Caregiver Employment Status and Time to Institutionalization of Persons with Dementia

Background - This study was undertaken to examine the association between caregiver employment status and the time to institutionalization of persons with dementia. No study has previously examined this association. Methods - The database of the Canadian Study of Health and Aging was used to obtain data on 326 caregiver/care-recipient dyads. Caregivers were primary, informal carers; care-recipients were diagnosed with dementia and living in the community at baseline. Care-recipients were followed from the date of their baseline screening interview until the date of institutionalization, the date of death before institutionalization, or the date of the 5-year follow-up interview. An accelerated failure time model with a Weibull distribution was used to conduct the survival analysis. Results - During the 5-year follow-up period, 139 care-recipients (45%) were institutionalized; the median time to institutionalization was 1,821 days (95% confidence interval [CI]: 1,539-1,981 days) for the care-recipients of employed caregivers and 1,542 days (95% CI: 1,284-1,653 days) for the care-recipients of unemployed caregivers (p = 0.0634). The adjusted acceleration factor was 1.85 (95% CI: 1.08-3.86), controlling for caregiver thoughts about institutionalizing the care-recipient, caregiver health, and the use of a day center to help provide care. Conclusions - For the care-recipients of employed caregivers, the adjusted time to institutionalization was longer than for the care- recipients of unemployed caregivers.dementia, caregiver, employment, time to institutionalization

Prevalence, Risk Factors, and Primary Causes of Disability Among Canadian Seniors: An Analysis of the 1986 and 1991 Health and Activity Limitation Surveys

An aging Canadian population highlights the need to examine the prevalence and causes of disabilities in seniors in order to be able to meet their health care needs. This report represents a step in that direction by examining disabilities among Canadian seniors using the 1986 and 1991 Health and Activity Limitation Surveys (HALS), two nation-wide surveys assessing the prevalence and impact of disabilities in the Canadian population. From these two surveys, disabilities among noninstitutionalized seniors, 65 years of age and older, were examined. Findings revealed that over 40% of seniors had at least one disability that impacted on activities of daily living and that one-quarter of disabled seniors were severely disabled. Risk factors that were associated with having a disability included marital status, language spoken, total household income, tenure of dwelling, number of people living in the household, and region of the country. Mobility and agility disabilities were the most common types of disabilities among seniors, with approximately 80% of disabled seniors having at least one mobility or agility disability. Further, mobility and agility disabilities tended to coexist, with approximately 70% of all seniors who had a mobility disability also having an agility disability. Arthritis/rheumatism was the medical condition that most often caused mobility and agility disabilities, followed by cerebrovascular disease, other forms of heart disease, and fractures/bone breaks. Women were more likely than men to have mobility and agility disabilities, with other risk factors associated with having mobility and agility disabilities similar to those for having any disability. The findings of this report indicate that many Canadian seniors suffer from disabilities, particularly disabilities that affect their mobility and agility. Therefore, to have a substantial effect on reducing the impact of disabilities on Canadian seniors, efforts should be directed toward finding effective medical interventions that reduce or control the most common conditions which result in mobility and agility disabilities. Further, finding means to reduce the negative impact that mobility and agility type impairments have on everyday living would serve to help disabled seniors.disability; seniors; HALS

The Use of Behavior and Mood Medications by Care-recipients in Dementia and Caregiver Depression and Perceived Overall Health

The mental and physical health of dementia caregivers has been shown to be worse than that of non-caregivers. The present study was undertaken to investigate whether the caregivers of persons who take medications for behavior and mood problems in dementia are less depressed, and perceive their overall health to be better, than the caregivers of persons who do not take such medications. Behavior and mood medications include anti-psychotics, anti- depressants, and anti-convulsants. The Canadian Study of Health and Aging was used to identify informal, unpaid caregivers of persons with dementia (i.e., Alzheimer's disease, vascular dementia, or other dementia [e.g., Parkinson's disease]). The caregivers of persons diagnosed with cognitive impairment not dementia or no cognitive impairment were also included in the study. Care-recipient use of behavior and mood medications was not found to affect caregiver depression (OR = 1.02; 95% CI = 0.62 to 1.66) or caregiver's perceived overall health (OR = 1.35; 95% CI = 0.80 to 2.27).dementia; caregiver; medication; behavior; mood

A Review of the Literature and An Analysis of Mortality and Hospitalization Data to Examine Patterns of Injuries Among Canadian Seniors

Injury is a major cause of morbidity and mortality among seniors in Canada, resulting in large personal and economic costs. However, despite the importance injuries play in the health of seniors, with the exception of falls, there has been relatively little research aimed at understanding risk factors associated with injuries among this age group. Therefore, the purpose of this report is two-fold: a) to review the existing literature on the epidemiology of injuries among seniors and b) to examine in detail the epidemiology of injuries among Canadian seniors using data provided by the Health Statistics Division of Statistics Canada.seniors; injury; mortality

Does Cognitive Status Modify the Relationship Between Education and Mortality? Evidence from the Canadian Study of Health and Aging

Background: There is compelling evidence of an inverse relationship between level of education and increased mortality. In contrast to this, one study showed that among subjects with Alzheimer's Disease, those with high education are more than twice as likely to die earlier; however, this result has proven difficult to replicate. We examine the relationship between education and mortality by cognitive status using a large, nationally representative sample of elderly. Methods: A representative sample of 10,263 people aged 65 or over from the 10 Canadian provinces participated in the Canadian Study of Health and Aging in 1991. Information about age, gender, education, and an initial screening for cognitive impairment were collected; those who screened positive for cognitive impairment were referred for a complete clinical and neuropsychological examination, from which cognitive status and clinical severity of dementia were assessed. Vital status and date of death were collected at follow-up in 1996. The analysis was conducted using survival analysis. Findings: Cognitive status modifies the relationship between education and mortality. For those with no cognitive impairment, an inverse relationship between education and mortality exists. Elderly with cognitive impairment but no dementia, or those with dementia, are more likely to die early than the cognitively normal at baseline, but no relationship exists between education and mortality. Interpretation: These findings do not support previous work that showed a higher risk of mortality among highly educated dementia subjects.Alzheimer disease; cognition; dementia; education; epidemiology; etiology; mortality

Agreement between Self-Reported and Routinely Collected Health Care Utilisation Data among Seniors

Objective: To examine the agreement between self-reported and routinely collected administrative health care utilisation data, and the factors associated with agreement between these two data sources. Data Sources/Study Setting: A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Health’s Registered Persons Data Base in 1992. Health professional billing information and hospitalisation data were obtained from the Ontario Ministry of Health and Long-Term Care (OMH) and the Ontario Health Insurance Plan (OHIP). Principal Findings: Substantial to almost perfect agreement was found for the contact utilisation measures, while agreement on volume utilisation measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioner and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than $25,000, had poor/fair/good self-assessed health status, or had two or more chronic conditions. Conclusion: The findings of this study indicate that there are substantial discrepancies between self-reported and administrative data among older adults. Researchers seeking to examine health care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health care policies.health services utilisation; seniors; self-reports; agreement; billing data

Sensory Impairments among Canadians 55 years and Older: An Analysis of 1986 and 1991 Health and Activity Limitation Survey

It has been well established that increasing age is associated with worsening health and decreasing functional ability among seniors, including conditions that lead to hearing and seeing impairments. The development of such sensory impairments can lead to a reduced quality of life by interfering with the ability to carry out activities of daily living and engaging in social activities. The review, which precedes the findings of this report, highlights the impact of sensory impairments on seniors (65 years and older) by first describing the prevalence of hearing and seeing impairments in this population and then examining the association between sensory impairment and physical, cognitive, and social functioning.HALS; aging

Prevalence, Risk Factors, and Health Care Utilization for Injuries Among Canadian Seniors: An Analysis of 1994 National Population Health Survey

Despite the impact injuries have on hospitalization and mortality, relatively little research has been conducted examining injuries among seniors that do not require hospitalizations. Additionally, there is a paucity of research on the utilization of health care resources, other than hospitals, by injured older adults. The objective of this study is to examine the prevalence and characteristics of injuries not captured by the hospitalization and mortality data, risk factors associated with such injuries, and health care utilization among Canadian seniors using Statistics Canada's National Population Health Survey (1994). Specifically, this report has the following objectives: 1.To examine the prevalence of injuries among 55-64 year olds and seniors (65+). 2.To identify the causes, types, and locations of injuries. 3.To identify risk factors of injuries. 4.To compare health care use between injured and noninjured people.injuries; seniors; NPHS

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors