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Examines feasibility and effectiveness of implementing a directive education program called "Let Me Decide" to veterans living in Ontario. Discusses two methods used to evaluate implementation of the program. Reports that 97% of the veterans found the education process beneficial whether or not they completed the directives. (Author/JDM)

OBJECTIVES: Suicide in recent veterans is an international concern. An association between mental disorders and suicide has been established, but less information is available about an association between physical health problems and suicide among veterans. This study extends this area of inquiry by examining the relationship of both physical and mental health problems with suicidal ideation in a representative national sample of Canadian veterans. METHODS: Subjects were a stratified random sample of 2,658 veterans who had been released from the Canadian Armed Forces Regular Force during 1998-2007 and had participated in the 2010 Survey on Transition to Civilian Life. Associations between physical and mental health and past-year suicidal ideation were explored in multivariable regression models using three measures of physical and mental health. RESULTS: The prevalence of suicidal ideation was 5.8% (95% confidence interval [CI]: 5.0%-6.8%). After adjustment for covariates, ideation was associated with gastrointestinal disorders (adjusted odds ratio [AOR] 1.66, CI: 1.03-2.65), depression or anxiety (AOR 5.06, CI: 2.97-8.62) and mood disorders (AOR 2.91, CI: 1.67-5.07); number of physical (AOR 1.22, CI: 1.05-1.42) and mental conditions (AOR 2.32, CI: 2.01-2.68); and SF-12 Health Survey physical health (AOR 0.98, CI: 0.96-0.99 for each 1 point increase) and mental health (AOR 0.88, CI: 0.87-0.89). CONCLUSIONS: Physical health was independently associated with suicidal ideation after adjustment for mental health status and socio-demographic characteristics. The findings underscore the importance of considering physical health in population-based suicide prevention efforts and in mitigating suicide risk in individual veterans. KEY WORDS: Veterans; suicidal ideation; physical health; mental health; suicide La traduction du resume se trouve a la fin de l'article. Can j Public Health 2014;105(2):e109-e115. OBJECTIFS : Les suicides de militaires recemment demobilises sont un enjeu international. On a etabli une association entre les troubles mentaux et le suicide, mais on a moins d'information sur une association possible entre les problemes de sante physique et le suicide chez les anciens combattants. Nous avons voulu elargir le champ de recherche en examinant la relation entre les troubles de sante physique et mentale et l'ideation suicidaire au sein d'un echantillon national representatif d'anciens combattants canadiens. METHODE : Nos sujets etaient un echantillon aleatoire stratifie de 2 658 anciens combattants demobilises de la force reguliere des Forces canadiennes entre 1998 et 2007 et ayant participe a l'Enquete sur la transition a la vie civile de 2010. Nous avons analyse les associations entre la sante physique et mentale et l'ideation suicidaire au cours de l'annee anterieure a l'aide de modeles de regression multivaries comportant trois indicateurs de sante physique et mentale. RESULTATS : La prevalence de l'ideation suicidaire etait de 5,8 % (intervalle de confiance de 95 % [IC] : 5,0-6,8). Compte tenu des covariables, l'ideation etait associee aux troubles gastro-intestinaux (rapport de cotes ajuste [RCA] 1,66, IC : 1,03-2,65), a la depression ou a l'anxiete (RCA 5,06, IC : 2,97-8,62) et aux troubles de l'humeur (RCA 2,91, IC : 1,67-5,07); au nombre de troubles physiques (RCA 1,22, IC : 1,05-1,42) et mentaux (RCA 2,32, IC : 2,01-2,68); a l'etat de sante physique selon le questionnaire de sante SF-12 (RCA 0,98, IC : 0,96-0,99 pour chaque point d'augmentation) et a l'etat de sante mentale selon le SF-12 (RCA 0,88, IC : 0,87-0,89). CONCLUSIONS : La sante physique etait independamment associee a l'ideation suicidaire apres elimination des effets de l'etat de sante mentale et des caracteristiques sociodemographiques. Ces constatations soulignent l'importance de tenir compte de la sante physique dans les efforts de prevention du suicide axes sur l'ensemble de la population et pour attenuer le risque de suicide chez les anciens combattants sur une base individuelle. MOTS CLES : ancien combattant; ideation suicidaire; sante physique; sante mentale; suicide, Suicide is an important public health problem and therefore is of interest to Veterans Affairs Canada (VAC) and similar agencies worldwide that support the well-being of veterans and their families. [...]

Several Canadian surveys revealed a need for training of health and social service personnel in long-term case management of elderly clients. Proposed curriculum content areas are understanding case management, special knowledge of older adults, environmental factors, and case management techniques. (SK)

OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. METHODS: The 2010 Survey on Transition to Civilian Life was a national computer-assisted telephone survey of CF Regular Force personnel who released during 1998-2007. HRQoL was assessed using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores. Descriptive analysis of HRQoL was conducted for socio-demographic, health, disability and determinants of health characteristics. RESULTS: Mean age was 46 years (range 20-67). Compared to age- and sex-adjusted Canadian averages, PCS (47.3) was low and MCS was similar (52.0). PCS and MCS were variably below average for middle age groups and lowest for non-commissioned ranks, widowed/divorced/separated, 10-19 years of service, physical and mental health conditions, disability, dissatisfaction with finances, seeking work/not working, low social support and difficulty adjusting to civilian life. Among Veterans Affairs Canada clients, 83% had below-average physical PCS, 49% had below-average MCS, and mean PCS (38.2) was significantly lower than mean MCS (48.3). CONCLUSIONS: HRQoL varied across a range of biopsychosocial factors, suggesting possible protective factors and vulnerable subgroups that may benefit from targeted interventions. These findings will be of interest to agencies supporting Veterans in transition to civilian life and to researchers developing hypotheses to better understand well-being in Canadian Veterans. KEY WORDS: Veterans; veterans health; SF-12; health-related quality of life; mental health; chronic disease OBJECTIFS: Decrire la qualite de vie liee a la sante (QVLS) des hommes et des femmes en uniforme ayant ete membres des Forces canadiennes ('anciens combattants') apres leur transition a la vie civile, et la comparer aux normes canadiennes ajustees selon l'age et le sexe. METHODE: L'Enquete sur la transition a la vie civile de 2010 etait une enquete telephonique nationale assistee par ordinateur menee aupres du personnel de la force reguliere des Forces canadiennes ayant ete libere entre 1998 et 2007. Nous avons evalue la QVLS a l'aide des cotes sommaires physiques (CSP) et mentales (CSM) du questionnaire SF-12. Nous avons procede a l'analyse descriptive de la QVLS selon les caracteristiques sociodemographiques, de la sante, de l'invalidite et des determinants de la sante. RESULTATS: L'age moyen des repondants etait de 46 ans (20-67 ans). Comparativement aux moyennes canadiennes ajustees selon l'age et le sexe, la CSP (47,3) etait inferieure et la CSM etait semblable (52,0). Les CSP et CSM etaient variablement inferieures a la moyenne dans les groupes d'age moyen; elles etaient les plus faibles pour le grade des sousofficiers, les personnes veuves, divorcees ou separees, les personnes ayant entre 10 et 19 ans d'anciennete, les personnes ayant des troubles medicaux physiques et mentaux, les personnes handicapees, les personnes insatisfaites sur le plan financier, les personnes cherchant du travail ou sans travail, les personnes ayant peu de soutien social et celles ayant du mal a s'ajuster a la vie civile. Parmi la clientele du ministere des Anciens Combattants du Canada, 83 % avaient une CSP inferieure a la moyenne, 49 % avaient une CSM inferieure a la moyenne, et la CSP moyenne (38,2) etait significativement inferieure a la CSM moyenne (48,3). CONCLUSION: La QVLS varie en fonction d'un eventail de facteurs biopsychosociaux, ce qui suggere l'existence de facteurs de protection et de sous-groupes vulnerables qui pourraient beneficier d'interventions ciblees. Ces constatations interesseront les organismes d'appui aux anciens combattants en transition vers la vie civile et les chercheurs qui elaborent des hypotheses pour mieux comprendre le bien-etre des anciens combattants canadiens. MOTS CLES: ancien combattant; sante anciens combattants; SF-12; qualite de vie liee a la sante; sante mentale; maladie chronique, Military personnel transitioning from military service to civilian life undergo a complex, multifaceted process with variable institutional, health, psychological, work, family, and community dimensions. (1-4) For most, transition is relatively [...]

In 1999 Veterans Affairs Canada (VAC) implemented the Overseas Service Veterans (OSV) At Home Pilot Project in response to the problem that a growing number of clients were on waiting lists for beds in long-term care facilities. The At Home pilot offered certain clients on waiting lists, who met nursing-level care and military-service requirements, access to home care and treatment services for which they had previously been ineligible. A review of the pilot showed that a large majority of clients preferred to remain at home, with support, rather than accept a long-term care placement, even when a bed became available. The pilot has helped reduce waiting times for nursing home beds and may have important implications for reducing costs and the demand for long-term care beds.

To evaluate the feasibility and effectiveness of implementing a 'Let Me Decide' advance directive education program among veterans living in the community, the authors studied 150 veterans in south central Ontario. Thirty-four veterans had preexisting Powers of Attorney and were removed from the analysis, leaving a total sample of 116. Two methods of systematically implementing a directive program were evaluated after the intervention period and 6 months later. Eighty-two (71%) of the 116 veterans expressed interest in receiving detailed information about the program, and 67 (82%) of the 82 interested veterans were educated. Forty-two (63%) of the 67 educated veterans completed directives. Of the 116 interested veterans, 42 (36%) completed directives. Veterans who were educated about directives were surveyed at follow-up, and 37 of 38 (97%) respondents reported that the education process was beneficial and should be offered to other veterans. This response pattern was consistent among those who completed and those who did not complete directives.