Ask most Canadians and they will tell you that Canada is the best country in the world to live in and will probably want to stay here until their life ends.  However, according to the Economic Intelligence Unit (EIU), Canada is far from the best country to die in.  Earlier this month, the EIU released a report that measured the Quality of Death for 40 countries in the world.  Tied with the United States in 9^th place, Canada has a great deal of work to do if our baby-boomer population wants to have peace of mind during their final days. 

 The Breakdown
Canada’s overall ranking has to do with four specific criteria.  The four categories along with their weighted value and Canada’s ranking (out of 40) for each category is as follows:

 1) Basic End-of-Life Healthcare Environment (20%) – ranked 20^th

2) Availability of End-of-Life Care (25%) – ranked 9^th

3) Cost of End-of-Life Care (15%)  – ranked 27^th

4) Quality of End-of-Life Care (40%) – ranked 5^th 

 Looking at these results, it is clear there is something wrong with this picture.    Ranking 5^th place worldwide, Canada has one of the highest quality end-of-life care available yet can’t seem to provide a high quality of death overall.  It’s not because we don’t have the resources.  We rank highest in the availability of painkillers and since 2008, all 17 of our medical schools are obligated to train physicians in palliative care.

So what’s the problem?   
The healthcare environment and cost to Canadians poses a dramatic barrier in achieving an overall high quality of death. 

 Due to Canada’s outstanding landmass, the palliative services that Canada does offer cannot support our citizens. According to the report, Canadians, like many regions in Africa, rely more on interspersed community based support from volunteers, families and friends for palliative care compared to other developed countries.   Sadly, as a result, less than 5% of Canadians receive adequate end of life care services.

 With little to no government funding, palliative services are costly.  The refundable tax credit that is available for respite or informal caregivers is peanuts compared to the actual cost of looking after a palliative patient.  And, places that offer palliative care services like the West Island Palliative Care Residence has to raise its remaining balance of $1,300,000 from donations each year, after it receives its portion of the operating budget from the government.

 When it comes to other countries, Canada ranks lowest in our willingness to discuss death.  From a culture where death has become more of a medical phenomenon, Canadians have distanced themselves from the holistic experience of death.

 So what’s next?
Hopefully at this point, Harper’s eyes have been opened.  It’s been 3 years since he disbanded the End-of-Life Care Secretariat and we still haven’t seen a formal national policy on palliative care. 

 Canadian citizens need to step up their awareness of what palliative care has to offer and with that, comes an understanding of the need for discussions about death.  Talking about death is not an easy subject to broach but when it comes time to prepare for the inevitable, it is justifiable to question how an individual is going to experience their end of life.  In Canada, when the answer is that they probably won’t experience it the way they want to, then something needs to be done.

 You could always move to the UK, who are currently ranked #1, but you shouldn’t have to. In the end, when Canadians experience end-of-life care, it’s really good and that is definitely something we should be proud of. The trained professionals are available; making them accessible is the next step.

 For the full report from the EIU and the list of indicators for each category click here.

Social isolation is often overlooked as a serious health concern for the elderly.  We are frequently molded to view seniors as retirees with vivacious social lives.   The reality is that a large proportion of our elderly population face social isolation and the consequences can be devastating.

Social isolation takes place when individuals withdraw themselves from friends, family members and other community networks.  It can be a subjective feeling or it can be observed by others; it is a removal of all vital social connections.   For most, social isolation is not a choice but rather an outcome of a particular situation. Many different events can put people at risk for social isolation and these can include:

• Illness
• Loss of a loved one
• Reduced social network
• Relocation – especially to a long term care facility
• Physical disability
• Low self-esteem
• Fear of falling
• Living alone
• Geographical location

Almost 30% of the Canadian population lives alone and it is one of the most influential determinants of social isolation.  As a result, less stimulation and integration from household members can lead to a life of reclusion.  As women continue to outlive men, they are at an even higher risk of being alone.

Consequentially, studies have shown that social isolation is associated with higher blood pressure, increased risk of disability, poor recovery from illness, risk of poor mental health like depression and suicide, and early mortality rates.

What can be done?

Get involved – Many organizations around Montreal offer programs specifically geared towards senior involvement.  Montreal Family Ties is a great website dedicated to helping caregivers who live out of town.  But even for those who live nearby, this website has information directed to various recreation and community centers available to seniors, along with many other additional resources. http://www.montrealfamilyties.net/Recreation.html

Volunteer - Volunteering is a way for seniors to get active socially while giving back to their community at the same time.  It can provide a sense of fulfillment and broaden an individual’s social network.

Use snail mail – Often times, seniors feel overwhelmed because of the demands of the technological world.  Writing letters is a great way to stay connected.  Whether it’s a pen pal from another country or someone who lives across the city, sharing moments with someone through a letter can certainly make a difference.

Schedule a tea time – It doesn’t have to be tea, necessarily, but making time, even once a week, to meet up with a friend or family member is something to look forward to.  Both parties will have the opportunity to catch up and share a few laughs.  After all, laughter is the best medicine.

Having active social connections promotes both physical and psychological well-being. There is no doubt about it; we need to remain socially active as we age.  Not only does it make us healthy, it makes us human.

The media has been overwhelmed lately with information about Alzheimer’s Disease and it’s all been good news.  Since the recent discovery of a new test that could determine Alzheimer’s diagnosis 10 years before symptoms appear, it’s been all the buzz.  In Honolulu this week, the National Institute on Aging and the Alzheimer’s Association met at the Alzheimer’s Association International Conference on Alzheimer’s Disease to propose a modification to the diagnostic criteria of Alzheimer’s disease.  With no amendments in the past 25 years, it’s about time they took some action.

 In order to move forward with treating and managing Alzheimer’s disease, we also need to move forward in our process of determining when someone has Alzheimer’s and understanding what it means to have Alzheimer’s.  Things have certainly changed in the past 25 years and perhaps now the awareness of Alzheimer’s can spread out to a larger community.

 Since it may be hard to keep track of what has been going on lately, the following are a few of the latest updates from the conference as well as some news from the medical world:

Diagnostic criteria to be changed – presence of biomarkers which are measurable characteristics that indicate a pathogenic process will be added to the list of diagnostic criteria for Alzheimer’s and can allow for CSF tests and MRI tests to be conducted before cognitive impairments develop.  Read more…

Proposal of 3 levels of Alzheimer’s – by having three different phases (preclinical Alzheimer’s, mild cognitive impairment due to Alzheimer’s and Alzheimer’s dementia), doctors may be able to more specifically diagnose patients before symptoms are too grave to be treated.  Read more…

Blood test may be able to detect Alzheimer’s 10 years before symptoms occur -  a new blood plasma protein, clusterin was identified by the Institute of Psychiatry at King’s College London and scientists suggest that clusterin levels rise many years before the effects of Alzhimer’s are apparent. Read more…

New compound may help individuals already diagnosed with Alzheimer’s  – scientists discover new compound, P7C3 that may work to promote growth of new neuron connections in patients already diagnosed with Alzheimers Read more…

 It may be difficult to know what to believe and what direction to go in, but by being on top of the latest developments in Alzheimer’s disease, you are sure to be one step closer to helping yourself or your loved one. 

 Keep your eyes and ears open – this issue is not going away any time soon.

 Stroke is the 3^rd leading cause of death in Canada with over 50,000 Canadians suffering from some form of stroke each year.  A recent study called the Interstroke study, published by Lancet online in June, is being held as the largest international case-control study to assess the importance of risk factors for stroke.  The study which took place over a period of 3 years in 22 countries around the world, accounts for varying levels of modifiable and non-modifiable predictors of stroke.

 After studying 3000 participants from various backgrounds, the researchers have identified 10 major risk factors that account for 90% of stroke cases.  In order of most significant to least, the risk factors involved are the following:

Risk Factors

1)     High blood pressure – measuring consistently higher than 140/90

2)     Smoking

3)     Abdominal obesity

4)     Diet high in saturated fats and salt

5)     Lack of physical activity

6)     Diabetes

7)     Alcohol consumption (<30 drinks/month)

8)     Psychological or social problems like depression

9)     Heart arrhythmias

10)  Specific blood proteins that store fat

 When it comes to stroke risk, there are factors that can’t be controlled like age, race and sex but knowing that 90% of risk factors are modifiable, the rates of stroke should be decreasing yet it remains as one of the top 5 causes of death in Canada.

 It is not news that high blood pressure, including the other risk factors, plays a major role in determining chances of stroke.  Untreated high blood pressure has been known as the silent killer for quite some time but studies of this magnitude clearly expose the importance of following a healthy diet, engaging in regular physical activity and talking care of one’s body.   Like any study, these results are not conclusive but the next phase of the study plans to investigate another 10,000 participants in which the results will certainly be significant, if not, revolutionary.

 What can you do right now?

It’s easy to say that you’ll stop drinking or smoking or that that you’ll start exercising but actually doing it is always the hardest part.    Start with small goals.  Researchers also noticed that those following a Mediterranean diet seemed to have substantially lower risk of stroke.  A Mediterranean diet allows you to incorporate foods that you might already love like fruits, vegetables and grains, meats and by making a few tiny adjustments, you can put yourself on the right track.  The idea is to consume more fish than red meat, substitute butter for olive oil and allow for moderate consumption of red wine as well as use herbs and spices instead of salt.  The diet is supposed to be light on the heart and likely isn’t a dramatic change to your lifestyle.  With one aspect of your life in the right direction, you can start to work on other areas of your life that might be putting you at risk.

 The Heart and Stroke Foundation of Canada can help.  In Quebec, there are various programs that help educate and motivate the population about stroke prevention and stroke maintenance.

• They offer CPR courses that teach how to recognize the signs of a stroke and how to respond if someone may be suffering from one;
• Heart at Work is a great tool that can be used by employers to help encourage healthy practices in the workplace;
• Heart in Motion is modeled after a unique program in Ireland that designates walk zones to allow you to measure the distance travelled.  In Quebec, these walk zones are implemented in Laval, Sherbrooke, Cote-St-Luc, Kirkland, Beauport, St-Adolphe d’Howard, Trois-Rivières, Rimouski, Longueuil, St-Hyacinthe and Chibougamau;
• If you want more information about how to live with heart issues, Take Life to Heart can help identify risky behaviours and introduce ways to reduce them.

 If you are concerned about your situation or someone you know, visit the Heart and Stroke Foundation at www.heartandstroke.qc.ca  for more information about the disease.

Further to our discussion a few weeks ago about the two sides of the elderly driving debate, The Wall Street journal highlights yet another side of the argument.  According to a recent study, when senior drivers get behind the wheel, not only are they getting into fewer crashes than they used to ,the results aren’t as fatal either.

To read more, follow the link below:
http://blogs.wsj.com/drivers-seat/2010/06/22/study-says-elderly-drivers-are-among-the-safest/?blog_id=146&post_id=1637