Unmet home care needs in Canada.

BACKGROUND: Unmet home care needs have been linked to poor health, increased use of other health services, admission to nursing homes and reduced emotional well-being. DATA AND METHODS: Using data from the 2015/2016 Canadian Community Health Survey, this article describes home care use and unmet home care needs by type (i.e., home health care [HHC] and support services) in community-dwelling adults. Among the population with home care needs, the degree to which needs were met, partially met or unmet is presented, as well as information about the barriers to obtaining home care services and the places services were sought. Multivariate analysis was used to examine factors associated with unmet home care needs by type, while controlling for predisposing, enabling and needs-related factors. RESULTS: In 2015/2016, just over one-third (35.4%) of people with home care needs, an estimated 433,000 people, did not have those needs met. This was more prevalent among those with support needs than those with HHC needs. Availability of services was most often cited as a barrier to obtaining home care services, particularly for those with an unmet need for HHC services. Age group, household type, long-term care insurance and health status factors were associated with perceiving an unmet home care need, with few differences by type of unmet need. DISCUSSION: The degree to which needs were met and the perceived barriers to obtaining home care services varied by type of unmet home care need. The results indicate proportionally higher unmet needs for home care services among adults aged 35 to 49. This suggests a possible service gap.

Formal home care use in Canada.

BACKGROUND: Formal home care services (those typically delivered by health care providers or volunteer organizations) are different from informal home care services (given by family, friends or neighbours), and thus represent a partial picture of all home care provided. Home care has been associated with decreased mortality, improved quality of life, and reduced hospitalizations and health care costs. DATA AND METHODS: New data from the annual Canadian Community Health Survey (CCHS) 2015/2016 are used to estimate, for the first time, the number and percentage of households in which at least one person of any age received formal home care services in Canada during the previous year. A descriptive analysis of socioeconomic characteristics of households receiving formal home care is presented. RESULTS: An estimated 6.4% of households (881,800) in Canada received formal home care services in the past year, most frequently nursing (46%) and personal/home support services (46%). Households with parents and adult children (age 25 or older), one-person households, and households with lower socioeconomic status were most likely to have received formal home care. Costs were covered by a range of sources. They were paid solely by government (52%), solely out of pocket (27%), solely by insurance (7%), at least partially by insurance and/or government (8%), and by other sources (6%). Households that received home health care services only-particularly nursing services-were more likely to have their costs entirely covered by government, while those that received support services only were more likely to pay out-of-pocket costs. DISCUSSION: This descriptive analysis of household use of formal home care services by socioeconomic characteristics and type of care will help inform health care policies and programs. Future person-level analysis can examine the independent factors associated with home care use.

Parkinson's disease: Prevalence, diagnosis and impact.

This article provides information on Parkinson's disease, using the 2010/2011 Canadian Community Health Survey, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey of Living with Neurological Conditions in Canada. An estimated 0.2% of Canadian adults in private households (55,000), and 4.9% of those in residential institutions (12,500), had Parkinson's disease. Younger age at symptom onset was associated with a longer period to disease diagnosis. As a result of the condition, 58% reported that social interactions were negatively affected, 61% reported out-of-pocket expenses, and 56% reported receiving assistance with activities such as housework, transportation or personal care. Among those receiving assistance, 84% relied at least in part on family, friends or neighbours. The primary informal caregiver tended to be a spouse (64%), female (62%), live in the same household (72%), and provide assistance on a daily basis (76%).

Cognitive performance of Canadian seniors.

With data from the 2009 Canadian Community Health Survey--Healthy Aging Cognition Module, five cognitive functioning categories based on normative values that adjust for age, sex and education were created. The two lowest categories were combined to identify seniors (65 or older) without Alzheimer's disease or dementia living in private households, who had low scores on four cognitive tasks: first recall, second recall, semantic fluency, and processing speed. Low income, not living with a spouse or partner, and diabetes were associated with low scores on each task. Heart disease, impairment in instrumental and daily activities, receiving home care, social participation, loneliness, and self-perceived general and mental health were also associated with low cognitive performance, although the associations differed by cognitive task.

14-year diabetes incidence: the role of socio-economic status.

BACKGROUND: Diabetes prevalence is associated with low socioeconomic status (SES), but less is known about the relationship between SES and diabetes incidence. DATA AND METHODS: Data from eight cycles of the National Population Health Survey (1994/1995 through 2008/2009) are used. A sample of 5,547 women and 6,786 men aged 18 or older who did not have diabetes in 1994/1995 was followed to determine if household income and educational attainment were associated with increased risk of diagnosis of or death from diabetes by 2008/2009. Three proportional hazards models were applied for income and for education--for men, for women and for both sexes combined. Independent variables were measured at baseline (1994/1995). Diabetes diagnosis was assessed by self-report of diagnosis by a health professional. Diabetes death was based on ICD-10 codes E10-E14. RESULTS: Among people aged 18 or older in 1994/1995 who were free of diabetes, 7.2% of men and 6.3% of women had developed or died from the disease by 2008/2009. Lower-income women were more likely to develop type 2 diabetes than were those in high-income households. This association was attenuated, but not eliminated, by ethno-cultural background and obesity/overweight. Associations with lower educational attainment in unadjusted models were almost completely mediated by demographic and behavioural variables. INTERPRETATION: Social gradients in diabetes incidence cannot be explained entirely by demographic and behavioural variables.

H1N1 vaccination.

Early results (January to April) from the 2010 Canadian Community Health Survey show that an estimated 41% of Canadians (excluding those in the territories) aged 12 or older had been vaccinated for H1N1 by April 2010. The percentages were higher in the Atlantic provinces, Quebec and Saskatchewan than in Canada overall. Relatively high percentages of females and people aged 45 or older were vaccinated; the percentage of immigrants who had done so was relatively low. Being in a priority group (health-care worker, having children younger than 5 in the household, or having a chronic condition that could increase the risk for complications from H1N1) increased the likelihood of vaccination. A history of seasonal flu vaccination and having a regular doctor were also associated with H1N1 vaccination. Nearly three-quarters of those who had not been vaccinated reported that they did not think it was necessary.