Incapacités et services de maintien à domicile chez les personnes âgées : évolution récente au Québec

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Estimation de l’espérance de vie optimale au tournant du xxie siècle

La mesure de l’espérance de vie optimale est un exercice qui vise à estimer le nombre d’années que peut espérer vivre une population à partir des taux les plus faibles de mortalité, selon la cause, l’âge et le sexe, observés parmi les pays les plus industrialisés. Les résultats de cet exercice révèlent que l’espérance de vie optimale à la naissance, basée sur les données de 2001, serait de 87,6 ans chez les femmes et de 81,1 ans chez les hommes. En comparaison pour la même année, les valeurs d’espérance de vie à la naissance les plus élevées dans le monde industrialisé étaient enregistrées au Japon avec 85,0 ans chez les femmes et 78,1 ans chez les hommes. Au Québec, les valeurs se situaient à 82,2 ans chez les femmes et à 76,4 ans chez les hommes. Ces résultats suggèrent que des gains importants sont encore possibles en ce qui concerne la longévité moyenne des populations nationales.Optimal life expectancy measurement aims to estimate the number of years of life a population can expect, based on the lowest mortality rates by cause, age and sex observed in the most industrialised countries. The results of this exercise show that optimal life expectancy at birth, based on 2001 data, would be 87.6 years for women and 81.1 years for men. In comparison, the highest actual life expectancies at birth for the same year, recorded for Japan, are 85.0 years for women and 78.1 years for men. In Quebec these values are 82.2 years for women and 76.4 years for men. These results suggest that important gains in average longevity of national populations are still possible

Le soutien aux personnes �g�es en perte d'autonomie: jusqu'o� les baby-boomers pourront-ils compter sur leur famille pour r�pondre � leurs besoins ?

Projection of future needs for home care services typically uses current utilisation patterns and population ageing. Accurately assessing this need is much more complex since disability patterns among the elderly are changing and availability of caregivers is affected by changes in family structure. This paper projects annual growth rates between 2001-2031 in the need for informal and formal support among elderly in Quebec and discusses the policy implications of the increasing demand for informal caregivers. Using Statistics Canada Life Paths micro-simulation model, these projections incorporate disability rates and the upcoming availability of informal caregivers. The authors conclude that continued focus on family to meet the needs of elderly without increased formal support is not sustainable in the long term.Population aging, caregiving, disability, informal and formal support, Quebec

Sex, age, deprivation and patterns in life expectancy in Quebec, Canada: a population-based study

<p>Abstract</p> <p>Background</p> <p>Little research has evaluated disparities in life expectancy according to material deprivation taking into account differences across the lifespan between men and women. This study investigated age- and sex-specific life expectancy differentials related to area-level material deprivation for the province of Québec, Canada from 1989-2004.</p> <p>Methods</p> <p>Age- and sex-specific life expectancy across the lifespan was calculated for three periods (1989-1992, 1995-1998, and 2001-2004) for the entire Québec population residing in 162 community groupings ranked according to decile of material deprivation. Absolute and relative measures were calculated to summarize differences between the most and least deprived deciles.</p> <p>Results</p> <p>Life expectancy differentials between the most and least deprived deciles were greatest for men. Over time, male differentials increased for age 20 or more, with little change occurring at younger ages. For women, differentials increased across the lifespan and were comparable to men at advanced ages. Despite gains in life expectancy among men relative to women, differentials between men and women were greater for most deprived relative to least deprived deciles.</p> <p>Conclusions</p> <p>Similar to the US, differentials in life expectancy associated with area-level material deprivation increased steadily in Québec from 1989-2004 for males and females of all ages. Differentials were comparable between men and women at advanced ages. Previous research indicating that life expectancy differentials between most and least deprived areas are greater in men may be due to a focus on younger age groups.</p

The Malaria Testing and Treatment Market in Kinshasa, Democratic Republic of the Congo, 2013

Background The Democratic Republic of Congo (DRC) is one of the two most leading contributors to the global burden of disease due to malaria. This paper describes the malaria testing and treatment market in the nation’s capital province of Kinshasa, including availability of malaria testing and treatment and relative anti-malarial market share for the public and private sector. Methods A malaria medicine outlet survey was conducted in Kinshasa province in 2013. Stratified multi-staged sampling was used to select areas for the survey. Within sampled areas, all outlets with the potential to sell or distribute anti-malarials in the public and private sector were screened for eligibility. Among outlets with anti-malarials or malaria rapid diagnostic tests (RDT) in stock, a full audit of all available products was conducted. Information collected included product information (e.g. active ingredients, brand name), amount reportedly distributed to patients in the past week, and retail price. Results In total, 3364 outlets were screened for inclusion across Kinshasa and 1118 outlets were eligible for the study. Among all screened outlets in the private sector only about one in ten (12.1%) were stocking quality-assured Artemisinin-based Combination Therapy (ACT) medicines. Among all screened public sector facilities, 24.5% had both confirmatory testing and quality-assured ACT available, and 20.2% had sulfadoxine-pyrimethamine (SP) available for intermittent preventive therapy during pregnancy (IPTp). The private sector distributed the majority of anti-malarials in Kinshasa (96.7%), typically through drug stores (89.1% of the total anti-malarial market). Non-artemisinin therapies were the most commonly distributed anti-malarial (50.1% of the total market), followed by non quality-assured ACT medicines (38.5%). The median price of an adult quality-assured ACT was $6.59, and more expensive than non quality-assured ACT ($3.71) and SP ($0.44). Confirmatory testing was largely not available in the private sector (1.1%). Conclusions While the vast majority of anti-malarial medicines distributed to patients in Kinshasa province are sold within the private sector, availability of malaria testing and appropriate treatment for malaria is alarmingly low. There is a critical need to improve access to confirmatory testing and quality-assured ACT in the private sector. Widespread availability and distribution of non quality-assured ACT and non-artemisinin therapies must be addressed to ensure effective malaria case management

Les inégalités sociales de mortalité prématurée au Québec et dans ses régions : différentes mesures, différentes perspectives

It is well known that social factors are determinants of population health. The Commission on Social Determinants of Health at the World Health Organisation promotes the international mobilisation and the creation of national surveillance systems to monitor the trends in social inequalities in health with the aim of attaining health equity. In this context, the province of Quebec in Canada has created the Quebec Health Inequalities Surveillance System (SSISSQ) which systematically monitors of temporal and spatial trends in health inequality and their determinants. The SSISSQ provides five inequality measures: the difference, the ratio, the concentration index as well as the attributable risk and the number of attributable cases. These complementary measures facilitate the analysis of health inequality from different perspectives: in absolute and relative terms, between pairs of population groups and between all population groups.The aim of this paper is to describe the inequalities in premature mortality between 1989 and 2013 at three geographical levels: the province of Quebec, the four geographical zones and the 18 administrative health regions. During this period, we observed a reduction in premature mortality of 38% in the province of Quebec. However, premature mortality remains higher in the more deprived groups compared to the less deprived groups. We found considerable variation in the magnitude of inequality among Quebec’s administrative health regions, and as well, with premature mortality inequality is found to be more pronounced in large towns as compared to rural areas. We asked whether or not inequalities have increased or decreased over time. Depending on the inequality measure that we used, the answer to this question varied. For example, in some health regions inequalities appeared to increase over time when measured by the ratio and concentration index, while they seem stable when analyzed by the difference or the attributable fraction in the population. Each inequality measure contributes a particular view on the inequalities and answers to a different objective. Together, they allow to draw a more complete and nuanced picture of mortality inequality over time and across geographical zones and help to support planning and intervention strategies