There are at present two inconsistencies with respect to the sharing of personal health information (PHI) among health care professionals caring for a patient whom the information concerns. First, there is an inconsistency between what is in theory the ethics and law governing the confidentiality and privacy of this information—it may only be disclosed with informed consent—and what is the actual practice of health care professionals—they share it without such consent. Second, there is an inconsistency between what ethics and law demand in theory and what all parties want: They all approve of the current practice. Ethics and law can be brought into line with what is needed to act in the patient's best interests and with what people want, without opening up any serious potential for abuse of privacy and confidentiality, by establishing a safeguarded, provision-of-care exception that allows co-caring health care professionals to share patients' PHI. The requirements for a system establishing such safeguards are proposed. The basic governing presumption is respect for the person and for rights to autonomy, self-determination, privacy, and confidentiality. Therefore, disclosure may only be made with the informed consent of the competent person to whom the information pertains, unless a defence of necessity applies. Where there is doubt about someone's competence, there should likewise be doubt about disclosure without that person's informed consent. Where the person is incompetent, such a disclosure can be made to the patient's substitute decision makers, most often the family, if that is necessary for the care of the patient and in the patient's best interests. To the extent possible, consistent with the best interests of the patient, the wishes of incompetent people should be respected.

Michèle Charpentier's book explores the idea of government's sharing, with private and community resources, the responsibility for services for the frail elderly. Charpentier addresses the issue of the emergence of private residences, within the context of the evolution of the Quebec government. This book traces the history of Quebec policies on support of the frail elderly, discusses the social, ethical, and legal stakes involved in the development of private residences, and presents the points of view of different stakeholders affected by this dilemma. Charpentier's book proves to be both a rich and nuanced reflection on the legitimacy of the government's intervention, as well as on the opportunities for development available to the government, in the housing sector in particular, and on a broader scale, in the general area of services for the fragile elderly.

Developments in information technology and the ongoing restructuring of health services to increase provision in community settings militate in favour of a streamlining of communications and the exchange of information about patients among health and social care providers. Yet the principles of confidentiality and privacy appear to inhibit this process. In order to explore the practical, ethical, and legal imperatives attendant upon personal health information exchange, we conducted a series of interviews with professional care providers, persons with early-stage dementia, and their family caregivers. The findings indicate some degree of discordance. Professionals reported valuing disclosure both to colleagues and family caregivers on the basis of its being in the patients' best interests. Patients also valued inter-professional exchange, but sought strong control over disclosure to family members. Family caregivers valued being kept informed of the patient's condition, even without the latter's consent. Implications for research and policy are discussed.

Cet ouvrage nous aide à mieux comprendre les relations complexes entre la santé physique et la dépression au sein de la population âgée. Les parties les plus intéressantes du livre s'attachent à discuter de l'influence de variables potentiellement responsables de la médiation des liens bidirectionnels entre la santé physique et la dépression chez les aîné(e)s, et des implications de ces découvertes pour une meilleure identification et des traitements plus adéquats de la dépression parmi les patient(e)s médicaux(ales) âgé(e)s. Malgré une organisation des chapitres qui laisse à désirer une perspective nettement médicale sur le sujet, cet ouvrage représente une contribution importante à notre compréhension de la dépression à l'âge adulte avancé.

The purpose of this phenomenological study was to explore the everyday experience of community-dwelling elders, with particular attention to seniors' perceptions of safety, fear of falling, independence, and quality of life. We also aimed to identify contextual factors that influence the health of elders who had fallen and/or had a fear of falling. Data from in-depth interviews with a purposeful sample (n = 9) of elders were analysed using interpretative analysis procedures. Both individual and team analysis was undertaken until interpretations of the experiences of the participants were inductively developed and crystallized into a holistic interpretation of the participants' shared experience. The holistic experience was comprised of two opposing, dynamic life forces: exercising precaution and striving for independence. Within each life force, participants used five major strategies that simultaneously constrained and expanded their life space. Health-promoting practice and policy implications, as well as areas for further research, are discussed.

This article provides an introduction to the special volume on research related to issues of social isolation and loneliness for older people. It discusses some key concepts and provides a brief overview of the articles included in the volume.

This study compared the changes in some bio-psychosocial variables (functional independence, nutritional risk, pain, balance and walking, grip strength, general well-being, psychiatric profile, perception of social support, leisure satisfaction, and caregivers' feeling of burden) in four categories of clients during their program at a geriatric day hospital (GDH). The study also evaluated whether or not improvements, if any, were maintained 3 months after discharge. One-hundred-and-fifty-one people, categorized by primary reason for admission, were assessed at the GDH with reliable and valid tools, at admission and at discharge. Three months after discharge, they were reassessed with the same tools. Overall, two categories of clients, stroke / neurological diseases and musculoskeletal disorders / amputations, improved the most. For the gait disorders and falls group, only the functional independence score improved, but not at a clinically significant level. Finally, clients in the cognitive function disorders / psychopathologies group improved the most on their well-being scores and caregivers' burden decreased the most. All gains were maintained up to 3 months after discharge, except for leisure satisfaction. With the exception of clients who attended the GDH because of gait disorders and falls, the improvements and maintenance achieved in each category occurred in the domains where improvement had been hoped for, because of the particular disabilities in question and because of the nature of the GDH services offered.

Il est grand temps, essentiel en fait, que nous accordions toute l'importance qu'il mérite au témoignage des personnes atteintes de démence. Cet ouvrage, s'appuyant sur le point de vue des personnes qui vivent avec la maladie, vient enrichir la masse croissante de connaissances sur la démence. Pour répondre à la question « Comment vit-on chaque jour avec une maladie mentale comme la maladie d'Alzheimer (MA)? », l'auteure choisit de donner la parole à des personnes atteintes de démence. L'ouvrage reconnaît la contribution de ces personnes au corpus de connaissances sur la démence, il relate leur expérience et dénonce les stigmates associés à la maladie: à savoir que ces personnes sont des coquilles vides qui représentent un fardeau pour la société. Au contraire, nous dit l'auteure, ce sont elles les « vrais experts », et nous devons les écouter. Cet ouvrage est un outil indispensable pour tous les fournisseurs de services de santé et ceux qui s'occupent de personnes atteintes de démence, mais aussi pour les enseignants, les chercheurs, les décideurs et le personnel des sociétés d'Alzheimer. Ceux qui vivent avec la démence auront le sentiment d'être compris en lisant le récit d'autres personnes dans leur situation. L'ouvrage apporte une contribution précieuse à la recherche sur la démence, il nous fait mieux comprendre la maladie du point de vue des « experts » – ceux qui vivent avec la démence.

Urinary incontinence is common in the elderly. The epidemiology of fecal and double (urinary and fecal) incontinence is less known. The Canadian Study of Health and Aging (CSHA) is a national study of elderly living in the community at baseline (n = 8,949) and interviewed in 1991–1992, 1996, and 2001. Using data from the CSHA, we report the prevalence of urinary, fecal, and double incontinence in each wave and the cumulative incidence between waves and investigate the predictors of urinary and fecal incontinence. Urinary incontinence increased rapidly in old age, being almost twice as high in women as in men. Fecal and double incontinence were less common, but also increased rapidly with age. In women, parity showed a positive relationship with (prevalent) urinary incontinence. In men, diabetes was a risk factor for urinary and fecal incontinence. We conclude that urinary, fecal, and double incontinence increase rapidly with age and that inquiry about incontinence should be part of routine medical and nursing assessment of all elderly.

The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year period (T1, T2, T3); 482 people aged 75 years or older from 2 communities, 272 in the experimental and 210 in the control group, were followed. Analyses were conducted using parametric and non-parametric statistics, a generalized linear model, and Cox regression for survival analysis. A declining trend in institutionalization was observed and the desire to be institutionalized was lower in the study group. When absence of deterioration on follow-up was analysed in terms of the level of autonomy, the ISD network produced positive effects on the frailer clientele at T1, effects that tended to be maintained at T2. In regard to caregivers' burden, the ISD network seemed to have been effective, with caregivers' burden being less at T1 and T2. The ISD network did not have a marked effect on the utilization of services. The ISD network did, in fact, produce some effects that should be seen as important for the elderly population.

The Bangor Longitudinal Study of Ageing (BLSA), conducted in rural Wales from 1979 to 1999, followed a cohort of survivors from more than 500 people over 20 years. Using both quantitative and qualitative data from the study, the factors associated with increases and decreases in loneliness and social isolation were identified. The study was based on a population sample and survivors were followed up every 4 years. From 1983 to 1987, 30 people aged 75 and over in 1979 were studied intensively. The customary measure of loneliness was used, as well as an aggregate measure devised by the research team. Social isolation was similarly measured, using an aggregate measure. Respondents were assessed as demonstrating low, moderate, or high levels of loneliness or isolation. Subsequently, statistical models of loneliness and social isolation were developed. Some respondents were assessed as not experiencing social isolation or loneliness during the study. Others showed changes in levels. In this article, the data are explored, seeking factors associated with changes in social isolation and loneliness. Outcome measures of these two variables of interest are compared with items from the aggregate measures and other identifiable intervening variables. The article discusses which change variables contribute most to levels of isolation and loneliness and result in different combinations of these two outcomes. Implications for policy and practice are discussed.

The objective of this study was to describe the incidence, type, risk factors, and sequelae of fractures experienced by community-dwelling elderly Canadians. Data are from the Canadian Study of Health and Aging (CSHA), a longitudinal cohort study, collected in three waves: baseline (1991), wave 2 (1996), and wave 3 (2001). In CSHA-2 (1996), fractures were reported by 3.7 per cent of men and 7.5 per cent of women; in CSHA-3 (2001), by 2.9 per cent of men and 7.3 per cent of women. The distribution of fracture types was similar for men and women. Risk factors for women were increased age, history of fracture, and regular alcohol use; for men, stroke, arthritis, and lack of independent bathing. Walkers or wheelchairs were needed by over 30 per cent of those with any lower body fracture. One third of subjects with any fracture and over 50 per cent with femur fractures reported moderate or severe pain. It is concluded that elderly Canadians are at high risk for fractures, and older women are at most risk. Pain and mobility problems were common sequelae. The need for primary and secondary prevention of these age-related events is paramount.

This paper focuses on the role of religion and ethnicity in providing social support for elderly Dutch Canadian Catholic and Calvinist parents and in establishing ethno-religious retirement and long-term care facilities. The data come from a 1995 survey of elderly Dutch Canadian immigrants (N = 79) and their adult children (N = 364) examining intraethnic differences in ethnic persistence and parent care. Continuity theory provides the theoretical framework for this study. In the last few decades, second generation Dutch Calvinist immigrants have been busy establishing retirement and long-term care facilities to look after the needs of the older Calvinist generation. Dutch Catholic immigrants have established very few retirement and nursing homes for their elderly members. Ethnic and religious differences influence the kind of support available to elderly Dutch Canadians.

The purpose of this paper was to identify predictors of social isolation and loneliness for very old rural and urban adults. With data from the 1996 Aging in Manitoba Study (N = 1,868; age range 72–104), separate multiple regression models were constructed for rural and urban sub-samples, using the life space index (LSI) to measure social isolation as one outcome, and a loneliness index created by the authors from a combination of items to measure loneliness as a second outcome. Different factors were found to predict the outcomes for the two sub-samples. The models with isolation as the outcome produced five predictors for the rural sub-sample and three for the urban sub-sample. Only living alone was the same for both groups. The models with loneliness as the outcome produced five predictors for the rural sub-sample and two for the urban sub-sample, again with only one factor in common – four or more chronic illnesses. We conclude that health and social factors are important predictors of social isolation and loneliness, and sensitivity to these factors may improve the experience of older adults.

Narrative approaches in the field of aging are receiving increasing attention by theorists and practitioners alike. This article draws on recent thinking in narrative gerontology to look at three aspects of aging on which a narrative perspective can shed further light. In relation to the temporal aspects, the notion of storytime is examined. Concerning its poetical aspects, the article considers the stages, styles, genres, contexts, and selves of self-storying. Under spiritual aspects, the topics of meaning and identity are explored. A discussion of these aspects may be seen to converge on the theme of wisdom and the possibility of wisdom environments.