Clinical and Advocacy: Dementia increasing in Canada, national policy urgently needed to address demand for care

Canada needs a plan to deal with increase in dementia: Editorial

The Trudeau government should use some of its early goodwill to kick-start the process of developing a national plan to address the slow-motion crisis of dementia.

Editorial. (Nov 30 2015). The Star. Retrieved from: http://www.thestar.com/opinion/editorials/2015/11/30/canada-needs-a-plan-to-deal-with-increase-in-dementia-editorial.html

Health experts have been warning for years that Canada must face up to the growing crisis brought on by a rising tide of people afflicted with dementia. As the population ages, we will all be touched – as patients, as caregivers, and as taxpayers.

This is a global problem, as explained over the past 10 days in a series of articles by Star writers Jennifer Yang, Kate Allen and Amy Dempsey. No country will be spared, but some will be better prepared than others. And it’s high time Canadian governments came together and developed a national strategy to deal with a crisis that will severely challenge both health care budgets and society as a whole.

We can learn much from looking at the experience of a country that has aged faster than us and is already grappling with the issue we will face over the next couple of decades. In Japan, the world’s first “super-aged” nation, those over 65 already form a quarter of the population. And, as Yang reported, that country is pioneering ways to deal with a rising tide of people living with dementia – 4.6 million of them.

The Japanese are training thousands of doctors on dealing with dementia – from making the right diagnosis to supporting caregivers. One city, on the outskirts of Kyoto, has dedicated itself to become a “dementia-friendly” community where people with the disease can live normally.

Most importantly, as far back as 2000 the Japanese government introduced mandatory long-term care insurance. Everyone starting at age 40 must pay into a national insurance fund. When they turn 65 or are afflicted by an aging-related disease such as dementia, they can draw on a variety of support services – from daycare to meal preparation.

Since funding is guaranteed through the insurance plan, that has created a robust market for such services.

It’s far from clear that such a plan could work in Canada. Social norms are very different in Japan, and our health care system is run by individual provinces. But it’s the type of big thinking that is badly needed – but so far sadly lacking – in this country.

The provinces, including Ontario, haven’t yet put together an overall strategy for dealing with our aging population. They still struggle even to provide a bare minimum of home care. And yet just the cost of treating the 747,000 Canadians with dementia has already hit $33 billion a year and is rising fast.

The Trudeau government should use some of its early goodwill to kick-start the process of developing a national plan to address the slow-motion crisis of dementia. Others are already leading the way.

More articles from the Star series on dementia:

Star page: http://www.thestar.com/news/dementia.html

How cardiovascular health plays a role in dementia risk

How to lower the risk of dementia

How nun dodged Alzheimer’s part of dementia’s mystery

The country bracing for a wave of new dementia cases

The growing impact of dementia — are we ready?

Professional help for amateur caregivers: Goar

Toronto doctors test brain scan technique that could predict Alzheimer’s

Japan: Dementia lessons from the world’s oldest country

How Japan is training an entire country to help with dementia

Life transitions: Men, retirement and mental health

Men vulnerable to boredom, depression in retirement

Brenda Bouw (Nov. 26, 2015). The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/globe-investor/retirement/retire-health/men-vulnerable-to-boredom-depression-in-retirement/article27490557/

John McLeod is ready to say goodbye to the working world. In February, the 59-year-old expects to retire, but there’s one major flaw in his plan: He isn’t sure how to fill the days and whether that could affect his well-being.

“I’m not really going toward anything; I’m just going away from work,” says Mr. McLeod, who has helped his wife run her real-estate law practice in Guelph, Ont., since 2000.

Mr. McLeod does a bit of carpentry work, is an avid reader and member of a local book club, and is planning to travel with his wife. Still, he sees a major activity gap in retirement.

“My concern would be that, after six or 12 months or even three years, I’d be saying, ‘What on Earth am I going to do today?’ That’s where the concern comes from of either boredom or depression,” says Mr. McLeod. “I’m not a depressive person, really, but I know it can happen.”

Experts say men are more susceptible to depression in retirement, in part because their identity is more closely tied to their careers compared to women.

“For a lot of men it really is a loss of a sense of identity – something that we get from work,” said clinical psychologist Marnin Heisel, director of research and associate professor in the department of psychiatry at the University of Western Ontario in London, Ont. He and his colleagues are doing research on men struggling in their transition to retirement, and are developing a program to reduce the risk for the onset of depression, hopelessness and suicide.

While employed, men develop a strong routine and many of their friendships come from work, says Dr. Heisel.

“For a lot of guys, when they retire, they lose that social network and social connection … and the meaningful contribution they get out of what they do.”

A 2012 study done by Elizabeth Mokyr Horner, a health services and policy researcher at the University of California, Berkeley, found that male retirees experience high levels of satisfaction directly after retirement, but then it falls sharply a few years later.

That was followed by a 2013 study from The Institute of Economic Affairs that says retirement increases the probability of suffering from clinical depression by about 40 per cent. Men also have the highest rates of suicide worldwide, according to the World Health Organization.

Statistics from the U.S.-based Centers for Disease Control and Prevention show the highest increase in suicide is in men 50 and over, while suicide rates for men are highest among those 75 and older. Men 80 and older are the group with the highest suicide rates in Canada, according to research from the Mood Disorders Society of Canada.

While retirement isn’t always the trigger, experts say the change in lifestyle can be a cause of some cases of depression.

It’s not the job or the money that men miss so much in retirement, but the socialization and self-esteem that work brings, says Ken LeClair, co-chairman of the Canadian Coalition on Seniors Mental Health (CCSMH) and professor of psychiatry at Queen’s University in Kingston.

“The best thing that can happen to someone before they retire is that they hate their job at the end. Those that have loved it and are restructured out or pushed out have a harder time,” says Dr. LeClair. “If I had a recipe for good retirement it would be to have a bad job in the last three working years.”

In a soon-to-be-released book about men and retirement, Victoria-based author Lyndsay Green found men have “deeply rooted fears” about leaving the working world.

That includes loss of identity after years of defining themselves as the family breadwinner, and a “profound” attachment to what they do for a living.

“Most of the men I interviewed like the structure that work gave to their life and they really like the sense of purpose. … It didn’t matter if they were the janitor or the CEO. Something they were doing was contributing to the greater good,” says Ms. Green, whose book is called Ready to Retire? What You and Your Spouse Need to Know About the Reality of Retirement.

Among the 44 men she interviewed between 56 and 88 – two-thirds of them at what she calls “peak retirement age” of 64 to 75 – Ms. Green learned the key to a happier retirement was having “multiple selves,” which means hobbies and other activities to keep busy. Another key coping mechanism was to “admit the workplace is going to move on without them.”

Some men join community groups in retirement to keep busy. One growing trend in Canada is the “men’s sheds,” a model that started in Australia in 1978 that helps to integrate older men into the community. The sheds, where men gather to do woodworking, bike repair and other hobbies, were targeted to men undergoing major life changes such as retirement, divorce or the loss of a spouse.

Studies have shown participation decreased self-reported symptoms of depression and promoted a sense of purpose through relationships and sharing of skills. A University of Manitoba study, published in the Ageing & Society journal, showed similar results in men who participated.

Mitch Anthony, author of The New Retirementality, says too often men underestimate the need for balance “and the value of work and what work brings to them.”

The old picture of retirement, where every day is like Saturday, doesn’t work for a lot of retirees, says Mr. Anthony.

“When you don’t have work, your leisure takes on a different meaning. The reason golf is so much fun to so many people – or whatever their leisure activity is – is because it means you aren’t at work. When you remove your work, your leisure becomes work,” Mr. Anthony says. It’s then that many retirees become bored, and sometimes also depressed.

“The lie behind the whole retirement model is that our age predicts our usefulness,” says Mr. Anthony. “It doesn’t matter how much money you have in retirement, it doesn’t give you purpose.”

Clinical: ADHD, medication and bullying

Teens on ADHD meds are twice as likely to be bullied

Laura Bailey-Michigan (November 27, 2015). Futurity. Retrieved from: http://www.futurity.org/teenagers-adhd-bullying-1057762-2/

University of Michigan - Original Study

Children who take Ritalin or other medications for ADHD are twice as likely to be physically or emotionally bullied by their peers as those who don’t have ADHD, a new study shows.

At even higher risk are middle and high school students who sell or share medications—they are four-and-a-half times likely to be victimized.

The findings hold true for both boys and girls.

Previous studies have shown that children with ADHD have a harder time making and keeping friends and are bullied and victimized more. The new study, published in the Journal of Pediatric Psychology, is believed to be the first known to look at how stimulant medications affect relationships with peers.

[Bullies who were bullied at risk for suicide]

“Many youth with ADHD are prescribed stimulant medications to treat their ADHD and we know that these medications are the most frequently shared or sold among adolescents,” says Quyen Epstein-Ngo, research assistant professor at the University of Michigan.

For the study, researchers surveyed nearly 5,000 middle and high school students over four years. About 15 percent were diagnosed with ADHD and roughly 4 percent were prescribed stimulants within the past 12 months.

Of those who took ADHD meds, 20 percent reported being approached to sell or share them, and about half of them did. When looking at the overall figures, relatively few students were asked to divert their medications or did. However, the numbers don’t tell the entire story, Epstein-Ngo says.

“Having a diagnosis of ADHD has lifelong consequences. These youth aren’t living in isolation. As they transition into adulthood, the social effects of their ADHD diagnosis will impact a broad range of people with whom they come into contact.”

[Can fidgeting help teens with ADHD think?]

From 2003 to 2011, there was a 42 percent increase in ADHD cases diagnosed in the United States, and between 2007 and 2011, there was a 27 percent increase in stimulant-treated ADHD.

The findings shouldn’t scare parents away from considering a stimulant medication. Rather, the study reinforces why parents must talk to kids about never sharing their medications.

“For some children stimulant medications are immensely helpful in getting through school,” Epstein-Ngo says. “This study doesn’t say ‘don’t give your child medication.’ It suggests that it’s really important to talk to your children about who they tell.”

It’s unclear why kids with prescriptions for stimulant medications are more at risk for bullying and victimization, but Epstein-Ngo says it’s probably due to several factors.

“Is it a function of the fact that they are in riskier situations, or are they being coerced and forced to give up their medications? Probably a little bit of both.”

The National Institute on Drug Abuse funded the work.

Source: University of Michigan

Clinical: Loneliness leads to health risks

Health risk of loneliness has physiological basis: study

AFP/CTV News (November 24, 2015). Retrieved from: http://www.ctvnews.ca/health/health-risk-of-loneliness-has-physiological-basis-study-1.2671985

Washington, United States - Loneliness can increase the risk of premature death by 14 per cent in older adults, according to a study published Monday that posits a physiological basis for the phenomenon.

The dangers of social isolation have long been known but its effects on the body have not been well understood, the researchers said in the work published in the Proceedings of the National Academy of Sciences/PNAS.

Led by University of Chicago psychologist John Cacioppo, the research team had previously identified a link between solitude and both a heightened expression of genes involved in inflammation and a diminution in the activity of other genes that play a role in the body's antiviral responses.

The result is a weakened immune systems that makes a person who lives alone more vulnerable to illness.

In their latest research, the researchers looked at leukocytes, white blood cells that the immune system uses to protect against bacteria and viruses.

They found the same shift in genetic expression in the white blood cells of people who lived alone and in social isolation.

They also found that loneliness predicted the gene behavior a year or more in advance -- and conversely that gene expression predicted loneliness measured a year or more later.

"Leukocyte gene expression and loneliness appear to have a reciprocal relationship, suggesting that each can help propagate the other over time," the researchers said.

"These results were specific to loneliness and could not be explained by depression, stress or social support," they said.

The investigators then studied rhesus macaques, a highly social primate, and found a similar cellular process linked to their social experience.

"Lonely-like" monkeys had increased gene expression involved in inflammation and less gene expression in antiviral defenses.

They were also found to have higher levels of noreprinephrine, a "fight-or-flight" neurotransmitter that stimulates the production of immature monocytes, a white blood cell with high inflammation/low antiviral defense gene expression.

"Both lonely humans and 'lonely like' monkeys showed higher levels of monocytes in their blood," the researchers said.

Other studies showed that the increased production of immature monocytes was amplifying the high inflammation/low antiviral effect in the pool of white blood cells.

"The 'danger signals' activated in the brain by loneliness ultimately affect the production of white blood cells," they said.

"The resulting shift in monocyte output may both propagate loneliness and contribute to its associated health risks."

Mental Health Services for Refugees Coming to Canada

Refugees to be offered mental health services in Canada

Mark Kennedy (November 24, 2015). Ottawa Citizen. Retrieved from: http://ottawacitizen.com/news/national/refugees-to-be-offered-mental-health-services-in-canada

Some of the Syrian refugees coming to Canada could be afflicted with mental health problems and will be offered psychological counselling to help them through their ordeal, says the federal health minister.

Jane Philpott, who chaired the cabinet sub-committee that drafted the government’s Syrian refugee plan, said Tuesday that the initiative has a range of goals.

“One of the guiding principles was what is in the best interest of the refugees,” said Philpott, a Toronto physician who is a first-time MP.

“Obviously we have the health and safety of Canadians in mind. But the health and well-being of refugees was also forefront in our mind.”

In a federal document leaked last week, the government acknowledged that “the influx of a large number of minimally vetted refugees will certainly lead to perceived concerns to the public health of Canadians and the increased risk of infectious disease.”

On Tuesday, federal officials stressed that before refugees leave the Middle East, they will undergo a health check that includes screening for communicable diseases such as tuberculosis. Upon arrival in Canada, there will be another health check.

Philpott said the government is designing the refugee plan so that the migrants move relatively quickly to their host communities from the moment of their arrival in Canada.

Among the questions driving the plan: “How will people adapt well? How will the effects of conflict, the effects of displacement, the effects of travel, the effects of separation of family all be minimized?”

The refugees have escaped a violent civil war in their Syrian homeland and have spent months, perhaps years, in limbo as they live in settlement camps or communities in countries such as Turkey, Lebanon, and Jordan. Many are still living with vivid memories from the conflict that has claimed the lives of more than 200,000 Syrians.

“Mental health concerns are amongst the concerns that we expect to see, of the health concerns of refugees,” said Philpott.

“There is an understanding that counselling services may need to be available and that is part of the traditional refugee settlement package.”

She said refugees will have access to the interim federal health program that provides not just basic insured health services that fall under medicare, but also things like dental and prescription drug coverage.

mkennedy@ottawacitizen.com
Twitter.com/Mark_Kennedy_

Related

• Canada unprepared for refugees’ mental health issues, experts say

Advocacy and Information: Youth Mental Health and Suicide

Rightbyyou.ca

It’s one of the most pressing issues facing our teens today – the lack of support for mental illness and its tragic consequences, such as suicide. 1.2 million Canadian children and youth are affected by mental illness – yet less than one-quarter of them are getting help. Suicide is one of the leading causes of death among our youth.

Let’s open the door so that we can drive more conversations regarding youth mental health, and get our children the help they need.

Bust The Myths

Looking for more information on how to talk about suicide, mental health or mental illness with youth?

Visit the link to check out the videos as experts, parents and youth share their perspectives and bust the most common myths that exist today around this issue.

Web: http://www.rightbyyou.ca/en/bust-the-myths

Get the Guide

Information, resources and tips for parents and caregivers on how to support your teen’s mental health.

Web: http://www.rightbyyou.ca/en/get-the-guide

Facts

Suicide is the #1 or leading cause of non-accidental death among youth.

Navaneelan, T. Statistics Canada – Catalogue no. 82-624-X. Suicide rates: An overview. July 2012

Every year we lose 762 young Canadians to suicide. Statistics Canada, 2009

We lose 2 young Canadians each day to suicide. Statistics Canada, 2009

As many as 173,000 young people (or up to 8%) will try to take their own lives.

TB Eaton DK, Kann L, Kinchen S, Shanklin S, Flint KH, Hawkins J, et al. Youth risk behaviour surveillance - United States, 2011. Morbidity and Mortality Weekly Report CDC Surveillance Summary 2012;61(4). / Population age group 15-19, Statistics Canada, 2012.

1 in 5 youth (aged 9 to 19) have a mental health problem or illness.

Risk Analytica/Mental Health Commission of Canada 2011 Impact Study

70% of mental health problems and illnesses have their onset during childhood and teen years.

Government of Canada. (2006). The human face of mental health and mental illness in Canada

3 out of 4 children and youth with a mental health problem or illness will not receive treatment.

Waddell C, Offord DR, Shepherd CA, Hua JM, McEwan K. (2002). Child Psychiatric Epidemiology and Canadian Public Policy-Making: The State of the Science and the Art of the Possible. Can J Psychiatry, 47(9), 825-832.

Over 20% of children with diagnosed mental health issues wait more than a year for treatment; the average delay is 12 months. Healthy Kids Inside and Out: The 2011 RBC Children’s Mental Health Survey

Almost 90% of people who die by suicide have a mental illness.

Arsenault-Lapierre G, Kim C, Turecki G. BMC Psychiatry 2004, 4:37 doi: 10.1186/1471-244X-4-37.

23% of all deaths for youth aged 15 to 19 can be accounted for by suicide.

Navaneelan, T. Statistics Canada – Catalogue no. 82-624-X. Suicide rates: An overview. July 2012

Suicide and substance abuse blamed for increased death rate for white, middle-aged Americans

Suicide and substance abuse blamed for death rate increase in white, middle-aged Americans

By Mike Stobbe (November 2, 2015). The Associated Press; Global News. Retrieved from: http://globalnews.ca/news/2313699/suicide-and-substance-abuse-blamed-for-death-rate-increase-in-white-middle-aged-americans/

NEW YORK – The U.S. death rate has been falling for decades, but researchers have detected one group in which the rates have been steadily ticking up — middle-aged white people. Suicides and deaths from drug overdose and alcohol abuse are being blamed.

It’s a problem that’s being called a quiet epidemic by health experts in the U.S.

Deaths rates for other races have continued to fall, as they have for whites 65 and older. But death rates for whites 35 to 44 have been level recently, they’re beginning to turn up for whites 55 to 64, and — most strikingly — death rates for whites ages 45 to 54 have risen by half a per cent per year since 1998, said the authors, Anne Case and Angus Deaton of Princeton University.

The increase started in the late 1990s and probably is related to the increased availability around that time of certain prescription painkillers, they said.

READ MORE: Prescription to die for: Study finds ‘exceptional’ death rates among opioid patients

“It certainly can’t be helping,” said Deaton, who last month was awarded a Nobel Prize in economics for unrelated work on consumer spending.

Their paper was published online Monday by the Proceedings of the National Academy of Sciences.

The increase in the death rate represents “an overlooked ‘epidemic’ with deaths comparable to the number of Americans who have died of AIDS,” according to research from Princeton University.

Federal researchers have reported — repeatedly — on worrisome increases in deaths from suicides and drug overdoses. And they have noted the bulk of those deaths have been white and middle-aged. So the Case and Deaton findings aren’t exactly surprising, said Robert Anderson, who oversees the Centers for Disease Control and Prevention branch that monitors death statistics.

But the Princeton pair brought a new lens to the government’s statistics, breaking down death numbers by age and race in a way the government has not highlighted, he added.

“White Americans who are middle-aged were really doing worse,” Case summarized. “And that’s not news we were hearing.”

There has not been a similar increase in middle-aged people living in other affluent countries, the researchers said.

White death rates still are not nearly as bad as black rates — not even for those 45 to 54. The rate is about 415 deaths for every 100,000 white people in that age group. For blacks, it’s 582 per 100,000.

U.S. death rates have been on a general decline for more than century, thanks mainly to public health measures and advances in medical treatment. In recent decades, the improvement has been driven by declines in death rates from heart disease and cancer — the nation’s two leading killers.

READ MORE: Overdose deaths rising fastest among middle-aged US women

But from time to time, death rates for certain demographics have gone up. That’s generally happened in younger groups, who die in smaller numbers than the elderly and so have death rates that can be more easily swung. That happened with death rates for some age groups of white and black men during the height of the AIDS epidemic, for example, Anderson said.

Of the 2.6 million deaths in 2013, about 123,000 — less than 5 per cent — were in white, non-Hispanic people ages 45 to 54.

But why the increase in this particular age set? And why only in white people? And why has it been inching up for them for 15 years?

The new study cited national health survey data showing increases over time in the proportion of middle-aged white people who said they suffered physical pain, trouble with daily activities, and poor mental health.

READ MORE: Mental health report warns of stress, suicide risk in Canada

Those problems are not unique to white people. But studies have found white patients with pain are more likely to be prescribed opioid painkillers. And whites have been more likely to attempt suicide when faced with physical or mental hardships, for a range of possible reasons that include smaller networks of social support, say other experts.

Education is also a factor. The study found among whites with a college degree, the death rates were actually quite low. But for whites who achieved no more than a high school diploma, they were a whopping 736 per 100,000.

But again, why that one age group?

It’s not clear. But that is a particularly tough time in life to suffer a serious financial setback or a debilitating health problem, noted John Phillips, who oversees some of the National Institute on Aging’s funding of research into what affects aging and health. The institute funded the study.

“You’re supposed to be heading into your prime earning years, and far from being able to collect retirement benefits,” he said. A job loss or other long-lasting hardship can be very hard to cope with, he added.

With files from Global’s Rebecca Joseph. 

Mental Health Film Night: Deprogrammed - Vancouver, BC

The Institute of Mental Health, UBC Department of Psychiatry and The Cinémathèque present:

Deprogrammed Wednesday, November 18, 2015 - 7:30pm Canada 2015. Dir: Mia Donovan. 90 min. DCP VANCOUVER PREMIERE! In the 1970s, the youthful search for meaning could often land you in a cult. As membership in the Moonies, the Children of God, the Christ Family, the Love Family, the Hare Krishnas, and others increased, so too did panic amongst middle-class parents, reaching a fever pitch with the 1978 Jonestown massacre. Into this maelstrom stepped deprogramming expert Ted “Black Lightning” Patrick, “a 10th-grade drop-out with a PhD in common sense.” Patrick's “reverse brainwashing” methods were unorthodox, if not plainly criminal, involving as they did kidnapping, forced confinement, repetitive interrogations, and sleep deprivation. Mia Donovan (Inside Lara Roxx) raises questions of the rights of the individual and free will in this fascinating documentary, which features interviews with the now 84-year-old (and unrepentant) Patrick, never-before-seen archival footage of deprogramming sessions, and current interviews with former cult members, some grateful for Patrick’s interventions, some not. - - - - - - - - - - - - - - - - - - Post-screening discussion with Dale Beyerstein, the Chair of the Philosophy Department at Langara College. Dale has also taught philosophy at Malaspina College, Douglas College, Kwantlen College and UBC. He is a founding member of the BC Skeptics, and a director-at-large of the organization. Moderated by Dr. Harry Karlinsky, Clinical Professor, Department of Psychiatry, University of British Columbia. More Info and Trailer

Autism: Adults with autism at risk for seizures, depression

Adults with autism at risk for seizures, depression

Posted by Lori Barrette-Rochester (November 9, 2015). Futurity. Retrieved from: http://www.futurity.org/adults-autism-depression-seizures-1044592/

University of Rochester - Original Study

Adults with autism are more likely to suffer seizure disorders and depression, according to a new study. The findings are noteworthy because seizures are associated with shorter life expectancy and an increased need for assistance with daily living activities.

Young adults with autism also have higher rates of hypertension, high cholesterol, allergies, and anxiety.

“Autism is one of the most common neurodevelopmental conditions in childhood, estimated to affect 1 in 68 children. Although it has been extensively studied in children, little is known about health conditions in adults with autism,” says lead author Robert J. Fortuna, assistant professor of medicine and pediatrics in primary care at the University of Rochester Medical Center.

[Gaze differs in autism, and not just for faces]

“This study highlights the importance of careful monitoring of their health status and urges us to examine best practices to facilitate their access to high-quality health care,” says senior author Philip W. Davidson, a professor emeritus of pediatrics, environmental medicine, and psychiatry.

Davidson and colleagues compared information from 255 adults ages 18 to 71 with autism spectrum disorder (ASD) to a similar group of the general population. A significant portion of the studied group had intellectual disabilities as measured by IQ scores. Those with intellectual disability and depression were more likely to need help with functional tasks.

Ultimately, the majority of older adults over 40 years of age with autism required some assistance with activities of daily living, such as dressing and bathing.

“Adults with autism frequently face barriers to accessing health care and receiving recommended treatments for common problems,” Fortuna says. “Therefore, greater awareness is needed to ensure that adults with autism are treated for conditions that are more prevalent with autism as well as conditions that are commonly encountered with advancing age.”

The University of Rochester and the University of Illinois at Chicago funded the work, which appears in the Journal of General Internal Medicine.

Source: University of Rochester

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