The paper reviewed here is ‘The Annual Report of the Chief Medical Officer 2009’ and which is freely available here. This is the last Annual Report by Chief Medical Officer Liam Donaldson and in the introduction he gives a brief outline of the history of the Chief Medical Officer. The report covers broad health issues which are relevant to many clinical disciplines and these include physical activity, cold weather, rare diseases, grandparenting and climate change. Then there follows an brief overview of previous Annual Reports, special reports by the Chief Medical Officer and reports commissioned by the Chief Medical Officer. Donaldson looks at the response to his previous report including the support for a minimum price for alcohol as well as the developments in the management of chronic pain.
While the areas of discussion in the current report are broad and applicable to a number of areas there were a few that I thought were particularly interesting in relation to mental illness. Thus there is a discussion of the risks associated with physical inactivity. There are numerous studies which show the benefits of exercise in slowing the progress of dementia although this is still an emerging area of research. There are also other pieces of research suggesting benefits for exercise in depression as well as other illnesses.
Thus the emphasis on exercise and avoiding physical inactivity with subsequent responses to this report may have beneficial effects for these illnesses although both time and further research will tell. The recommended actions address physical activity in school age children as well as supporting further research into age-specific advice.
The section on deaths in winter is relevant across all age groups but the report draws attention to the particular vulnerability in older adults. While reading this I wondered if people with undiagnosed dementia in the community might be at an elevated risk but wasn’t able to find any data on this with the somewhat limited search I performed*. The report mentions the success of Finland in managing with cold weather but also the advantages of clothing geared towards the cold weather in minimising health consequences. In the section on rare diseases the report notes that taken together rare diseases are in fact common. There are a number of rare conditions which can have psychiatric associations and so the recommendations here of inclusion in a UK screening program may lead to a reduction in psychiatric conditions if the underlying illness is both recognised and treated where possible. Increasing the detection rate would also mean that psychiatric associations would be more likely to be recognised particularly if such associations are reported in the literature. The possible appointment of a National Clinical Director for rare diseases would also be encouraging.
I found the section on grandparenting particularly illuminating. With ageing demographics a significantly higher proportion of the population are grandparents and the report notes that this is an area where a health strategy can have benefits. The report provides a brief overview of some research findings on this relationship and how important it can be for a child’s development both emotionally and for health in general. This in turn could be relevant for aspects of health service delivery for older adults. While reading this I thought that conditions such as Mild Cognitive Impairment or dementia could impact on this relationship and perhaps that might be an area of future research**.
The report looks at the possible effects of climate change on health as well as making recommendations and then there is a breakdown of topics according to regions and these topics include well-being. It will be interesting to see what the responses to this report will be.
* Using pubmed with search terms ‘winter and dementia’ as well as ‘cold weather and dementia’ I wasn’t able to find any obviously relevant articles. I wasn’t clear on the years of the search as these weren’t given in the default search. In other searches I was able to find articles going as far back as 1875 so it looks as though there has been significant expansion of the indexed articles.
** Using pubmed again, there were two relevant papers although the 2nd didn’t have an abstract. The first paper (Celdran et al, 2009) was a Spanish qualitative study looking at the experiences of adolescents with grandparents with dementia. The authors in that study concluded that
‘Advice to other adolescents primarily focused on accepting the dementia as well as acquiring behavioral coping strategies‘
Celdrán M, Triadó C, Villar F. Int J Aging Hum Dev. 2009;68(3):243-59. Learning from the disease: lessons drawn from adolescents having a grandparent suffering dementia.
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