BackgroundIn the many descriptive studies on prescribed psychotropic drug use by community-dwelling older persons, several sociodemographic and other factors associated with drug use receive inconsistent support.MethodEmpirical reports with data on at least benzodiazepine or antidepressant drug use in samples of older persons published between 1990 and 2001 (n = 32) were identified from major databases and analyzed to determine which factors are most frequently associated with psychotropic drug use in multivariate analyses. Methodological aspects were also examined.ResultsMost reports used probability samples of users and non-users and employed cross-sectional designs. Among variables considered in 5 or more reports, race, proximity to health centers, medical consultations, sleep complaints, and health perception were virtually always associated to drug use. Gender, mental health, and physical health status were associated in about two-thirds of reports. Associations with age, marital status, medication coverage, socioeconomic status, and social support were usually not observed.ConclusionsThe large variety of methods to operationalize drug use, mental health status, and social support probably affected the magnitude of observed relationships. Employing longitudinal designs and distinguishing short-term from long-term use, focusing on samples of drug users exclusively, defining drug use and drug classes more uniformly, and utilizing measures of psychological well-being rather than only of distress, might clarify the nature of observed associations and the direction of causality. Few studies tested specific hypotheses. Most studies focused on individual characteristics of respondents, neglecting the potential contribution of health care professionals to the phenomenon of psychotropic drug use among seniors.

Evaluation of the therapeutic alliance is crucial for understanding the therapeutic process and its results. However, few instruments are available in French. This article aims to validate a French short form of the Working Alliance Inventory (WAI). Unlike other questionnaires, the WAI is the most widely used in psychotherapy research as well as in social psychiatry. Confirmatory factor analyses were carried out on a sample of 150 client-case manager dyads in order to determine the validity of this short-form instrument. The results of these confirmatory factor analyses allowed us to answer different authors' questions (Horvath and Greenberg, 1989; Tracey and Kokotovic, 1989) regarding the factorial structure of the WAI. The results also indicated a unidimensional solution as being the most valid for the two samples. We suggest that, in future studies, only one score be considered for the evaluation of the WAI. We also suggest modifying two statements in the English and French versions in order to render a faithful comparison between the therapist and client versions.

The important role of family caregivers in maintaining their disabled and elderly members in the community is becoming increasingly recognized. Caregiver research, for the most part, has explored burden and emotional distress as outcomes of the caregiving experience. Although there is a growing consensus among health-care researchers concerning the importance of quality of life (QoL) as an outcome, there is little research examining QoL of family caregivers. The purpose of this paper, therefore, was to construct a conceptual framework from which to study the QoL of family caregivers of stroke survivors. Findings from a review of studies addressing the QoL of these caregivers guided the development of the model. The components of the model include the caregiving situation, characteristics of the caregiver, and environmental factors, and their proposed relationships with QoL. This model provides a framework for investigating how the caregiving experience impacts on the caregiver's QoL.

We explore in this qualitative research the challenges faced by bilingual health and social services professionals in a Canadian bilingual setting, as well as the strategies used to overcome them. Eight focus groups were conducted with a total of 43 bilingual Francophone professionals who offered services in French in 21 health and social service organizations in eastern Ontario, Canada. We highlight linguistic issues affecting a minority Francophone clientele, the shortage of services in French, and organizational issues within these agencies. The solutions that the professionals adopt for better serving the clients and overcoming these challenges focus on adapting services from linguistic angles. In the long term, such an enhanced approach can affect staff well-being. Ensuring access to services for linguistic minority populations and the active offer of same should not rest solely on the shoulders of such professionals, but rather on organizational strategies.

Results of the present study converge with those obtained on the original widely used English version. Therefore, we suggest that clinicians use the questionnaire by referring to each item separately and by considering such patient characteristics as age, sex, and diagnosis. We also suggest that researchers wishing to evaluate health and social functioning of persons with serious mental disorders use the total score. Caution is, however, warranted when interpreting the total score for a French-speaking population, because the factorial solution 1-dimension model did not prove to be satisfactory.

A quarter of the elderly population is prescribed benzodiazepines (BZD). This has led to growing concerns about drug dependence and the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for dependence to a substance. This study aimed to understand how dependence was experienced by long-term BZD users. Interviews were conducted with 45 elderly persons who had been using BZDs for an average of nine years. These users' comments suggest six indicators of dependence: self-identifying as a dependent user, invoking multiple stressors to justify BZD use, using BZD to cope with anticipated stressors, trivializing the dangers of BZDs, keeping a supply in reserve, having previously tried and failed to stop, and reducing the dosage. Our results stress the need to take a more elaborate, person-centered view of dependence.

This article identifies home care practitioners' perceptions of the responsibilities, difficulties, and needs for support of caregivers. It is based on a study undertaken in Quebec with 55 practitioners and 10 administrators from 10 CLSCs located in rural, urban, and metropolitan areas. The study had a qualitative, multiple-case design and used logs recording all contact with caregivers in the space of a week, followed by semi-structured interviews. Analysis reveals that practitioners tend to perceive the work of caregivers as mainly instrumental and clinical, ignoring the family relations that tie them to their relative. Although aware of the difficulties facing caregivers and the negative impacts of caregiving, a majority of practitioners have high expectations of caregiver participation in treatment plans, albeit as quasi-nurse's aides. Our analysis offers an explanation for this apparent contradiction by examining practitioners' values with regard to family responsibility for care.

The purpose of this cross-sectional study was to compare two groups of families on measures of current family functioning and to explore factors related to current family functioning. Surveys were mailed to parents from families (n = 27) whose child aged 1 to 5 years had been hospitalized in a pediatric intensive care unit (PICU) and parents from families (n = 25) whose child aged 1 to 5 years had been hospitalized on a general care unit (GCU) in a large Midwestern children's hospital within 3 years of their child's discharge. Time since discharge ranged from 16 to 158 weeks (M = 84.9, SD = 36.0). The Cohesion and Adaptability subscales of the FACES III and the Feetham Family Functioning Survey (FFFS) were used to measure family functioning, and the Pediatric Risk of Mortality Scale (PRISM) was used to measure child acuity during hospitalization. Family functioning scores were not significantly different for PICU and GCU families. PRISM scores were negatively related to family adaptability for mothers and to family cohesion for fathers. Length of hospital stay was negatively related to fathers' adaptability ratings. Length of stay and PRISM scores were significant predictors of fathers' cohesion ratings; PRISM and location (PICU vs. GCU) were significant predictors of mothers' adaptability ratings. The findings suggest that it is not a PICU admission alone that has negative effects on the family; rather, the additive effects of how sick the child is on admission, where the child is hospitalized, and how long the child stays in the hospital may have negative consequences for the family.