Abstract
Background: Despite an abundance of data and analysis of First Nations morbidity and mortality rates, accurate data have not been available to serve the First Nations community in Eastern Canada.
Methods: Data for Eskasoni, the largest Mi’kmaq community, were obtained for 1996 through 1999 and Cape Breton and Nova Scotia were used as regional and provincial reference populations respectively. Age-adjusted relative risks (AARR) were calculated for overall mortality and disease-specific hospital admissions.
Results: Eskasoni’s mortality AARR was greater than 1.0 in 3 of the 4 years studied, although the data may understate Eskasoni’s mortality rates. Eskasoni’s total admission AARRs were significantly greater than the two reference populations. Neoplasm admission rates were generally lower, while circulatory disease admission AARRs were significantly higher. A rise in diabetic admission rates was noted with the AARR reaching statistical significance in the final years of the study. Respiratory disease was the leading cause of hos-pitalization with significantly greater rates of admission than regional or provincial rates. Pneumonia and influenza accounted for more than one half of respiratory admissions. Infectious disease admissions were more prevalent in Eskasoni while rates of liver disease were generally low.
Conclusion: Results suggest that members of the largest Mi’kmaq band are at greater risk for a number of disease categories and health promotion should be targeted toward respiratory ailments, circulatory disease and diabetic management. Further analysis, however, remains an important priority.
Résumé
Contexte: Malgré une foule de données et d’analyses de la morbidité et des taux de mortalité des Premières Nations, on ne dispose pas de données précises pour servir les communautés des Premières Nations dans l´est du Canada.
Méthode: Des données pour Eskasoni, la plus grande communauté mi’kmaq, ont été obtenues pour les années 1996 à 1999, et les populations du cap Breton et de la Nouvelle-Écosse ont été employées respectivement comme populations de référence régionale et provinciale. Les risques relatifs ajustés selon l’âge (RRAA) ont été calculés pour les taux de mortalité généraux et pour les hospitalisations dues à certaines maladies.
Résultats: Le RRAA lié à la mortalité à Eskasoni était de 1,0 pour trois des quatre années étudiées, quoique les données aient pu sous-estimer la mortalité à Eskasoni. Les RRAA liés aux hospitalisations à Eskasoni étaient sensiblement plus élevés que dans les populations de référence. Les taux d’hospitalisation pour néoplasme étaient généralement inférieurs, tandis que les RRAA d´hospitalisation pour maladies circulatoires étaient sensiblement plus élevés. Une augmentation des taux d’hospitalisation pour diabète a été observée, et le RRAA associé à cette maladie est devenu significatif pendant les dernières années de l’étude. Les maladies respiratoires étaient la principale cause d’hospitalisation, avec des taux sensiblement supérieurs. La pneumonie et la grippe ont représenté plus de la moitié des hospitalisations dues aux maladies respiratoires. Les hospitalisations dues à des maladies infectieuses étaient plus communes dans Eskasoni, tandis que les taux d’infection hépatique étaient généralement bas.
Conclusions: Les résultats donnent à penser que les membres de la plus grande bande de Mi’kmaqs sont plus vulnérables à certaines catégories de maladies, et que la promotion de la santé devrait être axée sur les maladies respiratoires, les troubles de la circulation et la gestion du diabète. Il serait cependant important de procéder à des analyses plus poussées.
Footnotes
Acknowledgements and Disclaimer: The purchase and analysis of LTC population data were supported by an Alberta Heritage Foundation for Medical Research, Health Research Fund operating grant (199900342).
This study was made possible as a result of data provided by Alberta Health and Wellness. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. Neither the Government nor Alberta Health and Wellness expresses any opinion in relation to this study.
Reference
- 1.Asahara K, Konishi E, Soyano A, Davis AJ. Long-term care for the elderly in Japan. Ger Nurt. 1999;20(1):23–26. doi: 10.1016/s0197-4572(99)70052-2. [DOI] [PubMed] [Google Scholar]
- 2.Bernabei R, Gambassi G, Lapane K, Sgadari A, Landi F, Gatsonis C, et al. Characteristics of the SAGE database: A new resource for research on outcomes in long-term care. J Geront Series A -Bio Sci Med Sci. 1999;54(1):M25–33. doi: 10.1093/gerona/54.1.m25. [DOI] [PubMed] [Google Scholar]
- 3.DeCoster C, Roos NP, Bogdanovic B. Utilization of nursing home resource. Med Car. 1995;33(12):DS73–DS83. doi: 10.1097/00005650-199512001-00009. [DOI] [PubMed] [Google Scholar]
- 4.Fries BE, Schroll M, Hawes C, Gilgen R, Jonsson PC, Park P. Approaching cross-national comparisons of nursing home resident. Age & Agein. 1997;26(Suppl.2):13–18. doi: 10.1093/ageing/26.suppl_2.13. [DOI] [PubMed] [Google Scholar]
- 5.National Population Health Survey Cycle 2 -Residents of health care institutions, 1996/9. Health Report. 1999;11(1):71. [Google Scholar]
- 6.Parker D, DeBellis A. A profile of dying residents in South Australian nursing home. J Pall Nurt. 1999;5(4):162–70. doi: 10.12968/ijpn.1999.5.4.12669. [DOI] [Google Scholar]
- 7.Shapiro E, Tate RB, Roos NP. Do nursing homes reduce hospital us. Med Care. 1987;25(1):1–8. doi: 10.1097/00005650-198701000-00001. [DOI] [PubMed] [Google Scholar]
- 8.Shapiro E, Webster LM. Nursing home utilization patterns for all Manitoba admissions, 1974–198. Geronto. 1984;24(6):610–15. doi: 10.1093/geront/24.6.610. [DOI] [PubMed] [Google Scholar]
- 9.Stark AJ, Gutman GM. Client transfers in long-term care: Five years experience. Am J Public Health. 1986;76(11):1312–16. doi: 10.2105/AJPH.76.11.1312. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Teno JM, Branco KJ, Mor V, Phillips CD, Hawes C, Morris J, Fries BE. Changes in advance care planning in nursing homes before and after the patient Self-Determination Act: Report of a 10-state survey. J Am Geriatr Sol. 1997;45(8):939–44. doi: 10.1111/j.1532-5415.1997.tb02963.x. [DOI] [PubMed] [Google Scholar]
- 11.Tully P, Mohl C. Older residents of health care institution. Health Report. 1995;7(3):27–30. [PubMed] [Google Scholar]
- 12.Burke MA, Lindsay J, McDowell I, Hill G. Canadian Social Trend. 1997. Dementia among senior; pp. 24–27. [Google Scholar]
- 13.Magaziner J, German P, Zimmerman SI, Hebel JR, Burton L, Gruber-Baldini AL, et al. The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: Diagnosis by expert pane. Gerontol. 2000;40(6):663–72. doi: 10.1093/geront/40.6.663. [DOI] [PubMed] [Google Scholar]
- 14.Monahan DJ. Informal caregivers of institutionalized dementia residents: Predictors of burde. J Gerontol Social Work. 1995;23(3/4):65–82. doi: 10.1300/J083V23N03_05. [DOI] [Google Scholar]
- 15.Canadian Study of Health and Aging. http://csha.ca/r_study_results.asp.
- 16.Guihan M, Weaver FM, Cowper DC, Nydam T, Miskevics S. Using Department of Veterans Affairs Administrative databases to examine long-term care utilization for men and women veteran. J Medical System. 1999;23(3):201–18. doi: 10.1023/A:1020571504693. [DOI] [PubMed] [Google Scholar]
- 17.Litwin H, Lightman E. The development of community care policy for the elderly: A comparative perspective. J Health Serv. 1996;26(4):691–708. doi: 10.2190/387A-F71L-QADX-9BP7. [DOI] [PubMed] [Google Scholar]
- 18.Roos NP, Roos LL, Mossey J, Havens B. Using administrative data to predict important health outcome. Med Care. 1988;26(2):221–39. doi: 10.1097/00005650-198803000-00001. [DOI] [PubMed] [Google Scholar]
- 19.Rosenberg MW, Moore EG. The health of Canada’s elderly population: Current status and future implication. CMA. 1997;157(8):1025–32. [PMC free article] [PubMed] [Google Scholar]
- 20.Ross MM. Spousal caregiving in later life: An objective and subjective caree. Health Care for WoMed. 1991;12(1):193–203. doi: 10.1080/07399339109515932. [DOI] [PubMed] [Google Scholar]
- 21.Shapiro E, Tate RB. Predictors of long term care facility use among the elderly. Can J Aging. 1986;4(1):11–19. doi: 10.1017/S0714980800015798. [DOI] [Google Scholar]
- 22.Woo J, Ho SC, Lau J, Yuen YK. Age and marital status are major factors associated with institu-tionalization in elderly Hong Kong Chines. J Epidemiol Community Health. 1994;48(3):306–9. doi: 10.1136/jech.48.3.306. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Veterans Affairs Canada. Discussion paper. Long term care trends in Canada. 1998. [Google Scholar]
- 24.Chapin R, Dobbs-Kepper D. Aging in place in assisted living: Philosophy versus policy. Gerontol. 2001;41(1):43–50. doi: 10.1093/geront/41.1.43. [DOI] [PubMed] [Google Scholar]
- 25.Marek KD, Rantz MJ. Aging in place: A new model for long-term care. Nurs Admin. 2000;24(3):1–11. doi: 10.1097/00006216-200004000-00003. [DOI] [PubMed] [Google Scholar]
- 26.Rosewarne RC. Australian approaches to resident classification and quality assurance in residential car. J Aging Social Policy. 2001;13(2–3):117–35. doi: 10.1300/j031v13n02_09. [DOI] [PubMed] [Google Scholar]
- 27.Friedman R, Kalant N. Comparison of long-term care in an acute care institution and in a long-term care facility. CMA. 1998;159(9):1107–13. [PMC free article] [PubMed] [Google Scholar]
- 28.Bowers B, Esmond S, Jacobson N. The relationship between staffing and quality in long-term care facilities: Exploring the views of nurses aide. J Nurs Care Quality. 2000;14(4):55–64. doi: 10.1097/00001786-200007000-00009. [DOI] [PubMed] [Google Scholar]
- 29.Bowers B, Lauring C, Jacobson N. How nurses manage time and work in long-term care. J Adv Nurt. 2001;33(4):484–91. doi: 10.1046/j.1365-2648.2001.01686.x. [DOI] [PubMed] [Google Scholar]
- 30.Castle NG. Outcomes measurement and quality improvement in long-term care. J Healthcare Qual: Promoting Excellence in Healthcare. 1991;21(3):21–25. doi: 10.1111/j.1945-1474.1999.tb00960.x. [DOI] [PubMed] [Google Scholar]
- 31.Guse LW, Masesar MA. Quality of life and successful aging in long-term care: Perceptions of residents. Issues in Mental Health Nurs. 1999;20(6):527–39. doi: 10.1080/016128499248349. [DOI] [PubMed] [Google Scholar]
- 32.Hirth RA. Consumer information and competition between nonprofit and for-profit nursing homes. J Health Econ. 1999;18(2):219–40. doi: 10.1016/S0167-6296(98)00035-6. [DOI] [PubMed] [Google Scholar]
- 33.Pandolph A, Mazzoni-Maddigan J, Watzlaf VJ, Silverman M. Development of a pilot quality assessment tool for long-term care facilities. Topics in Health Info Manage. 1997;18(1):23–31. [PubMed] [Google Scholar]
- 34.Policy Advisory Committee. Long Term Care Review (Broda report) 1999. [Google Scholar]
- 35.Alberta Health. A three-year business plan 1995–96 to 1997–98. 1995. [Google Scholar]
- 36.Pruitt CM., Jr The continuum concept comes of age. Topics in Health Info Manage. 1997;18(1):1–5. [PubMed] [Google Scholar]
- 37.Wilkins K, Park E. Home care in Canada. Health Reports. 1996;10(1):29–37. [PubMed] [Google Scholar]
- 38.Ministry of HealthLong-Term Care. Long-term care redevelopment. 2003. [Google Scholar]
- 39.Montgomery CL. Coping with the emotional demands of caring. Adv Practice Nurs Q. 1997;3(1):76–84. [PubMed] [Google Scholar]
- 40.Ostwald SK. Caregiver exhaustion: Caring for the hidden patients. Adv Practice Nurs Q. 1997;3(2):29–35. [PubMed] [Google Scholar]
- 41.Cartwright JC. Nursing homes and assisted living facilities as places for dying. Ann Rev Nurs Research. 2002;20:231–64. doi: 10.1891/0739-6686.20.1.231. [DOI] [PubMed] [Google Scholar]
- 42.Hanson LC, Henderson M, Menon M. As individual as death itself: A focus group study of terminal care in nursing homes. J Pall Med. 2002;5(1):117–25. doi: 10.1089/10966210252785088. [DOI] [PubMed] [Google Scholar]
- 43.Kayser-Jones J. The experience of dying: An ethnographic nursing home study. Gerontol. 2002;42(3):11–19. doi: 10.1093/geront/42.suppl_3.11. [DOI] [PubMed] [Google Scholar]
- 44.Keay TJ, Fredman L, Taler GA, Datta S, Levenson SA. Indicators of quality medical care for the terminally ill in nursing homes. J Am Geriatr Soc. 1994;42(8):853–60. doi: 10.1111/j.1532-5415.1994.tb06557.x. [DOI] [PubMed] [Google Scholar]
- 45.Zerzan J, Stearns S, Hanson L. Access to palliative care and hospice in nursing homes. JAMA. 2000;284(19):2489–94. doi: 10.1001/jama.284.19.2489. [DOI] [PubMed] [Google Scholar]
- 46.Harrington C. Nursing home staffing: A need for humane policy. Policy, Politics Nurs Practice. 2001;2(2):117–27. doi: 10.1177/152715440100200206. [DOI] [Google Scholar]
- 47.Mitty EL. Role of nursing in long-term care. Health Care Manage. 1997;31:55–75. [PubMed] [Google Scholar]
- 48.Pearson K, Hocking C, Mott J, Riggs T. Staff in Australian nursing homes: Their qualifications, experience and attitudes. Contemporary Nurs. 1993;1(1):15–22. doi: 10.5172/conu.2.1.15. [DOI] [PubMed] [Google Scholar]
- 49.Robertson EM, Higgins L, Rozmus C, Robinson JP. Association between continuing education and job satisfaction of nurses employed in longterm care facilitie. J Cont Educ in Nur. 1999;30(3):108–13. doi: 10.3928/0022-0124-19990501-06. [DOI] [PubMed] [Google Scholar]
- 50.Stone RI. Research on frontline workers in long-term car. Generation. 2001;25(1):49–57. [Google Scholar]
- 51.Coburn AF. Rural long-term care: What do we need to know to improve policy and program. J Rural Healt. 2002;18:256–69. doi: 10.1111/j.1748-0361.2002.tb00935.x. [DOI] [PubMed] [Google Scholar]
- 52.Statistics Canada. http://www.statcan.ca/english/.Pgdb/People/Population/demo31c.htm.
- 53.Hughes M, Le Riche P, Mayes D. Long-term care for older people: An analysis of placements in Greenwic. Managing Community Care. 2001;9(4):20–25. [Google Scholar]