RISK FACTORS, TRENDS, HEALTH CARE AND GENERAL LIFE SATISFACTION FOR SELECT NEUROLOGICAL CONDITIONS AMONG AN AGING POPULATION IN CANADA

Abstract

There is an increasing number of people with neurological conditions. These people are living longer due to advances in critical care medicine and increasing survival and life expectancy rates among an aging population. As a result, neurological conditions and their attendant disabilities impact over 3.7 million people living in Canada and account for large health care expenditures, both by the publicly funded health system and through out-of-pocket payments by individuals with the conditions. Our main objective is to discover, other factors besides age, that affect the quality of life for Canadians living with neurological conditions. We use nationally representative population based survey data to identify risk factors, trends, health care and general life satisfaction for select neurological conditions found among Canadians. In order to inform health systems planning and direction of financial resources, policy and services, especially amidst grim predictions on the overall burden of these conditions on the Canadian economy, we examine specific neurological conditions (Alzheimer’s disease (AD)/dementia, Parkinson’s disease (PD), stroke effects, migraine headaches, multiple sclerosis (MS), cerebral palsy, epilepsy, amyotrophic lateral sclerosis (ALS), Huntington's disease, Tourette’s syndrome, dystonia, muscular dystrophy, hydrocephalus, spina bifida, brain and spinal cord tumors, and brain and spinal cord injuries), either independently or collectively in four distinct studies. In the first study, chapter 3, we confirmed through our systematic review and meta-analysis that toxic occupational exposures are significant risk factors for the development of Parkinson’s disease especially that confirmed by a neurologist or nurse using standardized diagnostic methodology. The second study analyzed the trends in AD/dementia prevalence by age, gender, education and geographic regions and found increasing prevalence across all strata of the community, with more men than women living with AD/dementia in the community. Increases in prevalence over the twenty-year period were less among those with higher levels of education and in the 45-64 age category, while prevalence was higher in the 65-79 age category and ballooned in the 80+ age categories of both men and women. The third study assessed the relationship between self-reported unmet care needs and general health care satisfaction, satisfaction with physician and satisfaction with hospital services among Canadians with neurological conditions. We found that patient satisfaction was positively influenced by quality and availability of provincial and received care and being satisfied with life in general while unmet health care needs and receiving emergency services at the hospital had a negative impact on patient satisfaction. The final study which examined the association between spirituality/religiosity and general life satisfaction among Canadians with neurological conditions found a protective relationship between spiritual values providing strength to face everyday difficulties, regular attendance at religious services and self-perceived physical and mental health and satisfaction with life in general. The final take-home messages from our findings is that a population-based approach and a coordinated holistic system of care are needed for primary prevention of neurological conditions and the enhanced quality of life among the patients.