Men­tal ill­ness and an ag­ing pop­u­la­tion

Grow­ing num­bers of se­niors face smaller in­creases in health-care dol­lars

The Hamilton Spectator - - COMMENT - NORM STEFNITZ Norm Stefnitz grad­u­ated from U of T in Po­lit­i­cal Science & Eco­nomics, earned his C.F.A. des­ig­na­tion, was chair of the Cana­dian Coun­cil of Fi­nan­cial An­a­lysts, head of per­sonal in­vest­ments at a Canada-wide trust com­pany, and founded Pri­or­ity

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.

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