Factors associated with shingles and pneumococcal vaccination among older Canadians.

Background: Immunization against vaccine-preventable diseases such as shingles and pneumococcal disease is especially pertinent among older Canadians. However, vaccine uptake remains low. Data and methods: Data from the Canadian Health Survey on Seniors (CHSS) - 2019/2020 were used to examine receipt of shingles and pneumococcal vaccines among Canadians aged 65 and older living in the community. Multivariable logistic regression was used to identify individual predisposing, enabling and needs-related factors associated with receipt of each type of vaccination. Reasons reported for not getting vaccinated were also examined. Results: Based on the 2019/2020 CHSS, an estimated 36.3% of Canadians aged 65 and older (2.3 million people) had received the shingles vaccine, while 51.1% (3.1 million) had received the pneumococcal vaccine. Being a woman, having higher socioeconomic status, having had the flu shot and having a regular health care provider were associated with increased odds of vaccination. Being an immigrant, living outside large population centres, and belonging to South Asian or Chinese population groups were associated with lower odds of vaccination. Over one-third of unvaccinated people did not think the shingles vaccine (39.7%) or the pneumococcal vaccine (36.6%) was necessary. Other frequently reported reasons for non-vaccination were not having heard of the vaccine or the doctor not mentioning it; for the shingles vaccine, 12% cited cost as a reason. Interpretation: Understanding factors associated with uptake of vaccines and reasons for not obtaining them among older Canadians will help to inform policy and programs aimed at preventing the burden of these diseases.

Access to specialized health care services among older Canadians.

Background: Canada is experiencing rapid population aging, which has a wide range of implications, including an increased need for health care services. However, very few studies have examined use of specialized health care services (e.g., visits to medical specialists, non-emergency tests, and surgeries) among older Canadians. Data and methods: Data from the Canadian Health Survey on Seniors - 2019/2020 were used to examine specialized health care service use among older Canadians. Latent class analysis was calibrated using a nationally representative sample of 39,047 Canadians aged 65 years or older to identify distinct patterns of need factors related to health care service use. Multivariable logistic regression, stratified by gender, was used to examine the association of predisposing characteristics, enabling resources, and need factors with specialized health care service use. Results: In 2019/2020, an estimated 2.6 million older Canadians (43.4%) visited medical specialists, 1.4 million (23.2%) got non-emergency tests, and 0.6 million (10.4%) had non-emergency surgeries. Among those, 15.6% reported experiencing difficulties accessing services. Women were less likely than men to have visited medical specialists and have received non-emergency tests. Lower education was consistently associated with lower odds of specialized health care service use. Individuals in the multimorbidity, high stress-multimorbidity-disability, and poor physical and mental health classes were more likely than those in the comparatively healthy class to use specialized health care services and to experience difficulties accessing them. Interpretation: Findings of this study highlight gender differences and the importance of considering multidimensional need factors - ranging from physical health to mental health to psychosocial factors - in examining use of specialized health care services.

Immigrant status and loneliness among older Canadians.

Background: Prevalence of loneliness among Canadians has become an important concern because of its wider consequences on health and well-being. However, there are limited Canadian studies about loneliness disaggregated by gender and across various subgroups of older Canadians, particularly immigrant subgroups. Data and methods: Data from the Canadian Health Survey on Seniors (CHSS) - 2019/2020 were used to estimate the prevalence of loneliness among older Canadians in a nationally representative sample of 38,941 Canadians aged 65 and older. The association between immigrant status and loneliness was assessed using multivariable logistic regression adjusted for demographic, socioeconomic and health characteristics. Analyses were conducted for men and women combined and separately. Results: In 2019/2020, an estimated 1.1 million older Canadians (19.2%) experienced loneliness, with women having significantly higher likelihood of being lonely than men. Among men, both European and non-European immigrants were more likely to experience loneliness than the Canadian-born population. Among women, the likelihood of loneliness was higher among European immigrants than among those born in Canada. For both men and women, immigrants who migrated as adults (from ages 18 to 44) and long-term immigrants (20 years or more in Canada since immigration) were at higher risk of loneliness than the Canadian-born population. The likelihood of being lonely was higher among people living with multimorbidity or experiencing barriers to social participation. Interpretation: The findings underscore the importance of considering immigrant subgroups and gender in examining loneliness among older Canadians and when developing policies and programs to address loneliness.

Sleep duration, sleep quality and obesity in the Canadian Armed Forces.

Background: Research has identified an association between sleep and obesity in the general population. It is also important to examine this association in a military population. Data and methods: Data from the 2019 Canadian Armed Forces Health Survey (CAFHS) were used to estimate the prevalence of sleep duration, sleep quality characteristics, overweight and obesity for Regular Force members. The relationship of sleep duration and sleep quality with obesity was assessed with multivariable logistic regression that controlled for sociodemographic, work and health characteristics. Results: Females were significantly more likely than males to report meeting recommended sleep duration (7 hours to less than 10 hours; 48.7% vs. 40.4%), trouble falling or staying asleep (32.3% vs. 23.5%), or that sleep was not refreshing (64.0% vs. 57.7%). Difficulty staying awake did not differ significantly between males and females (6.3% vs. 5.4%). Obesity, but not being overweight, was significantly more prevalent among those who had short (less than 6 hours) or borderline (6 hours to less than 7 hours) sleep duration, or poor sleep quality. Compared with recommended sleep duration, short sleep duration (adjusted odds ratio [AOR] 1.3; 95% confidence interval [CI]: 1.2 to 1.6) and borderline sleep duration (AOR 1.2; 95% CI: 1.1 to 1.4) were associated with obesity for males, but not females, in fully controlled models. Sleep quality indicators were not independently associated with obesity. Interpretation: This study adds to the body of evidence that identifies an association between sleep duration and obesity. The results emphasize the importance of sleep as one of the components of the Canadian Armed Forces Physical Performance Strategy.

Correlates of vaping among adolescents in Canada.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk. Data and methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours. Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping. Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

Association of frailty and pre-frailty with increased risk of mortality among older Canadians.

BACKGROUND: Frailty is a complex syndrome that is associated with aging but not synonymous with the normal aging process. It has been associated with all-cause mortality, but less is known about frailty and mortality from specific causes. DATA AND METHODS: Data from the 2013 and 2014 Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics - Death Database were used to estimate the prevalence of frailty among Canadians aged 65 or older. Levels of frailty were based on validated cut-points for the 30-item frailty index. The relationship of frailty to mortality risk during the period of three to five years following the CCHS interview was assessed with Cox proportional hazards models adjusted for sociodemographic factors and health behaviours. Associations between frailty and mortality from neoplasms, circulatory diseases and disease of the respiratory system were examined in separate models. RESULTS: An estimated 1.1 million (22%) community-dwelling older adults were frail in 2013 and 2014, and another 1.6 million (32%) were considered pre-frail. Frailty was more common among females than males and among those in older age groups. The risk of mortality increased significantly with increasing levels of frailty, even after accounting for sociodemographic factors and health behaviours. This was the case for all-cause mortality, as well as for death from three major underlying causes-neoplasms, and diseases of the circulatory and respiratory systems. DISCUSSION: Even individuals who were classified as pre-frail had an increased risk of mortality overall and from three leading causes compared with those who were robust, demonstrating the importance of screening community-dwelling older adults for frailty.

Hypertension associated with hearing health problems among Canadian adults aged 19 to 79 years.

BACKGROUND: Hypertension is a common condition experienced by close to one-quarter of the adult population in Canada. There is evidence that this condition or the medications used to treat it may lead to hearing health problems (defined in this study as having hearing loss, tinnitus or both conditions). DATA AND METHODS: Data from the Canadian Health Measures Survey from 2012 to 2015 were used to estimate the prevalence of hypertension and hearing health problems for individuals aged 19 to 79 years (n=6,198). Data from cycles 3 (n=3,072) and 4 (n=3,126) were combined. The relationship of hypertension to hearing health problems was assessed with multivariate logistic regression. RESULTS: An estimated 40% of the adult population were free of hearing health problems, while the remaining 60% had either hearing loss (23%), tinnitus (22%) or both conditions (14%); 22% of the adult population had hypertension. Hearing health problems were significantly more prevalent among adults with hypertension (79%) than among those without hypertension (54%). Hypertension was associated with greater odds of hearing health problems in both males (adjusted odds ratio [AOR]=1.7) and females (AOR=1.6), even after accounting for age, sociodemographic, health-related and noise exposure variables. INTERPRETATION: This study adds to the body of evidence that identifies hypertension as a potentially modifiable risk factor for hearing loss and tinnitus. Males and females with hypertension had a higher risk of experiencing hearing health problems, demonstrating the importance of screening those with hypertension for hearing health.

Food insecurity and mental health during the COVID-19 pandemic.

BACKGROUND: Food insecurity has been linked to adverse mental health outcomes. This study assessed the association between household food insecurity and self-perceived mental health status and anxiety symptoms among Canadians in the early months of the COVID-19 pandemic. DATA AND METHODS: The Canadian Perspectives Survey Series 2 collected cross-sectional data from May 4 to 10, 2020, on Canadians aged 15 years or older residing in the ten provinces. The brief six-item Household Food Security Survey Module was used to measure participants' households as food secure or marginally, moderately or severely food insecure within the previous 30 days. Logistic regression was used to assess associations between food security status and self-perceived fair or poor mental health and moderate or severe anxiety symptoms, adjusting for sociodemographic covariates. RESULTS: Approximately one in seven Canadians (14.6%) lived in a household that experienced some level of food insecurity. Of these individuals, 9.3% reported recently accessing free food from a community organization. About one in five Canadians self-perceived their mental health as fair or poor (22.0%), or self-reported moderate or severe anxiety symptoms (18.2%). With covariate adjustment, individuals in households with moderate food insecurity had nearly three times higher odds of reporting fair or poor mental health, and moderate or severe anxiety symptoms, compared with individuals in food-secure households. Among those with severe food insecurity, adjusted odds ratios were 4.0 (95% confidence interval [CI]: 2.0 to 7.9) for fair or poor mental health, and 7.6 (95% CI: 3.9 to 14.7) for moderate or severe anxiety symptoms. DISCUSSION: In the early period of the COVID-19 epidemic in Canada, household food insecurity was independently associated with poorer mental health outcomes. Monitoring both food insecurity and mental health will be important as the COVID-19 pandemic continues.

Social isolation and mortality among Canadian seniors.

BACKGROUND: Subjective and objective measures of isolation have been associated with increased risk of mortality in many studies, and some have found differential effects. DATA AND METHODS: Canadian Community Health Survey-Healthy Aging data (2008/2009) linked to the Canadian Vital Statistics-Death Database were used to estimate the prevalence of social isolation measured objectively (low social participation) and subjectively (feelings of loneliness and weak sense of community belonging). Associations with death during the 8 to 9 year follow-up period were examined with multivariate Cox proportional hazards models controlling for sociodemographic and health-related characteristics. Structural equation models (SEM) examined direct paths with survival time and indirect effects through health status controlling for covariates that were significant in the Cox models. Analyses were stratified by sex. RESULTS: An estimated 525,000 people (12%) aged 65 or older felt socially isolated and over 1 million (1,018,000) (24%) reported low participation. In multivariate Cox models, low participation was significantly associated with death for men and women even when the potential confounding effects of subjective isolation, socio-demographic characteristics, health status, and health behaviours were considered. Subjective isolation was not associated with death in final multivariate models for men or women. SEM revealed significant associations between low participation and survival time for men and women. In addition to the direct effects, there were significant indirect effects mediated by health status. There were no direct effects of subjective isolation on survival for men or women, only indirect effects mediated through health status. DISCUSSION: Subjective and objective isolation differed in their association with mortality.

Sexual orientation and complete mental health.

BACKGROUND: Previous research indicates that lesbian, gay and bisexual individuals have poorer mental health than their heterosexual counterparts. The concept of complete mental health, which combines the presence of positive mental health and the absence of mental disorder, has not been thoroughly examined in this population. DATA AND METHODS: Data from the 2015 Canadian Community Health Survey (CCHS) were used to estimate the number and percentage of men and women aged 15 and older who self-identify as lesbian, gay, bisexual, or heterosexual. Complete mental health was defined as the presence of flourishing mental health together with the absence of any self-reported mood disorder, anxiety disorder or suicide ideation in the previous 12 months. Multivariate logistic regression models stratified by sex were used to identify differences in complete mental health among gay, lesbian, bisexual, and heterosexual individuals. RESULTS: In 2015, an estimated 252,000 (1.9%) Canadian men identified as gay and 145,000 (1.1%) as bisexual, while 153,000 Canadian women (1.1%) identified as lesbian and 299,000 (2.2%) as bisexual. Gay men had significantly lower unadjusted odds of complete mental health, but this association was no longer significant when controlling for sociodemographic and health factors. The likelihood of complete mental health was not significantly different for lesbians than for heterosexual women. Both bisexual men and bisexual women had significantly lower odds of complete mental health in the fully adjusted models. DISCUSSION: Awareness of poorer mental health outcomes, particularly for bisexual individuals, can help guide specific interventions aimed at improving the mental health and well-being of sexual minority populations.

Infant bed sharing in Canada.

BACKGROUND: There is debate about the practice of bed sharing, which is defined as sharing a sleep surface with an infant. Most public health guidance in Canada, including the 2011 Joint Statement on Safe Sleep, advises parents against it because of an association with infant injury and death. However, proponents cite potential physical and psychological benefits, and evidence suggests that the risks associated with bed sharing are low in the absence of other risk factors. Until now, little has been known about the prevalence of and reasons for bed sharing in Canada. DATA AND METHODS: Canadian Community Health Survey data from 2015 and 2016 were used to estimate the prevalence of and reasons for bed sharing by selected characteristics among women aged 15 to 55 who had given birth in the past five years. Multivariate analysis examined factors independently associated with frequent bed sharing. RESULTS: An estimated 33% of women reported that their infant had frequently (every day or almost every day) shared a sleep surface with someone else; 27% had bed shared occasionally (once or twice a week, a few times a month or less than once a month) and 40% had never bed shared. Breastfeeding was the most common reason for bed sharing (39%), followed by facilitating the mother's or infant's sleep (29%). In multivariate analysis, age group, marital status, province or territory of residence, region of mother's birth and breastfeeding were significantly associated with frequent bed sharing. DISCUSSION: The data indicate that bed sharing is relatively common and suggest that parents are doing it for practical reasons. The results of this study will provide baseline data and inform policies and programs related to safe sleep practices.

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.

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.

Multiple sclerosis: Prevalence and impact.

This article provides new information about multiple sclerosis (MS) using the 2010/2011 Neurological Conditions Prevalence File, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. An estimated 93,500 Canadians living in private households and 3,800 residents of long-term care institutions had been diagnosed with MS. Prevalence estimates were 159 and 418 cases per 100,000 population for men and women, respectively; 2.6 women reported MS for every man with the condition. Among the household population, MS was generally diagnosed between the ages of 20 and 49 (82%). For the majority (68%), MS was their only neurological condition. The impact of MS included pain that prevented activities, impairments in mobility, cognition or sleep, and limitations in social functioning. Almost two-thirds (64%) stated that MS affected their lives at least moderately.

Medically unexplained physical symptoms (MUPS) among adults in Canada: Comorbidity, health care use and employment.

Based on data from the 2014 Canadian Community Health Survey and the 2012 Canadian Community Health Survey-Mental Health, this study provides estimates of the prevalence of medically unexplained physical symptoms (MUPS) in the household population aged 25 or older. MUPS are examined in relation to sociodemographic characteristics, physical and mental comorbidity, health care use and unmet needs, labour force participation and productivity. In 2014, 5.5% of Canadian adults-an estimated 1.3 million - reported having chronic fatigue syndrome (1.6%), fibromyalgia (2.0%) and/or multiple chemical sensitivity (2.7%). Half (51%) of people with MUPS reported other chronic physical conditions, compared with 8% of those without MUPS. Similarly, mental comorbidities were more prevalent among those with MUPS. Higher health care use was observed among people with MUPS, but 25% of them reported unmet health care needs, compared with 11% of those without MUPS. People with MUPS were more likely than those without MUPS to be permanently unable to work or to not have a job; fewer than half (45%) were employed. Among those who were employed, 18% had missed work because of a chronic condition, compared with 5% of workers without MUPS.

Nutritional risk, hospitalization and mortality among community-dwelling Canadians aged 65 or older.

BACKGROUND: Nutritional risk has been associated with various negative health outcomes among older people. Limited longitudinal research has examined the relationship between nutritional risk and hospitalization and death in community-dwelling older people. DATA AND METHODS: Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) linked to the Discharge Abstract Database and the Canadian Mortality Database were used to estimate the prevalence of nutritional risk among seniors and examine its relationship with acute care hospitalization and death during the 25- to 36-month period following the CCHS-HA interview. Multivariate Cox proportional hazards models were used to identify important covariates, while adjusting for demographic and socioeconomic characteristics, health status, and lifestyle factors. RESULTS: A third (34%; 979,000) of Canadians aged 65 or older living in 9 provinces (excluding Quebec) were at nutritional risk in 2008/2009. These seniors had a higher risk of an acute care hospitalization (hazard ratio (HR) 1.2; 95% CI: 1.1 to 1.4) or death (HR 1.6; 95% CI: 1.3 to 2.0) during the follow-up period, even when potential confounders were taken into account. Seniors at nutritional risk in 2008/2009 were more likely than those not at nutritional risk to die during follow-up (9% versus 5%) and averaged shorter survival times: 498 days (95% CI: 462 to 534) compared with 538 days (95% CI: 501 to 574). INTERPRETATION: Based on an analysis of data from a large population-based survey linked to routinely collected hospital and death data, nutritional risk is independently associated with acute care hospitalization and mortality. Results highlight the importance of monitoring seniors for nutritional risk.

Threshold and subthreshold Generalized Anxiety Disorder (GAD) and suicide ideation.

BACKGROUND: Subthreshold Generalized Anxiety Disorder (GAD) has been reported to be at least as prevalent as threshold GAD and of comparable clinical significance. It is not clear if GAD is uniquely associated with the risk of suicide, or if psychiatric comorbidity drives the association. DATA AND METHODS: Data from the 2012 Canadian Community Health Survey-Mental Health were used to estimate the prevalence of threshold and subthreshold GAD in the household population aged 15 or older. As well, the relationship between GAD and suicide ideation was studied. Multivariate logistic regression was used in a sample of 24,785 people to identify significant associations, while adjusting for the confounding effects of sociodemographic factors and other mental disorders. RESULTS: In 2012, an estimated 722,000 Canadians aged 15 or older (2.6%) met the criteria for threshold GAD; an additional 2.3% (655,000) had subthreshold GAD. For people with threshold GAD, past 12-month suicide ideation was more prevalent among men than women (32.0% versus 21.2% respectively). In multivariate models that controlled sociodemographic factors, the odds of past 12-month suicide ideation among people with either past 12-month threshold or subthreshold GAD were significantly higher than the odds for those without GAD. When psychiatric comorbidity was also controlled, associations between threshold and subthreshold GAD and suicidal ideation were attenuated, but remained significant. INTERPRETATION: Threshold and subthreshold GAD affect similar percentages of the Canadian household population. This study adds to the literature that has identified an independent association between threshold GAD and suicide ideation, and demonstrates that an association is also apparent for subthreshold GAD.

Epilepsy in Canada: Prevalence and impact.

This article provides information about the prevalence and impact of epilepsy, based on the 2010 and 2011 Canadian Community Health Surveys, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. An estimated 139,200 Canadians had epilepsy. Among the household population, epilepsy was generally diagnosed before age 30 (75%). For the majority of these people (64%), epilepsy was their only neurological condition. People with epilepsy were more than twice as likely to have been diagnosed with a mood disorder, compared with the general population (17% versus 7%), and eight times as likely to experience incontinence (34% versus 4%). Overall, an estimated 18% reported that their life was affected quite a bit or extremely by epilepsy; 44% felt that their life was impacted a little bit or moderately; and 39% felt that their life was not impacted at all. This study examined the impact of epilepsy on interactions with others, sleep, driving, education, and employment.

Alzheimer's disease and other dementias in Canada.

This article provides information on Alzheimer's disease and other dementias, using the 2010/2011 Canadian Community Health Survey, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. Among Canadians aged 45 or older, an estimated 0.8% in private households and 45% in long-term residential care facilities had a diagnosis of dementia. Prevalence rose with age. The vast majority of people with dementia in private households received assistance with medical care (81%), housework and home maintenance (83%), meal preparation (88%), emotional support (90%), transportation (92%), and managing care (92%). Among those receiving assistance, 85% relied, at least in part, on family, friends or neighbours. The primary caregiver tended to be a spouse (46%) or an adult child (44%), most of whom were daughters (71%). The majority of primary caregivers lived in the same household (83%) and provided daily care (86%).

Chronic pain, activity restriction and flourishing mental health.

BACKGROUND: According to the activity restriction (AR) model, a potential explanation for the impact of chronic pain on mental illness is that pain contributes to depression by limiting usual activities. This study uses a measure of mental health (flourishing), rather than mental illness to examine associations between pain and activity restrictions. DATA AND METHODS: Data from the 2011/2012 Canadian Community Health Survey were used to study the relationship between pain intensity, pain-related activity prevention, and flourishing mental health in people aged 18 or older. Multivariate logistic regression was used in a sample of 26,429 people with chronic pain to identify significant relationships, while adjusting for potential confounders. RESULTS: In 2011/2012, an estimated 6 million Canadians aged 18 or older (22%) reported chronic pain. They were less likely to be in flourishing mental health than were people without chronic pain (69% versus 79%). The prevalence of flourishing mental health declined as pain intensity and the number of activities prevented because of pain increased. Pain intensity and pain-related activity prevention were each independently associated with flourishing mental health, even when socio-demographic and health factors were taken into account. Pain-related activity prevention partially mediated the association between pain intensity and flourishing mental health. INTERPRETATION: The results of this study support the AR model and highlight the importance of both pain intensity and activity restriction in relation to flourishing mental health.