advocacy group takes on the task of improving mental health of older canadians
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the canadian coalition for seniors’ mental health is reviewing, updating and creating best practice guidelines for those struggling with anxiety, depression, dementia and substance use.
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a group of multidisciplinary leading subject matter experts across canada in the field of anxiety disorders in older adults and a lived experience group have collaborated with the canadian coalition for seniors mental health (ccsmh) to develop the first-ever clinical guidelines for anxiety in older canadians. these guidelines will soon be followed by guidelines on social isolation and loneliness as well as dementia.
the canadian coalition for seniors’ mental health (ccsmh) received $2.5-million in funding from the public health agency of canada in early 2023 to address the mental health needs of the fastest growing segment of canadian society: older canadians. the not-for-profit organization is using these funds to review, update and create best practice guidelines for those struggling with a range of issues, including anxiety, depression, dementia and substance use.
“over the past 20 years, we have a lot of experience producing clinical guidelines — it’s one of our claims to fame,” says dr. david conn, a geriatric psychiatrist and co-chair of ccsmh. “we have a really good mix of clinicians and researchers from across canada working on this.”
although the current project ends in march, conn is hopeful they will receive funding for a second phase that will help disseminate, mobilize and implement the fruits of their labour.
“the more resources you have, the more you can do to spread the word and create other tools and resources that go along with the guidelines,” he says. “we usually create some tools for the public — for older adults themselves — that explain the guidelines in very practical terms.”
social isolation linked to death
in addition to spearheading the project, conn is working on new guidelines which will launch in 2024 for seniors who are dealing with social isolation and loneliness (sil). these are subjects seldom discussed in doctors’ offices despite a growing need to do so in the wake of the pandemic.
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“[social isolation and loneliness] have been lumped together because there’s some overlap, but we have data that shows us that some people are socially isolated but not lonely, while others are lonely but not socially isolated,” he says. “some people can be lonely with lots of people around them.”
it’s an important issue because research has shown there’s a strong association between sil and a person’s mental and physical health. and while it makes sense that people who are isolated or lonely might experience anxiety or depression, conn was a little surprised to see that sil is also associated with a much higher mortality rate. association does not equal causation, of course, but the evidence pointed to the need to produce guidance for healthcare providers who work in this area.
“i think one reason no one has done this already is because social isolation and loneliness are considered social issues, not medical issues,” he says. “there’s no diagnosis, and guidelines are usually diagnosis-based. we decided that it’s a health-related issue that should have guidelines.”
the sil guidelines will be divided into four sections: prevention, screening, assessment and intervention. a big part of the process will be encouraging doctors to ask their patients about social isolation and loneliness, while ensuring they have the tools required to recognize the signs for themselves. the guidelines will also help healthcare providers eliminate other conditions, such as depression or hearing loss, that could be contributing to the issue.
“it’s important to take an individualized approach that rules out treatable conditions — and treats them — where possible,” he says.
interventions for sil will include options such as therapy, social skills training and a relatively new phenomenon known as social prescribing.
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“one model of this it to have what they call link workers who can provide people with all the right contacts and information within a community that can support them and get them connected,” he says. “it makes a lot of sense because the average family doctor doesn’t have a lot of time to do this. this puts them in touch with someone who does.”
challenging the stigma around anxiety
also new among the ccsmh’s best practice guidelines is education on the management and prevention of anxiety among older canadians. these guidelines were launched on january 25.
canadians face a new set of challenges as they grow older, including changes to the brain that can leave them susceptible to anxiety, says dr. andrea iaboni, an associate professor of psychiatry at the university of toronto. combine that with the fact that covid-19 is now a risk factor for the mental health disorder and the need for new guidelines is clear.
“the pandemic cut people off from the support structures and social contacts that were important,” she says. “it created new worries about their health and a lot people who got covid found themselves with these physiological changes that made them feel anxious.”
iaboni worked with a team of psychiatrists, psychologists, nurses, pharmacists and social workers for the past year to compile the most relevant information on caring for older adults with anxiety. although the work is primarily intended for healthcare providers, every guideline the ccsmh is working on will include resources for patients themselves.
“these are the first anxiety guidelines for older adults that have been developed using this kind of rigorous approach anywhere, as far as we know,” she says. “one of the reasons it’s important to have guidelines for older adults is that they’re a bit different when it comes to medications. the risks are different and we really have to take that into consideration.”
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the anxiety guidelines are broken down into multiple sections and include risk factors for seniors, assessment and diagnosis, and treatments (both non-pharmacological and medication-based). they cater to the complicated health needs of older adults while addressing the range of ways in which they may interpret what they’re experiencing.
“older adults are less likely to say they’re anxious and more likely to talk about the physical manifestations, such as feeling short of breath or dizzy,” she says. “it’s very common that they aren’t really aware of the psychological connection between the way they feel and the anxiety and stress they’re under.
“there’s also a lot of stigma older adults have about discussing their problems and reaching out for help. there’s a whole generation of people who are very independent and stoic and want to handle things on their own. that can certainly be a barrier to getting help.”
a dementia tool kit that speaks to caregivers too
the ccsmh is also developing new guidelines on the assessment and management of behavioural and psychological symptoms of dementia (bpsd) to help healthcare providers better understand how to respond to the changes in mood and behaviour that can accompany a dementia diagnosis. in addition to altering memory and the way a person thinks, the neurocognitive disorder can cause profound changes in the way a person behaves.
“it can be like you’re dealing with a person who’s totally different than the person they were before,” says dr. lauren albrecht, manager of knowledge mobilization for ccsmh. “it can be really challenging for caregivers to navigate because sometimes the thing that worked yesterday won’t work tomorrow. we wanted to build a website that really explores this and gives people a lot of different tools that they can use to help navigate these changes in behaviour and mood.”
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although there are plenty of tools and information on dementia out there, it isn’t always credible or compiled in a way that’s easy to access and understand. the bpsd tool kit will simplify this process by curating the most relevant information and incorporating filters and other features to enable easy navigation.
“when you’re really stressed, it’s hard to have the time or capacity to sift through thousands of things you might find online,” says nick ubels, knowledge broker for ccsmh. “we wanted to cut through that and just give people the information they need to more effectively respond to those kinds of behaviours and mood changes.”
the tool kit will present this information in a wide range of formats, including videos, podcasts, infographics and tip sheets, while meeting patients and their caregivers where they live.
“it’s important that this resource speaks to care partners and people living with dementia because they’re dealing with the day-to-day life of this,” albrecht says. “behaviours don’t just happen in long term care or in clinical settings — they mostly happen in people’s homes. we want to give families, loved ones and friends the tools they need to support the person in their life who has dementia.”
dave yasvinski is a toronto-based writer.
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