Veterans Affairs Committee on Jan. 29th, 2008

[The Chair, Conservative, Rob Anders]

It's an intriguing question. I was wondering about that myself earlier on.

Mr. Speechley, do you wish to speak to that?

[Clara Fitzgerald]

It's the veterans integrated services, and it is in the Keeping the Promise document on page 30, where it indicates that there is a single point of entry of questioning by the veteran and that there are various coordinators, intervention specialists, based on the needs of the veteran, and that the single point of entry is supposed to facilitate a more integrated delivery of services. As we know through the community care access centres that have been established in Ontario, the case managers are the people in the CCACs who are sort of the gatekeepers of the services a person is entitled to.

This integrated model looks very promising, but at the same time could be challenging, as Dr. Speechley was indicating, if it's not evaluated to see how really they are navigating the system.

So regarding VIS and VIP, we are talking about two things. We're not just getting the letters mixed up.

[The Chair, Conservative, Rob Anders]

Thank you. That clarifies it.

On to the Bloc Québécois, Mr. Roy, for five minutes.

[Jean-Yves Roy, Bloc, Haute-Gaspésie—La Mitis—Matane—Matapédia, QC]

Okay.

I have no other questions.

[The Chair, Conservative, Rob Anders]

Fair enough, that's fine, unless Mr. Perron would like to speak. No? Okay.

Now on to the Conservative Party, Mr. Shipley, for five minutes.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you, Mr. Chairman.

Thank you, Ms. Fitzgerald and Mr. Speechley, for coming out. In fact, I'm from your area just north of London. I can tell you that through the University of Western Ontario, Dr. Ted Hewitt does an exemplary job, I believe, of getting funds and doing the research that is so necessary and needed, not only for this but, likely as part of what he has gone out to get funding on, for many things that affect the livelihood of individuals and businesses, research that takes us out into the future. I just want to say welcome from one of the home guys who are not too far away from you.

Mr. Speechley, you mentioned a number of times the international falls prevention programs you're looking at and doing your research on. If I had time, I'd have some questions about the cost and the effectiveness of this particular survey.

You talk about the ones in places like Australia and New Zealand, where they've actually had falls prevention programs in place though a network, as I understand it. Can you tell me about the success of these programs and how they would relate to something that we could consider in Canada? They don't have a lot of winter in Australia and New Zealand. Set aside some things. I always get concerned about duplication in surveys just to keep things going, but is there something we can learn from them? What have you found in those programs that would be beneficial for us as a benchmark?

[Mark Speechley]

Thank you.

[The Chair, Conservative, Rob Anders]

Before our witness begins, we have a few side conversations on both sides of the table, and it is probably somewhat distracting for our witnesses and others concerned, so if we can maybe just....

Thanks.

[Mark Speechley]

I anticipated your question.

I tried to find some evidence that their national fall prevention programs were effective, and I guess they have been too recently introduced to provide evidence. Now that you mention 1999, if there was going to be an effect, we might start to see it. I looked for publications to that effect, and I couldn't find any.

At the national level, we don't have evidence that they work, but we know from several specific studies that we can modify risk factors and reduce falling in the study groups. I think we have to extrapolate from these studies to the national level, but I'm afraid I don't have evidence.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Ms. Fitzgerald, in one of your comments you talked about the document Keeping the Promise. You talked about the VIS, the VIP program, and how that may be a concern: integrating those two programs and the services that may come from them. Is that just a logistical issue?

[Clara Fitzgerald]

It's not so much a concern, it's that the the veterans integrated services explanation in the document is similar to what we're aware of in Ontario for older adults in general through the community care access centres. I think what's important to note is that it makes it look simple on paper, yet we know from various older adults and veterans we've spoken with that navigating the health care system is not simple, and often they are not aware of which programs are available to them.

At the same time, I think what I was trying to say was that the VIS program should be evaluated to measure if it actually helped with the uptake of a variety of services that were available to veterans and measured which services were being used more than others. You can take a look at the services being used compared to the services veterans are potentially not using, but we know from the research that they are appropriate in improving independence. If you did an analysis of how many veterans are accessing community-based functional mobility programs, I would guess the number would be very low, yet we know these programs and services are very important in helping them maintain their independence. Is it that they don't know about these programs, or is it that they know and they're not taking part in them?

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I think you have hit on two things that are true.

For example, we just did a study on post-traumatic stress and a number of health issues, and we found two elements. One is that we can't get the message out, or we're having trouble getting the message out, but I think the message is getting out better than it was. Then you have the other element where they know about it, but it's not them; they don't need it.

There's a third part. We heard from a witness from New Zealand or Australia that sometimes when they provide them free they won't take them. It's a sentiment that our veterans have--that they've always given, they won't take for nothing. So when you add a small fee to it there was a much bigger acceptance by those individuals to participate in the program.

In terms of our communications, I'm looking for help. How is the Canadian Centre for Activity and Aging funded? The reason I'm asking is I'm trying to see where you can fit in. You made the comment that you'd never been asked by Veterans Affairs, so I don't know how you got here. I think somebody from this one invited you. You have been invited and you will be learning because aging affects veterans and others. Where would you fit in to help us make that communication and fill in that gap between the VIS and VIP issues? For example, how do you see where you could fit in to help our veterans as a group of aging people?

[Clara Fitzgerald]

Thanks for the question. There's lots to think about.

To answer your first question, about how we are funded, the Canadian Centre for Activity and Aging, although we're a national centre, receives no core funding from any federal, provincial, or local government, nor do we receive, even though we are a research centre within the University of Western Ontario, any funding directly from the University of Western Ontario. So all of our funding is based on a variety of different research grants from a basic and applied perspective, and we generate revenue from a variety of different programs and services that we then deliver to train others to become leaders for older adults.

That's not to say, though, that a centre like ours should not be funded because we are a national centre, and the viability of a centre like ours rests on pins and needles from year to year, and our mandate is directed by the funds we receive. So some of the questions that were asked earlier were broader. If the research was extended beyond southwestern Ontario in different communities, it would be great to extend some of the research beyond certain communities, but we can only do what we're funded to do.

So that's to answer your funding question.

The second question was what is the role that the Canadian Centre for Activity and Aging might play. First of all, I think it's also important to note that the staff who run the veterans integrated services and the VIP program need to be aware of organizations such as ours that are doing extensive research in this area so that they can direct veterans to a variety of programs and services that they might not even be aware exist, and that these programs are evidence-based. A centre like ours can certainly help to get the message out to older people, because older people are the best people to get the message out to older people. So via those networks and the various communities we worked with nationally, ensuring that older people are getting the message out to other older people I think is really essential in not only hearing the message but doing something about it.

Someone said to me, when they met me, “It's a young Canadian Centre for Activity and Aging”, meaning I don't really look like I'm 65. But at the same time, the message is sometimes that if I was older and maybe sharing the message, the uptake of the message would be better received. So I think getting that message out through national publications for clinicians, practitioners, physicians, and then also ensuring that the information is translated at a level that older adults can share it with other older people is essential.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

You should have a way of getting it out through Tim Hortons.

I think my time is likely up.

[The Chair, Conservative, Rob Anders]

Yes, it is, sir. That being said, we have an interesting scenario with regard to the questioning.

So now, if Mr. Sweet wishes, he can have some time if he likes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you very much.

You were talking about comprehensive assessments for the aged. You were suggesting that it would be on a regular basis and there would be follow-ups to see how a person would be progressing or if there would be degradation in their physical capability or balance, whatever. In the broader world, outside of veterans, how common is it for a GP to send a senior for a comprehensive assessment?

[Mark Speechley]

Not at all. Well, no, not not at all, but it's not routine. So I'm thinking about on a person's 70th birthday, in the way that when a woman reaches 40 she's supposed to have a mammogram, and when a woman is sexually active she's supposed to have a PAP smear, about that kind of thinking applied to people on their 70th birthday. They would receive a comprehensive evaluation and it would go in their file and it would be repeated perhaps in five years or when they fall. That sort of thinking, to my knowledge, is not done in primary care anywhere in Canada.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You mentioned about recommendations. After a comprehensive assessment, then, there would be recommendations about how to sustain or develop a better degree of balance and mobility. You said it would have to be evidence-based. What would be the non-evidence-based argument? You must have come across that or you wouldn't say it. What are non-evidence-based recommendations?

[Mark Speechley]

They would be traditional medical practices that haven't been demonstrated to work. Fortunately, the number of those is getting smaller every year.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

That leads me to my next question. In some sense there must be some dichotomy in the fact that there's a lot of research out there but that it still has a long way to go. I notice in one place you say that “optimal exercises to preserve balance and reduce the risk of falls are not yet known”, and yet you have mentioned quite often that any increase in physical activities can reduce the chance of falls. I don't want to disparage the fact that even getting in shape makes you feel better—you can tell that from your husband—but there really is a lot more work to be done on what enhances someone's capability to be in better balance and reduce the risk of falls. Is that correct?

[Mark Speechley]

The point I was trying to make, and my apologies if I didn't make it clearly, is that we have some falls prevention research programs that clearly show a reduction in falls and we have some that show no reduction in falls. What we're trying to do now is figure out the minimum—the intensity, the regularity, and even the types of interventions that have to be done. We don't know where that point is. But it seems to me there's a bend in the line, rather than just a linear gradient, which you'd expect to find.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

And this is where you'd suggest there's a big gap in funding and that it could really help the research?

[Mark Speechley]

As a researcher, yes, I would say more research is needed.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You've been talking a lot about the veterans' integrative services. Have you had any communication with the gerontological group that made that recommendation? If I hear you correctly, you're generally okay with that model recommendation. The one thing I heard you repeatedly say is that you'd want some evidentiary practice, some capability of making sure it was executed properly and that there were measurable results.

Is that the only thing, or is there some other? Have you talked to them, and is there anything else you'd criticize the model for?

[Mark Speechley]

I know Norah Keating. I wasn't part of this document. I know some of the people who are involved in this. I'm just concerned that if all we do is assess and recommend, and that's it, it won't work. We have to assess, recommend, and then follow up—have rapport, assess again. It's not cheap, and it's going to cost money to save money. But it will save money, if we do it right. I guess the key point is that stopping at recommendations is not enough.