1662 Canadian Family Physician • Le Médecin de famille canadien dVOL 50: DECEMBER • DÉCEMBRE 2004
Research
s the demographic profile of Canada changes during the fi rst two decades of this century and the proportion of elderly peo- ple increases, some fear that formal supportive care systems will become overwhelmed and that many elderly people will not receive the care they need.
Th ose older than 75 will increase from 5.9% of the population in 2003 to 9.4% in 2026.1
Psychological factors, such as perceived self-effi cacy (self-efficacy pertains to optimistic beliefs about being able to cope with a variety of stressors), medi- ate the relationship between functional decline and the need for formal care services2; perceived self- efficacy makes a difference in how people think, how they act, and how motivated they are to be independent.3 Th e burden experienced by caregiv- ers of elderly people is also an important determi- nant of whether these elderly people need formal long-term or institutional care4; the lighter the bur- den, the less likely an elderly person is to need nurs- ing home placement.5
With these facts in mind, we undertook a study to measure the current level of care needed by community-dwelling people 75 and older who were not currently receiving home care, their levels of perceived self-effi cacy, and the weight of the burden experienced by their informal caregivers. We hoped
to determine whether seniors in Newfoundland are now healthier and causing less burden than in pre vious generations; recent studies have had such fi nd- ings in the United States6 and in Manitoba.7
METHOD
Random-digit dialing was used to recruit 346 subjects from a population of 10 900 people aged 75 and older living at home in eastern Newfoundland. To be eli- gible, subjects had to be mentally competent (scoring 17 or more on the Mini-Mental State Examination [MMSE]8), living in the community, and not receiving any type of formal home care services.
Nurses involved in the study visited each elderly person at home while his or her primary infor- mal caregiver was present. If the senior passed the MMSE and consented to participate (Table 1), the nurse assessed the level of perceived self-effi cacy using the General Perceived Self-Efficacy Scale (GPSES)9 and the level of burden on the caregiver using the Caregiver Burden Inventory (CBI).10 Th ese instruments were chosen because both are valid and reliable, well known, and commonly used.
Th e elderly people were asked to rate their own health using a 5-point scale taken from the National
Our elderly population feels well
Th ey are in control and not burdening their caregivers
Graham Worrall, MBBS, MSC, FCFP John Knight, MSC
Dr Worrall is Director of the Centre for Rural Health Studies and a Professor of Family Medicine at Memorial University of Newfoundland in Whitbourne. Dr Knight is a Research Statistician at the Centre for Rural Health Studies and at the Avalon Health Care Institutions Board in Whitbourne.
This article has been peer reviewed.
Cet article a fait l’objet d’une évaluation externe.
Can Fam Physician 2004;50:1662-1663.
s the demographic profile of Canada changes during the fi rst two decades of this century and the proportion of elderly peo- ple increases, some fear that formal supportive care
A
Table 1. Mean and median scores of people 75 and older living in the community on four assessment instruments: N= 346.
INSTRUMENT MEAN SCORE (SD)
MEDIAN SCORE (RANGE)
Mini-Mental State Examination (minimum score required: 17)
27.7 (2.7) 29.0 (16-30) General Perceived Self-Effi cacy Scale
(maximum score: 40)
34.2 (5.38) 36 (2-40) Caregiver Burden Inventory
(maximum score: 88)
12.3 (13.65) 8.0 (0-67) Client Assessment Protocols
(maximum number: 30)
2.7 (2.0) 2.0 (0-12)
VOL 50: DECEMBER • DÉCEMBRE 2004d Canadian Family Physician • Le Médecin de famille canadien 1663 Our elderly population feels well
Research
Population Health Survey,1 and demographic data were collected on them and their caregivers. Th e nurse then administered the Resident Assessment Instrument–Home Care (RAI-HC). The RAI- HC is a multidimensional functional and clinical assessment instrument that generates guidelines for planning individualized care called the Client Assessment Protocols (CAPs). Up to 30 CAPs can be triggered; each CAP indicates a potential cur- rent clinical or social problem.11
RESULTS
Of 346 subjects with a mean age of 80.6 years, 235 were women and 111 were men. Almost half (46%) lived alone. More than half (64%) had one of their children as primary caregiver, usually a daugh- ter (74%). Income levels were generally low (58%
received $20 000 or less yearly; only 5% received more than $40 000), and 74% had not gone beyond high school.
On the 5-point scale (excellent, very good, good, poor, very poor), 78% rated their own health as good, very good, or excellent. Perceived self-effi - cacy was high (mean score of 34.2 of a maximum of 40 on the GPSES), and caregiver stress was low (mean score of 12.3 of a maximum of 88 on the CBI). Mean number of CAPs generated by the RAI-HC was 2.7, compared with 8.7 among cli- ents receiving home care.12 Th is was not surpris- ing because the study population was chosen from among healthy seniors.
DISCUSSION
Results indicate that the current need for care, as assessed by the RAI-HC, is low among these seniors. Our data show an elderly population that feels well, has high perceived self-efficacy, and causes little burden on their informal caregivers.
Th ese self-rated fi ndings are supported by the fact that few CAPs (which indicate risk areas) were generated. At present, these seniors are putting lit- tle stress on formal care systems.
Recent evidence from the United States6 shows that healthy people living longer do not cost the
health care system any more. Th e Manitoba Centre for Health Policy found that, compared with the 1980s, fewer old people are now hospitalized, fewer have heart attacks, and fewer enter nursing homes.7 Whether this will remain the case in the near future when the number of elderly people rap- idly increases remains to be seen.
Contributors
Dr Worrall conceived and designed the project and wrote most of the article. Mr Knight reviewed the literature and extracted and analyzed the data.
Competing interests None declared
Correspondence to:Dr Graham Worrall, PO Box 449, Newhook Community Health Centre, Whitbourne, NL A0B 3K0; telephone (709) 759-2300; fax (709) 759-2387;
e-mail gworrall@mun.ca References
1. Statistics Canada. National Population Health Survey 1994-95. Ottawa, Ont: Industry Canada; 1995.
2. Schwartzer R. Measurement of perceived self-effi cacy: psychometric scales for cross-cultural research. Berlin, Ger: Frei Universitaat Press; 1993.
3. Bandura A. Self-effi cacy in changing societies. New York, NY: Cambridge University Press; 1995.
4. Moss M. Shifts in caregiving satisfactions with nursing home placements. Gerontologist 1988;28:62-6.
5. Brown LJ, Potter JF, Foster BG. Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc 1990;26:455-60.
6. Lubitz J, Cai L, Kramarow E, Lentzner H. Health, life expectancy and health care spending among the elderly.
N Engl J Med 2003;349:1048-55.
7. Manitoba Centre for Health Policy. Aging healthy. Centre Piece 2003;14:2008.
8. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading cognitive state for the clinician. J Psychiatr Res 1975;12:189-98.
9. Schwartzer R. General perceived self-effi cacy in 14 cultures. Berlin, Ger: Frei Universitaat Press; 1988.
10. Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden.
Gerontologist 1980;20:649-55.
11. Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI. Comprehensive clinical assessment in a community setting: applicability of the MDS-HC. J Am Geriatr Soc 1997;45:1017-24.
12. Canadian Collaborating Centre-interRAI. Minimum data set for home care (MDS-HC). Resident assessment instrument. Health Informatics Project. Whibourne, Nfl d: Memorial University of Newfoundland; 2001.
EDITOR’S KEY POINTS
• This survey of people older than 75 in eastern Newfoundland found that 78% rated their health as good or excellent.
• Their perceived self-effi cacy was reported as high; caregiver stress was reported as low.
• Contrary to usual predictions, many seniors who are living longer are healthy and are not necessarily burdening the health care system.
POINTS DE REPÈRE DU RÉDACTEUR
• Cette enquête conduite dans l’est de Terre-Neuve a montré que 78%
des plus de 75 ans jugent leur santé bonne ou excellente.
• Ils estiment jouir d’un haut degré d’autonomie; le fardeau imposé aux soignants est jugé faible.
• Contrairement aux prévisions habituelles, plusieurs des aînés qui atteignent un âge avancé sont en bonne santé et ne sont pas néces- sairement un fardeau pour le système de santé.
