Social and Economic Dimensions of an Aging Population


Vol. 4 No. 3

Autumn 2002

SEDAP (Social and Economic Dimensions of an Aging Population) is a multidisciplinary research program studying a wide range of aging-related issues and is funded by the Social Sciences and Humanities Research Council of Canada. SEDAP is centred at McMaster University and involves researchers from that institution as well as from the University of British Columbia, Université de Montréal, Queen's and the University of Toronto.


I. SEDAP Post-Doctoral Fellow

SEDAP is pleased to announce the appointment of Yuri Ostrovsky as a Post-Doctoral Fellow in the Department of Economics at McMaster. Yuri holds B.A. and M.A. degrees in Economics from York University. He has submitted his doctoral thesis, also at York University, entitled "Four Studies of Lifecycle Patterns of Housing Arrangements in Canada". He plans to continue his research on the role of housing wealth in the lifecycle and savings plans of Canadian households, using longitudinal data at McMaster's Research Data Centre. He will also pursue collaborative work with SEDAP member Tom Crossley of McMaster on the effect of changing household demographics on housing consumption.

II. SEDAP Research Papers

SEDAP Research Papers are available on the SEDAP website at no cost. Paper copies may be obtained for a nominal charge. Please contact Mrs. Gail Kalika, Department of Economics, KTH-426, McMaster University, Hamilton, Ont., Canada, L8S 4M4.

Brief descriptions follow of the most recently released papers in the SEDAP series.

SEDAP Research Paper No. 79:

Health Care in Rural Communities: Exploring the Development of Informal and Voluntary Care

Mark W. Skinner and Mark W. Rosenberg (Department of Geography, Queen's University)

In recent years, many governments have sought to reform the responsibilities of the state, communities and individuals with respect to the provision of public services. Although experiences vary considerably, the attendant re-working of central-local relations and public-private responsibilities has changed the nature of local governance and the organization and delivery of health care services. In this paper, home care in rural communities is examined as an example of the complex relationship among restructuring, governance and public services.

The authors undertake an analysis of informal and voluntary home care in Ontario using Statistics Canada data from the 1998-99 National Population Health Survey (NPHS) and the 1997 National Survey of Giving, Volunteering and Participating (NSGVP). Among the findings from these data sets are:

Among their conclusions, the authors emphasize the need for more detailed data that reflect rural communities, particularly in the NSGVP which does not provide data at the local level. They note that rural communities have among the highest relative proportions of the elderly population.

SEDAP Research Paper No. 80:

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

Jamie C. Brehaut (Ottawa Health Research Institute), Parminder Raina (Clinical Epidemiology and Biostatistics, McMaster University) and Joan Lindsay (Epidemiology and Community Medicine, University of Ottawa)

The authors of this paper posit that while there is compelling evidence that an inverse relationship exists between level of education and risk of increased mortality, the modifying effect of dementia status on the relationship between education and mortality is unclear. They also note that while many studies have compared subjects with dementia to non-demented elderly, relatively few have examined intermediate stages of cognitive decline. Cognitive impairment, no dementia (CIND) has been shown to be at least twice as prevalent as dementia at ages over 65. If CIND is best considered an extension of the healthy aging process, one might expect the association between education and mortality to mimic that of non- demented people. If CIND amounts to a heterogeneous diagnosis that includes some who progress to dementia and others who do not, one may expect no relationship between education and mortality. Their study thus examines the relationship between education and mortality over the spectrum of cognitive decline.

Data used in the paper were from the Canadian Study of Health and Aging (CSHA). In the first phase of the CSHA, conducted in 1991, representative samples of people aged 65 and over from the 10 Canadian provinces completed an initial screening interview. As part of this interview, participants were screened for cognitive impairment. Those who screened positive as well as a random sample of those who screened negative were referred for a complete clinical and neuropsychological examination. Of the 9681 participants included in the paper's analyses, 918 were diagnosed with dementia, 812 with CIND and 7951 were considered cognitively normal.

The original participants were followed up in 1996. Of the sample of 9681, 2719 had died by the time of follow-up. Those still alive at the end of follow-up were treated as censored observations. In addition to cognitive status, other predictors of mortality in this paper included education, gender, age and severity of dementia. The authors found that among those with no cognitive impairment, those in the low and medium education categories (less than 8 years of school, 8-12 years of school) were more likely to die than were those with more than 12 years of school. Those with CIND were more than twice as likely to die as those with no cognitive impairment and more than 12 years of school but this risk did not vary with education. Those with dementia were more than four times as likely to die than those with no dementia and more than 12 years of school but the risk did not vary significantly with education.

The authors also conducted an analysis on a sub-sample of subjects with Alzheimer's Disease and explicitly evaluated the importance of severity of dementia in modifying the relationship between education and mortality. For this sample of 583 Alzheimer's Disease subjects, they found no significant relationship between education and mortality. This remained true even when the severity of the dementia was included in the model.

SEDAP Research Paper No. 81:

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

Parminder Raina (Clinical Epidemiology and Biostatistics, McMaster University), Vicki Torrance-Rynard (Clinical Epidemiology and Biostatistics, McMaster University), Micheline Wong (Health Care and Epidemiology, University of British Columbia) and Christel Woodward (Clinical Epidemiology and Biostatistics, McMaster University)

Epidemiological and health services research has increasingly focused attention on health care utilization among the aging population. Self-reported questionnaires have been a commonly used method of collecting information on respondents' health status and their use of health care services. It is thus important to understand the accuracy of survey responses among seniors, especially since seniors have been found both to over and to underreport their use of health care services more often than younger individuals. If survey findings play an important role in policy-making decisions, then the possibility that discrepancies exist has important implications for future delivery and accessibility of health care services.

A sample of 1500 older people stratified by age and sex was identified using the Ontario Ministry of Health's Registered Persons Data Base (RPDB). The RPDB contains demographic information such as name, date of birth, sex and address for all residents registered for healthcare coverage in Ontario. Interviews were then conducted, resulting in complete data for 1038 seniors. Comparison between respondents and non-respondents showed that both groups were similar regarding gender, marital status, education, physical activity and perceived health status but that respondents were significantly more likely to be younger and to have a higher household income than non-respondents.

The study then used two data bases of routinely collected administrative data from the Ontario Ministry of Health and Long- Term Care (for data on hospitalizations) and the Ontario Health Insurance Plan (for health professional billing information). Information from these data bases was extracted for the year immediately preceding the interviews. The measures of any stay in hospital (yes or no) and any contact with a health professional (yes or no) were termed "contact utilization measures". The measures related to the number of nights stayed in hospital and the number of contacts with a health professional were termed "volume utilization measures". Missing data base records resulted in a sample of 1028 in the health professional analyses and 1036 in the hospital analyses.

The authors found substantial to almost perfect observed agreement between the interview data and the data bases for the contact utilization measures. A much wider range of agreement, from poor to almost perfect, was found for the volume utilization measures. The authors note that in some cases, high rates of agreement are a result of a large proportion of respondents reporting no use of health services over the previous year. Agreement generally decreased if respondents were male, aged 75 and older, had incomes of less than $25000 (1992) and had a lower self-assessed health status (poor/fair/good vs. very good/excellent). The authors note that since the respondents in this survey were seniors who were more likely to be younger and have a higher household income that non- respondents, their findings may overestimate the proportion of agreement compared with seniors in the general population.

editor: Deb Fretz -
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Last revised: Oct 8, 2002.