ElderWeb

The Canadian Institute for Health Information has released a new report called "Health Care in Canada 2000". This report looks at the performance of Canada's health care system, including the way that it adapts to the health care needs of seniors. The report analyzed the Canadian system, and compared it to systems in the United States, Australia, New Zealand, and the United Kingdom. In general, the report found that the confidence Canadians have in their health care system has dropped in the last 10 years. In 1991 about of Canadians 60% rated their system as good or better, but that had dropped to only about 25% by the year 2000.

Although only 12% of Canadians are age 65 or older, they account for 43% of all health care spending by provincial and territorial governments. Canadian seniors rated the quality of their medical care lower than did seniors in the United States, Australia, or New Zealand, although they were happier with their care than seniors in the United Kingdom.

About 185,000 Canadian seniors were living in nursing homes and other institutions in 1996/97. The average age of women in these facilities was 83 and the average age of men was far lower, 69. In addition, about 12% of Canadian seniors received publicly-funded home care services.

The report found that about 26% of Canadian seniors who had children often relied on their children as caregivers. One in four Canadians reported providing some sort of care to a family member in their home, and a study in Alberta found that 36% of respondents reported providing some sort of emotional, personal, or financial support to a family member in the last six months.

Both nurses and doctors in Canada are getting older themselves, leading to concerns about who will provide care to aging Canadians in the future. Nearly 40% of the physicians in Canada were age 50 or older in 1999, up from 35% in 1995. 90% of the nurses in Canada are over age 30, and more than 24% are age 50 or older.

The U.S. Food and Drug Administration (FDA) commissioned a study from a company called Cyveillance which states that of 11,000 "Canadian" Internet pharmacy sites they researched, most just redirect users to 1,099 sites that actually sell prescription drugs, and of the 1,009 sites that sell "Canadian" drugs, only 214 are actually based in Canada.

This raises many troubling questions and should justifiably frighten anyone buying drugs online, but little futher information was provided. I was not able to find any information about the study on the FDA web site at all, and only the press release is available on the Cyveillance site. The press release has been reproduced verbatim on numerous online and offline news outlets, but I only found one article, a story by Brian Krebs of the Washington Post, that seems to have dug further into the story (see it at http://www.washingtonpost.com/). Krebs tried to get additional information about the study, but was not able to find out which drug sites are actually located in Canada and was told by a FDA spokeperson that revealing that information would give Americans a "false sense of security" and that "as long as shipping medications into the United States remains illegal, the agency would continue to refuse to work with any entity supporting that activity."

I thought it would helpful to provide some tips to try to avoid problems when buying prescription drugs on the Internet:

1) Don't follow links in emails that offer Canadian drugs. One of the few bits of information in the press release was the fact that most of the bogus sites are only reachable via spam email links and cannot be found via legitimate search engine searches.

2) Many legitimate American sites will be be registered with the Verified Internet Pharmacy Practice service (VIPPS). Check their list at http://www.nabp.net/vipps/. Legitimate Canadian pharmacy sites can be found at the Canadian International Pharmacy Association (CIPA) at http://www.ciparx.ca/. If you don't see the site on one of these lists, you probably should avoid it.

3) CIPA also offers a list of tips on their web site to help ensure you are dealing with a legitimate Canadian pharmacy business, including suggestions to look for a Canadian Provincial pharmacy license number and a Canadian phone number (and to call that number to be sure it is legitimate). Consumers should also expect legitimate sites to require a prescription from a licensed physician.

Health Canada has released its annual report, which includes an overview of "extended services" (nursing home and home and community care) in each province or territory. These extended services are not covered by the federal program, so they differ from region to region.

In an article in the Journal of Clinical Nutrition, Randall J. Kaplan, from the University of Toronto in Canada, reports that memory of older people was significantly improved if they ate 50 grams of carbohydrates at breakfast, as compared to a high-glucose meal or no meal at all. The effects appeared to be the most pronounced on long-term memory and in those who had slight problems with glucose (blood sugar) regulation at the outset.

The new issue of Chronic Diseases in Canada (CDIC) contains a study of the elements of mobility that predict the survival of elderly patients with dementia difficulty. The study found that difficulty in dressing and getting about were important prognostic factors. A history of falls was also found to predict poor survival, as well as poor motor strength and inability to perform the examination to assess gait function.

Researchers developing a vaccine against Alzheimer's disease have shown that it seems to stop mice with the condition from losing their memory, which boosts hopes that such vaccines could delay or prevent similar symptoms in humans. The vaccine also reduces the build-up of protein deposits in mouse brains - the other major indicator of Alzheimer's disease. The pharmaceutical company Elan, based in Dublin, Ireland, is poised to begin large-scale human clinical trials of a potential treatment based on the vaccine. But what works in mice does not always work in people and the vaccine will still have to prove its worth in a battery of further tests.

Peter St George-Hyslop of the University of Toronto in Canada and his colleagues and a second team led by Dave Morgan of the University of South Florida at Tampa showed that the vaccine reduces learning and memory loss as the mice age. Each group gave Alzheimer's mice learning and memory tests, in which the animals had to swim to a submerged platform. In one trial the platform was moved each day, testing short-term memory. The second trial investigated 'spatial-reference' memory by leaving the platform in one place and testing the mice once a month. Mice given the test vaccine developed fewer and smaller protein deposits in their brains and performed markedly better than unvaccinated animals in both types of memory test.

Whether the protein deposits actually cause dementia in people is unclear. Some researchers believe that preventing the deposits from forming should relieve the distressing mental symptoms, although others disagree. This research supports the hypothesis that the two are related, but other factors could still be involved.

A collection of research reports on this subject are included in the current issue of Nature Magazine.

Health Minister Allan Rock and Dr.Yves Morin, member of the Governing Council of the Canadian Institutes of Health Research (CIHR), today announced health research grants of over $4.6 million, including funding of $856,000 for an important evaluative study on health care delivery for the elderly.

The Research Centre in Gerontology and Geriatrics of the Sherbrooke Geriatric University Institute will receive funding of over $856,000 from Health Canada's National Health Research and Development Program (NHRDP) for a study which will evaluate the implementation and impact of mechanisms and tools designed to improve the integration of care and services for the frail elderly.

Health Minister Allan Rock announced Health Canada's intention to develop a new regulatory approach for Canadians to access marihuana for medical purposes. This will address some of the issues relating to transparency of the process and a clear definition of medical necessity that stemmed from the decision by the Court of Appeal for Ontario in the case of R. v. Parker, rendered on July 31, 2000. The new regulatory approach will define the circumstances, and the manner in which the use of marihuana for medical purposes will be authorized.

The matter of an appeal on the narrow legal issues raised by the Parker decision is still under consideration. Whether or not leave to appeal the case is sought, the move to establish this new regulatory approach will go ahead. Issues raised by key stakeholders will be considered as the regulatory process is developed.

Until the new regulatory approach is in place, Canadians can continue to apply for an exemption for medical purposes under Section 56 of the Controlled Drugs and Substances Act with the support of their medical practitioner. An interim guidance document and application form are available online.

To date, marihuana is not approved as a drug in any country in the world. Health Canada is funding research activities which will lead to the scientific data necessary to evaluate the safety and effectiveness of marihuana for medical purposes in the future.

One of these projects, whose results are being eagerly awaited by stakeholders across Canada, is taking place here in Montreal. This is a pilot project that will test new ways of delivering integrated health services to vulnerable seniors and evaluate the benefits of this approach. The project involves 600 elderly people in the Bordeaux-Cartierville and C'des-Neiges districts of Montreal. The concept is to work with interdisciplinary teams to offer an integrated range of relevant health services to these individuals.

This project will demonstrate new ways of organizing health services to optimize the quality and level of care afforded the growing segment of the population which is aging. More to the point, this project is not premised on creating a single delivery model that will be broadly imposed. It is premised on creating a knowledge base that all provinces and territories can build on and expand in order to develop new and more effective systems tailored to their distinct realities.

The Federal Trade Commission has won a $19.7 million judgment against Canadian telemarketers the FTC charged with operating an illegal international lottery scam. The FTC alleged that in calls from a Toronto-based boilerroom, the telemarketers used high pressure tactics to persuade consumers to send anywhere from $29 to thousands of dollars to invest in the lotteries. The federal court found that the defendants told consumers - most of whom were elderly - that they had been "specially selected" to participate in a system for playing the Canadian lottery and that the consumer was likely to win a large prize or jackpot by playing with the defendants. The court also found that telemarketers told the consumers that they were "registered" or "sponsored" by the Canadian Government to sell the lottery tickets, but failed to disclose that it was illegal to sell them to U. S. consumers. In fact, only a small percent of the money the telemarketers took in actually went toward the purchase of lottery tickets.

The defendants named in the FTC suit are Windermere Big Win International, Inc., Marathon Award Center, Inc., Sunshine Fortuity, Inc., Ernest Levy, a/k/a/Ernie Levy, Alan Silverstein, Selvanayagam Pararajasingam, Michael Levy, and George Ola. Consumers who believe they invested in foreign lotteries through one of the named defendants may apply for redress by contacting the FTC at 1-877-FTC-HELP.

Middle-class and upper-middle-class US and Canadian residents have similar odds of surviving cancer, but America's poorer residents do not fare as well as those in Canada, according to new study findings. The study was led by Dr. Kevin M. Gorey, of University of Windsor in Ontario, and reported on in the Journal of Public Health Medicine.

Among people on the bottom one third of the socioeconomic ladder, Canadians were about 35% more likely to survive cancer than similar US residents. The researchers attribute the results to the differences in the Canadian and US healthcare systems. Gorey noted that several previous studies have failed to detect a difference in cancer survival between the two countries, but the research did not break down the statistics by socioeconomic status. The disparity between the US and Canada was even greater when the analysis only included people who were diagnosed with cancer before age 65. In the US, most of these people would not be eligible for Medicare, the federal health insurance program for the elderly.

Alberta Canada Minister of Health and Wellness Gary Mar released the results of a survey of Albertans on the quality of their health care. He stated that the report shows that Albertans are generally happy with the health care they receive, since 86% rated the overall quality of their health care as good. Their assessment of the health care system improved, with 63% saying it was excellent or good, up from 57% in the prior year. On the other hand, their belief that access and availability of services was adequate dropped from 74% to 63% on availability of services, and from 73% to 64% on access to services. 79% said they waited less than one week for an appointment with a family physician, which was no change from the prior year.

The newest edition of the Canadian Guide to Programs and Services for Seniors has just been released and is available online. It presents accurate, up-to-date information on programs and services offered to Canadian seniors by the federal government and to better enable seniors to access them.

The Ontario provincial government is providing $6.3 million to expand and enhance adult day programs and respite services for people with Alzheimer Disease, Health and Long-Term Care Minister Elizabeth Witmer announced. The funding will be provided to 80 agencies across Ontario and now serve over 4,000 people, including 2,300 new clients.

New research comparing U.S. and Canadian healthcare systems found that Canadian patients with unstable angina were 44% more likely to have had a heart attack or died six months after coming to the hospital complaining of chest pain, but after one year the overall mortality rate for patients with small heart attacks and unstable angina was nearly the same for Canadians and Americans. Researchers found that more U.S. than Canadian hospitals were equipped to provide high-tech treatment to patients with unstable angina. More had on-site treatment facilities, and even when they did not have such facilities, U.S. patients were more likely to be transferred in a timely manner to a hospital that did. The study was done by researchers at the University of Alberta, and was reported in the September 19 issue of Circulation Magazine.

The Prime Minister and the other Canadian Ministers met in Ottawa September 11 and issued a "Health Communique." In it, they promised that the federal government would work with provinces and territories to improve Canadian health care. Among other things, they stressed they are committed to strengthened investment in home care and community care as critical components of a more fully integrated health system. They also promised that in order to ensure Canadians continue to have access to new, appropriate and cost-effective drugs, they will work together and mandate their Health Ministers to develop strategies for assessing the cost-effectiveness of prescription drugs, and will create a common intergovernmental advisory process to assess drugs for potential inclusion in government drug plans.

A collaborative effort between the Alzheimer Society of Canada, AstraZeneca Canada Inc., AstraZeneca US and the Canadian Institutes of Health Research (CIHR) through its partnership with Canada's Research-Based Pharmaceutical Companies (Rx&D) will help generate new research into Alzheimer Disease. The Alzheimer Disease Research Grants Program is designed to stimulate individual Canadian investigators to undertake innovative research into the cause and cure of Alzheimer Disease. The Program offers up to four biomedical research grants focussed on the causes, diagnosis and treatment of Alzheimer Disease for each of two years. Researchers are invited to submit proposals designed to yield new insights into the prevention and treatment of Alzheimer Disease. Applications for up to $100,000/annum for projects of up to two years will be considered.

The Governing Council of the Canadian Institutes of Health Research have approved the names and mandates of 13 "Virtual Institutes" including the Institute of Healthy Aging. The recruitment process for Scientific Directors and Institute Advisory Boards will begin immediately.

The mandate of the CIHR Institute of Healthy Aging is to support research to promote healthy aging and to address causes, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range of conditions associated with aging. Research areas include long-term health promotion policies and strategies (individual, community, and population levels); health determinants - to elucidate the multi-dimensional factors that affect the health of aging populations and lead to a differential prevalence of health concerns; application of knowledge regarding health advantage and health risk factor to prevent or postpone functional disability disease, injury, and disability prevention (or postponement; factors which enable the elderly to remain independent: e.g. community characteristics, housing, transportation, volunteers; and geriatrics research: best practice research on care of the elderly (e.g. service delivery, co-morbidity, medication use and mis-use, iatrogenic problems, rehabilitation, palliation).

- Contributed by Bill Hyde

A former Montreal-based broker, who appointed himself as an executor and heir in an elderly female client's will and then neglected to tell his employer of his new beneficial interest, has been fined $25,000 by the Investment Dealers Association of Canada (IDA). According to the IDA, Quynh Lam Phan, then a registered representative with Levesque Securities Inc. (now National Bank Financial Inc.) violated industry regulations by helping draft a will for his client, which would give him 25% of her capital, then failed to notify his employer or update the client's new account application form to reflect his new-found personal interest in the account. Phan's client's estate included a car and property in Florida, and the total value of her account was approximately $1 million Canadian.

The Ontario Legislature has enacted numerous changes to the Health Care Consent law, which will become effective in December of 2000.

The intent of this document is to provide an inventory of the surveys, databases, publications, articles and work in progress in Statistics Canada that relate to Canada?s retirement income programs. The inventory provides information on publications, output and relevant data elements produced by the surveys and databases. It does not provide an exhaustive description of these data sources, but instead focuses on the information that can be used for purposes of researching/analysing retirement income programs. Some of the information contained does not specifically relate to these programs but might be used as a secondary source when doing research in this area.

Monthly payments for Canadian Old Age Security pensions, Guaranteed Income Supplements, Spouse's Allowances and Widowed Spouse's Allowances increased by 0.9% on July 1st.

The current issue of the Journal of Clinical Oncology has a report from researchers who investigated complaints that breast cancer patients receiving chemotherapy have difficulty in their ability to remember, think, and concentrate. The research team was led by Dr. Ian F. Tannock of Princess Margaret Hospital in Toronto. Tannock's team found that, regardless of the women's mood, age and education, chemotherapy patients did show signs of mental impairment. They believe the cancer drugs may be acting on healthy brain cells, but that is still unclear. Tannock cautioned that this potential side effect should not scare away breast cancer patients, but that they should be fully aware of the possible adverse consequences of chemotherapy. He said, "As an oncologist, one thing that worries me is that some women might use this as an argument against a treatment that can help them."

In the current issue of Health Affairs, Allan Rock, Canada's minister of health, believes that Canadians want to see their revered health care system flourish once more. He discusses the problems the system is facing as funding shifts more and more to the provinces. He notes that, of the $90 annual spending on health care in Canada, the federal government contributes about 23 cents, the public contributes about 31 cents, and the remaining 45 cents is paid for by the provinces. So the federal government now contributes less to health care costs than the public.

The Canadian National Advisory Council on Aging has issued its recommendations for home care in Canada. They recommend:

Home care be considered an integral part of publicly funded health services.

Canada Health and Social Transfer (CHST) funding recognize the demographic differences in current and future demand for home care services amongst provinces.

Federal, provincial and territorial governments collaborate to develop a set of national home care objectives.

Public administration with a single payer be one of the objectives of a national home care system.

Portability of home care services be one of the objectives of a national home care system.

Reports on the Canadian health care system include measurements of home care expenditures, services and outcomes against a set of national home care objectives.

Federal and provincial governments continue to investigate the most effective and efficient delivery mechanisms for home care services.

Provincial governments adopt a set of nationally comparable standards for the training and compensation of professional home care workers.

The federal government act as a role model by providing a comprehensive set of home care services to Canadians for whom it has primary health care responsibility, e.g. Aboriginal people and veterans.

A section with a special emphasis on home care be maintained within Health Canada to ensure a strong federal presence in home care policy development.

The federal government explore extending Employment Insurance coverage to workers who leave work temporarily to provide informal care.

The federal government act as a model employer by incorporating a comprehensive and flexible set of provisions for adult caregiving in labour agreements with its employees.

The federal government devote additional funding to enhance research on the effectiveness and efficiency of different home care delivery models.

Results of the Canadian Home Care Study are available from the National Association for Home Care (NAHC). This study, "The Comparative Cost Analysis of Home Care and Residential Care Services," examined the utilization and cost of services provided to people who received care at home as compared to those who received care in a residential setting. The results were stratified by the level of care needed to try to make comparisons more meaningful.

Overall, costs for community-based care averaged $8,900 a year, while residential care averaged $30,000 a year. The difference in costs varied with the level of care needed, so that home care represented about 40% of residential care costs for those with lower care needs, but 75% of residential care costs for those with more acute needs. The cost of home care as compared to residential care is highest for clients whose needs are changing, and for clients who die while under care.

Partially in response to this study, Canadian Health Minister Allan Rock proposed an expanded national home care program in a letter to officials in the nation's 10 provinces.

Canada's National Advisory Council on Aging (NACA)has published a report, "Seniors of Tomorrow" in the current issue of their "Expressions" newsletter. In this "Crystal Ball Issue", they discuss demographic trends, policy issues, health, wealth, and make various reflections and prognostications about aging in Canada. For instance, they discuss retirement, and observe several trends:

Involuntary retirement used to happen when people reached mandatory retirement age, but now it's more likely to result from job loss or caregiving.
Reversing retirement (returning to the work force) is a new trend, more common among men than women.
There may be a trend toward no retirement because of the need to supplement income.

- submitted by Bill Hyde

The Toronto Globe & Mail reported that a recent trial has stirred up controversy about the regulation of retirement homes in Ontario. On trial was a retirement home resident accused of beating up his 93 year-old roommate for snoring too loudly. The older man later died. The news has stimulated concerns about the industry as a whole.

Ontario is one of the few provinces that does not regulate retirement homes. "Some of the retirement homes are excellent. But others can be just like little cesspools. You would be afraid to put your pet in them, let alone your parents," said David Kelly, deputy executive director of Senior Link, a Toronto advocacy group for the elderly. In another case, police arrested workers at the Queen's Retirement Residence in Toronto last November, charging them with swindling more than $70,000 from residents.

The City of Toronto responded by setting up a hot line for complaints. It has received nearly 700 calls since it was set up late last fall, many of them relating to poor staffing and food and sanitation issues. Brenda Elliott, parliamentary assistant to Helen Johns, the Ontario minister responsible for seniors, undertook a "listening tour" last month at the request of the minister to assess the state of the industry. However, Ms. Elliott said that she believes they would rather be self-regulating than be regulated by provincial legislation.

The Ontario Seniors Secretariat reports that they are working with the Ontario Residential Care Association (ORCA)to strengthen the self-regulatory framework for Ontario's rest and retirement home industry.

The Canadian Council of Motor Transport Administrators (CCMTA) held a national workshop last October on Maturing Drivers. Their 'Project Group on Maturing Drivers' will be assessing and compiling the workshop's deliberations into a report, discussing issues such as:

The need to strike a balance between the right of an individual to continue to drive and protection of the public good by ensuring that roads are safe.

Testing standards may need to be reviewed and adapted to fairly assess a maturing driver's performance.

The loss of a drivers license is a potentially traumatic experience which may lead to huge change in lifestyle.
Vehicles and road signs may need to be re-designed with an older population in mind.

It hoped that the work of the CCMTA project group will lead to the development of a national model licensing program for maturing drivers by provincial/territorial governments. The project report will be approved at the upcoming meeting in June.