IPA Bulletin

PSYCHOGERIATRICS AROUND THE WORLD: CANADA'S NEW MODEL FOR COLLABORATION
Canadian Coalition for Seniors Mental Health Forms to Assist Aging Population

DAVID K. CONN, SHELLY HABER, AND KEN LECLAIR 

Prompted by concern about inadequate mental health services for the residents of long-term care facilities, the Canadian Academy of Geriatric Psychiatry developed the Millennium Project in 1999 with the goal of “improving the mental health of the elderly in long-term care through education, advocacy and collaboration.”

The Academy formed a partnership with Health Canada and ten other organizations to plan a National Symposium. The National Symposium, “Canadian Invitational Symposium on Gaps in Mental Health Services for Seniors in Long-Term Care Facilities,” was held in April 2002 in Toronto. The participants, who represented more than 65 organizations from across Canada, included national and provincial associations, policymakers, consumers, service providers, educators, researchers and private industry. The main outcome of the symposium was overwhelming support for the establishment of the Canadian Coalition for Seniors’ Mental Health. The purpose of the Coalition is to improve the mental health of seniors through a coordinated national strategy. The Coalition’s first priority will focus on the needs of seniors living in long-term care facilities.

The participants highlighted many strategic initiatives, including:  a) educating professionals, frontline workers and family caregivers;  b) promoting and enhancing research opportunities to better understand effective practices;  c) advocating for policies and programs to ensure high quality care and enhance public understanding of related issues, including ageism and stigma;  d) enhancing assessment and treatment to improve outcomes and quality of life;  e) providing direction to ensure environments are designed to promote mental health;  f ) involving family members in the provision of care through education and awareness of seniors’ mental health issues; and  g) improving the recruitment and retention of health professionals with expertise in elder care.

Several leading national associations have committed to work collectively on this project and have established a steering committee. Health Canada will act in an advisory capacity to the committee and will be the principal contact with the department on matters relevant to federal jurisdiction in the area of seniors mental health. 

The coalition will focus on issues related to mental illnesses such as mood, anxiety and psychotic disorders, as well as emotional and behavioral disturbances that occur as a result of medical/neurological illnesses. 

In recent years nursing homes have been termed “modern mental institutions for the elderly.” Studies estimate that approximately 80 percent of nursing home residents suffer from mental disorders. One of the most rigorous studies was carried out by Rovner et al, who evaluated 454 consecutive nursing home admissions.¹ More than two-thirds of the residents had some form of dementia and 10 percent suffered from a mood disorder. Forty percent of the residents suffering from dementia had psychiatric complications such as depression, delusions or delirium. A comprehensive review of the literature with regard to the prevalence of behavioral and psychological symptoms of dementia yielded median figures of 44 percent for global agitation, 24 percent for verbal aggression and 14 percent for physical aggression.² The prevalence rates of delusions and hallucinations in patients with Alzheimer’s disease have been estimated to be 36 percent and 28 percent, respectively.³ Studies of depression suggest that between 15 and 25 percent of nursing home residents have symptoms of major depression, and another 25 percent have depressive symptoms of lesser severity.^4,5 Despite the need for mental health services by nursing home residents, very few receive psychiatric or other mental health services. A study of long-term care facilities in Ontario revealed that 88 percent of nursing homes receive five hours or less per month of psychiatric care for their whole institution.⁶  For seniors living in the community, concerns include the rapidly increasing number of dementia cases (as a result of aging of the population), high rates of unrecognized depression and completed suicide, limited availability of mental health services including community outreach, and poor funding of critically important home care services.

The coalition has received an 18-month grant from Health Canada–Health Population Fund to begin specific initiatives. One of its first projects will be to compile inventories of educational materials for health care professionals and family caregivers.

David K. Conn is Psychiatrist-in-Chief, Baycrest Centre for Geriatric Care and President Canadian Academy of Geriatric Psychiatry; Co-Chair, Canadian Coalition for Seniors’ Mental Health. Shelly Haber is Project Director, Canadian Coalition for Seniors’ Mental Health. Ken LeClair is Professor and Chair, Division of Geriatric Psychiatry, Department of Psychiatry, Queen’s University, Kingston; Co-Chair, Canadian Coalition for Seniors’ Mental Health

ACCESS For information on the Canadian Coalition for Seniors’ Mental Health, please contact either David Conn or Shelly Haber, Project Director, (416) 781-2886, s.haber@sympatico.ca.

REFERENCES 

1. Rovner BW, German PS, Broadhead J, Morriss RK, Brant LJ, Blaustein J, Folstein MF. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr 1990;2:13-24.

2. Tariot PN, Blazina L. The psychopathology of dementia. In: JC Morris (ed) Handbook of
Dementing Illnesses. New York: Marcel Dekker, 1994, p. 461-75.

3. Wragg RE, Jeste DV. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry 1989;146:577-587.

4. Ames D. Epidemiological studies of depression among the elderly in residential and nursing homes. Int J Geriatr Psychiatry 1991;6:347-354.

5. Katz IR, Lesher E, Kleban M, Jethanandani V, Parmelee P. Clinical features of depression in the nursing home. Int Psychogeriatr 1989;1:5-15.

6. Conn DK, Lee V, Steingart A, Silberfeld M. Psychiatric services: A survey of nursing homes and homes for the aged in Ontario. Can J Psychiatry 1992;37:525-530.

Reprinted from IPA Bulletin Volume 19 Number 4