Executive Summary. Demographics

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2 Executive Summary Demographics Seniors made up 18.4% of the total population within the North Bay Parry Sound District Health Unit (NBPSDHU) region in The majority of NBPSDHU region seniors were female and aged 65 to 69 years. Within the next 10 years, estimates for the North East Local Health Integration Network (NE LHIN) region project population increases across all senior age groups, with the greatest increase expected in individuals aged 65 to 69 years. According to the 2006 census, almost half of seniors in the NBPSDHU region reported having no high school certificate, diploma or degree. Knowledge of official languages varied by district, but on the whole, a higher percentage of NBPSDHU region seniors had knowledge of either only French or both French and English compared to Ontario seniors. More seniors in the NBPSDHU region identified as Aboriginal compared to Ontario, however a lower percentage of NBPSDHU region seniors were visible minorities. According to the 2006 census, similar percentages of the senior population in the NBPSDHU region and Ontario participated in the labour force; however a lower percentage of NBPSDHU region seniors were unemployed. Like Ontario, most NBPSDHU region seniors have an after-tax income between $10,000 and $19,000, and more males than females gain income from employment. Median and average incomes are lower among NBPSDHU region seniors compared to Ontario seniors, although a lower percentage of NBPSDHU region seniors are low income after taxes. In 2006, about 29% of seniors in the NBPSDHU region reported living alone and 68% reported living in a family household. In 2009/10, over 97% of seniors in the NBPSDHU region were identified as living in food secure households, an estimate similar to that for Ontario seniors. Measures of Health & Well-Being In 2009/10, a lower percentage of NBPSDHU region seniors rated their health as being good or better compared to individuals aged 12 to 64 years; however, a lower percentage of NBPSDHU region seniors found their life stressful compared to the younger NBPSDHU region population. In 2007, life expectancy for females and males in the NBPSDHU region was slightly lower than expectancies for Ontarians as a whole; 81.4 years for NBPSDHU women and 77.5 for NBPSDHU men. Life expectancy for NBPSDHU region senior females and males has risen by about a year since Health-Related Behaviours & Conditions In 2009/10, the percentage of seniors who reported consuming fruit and vegetables five times a day in the NBPSDHU region (47%) was comparable to the Ontario estimate (47%) and to the estimate for NBPSDHU region population aged 12 to 64 (48%). About 40% of NBPSDHU region seniors in 2009/10 were at least moderately active, an estimate comparable to that for Ontario. About 60% of NBPSDHU region seniors were overweight or obese in 2009/10, similar to the estimate for Ontario seniors. The percentage of self-reported daily or occasional smokers among NBPSDHU region seniors in 2009/10 was significantly lower compared to the same estimates among the NBPSDHU region population aged Seniors In the NBPSDHU Region: A Health Status Report Page i/vi

3 12 to 64 years (8% versus 26%, respectively). The percentage of NBPSDHU region seniors residing in smoke-free homes has risen significantly from 2000/01 through to 2007/08. The percentages of NBPSDHU region seniors who reported drinking in excess of the low-risk drinking guidelines in 2009/10 and drank heavily in 2005 were significantly lower compared to the younger NBPSDHU region population. Chronic Diseases & Conditions The majority of NBPSDHU region seniors reported having arthritis in 2009/10, a significantly higher percentage compared to Ontario seniors. High blood pressure was prevalent among NBPSDHU region seniors in 2009/10, with more than half reporting having been diagnosed with high blood pressure. In 2009/10, about 14% of NBPSDHU region seniors had been diagnosed with diabetes in their life, comparable to the Ontario estimate. In 2005, about a quarter of NBPSDHU region seniors had been diagnosed with cataracts and about a tenth had been diagnosed with glaucoma. Mental Health In 2009/10, about 80% of NBPSDHU region seniors described their mental health as at least very good, a percentage similar to the Ontario estimates and to the younger NPBSDHU region population. Mood disorders among NBPSDHU region seniors were about as prevalent in 2007/08 as in the younger NPBSDHU region population and comparable to Ontario seniors overall. Average mental health hospitalization rates between 2007 and 2009 among NBPSDHU region seniors were highest for cognitive disorders such as delirium and dementia (e.g., Alzheimer s disease), followed by mood disorders and schizophrenic or other psychotic disorders. Injuries Fewer than 10% of NBPSDHU region seniors reported having a serious injury in 2009/10, significantly lower than the same estimate among the NBPSDHU region population aged 12 to 64 years. Almost 50% of these serious injuries were due to a fall. Falls were the leading cause of average injury hospitalizations among NBPSDHU region seniors between 2007 and 2009, followed by motor vehicle collisions and overexertion. Hip fracture hospitalizations were significantly higher among NBPSDHU region female seniors compared to males. Infectious Diseases Between 2006 and 2010, influenza accounted for the most confirmed cases of a reportable disease among NBPSDHU region seniors, followed by salmonellosis and invasive Streptococcus pneumonia infections. The rate of confirmed influenza cases has declined significantly between the 2001/02 and 2009/10 influenza seasons. Between 2001 and 2010, NBPSDHU region seniors aged 90 years and older had the highest incidence rate for confirmed influenza compared to NBPSDHU region seniors aged 65 to 89. The emergency department visit rates for influenza and pneumonia have risen from 2007 to 2010, and were higher for NBPSDHU region seniors compared to Ontario and North East LHIN region seniors in About 94% of NBPSDHU region seniors reported receiving a flu shot in 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page ii/vi

4 Emergency Department Visits Most emergency department visits among seniors between 2007 and 2009 were nonspecific in cause, followed by injuries, and poisonings & other consequences of external causes. The average emergency department visit rate for NBPSDHU region seniors was significantly higher than the Ontario estimate. Hospitalizations The average hospitalization rate for NBPSDHU region seniors between 2007 and 2009 was highest for diseases of the circulatory system, followed by diseases of the digestive system and diseases of the respiratory system; all rates were significantly higher than the provincial estimates. Mortality Top causes of mortality among NBPSDHU region seniors between 2005 and 2007 included diseases of the circulatory system (highest), followed by neoplasm (e.g., cancers) and diseases of the respiratory system. Within diseases of the circulatory system, ischaemic heart diseases were the leading cause of mortality followed by cerebrovascular diseases (e.g. stroke). Mortality rates for disease of the circulatory system were highest among seniors aged 90 years and over. Average incidence rates for cancers (i.e., malignant neoplasms) between 2005 and 2007 were highest for breast, prostate, lung and colorectal cancers among NBPSDHU region seniors. Average incidence rates for all types of malignant cancers general were highest for seniors aged 75 years and older. Average mortality rates for prostate cancers among male seniors and lung and bronchus cancers among female seniors were significantly higher in the NBPSDHU region compared to in Ontario. Average mortality rates for all malignant cancers combined increased with age. Access to Health Services & Utilization In 2009/10, almost 95% of NBPSDHU region seniors reporting having a regular doctor. About 92% of seniors in the NBPSDHU region had spoken with a family doctor or general practitioner. On the other hand, about 57% of NBPSDHU region seniors had spoken with a dentist or orthodontist in 2009/10. Although about three-quarters of NBPSDHU region seniors reporting having insurance for prescriptions, only 44% had insurance that covered dental expenses in 2009/10. Furthermore, only 30.4% had insurance for eye glasses or contacts. Home care services paid partially or wholly by the government were received by about 11% of NBPSDHU region seniors in 2009/10. Such services include nursing care, personal care and housework. Additionally, 7.4% of seniors received home care services not covered by the government, services such as housework, meal preparation or delivery, or shopping. In 2009/10, about 41% of NBPSDHU region seniors experienced activity limitations, a significantly lower percentage compared to the same estimate in 2000/01. Almost a quarter of NBPSDHU region seniors needed help with one or more tasks of daily living, an estimate significantly higher compared to the younger NBPSDHU region population. Seniors In the NBPSDHU Region: A Health Status Report Page iii/vi

5 Data sources & Interpretation Data presented within this report has been extracted from several sources. Data sources, as well as relevant notes or symbols have been noted as footnotes below their corresponding tables and graphs. Definitions for relevant terms are provided in the left hand column. The term senior is used within this report to describe persons aged 65 years and older. Excluded from sampling in the Canadian Community Health Survey are individuals living on Indian Reserves or on Crown Lands, institutional residents, full-time members of the Canadian Forces and residents of certain remote regions. Data from the Canadian Community Health Survey (CCHS) was estimated using IBM SPSS Statistics version 19.0 and variance for these estimates were calculated using the bootstrapping method. For these statistics, responses for each indicator were analyzed to account for response categories such as don t know, refusal or not stated. It is noted on the graph when the percentage of responses exceeded 5% for any given estimate, as missing values may bias the estimate by omission of responses. As the local health integration regions (LHINs) were not created until 2005, data from earlier cycles of the CCHS survey (e.g., 2000/01, 2003) were not available for the North East LHIN. All rates included in this report have not been adjusted for age or any other factor (i.e., crude). As such, the effects of differing age distributions between different regions or time periods has not been controlled for. Average three-year rates were calculated by summing the number of events during those three years and calculating the average. The population count from the middle year was then used to calculate the rate. Averages rates were used in selected analyses as a small number of events (<20) may result in highly unstable annual rates. Sampling variability has been estimated using 95% confidence intervals. These intervals have been calculated wherever pertinent to provide a measure of statistical precision and to allow comparison between regions in regards to significant differences. Confidence intervals for emergency department visit, hospitalizations and mortality data were calculated with STATA version 11.2 (College Station, Texas) using the Wilson method, while confidence intervals derived from the CCHS are calculated from the bootstrapping method. Any difference between regions or time periods described as significant is statistically meaningful. Without statistical significance you cannot say with certainty that the differences are real, or simply due to chance. Wherever possible, NBPSDHU data has been compared with estimates from the Parry Sound District, Adjusted Nipissing District, North East Local Health Integration Network (NE LHIN or North East LHIN) and Ontario (see Appendix A). Seniors In the NBPSDHU Region: A Health Status Report Page iv/vi

6 Production team: Lead Authors: Dinna Lozano Epidemiologist Casey Hirschfeld Research Assistant John Mitchell Research Assistant Chris Bowes Research & Policy Analyst Editorial Support: Louise Gagné Manager, Planning & Evaluation Table of Contents Executive Summary...i Data sources & Interpretation...iv 1.0 Demographics Population Population Projections Labour Force Activity Income Food Security Educational attainment Marital status Living arrangements Language Ethnicity & Aboriginal Identity Measures of Health & Well-Being Life Expectancy Self-Rated Health Self-perceived Life Stress Health-Related Behaviours & Conditions Dentures Consumption of Fruits & Vegetables Physical Activity Overweight & Obesity Smoking Smoke-Free Homes Low-Risk Drinking Heavy Drinking Medication Use Chronic Diseases & Conditions High Blood Pressure Diabetes Cataracts Glaucoma Seniors In the NBPSDHU Region: A Health Status Report Page v/vi

7 Suggested Citation: North Bay Parry Sound District Health Unit. (2012). North Bay Parry Sound District Health Unit Seniors Health Report. North Bay, ON: NBPSDHU For more information, please contact: Dinna Lozano North Bay Parry Sound District Health Unit 681 Commercial Street North Bay, Ontario P1B 4E7 Phone: ext Toll-free: Fax: Mental Health Perceived Mental Health Mood Disorder Mental Health Hospitalizations Injuries Serious Injuries Injury Hospitalization Hip Fracture Hospitalizations Infectious Disease Influenza Salmonellosis Sexually Transmitted & Bloodborne Infections Emergency Department Visits Top 10 Causes of Emergency Department Visits Hospitalizations Top 10 Causes of Hospitalization Mortality Top 10 Causes of Mortality Diseases of the Circulatory System Cancer Access to Health Services & Utilization Contact with Health Professionals Home Care Activity Limitations Help in Daily Living Insurance Insurance for Prescriptions Insurance for Dental Expenses Insurance for the Cost of Eye Glasses or Contacts Appendix A: Map of the NBPSDHU Region, North East LHIN Region & Ontario...78 Appendix B: NBPSDHU Region Senior Population & Percentage of Total Planning Area, by Planning Area...79 References...80 Seniors In the NBPSDHU Region: A Health Status Report Page vi/vi

8 1.0 Demographics 1.0 Demographics 1.1 Population In the NBPSDHU region, there were 23,199 people aged 65 and older in 2009, which accounted for 18.4% of the region s total population (see Table 1). The senior population was highest in the North Bay region, followed by the West Parry Sound and West Nipissing regions (see Appendix B). In regards to planning areas within the NBPSDHU region, seniors constituted about 23.4% of the total population of the West Parry Sound region, however only 13.6% of the East Nipissing region population were seniors. Females accounted for 54.2% of the senior population in the NBPSDHU region. In Ontario, 13.7% of the total population were seniors, and females accounted for 56.1% of the senior population in the province. In Canada, an increasing life expectancy has led to an increase in the seniors population, and life expectancy differences in gender contribute to larger numbers of female seniors, compared to males. In 1997, the life expectancy at birth for men was 75.8 and 81.4 for females. By 2041, these numbers are expected to increase to 81 years for men and 86 years for females. Proportionally in Canada, women make up the majority of seniors, and this proportion increases in older age groups. (Health Canada, 2001). Table 1. Seniors Population in the NBPSDHU Region and Ontario, by Age Group & Sex, NBPSDHU Region Ontario Age Group Female Male Total Age Group Female Male Total ,769 3,587 7, , , , ,933 2,848 5, , , , ,372 2,104 4, , , , ,805 1,334 3, , , , , , ,170 55, , ,082 20,229 73,311 Total 12,574 10,625 23,199 Total 1,002, ,390 1,787,927 Data Source: Statistics Canada 2009, Ontario Ministry of Health & Long-term Care, intelllihealth Ontario, Date Extracted: 06/23/11. Seniors In the NBPSDHU Region: A Health Status Report Page 1/85

9 Age Group Age group 1.0 Demographics As in Ontario, the largest percentage of seniors in the NBPSDHU region was 65 to 69 years old in 2009 (see Figure 1). In each age group from 65 years on, female seniors outnumbered male seniors in both the NBPSDHU region and the province (see Table 1 & Figure 1). Seniors within the NBPSDHU region constituted a higher percentage of the total population as compared to Ontario in every senior age group. Seniors are the fastest growing segment of the Canadian population. In 1921, proportionally, seniors accounted for one in twenty Canadians. In 2001 seniors accounted for one in eight Canadians. In Canada the fastest growth is occurring for seniors aged 85 and older, with this group doubling nationally between 1981 and 2001 (Health Canada, 2002a). Nationally, it is estimated that seniors will account for approximately 27% of the Canadian population by 2051 (Public Health Agency of Canada, 2010). Figure 1. Percentage of the Total Male and Female Populations in the NBPSDHU region and Ontario aged 65 years and Older, by Age Group and Sex, NBPSDHU Ontario Percent Percent NBPSDHU Male 2009 NBPSDHU Female 2009 Ontario Male 2009 Ontario Female 2009 Data Source: Statistics Canada 2009, Ontario Ministry of Health & Long-term Care, intelllihealth Ontario, Date Extracted: 06/23/11. Seniors In the NBPSDHU Region: A Health Status Report Page 2/85

10 1.0 Demographics Definitions Population projection: The projected number of people in a future year. Projection calculations are developed by the Ministry of Finance, using the cohort-component method for each year. Projections are based on the expected number of births, deaths and migration components (e.g. immigration, net emigration, net change in non-permanent residents, interprovincial in and out migration and intraprovincial in and out migration) and recent trends of these components within a given age and sex category (Ontario Ministry of Finance, 2011). Local health integration network (LHIN) projections are based on the most recent population estimates released by Statistics Canada. 1.2 Population Projections Between 2012 and 2021, senior populations in the North East LHIN region are projected to rise across all age groups over 64: 28.8% for 65 to 69 year olds, 40.2% for 70 to 74 year olds, 27.9% for 75 to 79 year olds, 13.5% for year olds and 23.4% for year old (see Figure 2). In 2021, the population of seniors in the age group of 90 years old and over is projected to be 61.2% greater. While increased life expectancy has influenced the growth of the seniors population in Canada, changes in fertility rates have also influenced the aging of the Canadian population. Over the past 30 years, the fertility rate has been below the rate for natural replacement. During the mid-1940s to the mid-1960s, the fertility rate for women was three or more children per woman (Health Canada, 2002a). This created the large population of baby boomer generation that is now moving into the seniors age groups, and will do so for the next couple of decades. Seniors In the NBPSDHU Region: A Health Status Report Page 3/85

11 Projected Population 1.0 Demographics Figure 2. North East LHIN Region Population Projections for Seniors, by Age Group, years old years old years old 45, years old years old 90+ years old 42,791 (28.8% ) 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 33,215 25,380 19,341 14,626 8,059 3,945 35,583 (40.2% ) 24,730 (22.9% ) 16,599 (43.5% ) 9,943 (23.4% ) 6,359 (61.2% ) Year Data Source: Ontario Ministry of Finance , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Date Extracted: 09/01/ Labour Force Activity According to the 2006 census, the percentage of seniors participating in the labour force within the NBPSDHU region was roughly similar to the provincial estimate (see Table 2). A lower percentage of seniors in the NBPSDHU region were unemployed compared to Ontario seniors. The majority of those participating in the NBPSDHU labour force were paid workers (71.9%), followed by self-employed unincorporated workers (27.8%) and unpaid family workers (0.6%). A greater percentage of Parry Sound s senior labour force was self-employed compared (30.3%) to the senior working population of the Adjusted Nipissing District (19.1%). There has been an increase in the number of seniors in Canada that are part of the paid labour force. This increase is due to both returning to work after retirement and delaying retirement past the age of 65 years. In 2009, 11% of seniors in Canada were part of the paid workforce, and men (15%) were more likely to be part of the labour force than women (7%; Public Health Agency of Canada, 2010). Seniors In the NBPSDHU Region: A Health Status Report Page 4/85

12 1.0 Demographics Definitions Participation rate: The percentage of the population who reported participating in the labour force, excluding institutional residents (Statistics Canada, 2010). Unemployment rate: The percentage of the population unemployed of the total labour force, excluding institutional residents (Statistics Canada, 2010). Paid worker: Includes wage and salary earners and self-employed persons in incorporated companies, the latter included because they are considered employees of their own companies; excludes institutional residents (Statistics Canada, 2010). Table 2. Labour Force Activity and Class of Worker among Seniors, by Region, 2006 Census. Characteristic Adjusted Nipissing District* Parry Sound District NBPSDHU Region Ontario Labour force activity Total 12,285 8,255 20,540 1,556,260 In the labour force , ,480 Participation rate, % Unemployment rate, % Class of worker Paid workers (employees & incorporated selfemployed), % Self-employed (unincorporated), % Unpaid family workers, % Not applicable, % *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. Persons who were either employed or unemployed during the week (Sunday to Saturday) prior to the Census Day (May 16, 2006). Individuals less than 15 years old were termed as not applicable. Data Sources: 1) Adjusted Nipissing District, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 1), Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Topic-based tabulation Census of Population.. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 5/85

13 1.0 Demographics Definitions After tax Income: Includes market income (e.g., employment income, retirement pensions) and government transfer payments (e.g., Old Age Security pensions, Canada pension plans, etc.), less income tax (Statistics Canada, 2010) Median employment income: The income in dollars which divides the income distribution ranked by size of income into two halves (half below the median and half above the median) (Statistics Canada, 2010). Average employment income: The weighted mean total income. Calculated from unrounded data by dividing the aggregate income of a specified group of individuals by the number of individuals with income in that group (Statistics Canada, 2010). 1.4 Income Income distribution According to the 2006 census, the median after-tax income for seniors within the NBPSDHU region was $20,080 and $21,264 for Ontarians. NBPSDHU region senior males receive a higher after-tax income than females. NBPSDHU male seniors earned a median after-tax income of $24,472, compared to a median of $17,369 among female seniors. Most seniors received incomes between $10,000 and $19,999 after tax in the Adjusted Nipissing District, Parry Sound District, NBPSDHU region and in Ontario (see Figure 3). Income is one of the most important determinants of health and is essential in ensuring access to appropriate housing, nutritious food to maintain health, and noninsured medical services and supports. Over the past 25 years the financial situation of seniors have improved in Canada, with senior couples seeing an average after-tax income increasing by 18% in 2003 (Statistics Canada, 2006a). Standard error of average income: A dollar amount which indicates the precision of the estimate of average income (Statistics Canada, 2010). Seniors In the NBPSDHU Region: A Health Status Report Page 6/85

14 Percentage of Seniors 1.0 Demographics Figure 3. Percentage of Seniors, by After-Tax Income & Region, 2006 Census No income Less than $10,000 $10,000 to $19,999 $20,000 to $29,999 $30,000 to $39,999 $40,000 to $49,999 $50,000 and over Adjusted Nipissing District * Parry Sound District NBPSDHU Ontario After-tax income brackets *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. Data Sources: 1) Adjusted Nipissing District, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 1), Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 7/85

15 1.0 Demographics Definitions Full-time: Worked 30 hours or more per week (Statistics Canada, 2010). Part-time: Worked less than 30 hours per week (Statistics Canada, 2010). All others: Includes persons who did not work in the reference year (Statistics Canada, 2010) Employment income According to the 2006 census, more male seniors in the than female seniors gained income from employment, both within the NBPSDHU region and Ontario (see Table 3). Median and average employment income were lower for NBPSDHU region seniors compared to the same group in Ontario, across both sexes. Senior NBPSDHU region males out earned females working full-time in terms of median income, but the opposite was observed for seniors who worked part-time and other work. There is an association between income and life expectancy in good health. In 2001, men aged 65 and older in the highest income groups could expect to live 1.3 more years in good health than men in the lowest income groups. For women the difference was 0.5 years (Statistics Canada, 2006a). Table 3. Employment Income for Seniors, by Sex, Work Activity & Region, 2006 Census NBPSDHU Region Ontario Males Females Total Males Females Total Full-time Total with employment income ,275 16,855 63,125 Median employment income, $ 21,330 16,489 21,274 30,916 28,065 30,036 Average employment income, $ ,268 26,190 60,094 34,920 53,372 Standard error of average income, $ 3,793 3,437 2,892 1, ,360 Part-time & all others Total with employment income 2,455 1,055 3, , , ,715 Median employment income, $ 324 2, ,550 1,419 Average employment income, $ 8,510 6,233 7,827 16,041 10,738 14,048 Standard error of average income, $ 1, , Overall Total with employment income 2,855 1,215 4, , , ,845 Median employment income, $ 518 2,678 1,070 3,132 4,109 3,594 Average employment income, $ 11,379 7,989 10,366 25,403 14,131 21,396 Standard error of average income, $ 1, , Data sources: 1)NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 10),Employment income statistics (4) in constant (2005) dollars, work activity in the reference year (3), immigrant status and period of immigration (10), age groups (5A), highest certificate, diploma or degree (5) and sex (3) for the population 15 years and over with employment income of user-defined geographic areas (9), 2005, 2006 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada Employment income statistics (4) in constant (2005) dollars, work activity in the reference year (3), immigrant status and period of immigration (10), age groups (5A), highest certificate, diploma or degree (5) and sex (3) for the population 15 years and over with employment income of user-defined geographic areas (9), 2005, 2006 Census (20% sample data). Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 8/85

16 1.0 Demographics Definitions Low income: A term used to categorize economic families or unattached individuals into low income groups, based on devoting 20% more than average to necessities such as food, shelter and clothing (Statistics Canada, 2007a). A low income classification is not intended to measure poverty, rather identify those who are substantially worseoff than average in terms of income. Low income cut-offs (LICOs) vary depending on family size and degree of urbanization, and are updated annually. Includes all individuals living in private households. After-tax income cut-offs take into account the reduced spending power of families because of income taxes paid. Since lowincome cut-offs are a relative measure, progressive tax rates taken into account after taxes results in fewer families or individuals falling below the low income cut-off (Statistics Canada, 2007a). Private household: Refers to a person or a group of persons (other than foreign residents) who occupy a private dwelling and do not have a usual place of residence elsewhere in Canada (Statistics Canada, 2010). This definition excludes those who live in collective households and includes those living with non-relatives, living alone and living with relatives or in census families Low income Overall, approximately 2.3% of seniors living in private households in the NBPSDHU region met the low income classification after-tax, lower than Ontario (see Table 4). A higher percentage of seniors in the Adjusted Nipissing region were low income after-tax compared to Parry Sound seniors, in all living situations. The prevalence of after-tax low income status was lowest for those living in private households. Within private households, low income status prevalence was generally higher among unattached seniors (i.e. living alone or living with non-relatives) within all regions. The percentage of seniors living in low-income has decreased in Canada from 29% in 1978 to 6% in 2008 (Public Health Agency of Canada, 2010). This decrease has been attributed to earlier introduction of retirement and financial income supplement programs. Seniors In the NBPSDHU Region: A Health Status Report Page 9/85

17 1.0 Demographics Table 4. Low Income Status After Tax for Seniors, by Living Arrangement, Sex & Region, 2006 Census Living arrangement Adjusted Nipissing District* Parry Sound District NBPSDHU Region Ontario M F T M F T M F T M F T Living alone, % Living with nonrelatives, % Living in private households, % *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. M=Male; F=Female;T=Total (i.e., both sexes combined) Data source: 1) Adjusted Nipissing District, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 2), Income status before tax and income status after tax (8), economic family structure and presence of children for the economic families; sex, household living arrangements and age groups for the persons 15 years and over not in economic families; and sex and age groups for the persons in private households (88) of Canada, provinces, census metropolitan areas and census agglomerations, 2005, 2006 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada, Income status before tax and income status after tax (8), economic family structure and presence of children for the economic families; sex, household living arrangements and age groups for the persons 15 years and over not in economic families; and sex and age groups for the persons in private households (88) of Canada, provinces, census metropolitan areas and census agglomerations, 2005, 2006 Census (20% sample data). Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 10/85

18 Percentage of Seniors 1.0 Demographics Definitions Food security/insecurity: An indicator derived from 18 questions ranging in severity from worrying about running out of food, and children not eating for a whole day. Since food security is a household measure, it is not intended to describe the food security status of each individual member residing in the household. Ten of the questions are specific to adults in the household or the household in general, while eight pertain to any children in the household. Individuals classified as food secure answered none or one question in the affirmative. Being food insecure may indicate difficulty with income-related food access. Persons who answered 2 to 5 adult-specific questions in the affirmative were classified as moderately food insecure, an indication of compromise in quality and/or quantity of food consumed. Lastly, severe food insecurity corresponds to those who answered 6 or more questions in the affirmative, indicating reduced food intake and disrupted eating patterns. Individuals who did not answer any one required question were termed as not stated responses. 1.5 Food Security In 2009/10, 97.2% of seniors lived in food secure households within the NBPSDHU area, compared to 97.0% in Ontario (see Figure 4). None of the regional estimates in 2009/10 were significantly different from those in 2005 or 2007/08. Of the NBPSDHU region population aged 12 to 64 years, 90.7% lived in food secure households in 2009/10, a significantly lower percentage compared to seniors. As seniors age, they experience a decrease in lean body mass and require fewer calories. Therefore, to maintain appropriate vitamin and mineral requirements along with decreased intake, seniors need to consume foods with a higher concentration of nutrients (Public Health Agency of Canada, 2010). Figure 4. Percentage of Households with a Senior that were Food Secure, by Region, 2005, 2007/08 & 2009/ / /10 NBPSDHU NE LHIN Ontario Year(s) -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Note: This indicator was not available in 2000/01 or Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 3.1, 4.1, 5.1), 2005, 2007/08, 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 11/85

19 Percentage of Seniors 1.0 Demographics 1.6 Educational attainment Almost half (47%) of seniors in the NBPSDHU region have less than high school education compared to 17.3% of 25 to 64 year olds (North Bay Parry Sound District Health Unit, 2009). More NBPSDHU region seniors have not attained a high school degree compared to Ontario seniors (47.2% versus 40.9%; see Figure 5). Almost half of senior females (49.2%) have no certificate, diploma or degree versus 44.9% of male seniors within our region. The percentage of seniors who have attained a college or university degree or diploma is higher among Ontario seniors compared to NBPSDHU region seniors. There is a correlation between educational attainment and income for seniors. Between 2002 and 2007, seniors whose highest level of education was high school or less were more than twice as likely as seniors with a university degree to have lived in a low-income household (Public Health Agency of Canada, 2010). Figure 5. Percentage of Seniors, by Highest Level of Educational Attained & Region, 2006 Census No certificate, diploma or degree High school certificate or equivalent Apprentices hip or trades certificate or diploma College, CEGEP or other nonuniversity certificate or diploma University certificate or diploma below bachelor level University certificate or degree * Adjusted Nipissing District Parry Sound District NBPSDHU Ontario Highest Level of Educational Attainment *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. Data Source: 1) Adjusted Nipissing District, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 11). Labour force activity (8), highest certificate, diploma or degree (14), Aboriginal identity (8), age groups (12A) and sex (3) for population 15 years and over of user-defined geographic areas (9), 2006 Census 20% sample data. Original source: catalogue no XCB ) Ontario data: Statistics Canada Labour force activity (8), highest certificate, diploma or degree (14), Aboriginal identity (8), age groups (12A) and sex (3) for population 15 years and over of user-defined geographic areas (9), 2006 Census 20% sample data. Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 12/85

20 Sex 1.0 Demographics 1.7 Marital status According to the 2006 census, the proportion of legally married seniors was similar between the NBPSDHU region and Ontario, as were the percentage of those widowed, separated, divorced and never legally married. The majority of NBPSDHU region senior males were legally married, as compared to about half of females (see Figure 6). Conversely, 40.5% of females were widowed versus 13.5% of males. Marital status of seniors can have an impact on overall health. Seniors who live with a spouse generally have more immediate and easier access to support and care for illness, disabilities, and long-term health issues, compared to seniors who live alone. In other instances, the influence can be negative if both partners have health issues, or if the health needs of a spouse become too large a burden for the other partner (Statistics Canada, 2006a). Figure 6. Percentage of NBPSDHU Region Seniors, by Marital Status & Sex, 2006 Census. Never legally married (single) Separated, but still legally married Widowed Legally married (and not separated) Divorced 2.5 Females Males Percentage of Seniors Data Source: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 1), Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 13/85

21 1.0 Demographics Definitions Family household: May consist of one family (e.g. a couple with or without children) or multiple families (two or more families occupying the same dwelling). For example, includes married or commonlaw couples with or without children, living with relatives or living with a census family (Statistics Canada, 2010). Non-family household: Either one person living alone or two or more persons who share a dwelling, but do not constitute a family (Statistics Canada, 2010). 1.8 Living arrangements Overall, a lower percentage of seniors in the NBPSDHU region lived in family households compared to seniors in Ontario. These estimates are applicable to all those seniors who live in private households only. According to the 2006 census, a higher percentage of Parry Sound s seniors lived in family households, as compared to seniors in the Adjusted Nipissing District (see Table 5). Social well being for seniors is influenced by life circumstances such as living arrangements (Public Health Agency of Canada, 2010). Seniors who live alone are less likely to describe themselves as being very happy, compared to those living with a spouse or other persons (Statistics Canada, 2006a). Table 5. Living Arrangements for Seniors by Region, 2006 Census Living arrangements Adjusted Parry Sound NBPSDHU Ontario Nipissing District* District Region Total persons in family households, % Total persons in non-family households, living with at least one other person, % Living alone, % *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. Data Source: Adjusted Nipissing, Parry Sound District & NBPSDHU data: Statistics Canada Household living arrangements (11), age groups (20) and sex (3) for the population in private households of Canada, Provinces, Territories, census divisions and census subdivisions, 2006 census 20% sample data. Topic-based tabulation Census of Population. Original source: no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 14/85

22 1.0 Demographics 1.9 Language According to the 2006 census, approximately a fifth of seniors in the NBPSDHU region reported French as their mother tongue (21.4%) compared to only 5.1% of Ontario seniors. Meanwhile, English was identified as the mother tongue for 67.5% of NBPSDHU region seniors and 62.1% of Ontario seniors. The vast majority of NBPSDHU regions seniors reported speaking English most often at home (82.4%), followed by French (13.9%), Italian (0.8%), German (0.8%) and both English and French (0.6%). In comparison, 76.7% of Ontario seniors reported speaking English most often at home, followed by Italian (4.5%), French (2.7%), Chinese (1.6%; not otherwise specified, e.g. Mandarin) and Cantonese (1.6%). Knowledge of English was only common among Parry Sound s seniors, while in the Adjusted Nipissing District, 60.2% of seniors reported having knowledge of only English but a substantial proportion knows both English and French. Overall, a greater percentage of NBPSDHU region seniors have knowledge of both English and French (22.2%) compared to Ontario seniors (8.1%; see Figure 7). Less than 1% of NBPSDHU region seniors had knowledge of neither English nor French. Health literacy skills for seniors are necessary to make basic health decisions and to access and accurately assess relevant health information. Language is a key component of health literacy, and an understanding of languages spoken and understood in a community is essential in efforts to engage individuals (Public Health Agency of Canada, 2010). Seniors In the NBPSDHU Region: A Health Status Report Page 15/85

23 Region 1.0 Demographics Figure 7. Percentage of Seniors, by Knowledge of Official Languages & Region, 2006 Census. * Adjusted Nipissing District Parry Sound District NBPSDHU Ontario 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Parry Sound Adjusted Nipissing Ontario NBPSDHU District District English only French only English and French Neither English nor French Percentage of Seniors Data Sources: 1) Adjusted Nipissing District, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 1), Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 16/85

24 1.0 Demographics Definitions Aboriginal identity: A person identifying with at least one Aboriginal group (i.e. North American Indian, Métis or Inuit and/or those who reported being a Treaty Indian or a Registered Indian, as defined by the Indian Act of Canada and/or those who reported they were members of an Indian band or First Nation) (Statistics Canada, 2010). Excludes institutional residents. Visible minority: Persons, other than Aboriginal peoples, who are non-caucasian in race or non-white in colour. Excludes institutional residents and those who identify as Aboriginal Ethnicity & Aboriginal Identity According to the 2006 census, a higher percentage of seniors in the Adjusted Nipissing District self-identify as Aboriginal (3.7%) compared to seniors in the Parry Sound District (1.9%; see Table 6). In the Adjusted Nipissing District, a majority of Aboriginal seniors identified themselves as Métis (81.6%), while a higher percentage of Parry Sound District Aboriginal seniors identified themselves as North American Indian (62.5%). Overall, only 3.0% of NBPSDHU region seniors identify themselves as Aboriginal, however, this is 3.7 times higher than the percentage of Ontario seniors with an Aboriginal identity (0.81%). Of those who identify themselves as Aboriginal within the NBPSDHU region, 55.3% identify as North American Indian and 73.5% as Métis. Like the Aboriginal population in Canada, the Aboriginal seniors population is on average younger than the non- Aboriginal population (Statistics Canada, 2006a) NBPSDHU region seniors who are visible minorities are rare (0.9% of the regional senior population), compared to constituting approximately 12.5% of Ontario seniors. Table 6. Aboriginal Identity among Seniors, by Region, 2006 Census Aboriginal identity Adjusted Nipissing Parry Sound NBPSDHU Ontario District* District Region Total Aboriginal identity population, % North American Indian single response, % Métis single response, % Aboriginal responses not included elsewhere, % *Adjusted Nipissing District only includes municipalities served by the NBPSDHU; excludes South Algonquin, Temagami, and Bear Island. Expressed as a percentage of those who self-identified as Aboriginal. May not add up to 100% as more than one Aboriginal ancestry can be selected. Data Sources: 1) Adjusted Nipissing, Parry Sound District & NBPSDHU data: Statistics Canada, Semi-custom tabulations created for NBPSDHU (Table 1), Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2009 Census (20% sample data). Original source: catalogue no XCB ) Ontario data: Statistics Canada Selected demographic, cultural, educational, labour force and income characteristics (830), Mother tongue (4), Age groups (8A) and Sex (3) for the population of user-defined geographic areas (9), 2006 Census (20% sample data). Topic-based tabulation Census of Population. Original source: catalogue no XCB Seniors In the NBPSDHU Region: A Health Status Report Page 17/85

25 2.0 Measures of Health & Well-Being 2.0 Measures of Health & Well-Being Definitions Life expectancy: The average length of time an individual/group of individuals will live. Life expectancy calculations are based on the mortality rate for 65 to 69 year olds in the same year. 2.1 Life Expectancy At birth, life expectancy for NBPSDHU region females in 2007 was 81.4 years and 77.6 years for males. In Ontario, females born in 2007 had a life expectancy of 83.4 years and male newborns could be expected to live to 78.9 years. Life expectancy at 65 years of age has increased across both sexes and within the NBPSDHU region and Ontario (see Figure 8). Based on 2007 mortality rates for the NBPSDHU region, females at 65 years of age can expect to live 20.6 more years, and males 17.1 years beyond age 65. Estimates for life expectancy among NBPSDHU region senior males and females are slightly lower compared to that of Ontarian senior males and females. Since 1997, life expectancy at age 65 has increased approximately one year for both males and females within the NBPSDHU region. For seniors in Ontario, life expectancy has increased approximately two years for females and one year for males between 1997 and The over-representation of women in older age groups is due to a longer life expectancy; however, the gap in life expectancy between men and women is narrowing (Public Health Agency of Canada, 2010; Statistics Canada, 2007b). Life expectancy varies by many factors, including ethnicity, geography, and gender. The majority of people perceive a longer life as desirable; however, an even more important goal according to Statistics Canada (2007b) is a long life in good health. Seniors In the NBPSDHU Region: A Health Status Report Page 18/85

26 Additional Years Expected to Live at Age Measures of Health & Well-Being Figure 8. Expected Years to Live at Age 65, by Sex & Region, NBPSDHU - Males NBPSDHU - Females Ontario - Males Ontario - Females Year Data Source: 1) Mortality counts: Ontario Office of Registrar General , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: 06/24/ ) Population estimates: Statistics Canada , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: 06/24/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 19/85

27 Percentage of Seniors 2.0 Measures of Health & Well-Being Definitions Self-rated health: Individuals were asked to rate their health as excellent, very good, good, fair or poor. 2.2 Self-Rated Health The percentage of seniors living within the NBPSDHU region who rated their health as good or better has not varied significantly since 2000/01 (see Figure 9). In 2009/10, 79.5% of NBPSDHU region seniors rated their health as good, very good or excellent; an estimate consistent with that of the North East LHIN region and Ontario. This percentage is significantly lower than the 90.8% of the population aged 12 to 64 years who perceived themselves to be in good health or better. Perceived health refers to a person s overall health, not only the absence of disease or injury, but also physical, mental, and social well-being (Statistics Canada, 2011). Among seniors, perceived health impacts all areas of life, including willingness to seek and accept help (Chan et al., 1998). Several factors influence senior s perception of health, including recent hospitalization, requiring regular medical follow-up, hearing impairment, history of chronic medical conditions, hypertension and ischaemic heart disease, asthma or chronic obstructive lung disease, impairment in activities of daily living, history of falls, need to take medications regularly, and financial difficulty (Chan et al., 1998). Figure 9. Percentage of Seniors who Rated their Health as Good, Very Good or Excellent, by Region, 2000/01, 2003, 2005, 2007/08, & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 20/85

28 Percentage of Seniors 2.0 Measures of Health & Well-Being Definitions Self-perceived life stress: Individuals were asked to rate the amount of stress in most days of their life as not at all stressful, not very stressful, a bit stressful, quite a bit stressful, and extremely stressful. 2.3 Self-perceived Life Stress Only 14.8% of seniors living within the NBPSDHU region rated their life as quite a bit or extremely stressful in 2009/10 (see Figure 10).This figure is not significantly different from estimates from the North East LHIN region and Ontario, and has not changed significantly since 2000/01. Meanwhile, in 2009/10 almost 30% of the NBPSDHU region population aged 15 to 64 years found their life to be at least quite a bit stressful, a significantly higher percentage compared to seniors. Loneliness, financial stress, neighborhood stress, age discrimination, and major life events, such as widowhood and retirement, are important predictors of perceived life stress among seniors (Scott et al., 2011). Stress has many negative health consequences, including heart disease, stroke, high blood pressure, and immune and circulatory system complications (Statistics Canada, 2011). Furthermore, stress has been linked to negative health behaviours such as smoking, alcohol consumption, and unhealthy eating habits (Statistics Canada, 2011). Figure 10. Percentage of Seniors who Rated their Life Stress as Quite a Bit or or Extremely Stressful, by Region, 2000/01, 2003, 2005, 2007/08, & 2009/ E E E E E / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. E-Interpret with caution; the estimate is associated with high sampling variability. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08, 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 21/85

29 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions 3.0 Health-Related Behaviours & Conditions 3.1 Dentures Almost two-thirds (60.9%) of seniors within the NBPSDHU region reported wearing dentures (false teeth) in 2009/10; an estimate consistent with those for the North East LHIN region and Ontario. Significantly less Ontario seniors reported wearing dentures in 2009/10 compared to Removable dentures are a common solution for seniors to replace missing teeth (British Columbia Dental Association, 2009). Proper care of dentures is important for the health of dentures, as well as an individual s overall oral health. Individuals with dentures, whether partial or complete, can still develop gum disease around any remaining natural teeth (Canadian Dental Association, 2011). If an individual develops gum disease, there is a risk that dentures will no longer fit properly. Figure 11. Percentage of Seniors who wore Dentures or False Teeth, Lasting 6 Months or More, by Region, 2003, 2005, & 2009/ * / /10 NBPSDHU NE LHIN Ontario Year *-A significant statistical difference exists between the regional and provincial estimate in the same survey year(s). The statistic is significantly different from the previous year s estimate within the same region. -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Note: NBPSDHU region residents were not asked about denture use in the 2003 survey year. This question was not asked in Ontario in 2007/08. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 5.1), 2003, 2005 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 22/85

30 3.0 Health-Related Behaviours & Conditions Definitions Fruit and Vegetable Consumption: Individuals are asked how often they usually eat the food item (e.g. once a day, twice a month). The reporting unit (e.g. day, week) and the number of times per reporting unit (e.g. twice, once) is entered. Foods included in the module are: fruit juices such as orange, grapefruit or tomato, fruit, green salad, potatoes (not including French fries, fried potatoes or potato chips), carrots, and other vegetables. The question about other vegetables is worded Not counting carrots, potatoes, or salad, how many servings of other vegetables do you usually eat? The use of the word serving does not refer to a specific quantity. Responses to these questions are combined to give the number of times per day that an individual eats vegetables and fruits. 3.2 Consumption of Fruits & Vegetables Among NBPSDHU region seniors, 47.1% reported eating fruits and vegetables five or more times a day in 2009/10 (see Figure 12). This estimate has not varied significantly since 2000/01. A comparable percentage (48.1%) of NBPSDHU region residents aged 12 to 64 years consumed fruits and vegetables at least five times a day in 2009/10. Nutrition is an essential component of healthy human development and the overall health and well-being of seniors (Health Canada, 2002b). There are many benefits to healthy eating for seniors, which include increased mental acuteness, resistance to illness and disease, higher energy levels, a more robust immune system, faster recuperation times, and better management of chronic health problems (Kovatch & Kemp, 2011). Poor nutrition may result in a prolonged recovery from illness, an increased cost and incidence of institutionalization, and a poorer quality of life (Priddle, 2011b). Research has shown that as people age they make better food choices; however, in attaining nutritional well being, there are difficulties related to aging (Priddle, 2011b). For example, many age-related physical and medical conditions may play a role in poor nutrition, such as anxiety, cancer, dementia, depression, diabetes, false teeth, gastroesophageal reflux disease, immobility, Parkinson s disease, and vertigo. Seniors In the NBPSDHU Region: A Health Status Report Page 23/85

31 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions Figure 12. Percentage of Seniors who Consumed Fruits and Vegetables Five or More Times a Day, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Definitions Physical Activity: Levels of physical activity (inactive, moderately active and active) are derived from responses to questions about the frequency, nature and duration of the individual s participation in leisure-time physical activity. Types of activities included walking for exercise, gardening or yard work, swimming, bicycling, popular or social dance, home exercises, ice hockey, ice skating, in-line skating or rollerblading, jogging or running, golfing, exercise class or aerobics, downhill skiing, bowling, baseball or softball,..continued on next page 3.3 Physical Activity In 2009/10, 39.7% of NBPSDHU region seniors reported being moderately active or active, compared to 41.3% of seniors within the North East LHIN region and 40.3% of Ontario seniors (see Figure 13). The percentage of seniors who reported being at least moderately active versus inactive has not changed significantly in either the NBPSDHU region, North East LHIN region or Ontario regions since Of the NBPSDHU region population aged 12 to 64 years, 64.3% were at least moderately active in 2009/10, a significantly higher percentage compared to NBPSDHU region seniors. Seniors In the NBPSDHU Region: A Health Status Report Page 24/85

32 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions Physical Activity continued: tennis, weight-training, fishing volleyball, basketball and up to three other activities. Each activity was assigned a metabolic equivalent value to derive the estimated energy expenditure. Classification is based on average daily physical activity over the previous 3 months, and is based on the amount of energy expenditure Active: Energy expenditure of 3.0 kcal/kg/day or more Moderately active: Energy expenditure between 1.5 and 2.9 kcal/kg/day Inactive: Energy expenditure less than 1.5 kcal/kg/day. Some risk factors for physical inactivity are low income, low education levels, disabilities and chronic health conditions, and living in an institution or in isolation. Barriers to physical activity for seniors include fear of injury, illness, disability, pain, lack of energy, motivation, skill, and time, inadequate facilities, cost, and lack of safety (Public Health Agency of Canada, 2006). Regular physical activity positively impacts functional capacity, mental health, fitness level, the prevention and management of chronic diseases, and overall well-being (Public Health Agency of Canada, 2006). Furthermore, participating in regular physical activity has many benefits on aging, including prolonged health and increased chance of recovery from poor health; however, seniors are the most inactive age group of the Canadian population. Figure 13. Percentage of Seniors who were Moderately Active or Active, by Region, 2003, 2005, 2007/08 & 2009/ / /10 NBPSDHU NE LHIN Ontario Year(s) -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Note: Estimates for 2000/01 were not included as the energy expenditure assessment for soccer as an activity differed between the 2000/01 and 2003, 2005, 2007/08 and 2009/10 cycles. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 4.1, 5.1), 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 25/85

33 3.0 Health-Related Behaviours & Conditions Definitions Body mass index: Self-reported heights and weights were used to derive body mass index (BMI) score for each individual, and BMI categories. BMI is a ratio of weight to height. BMI classifies this ratio into the following categories: Underweight: BMI less than 18.5 Normal weight: BMI between 18.5 and 24.9 Overweight: BMI between 25.0 and 25.9 Obese: BMI of 30 or over Health Canada (2003) notes that BMI categories may vary slightly for adults age 65 and older, with the normal range beginning somewhat above 18.5 and extending into the overweight range, however the BMI categories established for adults 18 years and older are recommended to be used for population purposes. 3.4 Overweight & Obesity The majority (61.6%) of NBPSDHU region seniors had a BMI score that classified them as overweight or obese in 2009/10, similar to the 62.3% of overweight or obese among NPBSDHU region adults aged 18 to 64 years (see Figure 14). A significantly higher percentage of Ontario seniors were obese or overweight in 2009/10 compared to in 2000/01 (59.2% compared to 51.6%, respectively). Being overweight or obese puts an individual at an increased risk for chronic diseases such as type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain types of cancer (World Health Organization, 2003). The consequences of overweight and obesity range from an increased risk of premature death to serious chronic conditions that reduce the overall quality of life. Health problems related to obesity that are not fatal include respiratory difficulties, chronic musculoskeletal problems, skin problems, and infertility (World Health Organization, 2003). Health problems related to overweight and obesity that are life threatening include CVD problems, conditions associated with insulin resistance such as type 2 diabetes, certain types of cancer, and gallbladder disease. Seniors In the NBPSDHU Region: A Health Status Report Page 26/85

34 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions Figure 14. Percentage of Seniors who were Overweight or Obese, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Definitions Smoker: Smokers cigarettes daily or occassionaly at the present time 3.5 Smoking The percentage of NBPSDHU region seniors who described themselves as daily or occasional smokers (8.3%) in 2009/10 was similar to the same estimate for the North East LHIN (9.3%) and Ontario (9.1%; see Figure 15). NBPSDHU region estimates for all years should be interpreted with caution as they are associated with high sampling variability. A higher proportion of individuals in 2000/01 were interviewed in person, which may have affected the comparability of those who reported smoking in subsequent survey cycles which were conducted by telephone and in person (St-Pierre & Beland, 2004). Seniors In the NBPSDHU Region: A Health Status Report Page 27/85

35 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions The mortality rate among seniors who currently smoke is double that of seniors who have never smoked (Health Canada, 2002d). Furthermore, tobacco use has been linked to eight of the top fourteen causes of deaths for seniors. Tobacco use can complicate health conditions that are common among seniors such as heart disease, a variety of cancers, diabetes, respiratory disease, high blood pressure, circulatory and vascular conditions, duodenal ulcers, reductions in smell and taste, osteoporosis, cataracts, effects of teeth and gums, and sleep disturbances (Health Canada, 2002d). Other effects of tobacco include decreased bone density, appearance of premature aging, and decreased effectiveness of drug therapies, such as antidepressants. Figure 15. Percentage of Seniors who Reported Smoking Daily or Occasionally, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ E E E E E / / /10 NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 28/85

36 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions 3.6 Smoke-Free Homes Between 2000/01 and 2007/08, significantly more NBPSDHU region seniors reported residing in households where smoking was not permitted inside the home (51.5% compared to 72.2%, respectively; see Figure 16). A comparable percentage (71.6%) of the NBPSDHU region population aged 12 to 64 years reported in 2009/10 not permitting smoking in the home. The disease risks associated with tobacco smoke are not limited to smokers; non-smokers who are exposed to second hand smoke are also at risk (Office of Environmental Health Hazard Assessment, 1997). Evidence has revealed that there is no risk-free level of exposure to second hand smoke (Office of the Surgeon General, 2007). Exposure to second hand smoke has been linked to a variety of adverse health outcomes, such as coronary heart disease and lung cancer (Office of the Surgeon General, 2007). Furthermore, exposure of adults to second hand smoke has immediate adverse effects on the cardiovascular system. Figure 16. Percentage of Seniors who Lived in Smoke-Free Homes, by Region, 2000/01, 2003, 2005 & 2007/ / /08 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. Note: Data from 2009/10 was not included due to an error in data collection (smokers were assessed instead of non-smokers). Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1), 2000/01, 2003, 2005 & 2007/08. Seniors In the NBPSDHU Region: A Health Status Report Page 29/85

37 3.0 Health-Related Behaviours & Conditions Definitions Low-Risk Drinking Guideline: The low-risk drinking guideline is based on alcohol use during the past year, alcohol use during the past week, pregnancy status and breast-feeding status. Individuals exceeded the low-risk drinking guidelines if: 1) they were a man who drank more than 14 drinks per week; or, 2) they were a female who drank more than 9 drinks per week; or, 3) a male or a female who drank more than 2 drinks on any day of the previous week. The low-risk drinking guidelines are for people of legal drinking age and do not apply to special cases such as people with certain health problems, taking medications, family history of drinking problems, family history of cancers, pregnant, trying to become pregnant, or breastfeeding, etc. (Centre for Addiction & Mental Health, 2011). 3.7 Low-Risk Drinking Approximately 11.4% of NBPSDHU region seniors drank in excess of the low-risk drinking guidelines, not significantly different from the percentage in the North East LHIN region or Ontario, however this estimate should be interpreted with caution as it is associated with high sampling variability (see Figure 17). Comparatively, 23.8% of the NBPSDHU region population aged 19 to 64 years reported exceeding the low risk drinking guideline in 2009/10, a significantly higher percentage compared to NBPSDHU region seniors. Between 2000/01 and 2007/08, the percentage of Ontario seniors who exceeded the low-risk drinking guideline increased significantly from 7.3% to 9.6%. Low-risk drinking has been associated with health benefits that result in delaying death from heart disease or stroke for older individuals, particularly for those aged 70 years or older (Canadian Centre on Substance Abuse, 2011). Drinking in excess of the low-risk guidelines has been linked to serious health problems such as gastrointestinal bleeding, abnormal heart function, stroke, and respiratory depression. Drinking in excess of the low-risk drinking guidelines has also been linked to an increased risk for developing type 2 diabetes (Region of Peel, 2011). Seniors In the NBPSDHU Region: A Health Status Report Page 30/85

38 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions Figure 17. Percentage of Seniors who Exceed the Low-Risk Drinking Guidelines, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ E E E E E / / /10 NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 31/85

39 Percentage of Seniors 3.0 Health-Related Behaviours & Conditions 3.8 Heavy Drinking Estimates for 2003, 2007/08 and 2009/10 are not available for seniors within the NBPSDHU region. Of all seniors who did or did not consume alcohol within the previous 12 months in 2005, 6.2% of NBPSDHU region seniors reported consuming 5 drinks or more on at least one occasion per month, although this estimate should be interpreted with caution as it is associated with high sampling variability (see Figure 18). Among North East LHIN region seniors, 5.6% reported consuming 5 or more drinks of alcohol on at least one occasion per month in 2009/10. In 2005, 22.0% of the NBPSDHU region population aged of 12 to 64 years who had consumed alcohol in the previous 12 months reported having at least one bout of heavy drinking per month, a significantly higher percentage compared to NBPSDHU region seniors. Seniors are more vulnerable to the negative effects of alcohol because as people age, they become more sensitive to the effects of alcohol and their bodies process alcohol more slowly (CAMH Healthy Aging Project, 2006). Alcohol reduces muscle control, which increases the risk of injury due to a fall. Furthermore, alcohol can make some health issues worse, such as confusion, memory loss, liver damage, diabetes, heart or blood problems, and stomach problems. There are over 150 medications that are commonly prescribed to seniors that can cause increased and dangerous effects if taken with alcohol, such as slurred speech, sleepiness, stumbling, and falls (CAMH Healthy Aging Project, 2006). Sometimes this results in seniors not taking their medication if they are going to drink; however, if medication is not taken as prescribed, it can also cause problems. Figure 18. Percentage of Seniors with a Heavy Drinking Episode on at Least One Occasion per Month, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ E 2000/ / /10 NBPSDHU NE LHIN Ontario Year(s) E E E-Interpret with caution; the estimate is associated with high sampling variability. Note: The 2003, 2007/08 and 2009/10 estimates for the NBPSDHU region were suppressed due to low case count and/or high sampling variability. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 32/85

40 Types of Medication 3.0 Health-Related Behaviours & Conditions Definitions Medication Use: Use included medications acquired through prescription or over the counter. 3.9 Medication Use In 2003, the majority (61.6%) of NBPSDHU region seniors reported using pain relievers such as aspirins and antiinflammatories (see Figure 19). Other medications reported by seniors included blood pressure medication, other medication, heart medication and diuretics. It is estimated that half of all prescriptions are not taken properly by seniors (CAMH Healthy Aging Project, 2006). Furthermore, the use of multiple medications at once is common among seniors and is a major concern related to seniors health (Statistics Canada, 2009). People who take multiple medications at once are more prone to adverse drug reactions. For example, when medications interact they may not work as well. Figure 19. Percentage of Seniors by Top 5 Type of Medication Taken, by Region, Diuretics Heart Medication Other Medication Blood pressure medication Pain Reliever Pain Reliever Blood pressure medication Other Medication Heart Medication Diuretics NBPSDHU Ontario Percentage of Seniors Does not include tranquilizers, diet pills, antidepressants, codeine/demerol/morphine, allergy medicine, asthma medicine, cough or cold medicine, antibiotic, steroids, insulin, diabetes medication, sleep medication, stomach medication, laxatives, birth control, menopausal hormones or thyroid medication. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1), Seniors In the NBPSDHU Region: A Health Status Report Page 33/85

41 Percentage of Seniors 4.0 Chronic Diseases & Conditions 4.0 Chronic Diseases & Conditions In 2009, 89% of Canadian seniors were living with at least one chronic condition, and many seniors were living with multiple chronic conditions (Public Health Agency of Canada, 2010). Leading chronic conditions among seniors in Canada include arthritis or rheumatism, high blood pressure, diabetes, heart disease, cancer, stroke, Alzheimer s disease, cataracts, glaucoma, mood disorder and anxiety disorder. In 2009/10, 61.9% of NBPSDHU region seniors reported having arthritis, a significantly higher estimate compared to 47.0% of Ontario seniors. 4.1 High Blood Pressure High blood pressure, as diagnosed by a health professional and lasting 6 months or longer, was reported among 55.5% of NBPSDHU region seniors in 2009/10; an estimate not significantly different from that for North East LHIN region and Ontario seniors (see Figure 20). Prevalence of high blood pressure has not changed appreciably among seniors in the NBPSDHU, North East LHIN or Ontario regions since 2000/01. On the contrary, only 15.0% of NBPSDHU region residents aged 12 to 64 years had been diagnosed with high blood pressure in 2009/10, a significantly lower percentage compared to seniors. If left untreated, high blood pressure can damage the heart, blood vessels, kidneys, eyes, and the brain (Priddle, 2011a). Furthermore, obesity, sodium intake, alcohol, lack of exercise, stress, race, heredity, and age are all risk factors that contribute to high blood pressure. Figure 20. Percentage of Seniors who had been Diagnosed with High Blood Pressure, Lasting 6 Months or More, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 34/85

42 Percentage of Seniors 4.0 Chronic Diseases & Conditions 4.2 Diabetes In 2009/10, 14.2% of NBPSDHU region seniors reported having been diagnosed with diabetes in their lifetime, significantly higher compared to 4.9% of NBPSDHU region residents between 12 and 64 years of age; however all NBPSDHU region estimates for prevalence of diabetes should be interpreted with caution, as they are associated with high sampling variability (see Figure 21). Between 2000/01 and 2009/10, prevalence of diabetes has increased significantly among Ontario seniors. In Canada, seniors represent roughly 48% of the total number of people with diabetes, and this is expected to increase as Canada s population continues to age (Public Health Agency of Canada, 2011a). Furthermore, it is estimated that one-third of seniors with diabetes have not been diagnosed (Franse et al., 2001). If left untreated or improperly managed, diabetes can results in complications such as blindness, heart disease, stroke, kidney disease, nerve damage, and erectile dysfunction (Canadian Diabetes Association, 2011). Figure 21. Percentage of Seniors who had been Diagnosed with Diabetes, Lasting 6 Months or more, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ E E E E E / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. E-Interpret with caution; the estimate is associated with high sampling variability. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 35/85

43 Percentage of Seniors 4.0 Chronic Diseases & Conditions 4.3 Cataracts In 2005, about a quarter (25.7%) of seniors within the NBPSDHU region reported having been diagnosed with cataracts by a health professional; an estimate comparable to that for the North East LHIN region and Ontario (see Figure 22). Prevalence of cataracts among this age group has remained stable since 2000/01 among all regions. Cataracts are painless clouding of the lens in the eye, which blocks light from reaching the retina and impairs vision (Canadian National institute for the Blind, 2011a). They are the leading cause of blindness in the world (World Health Organization, 2004). The prevalence of cataracts increases with age, and studies have shown that the prevalence of cataracts doubles with every decade after 40 years of age (World Health Organization, 2001). Risk factors for age-related cataracts include exposure to ultraviolet-b (UV-B) radiation, diabetes, corticosteroid use, tobacco use, and alcohol use (World Health Organization, 2001). There are no medications to treat cataracts; however, surgery can restore vision (Glaucoma Research Foundation, 2011). Cataracts or complications from cataract surgery are thought to increase the risk of falling (Public Health Agency of Canada, 2005). Figure 22. Percentage of Seniors who had Cataracts, by Region, 2000/01, 2003 & E / NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. Note: This question was not asked in Ontario in 2007/08 or 2009/10. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1), 2000/01, 2003 & Seniors In the NBPSDHU Region: A Health Status Report Page 36/85

44 Percentage of Seniors 4.0 Chronic Diseases & Conditions 4.4 Glaucoma The percentage of seniors within the NBPSDHU region who reported having glaucoma as diagnosed by a health professional in 2007/08 (7.8%) did not vary significantly compared to Ontario or the North East LHIN, although this statistic should be interpreted with caution as it is associated with high sampling variability (see Figure 23). Prevalence of glaucoma among seniors has not changed significantly in the NBPSDHU region since 2000/01. Glaucoma is an eye disorder characterized by damage to the optic nerve, commonly due to build up of pressure in the eye due to excess fluid (Canadian National Institute for the Blind, 2011b). It is the second leading cause of blindness in the world (World Health Organization, 2004). Glaucoma is more common among seniors, who are six times more likely to be diagnosed with the disease (Glaucoma Research Foundation, 2011a). Risk factors associated with glaucoma include advanced aging, family history, people of African descent, myopia (nearsightedness), diabetes, migraine, hypertension, long-term corticosteroid use, and previous eye injury (Apotex Inc., 2011). Seniors with visual deficits including reduced acuity or contrast sensitivity, declined accommodation to light and darkness or altered depth perception are more likely to have a fall (American Geriatrics Society et al., 2001). Figure 23. Percentage of Seniors who had Glaucoma, by Region, 2000/01, 2003 & E E / NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. Note: The 2003 estimate for the NBPSDHU region was suppressed due to low case count. This question was not asked in Ontario in 2007/08 or 2009/10. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1), 2000/01, 2003 & Seniors In the NBPSDHU Region: A Health Status Report Page 37/85

45 Percentage of Seniors 5.0 Mental Health 5.0 Mental Health 5.1 Perceived Mental Health About three-quarters (75.9%) of seniors in the NBPSDHU region described their mental health as very good or excellent in 2009/10, a percentage not significantly different from the North East LHIN region and Ontario estimates, or from NBPSDHU region residents aged 12 to 64 years (see Figure 24). The percentage of seniors who rated their health as at least very good has not varied significantly within any region since 2003, except for a significant increase in the North East LHIN between 2007/08 and 2009/10. Poor mental health is not always a cause of progressive irreversible disease and a result of oldage among the elderly. Contributing factors to mental health include the loss of social relationships, widowhood, retirement, change in income status, isolation, disability, physical inactivity, chronic disease and/or pain, illness and sensory impairments (Public Health Agency of Canada, 2010). It is important to note that seniors living in long-term care facilities were not included in this sample, a population where an estimated 80% to 90% have some form of mental health issue (Conn, 2002). Figure 24. Percentage of Seniors who Self-Reported their Mental Health as Very Good or Excellent, by Region, 2003, 2005, 2007/08 & 2009/ / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Note: This question was not asked in Ontario in 2000/01. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 4.1, 5.1), 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 38/85

46 Percentage of Seniors 5.0 Mental Health 5.2 Mood Disorder The prevalence of diagnosed mood disorders among seniors within the NBPSDHU region has not changed significantly between 2003 and 2007/08 (prevalence of 9.5% and 7.2%, respectively; see Figure 25). In Ontario, the 2007/08 prevalence for diagnosed mood disorders was significantly higher than the previous estimate in In 2007/08, mood disorders were about as prevalent among NBPSDHU region residents aged 12 to 64 years (9.4%) as they were in seniors. Mood disorders include depression, bipolar disorder, mania, manic depression or dysthymia. Of seniors with a mood or anxiety disorder in Canada, 34.1% stated their mental illness began before the age of 25, and 13.9% stated it began while in their current age group (Government of Canada, 2006). Depression, a type of mood disorder, is more common among individuals with chronic conditions, which are in turn more common among the senior population. Mental illness may be difficult to diagnose in the elderly due to confusion of symptoms of physical problems with those of an underlying mental illness, assuming symptoms of depression or anxiety as part of the process of aging, differing symptoms of mental illness among the elderly compared to younger age groups and the presence of dementia. Figure 25. Percentage of Seniors who had been Diagnosed with a Mood Disorder, by Region, 2003, 2005, 2007/08 & 2009/ E E E E / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. E-Interpret with caution; the estimate is associated with high sampling variability. Note: The 2009/10 estimate for the NBPSDHU region was suppressed due to high sampling variability. This question was not asked in Ontario in 2000/01. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 4.1, 5.1), 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 39/85

47 5.0 Mental Health Definitions Mental Health Hospitalizations Hospitalization data extracted from the Discharge Abstract Database (coded using the International Classification of Diseases-10) was filtered to only include hospitalizations of acute treatment only. Data from the Ontario Mental Health Reporting system (coded using the Diagnostic Statistical Manual of Mental Disorders IV coding system) was combined with data from the Discharge Abstract database (coded using the ICD-10 system) as follows: DSM-IV Primary Diagnosis Category Delirium, dementia, and amnesitic and other cognitive disorders Mood Disorders Schizophrenia and other Psychotic Disorders ICD-10 Grouping (Codes) Organic, including symptomatic, mental disorders (F00- F09); Alzheimer s disease (G30) Mood [affective] disorders (F30- F39) Schizophrenia, schizotypal and delusional disorders (F20- F29) 5.3 Mental Health Hospitalizations Delirium, dementia, and amnestic and other cognitive disorders are the leading cause of mental health hospitalizations for seniors in the NBPSDHU region, followed by mood disorders, and schizophrenia and other psychotic disorders. Per every 100,000 seniors in the NBPSDHU region, there were an average of 972 mental health hospitalizations between 2007 and 2009, a significantly higher rate compared to Ontario (see Table 7). The NBPSDHU region average rate of hospitalizations for delirium, dementia, amnesitic and other cognitive disorders was significantly higher than the rate for Ontario seniors. This rate was also significantly higher than the average hospitalization rates for mood disorders or schizophrenia within the same time period. Dementia is estimated to affect about 400,000 Canadian seniors, and prevalence among Canadian seniors is higher among those 80 years and older, representing 55% of all Canadians with dementia (Public Health Agency of Canada, 2006). Modifiable risk factors for Alzheimer s disease, the most common form of dementia, include high blood pressure, being overweight and elevated cholesterol, all factors which seniors are at greater risk for (Alzheimer Society, 2010). Delirium, most commonly found among seniors, is the inability to think clearly, pay attention or remember the events of a few days or hours ago (Public Health Agency of Canada, 2010). Delirium often occurs in hospitalized seniors, with 10% to 15% having delirium when admitted and 15% to 25% developing it after admission (Canadian Mental Health Association, n.d.). An estimated 32% of 67% of seniors with delirium are thought to go undiagnosed. Seniors In the NBPSDHU Region: A Health Status Report Page 40/85

48 5.0 Mental Health Table 7. Average Mental Health Hospitalization Rates per 100,000 Senior Population (95% CI) for Mood Disorders and Delerium, Dementia and Amnesitic and Other Cognitive Disorders, by Region, Type of Mental Health Disorder North East LHIN NBPSDHU Region Ontario Region Mental health and behavioural disorders (including hospitalizations due to Alzheimer s) 971.9* 862.3* 616.2* (853.7, 1,109.7) (805.5, 923.2) (604.6, 627.9) Delirium, dementia, and amnesitic and other cognitive disorders 532.9* (446.3, 636.4) Mood disorders (129.4, 239.8) Schizophrenia and other psychotic disorders 76.3 (46.8, 149.9) 421.5* (381.9, 464.4) 198.3* (171.6, 283.0) 66.3 (51.9, 84.9) (337.5, 355.0) (130.6, 141.5) 52.5 (49.2, 56.0) Average calculated using 2007 to 2009 hospitalization data and 2008 population estimates. *Estimate is statistically significant from provincial estimate of the same hospitalization cause. Data Sources: 1) Hospitalization counts: Discharge Abstract Database (CIHI) & Ontario Mental Health Reporting System (CIHI) , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 04/25/ ) Population estimates: Statistics Canada 2008, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 41/85

49 Percentage of Seniors 6.0 Injuries 6.0 Injuries Definitions Serious Injury: An injury serious enough to limit normal activities (e.g. broken bone, bad cut, sprain) which occurred in the past 12 months but was not a repetitive strain injury. 6.1 Serious Injuries Serious injuries were self-reported by 8.4% of NBPSDHU region seniors in 2009/10, a percentage not significantly different compared to North East LHIN region and Ontario estimates (see Figure 26). Of NBPSDHU region residents aged between 12 and 64 years, 18.3% reported having suffered from a serious injury, a significantly higher proportion compared to seniors. The percentage of seniors suffering from a serious injury has not varied significantly among all regions since 2000/01. Although seniors are less likely to be injured compared to younger individuals, serious injuries among seniors may limit their usual activities, and many do not fully recover and may suffer lasting physical repercussions such as chronic pain, and social impacts such as reliance on others to perform daily activities, loss of autonomy, isolation and institutionalization (Statistics Canada, 2006a; Health Canada, 2002c). Figure 26. Percentage of Seniors who Suffered a Serious Injury, by Region, 2000/01, 2003, 2005 & 2009/ E E E / / /10 NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. Note: The 2003 estimate for the NBPSDHU region was suppressed due to low case count. This question was not asked in Ontario in 2007/08. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 5.1), 2000/01, 2003, 2005 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 42/85

50 Percentage of Seniors 6.0 Injuries Of the serious injuries reported in 2009/10 by NBPSDHU region seniors, 46.7% were reported to be caused by a fall (not including transportation accidents; see Figure 27). Of NBPSDHU region residents aged 12 to 64 years who had suffered from a serious injury, 36.0% reported this serious injury resulting from a fall (36.0%), a percentage not significantly different from that of seniors. Although this estimate was not reportable for NBPSDHU region seniors in 2000/01 and 2003, the percentage serious injuries as the result of a fall was fairly constant between 2000/01 and 2003 among Ontario seniors. The most common cause of injury among seniors is falls (Public Health Agency of Canada, 2010). Aspects of physical health (e.g., muscle weakness, reduced physical fitness, disability), chronic and acute illness (e.g., arthritis, visual or hearing impairment, disorders of blood pressure), cognitive impairment and social factors (e.g., housebound or living alone) put seniors at greater risk for falls. Most injuries as a result of a fall among Canadian seniors were caused by slipping, tripping or stumbling on a surface, followed by falling on stairs and stumbling on ice or snow and most falls happened at home (Public Health Agency of Canada, 2005). Most injuries related to falls were sustained to the hip, thigh, knee, lower leg, ankle or foot. Figure 27. Percentage of Seniors who Suffered Injuries Caused by a Fall, by Region, 2000/01, 2003, 2005 & 2009/ E / / /10 NBPSDHU NE LHIN Ontario Year(s) E-Interpret with caution; the estimate is associated with high sampling variability. Note: The 2000/01 and 2003 estimates for the NBPSDHU region were suppressed due to low case count. This question was not asked in Ontario in 2007/08. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 5.1), 2000/01, 2003, 2005 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 43/85

51 6.0 Injuries Definitions Injury Hospitalizations: Injury hospitalizations include hospitalizations coded using International Classification of Diseases-10 (ICD-10) external cause codes (V00-Y99), excluding poisoning by drugs or gases, adverse effects of drugs and medicines and complications (for ICD-10 codes for excluded categories, see the External Cause of Injury and Mortality Matrix [Center for Disease Control, 2002]). Categories for external causes of injuries were coded based on the Center for Disease Control s External Cause of Injury and Mortality Matrix (Center for Disease Control, 2002). 6.2 Injury Hospitalization Between 2007 and 2009, the leading cause of injury hospitalizations among NBPSDHU region seniors were falls, followed by motor vehicle collisions and overexertion (see Table 8). The rate of hospitalization for falls was significantly higher among seniors in the NBPSDHU region compared to Ontario seniors. Falls among seniors may result in post-fall syndrome, which includes confusion, dependence, depression, immobilization, and loss of autonomy (World Health Organization, 2007). Furthermore, the psychological impacts of falls can result in a loss of confidence and restriction of activities, which may increase the risk of future falls (World Health Organization, 2007). Functional health issues, including age-related vision changes, reaction time, power, coordination, and speed of cognitive processing, are common among seniors and increase the risk of motor vehicle collisions (Public Health Agency of Canada, 2010). Factors, such as aging, decline in flexibility, poor physical condition, obesity, fatigue, and stress, increase the risk of overexertion (Washington State Department of Labor and Industries, 2009). Table 8. Average Injury Hospitalization Rates per 100,000 Senior Population (95% CI) for the Top 3 Specified Causes of Injury Hospitalizations in the NBPSDHU Region, by Region, Cause of Injury NBPSDHU Region North East LHIN Region Ontario Falls 1,529.8* (1,376.8, 1,696.3) 1,268.1* (1,198.5, 1,340.9) 1,110.0 (1,094.6, 1,125.7) Motor vehicle collisions 33.8 (17.9, 69.6) 65.6 (50.9, 83.7) 54.6 (51.3, 58.2) Overexertion 33.8 (17.9, 69.6) 32.6* (23.0, 46.3) 18.1 (16.2, 20.2) Average calculated using 2007 to 2009 hospitalization data and 2008 population estimates. *Estimate is statistically significant from provincial estimate of the same hospitalization cause. Note: Does not include patients transferred from other acute care facilities. One patient may have been assigned multiple external cause ICD-10 codes, therefore rates may not represent unique patients Data Sources: 1) Hospitalization counts: Discharge Abstract Database (CIHI) , Ontario Ministry of Health and Long- Term Care, IntelliHEALTH Ontario, Extracted Date: 11/30/ ) Population estimates: Statistics Canada 2008, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH, Extracted Date: 08/24/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 44/85

52 6.0 Injuries Definitions Hip Fracture Hospitalizations: Hospitalizations with an ICD-10 most responsible diagnosis of S72.0 (fracture of neck of femur), S72.1 (pertrochanteric fracture) and S72.2 (subtrochanteric fracture). 6.3 Hip Fracture Hospitalizations The average hip fracture hospitalization rate from 2007 to 2009 for seniors in the NBPSDHU region was not significantly different than the North East LHIN region and Ontario rates between 2007 and 2009 (see Table 9). Senior females have a significantly higher rate for hip fracture hospitalizations compared to males in the NBPSDHU region, as is the case in the North East LHIN region and Ontario. A higher rate of hip fracture hospitalizations occurs as seniors grow older, but this increase was only statistically significant across increasingly older age groups among Ontario seniors. Among Canadian seniors, up to 40% of fall-related hospitalizations involve hip fractures (Public Health Agency of Canada, 2010). Consequences of hip fracture include death due to post-operative complications and/or preexisting conditions (e.g. cardiovascular disease), reliance on others for daily activities, immobilization, confusion, fear of falling and depression (Stafinski & Menon, 2001; World Health Organization, 2007; Zuckerman, 1996). Osteoporosis is responsible for an estimated 70% of hip fractures among those 45 years and older (Gordon & Huang, 1995). Seniors In the NBPSDHU Region: A Health Status Report Page 45/85

53 7.0 Infectious Disease Table 9. Average Hip Fracture Hospitalization Rates per 100,000 Senior Population (95% CI) for Hip fracture Hospitalizations, by Region and Sex, Age Group (years) NBPSDHU Region North East LHIN Region Ontario M F T M F T M F T (202.7, 412.6) (637.9, 949.6) (502.6, 703.3) (286.6, 396.5) (712.8, 864.8) (535.8, 632.7) (337.2, 363.7) (730.0, 764.1) (562.3, 584.8) (40.2, 290.7) (98.3, 467.1) (230.1, 828.7) (265.6, 1,126.3) ,587.3 (869.6, 3,102.7) 90+ 2,547.8 (995.1, 6,367.1) (42.2, 278.9) (167.8, 604.8) (412.0, 1,083.4) 1,378.0 (947.8, 2,053.7) 2,016.5 (1,335.4, 3,034.3) 3,744.0 (2,501.5, 5,745.7) (47.0, 200.1) 278.7* (278.7, 461.9) (362.5, 800.9) 1,043.0 (739.8, 1,468.7) 1,873.3 (1,337.3, 2,675.4) 3,479.4 (2,399.6, 5,153.5) 87.0 (48.4, 147.8) (143.1, 316.6) (225.1, 463.8) (442.3, 861.8) 1,228.1 (851.0, 1,769.2) 2,258.5 (1,433.3, 3,541.7) (80.3, 195.7) (232.2, 436.9) (547.3, 866.3) 1,404.4 (1,161.0, 1,687.5) 2,101.8 ( ) 3,453.5 (2,780.3, 4,320.0) (74.5, 149.9) (208.5, 342.4) (428.1, 631.2) 1,074.2 (912.2, 1,264.7) 1,808.8 (1,518.2, 2,153.9) 3,134.8 (2,577.1, 3,834.4) 83.5 (72.9, 96.0) (152.2, 189.3) (293.7, 350.0) (564.9, 659.5) 1,202.1 (1,111.9, 1,299.6) (1,821.5, 2,219.0) (114.5, 141.8) (231.7, 273.8) (535.9, 603.1) 1,151.1 (1,099.4, 1,205.2) 1,991.2 (1,905.8, 2,080.5) 3,099.9 (2,952.9, 3,253.9) (97.8, 115.8) (200.0, 228.4) (435.9, 480.8) (898.1, 972.0) 1,718.8 (1,654.3, 1,785.8) (2,682.3, 2,926.6) Average calculated using 2007 to 2009 hospitalization data and 2008 population estimates. M=Male; F=Female;T=Total (i.e., both sexes combined) *Estimate is statistically significant from provincial estimate of the same age group. Estimate is statistically significant from the estimate for the other sex within the same age group and region. Data Sources: 1) Hospitalization counts: Discharge Abstract Database (CIHI) , Ontario Ministry of Health and Long- Term Care, IntelliHEALTH Ontario, Extracted Date: 07/07/ ) Population estimates: Statistics Canada 2008, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH, Extracted Date: 08/24/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 46/85

54 7.0 Infectious Disease 7.0 Infectious Disease Influenza accounted for the most reportable disease cases among NBPSDHU region seniors between 2006 and 2010 (see Table 10). The incidence of confirmed influenza cases among seniors was significantly higher than any of the other reportable diseases. Beyond the reportable diseases included in this report, health-care associated infectious diseases such as methicillin-resistant Staphylococcus aureus, Clostridium difficile, and vancomycin-resistent enterococcus are more common in Canadian patients 65 years and older (Public Health Agency of Canada, 2010). Chronic disease, weakened immune system, and some medications can make seniors more susceptible to infectious disease. Table 10. Top 5 Reportable Infectious Diseases among Seniors within the NBPSDHU Region, Communicable disease Number of cases Rate per 100,000 Senior Population (95% Confidence Intervals) Influenza (26.3, 41.9) Salmonellosis (6.1, 14.4) Invasive Streptococcus pneumoniae (5.7, 13.9) Campylobacter enteritis (4.6, 12.2) Hepatitis C (2.2, 8) Data Source: Ontario Ministry of Health and Long-term Care, integrated Public Health Information System (iphis), extracted 09/11/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 47/85

55 7.0 Infectious Disease Influenza Confirmed Case: Characterized as clinically compatible signs and symptoms with laboratory confirmation by detection or isolation of influenza virus from appropriate clinical specimen/s or demonstration of a significant rise in complement fixation antibody titres to influenza between acute and convalescent sera or an epidemiological link to a laboratory-confirmed case or detection of influenza-specific ribonucleic acid (Ontario Ministry of Health and Long-Term Care, 2009c). Influenza Season: Time span from September 1 st to August 31 st of the subsequent year. 7.1 Influenza The incidence rate of confirmed influenza cases among NBPSDHU region seniors was significantly lower in the 2009/10 influenza season than in 2000/01. As illustrated in Figure 28, the highest influenza incidence rate among both male and female seniors was in the 2001/02 influenza season at cases per 100,000 senior population. These statistics most likely do not reflect the true incidence of influenza, as many cases may not seek medical attention or may not undergo any of the laboratory testing necessary for classification as a confirmed case. Therefore, the estimates shown in the figure likely under-represent the true incidence of influenza among seniors. Seniors are a high risk group for influenza infections. Although incidence of influenza has typically been higher among children, seniors are at higher risk to develop serious complications (including bacterial infections and pneumonia), and to be hospitalized or die from influenza (Thompson et al., 2003; Thompson et al., 2004). In Canada, an estimated 10% to 20% of the population will get influenza, and on average, 4,000 to 8,000 deaths every year are attributed influenza in Canada, with most of those deaths occurring among seniors (Ontario Ministry of Health and Long-Term Care, 2011d; Schanzer et al., 2007). Seniors In the NBPSDHU Region: A Health Status Report Page 48/85

56 Rate per 100,000 Senior Population Count 7.0 Infectious Disease Figure 28. Crude Confirmed Influenza Incidence Rate per 100, 000 Senior Population and Case Count, by Sex, NBPSDHU Region, 2001/ / / / / / / / / / /1 0 Count Rate Influenza Season Note: The definition for a confirmed influenza case changed in 2009, when Detection of influenza-specific ribonucleic acid (RNA) was added as an indication of a confirmed case and a significant increase in complement fixation antibody titres was used as the definition of a confirmed case instead of a significant increase in hemagglutination antibody titres (Ontario Ministry of Health and Long-Term Care, 2009c; Ontario Ministry of Health and Long-Term Care, Public Health Division, 2005). Data Source: Ontario Ministry of Health and Long-term Care, integrated Public Health Information System (iphis), extracted 09/11/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 49/85

57 Rate per 100,000 Senior Population 7.0 Infectious Disease The older the age group, the higher the incidence rate of confirmed influenza between 2001 and 2010 for seniors within the NBPSDHU region. The highest rate was among seniors 90 and over at cases per 100,000 senior population, a significantly higher rate than the same rate among those 65-69, 70-74, and age groups (see Figure 29). Figure 29. Crude Confirmed Influenza 10 Year Incidence Rate per 100, 000 Senior Population, by Sex & Age Group, NBPSDHU Region, Males Females Total Age Groups Data Source: Ontario Ministry of Health and Long-term Care, integrated Public Health Information System (iphis), extracted 09/11/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 50/85

58 Rate per 100,000 Senior Population 7.0 Infectious Disease In 2010, the ED visit rate for influenza and pneumonia among NBPSDHU region seniors was higher than the same rates for North East LHIN region and Ontario seniors. The ED visit rate for influenza and pneumonia among NBPSDHU region seniors declined from 2003 to 2007, but increased from 2007 through 2010 (see Figure 30). These trends were also apparent in the North East LHIN region senior population, but the hospitalization rate among Ontario seniors remained fairly stable during this time period. Figure 30. Emergency Department Visit Rate per 100, 000 Senior Population for Influenza and Pneumonia, by Year & Region, , , , , NBPSDHU 2, , , , , , , ,245.8 NELHIN 2, , , , , , , ,843.4 Ontario 1, , , , , , , ,617.3 Year Data Source: Ontario Ministry of Health and Long-term Care, integrated Public Health Information System (iphis), extracted 11/10/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 51/85

59 Percentage of Seniors 7.0 Infectious Disease Approximately 93.8% of seniors reported having received their seasonal flu shot in the previous year in 2009/10, similar to percentages in the North East LHIN region and Ontario (see Figure 31). Previous to October 2000, universal influenza immunization free of charge was not provided by the Ontario government. Rather, only those aged 65 years and older, those with long-term health problems and other individuals at high-risk were eligible to receive free influenza vaccinations (Groll & Thomas, 2007). Flu shots help reduce the risk of getting influenza, thereby preventing influenza-related hospitalizations and complications in the person immunized, and indirectly by preventing influenza to be transmitted from that person to others. Figure 31. Percentage of Seniors who Reported having Received a Flu Shot Less than One Year Before, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 52/85

60 7.0 Infectious Disease Salmonella Confirmed Case: Characterized as laboratory confirmation of infection with or without clinically compatible signs and symptoms (i.e., isolation of Salmonella species [excluding Salmonella typhi or paratyphi] from an appropriate clinical specimen) (Ontario Ministry of Health and Long- Term Care, 2009d). 7.2 Salmonellosis Crude salmonellosis incidence rates among seniors within the NBPSDHU region have not changed significantly since 2001/02 (see Figure 32). Between 2009 and 2010, seven seniors were confirmed as salmonellosis cases, a rate of 15.1 per 100,000 seniors within the NBPSDHU region. The highest incidence rate between 2001 and 2010 was in the 70 to 74 year age group (32.8 cases per 100,000 senior population) and 65 to 69 year age group (17.8 cases per 100,000 senior population), however these rates were not significantly higher compared to other senior age groups (e.g., 75 to 79, 80 to 84, 85 to 89 and those 90 years and over). Seniors are considered one of the high risk groups for getting a Salmonella infection (Carrico, 2009). However, as with influenza, many infections are not confirmed via laboratory testing or individuals may choose not to seek medical advice or treatment, therefore, these cases most likely do not represent the true magnitude of the disease. From 2000 to 2004, the reported rate of Salmonella infection among Canadians aged 60 years and over was 14.5 cases per 100,000 (Public Health Agency of Canada, 2009a). Factors that contribute to increased susceptibility to and severity of foodborne pathogens among the elderly include an aging immune system, presence of chronic disease, nutritional status, dementia, physical activity, and risky food storage, handling and consumption behaviours (Kendall et al., 2006). Seniors In the NBPSDHU Region: A Health Status Report Page 53/85

61 Rate per 100,000 Senior Population Count 7.0 Infectious Disease Figure 32. Crude Confirmed Salmonellosis Rate per 100, 000 Senior Population and Case Count, NBPSDHU Region, 2001/ / / / / / /10 Count Rate Years Note: The definition for a confirmed salmonellosis case changed in Previous to 2009, the case definition was clinically compatible signs and symptoms with a) isolation of a species of Salmonella other than S. typhi or S. paratyphi from the stool or from any body site or b) an epidemiologic link to one or more laboratory confirmed cases. In 2009, the definition changed to laboratory confirmation of infection with or without clinically compatible signs and symptoms (isolation of Salmonella species excluding S. typhi or S. paratyphi from an approporiate clinical specimen, for example: sterile site, blood, stool, vomitus, urine) (Ontario Ministry of Health and Long-Term Care, 2005; Ontario Ministry of Health and Long-Term Care, 2009d). Data Source: Ontario Ministry of Health and Long-term Care, integrated Public Health Information System (iphis), extracted 09/11/ Sexually Transmitted & Bloodborne Infections Hepatitis B, C and syphilis were the only reportable sexually transmitted infections identified among seniors between 2001 and Only one case of hepatitis B was confirmed in an NBPSDHU region senior in the past ten years, while approximately nine cases of syphilis were identified and reported within this time period. The 10 year rate of confirmed hepatitis C infection was highest among individuals aged 70 to 74 years at 12.7 cases per 100,000 senior population and 65 to 69 year olds at 10.4 cases per 100,000 senior population, but these rates were not statistically different than rates among other senior age groups. Although seniors have not historically been a high risk group in regards to sexually transmitted infections (STIs), the incidence of such infections is rising in Canada. Unique circumstances among seniors, such as entering into a new relationship after a partner has deceased or minimized concerns about pregnancy and using condoms, may expose an individual to an infection. A lack of education on the symptoms associated with STIs, safe sex practices, the importance of discussing past sexual history or being screened for STIs among this population may worsen the chances of preventing and detecting an infection. Seniors In the NBPSDHU Region: A Health Status Report Page 54/85

62 8.0 Emergency Department Visits 8.0 Emergency Department Visits Definitions ICD-10 Chapter Categories: Emergency department visits, hospitalizations and mortalities were coded using the ICD-10 classification system. Data was extracted by the main problem diagnosis for ED visits, most responsible diagnosis for hospitalizations and primary cause of death for mortality data and classified by chapter (Canadian Institute for Health Information, 2009). 8.1 Top 10 Causes of Emergency Department Visits The average all-cause emergency department (ED) visit rate from 2007 to 2009 for seniors in the NBPSDHU region was significantly higher than the Ontario rate, but significantly lower than the North East LHIN rate (see Table 11). For every 100,000 NBPSDHU region seniors there were about 81,463 emergency department visits. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified are the leading cause of ED visits for seniors in the NBPSDHU region, followed by injury and poisoning and certain other consequences of external causes and diseases of the circulatory system. All ED visit rates for each of the top 10 causes were significantly higher than the Ontario rates. The leading cause of emergency visits for NBPSDHU region seniors is a category used to assign less well-defined conditions that point equally to two or more diseases or to two or more systems in the body, symptoms or signs that are transient, or where the precise etiology of symptoms was unknown (Canadian Institute of Health Information, 2009). Between 1993 and 2000, emergency department use increased among the elderly, and rates were highest per capita among the elderly (e.g. 85 years and over) (Institute for Clinical Evaluative Sciences, 2009). Between 2004/05 and 2008/09, fewer ED visits resulted in hospitalizations among Ontario seniors (Canadian Institute for Health Information, 2010). Seniors In the NBPSDHU Region: A Health Status Report Page 55/85

63 9.0 Hospitalizations Table 11. Average Emergency Department Visit Rates per 100,000 Senior Population (95% CI) for the Top 10 Causes of Emergency Department Visits in the NBPSDHU region, by Region, ICD-10 Chapter NBPSDHU Region North East LHIN Region Ontario All Causes 81,462.9* (80,950.6, 81,961.6) Symptoms, signs and abnormal 16,546.3* clinical laboratory findings, not (16,070.0, 17,036.8) elsewhere classified Injury & poisoning & certain other 11,284.4* consequences of external causes (10,879.3, 11,702.5) Diseases of circulatory system 9,024.8* (8,659.0, 9,404.5) Diseases of respiratory system 8,587.3* (8231.3, ) Diseases of musculoskeletal system & 6,825.5* connective tissue (6,506.2, 7,162.4) Factors influencing health status & 6,524.5* contacts with health services (6,209.2, 6,851.7) Diseases of digestive system 5,651.0* (5,358.1, 5,958.9) Diseases of genitourinary system 3,773.2* (3,534.5, 4,030.5) Diseases of skin & subcutaneous 2,739.6* tissue (2,535.1, 2,960.1) Endocrine, nutritional & metabolic 2,062.8* diseases (1,884.4, 2,254.4) 91,286.5* (91,105.1, 91,463.8) 20,162.1* (19,908.2, 20,418.5) 58, (58,384.2, 58,530.6) 14,064.6 (14,013.1, 14,116.3) 11,201.9 (11,002.9, 11,404.1) 9,265.3 (9,222.3, 9,308.4) 8,360.1* 6,080.1 (8,185.7, 8,537.8) (6,044.7, 6,115.7) 8,725.1* 5,134.5 (8,547.6, 8,906.6) (5,101.9, 5,167.4) 7,041.2* 3,951.4 (6,879.8, 7,205.3) (3,922.5, 3,980.4) 12,577.7* 4,005.5 (12,368.7, 12,790.5) (3,976.5, 4,034.7) 5,554.4* 4,255.6 (5,410.2, 5,701.6) (4,255.7, 4,285.6) 4,158.3* 3,003.7 (4,032.8, 4,286.8) (2,978.4, 3,029.1) 3,147.1* 1,884.8 (3,038.0, ) (1,864.7, 1,905.1) * 1,332.0 (1,887.7, ) (1,315.1, 1,349.1) Average calculated using 2007 to 2009 emergency visit data and 2008 population estimates. *Estimate is statistically significant from provincial estimate of the same ED visit cause. Data Sources: 1) Emergency department visit counts: National Ambulatory Care Reporting System (CIHI) , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 06/27/2011 for NBPSDHU and 11/08/2011 for North East LHIN and Ontario. 2) Population estimates: Statistics Canada 2008, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 56/85

64 9.0 Hospitalizations 9.0 Hospitalizations 9.1 Top 10 Causes of Hospitalization The average all-cause hospitalization rate for seniors in the NBPSDHU region from 2007 to 2009 was significantly higher than the rate for Ontario but significantly lower than the North East LHIN rate. Per every 100,000 seniors, about 27,000 hospitalizations occurred among NBPSDHU region seniors, while about 21,000 hospitalizations occurred for every 100,000 Ontario seniors (see Table 12). Diseases of the circulatory system were the leading cause of hospitalizations for seniors in the NBPSDHU region, followed by diseases of the digestive system. Diseases of the circulatory system include ischaemic and pulmonary heart disease, cerebrovascular disease, and hypertensive disease. The average hospitalization rate from 2007 to 2009 for seniors for circulatory system diseases in the NBPSDHU region, as well as the rest of the top 10 causes of hospitalizations, are significantly higher than the rates for Ontario. Of all acute-care hospitalizations, Canadian seniors account for a third of these hospitalizations (Statistics Canada, 2006b). Repeat hospitalizations are more common among the senior population. Likelihood of hospitalization among Canadian seniors is linked to chronic conditions and injury. Seniors In the NBPSDHU Region: A Health Status Report Page 57/85

65 9.0 Hospitalizations Table 12. Average Hospitalization Rates per 100,000 Senior Population (95% CI) for the Top 10 Causes of Hospitalizations in the NBPSDHU region, by Region, ICD-10 Chapter North East LHIN NBPSDHU Region Region Ontario All Causes 26,911.6* (26,338.6, 27,492.3) 28,039.7* (27,775.5, ) 20,504.9 (20,445.0, 20,565.0) Diseases of circulatory system 6,492.2* (6,179.1, 6,820.2) 6,915.2* (6,755.8, 7,078.6) 4,916.1 (4,884.1, 4,948.3) Diseases of digestive system 2,816.0* (2,607.2, 3,037.7) 2,947.8* (2,842.5, 3,057.6) 2,289.6 (2,267.5, 2,311.9) Diseases of respiratory system 2,764.6* (2,560.6, 2,987.5) 3,036.2* (2,929.3, 3,147.6) 2,243.3 (2,221.4, 2,265.4) Neoplasms 2,701.4* (2,497.0, 2,918.9) 2,433.6* (2,337.2, 2,533.2) 1,985.0 (1,964.4, 2,005.8) Symptoms, signs and abnormal 2,586.9* 3,291.0* 1,623.1 clinical laboratory findings, not (2,386.9, 2,800.0) (3,179.8, 3,406.8) (1,604.4, 1,642.0) elsewhere classified Injury, poisoning & certain other consequences of external causes 2,374.0* (2,183.9, 2,580.3) 2,199.9* (2,108.2, 2,294.8) 1,881.4 (1,861.3, 1,901.7) Diseases of musculoskeletal system & connective tissue 2,315.3* (2,129.0, 2,520.7) 2,158.8* (2,068.0, 2,252.8) 1,646.9 (1,1,628.1, 1,665.9) Diseases of genitourinary system 1,421.2 (1,276.6, 1,585.1) Mental health and behavioural disorders (including 866.2* hospitalizations due to (867.7, 996.9) Alzheimer s) Endocrine, nutritional & 748.8* metabolic diseases (644.7, 869.5) 1,548.5* (1,472.2, 1,629.3) 767.2* (714.0, 825.1) 1,332.6 (1,315.7, 1,349.8) 558.2* (547.2, 569.3) 874.6* 621.0* (817.7, 936.2) (609.4, 632.8) Average calculated using 2007 to 2009 hospitalization data and 2008 population estimates. *Estimate is statistically significant from provincial estimate of the same hospitalization cause. Note: Only hospitalizations at acute treatment hospitals were included. Chapters XXI (Factors influencing health status & contacts with health services) and XXIII (Provisional codes for research & temporary assignment) were excluded as they do not represent diseases or conditions. Data Sources: 1) Hospitalization counts: Discharge Abstract Database & Ontario Mental Health Reporting System (CIHI) , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 04/24/2012 2) Population estimates: Statistics Canada 2008, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 58/85

66 10.0 Mortality 10.0 Mortality 10.1 Top 10 Causes of Mortality The average all-cause mortality (death) rate for seniors in the NBPSDHU region from 2005 to 2007 was comparable to those rates for seniors in the North East LHIN region and Ontario. For every 100,000 seniors in the NBPSDHU region, about 4,000 seniors died (see Table 13). Diseases of the circulatory system (e.g., cerebrovascular and ischemic heart disease) are the leading cause of death for seniors in the NBPSDHU region, followed by neoplasms (e.g., lung, colon and breast cancer) and diseases of the respiratory system (e.g., chronic obstructive pulmonary disease, influenza, pneumonia). The average mortality rates from 2007 to 2009 for each of the top 10 causes of mortality among NBPSDHU region seniors were not significantly different compared to the Ontario mortality rates of the same cause, except for mortality rate from diseases of the nervous system, which was significantly lower compared to the Ontario rate. Across Canada, 47% of deaths are among seniors 80 years and older, and 30% are in seniors aged 60 to 79 years (Public Health Agency of Canada, 2010). Whereas, the primary cause of mortality are cancers in the 60 to 79 years age group (40% of deaths due to cancer, followed by 28% due to circulatory disease), diseases of the circulatory system are the primary diagnosis in deaths among those aged 80 years and older (38% due to circulatory disease, followed by 19% due to cancers). Mortality rates in Canada among seniors have declined significantly in all age groups except among those 90 years and over, a trend which has contributed to the rising life expectancy (Statistics Canada, 2006a). Seniors In the NBPSDHU Region: A Health Status Report Page 59/85

67 10.0 Mortality Table 13. Average Mortality Rates per 100,000 Senior Population (95% CI) for the Top 10 Causes of Mortality within the NBPSDHU Region, by Region, ICD-10 Chapter NBPSDHU Region North East LHIN Region Ontario All Causes 4,130.9 (3,875.4, 4,405.7) 4,418.3* (4,287.3, 4,554.0) 4,056.2 (4,026.2, 4,086.4) Diseases of circulatory system 1,482.1 (1,329.6, 1,651.9) 1,502.1* (1,425.2, 1,583.1) 1,389.0 (1,371.2, 1,406.9) Neoplasm 1,225.1 (1,085.6, 1,378.9) 1,267.3* (1,197.1, 1,342.3) 1,126.5 (1,110.6, 1,142.7) Diseases of respiratory system (284.6, 444.1) (393.3, 478.7) (379.2, 398.2) Endocrine, nutritional & metabolic diseases (155.3, 277.9) (185.7, 245.8) (181.9, 195.2) Diseases of digestive system (139.6, 256.7) (162.3, 218.8) (158.6, 171.0) Mental and behavioural disorders (124.0, 235.4) (180.6, 239.9) (183.4, 196.7) External causes of morbidity and mortality (93.3, 192.2) (119.0, 167.9) (130.8, 142.1) Diseases of nervous system 130.8* (89.5, 186.8) (142.1, 195.2) (194.7, 208.4) Diseases of genitourinary system 84.6 (52.6, 131.3) (96.0, 140.4) (107.3, 117.6) Certain infectious & parasitic diseases 55.4 (31.7, 96.8) 78.9 (62.7, 99.3) 75.4 (71.4, 79.7) Average calculated using 2005 to 2007 mortality data and 2006 population estimates. *Estimate is statistically significant from provincial estimate of the same mortality cause. Data Sources: 1) Mortality counts: Ontario Office of Registrar General , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 06/28/ ) Population estimates: Statistics Canada 2006, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 60/85

68 10.0 Mortality Definitions ICD-10 Block Categories for Diseases of the Circulatory System: Mortalities with the primary cause coded as Diseases of the Circulatory System (ICD-10 Chapter 9) were categorized according to block, or subcategories defined in the ICD-10 coding system (Canadian Institute for Health Information, 2009). ICD-10 Block Code Ranges I00-I02 I05-I09 I10-I15 I20-I-25 I26-I28 I30-I52 I60-I69 I70-I79 I80-I81 I96-I99 Name of ICD-10 Block Acute Rheumatic Fever Chronic Rheumatic Heart Diseases Hypertensive Diseases Ischaemic Heart Diseases Pulmonary Heart Disease and Diseases of Pulmonary Circulation Other Forms of Heart Disease Cerebrovascular Diseases Diseases of Arteries, Arterioles and Capillaries Diseases of Veins, Lymphatic Vessels and Lymph Nodes Other and Unspecified Disorders of the Circulatory System 10.2 Diseases of the Circulatory System The highest average mortality rate for diseases of the circulatory system among seniors in the NBPSDHU region between 2005 and 2007 was for ischaemic heart diseases, followed by cerebrovascular diseases (see Table 14). The average mortality rate for ischaemic heart diseases was significantly higher among NBPSDHU region seniors compared to Ontario seniors. The older the senior, the higher the average mortality rate due to a disease of the circulatory system (see Figure 33). Seniors aged 90 years and over had the highest mortality rate for diseases of the circulatory system of all seniors. Mortality rates were significantly higher for NBPSDHU region seniors aged 70 to 74 and 85 to 89 years compared to Ontario seniors in the same age groups. About 23% of Canadian seniors reported having some form of heart disease in 2009 (Public Health Agency of Canada, 2010). Ischaemic heart disease happens when the heart muscle is damaged by deficient blood supply (Public Health Agency of Canada, 2009b). Risk factors include physical inactivity, high blood pressure, diabetes, overweight and obesity, all factors which are more prevalent among seniors compared to younger individuals. Cerebrovascular disease include brain ischemia, brain haemorrhage and disorders of brain blood vessels, with stroke being the most common of these conditions (Public Health Agency of Canada, 2009b). Death rates for stroke were highest in those 85 years and older. Survivors of stroke are likelier to experience restrictions in activities of daily living, difficulties in cognitive function and a declined sense of well-being (Clarke et al., 2002). Seniors In the NBPSDHU Region: A Health Status Report Page 61/85

69 Average Mortality Rate per 100,000 Senior Population 11.0 Access to Health Services & Utilization Table 14. Average Mortality Rates per 100,000 Senior Population (95% CI) for the Top 3 Circulatory System Diseases in the NBPSDHU Region, by Region, DSM-IV Primary Diagnosis NBPSDHU Region North East LHIN Region Ontario Ischaemic Heart Diseases 971.2* (969.6, 1,109.1) Cerebrovascular diseases (191.2, 325.2) Other Forms of Heart Disease (100.9, 203.1) 897.0* (831.8, 960.6) 241.4* ( ) (168.4, 258.2) (741.5, 767.8) (284.2, 300.7) (191.3, 204.9) Average calculated using 2005 to 2007 mortality data and 2006 population estimates. *Estimate is statistically significant from provincial estimate of the same mortality cause. Does not include acute rheumatic fever, chronic rheumatic heart diseases, hypertensive diseases, pulmonary heart disease or diseases of arteries, veins or unspecified diseases of the circulatory system. Data Sources: 1) Mortality counts: Ontario Office of Registrar General , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 11/25/ ) Population estimates: Statistics Canada 2006, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Figure 33. Average Mortality Rates per 100,000 Senior Population (95% CI) for Diseases of the Circulatory System, by Age Group (Years) & Region, , , , ,000.0 * * 4, , * * * * * NBPSDHU , , , ,719.5 NE LHIN , , , ,990.4 Ontario , , , ,305.9 Age Group (Years) Average calculated using 2005 to 2007 mortality data and 2006 population estimates. *Estimate is statistically significant from provincial estimate in the same age group. Data Sources: 1) Mortality counts: Ontario Office of Registrar General , Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 11/28/ ) Population estimates: Statistics Canada 2006, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH Ontario, Extracted Date: 08/21/2011. Seniors In the NBPSDHU Region: A Health Status Report Page 62/85

70 11.0 Access to Health Services & Utilization 10.3 Cancer Incidence The average incidence rate for all malignant cancers among NBPSDHU region seniors from 2005 to 2007 was not significantly different compared to the same rate in Ontario seniors (see Table 15). Males in all regions (NBPSDHU region, North East LHIN region and Ontario) had a significantly higher rate for all malignant cancers compared to females. Prostate, colorectal, breast and lung cancer accounted for the most cancer cases among NBPSDHU region seniors between 2005 and The incidence rates of colorectal cancer in NBPSDHU region male seniors and lung and bronchus cancer in NBPSDHU region female seniors were significantly higher compared to the same rates in Ontario seniors. The average incidence rate of colorectal cancer was also significantly higher in NBPSDHU region male seniors compared to females. NBPSDHU region seniors aged 65 to 69 years had a significantly lower average incidence rate for all cancers compared to senior age groups 75 to 79 and 80 to 84 years (see Figure 34). This trend was apparent among North East LHIN region and Ontario seniors as well. Variation among incidence rates between regions can reflect differences in uptake of screening practices for the identification of certain cancers (e.g. mammographies for identifying breast cancer, fecal occult blood tests for colorectal cancer). As the risk of numerous cancers (e.g. breast, colorectal) increases with age, seniors account for the most (55%) new diagnoses of all cancers (Cancer Care Ontario, 2010). Incidence rates for prostate cancer have increased from the early 1990s in Ontario, likely due to the introduction of the prostate-specific antigen (PSA) screening test, although the effectiveness of screening healthy men is uncertain (Cancer Care Ontario, 2010). Soon after the age of 50, males begin to have higher incidence rates for cancers than females, as some cancers (e.g. colorectal and lung cancer) are more common at older age. Some risk factors contributing to cancer development may be more prevalent among seniors (e.g., physical inactivity and body fatness for colorectal and breast cancer). As for lung cancer, tobacco consumption, the greatest risk factor for cancer, only began to decline for men in the 1950s and for women in the 1960s (Ferrence, 1988; Holowaty et al., 2002). Therefore, elevated rates of lung cancer in seniors today are more of a reflection of past than current tobacco consumption. Seniors In the NBPSDHU Region: A Health Status Report Page 63/85

71 Incidence Rate per 100,000 Senior Population 11.0 Access to Health Services & Utilization Table 15. Average Incidence Rates per 100,000 Senior Population (95% CI) for Selected Cancers, by Sex & Region, Type of NBPSDHU Region North East LHIN Region Ontario Cancer Males Females Males Females Males Females All Malignant Cancers 2,716.0 (2,530.7, 2,911.3) 1,640.3 (1,509.8, 1,779.0) 2,728.4 (2,636.8, 2,822.3) 1,710.4* (1,645.0, 1,777.8) 2,622.6 (2,601.0, 2,644.3) 1,607.2 (1,592.4, 1,622.1) Breast (295.3, 422.1) (316.5, 376.6) (338, 351.8) Prostate * (666.6, 870.1) (683.3, 779.6) (805.9, 830.1) Lung and Bronchus (332.8, 481.6) 351.7* (292.7, 419.0) (463.7, 543.8) 343.5* (314.6, 374.5) (398.9, 416.0) (253.7, 265.7) Colorectal 483.9* (407.6, 570.4) (244.2, 360.7) (361.6, 432.8) (257.5, 312.0) (347.5, 363.5) Average calculated using 2005 to 2007 incidence data. *Estimate is statistically significant from provincial estimate in the same sex. Data Source: Cancer Care Ontario SEER*Stat Release 8 OCRIS (May 2010) released February (248.7, 260.5) Figure 34. Average Incidence Rates per 100,000 Senior Population (95% CI) for Malignant Cancers, by Age Group & Region, , , , , , * NBPSDHU 1, , , , , NE LHIN 1, , , , , Ontario 1, , , , , Age Group (Years) Average calculated using 2005 to 2007 mortality data. *Estimate is statistically significant from provincial estimate in the same age group. Data Source: Cancer Care Ontario SEER*Stat Release 8 OCRIS (May 2010) released February * Seniors In the NBPSDHU Region: A Health Status Report Page 64/85

72 11.0 Access to Health Services & Utilization Mortality In every region, males had a significantly higher average mortality rate for all malignant cancers from 2005 to 2007 compared to females (see Table 16). Among NBPSDHU region seniors, the mortality rate for cancers of the lung and bronchus were significantly higher in males compared to females. All mortality rates for NBPSDHU region seniors were comparable to provincial rates, with the exception of the mortality rate for prostate cancer among NBPSDHU region senior men and lung and bronchus cancer among women, both which were significantly higher compared to the Ontario rates. The older the senior, the higher the average mortality rate due to all malignant cancers (see Figure 35). This trend is especially apparent in North East LHIN region and Ontario seniors, where differences between age groups are significantly different, with the older age group having a significantly higher average mortality rate for malignant cancers between 2005 and 2007 compared to the younger age group. For all senior age groups except 80 to 84 year olds, mortality rates were significantly higher for North East LHIN region seniors compared to Ontario seniors. About 41% of deaths due to cancer in Ontario are among seniors aged 65 to 79 and 31% in seniors 80 years or older (Cancer Care Ontario, 2010). Survival rates vary according to the type of cancer, with lung cancer having a 5-year relative survival ratio of less than 20%, while prostate and female breast cancer both have ratios higher than 70%. Of all age groups, older adults have the worst relative survivals. Seniors In the NBPSDHU Region: A Health Status Report Page 65/85

73 Mortality Rate per 100,0000 Senior Population 11.0 Access to Health Services & Utilization Table 16. Average Mortality Rates per 100,000 Senior Population (95% CI) for Selected Cancers, by Sex & Region, Type of NBPSDHU Region North East LHIN Region Ontario Cancer Males Females Males Females Males Females All Malignant Cancers 1,469.7 (1,333.3, (892.3, 1,102.4) 1,507.7* (1,439.9, 1,018.7* (968.3, 1,071.0) 1,321.3 (1,306.0, (913.5, 936.0) 1,614.2) 1,577.9) 1,336.7) Breast (109.3, 191.9) (112.0, 149.1) (118.8, 127.0) Prostate 231.7* (179.9, 293.8) (178.1, 229.3) (168.2, 179.4) Lung and Bronchus (335.9, 485.3) 278.5* (226.4, 339.1) 436.7* (400.5, 475.2) 270.5* (244.8, 298.0) (348.0, 364.0) (207.4, 218.2) Colorectal (108.9, 201.3) (85.2, 159.7) (143.9, 190.3) (114.5, 151.9) (164.4, 175.4) Average calculated using 2005 to 2007 incidence data. *Estimate is statistically significant from provincial estimate in the same sex. Data Source: Cancer Care Ontario SEER*Stat Release 8 OCRIS (May 2010) released February (119.9, 128.2) Figure 35. Average Mortality Rates per 100,000 Senior Population (95% CI) for Malignant Cancers, by Age Group & Region, * * * * NBPSDHU , , , NE LHIN , , , , Ontario , , Age Groups (Years) Average calculated using 2005 to 2007 mortality data. *Estimate is statistically significant from provincial estimate in the same age group. Data Source: Cancer Care Ontario SEER*Stat Release 8 OCRIS (May 2010) released February Seniors In the NBPSDHU Region: A Health Status Report Page 66/85

74 11.0 Access to Health Services & Utilization 11.0 Access to Health Services & Utilization While seniors today are generally healthier than those of previous generations, they remain more likely than younger people to have chronic conditions and to suffer from poor health (Statistics Canada, 1999). Not surprisingly then, seniors also require and use more health care services than those in other age categories. Within a decade, almost one out of every five persons in Canada will be a senior citizen. Twenty years after that, it will grow to one in four (Public Health Agency of Canada, 2010). As the number of seniors in Canada continues to grow, the need for access to and utilization of health services will continue to increase Contact with Health Professionals In 2009/10, 91.7% of NBPSDHU region seniors had seen or talked to a family doctor or general practitioner about their physical, emotion or mental health in the previous 12 months, not significantly different compared to seniors in Ontario and the North East LHIN (see Figure 36). A significantly lower percentage (73.7%) of the NBPSDHU region population aged 12 to 64 years old had seen a family doctor or general practitioner in 2009/10 compared to NBPSDHU region seniors. The vast majority of NBPSDHU region seniors reported having a regular doctor in 2009/10 (see Figure 37). The proportion of NBPSDHU region seniors who reported having a regular doctor was not significantly different from the same estimate among North East LHIN region or Ontario seniors, and has not changed significantly since 2000/01. A similar percentage of the NBPSDHU region population aged 12 to 64 years reported having a regular doctor in 2009 (88.3%) compared to NBPSDHU region seniors. A little over a half (56.9%) of NBPSDHU region seniors had seen or talked to a dentist or orthodontist in the previous twelve months. About 66.7% of the NBPSDHU region population 12 to 64 years old had seen or talked to a dentist, which was not significantly different compared to NBPSDHU region seniors. Barriers to dental care include poor overall health, decreased cognitive ability, no perceived need for dental care, anxiety and fear of new situations or procedures, transportation, and costs (Marvin, 2001). Additionally, dentists may be more reluctant to treat seniors due to the perception that treatment may take longer or be more complicated, and the perception that seniors may have insufficient patience, endurance, or finances to have treatment. If gum disease is left untreated, it can result in the loss of teeth and an increased risk for diseases, such as respiratory disease (Health Canada, 2009). Furthermore, poor oral health can impact an individual s ability to chew and digest food properly, and consequently impact food choices which may lead to poor nutritional outcomes (Health Canada, 2009; Braine, 2005). Seniors In the NBPSDHU Region: A Health Status Report Page 67/85

75 Type of Doctor/Specialist 11.0 Access to Health Services & Utilization Figure 36. Percentage of Seniors who Seen or Talked to a Family Doctor/General Practitioner, Other Doctor, Dentist/Oral Hygienist/Orthodontist or Eye Specialist in the Previous 12 Months, by Region, 2009/10. Dentist/Oral Hygenist/Orthodontist Other Doctor Eye Specialist Family Doctor/General Practitioner Family Doctor/General Dentist/Oral Eye Specialist Other Doctor Practitioner Hygenist/Orthodontist NBPSDHU NE LHIN Ontario Percentage of Seniors Data Source: Statistics Canada, Canadian Community Health Survey (5.1), 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 68/85

76 Percentage of Seniors 11.0 Access to Health Services & Utilization Figure 37. Percentage of Seniors who had a Regular Doctor, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ * * * / / /10 NBPSDHU NE LHIN Ontario Year(s) *-A significant statistical difference exists between the regional and provincial estimate in the same survey year(s). The statistic is significantly different from the previous year s estimate within the same region. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 69/85

77 Percentage of Seniors 11.0 Access to Health Services & Utilization Definitions Home Care: Home care services received at home include health care, home maker or other support services. Home care may be received due to a health problem or condition affecting daily activities. Examples include nursing care, personal care or help with bathing, housework, meal preparation, meal delivery and respite care Home Care In 2009/10, approximately 10.8% of seniors received partially or wholly government-paid home care in the NBPSDHU region, an estimate that is not significantly different from estimates in the North East LHIN region or Ontario in the same survey year, nor compared to previous years (see Figure 38). Predominant types of home care received by NBPSDHU region seniors included nursing care (e.g. dressing changes, preparing medications), personal care (e.g. bathing, foot care) and housework (e.g. cleaning, laundry), received by 40.0%, 34.9% and 54.1% of those who received government care, respectively (interpret with caution as these statistics are associated with high sampling variability). Figure 38. Percentage of Seniors who Received Home Care in the Previous 12 Months, with Costs at Least Partially Covered by Government, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ E / / /10 NBPSDHU NE LHIN Ontario E Year(s) E E E-Interpret with caution; the estimate is associated with high sampling variability. Note: 2000/01 data was not collected for the NBPSDHU region. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 70/85

78 Percentage of Seniors 11.0 Access to Health Services & Utilization Fewer NBPSDHU region seniors received home care services not covered by the government in 2009/10 versus services paid by the government (see Figure 38 & 39). The type of service rendered at home not paid for by the government included housework, meal preparation or delivery, shopping and other health care services; however this data was not presented due to high sampling variability and low case numbers. Home care not paid for by the government was delivered mostly by a family member or spouse (62.1%; interpret with caution as the statistic is associated with high sampling variability), followed by homemakers (51.0%, interpret with caution). Volunteers and friends or neighbours provided home service as well, but due to low case count, estimates cannot be reported. Home care can bridge the gap between independent living and living in a residential care facility, as well as provide opportunities for seniors to continue to live at home if this is their place of choice (Public Health Agency of Canada, 2010). The majority of seniors care (about 72%) is provided through informal sources both family members and friends. For a number of seniors, formal care providers can help them maintain independence at home by offering support for acute/ chronic health conditions and with meal preparation and daily activities (Public Health Agency of Canada, 2010). Evidence shows that home care can be a lower cost alternative to residential care among recipients with similar care needs. Differences in cost arise when type and level of care changes. Figure 39. Percentage of Seniors who Received Home Care in the Previous 12 months that was not Covered by Government, by Region, 2003, 2005, 2007/08 & 2009/ E 15.0 E E E 10.0 * / /10 NBPSDHU NE LHIN Ontario Year(s) *-A significant statistical difference exists between the regional and provincial estimate in the same survey year(s). E-Interpret with caution; the estimate is associated with high sampling variability. Note: This question was not asked in Ontario in 2000/01. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 4.1, 5.1), 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 71/85

79 Percentage of Seniors 11.0 Access to Health Services & Utilization Definitions Activities: Activities include hearing, seeing, communicating, walking, climbing stairs, bending, learning or any other similar activities. Limitations are those caused by a long-term health condition or problem that has lasted or was expected to last 6 months or more Activity Limitations Since 2000/01, the proportion of seniors within the NBPSDHU region report difficulty with certain activities has decreased significantly (see Figure 40). Similarly, the proportion among Ontario and North East LHIN region seniors has also significantly decreased between 2007/08 and 2009/10. Among the NBPSDHU region population aged 12 to 64 years, 25.9% reported having difficulties with certain activities sometimes or often in 2009/10, a significantly lower percentage compared to NBPSDHU region seniors. Activity limitations are among the most important factors affecting a person s quality of life and the possibility of their full integration into society. Independence, an important concern for seniors, implies the ability to perform daily activities for oneself. Research has shown a strong positive relationship between self-perceived health and the potential to carry out daily activities without limitation or dependence on others (Statistics Canada, 2006a). Figure 40. Percentage of Seniors who had Activity Limitations in the Previous 6 Months, by Region, 2000/01, 2003, 2005, 2007/08 & 2009/ / / /10 NBPSDHU NE LHIN Ontario Year(s) The statistic is significantly different from the previous year s estimate within the same region. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 1.1, 2.1, 3.1, 4.1, 5.1), 2000/01, 2003, 2005, 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 72/85

80 Percentage of Seniors 11.0 Access to Health Services & Utilization Definitions Help in Daily Living: Instrumental activities of daily living used in the derivation of this variable include needing help with preparing meals, personal care (e.g. washing, dressing, eating, taking medication), moving about inside the house or looking after personal finances (e.g. making bank transactions or paying bills) because of any physical or mental condition, or health problem Help in Daily Living Almost a quarter (23.0%) of seniors residing within the NBPSDHU region reported needing help with one or more tasks of daily living, a figure which has not changed significantly since 2007/08 and is not significantly different from the North East LHIN region and Ontario estimates (see Figure 41). However, among the NBPSDHU region population aged 12 to 64 years, only 4.9% required help in daily living, significantly lower compared to NBPSDHU region seniors, although this estimate should be interpreted with caution. The likelihood of receiving more types of help in daily living increases significantly with age (Statistics Canada 2006). Among seniors aged 85 and over who received some type of care because of a long-term health problem, one-third got help in all four major categories of activities; that is indoor housework, outdoor work, transportation and personal care. This was the case for only 15% of seniors aged between 65 and 74 years. Figure 41. Percentage of Seniors who Needed Help in Daily Living, by Region, 2007/08 & 2009/ / /10 NBPSDHU NE LHIN Ontario Year(s) Note: In the 2000/01 CCHS survey, this derived variable did not include help with looking after personal finances as a task for which the individual needed help with. In the 2003 and 2005 surveys, needing help with heavy household chores was included in the derived variable. Due to these differences, statistics from 2000/01, 2003 and 2005 were not included. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 4.1, 5.1), 2007/08 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 73/85

81 12.0 Insurance 12.0 Insurance Insurance coverage for seniors within Canada differs from province to province. In Ontario, the Ontario Health Insurance Plan (OHIP) covers seniors for some basic checkups annually. Seniors are also covered, to a certain extent, for prescription drugs in Ontario, through the Ontario Drug Benefit (ODB). Private insurance, if affordable, is available to provide additional coverage. The inability to pay for health care services such as eye glasses and contact lenses, dental, and prescription drugs not covered by the government, is a barrier to health for seniors. Some seniors do not have the financial resources to pay for these services, or are not covered by any insurance plan Insurance for Prescriptions In 2005, slightly more than three-quarters of NBPSDHU region seniors reported having private, government or employer-paid insurance plans that covered part or all costs of prescription medications, a proportion not significantly different from those of the North East LHIN region and Ontario (see Figure 42). Similarly, 76.8% of the NBPSDHU region population aged 15 to 64 years had insurance for prescriptions in Every senior in Canada is covered by a provincially funded drug plan, although the extent of the coverage varies from province to province. Through the Ontario Drug Benefit (ODB) Program, the Ministry of Health and Long-Term Care covers most of the cost of prescription drug products listed in the ODB formulary, as well as some exceptional cases (Ontario Ministry of Health and Long-Term Care, 2011a). In addition, if an individual is receiving social assistance (Ontario Works or Ontario Disability Support Program assistance), they are eligible for ODB coverage. Under the ODB program, ODB eligible recipients may be asked to pay some portion of their prescription drug product. Provinces where seniors may have to pay a deductible, such as in Ontario for seniors who make a certain income, have reported rates of coverage that are lower compared to provinces without a deductible (Grootendorst et al., 2003). Individuals who pay a deductible may be less likely to realize that expenses beyond the deductible threshold are paid for by the government. Seniors In the NBPSDHU Region: A Health Status Report Page 74/85

82 Percentage of seniors 12.0 Insurance Figure 42. Percentage of Seniors who had Insurance that covered All or Part of the Cost of Prescription Medications, by Region, 2003, NBPSDHU NE LHIN Ontario Year The statistic is significantly different from the previous year s estimate within the same region. Note: This question was not included in the 2000/01 survey. This question was not selected as optional content by Ontario in the 2007/08 or 2009/10 surveys. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 3.1, 4.1), 2003 & Seniors In the NBPSDHU Region: A Health Status Report Page 75/85

83 Percentage of Seniors 12.0 Insurance 12.2 Insurance for Dental Expenses Almost half of seniors (44.4%) within the NBPSDHU region reported having insurance that covered all or part of dental expenses in 2009/10, an estimate that has not changed significantly since 2003 (see Figure 43). On the other hand, 69.7% of the NBPSDHU region population aged 15 to 64 years had insurance for dental expenses in 2005, a significantly higher percentage compared to NBPSDHU region seniors. Dental insurance is not covered by the provincial government except for some surgical procedures performed in a hospital (Ontario Ministry of Health and Long-Term Care, 2009b). Seniors must have private coverage or pay for regular dental services in a dentist s office. Lack of dental insurance is a significant barrier towards visiting a dentist and maintaining oral health (Health Canada, 2009). In particular, seniors living in long-term care facilities often are frailer, in poor health and may depend more on others for personal care, thereby increasing their risk of complications of poor oral health (Health Canada, 2009). Figure 43. Percentage of Seniors who had Insurance that Covered All or Part of Dental Expenses, by Region, 2003, 2005 & 2009/ / /10 NBPSDHU NE LHIN Ontario Year(s) -More than 5% of the responses were either refusals to answer the question, the answer was unknown by the individual or the answer was not stated. This can introduce bias by omission and may reduce representativeness of the data. Note: This question was not included in the 2000/01 survey. This question was not selected as optional content by Ontario in the 2007/08 survey. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 2.1, 3.1, 5.1), 2003, 2005 & 2009/10. Seniors In the NBPSDHU Region: A Health Status Report Page 76/85

84 Percentage of Seniors 12.0 Insurance 12.3 Insurance for the Cost of Eye Glasses or Contacts Compared to Ontario, a lower percentage of seniors residing within the NBPSDHU region had insurance that covered the cost of eye glasses and contact lenses in 2005, however, this difference was not statistically significant (see Figure 44). Of the individuals aged 15 to 64 years in the NBPSDHU region, 66.2% had insurance for the cost of eye glasses or contacts in 2005, a significantly higher percentage compared to NBPSDHU region seniors. OHIP covers people 65 years of age and older with coverage for an eye examination once every 12 months; however, there is no publicly funded insurance that covers seniors for eye glasses and contact lenses; they must purchase private insurance (Ontario Ministry of Health and Long- Term Care, 2009a). Figure 44. Percentage of Seniors who had Insurance that Covered All or Part of Costs of Eye Glasses or Contact Lenses, by Region, 2003 & NBPSDHU NE LHIN Ontario Year Note: This question was not included in the 2000/01 survey. This question was not selected as optional content by Ontario in the 2007/08 survey. Data Source: Statistics Canada, Canadian Community Health Survey (CCHS 3.1, 4.1), 2003 & Seniors In the NBPSDHU Region: A Health Status Report Page 77/85

85 Appendix A Appendix A: Map of the NBPSDHU Region, North East LHIN Region & Ontario Seniors In the NBPSDHU Region: A Health Status Report Page 78/85

86 Appendix B Appendix B: NBPSDHU Region Senior Population & Percentage of Total Planning Region Populations, by Planning Area (17.6%) (16.6%) (13.6%) (20.9%) (23.4%) (21.3%) Seniors In the NBPSDHU Region: A Health Status Report Page 79/85