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Evidence of meeting #8 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was dementia.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Eleanor White  President, Canadian Chiropractic Association
John Haggie  President, Canadian Medical Association
Barb Mildon  President-elect, Canadian Nurses Association
Frank Molnar  Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society
Maura Ricketts  Director, Office of Public Health, Canadian Medical Association
Don Wildfong  Nurse Advisor, Policy and Leadership, Canadian Nurses Association

4:50 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

No, we're the creatures of our environment. I'm an Ontario doctor, so all I know are the pros and cons of my system. Health care being a provincial mandate, I know my provincial environment.

I don't know if anyone else has anything else to add.

4:50 p.m.

President, Canadian Medical Association

Dr. John Haggie

I can only echo that. I think it's very much a patchwork. There are hot spots where there are local centres that have focused on dementia care, but they are little oases in a desert otherwise.

4:50 p.m.

Conservative

Parm Gill Conservative Brampton—Springdale, ON

To the Canadian Chiropractic Association, how beneficial is chiropractic treatment for seniors with chronic disease?

4:50 p.m.

Conservative

The Chair Conservative Joy Smith

I believe, Dr. Wildfong, you want to make a comment. And then who would like to take Mr. Gill's question following that? Okay, Ms. White.

First, we'll hear from Dr. Wildfong.

4:50 p.m.

Don Wildfong Nurse Advisor, Policy and Leadership, Canadian Nurses Association

I would just point out that I'm not a doctor, just to clarify that.

4:50 p.m.

Conservative

The Chair Conservative Joy Smith

Okay, Mr. Wildfong.

4:50 p.m.

Nurse Advisor, Policy and Leadership, Canadian Nurses Association

Don Wildfong

Thank you.

With respect to the healthy aging policies or provincial and territorial treatments of older adults, I think indeed there is variation across the country. And I think we'd do ourselves a great service to look at comparative analyses at an international level as well.

We know, for instance, that in places like Copenhagen—unlike in Canada, where we have public health nurses make home visits for the healthy babies and healthy children program, which is wildly successful—they have public health nurses visit people over the age of 70 in their homes to assess their needs, to help them with health system utilization and navigation, health information, and health-seeking behaviour. I think the international comparison is warranted.

4:50 p.m.

Conservative

The Chair Conservative Joy Smith

Who would like to take Mr. Gill's question?

4:50 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

I think he addressed it to the Canadian Chiropractic Association.

Lower back pain is incredibly prevalent in our society and generally starts in middle age, often occupationally, and can continue in a chronic manner. Geriatric lower back pain, or back problems, can have many different types of etiology.

As for effectiveness with respect to treatment from chiropractic spinal manipulative therapy, the way one treats different conditions varies depending upon the general health of the individual. I'd say that the longer the condition is in existence in the individual, the more the treatment becomes one of management, as opposed to curative.

Very often in a senior, if you can extend the independence of an individual or their ability to enjoy their life—and at a younger age to continue with their work—that's success. And chiropractic has an excellent record with back pain and back function.

4:55 p.m.

Conservative

Parm Gill Conservative Brampton—Springdale, ON

What proportion of the patients would you say are seniors?

4:55 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

In a typical practice? Is that what you're referring to?

4:55 p.m.

Conservative

Parm Gill Conservative Brampton—Springdale, ON

Yes.

4:55 p.m.

President, Canadian Chiropractic Association

Dr. Eleanor White

Again, I'll go back to my comment about the age of the practitioner. In my practice, I would say that over 50% of my patients are over 40. With a young grad, they may see more younger families.

4:55 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you so much, Ms. White.

Thank you, Mr. Gill.

Five-minute rounds come very short, don't they?

We'll now go to Dr. Sellah.

October 17th, 2011 / 4:55 p.m.

NDP

Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC

I would like to thank all our guests for coming here to refresh our memories and to make things clearer at times. I have two questions.

Just now, we were talking only about patients. My question is for Dr. Haggie and it is about the medical staff.

An aging population also affects the medical profession. Has your organization looked into what the medical workforce will be like in 2036? Over the next few years, should we change the number of training positions in universities and hospitals for health professionals? Do you think we should change recruitment policies for foreign-trained health professionals?

4:55 p.m.

President, Canadian Medical Association

Dr. John Haggie

In my province, 35% of the practitioners currently in practice are within five years of retirement, if you take 65 as a retirement date. However, what is happening is that a significant number of those practitioners are not retiring in the way the generation before them did. They are altering the way they work. They still have a lot to contribute. They have skills that they want to pass on. So they move away from the more acute, physically demanding areas of their specialties into something a little less exciting, from a physical point of view. That's one factor.

The aim of this country should be that it should be self-sufficient in terms of physicians. That then leads to the question of what that means.

We have had a huge increase in the number of medical students in this country. There are still more Canadians studying medicine abroad than there are studying medicine in Canada. That then raises all sorts of issues about repatriation.

There have been a variety of arguments, both legal and otherwise, that say these people who have been trained abroad and who have taken the Canadian exam should be entered into the residency program, for example, at the same rate. That's resolved itself at the moment.

The issue in terms of residency posts is that there are an inadequate number. We probably need 1.2 residency posts for every Canadian graduate, but if you have 3,500 Canadians who have graduated elsewhere, those numbers don't match.

The other problem is that we really don't know what residency spots are entirely appropriate. How many family physicians as a percentage of the global output of medical schools, residency programs, do we actually need, or will we need? If chronic disease is going to be the new paradigm, and it is, do we need to focus more on those specialties and disciplines and residency programs that actually produce that kind of graduate, rather than the acute specialty programs such as general surgery?

In my case, for example, we don't have the data on that. That's come to light lately because residents have done training and then found difficulty getting employed.

That's the background. Then there is question about how you deal with those doctors who have trained overseas and may not actually be Canadians and want to emigrate. I know for a fact that FMRAC, the Federation of Medical Regulatory Authorities of Canada, is actually looking at a streamlined, common licensing process for physicians, whether they trained in this country or they trained abroad.

That might answer some of those issues. Then you've got capacity issues in terms of whether they're coming in for residency spots, again because that's going to be it. Again, it's not a simple answer, unfortunately. It illustrates the complexity of what is an adaptive complex system.

5 p.m.

NDP

Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC

My second question is for Mr. Molnar.

The committee has also learned that, if 14% of the population today is 65 and over, in 2036 it will be 25%; that's 10 million people. Right now, what percentage of health care services goes to people age 65 and over? And how does your organization adapt to these changing demographics?

5 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Once again, my CMA president is going to have more data than I will. Acute care is where I live. In acute care, seniors are the main clientele despite the fact that the posters describing our hospital don't have any seniors on them. The Canadian Geriatric Society is a very small society. We have probably 200 geriatricians in this country. We should probably have 500 to 600 geriatricians. We don't have enough physicians trained in care of the elderly—those are family physicians who have an extra year of training.

Overall, if you look at geriatric medicine care of the elderly, the numbers of physicians who have the expertise in dealing with the multiple chronic diseases, who have cross-trained in multiple areas and can deal with cognition, are probably somewhere between 40% and 45% of what we really need. So we're far behind. The earning potential for those groups is lower than their peers', so it's not a competitive speciality. So we're not really getting a lot of residents into these areas. We're falling further and further behind. I would echo the comments that were made before. There's a real mismatch between the training positions that are being offered and what our society needs. The data is not there, but there is a huge mismatch. In geriatric medicine care of the elderly, that gap is growing.

I'm sure Dr. Haggie could talk to the numbers.

5 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you, Dr. Molnar.

Did you want to make a comment on that, Dr. Haggie?

5 p.m.

President, Canadian Medical Association

Dr. John Haggie

No. I think I would really just echo what has been said. I don't know that there's an awful lot more I can add, quite frankly.

5 p.m.

Conservative

The Chair Conservative Joy Smith

Thank you.

Now we'll go to Mr. Brown, please.

5 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

Thank you, Madame Chair.

This committee has done a lot of work on neurological disorders over the last few years, and I took an interest in Mr. Molnar's comments about dementia. A common thread has been on tax credits for caregivers. I wanted to tuck into some other areas related to dementia, ways that might alleviate some of the challenges that society and individuals inflicted with this disease live. I wanted to know what your thoughts were on the New Horizons program.

In the community I come from, Barrie, Ontario, one program that I thought was helpful was art for the aging. They had programs like that in seniors homes that would stimulate mental activity for those who were, unfortunately, going through dementia. There were also programs that engaged them in physical activity. I know we don't know a lot about dementia, but I understand that one thing we do know is that a way to delay onset is to increase the level of activity. The New Horizons program has a budget, I think, of $28 million for programs like that in seniors homes. Is this the type of thing you think is a wise investment?

5 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

I think the investment in terms of cognitive stimulation, exercise, etc., is useful all the way through one's lifespan. One, there's a lot of evidence now showing that all the stuff we've been talking about—exercise, nutrition—actually prevents dementia. Two, once you have dementia, to be given cognitive stimulation will certainly slow down the dementia. In my clinical practice, we see a lot of people with dementia who are living alone, becoming withdrawn, becoming socially isolated, and we see their dementias accelerate. As soon as they move into a residence that has some cognitive-stimulating program, their cognitive scores and their function actually improve to a degree we don't see with medications. So the cognitive stimulation can actually outperform the medications in many instances.

So absolutely, it's a worthwhile investment.

5:05 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

Okay. You said these can potentially prevent dementia. That's obviously an exciting concept. Do you know what types of techniques are being used in other countries, which Canada should look at? Are there any examples or models where there are more robust programs that would enable preventing this disease or delaying onset?

5:05 p.m.

Secretary-Treasurer, Member of the Executive, Canadian Geriatrics Society

Dr. Frank Molnar

Like all physicians, I have a whole pile of articles that are sitting in my office. I actually have a whole box of articles on different systems, different approaches to dementia, different systems around the world. So I do have a collection. I haven't gone through them, so I don't know that—