, ON M4M 2B5 (cleclerc@trh.on.ca), Tel: (416) 461-8252 ext. 2380, Fax: (416) 461-2953

Purpose: The purpose of this study was to determine the perceptions (attitudes, beliefs, thoughts, and feelings) of nursing staff in a complex continuing care/rehabilitation hospital regarding the use of chemical and physical restraints. Findings would be used to inform the implementation of a least restraint program.

Methods: Two focus groups were conducted, one with six registered nurses (RNs) and a second with six personal service providers purposively selected from across the hospital.

Results: The RNs' decisions to use restraints were influenced by their desire to do what is best for the patient. Their knowledge of a) the emotional and physical risks of restraint use, b) the temporary nature of restraints, and c) the need for thorough assessment, was over-ridden by their belief that restraints ensured patient safety and by their fears of litigation. Time and staffing concerns were also viewed as limiting the use of alternatives to restraints. Personal service providers had similar perceptions with the exception of identifying fewer physical risks of restraints, and more alternatives to restraints.

Conclusions: The findings of this study highlight the need to address underlying values and beliefs prior to implementing least restraint programs thereby maximizing their likelihood of success.

013

EFFECTS OF IMPOSED RISK AND PERCEIVED VULNERABILITY ON SUBSEQUENT EMOTIONS AND CONTROL STRATEGIES AMONG AN ELDERLY POPULATION

Joelle Ruthig, Judith Chipperfield, Raymond Perry, 315 Max Bell Centre, University of Manitoba, Winnipeg, MB R3T 2N2 (umkobyla@cc.umanitoba.ca), Tel: (204) 474-9255

Perceived vulnerability, the subjective susceptibility to negative outcomes, may influence individuals emotions and use of behavioral and psychological control-strategies, yet few studies have been conducted among aging populations. Our study focused on a sub-sample of Successful Aging Study participants (n = 171) to exam the impact of imposed risk (probability of hypothetical heart attack) and perceived vulnerability on older individuals emotions and use of control-strategies. We conducted 3 X 3 ANOVAs to examine imposed risk (low, unknown, and high) X vulnerability (invulnerable, neutral, vulnerable) on expected emotions and psychological and behavioral strategies. Out of the three vulnerability groups, vulnerable individuals expected to feel the most resignation and were most likely to seek information from doctors, regardless of imposed risk. Invulnerable participants expected the least regret (but only in the high-risk scenario), were least likely to prepare for or accept having an attack, and least likely to avoid thoughts about having an attack. Results suggest the imposed risk successfully impacted participants perceived susceptibility to a heart attack. Regardless of imposed risk, however, individuals who perceive themselves as invulnerable to health risks may experience fewer negative emotions (i.e., resignation and regret) and use fewer psychological (i.e., acceptance and avoidance) or behavioral control strategies, (i.e., preparing for health problem or seeking information) compared to their vulnerable counterparts.

014

TEST-RETEST RELIABILITY OF A FALLS RISK SELF-ASSESSMENT QUESTIONNAIRE FOR SENIORS

Martha Donnelly, Jenny Elliott, Jean Jamieson, Marilyn Malone, GPOT HCE-4, 715 West 12th Ave, Vancouver, BC V5Z 1M9 (marthad@interchange.ubc.ca), Tel: (604) 875-4461, Fax: (604) 875-5816

Most falls in the elderly are multifactorial. Falls can be reduced by individualized multicomponent interventions. Individuals are more likely to comply with interventions if they are involved in all steps of the assessment and treatment process. Although many fall risk assessment tools exist, none were found that allowed the individual input and control.

A one-page questionnaire was developed that included major risk factors identified in the literature, worded to reflect the clients viewpoint.

The objective of the current study was to determine the test-retest reliability of the questionnaire. Secondary objectives are a) to correlate the test scores with known risk factors for falling, specifically age, gender, history of previous falls; and b) to compare self assessment with valid measures of cognition, medication use, balance and mobility.

The study is currently taking place at two geriatric out-patient assessment and treatment programs in Vancouver

The results are not yet available but we intend to report reliability by the correlation coefficient for each item, using Cohens kappa. In addition we will present the distribution and mean overall scores compared by age, gender and history of previous falls and correlation between self-report and recorded medications, MMSE, Berg Balance Scale and TUG.

015

COMPARISON OF THE PREDICTORS OF DEPRESSION AND ANXIETY ACROSS NURSING HOME RESIDENTS, COMMUNITY-DWELLING ELDERLY, AND YOUNGER ADULTS

Liza Stelmach, Candace Konnert, Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4 (lddalzel@ucalgary.ca), Tel: (403) 220-4975, Fax: (403) 284-9516

In comparison to younger adults and community-dwelling elderly, the nursing home population is quite unique. For example, chronic illnesses, sensory declines, and experiences of loss are more common in this population, as is loss of decisional control and social support. Therefore, one might expect to find unique predictors of depression and anxiety in nursing home residents. The present study was designed to compare the predictors of depression and anxiety in a sample of 70 residents (mean age = 81.4, ranging from 61-98) to the results of previous studies conducted with younger adults and community-dwelling elderly. The following predictors were examined: indices of physical health and sensory functioning, cognitive status, primary and secondary appraisal and anticipatory coping, dysfunctional thoughts, perceived control, and indices of social support. The results include: perceived health, pain, feelings of harm/loss, and perceived control were found to consistently predict depression across the three age groups, while vision consistently failed to predict depression. Pain feelings of harm/loss and perceived control consistently failed to predict anxiety. Chronic illnesses, functional impairment, audition, threat, coping efficacy, dysfunctional thoughts, and social support were found to inconsistently predict depression and anxiety across the three age groups. Possible explanations of why there are unique predictors of depression and anxiety in nursing home residents are discussed.

016

FALLS PREVENTION IN SUPPORTIVE HOUSING: A COMMUNITY DEVELOPMENT PROJECT

Laurie Brady-Mueller, Fiona Sudbury, Veronica Doyle, 540 Hoffman Avenue, Victoria, BC V9B 5W4 (lbmueller@shaw.ca), Tel: (250) 744-4338, Fax: (250) 744-5696

The purpose of this study is to reduce falls in seniors, veterans and their caregivers living in a supportive housing complex and to create a model that will be sustainable and portable after the two year funded project is over. A coalition from seniors, veterans, and health care organizations developed and are implementing the project. This community development process assists seniors in creating solutions to hazards and risk factors in their lives. This poster will focus on a housing complex where 68 seniors rent a room and service package. The average age is 82, most are single, and two thirds are women. Falls are common. A group of residents attend falls prevention meetings as well as participate in generating and implementing solutions. An Evaluation team established from the coalition monitors the impact and outcome of the community development project. We have learned that community and capacity building between seniors, veterans, their caregivers and health care professionals is a valuable first step in creating safer living environments. This is a work in progress. This project is funded by Veterans Affairs Canada through Health Canada to the Vancouver Island Health Authority South Island Region.

017

THE DEVELOPMENT OF A DATABASE FOR A HOSPITAL-BASED GERIATRIC PROGRAM

Heather Grant, Susan Fairweather, Pamela Jarrett, Elizabeth MacDonald, Health and Aging Program, 130 Bayard Drive, Saint John, NB E2L 3L6 (jarpa@reg2.health.nb.ca), Tel: (506) 632-5458, Fax: (506) 632-5512

Background:

The Health and Aging Program (H&A) of the Atlantic Health Sciences Corporation (AHSC) consists 0f 180 inpatient beds an inpatient consultation service and outpatient clinics.A major challenge for the program has been limited data upon which to drw conclusions regarding patient outcomes.It was felt that the development of a reliable database would promote reearch and the development of quality improvement measures.

Methods:

An interdisciplinary research committee reviewed the literature and examined various standardized instruments.The respectice disciplines had input into the discipline specific tools chosen for the database.The database is maintained by the H&A program.A booklet was produced that explained how to administer each of the tools as well as their purpose.Teaching sessions were provided to the nursing staff and the other disciplines administering the tools

Results:

We have been successful in entering data refining our data elements and developing a list of diagnoses modeled after CIHR.

Conclusion:

This activity has increased the awareness of the staff regarding the importance of standardized tools to measure patient outcomes and stimulate research.

018

ASSOCIATIONS BETWEEN PSYCHOTIC BEHAVIORS AND DEPENDENCE IN ACTIVITIES OF DAILY LIVING

Mun Tran, Michel Bédard, David Molloy, Sacha Dubois, Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 (muntran@hotmail.com),Tel: (807) 345-2216, Fax: (807) 346-7734

Objectives: Cognitive impairment resulting from Alzheimers disease (AD) is associated with dependence in activities of daily living (ADL). The presence of psychotic behaviors (delusions/hallucinations) may further increase this dependence but their contribution remains to be fully elucidated.

Methods: We analyzed data from 558 individuals with AD referred to a memory clinic. Information on ADL (basic and instrumental), psychotic behaviors, depression symptoms, and cognitive impairment were collected with standardized instruments.

Results: The frequency of psychotic behaviors was correlated with dependence in ADL (r = .44, p = .001). The independent contribution of psychotic behaviors, after consideration for cognitive impairment and depression symptoms, was assessed with hierarchical regression models (basic and instrumental). Twenty-eight percent of basic ADL variance was explained by cognitive impairment and depression symptoms; psychotic behaviors (b = -0.13, p = .001) accounted for an additional nine percent of the variance. Cognitive impairment and depression symptoms explained 35% of instrumental ADL variance; psychotic behaviors (b = 0.22, p = .001) accounted for an additional seven percent.

Conclusion: Psychotic behaviors are associated with dependence in ADL after control for cognitive impairment and depression symptoms. Future research should confirm causal linkages between psychotic behaviors and dependence in ADL. This may have implications regarding interventions to maintain independent living in people with AD.

019

VET-LINK: A NEW, NATIONAL, INTERDISCIPLINARY CLINICAL-RESEARCH NETWORK TO IMPROVE HEALTH SERVICES FOR VETERANS

Maggie Gibson, Maryse Savoie, Belinda Parke, Veterans Care Program, Parkwood Hospital, 801 Commissioners Road East, London, ON N6C 5J1 (maggie.gibson@sjhc.london.on.ca),

Tel: (519) 685-4292 ext 42708, Fax: (519) 685-4031

Recent world events have reminded all Canadians of the unique challenges that accompany a military service career and underscore the importance of a comprehensive strategy to address current and emerging needs in veterans care. VET-LINK has evolved in response to this need. VET-LINK is a new, interdisciplinary network of researchers, clinicians, facility administrators and university-based affiliates from across the country, committed to the goal of improving health services (for example, pain management), for Canadian war veterans. Health services for veterans must address needs that are unique, secondary to a history of military service, and common, secondary to the processes of aging. VET-LINK is designed to enable clinician-researchers in veterans care to "take charge of the future" by building capacity, enhancing quality, and maximizing cost-efficiency through collaboration on: 1) applied research studies; 2) clinical education programs for providers and clients; 3) evidence-based service development, enhancement and evaluation; and 4) advocacy. As a grassroots initiative, VET-LINK is built on ongoing clinical and scientific activities in the partner facilities, and is structured to be inclusive, responsive and participatory. This poster describes the VET-LINK initiative, and invites further partnerships, liaisons and relationships.

020

WHAT CHARACTERIZES THE IDEAL GERIATRIC DAY HOSPITAL (GDH) PATIENT? A SIX-MONTH RETROSPECTIVE CHART AUDIT AND PROSPECTIVE SURVEY OF GDH REFERRALS

Costa Apostolides, Chris MacKnight, Queen Elizabeth II Health Sciences Centre, Veterans' Memorial Building, 5955 Veterans Memorial Lane, Suite 2650, Halifax, NS B3H 2E1 (capostol@is2.dal.ca), Tel: (902) 473-2443, Fax: (902) 473-4867

Introduction: Referrals to Geriatric Day Hospitals (GDHs) come from a variety of sources, including geriatricians, community family physicians, emergency room physicians, in-patient hospital wards, home care personnel and other professionals. The majority of referrals to GDHs are appropriate, as evidenced by improved outcomes. However, a proportion of patients referred to GDHs from various sources are sub-standard candidates for such programmes and result in misuse of valuable professional time and resources.

Methods: In the present study, a retrospective chart audit was conducted of all attendees to a local GDH during a six-month period (n=126). Data were collected on patient demographics, referral sources, reasons for referral, pre- and post- GDH goal attainment, pre- and post- GDH measures of disability and responses from a formal caregiver survey. Data were analyzed in order to assess patient outcomes and agreement between referral reasons, patient goals derived by the GDH assessment team and a caregiver survey.

Results: The mean goal attainment score (GAS) was 47.4 (SD=8.1), very close to the theoretically expected values of mean 50 and SD 10, indicating that most patients had realistic goals. Only 18 of 89 total attendees with completed goals had a GAS<40, indicating sub-optimal outcomes. The goal areas with the most significant beneficial change in goal attainment were mobility, balance, falls, pain, emotional, socialization, medications, incontinence and caregiver stress (range of mean change in goal areas 0.7-1). In addition, GDH team personnel were surveyed, in a subsequent six-month prospective analysis, regarding personal opinions about patient suitability before and after attending the GDH programme. There was general agreement between team members' subjective responses and the results of the chart audit.

Conclusion: The present study shows that suitable GDH candidates with a good probability of success may be chosen prior to GDH attendance.

021

INTEGRATING PROJECT DESIGN AND DISSEMINATION TO MEET HEALTH FOUNDATION REQUIREMENTS FOR MULTIDISCIPLINARY, MULTI-INSTITUTIONAL AND PLANNED DISSEMINATION RESEARCH PROGRAMS

Keith Sclater, Donna Smith, Anne Sclater, Director, Division of Geriatric Medicine,University of Alberta, c/o Glenrose Hospital, 1259, 10230 - 111 Avenue, Edmonton, AB T5G 0B7 (anne.sclater@ualberta.ca), Tel: (780) 474-8845, Fax: (780) 474-8846

Foundations funding health research have been concerned that research has been limited in design and distribution to restricted groups of investigators with little attention to applicability in clinical practice. Investigators are now requested to cooperate across disciplinary and institutional jurisdictions to develop proposals for technology that will have a positive impact on practice and service delivery. Also a plan is required for the translation, dissemination and adoption of research beyond an immediate academic audience into a more global domain. Theories of the adoption and diffusion of innovations suggest that problems such as shortages of trained staff, high staff turnover, administrative discontinuity, loss of corporate memory and severe financial cutbacks will interfere with knowledge development and utilization. Requirements for health corporation approval and financial commitment at the proposal development stage suggest the potential for corporate gate keeping of the research process. Requirements for early dissemination enhance the possibility that unproven technologies will be adopted prematurely. We present an integrated model for research development and dissemination in which decision-makers collaborate from the outset to overcome potential pitfalls.

*A project funded by the Canadian Health Services Research Foundation, the Alberta Heritage Foundation for Medical Research and organizational partners.

022

DOES A SINGLE ITEM MEASURE OF DEPRESSION PREDICT MORTALITY?

Philip St. John, Patrick Montgomery, Section of Geriatrics, GE 545 Health Sciences Centre, Winnipeg, MB R2C 0A1 (pstjohn@hsc.mb.ca), Tel: (204) 787-3365, Fax: (204) 787-4826

Background: Depression, measured by clinical interview or scales of depressive symptoms, predicts mortality. Objective: To determine if a single item measure of depressive symptoms predicts mortality.

Design: Secondary analysis of the Manitoba Study of Health and Aging.

Participants: 1751 seniors, sampled from a representative population registry. Measurements: Depressive symptoms were measured with one item drawn from the Centre for Epidemiologic Studies - Depression (CES-D) scale: "I felt depressed." This response was dichotomized into never/rarely, or sometimes/often/always. Activities of daily living (ADL) and instrumental ADLs (IADLs) were measured using the Older Americans Resource Survey (OARS). Cognition was measured using the Modified Mini-mental Status Examination (3MS).

Outcomes: Mortality over the five-year interval.

Results: Those with self-reported depressive symptoms had a five-year mortality of 30.2% versus 19.7% in those without self-reported depression (p <0.001, chi-square test). This association persisted after adjustment for age, gender, education and 3MS score: Odds ratio (OR) for mortality: 1.35 (95% confidence interval, 1.03, 1.76). In models with functional status, the single item was no longer predictive of mortality.

Conclusions: A simple, easily collected measure of depressive symptoms predicted mortality. Further study is needed in order to determine the usefulness of this question in a clinical sample.

023

GETTING "CODE STATUS" FROM THE HOSPITALIZED ELDERLY PATIENT: A SYSTEMATIC REVIEW OF THE LITERATURE

Chris Frank, Daren Heyland, Donald Farquar, Katherine Myers, Ben Chen, St. Mary's of the Lake Hospital, 340 Union St., Kingston, ON K7L 5A2 (frankc@pccc.kari.net),

Tel: (613) 544-5220, Fax: (613) 544-4017

Physicians have little guidance to help them communicate and effectively make decisions related to CPR with older patients.We systematically reviewed the literature to determine whether sufficient information exists to allow the development of guidelines to improve the frequency and quality of discussions related to CPR with hospitalized elderly patients. All original research papers involving hospitalized patients over age 65, with a research focus on communication, and where the main subjects were patients, family members or health professionals, were included for the review.

Forty-four papers met inclusion criteria. Themes emerging from our synthesis of results included: 1) Patients and families have limited understanding of CPR and overestimate its benefit, 2) The majority of patients are interested in discussions about CPR and sharing decisional responsibility with physicians, 3) Patients have variable decisional capacity, 4) Physicians do not routinely discuss CPR with older patients and patients do not initiate discussion, 5) Physicians do not provide patients or families with consistent information about resuscitation, and 6) Documentation of CPR discussions and decisions is poor.

To improve decision making related to CPR in hospitalized elderly patients, physicians need to initiate discussions, assess decisional capacity, share decisional responsibility, assess patient's understanding and involve the family where possible. Adequate documentation of discussions and patient preference may minimize misunderstandings about patient preference and increase the stability of decisions.

024

APPROCHE CHRONOMÉTRIQUE DU TRAITEMENT DU LANGAGE NON LITTÉRAL CHEZ LES SUJETS CÉRÉBROLÉSÉS DROITS

Maud Champagne, Jean-Luc Nespoulous, Yves Joanette, Institut universitaire de gériatrie de Montréal - Centre de Recherche, Secteur A, 4565, chemin Queen-Mary, Montréal, QC H3W 1W5 (champagn@univ-tlse2.fr), Tel: (514) 340-3540 poste 4775, Fax: (514) 340-3548

Les personnes âgées sont les plus sensibles aux accident vasculaire cérébraux. Lorsqu’un tel accident affecte l’hémisphère droit, il peut être la source de troubles de la communication prenant la forme d’une perturbation des habiletés pragmatiques du langage (e.g., langage non littéral). Ces difficultés proviennent notamment du fait que pour comprendre un énoncé non littéral, nous devons être capables de différencier ce que le locuteur dit de ce qu’il veut dire, en utilisant l’information contextuelle pour comprendre l’intention du locuteur.

L’objectif de cette étude est de tester les capacités des sujets cérébrolésés droits (CLD) à traiter différents types d’énoncés non littéraux. L’utilisation d’une approche chronométrique permet de montrer, chez 20 sujets CLD et chez 20 sujets contrôles appariés, l’existence d’une hiérarchie de complexité entre différents types d’énoncés non littéraux. Un déficit concernant le traitement du langage non littéral, excepté le traitement des demandes indirectes, est pourtant mis en évidence chez les sujets CLD.

Ces résultats montrent la pertinence d’une approche chronométrique. Etant donné le traitement différentiel existant entre les différents types d’énoncés non littéraux, ces résultats insistent aussi sur l’importance de s’intéresser au rôle des intentions dans le langage non littéral.

025

AGE AS A MODERATOR OF THE RELATIONSHIP BETWEEN PERCEIVED CONTROL AND AFFECT

Judith Chipperfield, Nancy McKeen, Darren Campbell, Loring Chuchmach; Health, Leisure, and Human Performance Research Institute, 307 Max Bell Centre, University of Manitoba, Fort Garry Campus, Winipeg, MB R3T 2N2 Tel: (204) 474-8762 Fax: (204) 261-4802 Email: (204) 261-4802

Strong perceptions of personal control have repeatedly been shown to relate to enhanced subjective well-being and reduced depression and negative affect. However, the relationship between perceived control (PC) and well-being may be moderated by age (Lang & Heckhausen, 2001). We examined this relationship in an analysis of 353 young old (< 80 years) and old-old (80+) individuals participating in the Successful Aging Study (SAS). After statistically controlling for gender, education, income, and health, regression analyses revealed that age did not moderate the relationship between PC and global positive affect, although PC did significantly predict positive affect (B = .218, p = .008). On the other hand, age did interact with PC to predict global negative affect (B = .647, p = .031). Among individuals who were younger than 80 years, declining levels of perceived control were associated with increasing levels of negative affect. No such relationship between PC and negative affect was found among old-old individuals. Supplemental analyses further revealed that the significant age by PC interaction may be apparent for some discrete emotions, in particular, frustration and perhaps, sadness, but not for others. This suggests that it may be critical to examine the discrete negative emotions that comprise global negative affect.

026

PSYCHOGÉRIATRIE: CONSTRUCTION D'UNE GRILLE DES COMPORTEMENTS À RISQUE

Rossitza Nikolova, Louise Demers, Anne Guérette, Louisa D'Altilia, Doreen Whitehead, Nona Moscovitz, 5800, boul. Cavendish, suite 600, Côte St-Luc, QC H4W 2T5 (rossitza.nikolova@umontreal.ca), Tel: (514) 488-3673 poste 468

Cette étude a pour but d'élaborer et de valider une échelle d'évaluation des comportements à risque présentés par les personnes âgées vivant à domicile et présentant des troubles de santé mentale. Au plan conceptuel, l'instrument est basé sur le modèle de Dalpé et al. (1997), lequel identifie cinq catégories de comportements à évaluer.

MÉTHODOLOGIE : Les items faisant partie de l'échelle ont été dégagés à partir des priorités des intervenants et de la recension des écrits. La validité de contenu de l'instrument a été évalué en terme de pertinence et clarté, à travers une consultation d'experts (cliniciens, chercheurs et aidants naturels).

RÉSULTATS : La grille contient 39 items jugés importants, répertoriés dans cinq domaines de risques liés à la santé physique et mentale et à la sécurité physique, psychologique et financière. Les items sont évalués par rapport à leur fréquence et à la gravité des conséquences sur des échelles ordinales de 2 et 5 niveaux de réponses.

CONCLUSION : L'instrument permettra de dépister un comportement à risque et de mettre en place les interventions psychosociales appropriées. Des études de reproductibilité inter-juges sont en cours et d'autres recherches sont prévues pour évaluer la structure factorielle et l'applicabilité de l'instrument.

027

MEALS-ON-WHEELS: GOODNESS OF FIT BETWEEN PROGRAM OBJECTIVES AND FUNDING CRITERIA

Joseph Tindale, Susan Thorning, Dept. of Family Relations & Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1 (jtindale@uoguelph.ca), Tel: (519) 824-4120 ext. 3796, Fax: (519) 766-0691

Meals on Wheels (MOW) is a non-profit community service. In Ontario the providers of these programs receive support and coordination through the Ontario Community Support Association (OCSA). In part, the OCSA has dones this by developing a MOW logic model. Partial funding comes from the Province and the remainder is in client fees. As the population ages, becomes more diverse in terms of dietary needs and other (dis)abilities, it becomes increasingly important that client needs, provider objectives, the OCSA logic model and provincial funding criteria are consonant. Our project purpose was to examine stakeholder (providers, volunteers, clients, food suppliers and funder) perceptions regarding the degree to which this consonance existed and to make recommendations to the degree it did not. In summer 2000 questionnaires were mailed to program stakeholders and phone interviews were conducted with provincial staff supervising funding. Results suggested changes would be useful with regard to: collaboration between providers and funder on gaps between unit cost criteria and program costs, organization and delivery; increased volunteer training; consistency in program delivery to aboriginal peoples; client profile comparisons between MOW and other food services, more attention to diverse dietary client needs and preferences.

028

BATTERIE D'ÉVALUATION DES TROUBLES DE LA COMMUNICATION DES CÉRÉBROLÉSÉS DROITS

Hélène Côté, Karen Eck, Bernadette Ska, Yves Joanette, Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montréal, QC H3W 1W5 (cotehe@hotmail.com), Tel: (514) 340-3540 poste 3041, Fax: (514) 340-3548

Lors du vieillissement, une augmentation de l’occurrence des maladies vasculaires est observée. Ainsi, nombreuses sont les personnes âgées victimes d’accidents vasculaires cérébraux dont les conséquences sont multiples. Entre autres, il est connu qu’une lésion à l’hémisphère cérébral droit peut entraîner des troubles de la communication verbale ayant d’importantes répercussions psychosociales chez la personne âgée. À ce jour, l’orthophonie clinique dispose toutefois de peu d’outils pour évaluer ces déficits communicatifs, notamment aucun en français, et tous présentent des limites théoriques et méthodologiques. Afin de pallier ce manque d’outil clinique, des chercheurs et des orthophonistes cliniciens se sont unis pour créer un protocole d’évaluation destiné spécifiquement à l’évaluation des troubles de la communication des cérébrolésés droits. Le résultat de ce projet, qui s’est déroulé au fil des trois dernières années, est une batterie d’évaluation constituée de 14 tâches investiguant les dimensions pragmatique, prosodique, lexico-sémantique et discursive du langage, toutes reconnues comme pouvant être atteintes suite à une lésion cérébrale droite. Le présent travail a donc pour objectif de présenter ce nouveau protocole d’évaluation en décrivant chacune des tâches ainsi que leur fondement théorique et leur utilité clinique.

029

EFFETS DE L'ÂGE ET DE LA SCOLARITÉ LORS DE L'ÉVALUATION DU LANGAGE

Hélène Côté, Évelyne Mercure, Bernadette Ska, Yves Joanette, Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montréal, QC H3W 1W5 (cotehe@hotmail.com), Tel: (514) 340-3540 poste 3041, Fax: (514) 340-3548

Il est connu qu'une lésion à l'hémisphère cérébral droit peut entraîner des troubles de la communication verbale et affecter, entre autres, la compréhension du langage figuré ainsi que les aspects discursifs du langage (Joanette et. al, 1990). Afin d'investiguer ces déficits, une batterie d'évaluation a été créée. On sait toutefois que certaines habiletés langagières peuvent être touchées lors du vieillissement. Ainsi, avant d'utiliser la batterie auprès de la population cérébrolésée, il importe d'abord d'identifier l'effet possible de l'âge et de la scolarité, ce qui permettra par la suite d'isoler l'effet spécifique de la lésion droite sur la communication. À cette fin, 60 adultes neurologiquement sains, répartis selon trois groupes d'âge et deux groupes de scolarité, ont été évalués avec les tâches de compréhension de métaphores et de rappel de récit. Les résultats démontrent que les sujets jeunes réussissent mieux que les sujets plus âgés à la majorité des épreuves. De même, les sujets plus scolarisés performent mieux à l'ensemble des tâches que les sujets moins scolarisés. Ces résultats vont dans le sens d'une altération des habiletés langagières avec l'âge, mais il importe toutefois de poursuivre la normalisation du protocole sur un plus grand nombre de sujets.

030

INFORMAL SUPPORT AMONG ONTARIO HOME CARE RECIPIENTS: FINDINGS FROM THE MINIMUM DATA SET FOR HOME CARE

Jeff Poss, John Hirdes, c/o Health Studies & Gerontology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1 (jwposs@healthy.uwaterloo.ca), Tel: (519) 888-4567 ext 2732, Fax: (519) 746-2510

Caregiving by family members, friends, and neighbours is an important component in maintaining elderly individuals in their homes. The Minimum Data Set for Home Care (MDS-HC) is a standardized assessment instrument designed to give a comprehensive health and care profile for community dwelling seniors, and includes a number of questions on informal support services. Twelve Ontario Community Care Access Centres completed MDS-HC assessments on clients receiving home care services (n=4837). Descriptive findings include those relating to age, gender, marital, and living status of the home care recipients, as well as time, relationship, and strain indicators of the informal caregivers. Bivariate and multivariate analyses show a complex relationship between informal caregiving and formal care services, with covariates including the care recipients physical status, cognition, marital status, living alone, age, behaviour, delusions, continence, and health instability. In addition, economic modelling shows the value of informal support services rivals the value of the formal care provided.

031

A MODEL OF INTEGRATED SERVICE DELIVERY NETWORK FOR FRAIL ELDERLY PEOPLE

Pierre Durand, Michel Tousignant, André Tourigny, Nicole Dubuc, Pascale Morin, c/o Réjean Hébert, Directeur scientifique / Scientific Director, Institut du vieillissement / Institute of Aging, 1036 Belvédère Sud, Sherbrooke, QC, J1H 4C4 (rejean.hebert@USherbrooke.ca) Tel: (819) 829-7131, Fax: (819) 829-7141

Presentations titles:

Impact of an Integrated Service Delivery (ISD) Network for Frail Elderly People

Pierre J Durand

New Validation of a Disability-based Case-mix for Elderly People in Integrated Care Services

Nicole Dubuc, Réjean Hébert, Johanne Desrosiers, Martin Buteau

Application of a Case-mix Classification Based on the Functional Autonomy of the Residents for Funding Long Term Care Facilities

Michel Tousignant, Réjean Hébert, Nicole Dubuc, France Simoneau, Linda Dieleman

A Computerized Clinical Chart in an Integrated Service Delivery Network: Elderly and Providers Viewpoints

André Tourigny, Lucie Bonin, Diane Morin, Martin Buteau, Luc Mathieu, Line Robichaud, Aline Vézina, Réjean Hébert, Daniel Pelletier, Line Beauchesne, Any Bussière, Pierre J. Durand

PRISMA-7 : A Screening Tool to Identify Older Adults with Moderate to Severe Loss of Functional Autonomy.

M. Raîche, R. Hébert, M.F. Dubois & PRISMA partners

Overview:

With the aging of the population and the scarcity of resources, it is essential to ascertain that the care which is provided responds adequately to the specific needs of the frail elderly, without duplication and in the most efficient manner. Integrated Service Delivery (ISD) networks constitute a pertinent solution which would insure the efficient management of the health services offered. This symposium will present an overview of the PRISMA* work in the Quebec province. The objectives of this research programme are to develop and evaluate mechanisms and tools designed to enhance the continuity of care and services. The mechanisms refer to consultation between decision-makers and managers at the regional and local level, the use of a single entry point, case management process, and individualised services plans. The tools refer to a unique assessment tool with a clinical information and management system (ISO-SMAF profiles), and a computerised system for communicating between institutions for client monitoring purposes. This ISD network is presently implemented in two areas and research is carried out using both qualitative and quantitative data to evaluate its process and impact. Results from one of these pilot experiments will be presented. In addition, a screening tool as well as two integrative tools used will be described: the ISO-SMAF Profile validation casemix system and the Computerized clinical chart. The ISO-SMAF Profiles represent a disability-based casemix for elderly people in an ISD network based on functional autonomy. Their development and application for long term facilities funding will be presented. As well, the development, implementation and some results regarding the elderly’s and the users’ perceptions of the Computerized Clinical Chart will be presented. These tools not only facilitate the delivery of services adapted to the clients' needs but can also continuously monitor the resources and manage the supply of services effectively and efficiently.

*PRISMA : Programme of Research to Integrate the Services for the Maintenance of Autonomy

032

PRISMA-7 : A SCREENING TOOL TO IDENTIFY OLDER ADULTS WITH MODERATE TO SEVERE LOSS OF FUNCTIONAL AUTONOMY

Michel Raîche, Réjean Hébert, Marie-France Dubois, Prisma partners, Centre de recherche sur le vieillissement de l’IUGS, 1036 Belvédère Sud, Sherbrooke, QC, J1H 4C4 (michel.raiche@USherbrooke.ca) Tel: (819) 821-1170 poste 2652, Fax: (819) 829-7141

Introduction

A significant proportion of older adults lives at home with moderate to severe disabilities. Early identification of these persons, without completing an exhaustive evaluation, is only possible with a screening tool. During the implantation of an integrated health network for older adults, the need for such a tool becomes evident.

Methods

From a random sample drawn from the electoral list of the Sherbrooke urban area, 594 community-dwelling subjects over 75 years old were selected, returned a postal questionnaire and were then evaluated at home. The postal questionnaire included 23 questions (answered by yes/no) developed according to a literature review on risk factors for functional decline. The functional autonomy was evaluated at home with the SMAF (Functional Autonomy Measurement System), a well validated disability scale. The definition of moderate to severe disability was a SMAF score Ž 15 out of 87.

Results

From the 22 questions, seven were identified as the best descriptors of a result Ž 15 on the SMAF scale, with a cut-off score of three or more positive answers. The sensitivity is 78.3% and specificity 74.7% for this score, 35.5% of the population being identified positive with the questionnaire.

Conclusion

PRISMA-7 questionnaire is a rapid and efficient tool to identify older adults with moderate to severe disability who could benefit from integrated services. This tool could be used by home care services, voluntary agencies, health professionals or acute care settings (e.g. emergency room) for targeting frail elderly individuals.

033

NEW VALIDATION OF A DISABILITY-BASED CASEMIX FOR ELDERLY PEOPLE IN INTERGRATED CARE SERVICES

Nicole Dubuc, Réjean Hébert, Lise Trottier, Centre de recherche sur le vieillissement – IUGS, 1036, rue Belvédère sud, Sherbrooke, QC J1H 4C4 (ndubuc@courrier.usherb.ca),

Tel: (819) 829-7131, Fax: (819) 829-7141

Cluster analysis is a useful technique for development of classification. But since different measures and algorithms can affect the results, we need to replicate the analysis under varying conditions.

Purpose: Comparing the original cluster solution of a disability-based casemix for elderly people to a different sample to assess the correspondence of the profiles.

Methods: The original cluster solution of the Disability profiles were determined by submitting the 29 items of the SMAF to cluster analysis and standardized validation procedures. A stratified multistage sampling of 1977 elderly people with disabilities living in different environments and regions was used. This solution was compared to a sample of 742 elderly people selected four years later with the same strategy in a different region. The obtained cluster centers from the original sample was employed with the new sample to define clusters and then compare results between the two groups.

Results: As an additional validity check on the original cluster solution, the results confirm the consistency of the 14 ISO-SMAF profiles, as homogeneity of clusters and the cluster centrods were very similar.

Conclusion: This validation project confirm that this disability-based casemix for elderly is generalizable to other objetcs and stable over time.

034

IMPACT OF AN INTEGRATED SERVICE DELIVERY (ISD) NETWORK FOR FRAIL ELDERLY

Pierre Durand, André Tourigny, Lucie Bonin, Michèle Paradis, Unité de recherche, Ch St-Augustin, 2135 Terrasse Cadieux, Beauport, QC G1C 1Z2 (pierre.durand@msp.ulaval.ca), Tel: (418) 667-3910 ext 306, Fax: (418) 667-2459

Aim: To study the effectiveness of a new integrated service delivery network for frail elderly living in a semi-urban community on functional autonomy, mortality, desire of being institutionalized, caregivers burden, utilization of services.

Methods: A quasi-experimental study was conducted from 1997 to 2000 with measures taken before implementation and every 12 months for 3 years; 482 people aged 75 years or older from 2 communities, 272 in the experimental group and 210 in the control group, were followed. Analysis were conducted using parametric and non-parametric statistics, generalized linear model, Cox regression for survival analysis.

Results: When mortality, institutionalization and loss of autonomy were combined, there was less people having encountered these events in the experimental group for those with moderate to severe loss of autonomy but not for the ones with mild loss of autonomy. This effect was significant at 12 months (49,1 % vs 31,3 p=0,002) and tended to remain at 24 months (35,9 vs 25,9 p=0,066). Desire of being institutionalized was positively and significantly modified in the experimental group at 12 and 24 months. Caregivers burden was significantly less at 12 and 24 months. The risk of being institutionalized tended to be greater in the control group.

035

A COMPUTERIZED CLINICAL CHART IN AN INTEGRATED SERVICE DELIVERY NETWORK: ELDERLY AND PROVIDERS VIEWPOINTS

André Tourigny, Lucie Bonin, Diane Morin, Aline Vézina, Unité de recherche en gériatrie, Ch St-Augustin, 2135 Terrasse Cadieux, Beauport, QC G1C 1Z2 (a_tourigny@videotron.ca), Tel: (418) 667-3910 ext. 308, Fax: (418) 667-2459

A new model of integrated service delivery system for frail elderly was developed and implemented in two local community service centres (CLSCs) in the Mauricie-Centre du Qu bec region (Bois-Francs project) in 1997. A year and a half later, a computerized clinical chart (CCC) was developed to facilitate communication exchange and interdisciplinary work between professionals and non professionals from different institutions (hospital, CLSCs, Long-Term care facilities, ambulatory services for the elderly such as day care centres and day hospital, geriatric assessment unit and rehabilitation unit, physicians). We will first describe why and how it was developed, for whom and what it does include. We will then look at the results of an on-going study. Using the conceptual model of information system success of De Lone and McLean, this study aims to identify the factors responsible for a high or low use of the CCC and high or low satisfaction related to system quality, information quality, use and perceived usefulness and perceived effects. This information comes from interviews with elderly, postal questionnaire sent to 200 professionals and non professionals, focus groups, direct observation and equipment inventories.

036

APPLICATION OF A CASEMIX CLASSIFICATION BASED ON THE FUNCTIONAL AUTONOMY OF THE RESIDENTS FOR FUNDING LONG-TERM CARE FACILITIES

Michel Tousignant, Réjean Hébert, Nicole Dubuc, France Simoneau, Centre de recherche sur le vieilissement, 1036, rue Belvédère Sud, Sherbrooke, QC J1H 4C4 (michel.tousignant@courrier.usherb.ca), Tel: (819) 821-1170 ext. 2351, Fax: (819) 829-7141

Introduction: Increasing public costs for the care of the elderly have created fundamental changes that are redefining the basic principles of health care funding. In the past, overall institutional funding was predominantly tied to spending. In view of the limitations of this approach to funding long term care facilities, case-mix classification try to take into account the characteristics of the residents as a tool for predicting costs. Recently, a new case-mix classification based on the functional autonomy profile of the residents, the ISO-SMAF profiles, was developed in the Province of Quebec, Canada. This classification could be used to change the funding system to base it on the functional autonomy characteristics of the residents.

Objectives: The main objective of this study was to apply the ISO-SMAF classification to funding long term care facilities in one area of the Province of Quebec and to compare the results of this new funding methodology to the formal methodology.

Design: This study used a cross-sectional design.

Methodology: The population under study comprised all residents of all 11 long term care facilities in the Eastern Townships area. Each resident was assessed using the SMAF. Theoretical budget was calculated based on the adjusted cost per year associated with each ISO-SMAF profile derived from a previous economic study.

Results: The theoretical budget based on the ISO-SMAF profile may highlight the under- or over-funding of a facility when compared to the usual funding system based predominantly on the number of beds and hours of care.

Conclusion: The results of this study show the feasibility of the new funding approach to long term care facilities. However, implementation of the ISO-SMAF classification for funding must be supported by continued and computerized residents' medical files including the SMAF.

037

MULTIPLIER LA FORMATION DES EQUIPES GÉRIATRI QUES AU TRAVAIL INTERDISCIPLINAIRE: UN PROGRAMME DE FORMATION POUR LES FORMATEURS

Ghislaine Massé Thibaudeau, Paule Lebel, Institut Universitaire de Gériatrie de Montréal, 4565 chemin Queen Mary, Montréal, QC, H3W 1W5 (ghislaine.masse-thibaudeau.iugm@ssss.gouv.qc.ca) Tel: (514) 340-3509, Fax: (514) 340-2832

Depuis 1997, des formatrices de la direction de l'enseignement et de la direction des ressources humaines de l'Institut universitaire de gériatrie de Montréal ont conçu et réalisé un programme de formation à l'interdisciplinarité pour les équipes cliniques du centre hospitalier. D'ici la fin de 2002, les treize équipes interdisciplinaires de l'IUGM auront été formées.

Suite à cette expérience, un programme de formation pour formateurs a été développé. Les sessions sont offertes aux responsables de formation ou aux responsables des programmes cliniques des établissements afin qu'ils deviennent eux-mêmes des agents multiplicateurs auprès de leurs propres équipes. Cette foramtion, d'une durée de trois jours, axée sur des concepts et des applications pratiques, comporte différents modules: concepts généraux et interdisciplinarité, communication, clarification et négociation des rôles professionnels, travail d'équipe, résolution de problèmes et de conflits, plan d'intervention individualisé, animation des réunions d'équipe et coaching des membres de l'équipe, plan d'action pour la formation. Depuis 1999, 66 formateurs ont participé à cette formation au cours de laquelle ils identifient des stratégies éducatives adaptées à leur milieu et se sensibilisent à l'importance de leur rôle de médiateur entre les équipes cliniques et les gestionnaires de l'établissement.

038

THE OLDER ADULT READINESS FOR HOSPITALIZATION PROGRAM

Belinda Parke, Heather Frame, Sven Jensen, 1150 Damelart Way, Brentwood Bay, BC V8M 1E3 (belinda.parke@caphealth.org), Tel: (250) 727-4117, Fax: (250) 727-4106

Hospitals are institutions designed to offer the finest in acute illness care. They are staffed with highly skilled and trained professionals acting from the best intentions with the finest technology. With this approach to care comes a tendency to expect that professionals will "know" what is best. Volunteer organizations also provide an important role in bridging the gap between professional services and informal but yet organized support. Joint hospital and volunteer organization partnerships are a means to achieving greater influence in reaching the mutual goal of enhancing the abilities of older citizens. The "Older Adult Readiness for Hospitalization" education program, a joint hospital community partnership, is designed to: enable effective and autonomous decision-making, support personal choice, and anticipate and prevent problems that might arise from the hospital experience. In this presentation, conference participants will learn about the program components, the partnership model and the process used to create the concept of "readiness".

039

BUILDING RESEARCH CAPACITY IN COMMUNITY CARE AGENCIES - PRELIMINARY FINDINGS FROM A FORMATIVE EVALUATION OF A MENTORSHIP PROGRAM

Lynda Hayward, Kim Eveleigh, Heather Derry, Jenny Ploeg, Brian Hutchison, Community Care Research Centre, 1200 Main St. West, HSC-3H1, Hamilton, ON L8N 3Z5 (haywarl@mcmaster.ca), Tel: (905) 525-9140 ext 22109,

Fax: (905) 546-5211

The community care sector is growing rapidly in both size and importance in the Canadian health care system. In their efforts to respond to the increased demand for community services in face of constrained resources, decision makers at all levels have limited expertise and research evidence on which to draw. Although community care is a growing field of study, research activities and capacity within community care agencies remain limited. This paper examines an innovative program that builds research capacity in community care agencies - the Community Care Research Centre, and specifically its mentorship program for agency staff. The mentorship experience in this program has consisted of active participation in the design and implementation of research projects and the dissemination of results, research seminars with faculty mentors, one-to-one discussion with research mentors about research issues and career development, and peer meetings to share experiences and provide support. The nature of the program, the mentoring process, research activities, and participants experiences are described. Preliminary qualitative results of a formative evaluation are presented and discussed.

This program has received funding from the Canadian Institutes of Health Research, Community Alliances in Health Research Program.

040

DEVELOPMENT OF INTERPROFESSIONAL EDUCATION IN GERIATRICS: A CASE STUDY

Janet Kow, St. Vincent's Hospital, 749 W. 33rd Ave, Vancouver, BC V5Z 2K4 (jkow@telus.net), Tel: (604) 877-3257, Fax: (604) 877-3169

Interprofessional teams are now the preferred models of care for community dwelling frail elderly. However, there is scant literature about educational programs for these teams. In this paper we discuss a case of development of an interprofessional educational module for geriatric topics. An educational program was developed in Vancouver, BC for the Frail Elderly Project, which is to be used by a community-based interprofessional team. The module is designed to be used by a wide variety of health care disciplines, including homemakers, trainees, clinical nurse specialists in geriatrics and physicians. This discussion investigates the challenge of incorporating various principles including interprofessional team learning, adult education theory, problem-based learning, the dignity of risk and client-directed care. Literature review and needs assessment were undertaken, objectives were written and a module was developed. A sample module on Falls in the Elderly is presented as a model of an educational program.

Funding Source: Vancouver/Richmond Health Board

041

LA PLACE DU RECOURS AUX MÉDICAMENTS PARMI LES STRATÉGIES DU BIEN-VIEILLIR, CHEZ DES FEMMES ÂGÉES ACTIVES ET SÉDENTAIRES, VIVANT DANS UN MILIEU ECONOMIQUEMENT DÉFAVORISÉ

Philippe Voyer, Suzanne Laberge, Geneviève Rail, Hélène Dallaire, Faculté des Sciences Infirmières, Université Laval, Cité Universitaire, Québec, QC G1P 7P4 Tel : (418) 656-2131 poste 8799 Facsimile : (418) 656-7825 Courriel : philippe.voyer@fsi.ulaval.ca

Les femmes âgées de 65 ans et plus constituent le segment de la population qui croît le plus rapidement en Amérique du Nord qui est le moins actif physiquement, particulièrement chez celles de milieux socio-économiquement défavorisés (SÉD) et qui présente une importante consommation de médicaments (Santé Québec, 2000). Appuyés sur l'approche théorique du bien-vieillir, développée par Baltes et Carstensen (1996) et par Rowe et Kahn (1998), les buts de cette étude étaient d'identifier les perceptions des aînées à l'égard de leur santé, la place qu'occupent les médicaments et l'activité physique parmi les stratégies du bien-vieillir et les freins perçus dans l'adoption de ces comportements chez des aînées vivant dans des milieux SÉD. Une étude de type qualitative a été réalisée auprès de 40 femmes âgées de 65 à 75 ans, certaines étant physiquement actives et d'autres physiquement moins actives. Les résultats démontrent que les perceptions que les aînées entretiennent à l'égard de leur santé sont au centre des stratégies qu'elles entreprennent vis-à-vis de leur vieillissement. L'activité physique représente une stratégie valorisée pour bien vieillir, mais rarement évoquée dans les mises en situation. À l'inverse, le recours aux médicaments est négativement perçu dans le vieillissement, mais fréquemment évoqué dans les mises en situation. Il n'apparaît pas y avoir plus de freins à la pratique de l'activité physique que pour le recours aux médicaments. Il apparaît que l'attitude positive entourant l'activité physique et négative entourant les médicaments se reflètent dans le discours des aînées, mais peu dans leurs comportements pour remédier à des situations de santé au cours de leur vieillissement. Cette étude est supportée financièrement par le CRSHC.

042

OLDER WIDOWERS' IDEAS ABOUT REMARRIAGE AND REPARTNERING

Deborah K. van den Hoonaard, Gerontology Dept., St.Thomas University, Fredericton, NB E3B 5G3 (dkvdh@stu.ca), Tel: (506) 460-0362, Fax: (506) 460-0330

This paper will discuss the perceptions of widowers over 60 who have lost their wives within the prevous 10 years about remarriage and/or repartnering. It is based on an in-depth interview study with 30 widowers most of whom live in New Brunswick. Findings indicate that widowers consider thinking about remarriage a far more intrinsic part of their experience as widowers than women do as widows. As well, they do not see their interest in women as related to their relationship with their wives and many begin to consider remarriage within months of their wives' deaths.

043

LOISIRS ET VIEILLISSEMENT AU QUÉBEC: LES ANNÉES 80 ET 90 / LEISURE AND AGING IN QUEBEC: THE EIGHTIES AND THE NINETIES

Marc-André Delisle, Pierre Skilling, Émilie Rivard, département de sociologie, Faculté des sciences sociales, Université laval, Québec, QC, G1K 7P4, (marc-andre.delisle@soc.ulaval.ca) Tel: (418) 656-2131 poste 4324, Fax: (418) 656-7390

Une méta-étude que nous avons effectuée révèle que les taux de pratique de la plupart des loisirs des aînés ont augmenté pendant les années 1980, mais que durant les années 1990, la pratique de plusieurs occupations s'est stabilisée ou a diminué comme dans l'ensemble de la population. Il en fut ainsi des activités physiques, éducatives, du bénévolat, de la fréquentation des associations et des voyages. Par contre, les Québécois âgés des années 90 ont fait davantage de sorties culturelles (théâtre, musées, bibliothèques) et ont lu plus de livres que ceux des années 1980. Au-delà des phénomènes conjoncturels, ces variations sont probablement révélatrices de la transformation des modèles de vieillissement qui s'amorce avec l'arrivée des baby-boomers.

The study we have done revealed that participation of the Quebec's elderly people to leisure activities increased during the eighties but stabilized or regressed during the nineties. This phenomenon probably indicates a mutation in aging sociocultural models with the coming of age the baby-boomers.

044

WOMEN AND REMARRIAGE IN LATER LIFE: MARITAL TRANSITIONS AND FAMILIAL RELATIONSHIPS

Laura Hurd Clarke, University of British Columbia, School of Social Work and Family Studies, 2080 West Mall, Vancouver, BC V6T 1Z2 (lcclarke@interchange.ubc.ca), Tel: (604) 822-2589, Fax: (604) 822-8656

This purpose of this paper is to explore older women's perceptions of remarriage after or around age 50. The paper draws on data from open-ended interviews with 25 women aged 47 to 90 who married a second or third time after or around age 50. Remarriage in later life continues to be uncommon, particularly amongst older women, and little is known about the lived experiences of those who choose to marry again following the death of or divorce from a first spouse. The paper discusses the women's perceptions of the quality of the second and third marital relationships. My findings indicate that financial issues are often a source of tension between the couple and/or across the generations, usually in relation to inheritance issues. Similarly, second and third marriages in later life tend to be characterized by changes in the gendered division of labour, the couple's experience of sexuality, and relationships with adult children, grandchildren and stepchildren. Implications for future older women are discussed in terms of the growing social acceptance of cohabitation as an option for couples and the increasing complexities of family structures. This research has been funded by a Canadian Institutes of Health Research Post Doctoral Fellowship.

045

ACCÈS AUX RESSOURCES, AUTONOMIE ET SANTÉ

Céline Gosselin, François Béland, Louise Getty, Michel Fournier, Direction de santé publique, 1301, rue Sherbrooke est, Montréal, QC H2L 1M3 (cgosseli@santepub-mtl.qc.ca), Tel: (514) 528-2400 poste 3373, Fax: (514) 528-2426

L’autonomie des aînés dépend en grande partie des ressources – physiologiques, économiques et sociales – auxquelles ceux-ci ont accès, la disponibilité de ces ressources étant largement influencée par la position occupée antérieurement dans la structure sociale. La présente étude s’intéresse à la distribution de ces différents types de ressources dans un échantillon de personnes âgées de 65 ans et plus (n= 1 392) vivant dans un quartier de Montréal (Canada). L’analyse de regroupement automatique ("cluster analysis") est utilisée pour identifier des profils différenciés en fonction de l’accès aux ressources. Cette analyse permet d’identifier les combinaisons de ressources les plus fréquentes et d’illustrer leur effet synergique sur l’autonomie, la perception subjective de la santé, le bien-être et la satisfaction de la vie. L’effet particulièrement délétère de la privation de certaines ressources nous amène à questionner les approches centrées exclusivement sur le maintien ou l’amélioration de l’autonomie fonctionnelle comme instrument de promotion de la santé et du bien-être des aînés.

046

LA PLACE DU RECOURS AUX MÉDICAMENTS PARMI LES STRATÉGIES DU BIEN-VIEILLIR, CHEZ DES FEMMES ÂGÉES ACTIVES ET SÉDENTAIRES, VIVANT DANS UN MILIEU ECONOMIQUEMENT DÉFAVORISÉ

Philippe Voyer, Suzanne Laberge, Geneviève Rail, Hélène Dallaire, Faculté des sciences infirmières, Université Laval,

Cité universitaire, Quebec, QC G1P 7P4 (philippe.voyer@fsi.ulaval.ca), Tel: (418) 656-2131 poste 8799, Fax: (418) 656-7825

047

COMPARING ELDERCARE PRACTICES IN HOME CARE AND LONG-TERM CARE FACILITIES: STRENGTHENING PROFESSIONAL-FAMILY RELATIONS IN THE FUTURE

Catherine Ward-Griffin, Nancy Bol, Kim Hay, Ian Dashnay, The University of Western Ontario, School of Nursing, Health Sciences Addition, London, ON N6A 5C1

Tel: (519) 661-2111 ext 86584 Fax: (519) 661-3928

Email: cwg@uwo.ca

Research suggests that positive relationships between health professionals and family caregivers of frail older adults are a critical dimension of ensuring quality, continuous, client-centred care. However, little is known about how relationships between professional staff and family members develop, nor how organizational culture may influence this development. Findings from two critical ethnographic studies revealed that relationships between nurses and family members in home care (HC) and in long-term care facilities (LTCF) are dynamic and multifaceted. Four different types of relationships emerged from 23 nurse-family caregiver dyads in HC ( nurse-helper, worker-worker, manager-worker, and nurse patient) and 17 nurse-family caregiver dyads in LTCF (conventional, competitive, collaborative, and carative). Though not a complete match, there are interesting similarities between nurse-family relationships in HC and LTCF. Elements of the competitive relationship can be seen in three of the four typologies in HC. The competitive relationship in LTCF was the most stressful of all the typologies for both nurses and family caregivers. Furthermore, there is evidence that institutional culture and agency policies and practices are major contributing factors in the development of certain types of nurse-family relationships. Findings suggest a need for change in policies and practices in both home care and long-term care facilities in order to strengthen professional-family relations in the future.

048

SUITE À L'APHASIE ET L'INSTITUTIONNALISATION... RENOUER AVEC SOI ET AVEC SA FAMILLE

Johanne Tremblay, Micheline Petit, Celine Larfeuil, Guylaine Le Dorze, Institut Raymond-Dewar, 3600, rue Berri, Montreal, QC H2L 4G9 (jtremblay@raymond-dewar.gouv.qc.ca), Tel: (514) 284-2214 poste 3227, Fax: (514) 284-0699

Cette communication présente les résultats d'une étude portant sur une intervention interdisciplinaire dont l'objectif était de réduire les conséquences psychosociales de l'aphasie chez la personne âgée institutionnalisée et deux des membres de sa famille. Au terme de l'intervention menée conjointement par une orthophoniste et une travailleuse sociale, une entrevue semi-dirigée a été conduite auprès de ces personnes à l'aide d'une grille comportant trois thèmes principaux: l'expérience vécue par la famille durant l'intervention, la perception des changements dans la communication et le processus d'adaptation des membres de la famille.

Six termes émergent de l'analyse qualitative des propos recueillis: la perception d'une amélioration de la confiance en soi et des habiletés langagières de la personne aphasique; la restauration de la relation mère-fille, l'augmentation de la communication avec les autres résidants ainsi que la satisfaction à l'égard de l'intervention.

Les résultats suggèrent différentes pistes de réflexion pour la recherche et l'intervention clinique. Ils illustrent principalement le rôle important joué par une intervention familiale basée sur la compétence des personnes aphasiques et de leur famille dans la réduction des conséquences psychosociales à long terme de l'aphasie et dans l'amélioration de leur communication.

049

VOLUNTEER CHAPLAINCY: A MODEL TO CONSIDER

Debby Vigoda, Ernie Gershon, Lori Gershon, Ontario Gerontology Association, 351 Christie Street, Suite C216, Toronto, ON M6G 3C3 (ontgeron@idirect.com),

Tel: (416) 535-6034, Fax: (416) 535-6907

For many seniors, meaning in life is expressed in religious beliefs, values and practices. Faith provides a guide for daily living, consolation and strength during difficult times and support in the face of death.

The Baycrest Centre for Geriatric Care is a large multi-service complex, with almost 1,000 patients and residents and almost as large a staff. In light of growing religious and spiritual needs of these people and the limited resources (human and financial) that existed, the Director of Pastoral Care at the Centre introduced an intensive screening and training program for volunteer chaplains. Recruits were expected to integrate study and clinical practice during the first year and make a commitment of at least one more year at Baycrest.

For the past six years, the three presenters have been the chaplains at the Baycrest supportive housing complex, providing spiritual support and avenues for religious expression. An added challenge to pastoral care is the significant proportion of residents (over fifty per cent) who are Holocaust survivors.

The role and responsibilities of the chaplains will be described as well as the response of the residents.

050

WAITING PLACEMENT OF COGNITIVELY IMPAIRED PERSONS: THE DANCE OF CAREGIVING

Vicky Strang, Priscilla Koop, Deirdre Jackman, 3rd Flr CSB, Faculty of Nursing, University of Alberta, Edmonton, AB T6G 2G3 (vicki.strang@ualberta.ca), Tel: (780) 492-6333, Fax: (780) 492-2551

There is continuing concern that community-based services are inadequate to support family caregivers as they await long-term institutional placement of their cognitively impaired family member. In this paper selected findings from a qualitative interpretative descriptive study exploring the experiences of caregivers while they await placement of their CI family member will be presented. The findings are based on semi-structured interviews of 30 family caregivers after their family members were admitted to the wait-list for long-term care placement. The analysis consisted of the systematic search for common recurring themes and relational patterns within the interview data. The image of dancing emerged as the caregivers talked about their experiences. The following themes surfaced within this dancing metaphor: crisis initiated the process of placement; synchronicity with the health care system was necessary for the waiting to continue; caregiver perceptions of control or lack of it and the relational reciprocity between caregivers and their CI persons influenced their abilities to continue in their waiting. Implications for practice and research will conclude the presentation.

051

OPEN ENVIRONMENTS THROUGH RECREATION IN CANADIAN LONG-TERM CARE FACILITIES: A REGIONAL ANALYSIS

Sherry L. Dupuis, Bryan Smale, Dept. of Recreation and Leisure Studies, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1 (sldupuis@healthy.uwaterloo.ca) Tel: (519) 888-4567, ext. 6188, Fax: (519) 746-6776

Long-term care facilities operating as "open environments" are believed to be richer and more humane, and can enhance the quality of life for persons living within those settings. Recreation staff can play a major role in the creation of more open environments, particularly by providing opportunities for continued involvement in the community for residents. Yet, our understanding of the extent to which community access initiatives are being introduced in long-term care facilities and the factors that might impede their provision remains limited. Using the results from a nation-wide survey of recreation practitioners working in long-term care facilities, the purpose of this study was: (a) to examine the extent to which more and varied community access recreation programmes are provided, (b) to identify the barriers perceived to be limiting the provision of programmes, and (c) to determine whether any regional differences exist across Canada. Results indicate that facilities in Quebec report significantly fewer community access opportunities than facilities in other regions of Canada, whereas facilities in British Columbia report significantly more. Quebec facilities also perceive significantly more constraints to the provision of community access programmes, especially with respect to community openness, administrative barriers, and accessibility. Effective strategies to assist recreation staff in overcoming these constraints and providing more open environments for residents are needed.

052

WOMEN TOGETHER IN LONG TERM CARE: WHAT DO RESIDENTS THINK?

Gloria Dixon, Department of Social Work, Misericordia Health Centre, 99 Cornish Avenue, Winnipeg, MB R3C 1A2 (gdixon@miseri.winnipeg.mb.ca), Tel: (204) 788-8166, Fax: (204) 779-0223

This presentation will discuss the results of a qualitative research study completed with residents residing on an interim long-term care unit. The unit is essentially all female residents. Residents were asked their views on various aspects of living in such an environment. Residents comments were strongly emphatic with regards to inter-personal and intrapersonal privacy. The presentation will focus on understanding the importance of privacy and the ways that residents achieve degrees of privacy.

053

AUTONOMY AND LTC RESIDENTS: PREFERENCES FOR PARTICIPATION IN CARE DECISION-MAKING

Laura Funk, Diane Allan, Centre on Aging, 305-1417 Harrison Street, Vicotria, BC V8S 3S3 (lmfunk@uvic.ca, dallan@uvic.ca), Tel: (250) 595-7532

Long-term care facility residents can be empowered by participating directly in care or medical decision-making (Kane, 1990; Asmundson et al., 1996; Minkler, 1983; Morris, 1997; Tulloch, 1995). This can also enhance their emotional and physical health (Gecas, 1989; Langer & Rodin, 1976; Minkler, 1984; White & Janson, 1986). However, research on preferences for participation in decision-making reveals that there is almost always some portion of individuals who do not want to be involved in medical and/or care decisions.

This research explores the predictors of the preferences of cognitively intact LTC facility residents to participate in decision-making, through the multi-variate analysis of data from semi-structured, face-to-face interviews with 100 residents sampled from six long-term care facilities in Victoria, British Columbia.

Generally, a large proportion of respondents preferred full, independent involvement in four types of care and medical decisions. Residents with higher levels of formal education, a greater number of chronic conditions, and those who are confident about the worth of their input tend to prefer more active involvement in decision-making. This research also suggests that predictors of a preference for independent control over decision-making are different than predictors of a preference for joint decision-making.

Implications for the empowerment of LTC facility residents and the meaning of decision-making in such environments will be discussed.

054

"VOLUNTEERING WITH SENIORS: WHAT YOU NEED TO KNOW" AN EDUCATIONAL WORKSHOP FOR VOLUNTEERS AND PROFESSIONALS

Wendy Johnstone, Suite 112, 7210 Mary Avenue, Burnaby, BC V5E 3K4 (wendyj@newvista.bc.ca), Tel: (604) 525-3288 ext. 4, Fax: (604) 525-7464

The aging of our population presents many unique and rewarding opportunities for volunteerism. Understanding the special needs of seniors can go a long way towards creating a positive volunteer experience. Volunteering with Seniors: What You Need to Know is an educational workshop designed to volunteers and professionals the proper tools and skills to use when working with seniors.

This interactive, fun-filled and educational workshop provides volunteers and professionals with helpful knowledge and special skills to use when working with seniors. These include understanding the myths and realities of aging, working with someone experiencing sensory decline, supporting seniors with mobility aids, communicating with older adults and awareness of commonly held health care policies. Participants leave our workshop feeling motivated, confident and well-educated on the special needs of seniors!

055

LE PROJET MOBILISATEUR DU GOUVERNEMENT DU QUÉBEC SUR LES RÉSIDENCES PRIVÉES AVEC SERVICES POUR PERSONNES AGÉES

Jean-Louis Bazin, Nicole Moreau, Secrétariat aux aînés, 1122, chemin St-Louis, 2e étage, Sillery, QC G1S 4Z5 (jean-louis.bazin @mfe.gouv.qc.ca), Tel: (418) 691-2077

Dans la foulée de l'Année internationale des personnes âgées et dans le cadre de l'élaboration du Plan d'action triennal 2001-2004 du gouvernement du Québec en vue d'adapter les services publics à la réalité des personnes vieillissantes, le Secrétariat aux aînés a initié une démarche de réflexion sur le logement des personnes âgées en constituant un comité interministériel sur cette question. La priorité a été accordée au secteur des résidences privées avec services pour personnes âgées et un projet mobilisateur impliquant l'intervention de plusieurs ministères et organismes a été développé et annoncé le 28 septembre 2001 par la ministre responsable des Aînés, Madame Linda Goupil, en même temps qu'a été rendu public le document « Le Québec et ses aînés: engagés dans l'action - Engagements et perspectives 2001-2004 ».

Ce projet mobilisateur et les mesures qu'il contient s'articule autour de huit thématiques qui délimitent les champs d'intervention privilégiés et en constituent les chantiers :

• Une vision commune et un langage commun

• Le recensement des résidences

• Des normes et des règlements appropriés

• L'accès à des soins et à des services de santé

• La sécurité et la protection contre les incendies

• La promotion d'un code d'éthique

• L'appréciation de la qualité des résidences privées pour personnes âgées

• Des activités de formation et de sensibilisation

La présentation fera état de la démarche qui a conduit à l'élaboration de ce projet mobilisateur ainsi que de ses principales étapes de réalisation. Seront aussi présentées les mesures gouvernementales mises de l'avant par les ministères et organismes en vue de mieux encadrer et d'assurer la qualité des résidences privées avec services pour les personnes âgées du Québec.

056

VIBROTACTILE INSTRUMENTAL RHYTHM PLAYING: IMPLEMENTING DRUM CIRCLES IN THE LONG TERM CARE FACILITY

Lori Schindel Martin, Chris Hagens, Patricia Morden, Sarah McDowell, Shalom Village Nursing Home, 60 Macklin Street North, Hamilton, ON L8S 3S1 (lori@shalomvillage.on.ca),

Tel: (905) 529-1613 ext. 228, Fax: (905) 529-7542

This workshop will describe the process through which vibrotactile rhythm groups, or drum circles, were implemented and evaluated in a long term care facility in Southern Ontario. A qualitative observational study was undertaken to evaluate the impact of the drum circles in three groups of residents, each representing a different level of cognitive capacity. The first group was conducted in the adult day program, the second group in the main nursing home, and the third group took place in the special care dementia unit. Trained observers recorded the reactions residents had to playing and listening to rhythms during the drum circles. The field notes were subjected to thematic content analysis. Preliminary results support that vibrotactile instrumental rhythm playing enhances communication, provides an opportunity for mastery, and promotes communal music-making. The workshop will include a demonstration of and active participation in a drumming session. Workshop participants will be provided with information on how to choose the necessary rhythm equipment as well as the process of initiating and facilitating a drum circle. This workshop will be of interest to all professional caregiving staff including therapeutic recreationists and music therapists.

057

LE CARNET DE SUIVI POUR PERSONNES APHASIQUES

Michelyne D. Hubert, Marie-Andrée Daigle et al. , pour le Comité interétablissements pour les personnes aphasiques, 4565 chemin Queen Mary, Montréal, QC H3W 1W5 (michelynehubert@hotmail.com), Tel: (514) 340-2800 poste 4127, Fax: (514) 340-2828

"Le Carnet de Suivi pour Personnes Aphasiques" est un outil développé dans la région de Montréal à l'intention des personnes aphasiques. Ce document est le fruit d'un travail de collaboration des membres du Comité interétablissements pour personnes aphasiques. Les membres de ce comité représentent, entre autres, plusieurs établissements de santé de la région de Montréal et l'Association québécoise des personnes aphasiques. Le but premier de ce comité est de favoriser une meilleure continuité des services offerts aux personnes aphasiques.

Cet outil est la propriété de la personne aphasique. Il lui servira d'aide-mémoire et de support à la communication.

Le Carnet de suivi est donc un outil de communication pour permettre aux différents intervenants de mieux connaître la personne aphasique et de comprendre ses besoins. C'est un outil qui permettra à la personne d'être plus autonome dans ses communications avec les intervenants et avec son entourage. Cet outil permettra, au besoin, d'orienter les intervenants vers les ressources utilisées par le passé et de dégager avec plus de facilité les services souhaités pour une plus grande qualité de vie.

Ce document sera facilement enrichi au fil du temps et des besoins de la personne aphasique.

Les participants à cet atelier pourront comprendre les motifs principaux ayant motivé la création de cet outil. Le contenu du "Carnet de Suivi" sera présenté ainsi que quelques exemples. Les présentateurs parleront de l'avenir souhaité de cet outil et de sa diffusion actuelle.

058

INVESTING IN THE FUTURE: THE CAG DIVISION-STUDENT MENTORSHIP PROGRAM

Sherry Anne Chapman, Sandra Hirst, Janice Keefe, Kristine Votova, Department of Human Ecology, University of Alberta, 3-02 Human Ecology Building, Edmonton, AB T6G 2N1 (sherryc@ualberta.ca), Tel: (780) 492-2865, Fax: (780) 492-4821

In keeping with this years Annual Scientific and Educational Meeting theme, Aging and Society: Taking Charge of the Future, the discussion leaders of this roundtable challenge delegates to invest in the future of Canadian gerontology through the CAG Division-Student Mentorship Program. From a total of 213 student members in 1995, only 93 members were registered in 2002 and the majority of them were from British Columbia, Ontario, and Alberta. The purpose of the roundtable is to explore future directions for the program as a medium for recruiting and developing student membership in the CAG and its divisions. In this formative year of the program, a Terms of Reference working document has been drafted and will serve as the basis for discussion. The mentoring of students is an essential objective within the CAG Divisions Terms of Reference. Mentorship is a mutually beneficial opportunity for students and the association. The program aims to support strategies that enhance the visibility of students in the CAG, promote their involvement, provide divisional experience, and serve to retain them as long-term members. Through the roundtable, we seek to further define program objectives and measures of success over the next five years. We encourage regular and student members from across all divisions to participate in the development of this mentorship program.

059

PRACTITIONERS AND FAMILIES: FROM THERAPY TO ADVOCACY, WHAT DO CAREGIVERS REALLY NEED?

Nancy Guberman, Jean-Pierre Lavoie, Deborah O'Connor, Amanda Grenier, École de travail social, UQAM, C.P. 8888 Succ. Centreville, Montreal, QC, H3C 3P8 (guberman.nancy@uqam.ca) Tel: (514) 987-3000 ext. 4520, Fax: (514) 987-8795

No systematized and validated model of practice with families of frail and disabled seniors currently exists. Various practices have been developed with caregivers which refer to approaches such as empowerment, problem-solving, assertiveness training, peer support and crisis intervention. Individual psychotherapeutic interventions have been developed aimed at reducing caregiver distress and to enhance the caregivers ability to manage specific problems using either cognitive, behavioral or psychodynamic approaches within a time-limited framework. Support groups/educational interventions usually focus on practical issues (information about the care recipients condition), feelings (encouragement of emotional reactions to caregiving, developing self-esteem), skills (coping, assertiveness) and developing both informal and formal support systems. Interventions can be seen as situated on a continuum which, at one end, has practices with individuals and at the other, more collective practices such as advocacy or pressure groups. A number of studies have begun to document and evaluate these interventions, although the majority have concentrated on education and support groups or respite services. Thus much less is known about individual interventions, advocacy and pressure groups, including their underlying frames of reference or philosophies, the process of implementation and their efficiency. How do professionals perceive their role with caregivers? Do they have the resources needed to work with them from an empowerment perspective? How can one link individual and community level interventions? This symposium brings together researchers to present the latest research and reflections identifying the major problems, advances and challenges confronting practitioners working with family members at different levels and from different perspectives.

TEETERING ON THE TIGHTROPE: RECONCEPTUALISING CAREGIVING INTERVENTIONS TO RESPOND TO BOTH INDIVIDUAL AND COMMUNITY LEVELS

Deborah OConnor

Therapeutic techniques with family caregivers often seem to pit individual approaches against community development and advocacy approaches. Drawing on ongoing research focused on exploring the impact of family support groups, this paper will begin to propose a framework for integrating an approach that responds at both levels. First a conceptual model will be proposed which draws on a structural approach to intervention. Next, this model will be examined in relation to findings from a recent study focused on caregiving support groups. Finally, the challenges associated for incorporating this dual level approach will be examined.

LES AIDANTES FAMILIALES ET LEURS RAPPORTS AUX PROFESSIONNELS, ENTRE EMPOWERMENT ET IMPUISSANCE

Jean-Pierre Lavoie, Ph.D. Direction de la santé publique de Montréal-Centre, CLSC René-Cassin, Diane Lessard, Ph.D. Chercheure autonome

Malgré les nombreux appels au partenariat entre les familles et les professionnels, particulièrement ceux des services à domicile, et malgré la reconnaissance officielle des aidants comme partenaires et clients de ces services, force est de constater que très peu de recherches ont porté sur les interrelations entre les aidants, d'une part, et les services à domicile et les professionnels, d'autre part. À partir des résultats d'un projet de recherche qualitative portant sur les processus d'empowerment et d'impuissance vécus lors du recours aux services, réalisé auprès de 32 aidantes, 16 conjointes et 16 filles, d'un territoire de CLSC de Montréal, nous avons pu constater le rôle stratégique des rapports entre professionnels et aidantes. Tout d'abord, les rapports avec les différents professionnels occupent une place importante dans le récit que font les aidantes de leur expérience de recours aux services et ces rapports sont fort variés. Ensuite, ces rapports s'articulent autour de deux enjeux majeurs que sont les normes associées à l'aide et aux soins et les relations de pouvoir entre les professionnels et les aidantes. Dans leurs rapports aux aidantes les professionnels peuvent autant renforcer que déconstruire certaines normes et ils peuvent autant établir un rapport autoritaire qu'égalitaire.

HOME CARE WORKERS PERCEPTIONS AND PRACTICES WITH CAREGIVERS: PARADOXES AND DILEMMAS

Nancy Guberman, Travail social, UQAM ; CLSC René-Cassin, Jean-Pierre Lavoie, Direction de la santé publique de Montréal-Centre ; CLSC René-Cassin, Sylvie Lauzon, Sciences infirmières, Université de Montréal, Jacinthe Pepin, Sciences infirmières, Université de Montréal, Maria-Elisa Montejo, CLSC René-Cassin

This communication will present some of the results of a qualitative study aimed at identifying how practitioners perceive caregivers and the types of practice they have developed to meet caregivers needs. Sixty-five (65) home care practitioners and managers from 10 CLSCs in Quebec were interviewed. The vast majority of respondents recognize the inestimable contribution of caregivers to the home care of frail or dependent elderly clients. Many evaluate that caregivers are overburdened, that they are doing too much and that they dont know how to set limits. But, despite this recognition, the majority of contacts that practitioners have with caregivers are oriented around the needs of the care receiver and, in the case of health professionals, consist of transferring professional activities to the caregivers. Although some respondents try to offer emotional support and advice and to encourage other family members to participate in care, they are generally frustrated by their limits in time and resources and confronted by many ethical dilemmas. A very small minority raised the issue of the need for community or socio-political intervention.

Discussant: Amanda Grenier

060

WHO HAS INFLUENCE IN LONG TERM CARE FACILITIES?

Sandra Loucks Campbell, 140 MacKay Crescent, Waterloo, ON N2J 3K3 (selcampb@artsmail.uwaterloo.ca), Tel: (519) 885-3016

Objective: To improve long term care accountability through enhanced understanding of workers' perceptions of their influence in the organization.

Method: As part of a larger study about decision making, a set of quantitative questions were posed to long term care workers about their own influence, the influence of their superior and the perceptions of others.

Participants included direct care workers, non direct care workers, staff leads and management personnel from a long term care facility in Ontario.

Results: Workers at all levels felt little influence in their work environment, and less influence than they perceive their supervisors have. Using concepts from chaos theory as a backdrop, comparisons will be drawn between worker responses at each organizational level. Variables related to worker perceived influence include their perception about their supervisor's level of influence, their use of the home philosophy in decision making and their level of education. Extracted qualitative data from both staff participants and related resident data will offer further explanation of the quantitative results.

Implications: The similarity of results across the work spectrum in long term care settings suggests points of intervention for the administrator wishing to enhance accountability at each organizational level.

061

WHERE HAVE ALL THE HOME CARE WORKERS GONE?

Margaret Denton, Isik Zeytinoglu, Sharon Davies, Director, Gerotological Studies, McMaster University, KTH-226, 1280 Main Street West, Hamilton, ON L8S 4M4 (mdenton@mcmaster.ca), Tel: (905) 525-9140, Fax: (905) 525-4198

Issues of retention and recruitment are of major concern to home health care agencies which result in difficulties in coordinating care and lack of continuity of care in the home. In 1996, 892 home care workers from three agencies in a mid-sized Ontario city participated in a survey on their work and health. By 2000, 468 (52%) of these respondents had left the agencies they had worked with. Of those who left, we were able to locate 377 respondents and mailed each a self-completion questionnaire asking why they left the agency and about their subsequent work experience. 253 (67%) responded to this second survey. Respondents indicated dissatisfaction with pay, hours of work, lack of organizational support, work load and health reasons including work-related stress as reasons for leaving. Less than one-third remained employed in the home care field, one-third worked in other health care and one-third were no longer working in health care. Data from the 1996 survey were then used to predict turnover and results show lack of organizational support, excessive workload, stress, job insecurity and extrinsic and intrinsic job satisfaction all lead to turnover.

062

A MINORITY OF SENIORS USE A MAJORITY OF HOSPITAL RESOURCES: A STUDY OF HOSPITAL USE IN MANITOBA

Verena Menec, Leonard MacWilliam, Manitoba Centre for Health Policy, 408-727 McDermot Ave., University of Manitoba, Winnipeg, MB, R3E 3P5 (vmenec@cpe.umanitoba.ca) Tel: (204) 789-3806, Fax: (204) 789-3910

It is well known that hospital use increases with age, with individuals aged 65 and above being more likely to be hospitalized than younger individuals. Yet research suggests that most hospital resources are consumed by a small proportion of seniors. The purpose of the present study was to extend this research by examining hospital use among the entire senior population (age 65+) in Manitoba (N about 150,000) in 1999. Data were derived from administrative sources (hospital discharge abstracts) that provide complete information on hospital use of the entire population. The results show that 38% of hospitalizations in Manitoba involved individuals aged 65+. Furthermore, seniors used 65% of all acute care hospital days and were responsible for 59% of inpatient costs. However, this large share of hospital resource used could be traced back to a small number of individuals. Indeed, 5% of seniors used 78% of all the hospital days consumed by seniors. These 5% of patients had very long hospital stays averaging 91 days. Given that most of these individuals likely did not require care in acute care hospitals, these findings suggest the need to examine alternatives to acute care for long-stay patients.

063

QUELLE TYPE DE RETRAITE POUR DEMAIN?

René Bédard, 1370 Prom. Cumberland Ridge, Cumberland, ON K4C 1E1 (rbedard@uottawa.ca), Tel: (613) 833-3449, Fax: (613) 562-5146

La meilleure manière d'avoir prise sur l'avenir, pour ceux et celles qui pensent prendre leur retraite un jour, est précisément de se préparer à se concevoir comme des personnes qui demeureront actives professionnellement, socialement et communautairement. Tout indique qu'Il faudra continuer à tisser et à créer des liens avec la société et spécialement avec les générations qui nous suivent. Or, quels mécanismes doivent être mis de l'avant pour se convaincre de cette réalité. Quelles sont les avenues à explorer pour faire en sorte que les futurs retraités continuent à demeurer des membres à part entière de leur société. Le défi est grand surtout pour ceux et celles qui ont cru que la retraite signifierait un arrêt presque complet de leur implication sociale et professionnelle.

Le malaise est perceptible chez plusieurs baby-boomers qui commencent à réaliser que, étant donné l'augmentation de l'espérance de vie, ils devront, d'une manière ou d'une autre, demeurer actifs et productifs plus longtemps. Cela sera bientôt vrai pour le domaine social, professionnel, mais surtout pour le domaine économique. Afin d'éviter les mauvaises surprises des années à venir, il est bon de se conscientiser actuellement aux changements majeurs qui sont le résultat de choix personnels et sociaux ayant été faits par la génération des baby-boomers.

064

LES CONSÉQUENCES D'UNE CATASTROPHE SUR LA SANTÉ BIOPSYCHOSOCIALE DES PERSONNES ÂGÉES: RÉSULTATS D'UNE ÉTUDE QUANTITATIVE

Danielle Maltais, Lise Lachance, Audrey Brassard, Université du Québec à Chicoutimi, Département des sciences humaines, 555 Boul. de l'Université, Chicoutimi, QC G7H 2B1 (danielle_maltais@uqac.ca), Tel: (418) 545-5011, Fax: (418) 545-5012

En juillet 1996, plusieurs personnes âgées de 50 ans et plus ont perdu leur maison ou ont subi des dommages majeurs à leur domicile. Cette communication présentera les résultats d'une étude tranversale qui compare l'état de santé biopsychosociale et les conditions de vie post-désastre de 76 sinistrés âgés de 50 ans et plus avec ceux de 57 non-sinistrés de même âge présentant les mêmes caractéristiques socio-démographiques. Les données recueillies auprès des répondants indiquent que deux ans après les événements, les sinistrés présentent un état de santé physique et psychologique plus précaire ainsi que des conditions de vie plus difficiles que les non-sinistrés. En ce qui a trait aux conditions de vie des sinistrés, ceux-ci sont plus nombreux que les non-sinistrés à avoir contracté un prêt depuis juillet 1996 et être aux prises avec des difficultés financières. Les données permettent aussi de constater que les victimes des inondations ont diminué leur nombre de leurs sorties sociales. Toutefois, l'exposition aux inondations ne semble pas avoir perturbé la fréquence et la qualité des relations sociales et affectives qu'entretiennent les répondants avec les membres de leur entourage.

065

ÊTRE ÂGÉ ET AUTONOME EN RÉGION, EST-CE POSSIBLE? LE CAS DES LAURENTIDES (QUEBEC)

Maria Elisa Montejo, Gérald Baril, Valérie Bourgeois-Gurin, 403, 8e Avenue, La Salle, QC H8P 2N5 (montejom@videotron.ca), Tel: (514) 368-3014

Au XXIe siècle, la croissance démographique des personnes âgées se poursuit. Toutefois, une bonne partie de cette population âgée est autonome. Au Canada et au Québec, il existe une préoccupation grandissante de la part des organismes publics pour connaître et développer des environnements favorisant la préservation et le maintien de l'autonomie de cette population. L’autonomie étant définie comme la capacité de disposer de soi, d’agir par soi-même pour combler des besoins physiques et psychosociaux.

Nous présenterons ici, quelques résultats préliminaires obtenus à partir d'une recherche qualitative en cours Étude descriptive des environnements physique et social contributifs de l’autonomie des aînés de la région des Laurentides, (Québec). L'analyse d’une cinquantaine d’entrevues semi-dirigées réalisées auprès les personnes âgées autonomes, vivant dans la communauté d’un environnement régional (urbain, semi-urbain et rural), permettra de montrer si leur insertion sociale (disponibilité du réseau social) d'une part, et d'autre part, leur participation aux organismes communautaires, socioculturels ou sportifs, contribuent d'une façon significative à maintenir leur autonomie fonctionnelle et psychosociale.

066

LA CLINIQUE EXTERNE DE COGNITION

Monique Nadeau, Marie-Jeanne Kergoat, 4565, chemin Queen-Mary, Montréal, QC, H3W 1W5 (monique.nadeau.iugm@ssss.gouv.qc.ca) Tel: (514) 340-2800 poste 3305, Fax: (514) 340-3542

La clinique externe de cognition de l’Institut universitaire de gériatrie de Montréal offre depuis deux ans une évaluation globale et un suivi thérapeutique à long terme à la clientèle gériatrique présentant des désordres cognitifs reliés à la maladie d’Alzheimer ou à d’autres désordres neuro-dégénératifs similaires. Dans un contexte d’Institut universitaire, cette clinique intègre des activités de soins, de recherche, d’enseignement et de promotion de la santé.

Suite à une évaluation diagnostique spécialisée, un plan d'intervention de même qu’un traitement adapté, structuré et dynamique est établi en tenant compte des besoins, des préoccupations et des caractéristiques du patient âgé et de son réseau de soutien. En plus de son expertise et de sa rigueur au niveau du diagnostic, la clinique se caractérise par la continuité et l’excellence de son suivi auprès du patient et de ses aidants en complémentarité avec les ressources du milieu, communautaires et institutionnelles. Elle offre aussi des rencontres individuelles de soutien et de groupe pour les aidants.

Elle est un lieu de formation dans les disciplines de la santé (soins infirmiers, neurologie, psychiatrie, gériatrie, médecin de famille, neuropsychologie) etc. Elle initie et collabore à des projets de recherche en continuité avec la mission du centre de recherche de l’Institut universitaire de gériatrie de Montréal. Ces axes de recherche touchent les neurosciences cognitives, les soins et services à la personne, la nutrition, la mobilité, et les troubles sensoriels.

067

L'ÉVALUATION DE LA QUALITÉ DE LA PRISE EN CHARGE CLINIQUE INTERDISCIPLINAIRE EN UNITÉ DE COURTE DURÉE GÉRIATRIQUE (UCDG)

Marie-Jeanne Kergoat, Judith Latour, Paule Lebel, Nicole Leduc, Katherine Berg, Aline Bolduc, Centre de recherche Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen-Mary, Montréal, QC H3W 1W5 (marie-jeanne.kergoat@umontreal.ca), Tel: (514) 340-3515, Fax: (514) 340-2832

Objectif: Discuter les outils retenus pour évaluer la qualité de la prise en charge clinique interdisciplinaire en UCDG au Québec.

Méthodes : Le syndrome de la chute est utilisé comme cas-traceur de la qualité. Nous analysons des dossiers patients. Une grille de collecte de données standardisée détaillant le processus clinique de prise en charge de patients admis pour chute a été élaborée selon une méthode consensus de type Delphi par 60 experts cliniciens. Un algorithme décisionnel, servant à valider la pertinence des items complétés selon des catégories diagnostiques de chute, y est associé. Un questionnaire administré au coordonnateur d'unité, sert à recueillir l'information sur la structure et certains processus de gestion clinique. L'applicabilité de ces outils sera vérifiée dans 3 UCDG du Québec choisies pour représenter les modèles existants d'UCDG. Dans chacune, 15 dossiers de patients admis pour chute et ayant reçu leur congé en 2000-2001 seront examinés.

Résultats: Présentation des trois instruments : grille de collecte de données du processus clinique, algorithme décisionnel et questionnaire sur les ressources et processus de gestion clinique.

Conclusion: Ce projet illustre une méthode originale d'évaluation de la qualité adaptée à l'hétérogénéité et la complexité de la pratique en milieu gériatrique.

068

LES CHUTES EN INSTITUTION: DE LA PRÉVENTION AU SUIVI

Louise Francoeur, Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen-Mary, Montréal, QC H3W 1W5 (louise.francoeur.iugm@ssss.gouv.qc.ca), Tel: (514) 340-2800 poste 3417, Fax: (514) 340-2807

Les chutes constituent des accidents fréquents et souvent lourds de conséquences chez les personnes âgées en institution. Le programme de prévention des chutes de l'Institut universitaire de gériatrie de Montréal a pour but de prévenir ces chutes ou d'en réduire les conséquences tout en conservant le maximum d'autonomie à la clientèle gériatrique et ainsi optimiser leur qualité de vie.

Ce programme de prévention se distingue par ses nombreuses applications cliniques adaptées aux différentes circonstances de chute rencontrées en institution. La version manuscrite du programme comprend les notions théoriques et les grands principes, les interventions préventives générales de même que les outils d'évaluation pour chacune des circonstances et les plans de soins type correspondants. On y retrouve aussi une bibliographie et des instruments cliniques complémentaires tels les plans de soins type reliés au port d'une contention et un protocole d'intervention lors d'une chute. Ce programme est destinée aux infirmières mais est conçu dans une perspective interdisciplinaire.

Cet exposé présentera le programme, son élaboration, la construction de ses outils cliniques et son évaluation.

069

A STUDY OF HOSPITAL RECOVERY PATTERN OF ACUTELY CONFUSED OLDER PATIENTS FOLLOWING HIP SURGERY

Julia Wong, Shirley Wong, Elaine Brooks, 30 Cowie Hill Road, Halifax, NS B3P 2P7 (elaine.brooks@cdha.nshealth.ca),

Tel: (902) 473-7502, Fax: (902) 473-2734

Title: A Study of Hospital Recovery Pattern of Acutely Confused Older Patients following Hip Surgery.

Authors: Elaine Brooks, R.N., M.N., Nurse Manager, QEII HSC, Halifax, NS; Julia Wong, R.N., Ph.D., Associate Professor, School of Nursing, Dalhousie University, Halifax, NS; Shirley Wong, R.N., Ph.D., Associate Professor, School of Nursing, Dalhousie University, Halifax, NS.

The incidence of total hip arthroplasty of osteoarthritis of the hip and surgical treatment for hip fracture increases sharply with age. The goal of postoperative care of patients following major hip surgery is to restore their functional status and prevent complications.

Postoperative acute confusion (ACS) is a significant problem among older surgical patients; its incidence is greater in orthopaedic than in general surgery. This descriptive prospective study described the hospital recovery pattern of older confused and non-confused patients after hip surgery.

The study sample included 54 patients aged 60 years or older consecutively admitted to a teaching hospital for emergency or elective hip surgery. Their cognitive status assessed by the Confusion Assessment Method (CAM), physiological status, functional ability, sleep satisfaction, and perceived discomfort were determined at baseline. These assessments were repeated on the first four postoperative days. The incidence of ACS over 4 postoperative days was 35%, 37%, 28%, and 12%, respectively. Confused and non-confused patients differed significantly in age, admission diagnosis, and length of hospital stay (p<0.05). Compared to confused patients, non-confused patients were significantly more independent in performing activities of daily living. Although both groups showed consistent improvement in functional status over time, improvement of the non-confused group is of greater magnitude. Older confused and non-confused patients recovered from hip surgery differently. Methods and guidelines are needed to help identify these patients and provide them with an appropriate rehabilitation program.

070

SOCIAL NETWORKS AND SELF-REPORTED HEALTH IN TWO FRENCH-SPEAKING CANADIAN COMMUNITY DWELLING POPULATIONS OVER 65

Maria-Victoria Zunzunegui, François Béland, Anna Koné, Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal, CP 6128 Succ Centre-Ville, Montréal, QC, H3C 3J7 (maria.victoria.zunzunegui@umontreal.ca) Tel: (514) 343-6086, Fax: (514) 343-5645

Objective: To evaluate the associations between the health status of older people with their networks of family, children, friends and community in two French speaking Canadian community dwelling populations 65 years and older using the conceptual framework proposed by Berkman and Thomas and to test if these associations vary between the two populations.

Methods: Data come from two 1995 surveys conducted in the city of Moncton (n=1518) and in Hochelaga-Maisonneuve, Montreal (n=1500). Social integration (a cumulative index of social activities ranging from 0 to 3), friends, family and children networks and social support were measured with validated scales.

Results: Logistic regression analysis using a structured inclusion of potential mediating variables showed that self rated health is better for those with good social integration and friends. In the final model, extended family ties were not associated to good health in either village while children social support was positively associated with good health only in Hochelaga-Maisonneuve. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, and exercise, locus of control and depressive symptoms were considered intermediate variables.

Conclusion: Social networks, integration and support show unique positive associations with health. The nature of these associations may vary among populations.

071

GENDER, MARITAL STATUS AND HEALTH: THEIR IMPACT ON LONELINESS IN THE VERY OLD

Baukje (Bo) Miedema, Sue Tatemichi, Family Medicine Teaching Unit, Dr. Everett Chalmers Hospital, PO Box 9000, Fredericton, NB E3B 5N5 (bmiedema@health.nb.ca), Tel: (506) 452-5714, Fax: (506) 452-5710

Objective: to examine which social and medical variables predict loneliness in the very old.

Method: longitudinal-sequential study using social and medical protocols of 149 individuals born in 1918 and who participated in the first year of the study.

Results: one-third of the participants who reported feeling lonely, the majority were women. Loneliness was strongly related to such social circumstances as being widowed, and living alone. Although a large number of participants suffered from chronic health problems, only a few health conditions were predictors of loneliness.

Conclusion: for one-third of the participants, loneliness was a regular fact of life. Although dissatisfaction with child and friend contact predisposes the elderly toward feeling lonely, child and friend contact does not have to be face-to-face but can be mediated by technology (telephone) and family contacts can be replaced by friend contacts.

072

COMPARING PREDICTORS OF POSITIVE AND NEGATIVE SELF-RATED HEALTH BETWEEN THE MIDDLE-AGED ADULTS (25-54) AND THE OLDER ADULTS (55 AND OVER)

Shahin Shooshtari, Betty Havens, T. Kue Young, Margot Shields, 807-2295 Pembina Hwy, Winnipeg, MB R3T 2H4 (Shooshtari70@hotmail.com), Tel: (204) 269-0753, Fax: (204) 269-0753

Objective: Using a population health framework, we explored the association between a wide range of socio-economic, lifestyle, individual, and environmental factors and their transitions over time with individuals' ratings of their own health.

Methods: The study sample was from the National Population Health Survey (NPHS) longitudinal panel, aged 25 and over, who were interviewed three times over the 4-year period (n=9431). Given the longitudinal nature of the data, secondary analysis of the NPHS data started with defining and developing the measures of change and transitions over time. Since the outcomes of interest were binary variables, logistic regression modeling was used. The complex NPHS sample design required consideration of the "design effect" addressed by using "normalized weights".

Results: While functional health status and number of chronic conditions were the most powerful predictors of positive and negative self-rated health, some other factors such as psychological distress, and their changes over time were also associated with the outcomes. Differences in these predictors were found for the middle-aged adults versus the older adults.

Conclusion: This population-based study provides health care decision-makers with more empirical evidence regarding the factors that determine people's health. It demonstrates the usefulness of longitudinal data in assessing the health of sub-populations.

Funding: Health Canada - Population Health Fund.

073

THE HEALTH IMPACT OF FAMILY CAREGIVING IN RURAL AND URBAN SETTINGS

Michel Bédard, Amanda Koivuranta, Amber Stuckey, Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 (mbedard@baynet.net), Tel: (807) 343-8630, Fax: (807) 346-7734

Past research demonstrated that family caregiving creates considerable emotional and psychological burden. We know comparatively little regarding the health impact of caregiving, and even less regarding differences that may be found across geographical settings. This study was set up to investigate the potential impact of caregiving on the health of caregivers and to determine if differences exist between rural and urban caregivers.

Methods: A convenience sample of caregivers to individuals with Alzheimers disease was recruited from a rural region and an urban region through agencies providing support for caregivers. Twenty rural caregivers and 17 urban caregivers were interviewed using standardized instruments.

Results: We found no differences between caregivers of rural and urban settings on reported health (p = .891), sleep quality (p = .430), healthy behaviors (p = .635), or burden (p = .466). However, for caregivers living in the rural setting, higher burden of care was related to fewer healthy behaviors (r-square = .58, p = .001). Among urban caregivers, we found no relationship (r-square = .001, p = .900).

Discussion: These results call for further research into the determinants of health for caregivers living in rural environments. The type and quantity of supports available to them may be directly related to health outcomes.

074

COMMUNITY PHARMACY BLOOD PRESSURE CLINICS LINKED WITH FAMILY MEDICINE PRACTICES TO IMPROVE MONITORING AND MANAGEMENT OF HIGH BLOOD PRESSURE AMONG OLDER ADULTS

Larry Chambers, Janusz Kaczorowski, Tina Karwalajtys, Bea McDonough, University of Ottawa Institute on Health of the Elderly associated with the SCO Health Service, 43 Bruyere Street, Ottawa, ON, K1N 5C8 (lchamber@scohs.on.ca) Tel: (613) 562-6036, Fax: (613) 562-4266

Attendence at community blood pressure (BP) clinics was assessed among patients to develop the best approach for a community-based program to improve BP monitoring among older adults through partnerships between pharmacies and family physician offices, aided by local public health nurses.

All regular patients 65 years or older (N=235) of one physician were invited by the physician's office to attend one of a series of pharmacy BP clinics scheduled in five local pharmacies. Volunteer peer health educators trained by public health nurses helped patients to measure their BP and record their readings and cardiovascular risk factors. Both in-pharmacy BP measuring devices and a validated automated device were used with each patient. A health record review by research nurses determined the frequency of BP monitoring and level of BP control among eligible patients.

The mean age of the patients was 75.7 (SD 6.4) years and 47% were male. Overall, 59% (137/235) of older adults attended a pharmacy BP clinic.

Thus, community pharmacy BP clinics were highly acceptable to patients and well attended. We will outline how this study provides important perspectives on feasibility and methodology toward extending the project to a larger number of family practices, community pharmacies and older adults.

075

ASPECTS VASCULAIRES DE LA DÉGÉNÉRESCENCE MACULAIRE LIÉE À L'ÂGE

Julie-Andrée Marinier, John V. Lovasik, Hélène Kergoat, John C. Chen, Michael G. Quigley, Université de Montréal, École d'optométrie, CP 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7 (helene.kergoat@umontreal.ca), Tel: (514) 343-7507, Fax: (514) 343-2382

Introduction : La dégénérescence maculaire liée à l’âge (DMLA) est la première cause de cécité chez la personne âgée en Amérique du Nord. La théorie vasculaire indique qu’une anomalie de la circulation choroïdienne serait un facteur de risque important dans la pathogenèse de la DMLA. Notre objectif était de mesurer le débit sanguin choroïdien pulsatile à divers stades de la DMLA afin de vérifier si une anomalie vasculaire est présente.

Méthodes : 96 sujets répartis dans un des 4 groupes suivants: 1) DMLA sèche, 2) DMLA humide, 3) DMLA disciforme et 4) contrôles, ont participé à l’étude. Le système Pulsatile Ocular Blood Flow – POBF a été utilisé pour mesurer le débit sanguin choroïdien.

Résultats : Le débit sanguin pour chaque groupe était: 1) 832.2 ± 48.1, 2) 860.4 ± 63.0, 3) 722.9 ± 61.9 et 4) 741.6 ± 53.6 µl/min, et ne différait pas entre les groupes (p>0.05).

Discussion : Le POBF mesure le débit sanguin pulsatile de l’ensemble de la choroïde. Il se pourrait que le débit sanguin non pulsatile soit altéré, ou que le débit sanguin soit altéré dans une zone plus localisée de la rétine où les lésions liées à la maladie sont plus concentrées. Une étude est planifiée pour tester ces hypothèses à l’aide de la débitmétrie par laser Doppler.

076

SURVEILLANCE SYSTEM FOR CREUTZFELD-JAKOB DISEASE IN CANADA

Terry Sutcliffe, Antonio Giulivi, LCDC Building, P1#0601E2, Ottawa, ON K1A 0L2, (terry_sutcliffe@hc-sc.gc.ca), Tel: (613) 946-9864, Fax: (613) 952-6668

Objective of CJD-SS: 1-To gather information for all cases of CJD identified to the Surveillance System since 1998 in order to establish a database for research on CJD in Canada, and 2-Participate in international studies to determine the epidemiology of variant CJD and to be made aware of any cases occurring in Canada.

Methods: In April 1998, all Canadian physicians involved in the care of probable cases of CJD have been informed about our project and have been asked to notify the CJD-SS, at the toll free number provided, in order that the Surveillance System can ensure complete follow-up. This would involve ensuring the collection of a blood sample from the patient for genetic sequencing, organizing the performance of an autopsy at time of death and obtain permission from the patient's family to conduct a medical records review as well as have a questionnaire completed.

Data and results obtained: As of December 2001 there have been 279 referrals to the Surveillance System; 121are confirmed cases of CJD by autopsy or biopsy reports. The incidence of CJD in Canada for 1999 and 2000 is 0.92 and 1.04 respectively. There have been 10 confirmed familial cases and NO cases of vCJD reported so far.

Conclusions: The Surveillance System, with the invaluable cooperation of both the physicians who care for patients with a diagnosis of CJD as well as their families, has been able to reflect the expected incidence of CJD of 1 person per million population. We have also been able to carry out further study on familial cases of CJD in Canada as well as contribute to the on-going worldwide research on CJD and vCJD.

077

TOWARD PLACE-THERAPY: PLACE-BIOSKETCH AS A TOOL IN CARING FOR RESIDENTS WITH DEMENTIA

Habib Chaudhury, Gerontology Research Centre, 2800-515 W. Hastings St., Vancouver, BC V6B 5K3 (chaudhury@sfu.ca),

Tel: (604) 291-5232, Fax: (604) 291-5066

As human experience takes place within the context of places, places can serve as a tool in understanding individual personal life experiences. Personal place-related experiences can be used to reconnect with people with dementia. Information about past places, such as childhood homes, neighbourhoods, schools and homes in early adulthood are potential resources for understanding the person behind the symptoms of dementia. This exploratory study looked at recollection of past places by residents with dementia in long-term care settings. Interviews were done with family members of the selected residents to gather place-related information. Verbal and visual prompts were used to conduct guided conversations with thirteen residents with dementia. Personally meaningful visual prompts were effective in triggering place-oriented past experiences among the residents. Substantive themes of the recollections include “childhood homes”, “holding onto emotions”, and “emergent present”. It is argued that place-based recollection can be a therapeutic activity for people with dementia. Place-biosketches of residents with dementia were developed based on interviews with the family members. A staff survey was conducted to assess the potential utility of the residents place-biosketches in understanding the residents personal life histories and programming activities that may be meaningful for them.

078

THE SASKATCHEWAN MOOD INVENTORY FOR INDIVIDUALS WITH MEMORY LOSS: A NEW TOOL FOR ASSESSMENT AND RESEARCH

Margaret Crossley, Catherine Burton, Department of Psychology, 9 Campus Drive, University of Saskatchewan, Saskatoon, SK S7N 5A5 (crossley@sask.usask.ca), Tel: (306) 966-5925, Fax: (306) 966-6630

The Saskatchewan Mood Inventory (SMI) is an instrument designed to facilitate research on emotion in dementia and to complement clinical neuropsychological assessment of early-stage individuals. The purpose of the SMI is to identify relationships between patterns of cognitive performance and family member ratings of emotional responses during daily activities. Family members are instructed to use the semi-structured written log to prospectively document the type and intensity of emotions expressed by the individual with dementia, to describe the associated emotion-evoking events or activities, and to monitor and record their own emotional reactions. Preliminary research with 27 family caregivers indicated that caregivers will use the log consistently during a two-week monitoring period to document an average of three emotion-evoking events per day. Although sadness was seldom reported, most caregivers used the full range of emotional descriptors for their own and their care-recipient's emotional responses. Caregivers' ratings of their own emotional state was highly correlated with their ratings of their family member with dementia. Narrative descriptions were subsequently coded for content, with acceptable interrater reliability, and reported in association with positive and negative emotional responses.

079

THE ROLE OF THE PSYCHOMETRIST IN AN AGING RESEARCH AND MEMORY CLINIC

Moira Remmen, Margaret Crossley, Department of Clinical Health Psychology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8 (moiraremmen@hotmail.com), Tel: (306) 655-2346, Fax: (306) 655-2340

Neuropsychological assessment of patients with a possible diagnosis of dementia involves a team approach in our Aging Research and Memory Clinic in Saskatoon, Saskatchewan. The psychometrist works with the neuropsychologist as well as a pre-doctoral student from the University of Saskatchewan Doctoral Program in Clinical Psychology, to conduct assessments of patients and their family members who are referred because of age-related cognitive decline or early-stage dementia. This presentation will discuss the psychometrist's role in modifying the testing environment and procedures in order to meet the needs of older patients, and his/her role in training graduate students to administer standardized tests. A Behavioural Rating Scale (BRS; Snow, 1989) is completed by the psychometrist as part of our assessment in order to document specific behaviors observed during testing. The presentation will summarize data collected using the BRS with over 100 clinic patients. These behaviours, as well as physical health concerns, require careful consideration by the psychometrist during test administration and by the neuropsychologist and graduate student during test data interpretation. We will also discuss the psychometrist's role in the collection of research data and in managing an information centre for patients and their family members. The roles of the psychometrist in a memory clinic are varied and challenging and provide many opportunities for enjoyable contact with patients, family members, students and other health care professionals.

080

MODEL OF DECLINE IN DEMENTIA OF THE ALZHEIMER TYPE AS MEASURED BY THE HIERARCHIC DEMENTIA SCALE (HDS)

Dolly Dastoor, Douglas Hospital, 6875 Boul La Salle, Verdun, QC H4H 1R3 (dasdol@douglas.mcgill.ca), Tel: (514) 761-6131 ext 2165

Alzheimer's disease is characterized by progressive and variable rates of decline in several domains of cognitive functions. A model to predeict this decline in individual patients as measured by the Hierarchic Dementia Scale (HDS) was developed, based on the risk factors of age of onset of symptoms, education, gender and place of residence.

60 patients with AD were assessed at 6 month intervals over 18 months and using a repeated measures uniariate and multivariate design format. The results show significant age and time effects for the total HDS score and for the seven cognitive domains. A model of decline in language and praxic functions was built using the Bayesian Information Selection Criterion (BIC). Of all the variables entered in the model (REML), age of onset, level of education and place of residence were selected as predictors of decline. For every year of difference in age of onset of symptoms, there was a significant difference of 1.60 points on the total HDS score, .72 points on the language score and .26 points on the praxic score.

The study indicates AD patients with earlier age symptoms onset, lower education and living in an institution will decline faster on the total HDS and language function scores.

081

VALIDATION OF A PAIN ASSESSMENT SCALE FOR SENIORS WITH SEVERE DEMENTIA

Shannon Fuchs, Thomas Hadjistavropoulos, Department of Psychology, University of Regina, Regina, SK S4S 0A2 (Thomas.Hadjistavropoulos@uregina.ca), Tel: (306) 585-4457, Fax: (306) 337-2321

Pain in seniors with severe dementia often goes undetected largely due to serious limitations in ability to communicate. Most attempts to develop pain assessment tools for seniors with severe dementia have been plagued with methodological problems (e.g., no statistical analysis, limited validity evidence). In order to address such concerns, we developed a caregiver-administered pain assessment checklist for seniors with severe cognitive impairments. The items were generated based on interviews with professional caregivers. Following item analysis, we finalized the composition of four internally consistent subscales. These were: a) facial expressions; b) activity/body movements; c) social and personality changes; and d) other (e.g., appetite /sleeping changes). The intercorrelations among the subscales suggest that, although the checklist measures a unified construct, the subscales are sufficiently distinct to warrant independent consideration. In this presentation, we are reporting on a validation study of our pain assessment scale. The validation process involves an examination of the ability of the scale to distinguish patient behaviour during pain events (e.g., after a fall or during a medical procedure) from when the patient is calm and from when the patient is expressing non-pain related distress (e.g., when a close relative is leaving the hospital).

082

WHO IS NOT COMING BACK? ANALYSIS OF FACTORS RELATED TO DROP-OUT FROM LONGITUDINAL STUDIES OF AGING

Stephen Griew, Suzanne Prior, Department of Gerontology, St. Thomas University, Fredericton, NB E3B 5G3 (griew@netcom.ca), Tel: (506) 458-7025, Fax: (506) 452-0611

There is wide agreement that drop outs from longitudinal studies of aging are not random, yet the literature on factors determining drop out does not yet clearly assess the relationships between these factors and a participant's withdrawal from a study. The present study attempts to inform this issue by examining a variety of psychological, sociodemographic, and health measures which were attained during the two years prior to drop out. These include tests of cognitive functioning, locus of control, life satisfaction, introversion, and neuroticism from a psychology protocol. Sociodemographic measures include risk-avoidance, income, and educational attainment, and health measures include personal assessments of health. The data were collected as part of the Fredericton 80+ Study, a longitudinal study of a cohort of individuals aged eighty years in 1998. Data on a sub-sample of individuals who ceased participation due to death is subjected to special analysis. Results from the analysis of drop outs from the Fredericton 80+ Study are compared with similar longitudinal studies in other countries. This comparison provides an important cross-cultural comparison of factors related to drop out. The implications of the findings for the interpretation of the drop-out phenomenon and for longitudinal studies of aging are discussed.

083

EXPLORING THE RELATIONSHIP BETWEEN EFFORT AND COGNITIVE PERFORMANCE IN GERIATRIC AND PSYCHOGERIATRIC POPULATIONS

Sarah Frogley, Keith Carlson, Rosehaven Care Centre, 4612 - 53 Street, Camrose, AB T4V 1Y6 (kcarlson@bethanygrp.org), Tel: (780) 679-3052, Fax: (780) 679-3001

In many geriatric facilities, cognitive ability is measured as part of routine care, assuming that the individual is putting forth his/her best effort. Is this actually the case? Effort and cognitive ability have not previously been studied in geriatric populations. Measuring both factors could determine whether cognitive performance is being compromised by lack of effort, rather than lack of ability. The Word Memory Test (WMT) (Green, Allen & Astner, 1996) was developed to test for malingering in claimants with traumatic brain injury and could be a useful tool for geriatric and psychogeriatric populations. The relationships among effort, depression and cognitive performance were explored in the present study. Residents of two continuing care facilities (psychogeriatric and standard continuing care) in a small urban centre in Alberta were screened with age, cognitive function and diagnostic inclusion criteria. The Modified Mini Mental State (3MS) Exam (1987) was administered in an initial interview. In a second interview, the 30 residents who scored in the mild impairment or normal range completed the WMT, Geriatric Depression Scale-short (1986), and additional Kaplan Baycrest Neurocognitive Assessment subtests (2000). No significant correlation was found between level of depression and effort or cognitive performance. Only 17% of participants scored above cutoff levels for measures of effort on the WMT and while all scored in the normal range on the 3MS, only half of those in the normal range passed effort measures. Implications of the results are discussed in terms of the applicability of the WMT for geriatric populations.

084

EMPIRICAL SUPPORT FOR PSYCHOSOCIAL INTERVENTIONS FOR NURSING HOME RESIDENTS

Liza Stelmach, Candace Konnert, Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4 (lddalzel@ucalgary.ca), Tel: (403) 220-4975, Fax: (403) 284-9516

Epidemiological data clearly suggests that the majority of nursing home residents require mental health services. As the number of elderly persons residing in nursing homes increases, the identification and effective treatment of mental health problems is becoming a priority. Considering the unique characteristics of residents and nursing homes, it cannot be assumed that psychosocial interventions that have been demonstrated as effective with younger adults and community-dwelling elderly will be as effective with nursing home residents. This poster discusses whether or not reminiscence and life review therapy, group therapy, music therapy, art therapy, pet therapy, and work therapy are empirically supported for use with the nursing home population, according to the criteria developed by the Task Force on the Promotion and Dissemination of Psychological Procedures (Chambless & Ollendick, 2001). A critical review of the literature indicates that none of these therapies meet full criteria to be classified as empirically supported for use with residents, however there is some preliminary support for the use of all of the therapies with this population. The reasons why none of these therapies currently meet criteria for an empirically supported treatment are discussed, and suggestions are provided for future research.

085

THE RELATIVE CONTRIBUTION OF EDUCATION, OCCUPATION, AND PREMORBID IQ TO DEMENTIA DIAGNOSIS

Douglas D. Garrett, Holly Tuokko, 3998 Bear Street, Victoria, BC V8N 3R1 (dgarrett@uvic.ca), Tel: (250) 472-0970

The detection of an incipient dementia is sometimes complicated by characteristics of the individual, such as educational attainment. For example, high functioning elders may not show deficits on cognitive measures until well into the disease course. High functioning can be defined in at least three ways: educational attainment, occupational status, and level of premorbid IQ. We examined the relative contribution of these three factors to dementia diagnosis cross-sectionally and longitudinally with data from the Canadian Study of Health and Aging (CSHA), a nationwide epidemiological study of dementia. At CSHA-1, estimated premorbid IQ was significantly correlated with dementia status (p=.001). In a separate regression analysis, education was also highly correlated with dementia status (p=.003); occupation did not account for any additional variance. For those with no cognitive impairment (NCI) at CSHA-1 who were seen five years later (CSHA-2), estimated premorbid IQ was again the strongest predictor of dementia status (p=.018), relative to either level of education (p=.023) or occupational classification (p=.993). These findings then highlight the need to consider specific characteristics of the individual when assessing for dementia, and suggest that future research into the clinical implications of these findings is warranted.

086

AWARENESS OF FINANCIAL ABILITIES IN DEMENTIA

Laura Van Wielingen, Holly Tuokko, Centre on Aging, Sedgewick Building, Room A 104, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 (htuokko@uvic.ca), Tel: (250) 721-6576, Fax: (250) 721-6499

The present study examined the relations between hierarchical levels of cognitive functioning and awareness of financial management capabilities among a sample of 42 community-dwelling persons with dementia. Financial tasks on the Measure of Awareness of Financial Skills (MAFS) were categorized and organized in a hierarchy of task complexity based on Piaget's operational levels of childhood cognitive development. Severity of global cognitive impairment as measured by performance on the Modified Mini-Mental State (3MS) examination was significantly related to awareness of financial abilities as measured by informant-participant discrepancy scores on the MAFS. For persons with mild and moderate/severe dementia, proportions of unawareness within simple and complex financial task categories were tabulated. Significantly more unawareness of financial abilities occurred when tasks were complex, as compared to when simple tasks were considered. Individuals with mild dementia demonstrated significantly less unawareness of abilities on simple items, whereas persons with moderate/severe dementia demonstrated a large and equivalent degree of unawareness of abilities across simple and complex tasks. These findings demonstrate a hierarchical pattern of decline in awareness in relation to complexity of financial tasks and supports literature suggesting that deficits first occur in complex cognitive tasks involving inductive reasoning or decision-making in novel situations.

087

PREDICTING INTENTIONS TO PROVIDE CARE FOR FRAIL ELDERLY PARENTS

Susan Pardy, V. Jane Knox, Department of Psychology, 62 Arch Street, Queen's University, Kingston, ON K7L 3N6 (pardy@psyc.queensu.ca), Tel: (613) 384-9981, Fax: (613) 384-9981

As the elderly segment of the population grows, more and more family members will be called upon to provide informal care to aging relatives. This study was designed to improve our understanding of the determinants of willingness to provide such care. An augmented model of the theory of planned behavior (TPB; Ajzen, 1985) was used to explore adult children's intentions to provide parental care. Middle-aged men (n = 79) and women (n = 81) completed questionnaires measuring attitude, subjective norm (SN), perceived behavioral control (PBC), anticipated regret (AR) and carer self-concept (CSC). Participants then read a vignette depicting a moderately impaired elderly woman or man and a description of the specific care he/she required. They indicated their intention to provide care if this were their parent. Overall, the TPB model accounted for 29.1% of variance in intentions to provide care. Surprisingly, women and men reported similar intentions. The findings imply that the decision to provide parental care is partly a motivated act influenced by rational and emotional factors.

088

LA BOSSE DES RÉMINISCENCES DANS LES RÊVES DES PERSONNES ÂGÉES: THÈMES D'INTÉGRATION ET D'IDENTITÉ

Philippe Cappeliez, Isabelle Pelletier, Vicky Rivard, Ecole de Psychologie, Université d'Ottawa, 11 rue Marie-Curie, Ottawa, ON K1N 6N5 (pcappeli@uottawa.ca), Tel: (613) 562-5800 poste 4806, Fax: (613) 562-5169

Le phénomène de la “bosse” en mémoire autobiographique (sur-représentation de souvenirs de l’adolescence-jeune vie adulte) pour les personnes âgées a été découvert aussi au sein des rêves. Une explication de ce phénomène a trait au développement de l’identité. Cette recherche teste cette hypothèse en analysant les rêves de personnes âgées comportant des références temporelles de la période de la “bosse”, comparativement à des rêves avec des références temporelles au passé récent. Les participantes sont 29 femmes âgées (moyenne: 65 ans). Des récits de rêves recueillis à la maison furent évalués indépendamment par deux juges, dans l’ignorance des hypothèses, sur ces dimensions: (a) position du rêveur en tant qu’acteur (Identité : nombre d’occurrences du mot “Je” / nombre de mots total); (b) préoccupation centrale du rêve selon 5 catégories: traumatismes; souhaits/idéaux; problèmes en suspens; anticipations; nouveautés; (c) type de réminiscence manifesté dans le rêve, selon 6 catégories : intégration, évasion, rumination, narration, résolution, transmission. L’importance des souhaits/idéaux dans les préoccupations et des réminiscences intégratives dans les rêves comportant des références temporelles de la période de la “bosse” en mémoire autobiographique appuient l’hypothèse selon laquelle les contenus de pensée dans ces rêves sont particulièrement axés sur des thèmes d’identité et d’intégration.

089

INTERVENTION NON-PHARMACOLOGIQUE POUR RÉDUIRE L'AGITATION VERBALE: UNE ÉTUDE PRÉLIMINAIRE

Annick Bédard, Philippe Landreville, École de psychologie, Université Laval, Québec, QC G1K 7P4 (bedard_annick@hotmail.com), Tel: (418) 656-2131 poste 8115

Cette étude a pour objectif d'évaluer l'efficacité d'une intervention non-pharmacologique pour réduire l'agitation verbale (AV) chez les personnes atteintes de démence résidant en centre d'hébergement et de soins de longue durée. L'intervention combine trois composantes soit l'attention, le confort et la stimulation sensorielle. Un protocole à cas unique est utilisé auprès de 2 participants. La première phase consiste à observer la fréquence et la durée des comportements d'AV afin d'établir le niveau de base avant d'introduire l'intervention. Une dernière phase d'observation est ensuite effectuée afin de vérifier si l'AV subit une augmentation après le retrait de l'intervention. Une mesure de validation sociale permet de comparer l'effet de l'intervention telle que mesurée par l'observation directe avec la perception du personnel soignant. Les résultats préliminaires suggèrent une augmentation de la fréquence et une diminution non statistiquement significative de l’AV pour l’un des participants et une absence de changement lié à l’intervention chez l’autre résident.

090

LA PLACE DU RECOURS AUX MÉDICAMENTS PARMI LES STRATÉGIES DU BIEN-VIEILLIR, CHEZ DES FEMMES ÂGÉES ACTIVES ET SÉDENTAIRES, VIVANT DANS UN MILIEU ÉCONOMIQUEMENT DÉFAVORISÉ

Philippe Voyer, Suzanne Laberge, Geneviève Rail, Hélène Dallaire, Faculté des sciences infirmières, Université Laval, Cité universitaire, Quebec, QC G1P 7P4 (philippe.voyer@fsi.ulaval.ca), Tel: (418) 656-2131 poste 8799, Fax: (418) 656-7825

091

DISCRETE POSITIVE EMOTIONS ARE RELATED TO HEALTH-SERVICES USE IN OLDER INDIVIDUALS

Nancy McKeen, Judith G. Chipperfield, Darren Campbell, Raymond Perry, University of Manitoba, Health, Leisure & Human Performance Research Institute, Faculty of Physical Education & Recreation Studies, Max Bell, 3rd floor, Winnipeg, MB R3T 2N2 (chipper@ms.umanitoba.ca), Tel: (204) 474-8762, Fax: (204) 261-4802

The importance of discrete positive emotions to objective health outcomes was investigated in this empirical study of 352 elderly community-dwelling individuals (age 72-99 years). Health services data was obtained for a 2-year period before and after an interview in which the participants were asked to describe their emotions in the prior 2 days. In a series of hierarchical multiple regressions, the relationship of 6 positive emotions (Content, Grateful, Happy, Hopeful, Proud, and Relieved) to 2 objective measures of health-services utilization (Physician Visits and Hospital Admissions) was examined, along with the influence of 5 demographic variables (Age, Gender, Education, Marital Status, and Income). The hypothesis that positive emotions would be associated with better health outcomes was confirmed. Also, age interactions showed developmental effects. Age by Hope and Age by Contentment interactions provide evidence of the protective effects on health of positive emotions among elderly adults (Fredrickson, 1998) and support the hypothesis that older adults experience developmental change involving better emotional regulation and increasing salience of emotion (Carstensen & Turk-Charles, 1994).

092

DESIGN FEATURE IMPLEMENTATION IN SCUS FOR RESIDENTS WITH DEMENTIA

Kate Oakley, Annie Murray, 25 Grammercy Park, Ottawa, ON K2C 4E1 (koakley@scohs.on.ca), Tel: (613) 596-4893

The number of Special Care Units (SCUs) required to house persons with dementia has increased dramatically in recent years. Seven theoretical design guidelines were developed to guide the creation of a housing environment to maximize the functioning of individuals with dementia. In theory, it is expected that newer SCUs will be more likely to implement the recommended design guidelines than older SCUs because there are no pre-existing structural limitations. The present study compared newer and older facilities to determine whether these recommendations were indeed followed. Post-occupancy Evaluations of 15 new and 14 pre-existing SCUs in British Columbia were assessed using the Professional Environmental Assessment Protocol (PEAP).

Two main findings were observed. 1. Contrary to expectation, older facilities obtained higher overall PEAP scores than newer facilities. 2. Large discrepancies were noted between design implementation measures and the opinions of Directors of Care for Regulation of Stimulation and Quality of Stimulation. That is, older SCUs tended to score themselves higher and newer SCUs lower than may be warranted. These findings suggest that design guidelines are not automatically incorporated into newer SCUs, and that individual differences in philosophy may influence the interpretation and, hence, ratings on the PEAP dimensions.

093

COMPRÉHENSION SPATIALE ENTRE 65 ET 75 ANS: UNE SÉNESCENCE IDENTIQUE CHEZ LES HOMMES ET LES FEMMES?

Isabelle Ecuyer-Dab, Constant Rainville, Romedi Passini, Yves Joanette, Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montral, QC H3W 1W5 (isabelle.ecuyer@umontreal.ca), Tel: (514) 340-3540 poste 3160, Fax: (514) 340-3548

L’objectif principal de la recherche en cours est de vérifier si, entre 65 et 75 ans, une meilleure appréhension, chez les hommes, de la façon dont un espace réel, tridimensionnel est organisé est liée à de meilleures habiletés masculines pour s’orienter spatialement. Appariés en fonction de l’âge et du niveau d’éducation, 24 hommes et 24 femmes, retraités et ne présentant pas de troubles légers de la cognition tel qu’évalué au moyen du MMSE, ont à reproduire en modèle réduit (40 par 50 cm) l’organisation spatiale d’une petite pièce (4 par 5 m) à l’intérieur de laquelle des panneaux de bois colorés d’une hauteur de 2 m ont été disposés symétriquement les uns aux autres. Les mêmes sujets doivent aussi effectuer une tâche d’orientation spatiale consistant à pointer du doigt en direction du lieu départ, puis du lieu d’arrivé, d’un parcours réalisé au sein d’un environnement fermé de type labyrinthe (10 m x 7 m). Les données spatiales qui, propres à chaque catégorie sexuelle, sont considérées et discutées ici en relation avec l’âge, visent aussi à mieux cerner les difficultés spatio-cognitves liées au vieillissement ainsi que celles qui sont spécifiques aux hommes et femmes de plus de 65 ans.

094

DRIVER REFRESHER COURSES: IDENTIFYING RESPONDERS

Wendy Lindstrom, Michel Bédard, Ivy Isherwood, et al., Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E4 (welindstr@sympatico.ca), Fax: (807) 346-7734

Introduction: Maintaining safe driving among older adults is crucial to their independence. Refresher courses to improve safety are increasing in popularity but they may not be suitable to all older drivers. This study was designed to identify predictors of improvement after a driving refresher course.

Methods: The cognitive and perceptual abilities of 18 older drivers were tested with standardized tests. These tests were followed by an on-road driving Evaluation, the refresher course, and a second on-road Evaluation. We examined if scores on the cognition/perception tests predicted the change observed on the driving test after the course.

Results: The average improvement in the driving score after the course was 6.31 (SD = 6.44, p = .001). The cognition/perception scores were unrelated to baseline driving scores (p = .318). However, a combination of these tests explained 72% of the variability in the change after the refresher course (p = .009) after controlling for age and gender.

Conclusion: Some older drivers may improve following a refresher course. We can identify these responders from their scores on simple tests of cognition and perception. Supported by the Ontario Neurotrauma Foundation.

095

LIFE SATSIFACTION, OPTIMISM, PERSONALITY, AND MARITAL AGGRANDIZEMENT AMONG OLDER ADULTS

Norm O'Rourke, Gerontology Research Centre and Programs, Simon Fraser University at Harbour Centre, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

More than 30 years ago, the need for a couples measure of biased responding was identified. Like other categories of self-report instruments, marital measures are believed to be highly susceptible to distortion. The Marital Aggrandizement Scale (MAS; ORourke, 2000) was developed to measure this phenomenon. The current study examines the association of life satisfaction, optimism, and personality variables in relation to this construct among an international sample of older married adults. The absence of neuroticism (or negative emotional reactivity) and openness to experience appear associated with selective recall of ones relationship history. In contrast, the trait of extroversion and dispositional optimism appear unrelated to MAS scores. Life satisfaction also emerged as a significant predictor of marital aggrandizement. These results are discussed in terms of positive biases in autobiographical information processing among those within enduring relationships.

096

PERSONALITY AND SOCIO-DEMOGRAPHIC VARIABLES AS ANTECEDENTS OF WELL-BEING

Norm O’Rourke, Gerontology Research Centre, Simon Fraser University at Harbour Centre, #2800 – 515 West Hastings St, Vancouver BC V6B 5K3 (ORourke@sfu.ca) Tel: (604) 291-5175. Fax: (604) 291-5066

Research examining the well-being of older adults has grown exponentially in recent years. Few studies, however, examine well-being over extended periods. Palmore, Nowlin and Wang posit a theoretical framework in which to predict well-being over time. This model is revised for the current study to include personality variables and marital satisfaction as factors related to the well-being of older adults. An international sample of older married adults was recruited (N = 197). Participants completed study measures at separate times, an average of 16 months apart. The resulting structural equation model provides general support for the framework proposed by Palmore et al. Personality appears related to well-being at baseline whereas socio-demographic variables appear to have a more enduring influence upon well-being. There appears to be considerable consistency in the well-being of older adults over time. Limitations of use of the Internet as a vehicle for data collection are considered as well as directions for future research.

097

WORKING TOGETHER FOR ELDER FRIENDLY COMMUNITIES

Chairperson: C. Austin, U of Calgary, Faculty of Social Work, Calgary, AB T2N 1N4 Participants: C. Austin; D. Hartley, U of Calgary, Faculty of Social Work; B. Howson, Calgary Health Region; D. Greenslade, Calgary Family Services; D. Flux, Seniors' Division, City of Calgary; R. McClelland, U of Calgary, Faculty of Social Work; J. Sieppert, U of Calgary, Faculty of Social Work; Patti Restoule, Calgary Health Region

The Elder Friendly Communities (EFC) partnership includes: The City of Calgary, The Calgary Health Region, Calgary Family Services, The United Way of Calgary & Area and the Faculty of Social Work, University of Calgary. This symposium includes a discussionof the needs assessment conducted in four neighborhoods in the City of Calgary, communities selected for their density of senior population, variability in income levels and ethnic diversity. The goal of the needs assessment was to develop a focused assessment of the assets, capacities and needs of seniors and their families. Close to 300 seniors, community experts and key informants participated in focus groups and interviews. Key themes identified in the qualitative analysis ofneeds assessment data will be presented. Seniors identified high priority issues in their own communities including: meeting the needs of isolated seniors, accessing information, home maintenance, housing, transportation and issues affecting immigrant seniors. Following completion of the needs assessment, community respondents were invited to participate ina community development process to address the issues and needs they identified. The EFC project operates on two levels: the partnership and senior-driven community development, staffed by workers from partnering organizations. The partnership is based principles that guide the collaborative process. Partnership activities have been analyzed to identifyfactors affecting its success and problem solvingstrategies. The senior driven, grass roots approach to community development highlights the uniqueness of EFC. Partnering organizations are developing and identifying best practices in community development with seniors. Community workers generate qualitative data that provide thebasis for systematically describing community development efforts. The multi-phase formative and summative research focuses on the development of methods for investigating both partnership and community dynamics, as well as outcomes for delivery system.

COMMUNITY NEEDS ASSESSMENTS

D. Hartley; U of Calgary, Faculty of Social Work

The four communities selected for the EFC Needs Assessment were diverse. Several variables were taken into consideration in the selection process: density of the older population (including the population 85+), proportion receiving GIS, the proportion whose mother tongue was not English or French (a proxy for cultural diversity). The four communities were: Acadia, Haysboro, Marlborough / Marlborough Park, and Varsity. Data were collected using three approaches, focus, groups, in-home interviews and key informant interviews. In total, 225 individuals participated in 28 focus groups. Forty two in home interviews were conducted with 57 individuals and 12 key informants were interviewed. A total of 294 respondents participated in the needs assessment phase. Focus group and interview tapes were transcribed and analysed by a team of researchers using the constant comparison method to identify key themes within and among the communities. Eight major themes emerged as the data were analysed. Seniors identified common themes across the communities: being valued and respected, staying active, building community, making ends meet, feeling safe, a place to call home, getting what you need and getting around. Service providers and key informants reflected broader, system- level concerns. There was considerable overlap in themes identified by seniors and service providers.

ELDER FRIENDLY COMMUNITIES PARTNERSHIP

B. Howson, Calgary Health Region; C. Austin, U of Calgary, Faculty of Social Work; Patti Restoule, Calgary Health Region

Partnership and collaboration has become a consistent expectation in service delivery and applied research.This is particularly the case when research and service provision requires the active involvement of multiple stakeholders in design, delivery and evaluation phases of innovative programs serving older adults. The EFC partnership seeks to develop evidence based approaches for community development with seniors and to integrate knowledge and action among the organizational partners. The partnership approach to community- based research where seniors' interests and activities are the key drivers, presents both operational and analytical challenges. This paper will present a description and analysis of the EFC partnership from both structural and process perspectives. Collaborative applied research is a time consuming process, requiring considerable commitment. Data focused on partnership dynamics are collected through retrospective interviews, document analysis and observation. Partnerships can be established, however their maintenance and sustainability involves a developmental process. The analysis of the EFC partnership experience is based in two sets of variables: those identified in meta-analyses of previous community based research, and those identified through the experience of individuals working in partnerships involving researchers and decision makers.

COMMUNITY DEVELOPMENT MODEL

R. McClelland, U of Calgary; D. Flux, City of Calgary;

D. Greenslade, Calgary Family Services

Community development with seniors differs from community-based service delivery because the seniors are the driving force in the work of identifying and creating solutions to local concerns. This involves a process that enhances community capacity to identify and meet a variety of needs. Functional and geographic communities interact to increase social capital and enhance the quality of life for seniors. The aim of community work with seniors is empowerment through skill building, leadership development, creating effective grassroots organizations, self-help activities and the articulation of important concerns to policy makers. The Elder Friendly Communities partnership has initiated pilot projects in four Calgary neighborhoods to pursue three goals: (1) to influence the community forces that affect the well being of seniors, (2) to increase the capacity of seniors and those concerned with the interested of seniors to assess, access, manage and alter the allocation of needed resources, and (3) to enhance the ability of seniors to contribute to the welfare of their communities. To these ends, staff from the partner organizations, as well as collaborating agencies, are working with grassroots senior groups. These pilot efforts will lead to demonstration projects designed to articulate best practices in community development with seniors.

RESEARCH DESIGN AND PROCESS

J. Sieppert, U of Calgary, Faculty of Social Work

This paper reports on a unique research process adopted within Calgary's Elder Friendly Communities Project that followed a very different model in the research process. Over the last two years this partnership conducted a needs assessment of senior services in four specific communities in the City of Calgary. This process adopted a participatory research framework as part of a larger community development process. The goal of this research was to develop a deeper, rich understanding of the assets, capacities and needs of seniors and their families in these communities. With this information as a foundation, more effective and responsive responses to seniors issues could then be formulated. Moreover, this could occur with the full participation of seniors who contributed to the research process. The paper will discuss the unique challenges and dimensions of conducting community development research in local communities. It will also discuss the lessons that can be learned from engaging in this process with full participation of a client group and a wide range of partners from different disciplines and organizations. The paper concludes with recommendations for conducting relevant and appropriate research using similar methods in other settings and for other populations.

098

MILD COGNITIVE IMPAIRMENT - A MULTI-CENTRE APPROACH TO ASSESSMENT

Howard Chertko, et al., Bloomfield Centre for Research on Aging, 3755, Côte Ste-Catherine Road, Montréal, QC H3T 1E2 (howard.chertkow@mcgill.ca), Tel: (514) 340-8260, Fax: (514) 340-8295

Mild memory loss in elderly individuals (often termed Mild Cognitive Impairment, MCI) usually precedes deterioration to dementia such as Alzheimer's Disease. In an effort to better understand the natural history and prognosis of MCI, we have organized a registry of such patients presenting to 13 Memory and Cognition clinics across the province of Quebec. This was necessary in order to allow researchers to begin sharing data, and to develop research projects into dementia which are multi-centre. We have developed shared diagnostic tools and protocols for clinical, neuropsychological, cognitive, and imaging Evaluation of our research projects. These shared protocols are being utilized across the province through a network set up under auspices of the FRSQ (Fonds de la recherche en santé de Québec). An initial cohort of 100 Mild Cognitive Impairment subjects is being entered into a registry. In the symposium, initial clinical, neuropsychological, and imaging results from the group will be presented. We will assess the impact of utilizing different definitions of MCI, and assess the extent to which an "MCI" cohort shows measurable abnormalities in other neuropsychological domains and on MRI imaging. It appears feasible to coordinate multiple clinical centres in order to speed accrual of subjects in diagnostic categories such as MCI.

099

THE CHALLENGE OF MILD COGNITIVE DISORDERS: THE VRQ CONSORTIUM ON AGING AND COGNITION APPROACH

Yves Joanette, Howard Chertkow, Sylvie Belleville, Noor Kabani, Hélène Kergoat, Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montreal, QC H3W 1W5 (yves.joanette@umontreal.ca), Tel: (514) 340-3540, Fax: (514) 340-3548

Cognition impairments and their impact on autonomy and quality of life are one of the most important challenges of current research in health and aging. One of the most important questions in this area is the early identification of individuals with mild cognitive impairments (MCI) converting into dementia. However, at this point in time, no single discipline approach has allowed to fully understand and predict this conversion. The goal of this symposium is to present the integrated approach taken by the Université de Montréal/McGill Consortium on Cognition and Aging recently funded by Valorisation Recherche Québec to the complex problem of mild cognitive disorders. Its scope encompasses basic fundamental research to research on efficient health services and includes neuroimagery, basic, and clinical cognitive research as well as behavioral neurology and geriatric approaches. The introduction to this symposium will allow a brief description of the Consortium. Then, four presentations will illustrate some of the currently ongoing integrated research efforts. The first presentation will allow to describe the joint effort of the consortium and the Axe cognition of the Québec Réseau de recherche en géronto-gériatrie based on a multi-center approach of the assessment criteria and tools for MCI. Then, the specific problem raised by the Evaluation of memory will be addressed. An example of the integrated approach will be provided through a third presentation looking at structural changes in the entorhinal cortex of individuals with MCI. Finally, the existence of visual impairments in the very early stages of an Alzheimer disease will be taken as an example of early sensory deficit in dementia-converting MCI individuals. Together, these presentations will stress the importance of an interdisciplinary approach to the challenging problem of evaluating and understanding MCI with the ultimate goal of providing these individuals with relevant strategies to prevent them to convert into dementia.

100

ÉVALUATION DE LA MÉMOIRE ET DES FONCTIONS EXÉCUTIVES CHEZ DES PERSONNES ÂGÉES AVEC TROUBLE LÉGER DE LA COGNITION (MILD COGNITIVE IMPAIRMENT) ET CHEZ DES PERSONNES AVEC DÉMENCE DE TYPE ALZHEIMER

Sylvie Belleville, et al., Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montreal, QC H3W 1W5 (sylvie.belleville@umontreal.ca),

Tel: (514) 340-3540, Fax: (514) 340-3548

Le but de ce projet est d’évaluer les troubles de la mémoire des personnes âgées avec Trouble Léger de la Cognition (TLC). Ces personnes se plaignent d’un trouble de la mémoire qui est confirmé par une évaluation formelle faisant appel à des mesures de mémoire normalisées pour l’âge et l’éducation. Bien qu’elles ne répondent pas aux critères de démence une grande proportion de ces personnes évoluent chaque année vers une démence de type Alzheimer (DTA). Nous avons évalué un groupe de personnes avec TLC à une batterie de tâches cognitives faisant appel à la mémoire de travail et aux fonctions exécutives. Les performances des personnes avec TLC étaient comparées à celles de sujets âgés sains et de personnes avec DTA. Les résultats indiquent que les personnes avec TLC ont des atteintes de la mémoire de travail et des fonctions exécutives mais que celles-ci sont plus circonscrites et généralement moins sévères que celles observées chez les patients DTA. Ces atteintes concernent principalement les capacités d’attention divisée (procédure adaptée de Brown-Peterson) et les capacités d’alternance. Les résultats de cette étude indiquent que ces deux tâches pourraient être utiles pour identifier les personnes qui sont à un stade pré-clinique de la DTA.

101

STRUCTURAL CHANGES IN ENTORHINAL CORTEX IN MILD COGNITIVE IMPAIRMENT AND ALZHEIMER'S DISEASE: AN MRI STUDY

Noor Kabani, et al., Bloomfield Centre for Research on Aging, 3755, Côte Ste-Catherine Road, Montreal, QC H3T 1E2 (noor@bic.mni.mcgill.ca), Tel: (514) 340-8260, Fax: (514) 340-7502

There is a lack of consistent association between brain volume and cognitive decline in early Alzheimers disease (AD) and mild cognitive impairment (MCI). Consequently, volumetric measure (VM) of entorhinal cortex (ER) is not a reliable predictor for the progression of AD. The aim of this study was to identify a structural imaging marker for early diagnosis of dementia. Isotropic 1mm T1-weighted and 1.5mm MT images were acquired to compare VM and magnetization transfer ratio (MTR) in 20 normal elderly (NE), 24 AD and 35 MCI subjects. Mean MTR/VM within the ER were calculated, following manual segmentation. Since collateral sulcus (CS) has a profound effect on ER-VM, the variation in CS was taken into account by calculating a ratio of the ER-VM and corresponding CS-VM. The results are described as corrected volume (CV) and mean MTR. The main finding was that both MCI (31.6+2.6**) and AD (31.6+2.4**) subjects exhibited significantly low (**p<0.01) MTR when compared to NE (34.1+2.4) while there were no significant differences in CV between NE (7.9+2.7), MCI (6.9+2.7) and AD (7.0+2.6). In conclusion, changes in MTR seen in absence of CV differences suggest that MTR may be a more reliable measure of sub-clinical changes in the entorhinal cortex.

102

DEMENTIA OF THE ALZHEIMER TYPE: VISION PRIOR TO COGNITION

Hélène Kergoat, Marie-Jeanne Kergoat, Lisette Justino, John V. Lovasik, Alain Robillard, Howard Chertkow, Howard Bergman, École d'optométrie, Université de Montréal, Centre de recherche, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen-Mary, Montreal, QC H3W 1W5 (helene.kergoat@umontreal.ca), Tel: (514) 340-3540, Fax: (514) 340-3548

Goal: Dementia of the Alzheimer Type (DAT) affects many aspects of cognition and possibly other neurological functions. Vision is the main sensory pathway through which many neuropsychological tests are applied to patients suspected of DAT. In this study, we investigated in vivo the primary visual pathways in DAT, on the basis of histology reports indicating cellular loss in the primary visual cortex, the optic nerve and the retina in individuals affected by DAT.

Methods: Thirty subjects with DAT (72.0 yrs ± 1.3) and 30 healthy seniors (72.1 yrs ± 1.3) participated in this study. Visually evoked potentials and retinal imaging were used to investigate the primary visual pathways objectively, from the retina up to the primary visual cortex.

Results: Our data indicated that the retina and the optic nerve head were spared by the disease process (p> 0.05); however the maculo-cortical pathways showed a delay in neural maculo-cortical transmission (p< 0.0164).

Conclusion: The results of our assessment of the intra-ocular anatomy and neural responsivity indicate that the retina and optic nerve head of individuals in the early to moderate stages of DAT are not affected. However, at the neuro-functional level, DAT is accompanied by a delay in neural transmission from the central retina to the primary visual cortex. This delay may be the result of the cholinergic deficiencies known to occur in the disease.

103

DEVELOPMENTS IN CAREGIVER EDUCATION

Sylvia Davidson, Patricia Hatton, Toronto Rehabilitation Institute, University Centre - Room 333, 550 University Avenue, Toronto, ON M5G 2A2 (Davidson.Sylvia@torontorehab.on.ca), Tel: (416) 597-3422 x3709, Fax: (416) 597-6542

As the population ages, we are faced with a startling increase in the number of individuals who will be affected by dementia and other mental health problems in their later years. Caregivers in institutions and the community must have increased understanding of such illnesses, in order to manage behaviour, provide quality care and enhance functioning in elderly individuals for as long as possible.

The Psychogeriatric Resource Consultation Program in Toronto has been given the mandate to promote and provide such education for caregivers in institutions and community agencies. A review of the literature supports ongoing staff education as a key element to improving quality of care. However, how to structure such education has not been clearly defined.

This paper will outline one approach to the provision of caregiver education. The process of reaching out to caregivers and assessing their learning needs will be described. Both qualitative and quantitative information has been gathered from surveys distributed to caregivers. How this information is being used to structure education sessions will be described, along with novel approaches to education in the institutional setting and how individualizing the knowledge transfer is achieved. Implications for further research and evaluation of the program will be addressed.

104

A STUDY TO IDENTIFY AGING-RELATED HEALTH INFORMATION NEEDS OF ELDERLY PERSONS, THEIR CAREGIVERS AND HEALTH CARE PROFESSIONALS

Krystyna Kouri, Gilbert Leclerc, Research Center in Gerontolog and Geriatrics, 375 Argyll Street, Sherbrooke, QC J1J 3H5 (kkouri.iugs@ssss.gouv.qc.ca), Tel: (819) 821-1170 ext. 3331, Fax: (819) 821-5202

Self-care has been identified as one of the pillars of health care and health care reform in Canada (Health Canada 1997, 1998). One of five key strategies identified as being supportive of self-care is related to the role of health professionals providing information to, and educating care recipients. In conjunction with this role, it is submitted that tools such as print materials, audio-visual aids and computer-based resources are useful adjuncts to facilitating self-care knowledge acquisition. At the Sherbrooke Geriatric University Institute, the infrastructure for a comprehensive community library with a focus on aging is presently under development. With the goal of further developing this “self-care and caregiving” oriented information and education centre within a scientific (andragogical / geragogical) framework, a study was conducted to identify aging-related health information needs of older individuals, their caregivers and health care professionals. In addition, the preferred modes of information acquisition of these groups were identified. The results of this research project are presented within the context of todays Information Age of health care.

105

USING SIMULATED RESIDENTS TO TEACH STAFF TO MANAGE DISPLAYS OF ANGER IN DEMENTIA

Lori Schindel Martin, Patricia Morden, Jacqueline Roberts, Gertrude Cetinski, Shalom Village Nursing Home, 60 Macklin Street North, Hamilton, ON L8S 3S1 (lori@shalomvillage.on.ca), Tel: (905) 529-1613 ext 228, Fax: (905) 529-7542

This paper will describe the results of a research study implemented to evaluate the effectiveness of a certification program designed to provide staff with the knowledge, skill, and confidence to respond to physical agitation experienced by residents with cognitive impairment living in long term care. A randomized controlled trial using a pre-test, post-test design was conducted using consenting staff members (n=40) who were randomly allocated to either attend the certification program or to be placed on the wait list to receive training later. The main outcome measure of the study was a skills lab that provided participants with the opportunity to interact with "actors" simulated to display overt behaviors. Both control and experimental groups participated in the skills lab prior to training, and again six weeks after the experimental group completed the certification program. Twenty-eight staff members completed both pre and post-training assessment measurements. Descriptive statistics and paired t-test analyses yielded statistically significant differences in change scores for perofmrance indicators in each of the three simulation scenarios. The results suggest that an initiative to educate staff will enhance knowledge, performance, and the confidence necessary for staff to respond positively to aggressive behaviour in cognitively impaired elders.

106

LIVE AND LEARN A NEW WAY

Kate Kincaid, Sir Sandford Fleming College, The Institute for Healthy Aging & Nursing, 599 Brealey Dr., Peterborough, ON K9J 7B1 (kkincaid@flemingc.on.ca), Tel: (705) 749-5529, Fax: (705) 749-5540

Sir Sandford Fleming College in Peterborough, Ontario, has developed an innovative and dynamic vision of care and education. A partnership with Marycrest Home and Anson House has led to the unique design of a model longterm care facility on campus. This facility will house the College's innovative academic centre, the Institute for Healthy Aging and will be committed to the highest standards of care.

Two hundred residents will experience an enhanced quality of living in an environment that supports their needs. They will share their wisdom with students, staff and volunteers in a vibrant intergenerational community while enjoying meaningful and challenging activities.

A professional environment of discovery and learning is envisioned, attracting staff, researchers, teachers and students. The Institute for Healthy Aging will co-ordinate learning and applied research opportunities, develop new College curriculum, promote healthy aging in the College and community, pilot new technology initiatives with its partners, and provide development and educational opportunities for professionals. The Canadian Foundation for Innovation (CFI) and Ontario Innovation Trust (OIT) support the Applied Technologies for Healthy Aging Research (ATHAR) labs in the College's new technology wing. The ATHAR simulation labs are networked to the smart-wired longterm care facility to provide alpha-beta testing sites.

107

HEALTH CARE REFORM: IMPLICATIONS FOR EQUITABLE ACCESS TO HOME CARE SERVICES

Margaret Penning, Diane Allan, Bernard Paill, Centre on Aging, Sedgewick Bldg., Rm. A104, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8W 2Y2 (mpenning@uvic.ca), Tel: (250) 721-6573, Fax: (250) 721-6499

Health care reform is a central issue on the domestic policy agenda. There is considerable concern within the social science, health service, and policy literature regarding the implications of these trends, particularly with regard to ensuring equitable access to home care and other services. However, empirical evidence is lacking. To address this gap, this paper examines trends in the utilization of home care services by age, gender, income and region of residence during a period of health reform (1990-1999) in the province of British Columbia. Using administrative health claims data documenting the utilization of home care services, multivariate regression analyses reveal similarities as well as differences in the trends evident for different groups. The implications of the findings for attempts to ensure equitable access to care through health reform will be discussed.

108

ACCESSING HOME SUPPORT SERVICES IN BRITISH COLUMBIA: GENDER AND INCOME MATTER

Karen Kusch, Department of Sociology, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC V8W 2Y2 (kkusch@uvic.ca), Tel: (250) 721-5791

Recent years have seen increased attention to home support and other home care services as affordable and preferable alternatives to long-term institutional care. Despite evidence that seniors identify instrumental assistance as integral to independence and quality of life, formal services are often limited to providing personal and medical care, leaving instrumental tasks out of the realm of publicly funded services. There has also been a trend toward streamlining and targeting programs to only the most 'needy', leaving many seniors ineligible for publicly funded care. While research evidence suggests that many seniors experience unmet personal and instrumental care needs as a result, little is known regarding the implications of these trends for those in different social groups. To address this issue, this study explores the links between gender, income, and access to home support services. Using data from the 1995 Victoria Patterns of Care project, the results of multinomial logistic regression analysis reveal significant gender and income differences in the probability of accessing both privately and publicly funded care. The theoretical and conceptual implications of the findings will be discussed and directions for future research proposed.

109

EVALUATING DAY CENTRE SERVICES: ISSUES AND INSIGHTS FOR ASSESSING SERVICE OUTCOMES

Mona Beck, Henri-Bradet Day Centre, 5425 Bessborough Avenue, Montreal, QC H3V 2S7 (mona.beck.chr@ssss.gouv.qc.ca), Tel: (514) 483-1380 x. 2003, Fax: (514) 483-4596

One major goal of the Day centre programs within Quebec is to maintain or improve the quality of life (QOL) of at-risk community residing older persons and their families. The context of service delivery and unique population needs however, pose challenges to Evaluation. This paper discusses the result of an Evaluation conducted at two local English speaking day centres in Montreal (N=49). Combining the use of three standardized instruments focused on depression, perceived physical and mental health and global quality of life, as well as focus groups with staff and participants this study provided insight into whether program objectives were being met. Results of the standardized instruments highlight the realities of physical decline and depression for the persons involved with day centre services. Yet, these findings reveal that despite physical decline, day centre participants' scores related to perceived mental health and overall quality of life stayed the same or improved after 6 months participation. This is reinforced through subjective focus group findings where participants discussed how the day centre provided them with learning opportunities, a sense of family, role or sense of contribution and helped them to combat social isolation and depression. Despite the expected high rate of attrition and challenges of Evaluation for this population, study results provide insight into areas which may be targeted in further Evaluations of day centre services.

110

A CLOSER LOOK AT THE FINANCIAL SECURITY OF OLDER CANADIANS

Catherine Larmer, Alexandre Genest, Division of Aging and Seniors, Health Canada Jeanne-Mance Building, 8th Floor, AL 19808A1, Ottawa, ON K1A 0K9 (Catherine_L_Larmer@hc-sc.gc.ca), Tel: (613) 952-8323, Fax: (613) 957-7627

An important indicator of the financial well-being of Canadians is their total net worth, defined as total assets minus debts. A recent study by Human Resources Development Canada examined the debts and assets of older Canadians. Drawing on custom tabulations from Statistics Canada's Survey of Financial Security (1999), our analysis looks at the debts, assets and total net worth of seniors and near-seniors on the basis of family status and socio-economic characteristics.

Findings indicate that most senior families had significant assets and little debt relative to non-senior families. The most significant non-financial asset among senior families was the principal residence, followed by assets in registered plans, (including RRSPs, RRIFs, and other registered plans). However, seniors are not a homogeneous group. Among unattached seniors, homeownership was perhaps the most significant determinant of net worth; those who were not homeowners had much lower net worth than those who were homeowners.

Near-senior families (55-64) had significant assets in owner-occupied housing and RRSPs. Just like unattached seniors, unattached near-seniors were less likely to have such assets. Further analysis is being conducted by Human Resources Development Canada to determine the importance of private pension assets among current and future seniors.

111

THE MENTAL HEALTH NEEDS OF URBAN AND RURAL OLDER BRITISH COLUMBIANS

Phyllis McGee, Centre on Aging, University of Victoria, Sedgewick Bldg. A, P.O. Box 1700, Victoria, BC V8W 2Y2 (pmcgee@uvic.ca), Tel: (250) 721-8987, Fax: (250) 721-6499

To explore the mental health needs of older British Columbians in various communities throughout the province, focus groups were conducted in four rural communities (populations 5,900 to 19,000) and two mid-size urban centres (75,000 to 80,000)to obtain information from stakeholders (e.g., physicians, nurses, social workers, administrators, caregivers, volunteers, seniors) about the range of mental health needs of older adults, how these needs are currently being met, innovative strategies being used to meet these needs, gaps in services and challenges being encountered. Discussions were audiotaped, transcribed and analyzed to identify recurring themes and compare rural and urban communities. Seniors living in rural and urban communities had similar mental health needs which clustered under six categories: physical, clinical, psychosocial, educational, spiritual and organizational. However, the availability of, and accessibility to, personnel, services and programs varied among communities, with some distinct similarities and differences between rural and urban communities. Furthermore, participants indicated that when addressing the mental health needs of older adults, the needs of care providers and caregivers must also be addressed.

112

A CLOSER LOOK AT THE FINANCIAL SECURITY OF OLDER CANADIANS

113

PATTERNS OF PSYCHOTROPIC DRUG USE IN OLDER ADULTS: RESULTS FROM THE CANADIAN STUDY OF HEALTH AND AGING

Judith Balfour, Gerontology Program, Simon Fraser University, Harbour Centre, Suite 2800, 515 West Hastings St., Vancouver, BC V6B 5K3 (jebalfou@sfu.ca), Tel: (604) 291- 5062, Fax: (604) 291-5066

Objective: To examine patterns psychotropic drugs use in older adults living in the community and in institutions using data from the clinical assessment component of Wave II of the Canadian Study of Health and Aging (CSHA-2) (n=2307).

Results: Bivariate analysis demonstrated that psychotropic use was higher among institutionalized elders than community dwellers, (46.6% vs. 20.8%, p<.001). This relationship was replicated in cognitively intact and impaired subjects (p<.001). The relationship held for all classes of psychotropic drugs examined; benzodiazepines, hypnotics and neuroleptics. This relationship held for all drug classes. The presence of aggression (47.0% vs. 26.3%, p<.001), agitation (42.3% vs. 26.5%, p<.001) and anger (25.5% vs. 38.2%, p<.001) were positively associated with taking psychotropic drugs. These relationships were replicated for cognitively intact and impaired subjects. Nevertheless, cognitive ability was demonstrated to be associated with the use of psychotropic drugs; cognitively impaired subjects were more likely to take psychotropic drugs than the cognitively intact, (34.1% vs. 19.7%, p<.001). This relationship held for all drug classes.

Conclusions: These results are consistent with current literature which indicates that psychotropic medications are frequently prescribed for older adults, especially those in institutions, to control behavioural symptoms. Further examination of the relationships among the covariates using multivariate analysis is warranted.

114

THE EXPERIENCES OF OLDER WOMEN RELOCATING TO SENIOR DESIGNATED APARTMENT BUILDINGS

Suzanne M. Dupuis-Blanchard, 217 Hector-Drolet Street, Dieppe, NB E1A 6W5 (dupuiss@umoncton.ca) Tel: (506) 858-4260, Fax: (506) 858-4017

Although relocation is not a new concept, few studies have described the experience of relocating to congregated housing for seniors. The objective of this qualitative grounded theory study were to discover older women's process of relocating to senior designated apartment buildings and to consider the implications of the study findings for gerontological knowledge, practice and research. The eleven older women interviewed identified the central problem as re-establishing self, the physical and psychosocial changes necessary to construct new, supportive and aesthetically pleasing living space while trying to maintain a sense of well-being. The basic social process that emerged is building a new nest, a non-linear process that includes the three phases of parting with a meaningful past, shaping a desired future and settling-in to an altered present. These phases are influenced by three environmental conditions: personal attributes, availability of informal support and feartures of the living environment. The results of this study provide direction to health care professionals in helping older women with relocation and other transitions. Funding for this study was provided by the Extendicare in Gerontology Scholarship awarded by the Canadian Nurses Foundation.

115

HEALING CIRCLE

Susan Bloom, Rabbi Michael Wolfe, Sondra Goldman,

5795 Caldwell Ave, Montreal, QC H4W 1W3 (susan.bloom@ssss.gouv.qc.ca), Tel: (514) 483-2121 ext. 302, Fax: (514) 483-1561

As professional nursing practice has evolved in long-term care over recent years, so to, has there been a growing awareness for the need for spiritual sustenance, self-reflection and healing for nurses and other health professionals caring for elderly residents. The healing circle is meant to be an arena for formalized rituals within a supportive group setting. The objective of the service is to help the members of the interdisciplinary team cope with the death of a resident, as well as addressing the issue of loss at large. Another positive element of this intervention, is the building of community within the interdisciplinary team. We rely on each other for support and for our energy. The service is of one hour in duration and is scheduled every three months. The participants are seated in a circle. Music is played as the staff enters the room. Symbols such as candles and/or water are placed in the centre of the circle. Rituals that are included in the service are reading of poems and prayers, singing, and reciting stories. Characteristic to the healing circle is the implementation of the "talking stick", a Native tradition used in tribal councils. The individual that holds the "talking stick", is the only person permitted to speak, and when finished he passes it to the person sitting next to him. Group members are not obliged to speak, but may "pass" the stick to the next person. Active listening to others is as important as speaking. The service concludes by instructing the participants to take a moment to reflect upon their experience, and to express it by either the drawing of a symbol, or the writing of a statement. The entire group then processes these feelings. This interactive workshop will provide health professionals with insight into their own feelings towards death. By attaining this self-understanding, we move closer in understanding someone else's fears and attitudes to death and suffering.

116

LE PLAN D'ACTION TRIENNAL: LE QUÉBEC ET SES AÎNÉS ENGAGÉS DANS L'ACTION

Jean-Louis Bazin, Rosita Harvey, Secrétariat aux aînés, 1122, chemin St-Louis, 2e étage, Sillery, QC G1S 4Z5 (jean-louis.bazin @mfe.gouv.qc.ca), Tel: (418) 691-2077

Dans la foulée de l'Année internationale des personnes âgées le gouvernement du Québec a décidé d'élaborer un plan d'action triennal en vue d'adapter les services publics au vieillissement de la population. À la suite de consultations tenues par le Bureau québécois de l'Année internationale des personnes âgées et des consultations tenues conjointement par le Conseil des aînés et le Secrétariat aux aînés, plusieurs comités interministériels thématiques ont été constitués afin d'identifier, autant que faire se peut, des mesures sectorielles et intersectorielles pour répondre aux besoins des aînés d'aujourd'hui et faire face à l'augmentation de la population âgée au cours des prochaines années. Ces mesures impliquant plus d'une trentaine de ministères et d'organismes gouvernementaux sont regroupées dans le document « Le Québec et ses aînés : engagés dans l'action - Engagements et perspectives 2001-2004 » rendu public le 28 septembre dernier par la ministre responsable des Aînés, madame Linda Goupil. Ces documents présentent les trois engagements gouvernementaux, les trois projets mobilisateurs impliquant plusieurs ministères et organismes ainsi que les quatre-vingts mesures sectorielles.

La présentation fera état des principales démarches réalisées en vue d'élaborer le plan d'action triennal. Seront aussi présentées les différentes mesures gouvernementales mises de l'avant dans ces engagements gouvernementaux.

117

DEVELOPMENT AND IMPLEMENTATION OF A RESEARCH-BASED PROTOCOL FOR FAMILY BEREAVEMENT SUPPORT FOLLOWING THE DEATH OF A NURSING HOME RESIDENT

Kathleen Davidson, Bethany Care Society, Palliative Care Advisor, 916-18A Street NW, Calgary , AB T2N 1C6 (davidsok@bethanycare.com), Tel: (403) 284-6048, Fax: (403) 284-6085

The survivors of nursing home residents are very unlikely to receive any formal bereavement support. Spouses of patients who died in hospice settings had significantly better grief resolution than did those whose spouses whose loved ones had died in nursing home settings. Bereavement care is an essential component of a hospice program but such care is not offered in most nursing homes.

Very little evidence exists to guide bereavement support for family members after the death of a nursing home resident. However, family bereavement support can be incorporated into the care plan of a dying nursing home resident with minimal cost and minimal disruption to staff duties and assignments. Furthermore, a research-based bereavement support protocol gives front-line staff confidence and direction to assist family members in a palliative situation when staff may be stressed and uncertain.

Based on the available evidence, a family bereavement support protocol was developed and implemented in four nursing homes. Seven key elements of the family bereavement support protocol have been implemented. Successful and consistent implementation of the research-based bereavement support protocol depends upon the recruitment, education, and commitment of front line workers, designated as Bereavement Leaders. To adequately prepare Bereavement Leaders, an education program was held to explain the elements and implementation of the bereavement support protocol. Process and outcome indicators are being monitored, and will be presented.

By May 2002, the Family Bereavement Support protocol will have been in place for one year. This workshop details the process of developing, implementing, and sustaining evidence-based bereavement support practices, and the outcomes for staff and bereaved family members of using the evidence-based bereavement support program.

118

ALBERTA: A VISION FOR THE FUTURE

Sandra Hirst, Peter Donahue, Carol Austin, Faculty of Nursing, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4 (shirst@ucalgary.ca) Tel: (403) 220-6270, Fax: (403) 284-4803

The Research Chair of the Alberta Association on Gerontology took the lead in an initiative designed to promote awareness of research needs and activities within this province. Funding was received from the provincial government and the University of Calgary to support an invitational summit entitled "The Future of Gerontological Education and Research in Alberta". The goals of the summit were to (1) articulate the visions, educational content, and delivery options for accessible and transferable gerontological education in Alberta, (2) identify the recruitment and retention issues for education and employment in order to make gerontology a viable career track, and (3) discuss the need for and benefits of gerontological research in this province. Informed representatives from different stakeholder groups (education, research, government, employers, seniors, and seniors' organizations) were invited to participate in a series of small group-facilitated discussions designed to identify the issues within each of the three goal topics and to generate related recommendations and strategies for action.

In this round table, the issues identified, priorities set, and recommendations for action from this summit are discussed from the perspectives of a gerontological educator, researcher, and practitioner.

119

FACING THE CHALLENGES OF AN AGING POPULATION: THE REALITY OF AGING COMMUNITIES AND THE EFFECTS ON SENIORS' SERVICES AND INDIVIDUALS

Patrice Karn, Maurice Gorman, 9 Hansen Ave., Kanata, ON K2K 2L9 (pakarn@uottawa.ca), Tel: (613) 591-5514, Fax: (613) 562-5147

Currently over one in ten people in Ottawa are seniors and this will rise to nearly one out of five in twenty years. However, some Ottawa neighbourhoods have already reached these demographic milestones and service providers and volunteer organizations are struggling to cope with current demands. These organizations are not in a position to cope with the practical realities of the demographics of aging: the sheer increase in demand; longer life spans on fixed incomes; seniors living alone without family support; and the complex needs of their very old clients. How do cities face these challenges in an era of downloaded responsibilities? With the major exceptions of hospital care and medical services, the services that most directly affect seniors' quality of life and ability to live in one's own home are the responsibility of municipal governments. Transportation services, street maintenance, policing, recreation, thoughtful planning of land use and development, low income housing, home support services, and some programs delivered by community support agencies, are examples of such services. The goal of this discussion session is to share strategies and ideas about how communities and individuals can cope with the realities and practical issues of demographic change. Questions to consider include: readiness for demographic change, status of existing services, alerting decision makers to potential problems, advocacy, identifying service gaps and communication between professionals and government bodies.

120

MULTICULTURALISM OR UNI-CULTURALISM IN RESIDENTIAL CARE?

Douglas Durst, Faculty of Social Work, University of Regina, Regina, SK S4S 0A2 (doug.durst@uregina.ca), Tel: (306) 585-4577, Fax: (306) 585-4872

Most citizens of Canada take great pride in its acceptance of newcomers and in 1988, the Canadian parliament unanimously passed the Canadian Multiculturalism Act to preserve and enhance the multicultural heritage of Canadians while working to achieve the equality of all Canadians in the economic, social, cultural and political life of Canada. Canada is only country in the world to have a national act promoting and supporting the diverse cultural and heritage background of its citizens. How this noble goal reaches the aging population of immigrants is an interesting question.

This paper will present preliminary findings of a 2-year study on multicultural issues in senior care for immigrant seniors in Regina, an urban prairie city. Multicultural concerns manifest themselves differently in the prairie regions than large diverse cities such as Vancouver or Toronto and little is known about these issues. The findings will provide a snapshot of the role multiculturalism plays or does not play in both larger and smaller personal care homes in an urban prairie city. It will give an idea of the diversity of the staff and care providers and provide direction for improved services and programs that are more culturally sensitive.

121

THE PATIENT RESTRAINTS MINIMIZATION ACT OF ONTARIO: IMPACT ON CLINICAL OUTCOMES IN GERIATRIC REHABILITATION PATIENTS (PART ONE)

Frank Knoefel, Kathleen Holdway, Susan Pisterman,

Anne Leclerc, c/o University of Ottawa Institute on Health of the Elderly, 43 Bruyere St., Ottawa, ON K1N 5C8 (Kholdway@scohs.on.ca), Tel: (613) 562-0050 ext.1350, Fax: (613) 562-4266

This is a two part presentation (part one). The main objective of the new "Patient Restraints Minimization Act" (Government of Ontario's E-Laws, 2001) is "to minimize the use of restraints on patients and to encourage hospitals and facilities to use alternative methods, . . .". In response to this legislation, new restraint policies (including restricting the use of bedrails) were implemented at SCO Health Service, one of North America's largest continuing care organization. As bedrails are frequently used on the Geriatric Rehabilitation Unit of the SCO Health Service, and because limited research on bedrails has been conducted with rehabilitation populations, we evaluated the clinical outcome of the new policy. A quasi-experimental design (n=60) was selected to examine the impact of bedrail reduction on patients' length of stay, functional status (FIM), risk for falls, bed-related falls and injuries. Participants assigned to the experimental group had bedrails lowered (new practice), while participants in the control group had bedrails raised (old practice). Comparisons between these two groups were conducted across the five outcome measures outlined above. To date 40 patients have been enrolled in the study. The results will address the implications for clinical practice and directions for future research.

122

THE PATIENT RESTRAINTS MINIMIZATION ACT OF ONTARIO: IMPACT ON CLINICAL OUTCOMES IN GERIATRIC REHABILITATION PATIENTS (PART TWO)

Jane Sohmer, Anne Leclerc, Kathleen Holdway, Louise Patrick, c/o University of Ottawa Institute on Health of the Elderly, 43 Bruyere St, Ottawa, ON K1N 5C8 (kholdway@scohs.on.ca), Tel: (613) 562-0050 ext 1350, Fax: (613) 562-4266

This is a two part presentation (part two). The main objective of the new "Patient Restraints Minimization Act" (Government of Ontario's E-Laws, 2001) is "to minimize the use of restraints on patients and to encourage hospitals and facilities to use alternative methods, . . .". In response to this legislation, new restraint policies (including restricting the use of bedrails) were implemented at SCO Health Service, one of North America's largest continuing care organization. As bedrails are frequently used on the Geriatric Rehabilitation Unit of the SCO Health Service, and because there is limited research on patients' perceptions of bedrails, a qualitative investigation (n=60) was conducted to examine patient's perception of bedrail use. Participants assigned to the group one had bedrails lowered (new practice), while participants in group two had bedrails raised (old practice). To date 40 patients have been enrolled in this study. The results will address the implications for clinical practice and directions for future research.

123

FUTURE PLANNING FOR CARE NEEDS OF ADULT OFFSPRING WITH DISABILITIES

Marlene MacLellan, Deborah Norris, Linda Bird, Ethel Langille Ingram, Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS B3M 2J6 (marlene.maclellan@msvu.ca), Tel: (902) 457-6546, Fax: (902) 457-6508

When contemplating the future care of adult offspring with lifelong disabilities, older caregiving parents frequently face a contradiction between their recognition of the importance of having plans in place and their ability to take action on the development of such plans. A qualitative study in the Atlantic provinces, through 56 in-depth interviews with older parents (>65) caring for an adult son/daughter, revealed that barriers to future planning were both systemic and personal. While seen as important, none of the parents had a comprehensive formal plan in place involving all four domains of care (residential, financial, legal and social). Degree of preparedness varied considerably, from formal strategies to relying on faith. Efforts to plan were often thwarted by systemic limitations of program eligibility, accessibility and availability. From the personal perspective, a strong theme emerged that what parents wanted had more to do with quality of life than with the tangible elements of care provision. The paradox is that while parents feel it is their role to plan, the viability and execution of a comprehensive plan necessitates broader system involvement, an element often missing in the planning process. A focused approach to working with families (rather than crisis intervention) in development of future plans is essential in response to changing family needs.

124

COMPARING ELDERCARE PRACTICES IN HOME CARE AND LONG-TERM CARE FACILITIES: STRENGTHENING PROFESSIONAL-FAMILY RELATIONS IN THE FUTURE

Catherine Ward-Griffin, Nancy Bol, Kim Hay, Ian Dashnay, The University of Western Ontario, School of Nursing, Health Sciences Addition, London, ON, N6A 5C1 (cwg@uwo.ca) Tel: (519) 661-2111 ext 86584, Fax: (519) 661-3928

125

THE PLACE OF CAREGIVERS IN SINGLE ENTRY ASSESSMENT TOOLS

Nancy Guberman, Janice Keefe, John Hirdes, Carole Naud, Pamela Fancey, École de Travail Social, UQAM, C.P. 8888 Succ. Centreville, Montréal, QC H3C 3P8 (guberman.nancy@uqam.ca), Tel: (514) 987-3000 ext 4520, Fax: (514) 987-8795

The Place of Caregivers in Single Entry Assessment Tools

Nancy Guberman, (University of Quebec at Montreal & CLSC René-Cassin), John Hirdies (University of Waterloo & Homewood Research Institute), Janice Keefe, (Mount Saint Vincent University), Pamela Fancey (Mount Saint Vincent University), Carole Naud (Ministère de la santé et des services sociaux du Québec). Daphne Nahmiash, & Lucy Barylak, (CLSC René Cassin).

Most, if not all, provinces in Canada are in the process or have implemented single-entry assessment tools for frail elderly living in the community. These tools are specifically aimed at evaluating the level of functional autonomy of the elderly and the extent of their informal support, to determine their home care or placement needs. Although, there is some room in these Evaluations to note aspects of the persons social environment, there is often little consideration for the situation of family members or others who are providing the “informal care”. And when assessors do note caregivers situations, they are most often not able to go beyond a summary analysis of caregiver burden. At present, within provincial home care systems, there is a lack of systematic and validated Evaluation tools that enable practitioners to record the context of caregiving situations and identify caregivers' specific service needs. This symposium will address the need to include caregiver issues in home care assessments and the challenges of articulating a caregiver assessment tool with the major assessment tools of the care receiver, the MDS-Home Care and the “Outil d’évaluation multiclientèle”. In particular, it will present a recently developed and validated tool (Guberman et al.) and will examine the benefits and limitations of combining a separate and comprehensive caregiver assessment tool, such as this, with existing tools.

Le développement d’un outil provincial pour évaluer des besoins des personnes ayant des incapacités: la place des proches Carole Naud (Ministère de la santé et des services sociaux du Québec)

Au moment où une grande majorité des personnes ayant des incapacités sont maintenues dans la communauté, il importe de consolider et uniformiser un outil d’évaluation de leur situation permettant de répondre de façon efficace et pertinente à leurs besoins. Un élément clé dans la vie de la majorité de ces personnes est la présence de proches qui offrent une quantité importante d’aide et de soutien. Les recherches ayant démontré que ce travail de soutien peut avoir des conséquences néfastes sur les proches, il devient essentiel d’intégrer une évaluation spécifique de leur situation à la grille d’évaluation de la personne en besoin. Le Québec travaille à la mise en place d’une grille d’évaluation unique pour tous ses programmes des services intégrés pour les personnes âgées en perte d’autonomie et les personnes présentant un profil gériatrique. La grille retenue est l’Outil d’Évaluation Multiclientèle qui est le tronc commun auquel des outils d’évaluation complémentaires se grefferont . C’est dans ce contexte que le Comité scientifique ayant pour mandat de faire évoluer l’Outil, examine les modalités de l’intégration d’un outil complémentaire pouvant évaluer la situation et les besoins des proches. Les modalités proposées par le Comité aviseur sur l’adoption d’un outil prévoient des marqueurs dans l’Outil d’Évaluation Multiclientèle qui ouviront au besoin sur des outils complémentaires ciblés. Nous présenterons nos réflexions à ce sujet .

Assessing caregiving arrangements using the MDS-Home Care John Hirdies (University of Waterloo & Homewood Research Institute)

The MDS-Home Care (MDS-HC) is a comprehensive assessment instrument designed to assess the strengths, preferences and needs of the frail elderly and persons with disabilities. The assessment covers a broad range of social, psychological, environmental and medical factors that can influence the clients ability to function independently. This instrument is being implemented in four Canadian provinces and one territory, and is now used in home care by one-fifth of US states. Included in the MDS-Home Care are a series of items dealing with caregiving arrangements including the caregiver’s relationship with the client, living arrangements, type and amount of support provided, capacity to increase support and signs of caregiver strain. This paper will examine MDS-HC data for about 13,000 home care clients from Ontario, Nova Scotia and Manitoba to illustrate the use of the instrument to assess the needs of clients and their caregivers. In particular, the relationship between signs of caregiver strain, client characteristics, access to services and eligibility systems will be discussed. Advantages and limits of assessing caregivers through the MDS-HC will be examined.

Caregiver Assessment: Justifying Caregivers Role and Needs Janice Keefe, PhD and Pamela Fancey MA (Mount Saint Vincent University), Nancy Guberman, (University of Quebec at Montreal) Daphne Nahmiash, & Lucy Barylak, (CLSC René Cassin).

A Caregiver Assessment Tool was developed to evaluate the specific needs of family caregivers as partners in the formal care system. Caregivers and home care assessors were involved in the development, testing and Evaluation of the Tool (40 assessors and 168 caregivers across seven research sites in Nova Scotia and Quebec). Caregivers were interviewed twice by a different assessor within seven working days. Assessors synopsis data were analyzed to determine the inter-rater reliability for 15 assessment areas and 18 key areas of concern, as well as assessors consistency between the assessment areas and key areas of concern.

Statistical tests indicate significant relationships for12 of 15 assessment areas, and agreement on key areas of concerns ranged from 65% to 99% with several Kappa reaching the moderate level. Statistically significant relationships exist between assessors ratings of difficulty and the identified service areas. Further, comments from assessors and caregivers support the comprehensiveness and validity of the Tool. Results suggest the Caregiver Assessment Tool is a valid and reliable instrument to understand caregivers needs, from which substantiated service plans may be developed. This work confirms that addressing caregivers needs accurately and reliably is important in the development of quality home and community care. This research was funded by Health Canada.

Benefits and limitations of a comprehensive specific caregiver assessment

Nancy Guberman, (University of Quebec at Montreal), Janice Keefe, PhD and Pamela Fancey MA (Mount Saint Vincent University) Daphne Nahmiash, & Lucy Barylak, (CLSC Rene Cassin).

Some authors feel that standardized assessments must be part of a comprehensive assessment and not the only method of assessment (Dewing & Pritchard, 2000; Ford & McCormack, 1999). Ford & McCormack (2000) go further in advancing that the adoption of standardized tools contradicts an espoused client-centered orientation, as they do not take into account the individuality of the person, their subjective views with regard to their needs, cultural diversity, values and beliefs and do not permit flexible and individualized responses. They propose a standardized approach to assessment that invites assessors to look at specified domains but leaves flexibility as to the order and thoroughness of assessment of each domain. The Caregiver Assessment Tool attempts to respond to the criticisms raised by Ford & McCormack. The tool covers ten areas which the literature, key informants, caregivers and practitioners identify as crucial for caregivers. Questions are formulated so as to elicit responses from the caregivers perspective and to allow them the possibility to explain under-lying rationales for difficulties or needs. Because this type of assessment opens the door to a subjective appreciation of the situation which may be influenced by the immediate environmental context, it is suggested that it be an on-going process over a period of two or three contacts. How does such a tool fit into the current care recipient assessment models? How does one move from assessing the frail persons needs to assessing the caregivers situation? Which caregivers should be assessed? This presentation will attempt to respond to these questions.

126

INTERVENTION DE RÉSOLUTION DE PROBLÈME FACE À L'AGRESSIVITÉ DE PERSONNES SOIGNÉES EN HÉBERGEMENT ET SOINS DE LONGUE DURÉE

Francine Lincourt Éthier, André Duquette, Cécile Michaud, Centre d’Acceuil Dante / Santa Cabrini, 6887 Chatelain, Montréal, Qc H1T 3X7 (frlincourt@hotmail.com) Tel: (514) 252-1535 poste 5105, Fax: (514) 252-6465

Cette recherche qualitative évalue comment un programme de formation sur la stratégie adaptative de résolution de problème a influencé trois infirmières travaillant en hébergement et soins de longue durée, dans la gestion du comportement agressif de la personne soignée et des réactions de stress associées.

Les résultats obtenus indiquent que les participantes identifient la grille d’observation des comportements d’agressivité, l’application à une situation d’agressivité vécue, les exercices écrits et les échanges comme étant les éléments éducatifs les plus aidants. Les principaux apprentissages s’articulent au développement d’une nouvelle façon de faire entraînant ainsi une vision réaliste des situations où les émotions sont prépondérantes. Les infirmières prennent conscience de l’impact de l’agressivité sur elles-mêmes teintant ainsi l’aspect réel du comportement agressif, filtrant leur compréhension et limitant leurs possibilités d’intervention. L’apprentissage de la stratégie adaptative de résolution de problème influence les infirmières dans la gestion de leurs réactions de stress par la conscientisation et la régularisation des émotions suscitées favorisant ainsi une réponse cognitive éclairée et un comportement approprié dans le choix d’une solution efficiente.

127

UNE TERRASSE EXTÉRIEURE UTILISÉE PAR DES RÉSIDENTS PRÉSENTANT DES COMPORTEMENTS PERTURBATEURS: IMPACTS ET RETOMBÉES

Francine Lincourt Éthier, Françoise Hamlat, Centre d’Acceuil Dante / Santa Cabrini, 6887 Chatelain, Montréal, Qc H1T 3X7 (frlincourt@hotmail.com) Tel: (514) 252-1535 poste 5105, Fax: (514) 252-6465

Par cet exposé, nous voulons partager l’expérience clinique de l’utilisation d’une terrasse extérieure par dix (10) résidents présentant des déficits cognitifs et des comportements perturbateurs. L’aménagement d’une nouvelle terrasse au pavillon Alfred-DesRochers de l’Institut universitaire de gériatrie de Montréal a été l’élément déclencheur du projet. Notre objectif était d’assurer une accessibilité régulière à l’extérieur de l’unité de soins à une clientèle non rejointe par des activités habituellement offertes. Plus spécifiquement nous voulions évaluer l’impact d’un environnement extérieur agréable et sécurisant sur les comportements perturbateurs, d’abord dans un contexte adapté et ensuite dans un contexte intégré. Nous présenterons les grilles d’observation utilisées sur l’unité de soins et sur la terrasse durant l’activité. Nous soulignerons les impacts de ce projet, tout en élaborant davantage sur l’activité la plus significative pour ces résidents : le patio-berçant. Finalement, nous décriront les retombées à court, moyen et long terme de cette réalisation qui s’est méritée le prix : "Une pensée bien semée" de la Société Alzheimer de Montréal.

128

RELATIONSHIPS BETWEEN CAREPROVIDERS AND RESIDENTS WITH DEMENTIA: CAN THEY BE MEASURED?

Katherine McGilton, David Streiner, 3550 Bathurst St, Toronto, ON M6A 2E1 (kathy.mcgilton@utoronto.ca), Tel: (416) 785-2500 ext 3011, Fax: (416) 785-4230

Quality of life for persons in long-term care facilities has been linked to their relationships with their careproviders (Bowers, Esmond & Jacobson, 2000). If this relationship can be defined and measured there is a possibility that this domain may serve as an indicator of quality of life. The major objective of this study was to test if the Careprovider-Resident Relationship self-report scale (CR scale) and the Careprovider Interactional Behavioral scale (CIBS) which are based on the constructs of reliability and empathy of the careprovider, demonstrate convergent validity. If this hypothesis holds true, there will be initial evidence that the observational tool is sufficient to capture the quality of relational care provided to residents with dementia with late stage dementia who cannot be interviewed. 76 care providers and 76 residents living in long-term care facilities were asked to participate. Residents were asked to rate the careproviders relational care and the careproviders interactional behaviors were assessed by a research assistant. Preliminary analysis of 24 dyads indicate that there is initial evidence of construct validity between the two scales (r = .60, p=.002). The potential implication of this finding is it will be possible to evaluate effective staff-resident relationships, even for persons with dementia.

129

USING KITWOOD'S (1997) MODEL TO ACCORD PERSONHOOD IN THE CONTEXT OF DEMENTIA: ILLUSTRATIVE CASE STUDIES OF BEST PRACTICES

Carol-Lynne Le Navenec, Otto von Mering, University of Calgary, Nursing, PF 2260, 2500 University Drive N.W., Calgary, AB T2N 1N4 (cllenave@ucalgary.ca), Tel: (403) 220-6269, Fax: (403) 284-4803

According to the late Dr. Tom Kitwood (1992), personhood refers to "a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being" (pp. 7-8). He maintains that the according of personhood for people with dementia implies more than recognition, respect, and trust. The purpose of this presentation is to provide illustrative examples from the literature of best practices that nurses and related health professionals could use to address the "five great needs which overlap, and come together in the central need for love: comfort, attachment, inclusion, occupation and identity: (pp. 81-84).

Kitwood, T. (1997). Dementia reconsidered. The person comes first. Buckingham, U.K: Open University Press.

130

AN URBAN COMMUNITY BASED GERIATRIC SERVICE

Douglas Duke, Teresa Genge, Angela Mayowski, Northeast Community Health Centre 14007-50th St., Edmonton, AB, T5A 5E4 (tgenge@cha.ab.ca) Tel: (780) 472-5036, Fax: (780) 472-5187

The Seniors's Health Clinic at the NECHC in Edmonton opened in September 2000, and was established to develop an outreach model to provide frail seniors, in an under serviced community, access to a specialized geriatric team. Linkage to appropriate health care services, and a component of ongoing management are seen as essential elements. The main challenge was making the "pertinent parts" of the health care system (home care, family physicians, emergency) aware of our program and then establishing a working rapport with them.

Data was collected including, age, gender, functional and cognitve abilities, and medcial conditions-providing health profiles of seniors accessing the clinic. Utilization data was collected reviewing referral source, reason for referral, and discharge disposition.Outcome measures included specific clinical indicators and quality of life measurements. The general population being served were of a low socioeconomic group, high users of emergency and inpatient admissions, and home care services.

The open referral system, home visit element, and geriatric management component are relatively unique to the Edmonton area and warrant consideration for further development. Our presentation will discuss strategies and interventions utilized to advance our program.

131

TRAINED GERIATRIC CLINICIANS AS GERIATRICIAN EXTENDERS

A. Elizabeth Watson, Brent Winstone, Natalie Kristjanson, Nina Labun, Donna Toews, Department of Geriatric Medicine, Seven Oaks General Hospital, 2300 McPhilips St., Winnipeg, MB R2V 3M3 (elizw@sogh.winnipeg.mb.ca), Tel: (204) 632-3117, Fax: (204) 697-2065)

Physicians specializing in the health care of the elderly are few and the demands on their time are great. In many instances, their assesments and recommendations for the non-medical issues can be done by trained geriatric clinicians leaving the geriatrician to focus on the specific diagnosing and medical management of the problems of the frail elderly. This paper looks at the improved utilization of a Geriatric Medicine Out-Patient Clinic in a Community Hospital setting after the introduction of a team of Geriatric Clinicians. We will review the training of the clinicians as well as the roles they play in the assesment of the frail elderly in the clinic setting. Trained clinicians can act as geriatrician extenders and provide a method of improved utilization of a scarce resource.

132

QUAND DYSPHAGIE RIME AVEC ÉQUIPE

Nathalie Blouin, Francine Bélisle, Louise St-Denis, Marie-France Jobin, Isabelle Ménard, Louise Francoeur, Institut universitaire de gériatrie de Montréal, 4565 Chemin Queen-Mary, Montréal, QC H3W 1W5 (medgen.iugm@sympatico.ca), Tel: (514) 340-2800 poste 3514, Fax: (514) 340-2832

L'équipe spécialisée interdisciplinaire en dysphagie (ÉSID), créée 1997, fonctionne en interdisciplinarité avec la conviction que l'apport de chacune des disciplines est essentiel à la prise en charge optimale d'une personne dysphagique. Cette équipe voit à l'encadrement des activités cliniques et administratives, au développement, à l'enseignement et à la recherche en matière de dysphagie.

L'équipe est constituée d'un médecin, d'un nutritionniste, d'un ergothérapeute, d'un orthophoniste, d'un inhalothérapeute et d'une infirmière. D'autres professionnels s'y greffent au besoin.

Depuis ses débuts, l'équipe est consultante pour les intervenants de première ligne des programmes de réadaptation fonctionnelle intensive, d'évaluation de courte durée gériatrique, de l'hôpital de jour et des soins de longue durée. Aussi, la clinique externe de dysphagie offre des services d'évaluation, de prise en charge et de suivi pour la population âgée, sur le plan local, régional et suprarégional. De plus, les membres de l'équipe contribuent au développement d'instruments, de protocoles et d'équipements pour l'évaluation clinique et vidéofluoroscopique.

L'équipe assure la diffusion de l'expertise par de l'enseignement à l'interne et à l'externe, des présentations et l'organisation de symposiums. Plusieurs publications, y compris une production audio-visuelle, ont été élaborées par des membres de l'équipe.

Cet exposé présentera le travail de l'équipe, son fonctionnement et ses réalisations.

133

EXPLORATION OF CORRELATES FROM THE PREVALENCE STUDY OF GAMBLING AND PROBLEM GAMBLING AMONG OLDER ADULTS IN MANITOBA

Debra Kostyk, Jamie Wiebe, Rona Maynard, Addictions Foundation of Manitoba, 1031 Portage Avenue, Winnipeg, MB R3G 0R8 (dkostyk@afm.mb.ca), Tel: (204) 944-6250, Fax: (204) 774-8091

Over the last ten years, Manitobans have experienced a large increase in gambling opportunities. Older adults face unique factors that may place them at greater risk of developing gambling problems such as loneliness, fixed incomes and post-retirement inactivity (Fessler, 1996). This paper will look at relationships between the categories of gambling, as measured by the South Oaks Gambling Screen Revised, and demographics, general well being and the use of substances. Methodology: A telephone survey collected data from 1,000 people 60 years of age and older. Households were randomly selected from a listed sample. Controls were in place to ensure representation by region, gender and age. Results: Males were more likely than females to have gambling problems. Age was not related to whether or not a person was involved in problem gambling. There were no significant differences between gambling categories related to education, income or region. Problem gamblers were more likely than non-problem gamblers to report feelings of anxiety and depression. Older adults, regardless of gambling level, had access to a family member or friend who they can talk to about problems. Those who were gambling at problematic levels were more likely than non-problem gamblers to consume five or more alcoholic drinks on one occasion and to use tobacco products.

134

EQUITY AND OUTLIERS: THE EFFECTS OF AGE ON RESOURCE UTILISATION

Jacqueline McClaran, MUHC, Dept Discharge Planning,

1650 Cedar Ave D16-173, Montreal, QC H3G1A4 (jacqueline.mcclaran@muhc.mcgill.ca), Tel: (514) 937-6011, 4-3960, Fax: (514) 934-8406

Patients who exceed 29 days of hospitalization are considered outliers in terms of DRG and 3rd party payor analysis. This is true across health care systems in Canada, the US, UK, Hong Kong, and other countries. Perceptions in university hospitals and critical care centers often includes the notion that elderly people take up more than their "fair share" of tertiary care. This paper compares data across systems and demonstrates that this notion is false, especially concerning outliers (long hospital stays). A decade of daily hospital census data plus prospective clinical indicators of function, discharge destination, and discharge location show that in a local 500 bed hospital, older individuals are more likely to be served by care maps and critical pathways leading to discharge, than are younger outliers, at day 30.(beddays analysed = 1.45mill). Further, onsite hospital census data (2001-2002) comparisons suggest that the McGill University Health Centre, the Hermann Hospital trauma center in Houston,Texas,Oxford university hospitals, and Hong Kong critical care centres have similar profiles, when outliers are treated as a proportion of in-patients. Health care system managers and care map drivers must take appropriate quality indicators and utilization costs into account, in service allocation.

135

STUDY OF DEMENTIA CARE NETWORKS IN ONTARIO

Larry Chambers, Louise Lemieux-Charles, Kevin Brazil, Susan Jaglal, Rhonda Cockerill, University of Ottawa Institute on Health of the Elderly, SCO Health Service, 43 Bruyere Street, Ottawa, ON K1N 5C8 (lchamber@scohs.on.ca), Tel: (613) 562-6036, Fax: (613) 562-4266

Four communities with dementia networks were studied using key informants, focus groups, questionnaries to providers, caregivers and individuals (267 dyads) with dementia, and reviews of agency documents (about 16 agencies with up to ten programs per network).

Network "context" looked at network evolution, governance and management. Review of operational processes focused on administrative coordination and task integration across agencies within networks.

For network "structure", we assessed patterns of relationships, the extent agencies are connected, and, the extent networks are dominated by one agency, or clique existance. This includes centralized control of services and service concentration in one or more agency within networks. We observed whether agencies shared staff/volunteers, facilities, traing programs/workshops, and administrative information. Within network service delivery, our observations focused on referrals sent, referrals received, case coordination, joint clinical programs, service contracts, and shared client-related information.

Network "effectiveness" was assessed at the network level (meeting networks' goals, collaboration among members, and, caregivers' and care recipients' perceptions of care). Predictors of these perceptions included characteristics of the caregiver and care recipient, and their social and emotional support networks.

Network effectiveness also was assessed from the agency's perspective: that is, whether the network meets agency goals and collaboration with other members.

136

HEALTH SERVICES UTILIZATION BEFORE AND AFTER BECOMING A LONG-TERM-CARE RESIDENT

Corrine Truman, Donna Wilson, Faculty of Nursing, Third Floor CSB, University of Alberta, Edmonton, AB T6G 2G3 (donna.wilson@ualberta.ca), Tel: (780) 492-5574, Fax: (780) 492-2551

Long-term-care (LTC) residents are generally among the oldest and weakest persons in any society. As such, they are often considered high users of health care services. Although few research studies have actually assessed LTC resident population trends or health services utilization among LTC residents, widespread concern exists about an aging population and a subsequent rise in health services utilization. For this and other related reasons, a research investigation was undertaken to describe and compare health services utilization by LTC residents both before and after their institutionalization. To enhance the reliability and validity of findings, if not generalizability of findings, this investigation was based on a complete set of Alberta Health and Wellness data for all classified LTC residents in Alberta over a 12 year period (1988-2000). Individual-anonymous data, including LTC resident population data, physician-claims data, inpatient hospital data, day procedures/outpatient clinics and emergency room data, and home care data were obtained for all 47,510 classified LTC residents.

Quantitative analysis (using the SPSS program for primarily descriptive and bivariate statistical procedures) revealed a number of major findings. Chief among these was variable health services utilization prior to becoming a LTC resident, and a decline in health services utilization after admission to LTC. Hospital admissions declined in number, there were fewer emergency and outpatient visits and day procedures, and home care services were no longer provided. If hospitalization did occur after LTC admission, the hospital stay was significantly shorter (29.7 versus 17.5 days), yet the same number of procedures were performed as before admission (X=1). The exception was physician visits, which rose in number (from 1 every 4 weeks to 1 every 2 weeks on average) but declined in cost (from $39.18 to $26.89 on average), indicating physician visits became more routine or health maintenance oriented and less oriented to diagnosing and treating illnesses.

Although concern could be expressed that institutionalization stigmatized or victimized these persons with regard to accessing acute health services, it was theorized instead that consistent daily nursing care and regular physician attention to primary health care needs stabilized their health and thus served to reduce the need for episodic illness-oriented care.

137

QUALITÉ DES SOINS ET DES SERVICES DANS UN RÉSEAU DE SERVICES INTÉGRÉS POUR PERSONNES ÂGÉES: PERSPECTIVES DES PERSONNES ÂGÉES, DES PERSONNES SOUTIEN ET DES INTERVENANTS

Paule Lebel, Francine Ducharme, Howard Bergman, François Béland, Institut universitaire de gériatrie de Montréal, 4565, chemin Queen Mary, Montréal, QC H3W 1W5 (paule.lebel.iugm@ssss.gouv.qc.ca), Tel: (514) 340-3509, Fax: (514) 340-2832

Une évaluation de la qualité des soins et des services intégrés aux personnes âgées en perte d'autonomie, dans le cadre du projet de démonstration SIPA réalisé dans deux territoires du CLSC montréalais, a été effectuée selon trois perspectives: les personnes agées, leurs personnes soutien ainsi que les intervenants. Le devis de recherche comporte: une approche quantitative (groupe expérimental SIPA, groupe témoin du maintien à domicile des CLSC) à partir de questionnaires (554 personnes âgées sans troubles cognitifs et 601 personnes soutien); une approche qualitative d'études de cas sélectionnés parmi la clientèle SIPA illustrant des services innovateurs implantés lors de cette expérimentation (étude de 20 dossiers cliniques par des experts cliniciens; entrevues semi-dirigées auprès de ces personnes âgées, leur personne soutien, gestionnaire de cas, médecin traitant et tout autre intervenant significatif. Les résultats démontrent des effets positifs sur : sentiment de sécurité des personnes âgées et des personnes soutien, planification et coordination des interventions, circulation de l'information et partage des rôles et responsabilités au sein de l'équipe interdisciplinaire SIPA, relations interpersonnelles. Des gains sont à faire au niveau de la collaboration avec les médecins de première ligne, l'accessibilité de certains services, la globalité et la justesse de certaines interventions.

138

STUDYING PERSON-CENTERED PERSPECTIVES OF CONTINUITY OF CARE IN THE LINCS RESEARCH PROGRAM

Donna Smith, Taranjeet Birdi, 2-141 Clinical Sciences Building, University of Alberta, Edmonton, AB T6G 2G3 (donna.smith@ualberta.ca), Tel: (780) 492-9544, Fax: (780) 492-6501

Frail older people have been identified as being at risk for discontinuity in care. The three-year LINCS Research Program was developed to study how continuity of care can be improved by policy and management decisions in the health system. The research is funded by the Canadian Health Services Research Foundation, the Alberta Heritage Foundation for Medical Research and organizational partners. Continuity of care is conceptualized as the dependent variable. The independent variables are several integration strategies being undertaken in two metropolitan health regions in Alberta and Saskatchewan to improve continuity of care. The LINCS Research Program will be conducted in two phases. In Phase 1 there is a focus on capacity-building and the development of a framework and methodology for system level description of the contexts in which the integration strategies are being implemented. This contextual description is critical to the ability to evaluate and replicate the integration strategies. In the second phase of the program, client-focused case studies will be conducted within each of the integration strategies. In this presentation we discuss the activities and outcomes of Phase I of the program with particular emphasis on the system level issues involving older clients and their families.

139

CARING FOR ADULTS WITH ALZHEIMER’S DISEASE: GENDER AS A DETERMINANT OF BURDEN

Michel Bédard, Rylee Kuzik, David Molloy, Sacha Dubois, Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1 (mbedard@baynet.net) Tel: (807) 343-8630, (807) 346-7734

Introduction: Women caring for someone with Alzheimers disease report more burden than men, a difference often attributed to womens willingness to report burden, or to their difficulties in dealing with care recipients. However, women caring for men may face more difficult behaviors (e.g., aggression). We designed this study to examine the role of gender in caregiver burden.

Methods: We measured caregiver burden, care recipient depression symptoms, cognition, problem behaviors, and independence in activities of daily living (ADL) in 554 patient/caregiver dyads. We used hierarchical regressions to examine the contribution of gender after care recipient characteristics, caregiver characteristics, and external supports.

Results: Women reported more role strain (16.24 vs. 12.38, p=.001), and personal strain (7.36 vs. 6.16, p=.010), than men. Regressions revealed that women caring for men reported more role strain than women caring for women, or men caregivers (coefficient = 5.61, p=.001). Dependence in instrumental ADL, and problem behaviors also contributed to role strain (p=.001). Regarding personal strain, we found no gender effect (p=.136). However, younger caregivers and caregivers experiencing more problem behaviors reported more personal strain (p=.001).

Discussion: Further research must examine what contributes to higher burden in women caring for men. This work may promote improved quality of life for care recipients and caregivers.

140

GENDER EQUIVALENCE OF RESPONSES TO A BRIEF VERSION OF THE ZARIT BURDEN INTERVIEW

Norm O'Rourke, Gerontology Research Centre, Simon Fraser University at Harbour Centre, #2800 - 515 West Hastings Street, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

Growing rates of dementia prevalence in Western nations have been described as a rising tide. This metaphor underscores the exponential impact illnesses such as Alzheimer disease will have upon families and the healthcare system in coming years. The brief burden measure purported by Hébert et al. (2000) has been devised to facilitate screening and detection of distress among caregivers. The current study compares patterns of response between male and female caregivers recruited as part of a longitudinal study of dementia prevalence (N = 1,095; Canadian Study of Health and Aging). This analysis of gender invariance suggests that the 2-factor structure reported by Hébert et al. (2000) underlies item response by both men and women. However, the relative salience of the personal strain factor is significantly greater for female caregivers. In contrast, the relative weight of responses upon the role strain factor does not differ. These results can be generalized with greater confidence given the representative and national composition of the study sample.

141

PREDICTORS OF BURDEN AMONG A REPRESENTATIVE SAMPLE OF DEMENTIA CAREGIVERS

Norm O'Rourke, Gerontology Research Centre Simon Fraser University at Harbour Centre, #2800 - 515 West Hastings Street, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

This study examines the predictive validity of depressive symptoms measured at baseline vis--vis expressed burden 5.4 years later among a randomly derived national sample of caregivers (N = 1,060). Participants were recruited as part of the Canadian Study of Health and Aging (CSHA). A hierarchical regression equation was computed to examine factors predicting burden. Descriptive features of caregivers were first entered (i.e., age, sex, marital status, years of education, relationship to patient, baseline levels of caregiver burden) to control for the effect of demographic variables and initial burden levels (R2 = .25, p < .01). Patient illness features at Time 2 (i.e., cognitive status, dementia-related behaviours, impaired ability to perform activities of daily living) were next entered accounting for a significant increase in observed variance (change R2 = .01, p < .01). Depressive symptoms at Time 1 were entered as a final step again accounting for a significant increase in burden scores at Time 2 (change R2 = .01, p < .05). Depressive symptoms as measured at baseline would appear to have significant predictive validity in terms of caregiver burden. This result is notable considering stringent statistical control for demographic variables, patient illness characteristics, and burden as measured at Time 1.

142

COGNITIVE IMPAIRMENT: THE FULL SPECTRUM

Holly Tuokko, Judes Poirier, Marlene Reimer, Mary Tierney, Howard Chertkow, Centre on Aging, Sedgewick Building A104, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 (htuokko@uvic.ca), Tel: (250) 721-6576, Fax: (250) 721-6499

Cognitive impairment in late life is of growing concern to clinicians, researchers, and policy makers, alike. The impact cognitive impairment may have on individuals and others living or working with them depends on many factors including characteristics specific to the individual (e.g., premorbid functional attainment, underlying pathology) and the context in which the person exists (e.g., availability of treatment regimes, the nature of the environment). In this session, a full spectrum of issues relevant to the conceptualization, identification, and management of cognitive impairment will be highlighted. Dr. H. Tuokko will address issues relevant to the conceptualization of cognitive impairment without dementia within the context of data from the Canadian Study of Health and Aging. Dr. Mary C. Tierney will compare the usefulness of classification and algorithm approaches to the prediction of Alzheimer's disease in various research samples. Dr. Judes Poirier will present an overview of recent pharmacogenomics research examining the impact of memory enhancing drugs in persons with Alzheimer's disease and the effect of gene variability on the quality of response. In so doing, he will describe research on a prototype device for performing genetic tests in doctor's offices. Dr. Reimer will speak on the challenges and outcomes of conducting quality of life research with cognitively impaired adults. Examples will be provided from her current research evaluating specialized environments for adults with middle to late stage cognitive impairment.

143

DYING WITH DIGNITY? PRACTICE AND POLICY IN END-OF-LIFE CARE IN HAMILTON NURSING HOMES

Elizabeth Asher, Christopher Justice, Gerontology, McMaster University, Hamilton, ON L8S 4M4 (justice@mcmaster.ca), Tel: (905) 525 9140 x. 24078

Many Canadians spend the last several months of their lives as residents of nursing home facilities. This paper describes the results of an exploratory research study aiming to understand the commonality and variability in practice of end-of-life care in Long Term Care Facilities. The study was conducted in Hamilton, Ontario and consisted of approximately 20 semi-structured, open-ended depth interviews with directors of care at most of the twenty-one local nursing homes. Results indicate that most nursing homes do not feel that there is clear policy guiding them in end-of-life practice and procedure. This may be related to significant variability from one facility to the next in practice around advanced directives, training in palliative care, understandings of cultural needs and comfort measures, and policy around transfers to hospital. This research suggests the need for further research in the area of end-of-life care in Long Term Care facilities and ultimately the development of policies and guidelines aimed at enhancing the experience of dying in these contexts.

144

ENHANCING GERONTOLOGICAL EDUCATION THROUGH EVALUATION AND INNOVATION

Christopher Justice, Gerontology, McMaster University, Hamilton, ON L8S 4M4 (justice@mcmaster.ca), Tel: (905) 525-9140 x. 24449

The McMaster programme was the first gerontology degree programme in Canada and is now in its 14th year. In 1999, as part of a formative Evaluation, we conducted a series of focus groups and interviews with faculty, community, students and alumni. This research reveals the tensions inherent in gerontology as a programme of study between orientation to practice and academic pursuits. The results of the research have lead the development of an Academic Plan (2001) aimed at enhancing gerontology education through resolving these tensions. This poster illustrates how the research results are linked to our plan to introduce both inquiry-based and problem-based learning into course design; to strengthen the experiential and practice component of the programme; to broaden the capstone experience to allow for a more practice-based thesis, and to strengthen links to the community. The vision is to educate gerontology graduates who are lifelong active learners; who possess core knowledge about aging and competencies in such things as critical thinking and communication; who are creative problem solvers and inquisitive thinkers capable of leadership in an aging society; and who are thoughtful and skillful advocates for older people.

145

IS THERE A CORRELATION BETWEEN FEAR OF CRIME AND THE BIOLOGICAL, PSYCHOLOGICAL AND SOCIAL DEVELOPMENT OF OLDER ADULTS?

Marie Beaulieu, Richard Lefrançois, Gilbert Leclerc, Micheline Dubé, Suzanne Hamel, Centre de recherche sur le vieillissement, IUGS, 1036 Belvédère Sud, Sherbrooke, QC, J1H 4C4 (marie.beaulieu@courrier.usherb.ca) Tel: (819) 821-1170 poste 2270, Fax: (819) 829-7141

Fear of crime has been studied in regards of age, residential area (urban vs rural), attitudes towards the justice system, past experience of victimisation, etc. Not much is known on personal characteristics of older adults experiencing fear of crime. The Quebec longitudinal study on aging (QUELSA) has studied 784 subjects divided in three cohorts (60, 70 and 80 years old) in three observation waves over a five year time period (1997 to 2001). It focused on the actualization of potential of the elderly using sixteen validated instruments to measure health lifestyle, functional autonomy, social support, psychological distress, etc. Secondary analysis of the material reveals that 19,4% to 24,8% of the subjects expressed fear of crime in one of the three waves. This poster presents compared personal characteristic of older adults experiencing or not experiencing fear of crime, per wave and cohort. It offers a nuance portray of who expresses fear of crime at old age. QUELSA has been funded by SSHRC, CQRS, FCAR.

146

LET ME DECIDE: THE ALBERTA EXPERIENCE

Eleanor Risling, Capital Health, Community Care Services - Regional Continuing Care # 406, 10216 - 24 St., Edmonton, AB T5N 4A3 (erisling@cha.ab.ca), Tel: (780) 496-7788, Fax: (780) 496-7557

An Evaluation study of the Let Me Decide (LMD) Program developed by Dr. William Molloy of Ontario is being conducted within the Capital Health Region of Alberta.

Objectives of this study are to:

1. Monitor implementation of the LMD Program.

2. Identify facilitators or barriers to implementation.

3. Measure the effectiveness of the educational program.

4. Measure program outcomes.

A non-randomized opportunistic sampling technique to account for all new admissions to two continuing care organizations is being employed. Health Care Facilitators have been designated at each facility to implement the program.

Feedback from the health care providers at the participating organizations, required revisions to the Ontario versions of the LMD to be compliant with Alberta legislation. This has resulted in two Alberta specific versions; a Health and Personal Care Directive and a Next of Kin's Expression of Wishes for Health Care Decisions for the Incompetent Person.

Evaluation methods to be utilized in determining the effectiveness of this program include interviews, focus groups, assessment of resident/family satisfaction, chart audits, and resource utilization studies.

This project is funded by the Alberta Medical Association's Medical Services Budget Innovation Fund. A final report will be completed by December 1, 2002.

147

A CONTEXTUALIZED MODEL OF AGING WELL

Sherry Anne Chapman, Department of Human Ecology, University of Alberta, 3-02 Human Ecology Building, Edmonton, AB T6G 2N1 (sherryc@ualberta.ca), Tel: (780) 492-2865, Fax: (780) 492-4821

Much as gerontological theory is a product of the era in which it is developed, views of successful aging are situated in history and society. In this poster, results are presented of a critical analysis of the evolution of models of successful aging over the past half century and of the development of a new, contextualized model of aging well that emerged from this analysis.

Gerontological conceptual and empirical papers served as the text of this philosophical hermeneutic analysis. The researcher applied previous thinking and experience to the text, dialectically moving between pre-understanding and the articles. Waves of successful aging conceptualization became meaningful as a result of their relationship with each other and an underlying system of gerontological and social conventions over time. The new model of aging well is situated in historical, societal, and familial contexts and is comprised of the following components: productive and social engagement, material resources, and cognitive, physical and spiritual well-being. The model accommodates heterogeneity. Rather than assuming that successful aging is unattainable without full cognitive and physical function, the premise of the new model is that individuals experiences may differ across the components, yet these individuals may all experience life satisfaction and happiness.

148

AGING AFFECTS POSTURAL KINEMATICS DURING HEAD TURNING IN STANDING AND WALKING

Caroline Paquette, Nicole Paquet, Joyce Fung, Centre de recherche, Hôpital juif de réadaptation, 3205, Place Alton-Goldbloom, Laval, QC, H7V 1R2 (caroline.paquette@mail.mcgill.ca) Tel: (450) 688-9550 poste 586, Fax: (450) 688-3673

Head movements are normally integrated with postural tasks. Our objective was to determine whether aging impacts on head-related postural kinematics. Six young (254 y/o) and five elderly (765 y/o) healthy subjects turned their head rapidly (up, down, left, or right) during step stance or walking. The 3-D positions of head, trunk and pelvis were recorded and the excursions analyzed. Elderly subjects stood and walked with increased trunk and pelvis flexion as compared to young subjects. Head turn amplitude was significantly reduced for the elderly, more markedly in walking (38.7% less) than standing (33% less). Horizontal head motions were accompanied by less trunk rotation in elderly (63 vs. 1410young). Young subjects used a strategy of increased trunk and pelvis rotations to accommodate horizontal head turns in walking more so than standing whereas elderly subjects did not. For up-down motions of the head, flexion-extension motions of the trunk were increased in walking as compared to standing for both elderly and young subjects. In conclusion, these elderly subjects were not able to adjust their posture related to head movements executed during different postural tasks, which may lead to balance hazards.

149

LA PERSÉVÉRANCE DES AÎNÉS BÉNÉVOLES ET LES PRATIQUES D’ENCADREMENT, DE FORMATION ET DE SOUTIEN DES BÉNÉVOLES

Ghyslaine Lalande, Gilbert Leclerc, 186, Grande Ligne, Lac-Etchemin QC G0R 1S0 (ghyslainelalande@hotmail.com), Tel : (418) 625-3433

Le réseau public compte sur l’apport des organismes communautaires et bénévoles de maintien à domicile. Mais la précarité des ressources bénévoles nuit au développement des services. Pour y remédier, on propose la formation et la supervision des bénévoles. Onze aînés bénévoles furent interviewés selon une méthodologie qualitative (théorisation ancrée): Quel est leur point de vue sur les pratiques d’encadrement, de formation et de soutien des bénévoles? Comment celles-ci influencent-elles leur satisfaction et leur persévérance? La persévérance des aînés bénévoles dépendrait de leur disponibilité, leur santé et leur évaluation de leur expérience bénévole. Celle-ci porte sur la pertinence de l’activité bénévole, l’intérêt de la tâche, les efforts consentis en regard des bénéfices reçus. L’évaluation est elle-même tributaire de leurs caractéristiques personnelles. Les pratiques d’encadrement, de formation et de soutien favorisent une évaluation positive et la persévérance des bénévoles aînés dans la mesure où elles prennent en compte leurs attentes, projet, disponibilité, motivations et intérêts. Cette étude met en lumière la nécessité pour les organisations bénévoles d’adapter leurs pratiques aux caractéristiques personnelles des bénévoles.

150

PLANS DE SOINS GUIDES GÉRIATRIQUES

Louise Francoeur, Anne Bourbonnais, Gabrielle Farley, 4565, chemin Queen Mary, Montreal, QC H3W 1W5 (louise.francoeur.iugm@ssss.gouv.qc.ca), Tel: (514) 340-3507 ou (514) 340-2800 poste 3417, Fax: (514) 340-2807

Depuis 1990, l'Institut universitaire de gériatrie de Montréal réalise des plans de soins guide associés à différentes problématiques spécifiques aux personnes âgées. Depuis l'implantation d'un progiciel clinique destiné aux infirmières, ceux-ci ont été intégrés au progiciel.

Chaque plan de soins guide comprend un diagnostic infirmier, des objectifs et des interventions permettant d'atteindre les objectifs fixés. Ils ont pour but de faciliter la réalisation des plans d'interventions individualiés à partir des problématiques de soins identidiés.

Ces plans de soins ont été conçus dans le cadre de programmes de soins élaborés à partir d'écrits scientifiques sur le sujet et de la pratique clinique. Dans un souci de normalisation, les concepteurs ont tentés de se rapprocher des nomenclatures reconnues telles que "Nursing Interventions classification" (NIC) et "Nursing outcomes classification" (NOC). Cependant, compte tenu des limites actuelles de ces dernières, la priorité a été accordée aux spécificités de la clinique gériatrique.

Actuellement, aucun résultat formel n'est disponible sur l'utilisation de ces plans de soins guide. Cependant, les commentaires préliminaires sont positifs et les utilisatrices y reconnaissent une valeur ajoutée par rapport aux outils traditionnels

151

THE DEVELOPMENT AND VALIDATION OF THE SENIOR ALCOHOL MISUSE INDICATOR (SAMI) TOOL

Bonnie Lum, Margaret Flower, Usoa Busto, Centre for Addiction and Mental Health, ARF Site, 33 Russell St., Toronto, ON M5S 2S1 (bonnie_lum@camh.net), Tel: (416) 535-8501 x6467, Fax: (416) 595-6618

We will examine the complexities in assessing older persons with dementia, depression, or substance misuse and the need for a specialized tool that will be able to differentiate the different conditions. We will demonstrate the negative impact of alcohol misuse that can lead to adverse consequences, though it remains under-detected because of inadequate screening tools. Participants will be introduced to existing assessment tools and the SAMI. The SAMI is a brief screening tool intended to elicit alcohol-related information from seniors. It will be available to health care workers who assess senior clients and will help them determine if alcohol is a factor in the presenting problem. The project consists of two phases. Phase I involves focus groups from the community (seniors and health care workers) responding to the SAMI, followed by health care workers field-testing the tool during their assessments of senior clients during home visits. A projected number of 1000 clients will be reached during this field-testing period. Phase II will involve the validation of the SAMI tool by participating senior health agencies across Canada. A follow-up interview with the clients will determine if the tool was effective in identifying seniors who may have issues with alcohol.

152

URBAN ELDERLY WOMEN AND FEAR OF CRIME: A SOCIOLOGICAL ANALYSIS

Cheryl Christian, 301F Isbister Building, 183 Dafoe Road, Department of Sociology, University of Manitoba, Winnipeg, MB R3T 2N2 (Christian_Cheryl@hotmail.com), Tel: 204) 474-9831, Fax: (204) 261-1216

As Canadians are exposed to more frightening images of crime, violence and victimization it is not surprising that fear of crime is believed to be increasing. Stereotypical images of "vulnerable" elderly women who are "paralyzed" with fear and have become "prisoners in their own homes" have contributed to the assumption that this segment of our population is the most fearful. The purpose of this study was to explore the experiences of fear of crime among a group of women, aged 65 and older, living alone in an urban environment. Using qualitative methodology, this research relied upon in-depth, semi-structured interviews with 20 women from Winnipeg, Manitoba. An exploration of the nature of fear revealed the characteristics of fear and identified associated signs of alarm. Implications of this research address the environmental and social factors associated with fear.

153

LA PRÉVENTION DES CHUTES - UNE APPROCHE CENTREÉ SUR L'USAGER

Carole St-Pierre, Cheryl Hirsh, Patrick Murphy-Lavallée, Centre gériatrique Maimonides, 5795 Caldwell, Côte St-Luc, QC H4W 1W3 (patrick.murphy-lavallee@ssss.gouv.qc.ca), Tel: (514) 483-2121 poste 312, Fax: (514) 489-0010

Les usagers de l'Hôpital de jour du Centre gériatrique Maimonides se composent essentiellement de personnes exposées aux chutes étant donné leur âge avancé, leur problèmes médicaux multiples et leur nombreuses limitations fonctionnelles. Le programme de prévention des chutes vise deux objectifs: optimiser l'autonomie onctionnelle et physique des usagers et enseigner les mesures pour augmenter la sécurité et la confiance.

La première étape consiste à effectuer une évaluation gériatrique de l'usager par l'équipe interdisciplinaire. Le programme de traitement consiste en une série d'interventions destinées à améliorer la force physique, l'équilibre, l'endurance, la mobilité et optimiser les habiletés fonctionnelles. D'autres stratégies plus spécifiques peuvent être envisagées. De plus, chaque usager participe aux rencontres de groupe de prévention des chutes, sous la direction d'une ergothérapeute et d'une physiothérapeute. Au cours des deux séances, les usagers revoient les facteurs qui causent les chutes, les mesures de sécurité

à prendre pour les prévenir et comment réagir en cas de chute. Les outils développés comprennent un vidéo, des affiches, une brochure d'information, des discussions interactives et des jeux questionnaires.

Le succès du programme se traduit par l'amélioration des habiletés fonctionnelles de l'usager, par la réduction du nombre de chutes rapportées et par une augmentation de la sécurité.

154

ACTIVITÉS D'APPRÉCIATION DE LA QUALITÉ SUR LA DOULEUR

Maryse Savoie, Valérie Roberge, Sarah Marshall, Brigitte Philippon, 305, boul des Anciens Combattants, Ste-Anne-de-Bellevue, QC H9X 1Y9 (masavoie@vac-acc.gc.ca), Tel: (514) 457-3440 ext 2572, Fax: (514) 457-8410

L'amélioration de la qualité débute par la compréhension que les problèmes de qualité sont des problèmes liés aux processus plutôt qu'aux personnes. Un processus est une série de séquences représentant toutes les étapes nécessaires à l'atteinte d'un résultat. Le système de prestation des soins est complexe et composé de plusieurs processus multidisciplinaires et transdépartementaux. Le processus d'évaluation et de soulagement de la douleur est un bon exemple d'un processus complexe impliquant plusieurs disciplines et départements.

Depuis trois ans la Direction des soins infirmiers et la Direction des services professionnels de l'Hôpital Sainte-Anne* collaborent afin de mettre en place des outils et des procédures visant l'amélioration de l'évaluation et du soulagement de la douleur. Un comité aviseur sur le soulagement de la douleur a été créé et un plan de développement comprenant quatre phases: sensibilisation, conception, implantation et évaluation a été élaboré.

La phase d'évaluation a été développée autour de trois indicateurs de qualité :

• % d'implantation du concept de la douleur comme 5e signe vital.

• % d'utilisation adéquate de la grille "Évaluation de la douleur et de son soulagement"

• % de bénéficiaires rapportant une diminution de 50% de l'intensité de leur douleur sur une période de 72 heures.

Le niveau de performance visé pour chacun de ces indicateurs est de 100%. L'appréciation de ces indicateurs se fait à travers la tenue d'audits de qualité aux trois mois. Les audits ont lieu sur les vingt unités de soins de l'hôpital.

Notre communication par affichage décrira la méthodologie et les résultats de ces audits ainsi que les activités d'amélioration de la qualité en découlant.

• Hôpital pour vétérans de juridiction fédéral.

155

LES FACTEURS ASSOCIÉS À LA CONSOMMATION DE BENZODIAZÉPINES DE COURTE ET DE LONGUE DURÉE CHEZ LES AÎNÉS DU QUÉBEC

Dany Fortin, Michel Préville, R Hébert, J Allard, Jean-Pierre Grégoire, Claire Ducharme, Anick Bérard, Centre de recherche sur le vieillissement, 1036, rue Belvédère Sud, Sherbrooke, QC J1H 4C4 (dany.fortin@courrier.usherb.ca), Tel: (819) 829-7131, Fax: (819) 829-7141

Les benzodiazépines font partie des médicaments les plus utilisés par les aînés. Malgré leur utilité, ces médicaments sont responsables de plusieurs problèmes iatrogènes chez les aînés. Bien que le Collège des médecins du Québec recommande de ne pas utiliser les benzodiazépines sur une période excédant trois mois, plusieurs consommateurs en utilisent pendant plusieurs mois. Le but de cette étude était de comparer les déterminants de la consommation de benzodiazépines de courte (< 3 mois) et de longue durée (> 3 mois) chez les aînés du Québec. Le cadre conceptuel de Andersen et Newman a servi à vérifier l’hypothèse selon laquelle les déterminants de la consommation de courte durée diffèrent de ceux de la consommation prolongée. Les données de l’Enquête Santé Québec de 1998 ont été appariées à celles de trois fichiers de la Régie de l’assurance-maladie du Québec. 2790 aînés non institutionnalisés ont fait partie de notre base échantillonnale ainsi que les personnes vivant avec elles. Les résultats ont montré que 34.4% des aînés consomment des benzodiazépines dont 48% ont une consommation de courte durée alors que 52% ont une consommation prolongée. La méthode de régression logistique polychotomique a servi à identifier les déterminants de ces deux types de consommation.

156

CAPACITY BUILDING IMPLEMENTATION STRATEGIES USED WITH THE CHRONIC DISEASE SELF-MANAGEMENT PROGRAM

Karen Hannah, Patrick McGowan, Suite 102, 5007 - 47A Avenue, Ladner, BC V4K 1T9 (khannah@dccnet.com), Tel: (604) 940-3568, Fax: (604) 940-2099

The Chronic Disease Self-Management Program (CDSMP) is a lay-led patient education initiative. Over 200 seniors with chronic conditions have played integral roles in bringing the program to Vancouver and Richmond as: members of a community advisory committee; program leaders; trainers of new program leaders; and assisting with implementation activities. The majority of seniors initially became involved when they took the program themselves. In the subsequent two-year period, strategies have been implemented to maintain their involvement and to develop their capacity as program leaders, and "diplomats". Strategies have also been used to involve spouses, significant others and care givers.

This community-based and community-driven project is innovative in its capacity-building approach. The CDSMP not only benefits the seniors who take the program, but also benefits seniors who become leaders and then deliver the program to others. The skills and confidence gained are transferable to other areas of their lives, and lead to better quality of life and independence. As a health promotion initiative, the program has clearly demonstrated a positive impact on population health, and opportunities for cost saving in the future by having the community address some of its own health needs. The project is funded by the Vancouver Coastal Health Authority.

157

ÉVOLUTION DE TROIS TYPES DE COMPORTEMENTS D'AGITATION: BÉNÉFICIAIRES DÉMENTS ET NON-DÉMENTS À L'ÉTUDE

Léonie Jean, Philippe Landreville, Laboratoire de gérontologie clinique, École de Psychologie, Université Laval, Ste-Foy, QC G1K 7P4 (leoniejean@hotmail.com), Tel: (418) 656-2131 poste 8115

L’agitation est une problématique susceptible d’affecter directement la façon dont les soins sont prodigués à la personne atteinte, d’où l’importance de connaître son évolution en vue de cibler adéquatement les interventions et de les appliquer au moment opportun. La présente étude cherche à déterminer l’évolution dans le temps de comportements agités chez 172 personnes âgées résidant en Centre d’hébergement et de soins de longue durée. Un objectif particulier est d’examiner cette évolution en fonction de la présence ou de l’absence d’un diagnostic de démence. La fréquence des comportements agités a été évaluée à l’aide de l’Inventaire d’agitation de Cohen-Mansfield à trois moments différents sur une période de huit mois. Trois types de comportements ont été étudiés : l’agitation avec agressivité (AA), l’agitation physique non-agressive (APNA) et l’agitation verbale (AV). Les participants ayant un diagnostic probable de démence (n=82) présentent davantage d’AA (p<.0001) et d’APNA (p=.001) que les participants sans diagnostic de démence (n=90). Cependant, les résultats ne démontrent aucune différence significative entre les temps de mesure ni d’interaction significative entre le temps et le diagnostic.

158

EXTENDED FAMILY AND THE EXPERIENCE OF SOLIDARITY

Stephanie Kuiack, Joan Norris, Michael Pratt, Box 14 FACS, University of Guelph, Guelph, ON N1G 2W2 (sldavey@uoguelph.ca), Tel: (519) 824 4120 ext 2210

Solidarity Theory (Bengtson et al) has been used to study emotional bonds of family members, particularly parents and their adult offspring. Recently, in-laws have been included in investigations of family solidarity with the assumption that the experience of solidarity for in-laws is similar to that of nuclear family members. The objective of this project is to understand if indeed family solidarity is experienced similarly between biological family members and in-laws. 50 G2 couples (mean age 38 years) and the maternal (mean age 64 years) and paternal (mean age 65 years) G1 parents each completed a questionnaire which tapped four constructs of solidarity (affection, association, consensus and normative) for the G2's nuclear family and the in-laws. GLM - repeated measures analysis suggests that there are significatn differences in how G2 females and G2 males experience solidarity toward their own parents versus their in-laws for the constructs of affection, association and norms. Alternatively, the G1 females and males generally report similar experiences of solidarity for their own child and the in-law. These findings suggest that we must analyze family solidarity with a sensitivity that there may be unique experiences of solidarity between family members and generations.

159

SELF-PERCEPTIONS OF SIGNIFICANT SPIRITUAL CHANGES IN LATER LIFE

Ellen Ryan, Ann Anas, Amy Brown, Nicole Domonchuk, McMaster Centre for Gerontological Studies, KTH 231 McMaster University, 1280 Main Street West, Hamilton, ON L8S 4M4 (ryaneb@mcmaster.ca), Tel: (905) 525-9140 ext 24995, Fax: (905) 525-4198

A sample of well-educated older adults (N = 168, Mean Age = 74.3 years, 61.9% Females), responded to an open-ended questionnaire about changes in their spirituality since early adulthood. Qualitative analyses revealed that, for many of the participants, sources of inspiration had changed over time in terms of positive lessons learned through significant life events (e.g., illness, retirement, changed marital status), more emphasis on personal relationships with family and close friends, and less emphasis on materialism. For those participants whose approach to religion or spirituality had changed, some indicated enriched traditional church beliefs and activities, while others expressed more personalized beliefs about spirituality or a tendency for less involvement in organized religion. Reasons given for the changes were categorized in terms of spiritual, societal, and personal life events. Illustrations of various spiritual changes will be discussed in terms of lifespan development, successful aging, and societal changes.

160

LES RÉSEAUX DE LA PÉNOMBRE: AUTONOMIE ET SOUTIEN FORMELS OU INFORMELS

Claude Galand, Nicole Leduc, François Béland, 3745 rue du Frère André #2, Montreal, QC, H3V 1B2 (galand@videotron.ca) Tel: (514) 731-8648

Recherche sur le regroupement et la configuration des réseaux formels et informels des aînés dans un quartier défavorisé de Montréal.

Le contexte actuel des services de santé, au Québec, oblige les personnes âgées à faire appel à plusieurs types de réseaux afin de rester partie prenante de la société sans se laisser envahir par la pénombre qui les guette.

Ainsi, l'objectif principal de la recherche est : D'évaluer et de comparer le regroupement et la configuration des réseaux formels ou informels utilisés par les aînés suivant une approche matricielle en mettant en relation les acteurs intervenant dans des fonctions de soutien et la nature des services obtenus.

Cet énoncé nous amènera à examiner la problématique de la convergence souhaitée par les gouvernements entre les services formels et informels en rapport avec les possibilités d'organisation des personnes âgées dans leur milieu de vie pour l'obtention de services de santé qui leur conviennent.

La méthodologie utilisée fait appel à une analyse statistique fine des résultats d'un questionnaire sur la santé et les besoins de services pour lequel 1500 personnes âgées, dans des ménages privés, ont répondues. Cet échantillon était nécessaire pour être représentatif et faire ressortir des phénomènes relativement peu fréquents.

161

RESILIENCE AND ADAPTATION IN LATER LIFE

Norm O'Rourke, Ph.D., Philippe Cappeliez, Richard Lefrançois, Jacques Gaucher, Gerontology Research Centre and Programs, Simon Fraser University at Harbour Centre #2800 - 515 West Hastings St., Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

Gerontology in general and psychology in particular, have been criticized for equating later life with inevitable loss and decline. In contrast to this pessimistic portrayal, older adults generally contend and adapt to the challenges of aging effectively. In addition, considerable variability appears to underscore resilience in later adulthood. Acknowledgement of this complexity is reflected in each of the topics addressed in this symposium. Philippe Cappeliez discusses the role of personality variables and life attitudes in relation to both adaptive and maladaptive ways in which older adults reflect upon the past. These functions of reminiscence are considered relative to life context, coping, and emotional regulation. Specific to those within enduring relationships, Norm ORourke describes the effects of personality and selective information processing (termed cognitive adaptation) as predictors of physical and mental health. The resulting model reflects the direct and indirect associations among personality, autobiographical memory, marital satisfaction and well-being among older married adults. Jacques Gaucher examines adaptation to trauma in later life relative to both gender and age cohort (i.e., young-old vis--vis old-old). These findings are understood within context of psychodynamic theory as applied to later life course development. Finally, Richard Lefran ois examines social support in relation to disability among octogenarians from the Qubec Longitudinal Study on Aging. Consistent with recognition of the complex role of interpersonal factors, these results indicate that social support can have both protective and deleterious effects in later life. In sum, this bilingual symposium seeks to address the complex cognitive, intrapsychic and social factors to advance our understanding of the range of antecedents impacting the well-being of older adults. Directions for future research are considered as well as the evolution of theory.

162

CONTRIBUTIONS OF REMINISCENCE TO COPING AND RESILIENCE IN LATE ADULTHOOD

Philippe Cappeliez, Norm O'Rourke, Ph.D., Gerontology Research Centre, Simon Fraser University at Harbour Centre, #2800 - 515 West Hastings Street, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

Drawing insights from contemporary theories on stabilizing and protective psychological processes in late adulthood, this communication integrates research findings into a model aimed at understanding the roles of reminiscence in late adulthood. Personality traits and life attitudes appear particularly important for the intra-personal functions of reminiscence. Specifically, a tendency toward emotional vulnerability (Neuroticism) predicts reminiscence for self-understanding and ruminating about a negative past. Openness to experience predicts reminiscence for addressing issues of life meaning and death. Among life attitudes, a weak desire to seek new challenges predicts reminiscence for generating stimulation, preparing for death, and ruminating about the past. Reminiscence also contributes to coping. Escapist reminiscence occurs in the context of uninspiring present and future, the person seeking refuge in the past rather than problem-solving. Reminiscence for death preparation happens in a context of disengagement from future involvement and passive coping. Reminiscence for identity is associated with seeking social support. Finally, reminiscence in an interactive context plays a role in emotional regulation, specifically emergence/maintenance of positive affect. Clinical implications of these findings for the practice of reminiscence interventions are drawn.

163

APPROCHE DES CONDUITES "AUTO-PROTECTRICES" ET/OU "AUTO-STIMULANTES AU COURS DU VIEILLISSEMENT"

Jacques Gaucher, Norm O'Rourke, Ph.D., Gerontology Research Centre, Simon Fraser University at Harbour Centre, #2800 - 515 West Hastings Street, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

A partir d'une investigation clinique utilisant un différenciateur sémantique de type Osgood, cette recherche contribue à évaluer l'influence de l'âge et du sexe sur la capacité psychique de résilience des personnes âgées face aux traumatismes de leur vieillissement. Elle s'est intéressée à deux populations d'hommes et de femmes séparées par des critères d'âge (un groupe de 65 ans et un autre de 85 ans) et avance la double hypothèse suivante: le sexe différencie les personnes âgées quant à leurs possibilités d'être résilientes et ; l'avancée en âge influe positivement sur la capacité psychique de résilience chez les personnes âgées. Des potentialités psychiques se développeraient au cours de la vieillesse. Cette recherche contribue à l'approche psychodynamique de la vieillesse selon laquelle les dispositions psychiques de l'âge avancé développent des capacités créatrices et adaptatives propres à la vieillesse. Le travail du détachement (Bianchi, 1989, Gaucher, 1999), le travail du vieillir (Quinodoz, 1997) et le ‘bilan de vie’ (Balier, 1976) constituent les mouvements psychiques permettant à la personne âgée de développer ses capacités d'adaptation et son maintien en santé.

164

INCAPACITÉ FONCTIONNELLE ET DÉTRESSE PSYCHOLOGIQUE CHEZ LES OCTOGÉNAIRES: LE RÔLE DU SOUTIEN SOCIAL

Richard Lefrançois, Norm O'Rourke, Ph.D., Gerontology Research Centre, Simon Fraser University at Harbour Centre, #2800 - 515 West Hastings Street, Vancouver, BC V6B 5K3 (ORourke@sfu.ca), Tel: (604) 291-5175, Fax: (604) 291-5066

This presentation reports on the role of social support as a moderator of the relationship between exposure to stressful life events, in this case disability, and psychological distress among a sample of 137 survivors age 84 to 89 in the last wave of the Quebec Longitudinal Study on Aging. Hierarchical multivariate regression analysis was performed to ascertain the main and additive effects of life events and social support on the outcome variable, and to identify a buffering (or moderating) effect of social support. The main findings are that disability as a negative life event still had a strong influence on distress, even after controlling for three measures of social support. Among the very old, it appears that social support may have negative consequences. The negative side and cost associated with social interaction, or social isolation resulting from psychological distress, may explain the absence of a protective effect of social support. Comparison between sexes suggests that women see themselves more as caregivers than care receivers. Distress could therefore be a result of their own failing health, the consequence of which is the inability to provide social support to others.

165

AN INTEGRATED MODEL OF WELL-BEING AMONG OLDER ADULTS

The current study examines multiple constructs contributing to the well-being of an international sample of older married adults. A convenience sample of 208 participants was recruited via an Internet website and more traditional means such as newspaper advertisements and contact with community groups. The resulting structural equation model combines distinct groupings of constructs to provide an integrated framework in which to organize previously disparate bodies of research. Within this model, the direct and indirect contribution of personality, marital satisfaction, and cognitive adaptation are examined relative to well-being among older adults. Contrary to previous findings, personality appears to have an indirect effect upon both marital satisfaction and well-being. Cognitive adaptation, in contrast, has both a direct and indirect effect upon well-being among older adults. Limitations of use of the Internet as a vehicle for data collection are considered as well as directions for future study.

166

LE PROGRAMME POUR LE BIEN-VIEILLIR: AU CLSC RENÉ CASSIN - IGSQ

Marie Amzallag, Frédéric Le Cren, Danielle Ros, CLSC René-Cassin, 5800 Boul. Cavendish, Suite 600, Côte St-Luc, QC H4W 2T5 (mamzallag@ssss.gouv.qc.ca), Tel: (514) 488-9163, Fax: (514) 485-1612

Comment favoriser un vieillissement optimal? C’est pour répondre à cette question qu’une équipe d'intervenants, de chercheurs et de bénévoles a développé un programme novateur de promotion/prévention de santé globale.

Ce programme Bien-Vieillir vise à soutenir la personne dans ses démarches de changement pour actualiser son potentiel et encourager l’amélioration de sa qualité de vie.

Un ensemble planifié de rencontres individuelles et de groupe est organisé autour de «modules» prioritaires : bien-être physique, activités cognitives, bien-être psychologique, buts et sens, réseau social , ainsi que planification de l’avenir .

Ces rencontres visent tout d’abord à accompagner la personne dans une prise de conscience reliée à son vieillissement, et la soutenir vers des changements favorisant la participation active de l’aîné au sein de la société. Le programme encourage le développement d'une plus grande solidarité sociale.

Le modèle Bien-Vieillir implique un engagement de la personne qui dépasse largement la simple acquisition d'informations spécifiques. Il est mis en oeuvre par des professionnels et des bénévoles formés, véritables conseillers qui accompagnent la personne dans sa démarche de changement. La recherche et l’évaluation du programme favorisent le développement de partenariats multidisciplinaires afin de consolider et d’affiner ce modèle de promotion/prévention en phase initiale d’implantation.

167

INTEGRAL (INVOLVING TENANTS TO ENABLE GREATER RESOURCES AND ACTIVE LIFESTYLES) PROGRAM EVALUATION (2001)

Wendy Johnstone, Suite 112, 7210 Mary Avenue, Burnaby, BC V5E 3K4 (wendyj@newvista.bc.ca), Tel: (604) 525-3288 ext. 4, Fax: (604) 525-7464

The New Vista Society instituted the INTEGRAL (INvolving Tenants to Enable Greater Resources & Active Lifestyles) Program in June 1999. Established to promote independence and quality of life for seniors living in independent subsidized housing, the program provides opportunities for socialization and overall well being, develops community and builds strong partnerships with the community at large.

The purpose of the 2001 Evaluation was to determine how well the INTEGRAL program goals were being met. Information was collected by two means. Firstly, yearly statistics were collected and secondly, a survey of all tenants was conducted to assess their perception of the impact of the INTEGRAL Program. Where applicable, results from the 2001 tenant survey are compared to findings from the 2000 (N=125) and 1999 (N=98) tenant surveys.

The 2001 survey response rate was 31% (N=146 ) and 97% of respondents felt that the INTEGRAL program was important. Tenants participated in programs for the purpose of socialization (71%), meeting new people (66%) and feeling connected to their community (66%). Other highlights included an increase in participation rates. In 2001, 32 tenant volunteers directly managing the 24 programs available to them; a 43% increase since 2000.

Additionally, 47% of respondents were members of a Tenant Association. In 2001, INTEGRAL had a participation rate of 31%, a 10% increase since 1999.

Results from this Evaluation show the importance of providing formal opportunities for seniors to socialize and connect with their community. As well, the INTEGRAL Program enables seniors to take a pro-active role in their housing and well-being and promotes independence and improvements in quality of life.

168

OLDER ADULTS COMPETING IN SPORT: A CONTEXT FOR IDENTITY MANAGEMENT, RESISTANCE AND EMPOWERMENT IN LATER LIFE

Rylee Dionigi, 14/102 Madison Drive, Adamstown Heights, New South Wales, Australia 2289 (rylee.dionigi@studentmail. newcastle.edu.au), Tel: ( + ) 61-2-4942 4559 , Fax: ( + ) 61-2-4921 7402

In a society that values youthfulness, independence and athleticism, older people are often not expected to compete in physically exerting sports. As the developed world's population ages, however, more and more older adults are participating in such non-traditional activities. Despite this growing interest, there is a lack of qualitative research on how older adults experience competitive sport. The purpose of this paper is to present qualitative data that explores the multiple meanings that older people attach to their participation in competitive sport. Data collected through in-depth interviews with Australian athletes, aged 60 years and over, and participant observation at a multi-sport event were analysed using both constant comparative and thematic analyses. The themes emerging from the data reveal that competitive sport provides an important context for older adults to negotiate identities which challenge the stereotypes associated with old age. The findings also contribute to knowledge about leisure as a site for empowering older people.

169

INTERAGIR AVEC LES AÎNÉS AYANT UN PROBLÈME DE COMMUNICATION: UN DÉFI POUR LES INTERVENANTS

Louise Getty, Guylaine Le Dorze, Lise Renaud, Marie Julien, Stéphane McDuff, Université de Montréal, École d'orthophonie et d'audiologie, C.P. 6128, succ. Centre-Ville, Montréal, QC H3C 3J7 (louise.getty@umontreal.ca), Tel: (514) 343-7672, Fax: (514) 343-2115

Dans les établissements de santé qui offrent des services aux aînés, la clientèle présentant une déficience de l’audition et du langage est très nombreuse et augmente au même rythme que la population vieillit. Ceci occasionne des difficultés de communication tant pour les intervenants que pour les aînés eux-mêmes. Des études menées par notre équipe de recherche ont montré qu’avec cette clientèle, les intervenants ont des besoins reliés à ces problèmes. Dans le but d’améliorer la communication entre les praticiens et les usagers des Centres de jour, le programme "Interagir avec les personnes ayant une déficience de l’audition ou du langage; un défi pour les intervenants et intervenantes des centres de jour " a été élaboré et expérimenté dans 6 centres de jour de la région montréalaise. Ce programme a été évalué et les résultats sommaires montrent que la formation a des effets sur les comportements des praticiens : ils sont plus sensibles aux problèmes de communication, se sentent mieux outillés pour y faire face et utilisent davantage de stratégies de communication. Ce programme de formation sera ensuite adapté aux besoins des intervenants d’autres établissements qui offrent des services aux aînés.

170

STRATÉGIES D'ADAPTATION À L'ARTHRITE CHRONIQUE CHEZ LES OCTOGÉNAIRES

Josée Roy, Gilbert Leclerc, 1036, rue Belvédère Sud, Sherbrooke, QC J1H 4C4 (josee.roy@usherbrooke.ca), Tel: (819) 821-1170 poste 2287, Fax: (819) 829-7141

Les traitements médicamenteux se sont avérés inefficaces jusqu'ici pour faire disparaître complètement les douleurs reliées à l'arthrite. Pour maintenir une niveau satisfaisant de qualité de vie, les personnes souffrant d'arthrite doivent avoir recours à d'autres stratégies. La présente étude avait pour but 1) d'explorer la perception et le vécu des personnes atteintes d'arthrite chronique, 2) de déterminer le type de stratégies (autres que la médication) qu'elles utilisent et 3) d'identifier les effets de ces stratégies sur le bien-être de l'individu. Une approche qualitative de type théorisation ancrée a été utilisée et des entrevues semi-structurées ont été réalisées auprès de 11 participants octogénaires. L'analyse des entrevues révèle qu'après avoir utilisé des stratégies de réduction de la douleur, les arthritiques tendent à développer de stratégies cognitives et comportementales en trois phases: l'acceptation de la situation, le recadrage positif et l'investissement dans l'action. Étant donné que la douleur est chronique, ce processus est circulaire : il doit être renouvelé chaque fois que la douleur réapparaît. Toutefois, grâce à ces stratégies, plusieurs personnes parviennent à maintenir un niveau satisfaisant de bien-être et à utiliser les capacités qu'il leur reste pour donner un sens à leur vie.

171

THE VALUE OF COMMUNITY EXPERTISE AND "KNOW HOW" IN ADDRESSING COMMUNITY TUBERCULOSIS PROBLEMS

Patrick McGowan, Mark Fitzgerald, et al., University of Victoria, Centre on Aging, Suite 102, 5007 - 47A Avenue, Delta, BC V4K 1T9 (mcgowan@dccnet.com), Tel: (604) 940-3574, Fax: (604) 940-2099

Tuberculosis in Aboriginal communities is an age-old problem that still exists today. This problem becomes even more difficult because TB infection turns into TB disease as persons grow older. The ongoing challenge is the early identification of persons with TB infection and adherence to medication treatment. The first step is to get community members to participate in TB Screening Clinics. Over the years various strategies have had limited success in achieving this objective.

In this project, seniors in two aboriginal communities worked with the researcher to develop a culturally appropriate TB Education Program. The program was then piloted in seven communities by trained lay persons. Then members of the planning committees (seniors) held a one-day workshop and trained an additional 50 program leaders. During the following six months these leaders delivered the program in their home communities. Evaluation criteria included examining the number of persons who participated in the TB Screening Clinics and the proportion of persons who accepted the medication in comparison to a control community.

A companion "qualitative" study will use community meetings and interviews to obtain information examining the effectiveness of the program. Seniors from the community planning committees have became research co-investigators in this study, and are involved in planning the appropriate research methods, carrying out the research activities, interpreting the information and disseminating the results.

172

OLDER ADULTS AND COMPLIMENTARY MEDICINE: MODELLING CHANGE ACROSS FOUR TYPES OF PRACTITIONERS

Kristine Votova, #306-120 Douglas, Victoria, BC V8V 2N9 (kristine_votova@sfu.ca), Tel: (250) 592-5441, Fax: (250) 592-5441

The recent increase in the acceptance and use of complimentary and alternative medicine (CAM) is not a new topic to the research arena. Research has shown that CAM users have different socio-demographic characteristics and health beliefs than non-users, yet little work has been done to look at the differences between different types of CAM users. The purpose of this paper is to look at the rates of CAM use for Canadian adults aged 55 and older, according to four types of CAM practitioners (chiropractic, homeopathic/naturopath, acupuncture and massage therapy) and to illustrate the illness context, enabling and predisposing characteristics of each. Hierarchical logistic regression models, using the longitudinal panel of the National Population Health Survey, will be used to compare types of CAM users to non-users over time. Overall, need (functional limitations due to pain and health status) is a better predictor of CAM use, despite the notable socio-demographic characteristics that differentiate CAM users from non-users. Generally, CAM users are not a generic group; substantial differences were found within each of the four types of CAM use studied. A discussion of how older adults choose different types of practitioners and the implications for future health care models will conclude this paper.

173

ELDER CARE: THE NEXUS FOR FAMILY, WORK AND HEALTH POLICY

Satya Brink, 4 Chemin Brink, Chelsea, QC J9B 2C6 (Brinks@attglobal.net), Tel: (819) 827-0456, Fax: (819) 827-3456

About 2 million Canadians were engaged in elder care in 1996 and over two-thirds of them were in the work force. The profile of the aging population in Canada indicates that as baby boomers age, the potential number of carers in the cohorts following are smaller. Furthermore, the shrinking labour force requires that workers, including carers, are engaged full time at their jobs. Health costs are reduced when elderly people live independently as long as possible, however, both the economy and families may pay a price. This paper examines data from the perspective of the senior, the care giver, the worker and the employer and the policy maker in order to disentangle the web of effects. It is important to do so, because the impacts could be long term, intergenerational and society-wide. The results show that unless policy makers link economic, social and health policy, the costs are shifted and the impacts are on all policy fields.

174

TRENDS IN HEALTH CARE USE AMONG SENIORS IN MANITOBA

Verena Menec, Leonard MacWilliam, Ruth-Ann Soodeen, Lori Mitchell, Manitoba Centre for Health Policy, 408-727 McDermot Ave., University of Manitoba, Winnipeg, MB, R3E 3P5 (vmenec@cpe.umanitoba.ca) Tel: (204) 789-3806, Fax: (204) 789-3910

The population of Canada is aging; what impact this will have on the health care system has become of increasing concern to policy makers. The present study was designed to shed some light on this issue by examining trends in health care use among the entire senior population (age 65+) in Manitoba (N about 150,000). Administrative data, which provide complete records of all health care contacts in Manitoba (including hospitalizations, nursing home use, and home care use) were used to examine trends over a 14-year time period (1985 to 1999). The results show that health care use has declined for some indicators. For example, the proportion of seniors who were hospitalized decreased, particularly among the oldest old (85+). Moreover, seniors remain in the community longer before being admitted to nursing homes. Individuals who are admitted to nursing homes are therefore older and frailer now than in the past. Home care use and respite care use (temporary relief for family members) correspondingly increased. These findings suggest that, as the population continues to age, there will be increasing need for community-based care (e.g., home care), as well as other community-based resources (e.g., adult day care) and relief options for informal care givers.

175

THE AGING IN MANITOBA LONGITUDINAL STUDY: THIRTY YEARS LATER

Gina Sylvestre, Betty Havens, Madelyn Hall, Aging in Manitoba Study, Department of Community Health Sciences, University of Manitoba, S110-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 (gsylves@cc.umanitoba.ca), Tel: (204) 975-7732, Fax: (204) 789-3905

The Aging in Manitoba Study conducted a follow-up survey in 2001 thus marking the thirtieth year of this longitudinal investigation. A total of 8,950 institutionalized and community-dwelling seniors were originally interviewed in 1971, 1976 or 1983, with surviving participants being re-interviewed in both 1990 and 1996. In the summer of 2001, survivors were once again re-interviewed (N=1012). All waves of the study have collected data relating to information on an older person's socio-demographic and social psychological characteristics, health and functional status, financial status, leisure activties, care and social networks, as well as use of services.

As an overview of the longitudinal study, a profile of the 2001 survivors is compared with previous study panels. Changes in the sample over time are evaluated by considering selected measures pertaining to demographic characteristics, living conditions and health and functional status. An Evaluation of changes in the sample over a thirty-year period demonstrates the particular value, relative to understanding the oldest-old, of following an aging population longitudinally. The impact of the Aging in Manitoba Study data in informing policy development for seniors will be chronicled. (This research has been supported by grants from CIHR, NHRDP, SSHRC and Manitoba Health).

176

SENIORS' UTILIZATION OF HEALTH SERVICES IN THE SECOND HALF OF THE 1990S: THREE SNAPSHOTS IN TIME AND SPACE

Mark Rosenberg, Eric Moore, Queen's University, Department of Geography, Kingston, ON K7L 3N6 (rosenber@post.queensu.ca), Tel: (613) 533-6046, Fax: (613) 533-6122

Using the National Population Health Survey (NPHS), this paper explores seniors' use of health services in the second half of the 1990s. The health services analysed are: physician use, hospital use, home care services and alternative health services. The time periods are: 1994/95, 1996/97 and 1998/99 and the geographical dimensions are by: province, urban versus rural and Canada's three largest census metropolitan areas (Montreal, Toronto and Vancouver). During the three waves of the NPHS, some changes were made to how questions were asked and how the geographic dimensions were defined other than at the provincial scale of analysis. These changes are documented and discussed with their implications for the overall analysis. We conclude by discussing what the trends over time and space mean for public policy in the coming decades.

177

GENDER DIFFERENCES IN CAREGIVERS? USE OF AND PERCEIVED BARRIERS TO COMMUNITY SUPPORT SERVICES IN ONTARIO

Bryan Smale, Department of Recreation and Leisure Studies, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1 (smale@healthy.uwaterloo.ca), Tel: (519) 888-4567 ext. 5664, Fax: (519)746-6776

Caregivers increasingly are being expected to provide support for their care receivers within the community as long as reasonably possible. In order to ensure they are sufficiently prepared to provide such support, every effort must be made to understand their experiences, articulate their needs for community support services, and enable them to overcome whatever constraints may be present to gaining access to those services. As part of Initiative 6 of Ontario's Strategy for Alzheimer Disease and Related Dementias, a comprehensive survey of community-based caregivers was undertaken to identify needs and issues with respect to community support services. In this presentation, differences between female and male caregivers are contrasted. Results from over 2,200 caregivers indicate that typically more than half of caregivers in Ontario are not making use of any of the formal community support services. Female and male caregivers show similar patterns of service use with only transportation services being used significantly more often by female caregivers. With respect to barriers, caregivers perceive the number of hours of formal support to both caregivers and care receivers as being inadequate, and that the health and social service system is difficult to navigate. Female caregivers significantly more often than males report that support for both caregivers and care receivers is inadequate, and that services are too expensive.

178

SONS WHO CARE: EXPLORING MEN'S CONTRIBUTIONS AND EXPERIENCES IN FILIAL CAREGIVING

Lori Campbell, Pat Carrier, McMaster Centre for Gerontological Studies, McMaster University, KTH 230A, 1280 Main Street West, Hamilton, ON L8S 4M4 (lcampbe@mcmail.cis.mcmaster.ca), Tel: (905) 525-9140 ext. 24943, Fax: (905) 525-4198

This research examines adult sons' contributions to filial care and the meaning caregiving has for these men. It also examines how caregiving is organized and negotiated within couples, and how it affects their marital relationship. Data for this study was collected through intensive interviews with adult sons who are married/partnered, their spouses, as well as unmarried sons. Participants were recruited through health and social service agencies and organizations in Hamilton and London, Ontario, between 1999-2002. Overall, these male caregivers tend to fall into two clusters. The first and most dominant cluster involves men who are married, employed, and living apart from their older parent. These men tend to be involved in care in more limited or 'traditional' ways. The second cluster includes men who tend to be unmarried, unemployed, and co-residing, and who are more intensely involved in a range of caregiving tasks, including 'nontraditional' domestic and personal care. These and other findings, discussed in this paper, demonstrate the complexity of the emotional, psychological, and social consequences of caregiving for these men.

179

TELEPHONE SUPPORT FOR FAMILY CAREGIVERS OF SENIORS WITH CHRONIC CONDITIONS: ESSENTIAL ELEMENTS OF SUPPORT INTERVENTIONS

Miriam Stewart, Alison Barnfather, Anne Neufeld, Lily Liu, 5-22 University Extension Centre, 8303-112 Street, Edmonton, AB T6G 2T4 (alison.barnfather@ualberta.ca), Tel: (780) 492-8022, Fax: (780) 492-8045

Accessible support programs can expand coping repertoires and improve health outcomes for families living with a relative with a progressively deteriorating condition. In this paper we describe elements of a one-to-one support intervention evaluated in a RCT. Experienced family caregivers (peer helpers) provided support via the telephone to new vulnerable family caregivers of seniors with stroke or Alzheimer disease. Forty trained intervention agents (13 health professionals and 27 peer helpers) supported 126 family caregivers in Edmonton, Calgary and Central Alberta. Qualitative data documenting the intervention included: peer helper field notes, helper and caregiver telephone discussions, caregiver responses to open ended questions in pre/post/delayed post-test interviews, monthly 'check in' telephone sessions with project staff, and peer helper exit interviews. All interviews were audiotaped and transcribed. Thematic content analysis revealed that peer helpers and family caregivers identified varied processes such as social comparison (validating and normalizing experiences), social exchange (reciprocity), and social learning (new knowledge from peers) as key elements of the intervention. Further, caregivers perceived that they received informational, affirmational, and emotional support that overcame current support deficits in their natural networks. The processes documented here facilitate replication in future research and have potential for application to programs, services and policies.

Funding: Alberta Heritage Foundation for Medical Research, Capital Care Group.

180

DIFFERENTIAL MEDICAL CARE USAGE: CAREGIVERS, INTERVENTIONS AND CONTROLS

Maureen Gorman, Peggy Ruyak, Kathy MacPherson, 5909 Veterans' Memorial Lane, AJLB QEII HSC, Halifax, NS B3H 2E2 (maureen.gorman@cdha.nshealth.ca), Tel: (902) 473-8617, Fax: (902) 473-4873

As the number of Canadians with dementia increases so will the number of informal caregivers. Unfortunately, these invaluable resources can become secondary victims of dementia as their health deteriorates from extended caregiving (e.g., depression, anxiety, psychotropic medication use and poorer perceived health than their peers). However, a clear association between caregiving and a decline in physical health has been unsupported. Problems include the lack of longitudinal studies and baseline measures of physical health prior to caregiving. This pilot study was designed to objectively and longitudinally address both of these issues by analysing information from the Nova Scotia Population Health Research Unit databases on hospital, ER and doctor visits and medications prescriptions, across a 6-year period for 57 caregivers and 58 controls matched on age, sex, access to services and baseline health care utilization. Caregivers were further broken down by participation in support groups, individual counselling, and no intervention. Our hypothesis that a significant increase in the utilization of medical services for the caregiver group with respect to their baseline use and to the control group was supported. Support group attenders showed significantly less medical care usage (than individual counselling) one year following diagnosis. Results will be discussed in terms of impact on the medical system and on clinical service delivery.

181

« COMÉDIEN » OU « PÈLERIN »? REPRÉSENTATIONS SOCIALES DE LA VIEILLESSE

Verena Haldemann, Dépt. De sociologue, Université de Moncton, Moncton, NB E1A 3E9 (haldemv@umoncton.ca)

A l'occasion d'une étude sur l'utilisation de services sociosanitaires par deux groupes ethnoculturels à Montréal, nous avons étudié les représentations sociales que construisent ces aînés de la vieillesse. L'analyse montre qu'ils se réfèrent à deux idéaltypes de rapport à la vieillesse, soit celui du "comédien" et celui du "pelèrin". Les aînés se positionnent vis-à-vis de ces modèles en fonction de leur situation personnelle et de leurs ressources. Leur rapport réel à la vieillesse est constamment remodelé et résulte de la marge de manoeuvre qu'ils ont pour se rapprocher de l'un ou de l'autre. Cette étude corrobore en partie la proposition selon laquelle les sociétés occidentales auraient tendance à imposer un modèle de vieillesse qui suppose un corps sans âge (ageless body) et un esprit sans histoire (timeless mind).

182

BEST PRACTICES IN ELDERLY MENTAL HEALTH CARE: MODEL AND PRACTICE

Elizabeth Lockhart, Penny MacCourt, Martha Donnelly, 467 Downey Road, North Saanich, BC V8L 5M6 (betsylockhart@hotmail.com), Tel: (250) 655-3190, Fax: (250) 655-3149

What are “best practices”? How should they be developed? What are the “best practices” in mental health care of elderly people? These questions are explored with reference to the development of the "Guidelines for Elderly Mental Health Care Planning for Best Practices for Health Authorities" in British Columbia. The essential elements of “best practices” are identified, regardless of the substantive issues or the field to which they are connected, and the process criteria for developing models or guidelines for best practices are also examined. The BC "Guidelines for Elderly Mental Health Care Planning" document is analyzed as an example both of a “best practices” and of a process for development of “best practices”. As well as serving as a model in itself, the "Guidelines for Elderly Mental Health Care for Best Practices for Health Authorities" document provides specific information directed to health authority decision makers about the older population requiring mental health care and the service system that should be in place to provide effective and dignified care.

183

ATTRACTING, DEVELOPING, NURTURING, AND RETAINING SENIOR "SUPER-VOLUNTEERS" IN FORMAL HEALTH CARE ORGANIZATIONS

Patrick McGowan, Faye White, Val Upton, Brenda Reynolds, Centre on Aging - Ladner Office, University of Victoria, Suite 102, 5007 - 47A Avenue, Delta, BC V4K 1T9 (mcgowan@dccnet.com), Tel: (604) 940-3574, Fax: (604) 940- 2099

The objective of this study was to investigate reasons why seniors from five ethnic communities engaged in volunteer activities within the formal health care system. In this study, volunteers were defined as persons who had made substantial contributions to their community through many years of extensive volunteer activity. To assist in developing the interview questions, investigators conducted focus group meetings with each ethnic group. The information elicited from these meetings assisted the team to develop specific questions which focused on each of the four categories of factors which contribute to behaviour as specified in the PRECEDE-PROCEED health promotion planning framework (i.e., Predisposing, Reinforcing, Enabling, and Environmental).

In-depth interviews were conducted with 10 senior volunteers from five ethnic groups (Chinese, South Asian, Aboriginal, Phillipine, and Euro-Canadian) for a total of 50 subjects. Interviews were taped, transcribed and then analysed with the assistance of NUDIST software. When the analysis was completed the team developed policies and preceedures that volunteer organizations could implement that would attract, develop, nurture, and retain "super-volunteers".

This presentation will summarize the interview findings and outline the policies and proceedures that were recommended to volunteer health organizations. This research was funded by the Canadian Centre for Philanthropy.

184

APPROCHES ADAPTÉES AUX TROUBLES COGNITIFS ET AUX TROUBLES DE LA COMMUNICATION

Stéphanie Caillé, Suzanne Généreux, Institut universitaire de gériatrie de Montréal, 4565 chemin de la Reine-Marie, Montréal, QC (ortophoniste.iugm@ssss.gouv.qc.ca), Tel: (514) 340-2800 poste 4106, Fax: (514) 340-2828

En présence d’une altération du fonctionnement cérébral, que ce soit dans un contexte de maladie dégénérative (démence de type Alzheimer, démence vasculaire, maladie de Parkinson par exemple) ou d’un événement aigu (tel un accident cérébro-vasculaire), les patients et notamment la clientèle gériatrique, peuvent présenter divers troubles au niveau de la cognition et de la communication.

Ces troubles peuvent en outre toucher le langage oral et écrit (aphasie), la parole (dysarthrie), la perception, l’habileté à effectuer des gestes, la mémoire à court terme et les ressources attentionnelles, la mémoire à long terme et les capacités d’apprentissage, les fonctions exécutives (planification, organisation, flexibilité mentale et capacités d’inhibition) et les capacités intellectuelles (jugement, raisonnement, capacités d’abstraction).

Les différentes pathologies que peuvent présenter les personnes âgées entraînent des profils d’atteintes différents. Ainsi, les tableaux correspondant à une maladie dégénérative corticale (DTA) ou sous-corticale (Parkinson) ou faisant suite à une lésion vasculaire (corticale ou sous-corticale, gauche, droite, frontale) montrent des déficits et des capacités préservées qui leur sont propres.

Ainsi, les approches à adopter et les moyens compensatoires pour pallier les difficultés cognitives et de la communication doivent tenir compte des particularités de chaque patient, des degrés d’atteintes et des capacités préservées.

Par exemple, on peut considérer les attitudes et le niveau de langage à adopter, l’utilisation de tableaux de communication, d’appareils électroniques compensatoires, de cahier-mémoires, d’agendas et de calendriers adaptés, les approches thérapeutiques à privilégier afin de modifier des comportements problématiques, de favoriser des apprentissages ou de limiter l’impact de troubles cognitifs au quotidien, etc.

185

GROUPE DE SOUTIEN DANS UN PROCESSUS DE CHANGEMENT EN CHSLD

Monique Labrecque, Anne Marise Lavoie, Lisette Hay, Université Laurentienne, École des sciences infirmières, 935 Chemin du Lac Ramsey, Sudbury, ON P3E 2C6 (amlavoie@nickel.laurentian.ca), Tel: (705) 675-1151 poste 3831, Fax: (705) 675-4861

Devant un changement majeur dans une résidence pour personnes âgées, la création d'une série de groupes de soutien a permis de pour a contribué à gérer les conflits interpersonnels, de pour à ajuster graduellement les paramètres de la réorganisation des services à l'alimentation et de pour à recentrer les interventions de soin sur les besoins alimentaires des résidents. Pour réaliser l'étude, la méthodologie de recherche-action fut utilisée. Par son processus évolutif, la recherche-action soutenait l'émergence, l'implantation voire même la consolidation ou la disparition des groupes de soutien. Le premier groupe de soutien servit de modèle; en effet, outre la création d'autres groupes, il permit de former les animateurs des groupes subséquents. À la suite du changement, trois groupes ont persisté en raison de leur rôle à maintenir la qualité de vie des résidents, les comités de dysphagie, des menus et de la coordination de l'alimentation entre l'équipe soignante et le personnel du service alimentaire.

186

ARE WE AS CARING AS WE SAY WE ARE? HOW TO MOVE FROM WORDS TO ACTION IN ADDRESSING THE STIGMA OF ADDICTIONS AMONG OLDER ADULTS

Jennifer Barr, Eileen McKee-Kristof, Lise Therrien, Charmaine Spencer, Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC V6B 5K3 (cspencer@shaw.ca), Tel: (604) 291-5047, Fax: (604) 291-5066

Many previously sensitive matters (such as divorce, mental disability, and diseases such as cancer) have become relatively open matters in recent decades. In marked contrast, some (such as alcohol misuse, mental illness or AIDS) remain highly stigmatized issues, and can still lead to strong negative responses from people. Health care providers, family and other key people can react in ways that treat older adults as less worthy of respect and assistance. This roundtable will challenge people to consider ways to move away from the obvious (and not so obvious) discriminatory practices that can result.

The four panellists (two counsellors, a community developer, and a researcher-lawyer) explore the many ways in which older adults with alcohol problems are refused access to needed services and can face other significant barriers. Drawing from practice and research, they highlight some reasons why this stigmatization occurs throughout Canada in both community and institutional settings; offer examples of underlying assumptions and attitudes that service providers and family commonly have about the problem; and identify the many significant ways that these attitudes and responses affect older adults lives.

They invite the audience to explore how alcohol adds another dimension to the reality of how helping professions currently respond to complex and challenging clients. They will also discuss stigmatization in the context of the need for education and advocacy at several levels - including with the client (increasing the person's sense of self worth), the systems around the client, the person's environment and at a policy level.

187

RESPONDING TO SENIORS WITH MENTAL HEALTH AND SUBSTANCE MISUSE ISSUES: TRAINING 'FIRST CONTACT' AND HOME SUPPORT STAFF

Randi Fine, 609 Vesta Drive, Toronto, ON M5N 1J2 (rfine@istar.ca), Tel: (416) 782-8527, Fax: (416) 782-1601

Recognizing the rapidly changing demographics in Canadian society in an era of fiscal restraints, it is clear that both immediate and long term planning is required to sustain the premise of maintaining our more frail seniors in the community. Considering the incidence of dementia, depression, chronic mental illness and substance misuse, and accepting that direct service providers in the community often receive little formal training in responding to seniors with mental health and/or addiction-related issues, we propose an immediate response through targeted education.

An innovative program to address the concerns of front-line/ first contact staff in home care and community agency settings has modeled this approach through a series sponsored by the Seniors' Working Group of the Community Health Network of West Toronto. The format and content of the education/ information opportunities were determined using information gathered through focus groups and from local service providers. The sessions were jointly planned and delivered by pooling the expertise and resources of local organizations and positive feedback has been received from both front-line workers and their managers.

In this workshop we will reflect on the lessons learned and the model developed through a collaborative effort to plan and deliver an orientation to seniors mental health and substance abuse issues for non-expert front line staff of community health and social service agencies. We will provide the context, explain the rationale, and demonstrate some of the resources developed and teaching techniques that have resulted in increased comfort levels of individual workers and their enhanced ability to respond with respect and compassion to seniors exhibiting a wide range of mystifying behaviours. Finally, we will share our findings and recommendations and suggest approaches for replicating this program in other communities and settings.

188

DU RÉPIT POUR LES PERSONNES-SOUTIEN DE PERSONNES ATTEINTES DE LA MALADIE D'ALZHEIMER

Françoise Gloutnay, Maria Mastroianni, 341 Deuxième avenue, Verdun, QC, H4G 2W4 (fgloutnay@hermes.usherb.ca) Tel: (514) 761-2535, Fax: (514) 639-0666

Un projet pilote au C.L.S.C. du Vieux La Chine, issus des besoins du milieu et d'une pré-enquête de type focus group auprès de personnes-soutien et d'intervenants oeuvrant avec des groupes d'aidants, vise 1) à diminuer le fardeau des personnes-soutien en augmentant leur soutien social, leur bien-être,leur estime de soi et leur sentiment de contrôle des impacts de la maladie de leur proche sur leur vie quotidienne, 2) à permettre aux personnes atteintes de la maladie d'Alzheimer de développer des relations stables et de confiance avec une auxiliaire-familiale,une bénévole et deux autres personnes atteintes ainsi que leurs personnes-soutien. Une triade de personnes atteintes est formée et c'est à tour de rôle que leur personne-soutien reçoit les deux autres personnes atteintes à son domicile. Ainsi, deux personnes-soutien sont libres pour quelques heures. Ces rencontres sont encadrées par une auxiliaire-familiale et une bénévole formées à cet effet. Nous décrirons notre programme, son originalité, ses objectifs, son implantation et les mesures évaluatives prévues. Nous insisterons sur les moyens innovateurs à mettre en oeuvre pour mieux répondre aux besoins de répit des personnes-soutien.

189

UNE INTERVENTION PSYCHO-ÉDUCATIVE POUR AIDANTS DE PERSONNES ÂGÉES ATTEINTES DE DÉMENCE DE TYPE ALZHEIMER: ANALYSE DES PROCESSUS

Jean-Pierre Lavoie, Francine Ducharme, Réjean Hébert, Louise Lévesque, Direction de la Santé Publique de Montréal-Centre, Écologie Humaine et Sociale, 1301, rue Sherbrooke Est, Monteral, QC H2L 1M3 (jplavoie@santepub-mtl.qc.ca), Tel: (514) 528-2400 poste 3370, Fax: (514) 528-2426

Une intervention psycho-éducative de groupe destinée aux aidants de personnes atteintes de démence a été développée et testée auprès de 158 aidants dans le cadre d’une étude multicentrique au Québec. Basée sur un cadre théorique stress-coping, cette intervention cible les comportements dérangeants de la personne atteinte. Elle s’est révélée efficace à réduire les réactions négatives des aidants à ces comportements. Une analyse des processus d’intervention, réalisée auprès d’un sous-échantillon de 30 aidants, fait l’objet de cette présentation. Des entrevues semi-dirigées, d’une durée moyenne de 40 minutes, ont été conduites, enregistrées et transcrites. Alors que plusieurs participants soulignent l’importance des processus éducatifs, notamment des informations reçues, des apprentissages sur le plan des stratégies utilisées pour composer avec les comportements difficiles et des exercices demandés, d’autres rapportent plutôt des processus associés aux groupes d’entraide, soit le soutien émotif mutuel et la verbalisation des émotions. Ces processus ont généré des effets différentiels : ceux rapportant des processus éducatifs semblent présenter les effets psycho-éducatifs attendus du programme, alors que les autres participants y trouvent des effets non attendus. Certaines caractéristiques des participants, le niveau de scolarité entre autres, sont liés aux processus rapportés. Cette analyse qualitative permet de mieux comprendre les effets quantitatifs du programme.

190

THE PREVALENCE OF DELIRIUM AMONG ELDERLY PATIENTS IN ACUTE-CARE SETTINGS

Carrie McAiney, Christopher Patterson, Cathy Reis, Esther Coker, Pat Ford, Anne Pizzacalla, Lori Pokoradi, Jackie Turner, Anne Tassonyi , McMaster University, 1200 Main Street West, Chedoke Campus, Bldg 74, Hamilton, ON L8N 3Z5 (mcaineyc@mcmaster.ca), Tel: (905) 521-2100 ext 74665, Fax: (905) 318-6556

Delirium among elderly patients in acute-care settings has been associated with increased length of stay, higher costs, excess morbidity and mortality, and greater burden of care. Despite these effects, it is often under-recognized by staff. In order to determine the extent of this problem in Hamilton, Ontario, and the corresponding need for education among hospital staff, a point prevalence study was undertaken. The two acute hospital corporations within Hamilton, representing five acute-care sites, participated in a Delirium Prevalence Day in Fall 2001. Approximately 100 staff volunteers from the participating sites were recruited and trained. The Confusion Assessment Method along with the Standardized Mini-Mental Status Examination were used to detect delirium among all elderly patients on non-critical care units. The prevalence of delirium was found to be 10.5% among the 554 patients assessed. The presentation will include a more detailed discussion of the results, as well as their implications in terms of the assessment and management of elderly patients in acute care settings.

This project was possible because of financial support received from the Specialized Health Care for the Elderly Regional Program (SHCERP), one of the five Regional Geriatric Programs in Ontario.

191

INFORMATION EXCHANGE IN COMMUNITY-BASED DEMENTIA CARE: PROFESSIONAL AND LAY PERSPECTIVES

Neil Drummond, Lorraine E. Ferris, Judith Globerman, Philip C. Hebert, Dorothy M. Pringle, Carole A. Cohen, Room F307, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5 (carole.cohen@swchsc.on.ca), Tel: (416) 480-4663, Fax: (416) 480-5889

Dementia care is complex and usually involves a variety of professional and lay individuals over the course of many years. Community-based care is particularly challenging as it is provided by many different professionals working at different health and social service agencies. Information exchange among these professionals is essential for optimum care to be provided to an individual with dementia and their family. This research study sought to investigate the incentives and barriers to the exchange of personal health information in community-based dementia care. Focus groups were held with groups of professionals who provide community-based care in Toronto. Nurses, occupational therapists, social workers, health care case managers, family and specialty physicians participated in seperate focus groups. A focus group meeting was arranged with community-residing individuals with dementia and one-to-one interviews were conducted with their identified caregivers. Professionals identified 5 key themes: 1) lack of formal rules; 2) complexity of dementia cases; 3) level of risk; 4) benefit to client and 5) teamwork. The lay group identified 3 key themes: 1) control; 2) family and 3) care teams. The implications of these findings will be discussed in light of the current trends in community-based care.

This study was funded by the Alzheimer Society Research Program, a joint initiative of the Alzheimer Society of Canada and its provincial and local affiliates.

192

GAMBLING AND SENIORS (WESTERN AND NORTHERN REGIONS): THE FINAL REPORT ON THE SURVEY OF KEY INFORMANTS - ADDICTIONS FOUNDATION OF MANITOBA

Ronalee Maynard, Deb Kostyk, 510 Frederick Street, Brandon, MB R7A 6Z4 (rmaynard@afm.mb.ca), Tel: (204) 729-3849, Fax: (204) 729-3844

This document summarizes the findings of the Seniors and Gambling Key Informant Survey (Western and Northern regions) developed by the Addictions Foundation of Manitoba (AFM). The survey was administered to community professionals who have extensive experience working with seniors and a good understanding of the general needs and issues of these individuals. The purpose of the survey was two-fold 1) to assess the impact of gambling on seniors 2) to gain insight as to how the AFM could effectively offer gambling services to seniors. The findings are summarized under four primary headings:

i) Demographics

ii) Seniors Gambling

iii) AFM - Awareness and Rehabilitation

iv) AFM - Education, Prevention and Significance

193

ADDICTION TREATMENT IN A LONG-TERM CARE FACILITY

Eileen McKee, COPA, 27 Roncesvalles Avenue, Suite 407, Toronto, ON M6R 3B2 (copa@interlog.com), Tel: (416) 516-2982 ext 224, Fax: (416) 516-2984

In order to complement its policy for staff to address alcohol issues, a long-term care facility in Toronto and COPA collaborated on the long-term goal of improving the quality of life of the residents who had a su