As of 2015, more Canadians are aged 65 or over than are under 15. Governments must take into account this significant demographic shift when developing policies that respond to the care and support needs of older Canadians; but beyond that, policies must create an environment that enables older citizens to continue to contribute socially and economically. In order for Canada to achieve these goals, we must all be vigilant and proactive about our health and well-being.
Our identities are defined to a large degree by the things we do. When our ability is diminished for whatever reason, be it a physical or a mental change that impacts our function, our sense of self often changes. Family and friends may also see us differently. The single greatest impact on functional ability in older people comes from sensory impairments like the loss of vision. Every year, more than 50,000 Canadians lose their sight. More than 5.5 million Canadians live today with significant eye disease that could cause vision loss.
The possibility of vision loss is frightening, but the good news is that many of the conditions that result in vision loss and blindness are treatable. Significant progress has been made in the development of therapies and preventive treatments for eye diseases such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion and glaucoma. In many cases, vision can be preserved or even restored if these conditions are diagnosed early enough. There is a challenge, though: comprehensive eye screening, and safe and appropriate treatments, must be available and accessible to all those who need them.
Scientific breakthroughs resulting in vision-saving preventive treatments are of little value if those who are at risk are not aware that they should be screened, or if the screenings are not accessible to them. Initiatives like the teleophthalmology program at the South Riverdale Community Health Centre in Toronto, which reaches out to provide screenings for large numbers of disadvantaged Canadians at risk of diabetic retinopathy, are powerful examples of creating solutions to ensure equal access regardless of social and economic status. But improving access is just a part of what must be done.
Improving education is also essential to empowering patients to be part of the decision-making about the most appropriate and effective treatment for the stage and nature of their condition. Self-determination is vital to a patient’s journey and to their lifestyle. When multiple treatments are available, as with the range of anti-VEGF drugs that treat several eye diseases, Canadians must be able to make an informed choice in their own vision care, independent of issues of cost.
Some provincial health departments are considering restrictions on the use or funding of anti-VEGF treatments, restrictions that could jeopardize a physician’s ability to prescribe the safest and most clinically and scientifically sound treatment for each patient. Decisions that may limit access to appropriate therapy must be based on good evidence, and must be made in consultation with stakeholders, including patients and their families, physicians and patients’ organizations.
Putting older Canadians at the centre of their own care is a moral imperative in its own right, but the benefits of this extend well beyond the gains for the individual. By changing the narrative of aging and refusing to accept that loss of vision, health and autonomy are inevitable, we create an entire cohort of experienced, committed and solid contributors to Canadian society.
Empowering people in this way is not a luxury. With a rapidly aging population in Canada and globally, enabling older Canadians to be active contributors rather than passive dependants in their vision care will pave the way for a period of unprecedented growth rather than economic crisis. We need these healthy, independent and clear-sighted older Canadians to lead the younger generations into a prosperous future.
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