Mental illness and an aging population
Growing numbers of seniors face smaller increases in health-care dollars
Your six-part series exploring mental illness in adults was timely. Award-winning Hamilton Spectator reporter Jon Wells is to be congratulated for his research covering the history, understanding and treatment of this complex disease.
It’s unlike treatment for a person with a visible fracture which can be reset and healed. Someone suffering from a mental illness is just as sick, but the disability is invisible, difficult to treat and may be incurable. Advancing age may be a factor in developing dementias that can be treated but are not yet curable.
Mental illness is widely considered a weakness, not a sickness. Families quietly suffer along with a mentally sick member. Mr. Wells’ work should help to allay much of that stigma.
St. Joseph’s Healthcare in Hamilton offers a beacon of hope. Psychiatrists assisted by psychologists provide direct treatment when patients present. But physicians specializing in aging illnesses are in short supply. According to a 2013 study by the University of Waterloo, University of Ottawa and the Schlegel-UW Research Institute for Aging, Canada had only 242 certified geriatricians versus more than 700 needed.
The Canadian Geriatrics Journal calls this shortage a perfect storm because of growing mental illness among aging Canadians. In 2008, a survey of 16 Canadian medical schools found “... undergraduate students received approximately 82 hours of geriatric teaching, but more than 300 hours of pediatrics education.”
Common mental disorders among seniors include dementia and depression, plus anxiety. Some develop criminal and suicidal urges, as among our First Nations youth. St. Joe’s helped them all. Also, McMaster University’s Institute for Research on Aging focuses on living safely in one’s own home. There are now 34 such aging-research centres in every province. Heart disease and cancer have been the leading causes of death among the elderly. Bipolar disorder and schizophrenia become common as our population ages.
Charitable organizations supporting mental health are active. The Canadian Mental Health Association recommends a national strategy on mental health. And the Alzheimer Society of Canada warns roughly 15 per cent of Canadians lived with dementia in 2011, whose number will double in 20 years. Both agencies promote public education and well-being. And there are other considerations: Concussion in sports received only scant attention in the past. It was a normal hazard. Athletes who sustained severe brain injury in football, soccer, boxing and hockey in their younger years may experience neurologic damage in their retirement years. According to the U.S.-based Centers for Disease Control and Prevention, a professional football player may receive 900 to 1,500 blows to the head in a season. A soccer player heading the ball sustains impact speeds of 70 m.p.h., representing more than a normal hazard. More prevention is needed.
Growing numbers of aging seniors (pre-boomers, boomers and early baby-busters) during the next 15 years will face smaller increases in health-care dollars that Ottawa will transfer to our provinces and territories. As a result, our overused and overcrowded hospitals are reinventing.
Hamilton Health Sciences president Rob MacIsaac favours a community health approach “... to help people better manage their health to reduce the chance they will need hospital care.” Examples of diseases that may be prevented rather than treated are chronic heart failure and chronic obstructive pulmonary disorder. Canadians must do their part to manage their health. Seniors may have to reinvent also. It’s smart to plan ahead how to retire, to reinvent a new career during retirement rather than to retread an old job, and to adapt to a healthier lifestyle.
There are some financial considerations requiring attention.
Revenue Canada provides tax relief for expenses paid for professional therapy by a medical doctor or psychologist. But the required minimum 40-km travel expense for therapy may exceed the distance a low-income patient can afford to pay. Let’s eliminate it.
Canada provides a disability tax credit for medical expenses over 3 per cent of net income in a year, but it may not help low-income seniors with smaller expenses. They depend on benefits, not credits. Canada’s CPP disability benefit is only about $1,212 per month until age 65 when it converts to a pension, insufficient to prevent poverty. Lower thresholds are warranted.