A Systematic Literature Review of Mental IllnessAmongst Canada’s Seniors

Lisa AdamsCNS-EH; PhD. (Prov. © - U of A)

Notice of Disclosure

I, Lisa Adams, the presenter, declares that there

is no apparent conflict of interest that may have a direct bearing on the subject matter of the presentation

The National Picture

In Canada, 20% of the population will be diagnosed with a MI during some time in their life, with the remaining 80% experiencing some indirect effect of MI through the experience of either a friend or relative (Health Canada, 2004)

Changing demographics

Already endure significant life events Most occur in elderly once they reach 65 years of age

(Donnelly, 2002)

Prevalence rate= 17-30% (Up to 88% in LTC facilities)

Incidence rate= 20% Aged 85 and older growing 4x faster than any other segment

of the population (Romanow, 2002) Dementia & Depression Under-diagnosed- somatic complaints (64% not yet dx.’d) Suicide

Societal Views

Two patients limp into two different Canadian medical clinics with the same complaint. Both have trouble walking and appear to require a hip replacement.

The first patient is examined within the hour, is x-rayed the same day and has a time booked for surgery the following week.

The second sees the family doctor after waiting a week for an appointment, then waits eighteen weeks to see a specialist, then gets an x-ray, which isn't reviewed for another month and finally has his surgery scheduled for a year from then.

Why the different treatment for the two patients?

Societal Views (cont’d)

The first is a Golden Retriever…

the second is a Senior Citizen.

SLR Definition

Defn.- A concise summation of the best available evidence which provides directions to health care professionals regarding their choice of therapy and/or intervention for their clients.

Benefits include:

1) Effectively reduces quantity of data for more efficient use

2) Decreased time and costs

3) Can help plan research & recognize and avoid mistakes

4) ID extraneous findings

5) Consistency and reliability

6) Generalizability

7) Increased power

8) Provides precision in estimates of risk and effect size

9) Decreases bias

10) Great publication starting point for students/clinicians

Steps to complete a SLR

Steps:

1) ID specific need and state clear question

2) Involve the experienced and knowledgeable

3) Provide a background

4) Clear, specific criteria and structured questions

5) Search a range of sources (Using key words)

6) Redefine question

7) Keep thorough record (Retraceable)

8) Assess eligibility criteria & consistencies/inconsistencies

9) Evaluate studies for validity

10) Summarize, distribute and disseminate results

SLR for Canada’s mentally ill seniors

Question: To what extent does the determinants of health, inclusive of social support, income, housing and health care practices, impact on the development of a mental illness among Canada’s elderly?

Experienced and KnowledgeableLiterature ReviewCriteria:

Canadian based Published between 2000 and 2005 key words- elderly, Canada, mental illness, housing, income, social support, health practices, and epidemiology that appeared in either the title, abstract and/or text who had some degree of their sample aged 65 years and older.

Range of Sources: Medline, CINAHL and IPA Internet search (Search engine, Google), Amicus

database, “Related topics” facility on Medline, bibliographies of accepted articles, published works of CCSMH, CMHA & CIHI

Manually & electronically

The Process of SLR (cont’d)

Redefine QuestionThorough recordEligibility criteria- In-/ConsistenciesAssess study’s validity

Results: 49 of 648 articles deemed relevant4 of 12 theses dissertations Table format

Summary: Each of social support, housing, income and housing all significantly Impacted on senior’s mental health.

Distribute and disseminate results For publication - Abstract

- Literature review - Methodology - Results - Discussion - Conclusion

Results Sample

Finding- Housing Impact Reference

Improved psychological well being and mental and physical health

Incr. self esteem and control

No benefit- Younger, not older people were found homeless and suffering from a MI

Incr. sense of security & safety, health & independence

Supportive environment needed to remain well & decr. incidence of MI

Incr. setbacks, crises & hospital readmissions

Decr. incidence of MI, incr. functioning and safety & decr. Stress

Decr. criminal history & MI symptoms, incr. social skills & functioning

Incr. cognitive functioning, improved mental health, social skills & use of services

Incr. QOL & meaning in one’s daily activities

Improved mental and physical health status

Health Canada (2004)

Oliver (2004)Acorn (1993)

NLAOT (2005)

Hermann & Smith (1989)

CMHA (2003)

Stergiopoulos & Herrmann (2003)

Goering, Wasylenki, Onge, Paduckak & Lancee (1992)

Lariviere, Gelinas, Mazer, Tallant & Paquette (2002)

Aubin, Hackey & Mercier (1999)

Dunn (2002)

All About Me!!!!

What can we as health clinicians do?

Goal: To discover the person behind the dementia.

e.g. preferences, needs, habits, routines, etc.

Guidelines: Social worker, nurse, & family members

Location: Visually friendly for staff and visitors

Benefits: - Increased understanding

- Increased comfort, acceptance &

- Therapeutic memory triggers

- Increased recognition, compassion and acceptance of one’s personhood

“All About Me”

My name is ______. My maiden name was ________ I was born in ______, in the year ________.Significant people in my life are_________ &

_________.My bathday is on _____________My birthday is on _____________ My favorite foods are ________, &________.I am allergic to ________My most frequent visitors are:___________________ My sleeping habits include: _____________________.Things that bring me peace and comfort include

__________ & ___________. I go to the dining room for all meals; I even like to go

to the dining room for breakfast on my bathday

Thank you!!!!

Questions

Discussion