Social Isolation, Physical Activity, and Subsequent Changes in Cognition Among Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

OBJECTIVE

The objectives of this study were to a) evaluate associations between social isolation and change in cognition over a 3-year period, and b) evaluate whether physical activity mediates the association between social isolation and cognition change.

METHODS

Using baseline and follow-up 1 data from the Canadian Longitudinal Study on Aging, latent change score models, incorporating direct and indirect pathways, were constructed to estimate the indirect effect of social isolation on cognitive change through physical activity. Multigroup models were constructed based on age group (45-65 versus 65+ years) and sex to allow for varying estimates across age and sex. The final analytic sample included 51,338 participants.

RESULTS

Indirect effects of social isolation on cognition through physical activity were evident in men and women 65+ years old for memory change ( = -0.005 [99.9% confidence interval = -0.007 to -0.002], p < .001 in both groups) and in male adults 65+ years old for executive function change ( = -0.01 [99.9% confidence interval = -0.02 to -0.006], p < .001). Statistically significant indirect effects were not observed for adults between 45 and 65 years old.

CONCLUSIONS

Social isolation is associated with diminished physical activity, and in turn, diminished physical activity is associated with decline in memory in older women and men, with larger declines in executive function in older men. Public health initiatives to promote physical activity-perhaps incorporating social interaction-among older adults experiencing social isolation could be one way to mitigate the negative impact of social isolation on cognitive health.

Social isolation and loneliness among older adults living in rural areas during the COVID-19 pandemic: a scoping review

BACKGROUND

The causes and consequences of social isolation and loneliness of older people living in rural contexts during the COVID-19 pandemic were systematically reviewed to describe patterns, causes and consequences.

METHODS

Using the Arksey and O'Malley (2005) scoping review method, searches were conducted between March and December 2022, 1013 articles were screened and 29 were identified for data extraction.

RESULTS

Findings were summarized using thematic analysis separated into four major themes: prevalence of social isolation and loneliness; rural-only research; comparative urban-rural research; and technological and other interventions. Core factors for each of these themes describe the experiences of older people during the COVID-19 pandemic and related lockdowns. We observed that there are interrelationships and some contradictory findings among the themes.

CONCLUSIONS

Social isolation and loneliness are associated with a wide variety of health problems and challenges, highlighting the need for further research. This scoping review systematically identified several important insights into existing knowledge from the experiences of older people living in rural areas during the COVID-19 pandemic, while pointing to pressing knowledge and policy gaps that can be addressed in future research.

Transition Into the Caregiver Role Among Older Adults: A Study of Social Participation and Social Support Based on the Canadian Longitudinal Study on Aging

OBJECTIVES

Older adults (65 years and older) are increasingly providing care for their spouses, family members, and nonkin others (e.g., friends and neighbors). However, available knowledge of older caregivers is limited to spousal caregivers and their psychological outcomes. Other caregiver role types or social outcomes among older caregivers are less well studied. Thus, this study examines the social participation and social support among older caregivers by comparing 3 types of older caregivers, including spousal caregivers, nonspouse family caregivers, and nonkin caregivers.

METHODS

Participants for this study were drawn from the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 3,789 older adults became caregivers during the 2 data collection time points. Linear mixed models were applied to examine the change of social participation and social support among the three caregiver role types over the course of survey.

RESULTS

The study finds that after transitioning into the caregiving role, spousal caregivers, and nonkin caregivers experienced a decline in social participation, and spousal caregivers also received less social support over time. When comparing the 3 caregiver role types, spousal caregivers reported the greatest decline in social participation and social support.

DISCUSSION

This study adds to the relatively limited knowledge of older caregivers by presenting the changes in social participation and social support after transitioning into 3 types of caregiver roles. The results indicate the need to provide support for caregivers, particularly spousal and nonkin caregivers, to help them maintain social relationships and networks for participation and support.

Contributors to mental health resilience in middle-aged and older adults: an analysis of the Canadian Longitudinal Study on Aging

OBJECTIVES

Identifying the correlates of mental health resilience (MHR)-defined as the discrepancy between one's reported current mental health and one's predicted mental health based on their physical performance-may lead to strategies to alleviate the burden of poor mental health in aging adults. Socioeconomic factors, such as income and education, may promote MHR via modifiable factors, such as physical activity and social networks.

DESIGN

A cross-sectional study was conducted. Multivariable generalized additive models characterized the associations between socioeconomic and modifiable factors with MHR.

SETTING

Data were taken from the population-based Canadian Longitudinal Study on Aging (CLSA), which collected data at various data collection sites across Canada.

PARTICIPANTS

Approximately 31,000 women and men between the ages of 45 and 85 years from the comprehensive cohort of the CLSA.

MEASUREMENTS

Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance was measured objectively using a composite of grip strength, sit-to-stand, and balance performance. Socioeconomic and modifiable factors were measured by self-report questionnaires.

RESULTS

Household income, and to a lesser extent, education were associated with greater MHR. Individuals reporting more physical activity and larger social networks had greater MHR. Physical activity accounted for 6% (95% CI: 4 to 11%) and social network accounted for 16% (95% CI: 11 to 23%) of the association between household income and MHR.

CONCLUSIONS

The burden of poor mental health in aging adults may be alleviated through targeted interventions involving physical activity and social connectedness for individuals with lower socioeconomic resources.

Help-Seeking Behaviors Among Older Adults: A Scoping Review

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

Environmental Influences on Life Satisfaction and Depressive Symptoms Among Older Adults With Multimorbidity: Path Analysis Through Loneliness in the Canadian Longitudinal Study on Aging

BACKGROUND AND OBJECTIVES

More older adults with multimorbidity are aging in place than ever before. Knowing how the environment affects their mental well-being could enhance the efficacy of age-friendly interventions for multimorbidity resilience. With reference to the Transdisciplinary Neighborhood Health Framework, we construct and examine a priori models of environmental influences on life satisfaction and depressive symptoms.

RESEARCH DESIGN AND METHODS

Baseline and follow-up data (after 3 years) were drawn from the Canadian Longitudinal Study on Aging to identify a subsample (n = 14,301) of participants aged at least 65 years with at least 2 chronic diseases. Path analysis examined sociobehavioral attributes (i.e., social support, social participation, walking) and loneliness as primary and secondary mediators, controlling for age, sex, education, and outcomes during baseline.

RESULTS

Good model fit was found (TFI = 1.00; CFI = 1.00; RMSEA < 0.001; SRMR < 0.001). The total effects of housing quality (rtotal = 0.08, -0.07) and neighborhood cohesion (rtotal = 0.03, -0.06) were weak but statistically significant in the expected direction. The mediators explained 21%-31% of the total effects of housing quality and 67%-100% of the total effects of neighborhood cohesion. Loneliness mediated 27%-29% of these environmental influences on mental well-being, whereas walking mediated a mere 0.4%-0.9% of the total effects. Walking did not explain the relationship between housing quality and mental well-being.

DISCUSSION AND IMPLICATIONS

Data supported a priori pathways from environment to mental well-being through sociobehavioral attributes and loneliness. If these pathways from neighborhood cohesion to life satisfaction reflect causal effects, community-based age-friendly interventions should focus on enhancing neighborhood cohesion to mitigate loneliness among multimorbid older adults for their mental well-being.

Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts

BACKGROUND

The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear.

METHODS

Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort.

RESULTS

Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60.

LIMITATIONS

Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts.

CONCLUSIONS

Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources.

A Study of Social Isolation, Multimorbidity and Multiple Role Demands Among Middle-Age Adults Based on the Canadian Longitudinal Study on Aging

Given the increasing complexity and fluidity of parenting, caregiving, and paid work patterns, in tandem with an increased risk of multimorbidity in mid-life, this study examines the relationship between these three concurrent roles and social isolation among middle-aged persons across multimorbidity statuses. Drawing upon life course theory, we applied linear mixed models to analyze 29,847 middle-aged participants from two waves of the Canadian Longitudinal Study on Aging. Findings reveal that participants experience greater social isolation over time, albeit the difference is extremely small. Among participants without multimorbidity, holding multiple roles is associated with lower social isolation. For those with multimorbidity, being employed full-time and providing intensive care are associated with social isolation. The occurrence of multiple roles demonstrates unique associations with social isolation among those with and without multimorbidity over time. Future research should study multimorbidity as a salient contextual variable. Moreover, enhanced support is needed for multimorbid middle-aged individuals with different role demands.

Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging

OBJECTIVES

The caregiving outcomes of spousal and adult-child caregivers are widely studied since they are the most common source of support provided to adults. However, the literature on social isolation among spousal and adult-child caregivers is very limited. In order to further elaborate and specify unique caregiving outcomes, this study focuses on social isolation, both longitudinally and comparatively between spousal and adult-child caregivers.

METHODS

This study was based on the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 5,226 participants (1,293 spousal caregivers and 3,933 adult-child caregivers) were selected. The Linear mixed models were used to examine the effect of caregiver type and caregiving intensity on social isolation over the course of survey.

RESULTS

Spousal and adult-child caregivers reported greater social isolation over time, and spousal caregivers exhibited a steeper increase in social isolation from Baseline to Follow-up 1 than adult-child caregivers. Also, an increase in caregiving hours resulted in greater social isolation. Finally, male spousal or adult-child caregivers were more likely to be socially isolated over time than their female counterparts.

DISCUSSION

The findings of this study contribute to the existing literature on caregiving outcomes by demonstrating an association between family caregiving and social isolation. The results indicate a strong need for intervention programs that aim to enhance social connectedness among family caregivers, and especially for those who perform intensive caregiving, are older age, and are from a lower socioeconomic status.

Linking Lives in Ethnically Diverse Families: The Interconnectedness of Home Leaving and Retirement Transitions

Drawing from a sociocultural life course perspective, this study examines the linkages between two age-related family transitions: young adult children leaving home and parental retirement. A sample of 580 ethnically diverse parents aged 50+ with at least one adult child aged 19-35 living in Metro Vancouver, British Columbia, Canada, was used in this study based on four cultural groups: British-, Chinese-, Persian/Iranian-, or South Asian-Canadian. Separate survival analyses are used to predict the timing of, and associations between children's leaving home and parents' retirement. Later timing of adult children's leaving home is associated with delays in retirement of parents and is influenced by a number of predictors. Main and interaction effects were supported for ethnicity, where belonging to the Persian/Iranian ethnic group (compared to British) delays home leaving, and belonging to Persian/Iranian and South Asian ethnic groups (compared to British) delays retirement timing.

Health supports needed for homeless persons transitioning from hospitals

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.

Development of a physical literacy model for older adults - a consensus process by the collaborative working group on physical literacy for older Canadians

BACKGROUND

Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines.

METHODS

An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older.

RESULTS

A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults.

CONCLUSION

Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.

A Lifecourse Model of Multimorbidity Resilience: Theoretical and Research Developments

The purpose of this article is to advance a Lifecourse Model of Multimorbidity Resilience. It focuses on the ways in which individuals face adversities associated with multimorbidity and regain a sense of wellness through a complex, dynamic phenomenon termed resilience. A comprehensive review of 112 publications (between 1995 and 2015) was conducted using several comprehensive electronic data bases. Two independent researchers extracted and synthesized resilience literature with specific applications to chronic illness. The article outlines five stages of theoretical development of resilience, synthesizes these with the aging and chronic illness literature, builds a rationale for a lifecourse approach to resilience, and applies the model to multimorbidity. Cultivating and maintaining resilience is fundamental to functioning and quality of life for those with multimorbidity. We found that there are a number of gaps in both basic and applied research that need to be filled to advance knowledge and practice based on resilience approaches.

Predicting Self-Care Behaviors Among Older Adults Coping With Arthritis

Objective: The purpose of this investigation is to examine correlates and predictors of self-care activities for persons diagnosed with arthritis both cross-sectionally and longitudinally. Method: Data from telephone surveys conducted with 313 older ( M = 68.8, SD = 8.93) individuals, chosen from a larger sample, who reported professionally diagnosed arthritis, were used. Results: A total of 10 of the 11 self-care activities changed significantly during the 1-year interval, with 9 showing increased participation. Results from hierarchical regressions showed that all three blocks of predictors explained significant portions of variance, with gender and perceived importance of general health significantly predicting self-care activities at Time 1, at Time 2, and longitudinally. Discussion: These results highlight the influence of demographic, health status, and health belief variables on self-care both cross-sectionally and longitudinally. Future work should focus on the mediating effects of these and other variables to better understand the processes by which individuals engage in self-care behavior.

Midlife Challenge or Welcome Departure? Cultural and Family-Related Expectations of Empty Nest Transitions

Mid- and later-life parental transitions to the “empty nest” are characterized by increasing complexity, uncertainty, and variability. Drawing upon a life course perspective coupled with a sociocultural stress model, this mixed-methods study focuses on parental perceptions of anticipated emotional challenge associated with their children’s homeleaving and how this is shaped by ethnic culture and other family-related factors. Data entail a subsample of 174 midlife parents (mean age = 51.8) with at least one adult child aged 18 to 35 living at home, collected as part of the “Mid/Later Life Parenting Project.” Study participants belonged to British-, Chinese-, Southern European-, or South-Asian groups living in Metro Vancouver, BC. Analyses indicate that societal and ethnic group norms, relationship quality, and living arrangement preferences, as well as supportive exchanges and economic constraints (e.g., housing costs) influence empty nest perceptions and pathways. Implications of these findings are applied to aging families and family development.

Estimating multiple morbidity disease burden among older persons: a convergent construct validity study to discriminate among six chronic illness measures, CCHS 2008/09

Background

Since approximately two in three older adults (65+) report having two or more chronic diseases, causes and consequences of multimorbidity among older persons has important personal and societal issues. Indeed, having more than one chronic condition might involve synergetic effects, which can increase impact on disabilities and quality of life of older adults. Moreover, persons with multimorbidity require more health care treatments, implying burden for the person, her/his family and the health care system.

Methods

Using the 2008/09 Canadian Community Health Survey (CCHS), this paper assesses the convergent construct validity of six measures of multimorbidity for persons aged 65 and over. These measures include: 1) Multimorbidity Dichotomized (0, 1+ conditions); 2) Multimorbidity Dichotomized (0/1, 2+); 3) Multimorbidity Additive Scale; 4) Multimorbidity Weighted by the Health Utility (HUI3) Scale; 5) Multimorbidity Weighted by the OARS Activity of Daily Living (ADL) Scale; and 6) Multimorbidity Weighted by HUI3 (using beta coefficients). Convergent construct validity was assessed using correlations and OLS regression coefficients for each of the multimorbidity measures with the following social-psychological and health outcome variables: life satisfaction, perceived health, number of health professional visits, and medication use.

Results

Overall, the two dichotomies (scales #1 & #2) showed the weakest construct validity with the health outcome variables. The additive chronic illness scale (#3) and the multimorbidity weighted by ADLs (#5), performed better than the other two weighted scales using (HUI #4 & #6). Measurement errors apparent in the dichotomous multimorbidity measures were amplified for older women, especially for life satisfaction and perceived health, but decreased when using the scales, suggesting stronger validity of scales #3 through #6.

Conclusions

To properly represent multimorbidity, using dichotomous measures should be used with caution. When only prevalence data are available for chronic conditions, such as in the CCHSs or CLSA, an additive multimorbidity scale can better measure total illness burden than simple dichotomous or other discrete measures.

Lifelong educational practices and resources in enabling health literacy among older adults

OBJECTIVE

The goal of this study is to examine the role of lifelong educational and learning practices and resources in enabling health literacy.

METHOD

A subsample of older adults (n = 2,979) derived from the 2003 seven country IALSS (Canadian survey) was used. An expanded Andersen-Newman model that included lifelong learning enabling factors was used to develop predictors of health literacy.

RESULTS

The formal education, lifelong and lifewide learning enabling factors exhibited the most robust associations with health literacy. These included education level; self-study in the form of reading manuals, reference books and journals; computer/Internet use, use of the library; leisure reading of books; reading letters, notes and e-mails; and volunteerism.

DISCUSSION

Findings are discussed in relation to the development and maintenance of health literacy over the life course. Programs and policies that encourage lifelong and lifewide educational resources and practices by older persons are needed.

From Cues to Action: Information Seeking and Exercise Self-Care among Older Adults Managing Chronic Illness

Drawing from the health belief model, cues to action have been theorized to influence health behaviours; however, few studies have examined these constructs explicitly. This study investigated the relationship between information cues to action and exercise self-care. It was hypothesized that reading about illness information, knowing about services, and consulting with others about one's illness triggers exercise self-care. The sample consisted of 879 chronically ill adults aged 50 and over, drawn from the Vancouver North Shore Self-Care Study. It was found that the odds of exercising almost doubled for readers of information about illness (compared to non-readers), after controlling for socio-demographic factors, illness context, and illness efficacy. Furthermore, knowledge of services and consultations were shown to increase the odds of exercise self-care. These findings provide support for the salience of cues to action as a pivotal theoretical construct. The implications of these findings for health promotion programs targeting persons with chronic illnesses are discussed.

A health profile of community-living nonagenarians in Canada

Due to increasing life expectancy over time, persons who live into their ninety, known as nonagenarians, are an important and growing segment of the Canadian population. In 2001, there were 130,325 nonagenarians (compared to 3,795 centenarians), and it is estimated that they will top 400,000 by 2026. This paper provides a health profile and an exploratory analysis of selected social determinants of health for community-living nonagenarians, using the 2001 Canadian Community Health Survey (Statistics Canada, 2003). Perceived health, selection of prevalent chronic illnesses, and several health behaviours are examined. One dominant pattern is the tendency for male nonagenarians to be in better health than their female counterparts. This finding is consistent with research on centenarians and is discussed in terms of a mortality selection effect. Other key findings include the strength of sense of belonging, income, and physical activity as potential social determinants of health, connected to particular dimensions of health status.

Self-Care Dimensions of Complementary and Alternative Medicine Use among Older Adults

BACKGROUND

There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM.

OBJECTIVES

This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM.

METHODS

Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey.

RESULTS

The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care.

DISCUSSION

Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.

Barry D. McPherson. Aging as a Social Process: Canadian Perspectives (4th ed.). Don Mills, ON: Oxford University Press, 2004

This book by Barry McPherson is the fourth edition of Canada's first textbook on aging. Aging as a Social Process is a comprehensive text that elucidates and links the physiological, psychological, and social domains of aging within the context of what are known as individual and population aging. As the title implies, the book focuses primarily on the social processes of aging embedded in the micro-, meso-, and macro-level environments. It therefore balances individual-level experiences and social-structural forces connected to the causes and consequences of aging. It has been updated and expanded to reflect the increasing diversity in aging and the aged and the concomitant growth in research. This is captured through the integration of theory, research, and policy, from multiple perspectives and methodologies, applied to a wider range of substantive issues than in previous editions of the text. For instance, Aboriginal people and aging, homelessness, dating and sexuality, gay and lesbian relationships, end-of-life care, home care, and older drivers are but a few of the topics added or significantly supplemented in this new edition. In particular, I found the inclusion of a chapter dealing with individual and population health a needed and welcome addition. A life-course perspective on these topics that embraces the multiplicity of experience as individuals move through life stages, exposed to different historical and cultural contexts and facing and creating different life choices and chances, connects the material presented in this text.

Home leaving trajectories in Canada: exploring cultural and gendered dimensions

In this exploratory study, we profile variations in home leaving, home returning, and home staying behaviour among four ethnocultural groups in Canada - British, Chinese, Indian, and South European. Data collected in a 1999-2000 survey of 1,907 young adults (ages 19-35) residing in the Vancouver area are used. Our principal foci are ethnocultural and gendered aspects of home leaving trajectories, specifically: ages at home leaving and returning, and reasons for home leaving, home returning and home staying. Special attention is paid to returners/boomerangers, given an increasing overall trend in home returning in Canada. We find that: (a) both ethnocultural origin and gender are important determinants of home leaving trajectory, (b) there is a distinct (but far from tidy) difference between European-origin and Asian-origin groups in home leaving trajectory, (c) British-Canadians leave home at the youngest ages and Indo-Canadians at the oldest ages, (d) the main reason for home leaving is independence for British-Canadians; schooling for Chinese-Canadians, and marriage for Indo-Canadians, (e) among all four groups, home returners leave home initially at younger ages and, with the exception of Indo-Canadian young men, who typically leave home for school, and (f) gender differences in home leaving trajectory are larger among the Chinese and Indo-Canadians than among persons of European origins. Overall, we conclude that the theorized trend of the individualized family life course holds for only some ethnocultural groups in Canada. We conclude with suggestions for future research directions on the topic of ethnicity and the home leaving life course transitions.

"There's no place like home": an analysis of young adults' mature coresidency in Canada

This article investigates the propensity for young adults to live in the parental home between the ages of 25 to 34--termed "mature coresidency." Drawing upon a synthesis of life course theory and the concept of social capital, a rationale is developed for examination of emotional closeness to parents during childhood and a number of socio-demographic and structural factors deemed to be important. Using a subset of young adults aged 25 to 34 (N = 1,760) from the 1995 Canadian General Social Survey, it is found that emotional closeness to mothers and fathers are major determinants of mature coresidency. Other important predictors include child's age, gender, marital status, and several family background factors. The implications of the findings are discussed for transitions to adulthood and family development against a changing social and economic landscape.

Self-care among older adults: an analysis of the objective and subjective illness contexts

OBJECTIVES

The authors hypothesize that older adults diagnosed with arthritis show a greater reliance on objective factors in their self-care behaviors, whereas those diagnosed with heart problems or hypertension demonstrate a greater reliance on more general belief-laden factors.

METHODS

A total of 794 older adults (mean age = 69.3) who were professionally diagnosed with arthritis, heart problems, or hypertension completed a telephone survey about a number of aspects of their illness condition and their general well-being.

RESULTS

The results from the hierarchical regression analyses indicate that objective factors and illness-specific beliefs are better predictors of self-care behavior in the arthritis group, whereas general beliefs (e.g., self-efficacy and general well-being) are better predictors of such behavior in the heart problems and hypertension groups.

DISCUSSION

The analyses support the authors' hypothesis. The results are discussed in the context of expanding the Health Belief Model of self-care.

The effects of socioeconomic status on exercise and smoking: age-related differences

The aim of this article is to examine the effects of socioeconomic status (as measured by education, income, and labor force status) on patterns of exercise and smoking for three age groups: persons aged 25 to 44, 45 to 64, and 65 and over. Two hypotheses drawn from the literature are tested: (a) that socioeconomic status is associated with risky lifestyle behaviors and (b) that the effect of socioeconomic status is greater for younger and middle-aged groups than for older age groups. Logistic regression analyses are performed on the 1990 Canadian Health Promotion Survey. Our results indicate that socioeconomic status affects health behaviors in relatively important ways, but this depends on the measure, the specific behavior, and the age group. The findings are discussed in relation to controversies about the existence of a culture of poverty and its impact on health behaviors, as well as to several age pattern hypotheses.

Homeleaving age norms: conflict or consensus?

While research attention has been directed to the normative timing aspects of some family transitions, little work on homeleaving has been undertaken. Drawing upon in-depth interviews with one child and one parent in 218 families in which the adult child has/had returned home (boomerang families) and 202 families in which the adult child has remained independently "launched," this article examines a number of aspects of norms regarding the appropriate timing of homeleaving. The following issues are examined: the degree of overall consensus regarding homeleaving age norms; variations by generation and by family type; factors viewed as conditioning the normative age at homeleaving; and perceptions regarding social approval/disapproval of young adults living at home. Results are discussed in terms of theoretical issues in the life course perspective regarding age norms.

Age at death due to ischemic heart disease: gender differences

This paper investigates gender differences in the timing of ischemic heart disease (IHD) mortality among white Americans. Three age-at-death groupings are examined, using a model incorporating three types of independent variables: lifestyle, socioeconomic status, and biology/heredity. Logistic regression techniques are used to analyze National Mortality Follow-back Survey data. Three hypotheses drawn from the literature are tested: (1) that IHD mortality risks will vary by gender and across the life course; (2) that the independent variables will exert a lower mortality risk for women than for men at all ages of death; and (3) that differential risks by gender will be larger for younger age-at-death groups. Findings support the first and third hypotheses. The importance of research on gender differentials in age at IHD mortality in relation to parental heart-attack mortality, smoking and spousal smoking, occupation, and fertility is highlighted.

Staff attitudes: monitoring technology in long-term care

1. Overall, care staff members displayed positive attitudes toward resident monitoring technologies, especially staff members working in facilities with more of this technology. 2. It is necessary to place nurses and other front-line health care workers in the center of the policymaking process that determines the technological versus human composition of any long-term care facility. 3. The ethnicity of the health care worker, and to a lesser extent their age and education, are more important than the job status in determining attitudes toward monitoring technology. 4. Comprehensive evaluations of technology used in care facilities should include the overall value of the technology, its impact on a facility's liability, its effect on the quality of care on residents, and whether use of the devices in question is ethical.

Residential attitudes and knowledge, use, and future use of home support agencies

Critical review of the health and social service use literature reveals a need to elaborate on the dynamics of factors identified in the behavioral models applied to this field. In particular, research has tended to omit direct measures of attitudes and awareness of social services, including their interrelationships. This study examines determinants of knowledge, use, and future use of local home support agencies among a sample of community-dwelling elderly over the age of 74 living in Kitchener-Waterloo, Ontario. Measures of domestic self-reliance, independent living and perceptions of futurity are incorporated into the analysis. Logistic regression is used to test the models. The results show that attitudes regarding domestic self-reliance and independent living influence use of home support agencies largely through their impact on service awareness. Interestingly, these relationships are opposite to those hypothesized. Education is also found to be a predictor of knowledge of home support, and living arrangement, health status measures, and knowledge arise as important predictors of use and future use. The findings are discussed in terms of their implications for the underlying behavioral models, and for service providers and policymakers.

The etiology of nonpsychotic emotional illness

Two hundred and fifty couples in the general population completed self-report questionnaires which measured life events, personality, marital intimacy, and symptoms of nonpsychotic emotional illness. Path analysis was utilized to explain the development of symptoms of nonpsychotic emotional illness. Personality traits of neuroticism and extroversion explained most of the variance of symptoms of nonpsychotic emotional illness. Life events played a much smaller but significant role and marital intimacy was a nonsignificant factor. The data support a proneness model for the etiology of nonpsychotic emotional illness.

Environmental adaptation by persons in their later life

In an attempt to delay institutionalization among elders while supporting their widespread desire for privacy and independence in living style, it has been deemed necessary to adapt the physical and social milieu to fit declining competence. The theoretical rationale underlying current housing policy can be identified in person-environment theories of aging. The aims of this article are to (1) assess critically and expand Lawton's ecological model of aging as it pertains to environmental decisions among the elderly, and (2) test a series of hypotheses derived from the theoretical discussion using a 1987 study of environmental adaptation among 280 elderly, 74 years of age and over, living in the community. The most striking finding is the tendency for older elderly to engage in psychological processes of adaptation to a greater extent than altering the physical or social characteristics of the home environment. The findings suggest extending the Lawton model to include a wider range of subjective attributes of the individual.

Physical distance and social contact between elders and their adult children

Several demographic trends threaten supportive ties between adult children and elderly parents, including fertility reduction, rising divorce rates, and increasing geographical mobility among young adults. This article focuses on the extent to which proximity of adult children influences several types of social contact between elders and their offspring. Initial analysis uncovered nonlinear patterns in the data. The results of the polynomial regression analyses indicate that physical distance is a potent determinant of several types of social contact. The importance of distance is not affected when statistically controlling for adult children's income, sex, and marital status and elderly respondents' age, sex, education, and ethnicity. The analysis also suggests that substitution occurs between contact types at certain points on the distance continuum.