Audrey A. Blandford

Informal and Formal Care: Exploring the Complementarity

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

Hospitalizations at the End of Life Among Long-Term Care Residents

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

Community-based services for the taking but few takers: Reasons for nonuse

This study examined reasons for not using nine community-based services and characteristics associated with these reasons among a sample of 293 older person–caregiver dyads in a Canadian province. The most frequent reasons were that the older persons health did not necessitate use, family/friends provided assistance, and the caregiver was unaware of the service. Cognitive impairment was associated with not using homemaker and/or cleaning services, in-home nursing services, and home-delivered meals as family/friends provided assistance; higher caregiver burden also emerged as significant for these services and personal care services. Male caregivers and caregivers with less education were more likely to be unaware of the availability of day centers, day hospitals, and formal respite services. Implications for future research and practice are highlighted.

Indicators of Home Care Use in Urban and Rural Settings

Cette étude emploie un modèle longitudinal pour l’examen des différences rurales-urbaines en matière d’utilisation de services de soins à domicile au fil du temps, et s’inspire des données de l’Étude sur la santé et le vieillissement au Manitoba (ESVM). Des paramètres ont été recueillis en 1991-92 sur des adultes de 65 ans et plus, vivant dans la communauté et ne souffrant d’aucun trouble cognitif, qui ne reçoivent pas de services de soins à domicile dans la province du Manitoba, Canada (n = 855). Le lieu de résidence était classé soit petite ville urbaine ou zone principalement rurale. Un suivi de cinq ans a permis de déterminer l’utilisation subséquente de soins à domicile. Les résidents urbains étaient plus susceptibles de recevoir des soins à domicile que ceux des petites villes ou des zones principalement rurales. Les caractéristiques associées à l’usage étaient différentes selon le lieu de résidence, à l’exception du fonctionnement physique de base et des changements au plan du fonctionnement physique qui ressortaient constamment en raison de leur importance. L’orientation de la recherche ultérieure fait l’objet de discussion. This study employs a longitudinal design to examine rural–urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were collected in 1991/1992. place of residence was categorized as urban/small-town zone or predominantly rural area. A 5-year follow-up determined subsequent home care use. Urban residents were more likely to receive home care than those in small-town zones or predominantly rural areas. Characteristics associated with use differed according to place of residence, with the exception of baseline physical functioning and changes in physical functioning that consistently emerged as significant. Directions for future research are discussed.

Cognitively Impaired Older Adults: Risk Profiles for Institutionalization

BACKGROUND This study focused on the identification of risk profiles for institutionalization among older adults diagnosed with cognitive impairment-not dementia or dementia in 1991/92 and subsequent institutionalization in the following 5-year period. METHODS Data were from a sample of 123 individuals aged 65+ and their unpaid caregivers in Manitoba, Canada. Cluster analysis was conducted using baseline characteristics of age, cognition, disruptive behaviors, ADLs/IADLs, use of formal in-home services, and level of caregiver burden. RESULTS Three distinct groups emerged (high risk [n = 12], medium risk [n = 40], and low risk [n = 71]). The high-risk group had the poorest cognitive scores, were the most likely to exhibit disruptive behaviors, were the most likely to need assistance with ADLs and IADLs, and had the highest level of burden among their caregivers. Follow-up of the groups validated the risk profiles; 75% of the high-risk group were institutionalized within the next 5 years, compared to 45% of the medium-risk group and 21% of the low-risk group. DISCUSSION The risk profiles highlight the diversity among individuals with cognitive impairment and the opportunity for differential targeting of services for the distinct needs of each group.

Impact of Residence on Prevalence and Intensity of Prescription Drug Use among Older Adults

Background: Higher levels of morbidity among older adults result in greater need for pharmaceutical products and pharmacy services compared with the need in the general population. Rural residents reportedly have reduced access to healthcare services secondary to transportation difficulties, a limited supply of healthcare workers and facilities, and financial constraints. Objective: To examine differences in the prevalence and intensity of prescription pharmaceutical use among urban and rural older adults in Manitoba, Canada. Methods: Participant data from the 1996/1997 Manitoba Study of Health and Aging were linked to pharmaceutical claims data recorded in Manitoba Healths Drug Program Information Network. The effect of residence on the prevalence and intensity of drug use was determined, in addition to the effects of other sociodemographic characteristics, measures of health, and health service utilization. Results: The prevalence of prescription pharmaceutical use did not differ between urban and rural residents (90.6% vs 89.5%, respectively; p = 0.60). Users of home-care services (OR 1.93; 95% CI 1.09 to 3.39), those who perceived their income as adequate (2.38; 95% CI 1.09 to 5.17), and those with a higher number of chronic health problems (1.42; 95% CI 1.26 to 1.62) were significantly more likely to access prescription medications. Rural and urban residents were equally likely to be high users of prescription drugs (21.3% vs 20.0%, respectively; p = 0.64). Conclusions: Poor health status is associated with a higher prevalence and intensity of use of prescription drugs among older Manitobans. Rural residence is not a barrier to receipt of prescription pharmaceuticals.

Subjective Well-being Among Native and Non-Native Elderly Persons: Do Differences Exist? *

This paper examines subjective well-being among Native and non-Native elderly persons. Though much has been written about Natives as a disadvantaged group in terms of income, education and health, studies which examine the subjective well-being of Natives are virtually non-existent. Subjective well-being is measured as general satisfaction with life and loneliness in this paper. Independent variables include demographic, health and social indicators. Natives have significantly lower life satisfaction than non-Natives. However, logistic regression analyses indicate that health and social factors are the major predictors of quality of life. While Natives experience a lower quality of life, it is accounted for by their worse health and disadvantaged social circumstances and is not attributable to being Native per se.