CCBI News – COVID; Dementia/Advance Care Plans; Technology/Care—Elderly; Disease/Ecological Disruption; Importance/Apology Spiritual Health

April 8, 2022

Dear Friends of CCBI,

COVID-19

We all prayed that the pandemic would eventually die out, but it hasn’t yet. The country is still divided about basic measures such as mask-wearing, partly because governments have muddied the waters with their differing responses. Ontario’s public health office advised dispensing with masks in most public places, while the Ontario Science Table and federal public health officials urged caution for a longer period of time. The sixth wave is resulting in rising rates of infections and hospitalizations, continuing to endanger compromised people, the elderly and health care workers especially. It’s not as if government were not alerted to this, and it’s strange that after two years of caution, a more ‘open season’ approach gained ground. It is unethical to ignore scientific advice in favour of placating the ‘tired of it all’ sector of the population, especially so near elections. Dr Teresa Tam, among other public health experts, continues to urge more caution, before and since the resurgence of cases. Dr Peter Juni, Director of the Ontario Science Table, stated in a recent interview: “The only thing that would make a difference is that if people start to mask up again consistently.” Is anyone in government listening?

Dementia and Advance Care Planning

A recent study in JAMA Health Forum shows that nearly 50% of older adults die with a diagnosis of dementia listed on their medical record, up 36% from two decades ago. The Alzheimer Society of Canada confirms the rising rate in patients with dementia, noting that currently over 500,000 Canadians are living with the disease, rising to 960,000 (almost double) in 2030. These figures are staggering, and while many measures are in place to support patients and caregivers, a cure is not yet in sight. The study notes, “…this offers a chance for more older adults to talk in advance with their families and health care providers about the kind of care they want at the end of life if they do develop Alzheimer’s disease or another form of cognitive decline.” It cannot be said strongly enough that, although perhaps seemingly counterintuitive, society needs to learn to talk about living with serious illness in advance of its happening, as a way of dealing with crises when they occur. “Advance Care Planning” is the generic name for this, and many Canadians have completed Powers of Attorney or similar documents for health and financial concerns, since these will be invaluable for our decision-makers if we become unable to speak for ourselves.

A major ethical concern on the horizon is an amendment to Canadian euthanasia legislation (MAiD) which will allow the procedure for people with severe mental illnesses beginning in 2023. Safeguards are being developed to prevent abuse of the system, but those were promised before the initial legislation in 2016, and euthanasia has already been extended, with the inclusion of mental illness as a further development. One of the safeguards, legally speaking, should be competence to consent. Moves are afoot, however, to allow a request for euthanasia in advance directives when those with early dementia are still deemed competent to consent, since they will inevitably be unable to do so at a later stage. It is unclear how this will operate, but meantime it is important that we state in our our own directives that we do not want any euthanasia procedures in any circumstance, and that those speaking on our behalf must ensure we are allowed to die of our condition or other natural causes, and not by MAiD.

Pope Francis’ Prayer Intention for April:

Let us pray for health care workers who serve the sick and the elderly, especially in the poorest countries; may they be adequately supported by governments and local communities!

The Globe and Mail – Future COVID-19 waves likely as Canada undergoes transitional period: Tam – The Globe and Mail

CITY TV – Ont. COVID wastewater data suggests up to 100K daily cases: science table director (citynews.ca)

Journal of the American Medical Association – JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network

Alzheimer Society – Dementia numbers in Canada | Alzheimer Society of Canada

Vatican News – https://www.vaticannews.va/en/pope/news/2022-04/pope-prayer-intention-april-health-care-workers.html

Technology and Care of the Elderly in Denmark
Dr Rory Fisher

The care of the elderly in Denmark is already the envy of other countries. Not ready to rest on its laurels, Health Care Denmark has published a White Paper entitled “A dignified elderly care in Denmark,” which can be accessed at:www.healthcaredenmark.dk. This presents the Danish approach to including a broad range of assistive living technologies to improve the quality of life for elderly citizens, and support health care professionals. Some of these technologies are in common use by municipalities across the country, others are still in trials. The aim is to empower the elderly to have a more active role in their treatment, keep them safe, and improve communication between them, their families, and caregivers.

For the senior’s protection, a portal is available that allows family members to check on the senior’s appointments, home care visits, and changes in prescriptions. “Dosecan”, a medication box, has a lid that lights up and beeps when it is time for the elder person to take their medication. If they do not press the OK button, the home care staff call or visit. Monitoring alarms are available with GPS that allow a call for help in an emergency. The home care provider has access to the medical history, so the staff are well informed as what response may be needed, if the emergency is other than a fall. The senior is also able to communicate with the health professionals, not only in an emergency, but at other times. Similar technology is used in nursing homes to allow freedom of movement. In case of a problem the staff can identify where the patient is and provide reassurance that help is on the way.

The Danes are very aware of the therapeutic advantages of exercise in the elderly in keeping them healthy and independent in the community. Person centered “everyday rehabilitation” supports independent living and increases satisfaction among elderly citizens. There are community exercise programs that use sensors to allow seniors to monitor their progress, reporting to a physiotherapist on a weekly basis. “DigiRehab” is a twelve week at home rehabilitation and exercise program. A tablet-based solution tests citizens physical abilities and provides them with a tailored exercise program. The exercises are performed twice weekly in the citizens’ homes. There is an instructional video and supervision by a caregiver. The results showed a decrease in the need for home care.

To improve cognitive function there is a program entitled “Brain + solutions,” which is an app that exercises cognitive functions such as attention, memory, problem solving and planning. In a trial in a nursing home, incontinence products with built in sensors were used that allowed caregivers to view the data on an app. This led to fewer manual checks, timely changes, and better sleep for the residents.

For cognitively impaired seniors, two innovations have been tried. One is “Sens-Aid,” a blanket that hugs residents to improve their well-being. It is weighted and has six “wings” which create a comfort zone. The second is a musical pillow with built in sound. In a nursing home trial, the music helped the senior to relax in troubled or agitated situations.

It is deemed to be very important that nursing homes have appropriate technology to provide as much support to the residents and staff as possible. In one nursing home, apartments are fitted with sensitive pressure sensitive flooring that alerts the staff in case of falls. The “Vendlet” turning system consists of two motorized bars on each side of the bed connected by a sheet. The bars turn the patient from side to side by using a hand control. In nursing homes, installing ceiling hoists as part of the basic structure improves the working environment, and ensures greater patient safety.

These are but some examples of the priority being placed on assistive technology for the elderly in Denmark. Canada has also very well-developed assistive technology but, for the most part, seniors must pay for it themselves, leaving those with sufficient financial resources able to afford better care. The Danish health care system, on the other hand, is based on the principle of equal and free access for all citizens, paid for by general taxes, making Denmark an enviable place for seniors to remain independent as they age.

Disease and Ecological Disruption
Bridget Campion, PhD

Can ecological factors play a role in the emergence and spread of disease, including Covid-19? According to a March 2020 article in The Guardian, the answer is, yes.

In the first place, many diseases in humans are zoonotic, that is, they were first harboured in other animals. Think of rabies or malaria, for instance. In fact, as the Guardian article reports, the CDC “estimates that three-quarters of new or emerging diseases that infect humans originate in animals.” Ebola is one such illness, as is Lyme disease – and Covid-19. The question is, why are these diseases emerging now?

According to The Guardian, “a number of researchers today think it is actually humanity’s destruction of biodiversity that creates conditions for new viruses and diseases such as COVID-19 … to arise – with profound health and economic impacts on rich and poor countries alike.” Pathogens that were once confined to largely undisturbed wilderness areas suddenly have new hosts available (human as well as other animals) as those areas are invaded by human activity. As David Quammen told The Guardian, “’We invade tropical forests and other wild landscapes….We cut the trees; we kill the animals or cage them and send them to markets. We disrupt ecosystems, and we shake viruses loose from their natural hosts. When that happens, they need a new host. Often, we are it.”

It isn’t simply the drive for resources and farmland that disrupts ecosystems. Kate Jones points to “rapid urbanisation that brings people into closer contact with animal species they may never have been near before….” This gives diseases an entry into dense urban settings and we are seeing the effects of this now.

As we begin to understand the interplay between ecological factors and disease, we may begin to glimpse some solutions. According to Jones, “change must come from both rich and poor societies. Demand for wood, minerals and resources from the global north leads to the degraded landscapes and ecological disruption that drives disease, she says. ‘We must think about global biosecurity, find the weak points and bolster the provision of health care in developing countries. Otherwise we can expect more of the same,’ she adds.” Other researchers “advocate rethinking urban infrastructure, particularly within low-income and informal settlements.” But as Richard Ostfeld says, “’There’s misapprehension among scientists and the public that natural ecosystems are the source of threats to ourselves. It’s a mistake. Nature poses threats, it is true, but it’s human activities that do the real damage. The health risks in a natural environment can be made much worse when we interfere with it….’”

Central to Laudato si’ is the message that the glory of God is manifested through the intricate and elegant interconnectedness of all of creation. As The Guardian article makes clear, if we ignore this, we do so at our peril.

Source

John Vidal, “’Tip of the iceberg’: is our destruction of nature responsible for Covid-19?” The Guardian March 18, 2020 https://www.theguardian.com/environment/2020/mar/18/tip-of-the-iceberg-is-our-destruction-of-nature-responsible-for-covid-19-aoe

Importance of the Apology for Spiritual Health
Bridget Campion, PhD

In a recent article published on the APTN News website, Murray Sinclair, former Chair of the Truth and Reconciliation Commission, discussed Pope Francis’ apology for residential schools. He noted that with the Pope’s acknowledgement of the suffering of the survivors and Indigenous People, it will be harder for members of Catholic clergy and the general public to deny the atrocities perpetrated by the residential school system. Sinclair also said that while the apology was an important step, it is simply a step and must be followed by action if reconciliation is to be effected. However, he pointed out that, for the sake of survivors, this need for action must not be used to diminish the importance of the apology. As APTN reports, “Sinclair…urged those members of the Indigenous community who are dissatisfied with the apology to, before berating it, consider the survivors who may need it to heal.” This raises the question of how apologies can benefit survivors of traumatic abuse.

According to work done by Cheryl Regehr and Thomas Gutheil, an apology has three conditions: an “[a]cknowledgement of the offense or provision of a truthful account of the offense” which serves as a public verification of “the victim’s experience”; a “willingness to admit wrongdoing” – in other words, “to declare voluntarily that one has no excuse, defense, justification, or explanation for the action”; and a “willingness to state that the act will not be repeated.”

Traumatic abuse, like that experienced by Indigenous children forced into the residential school system, is cloaked in secrecy and denial by perpetrators of the abuse. Not only do victims have no one to protect them, they have no one to verify their experiences. According to Regehr and Gutheil, an apology is “one means of acknowledging the suffering experienced by victims.” It brings the abuse to light – acknowledging that the abuse in fact occurred – and it places the responsibility for that abuse squarely on the shoulders of the perpetrators.

Throughout their meetings with Pope Francis, a common response emerged from the Indigenous delegates: survivors of residential schools felt “heard”. Then the Pope provided an apology. Even as much more needs to be done, Sinclair cautioned against dismissing the apology: “’There will be people who deny the validity of the apology, who will minimize the apology, who will say that the apology is not sincere, is not enough….’” However, he said that critics must be sensitive to “’the survivors who needed to hear those words – who are taking faith from those words, who are getting some spiritual healing from those words….’” – the survivors who heard an apology.

Sources:

Brett Forester, “Catholic Church must ‘address deniers’ following apology says Murray Sinclair” APTN News April 01, 2022 https://www.aptnnews.ca/national-news/catholic-church-must-address-deniers-following-apology-says-murray-sinclair/
Cheryl Regehr and Thomas Gutheil, “Apology, Justice, and Trauma Recovery” The Journal of the American Academy of Psychiatry and the Law Nov. 3, 2002, Vol. 30 No 3, 425-430 http://jaapl.org/content/jaapl/30/3/425.full.pdf

Mary, Queen of Peace, pray for us.

Moira, Bambi, Bridget and Rory