By Anna Tomczak, Department of Health Sciences, 杏吧原创 University

For many years the environment has been considered to have important effects on human well-being. Feng shui, for instance, is a Chinese philosophical system that aims to harmonize everyone with the surrounding environment through orientation of buildings and other structures. You might have heard not to align your bed with your door because doors generally have a strong flow of energy that may disrupt sleep. Although the health benefits of orienting your bed in a certain way are debatable, research has found that the surrounding environment does have an effect on both physical and mental health.

Our Aging Brains

As we age, so does our brain. This can lead to a series of irreversible changes that disrupts memory and other cognitive functions. These types of symptoms, when severe enough, are often grouped under the term dementia and include several different diseases, such as disease, , and disease (Butler & Radhakrishnan, 2012). Although dementia is considered an illness of aging, it not only has a major impact on those who have it, but also on their families and on the Canadian health care system. In Canada, it is estimated that there will be over 1,000,000 prevalent cases of dementia by 2038, with a total economic burden of $152.6 billion (Dudgeon, 2010)! The scary part is that there is no known cause of dementia. Several risk factors have been identified as contributors to the disease; however, they only account for part of it. For example, genes play a role in some cases but are thought to be linked to about 5-10% of dementia diagnoses (Dudgeon, 2010). Interestingly, even if an individual is genetically predisposed to a specific form of dementia, some believe that an environmental factor is necessary for the disease to develop (Elbaz, Dufouil & Alp茅rovitch, 2007). Additionally, there is no cure for dementia 鈥� it entails damage to the brain that can be slowed down but cannot be reversed. Available drugs may help with some of the related behavioural changes of dementia, but they cannot reverse the damage. With so little known about the causes of dementia, researchers have turned to the environment鈥攂oth physical and social鈥攊n hopes of finding preventative measures.

The Environment鈥擝uilt and Unbuilt

The environment is a broad term for everything natural and human-built that surrounds us 鈥� so studying its effects on human health can be difficult. As a result, some researchers focus specifically on the built environment, which is defined as buildings, transportation systems, energy systems, open space, and agricultural lands that make up and support our communities (Toronto Public Health, 2015). However, this definition remains quite general and encompasses many different possibilities. Research on the built environment has focused on air quality, available green space, walkability of certain areas, occupational environments, and even on the design of buildings. One can start to see how these types of environments can affect us physically, whether it is through the development of cardiovascular diseases, obesity, or cancer. However, it may be a bit more difficult to make the connections between these types of built environments and cognitive health outcomes, such as dementia. But in fact, there is evidence that our surrounding environment can influence the development and the progression of such diseases. For example, the built environment also encompasses factors that better allow individuals to interact with one another. Increased social interactions have been shown to reduce the risk of developing dementia, and lessen the symptoms of those who have it.

An Interdisciplinary Approach: 杏吧原创鈥檚 CIHR Meeting

In order to get a better understanding of the relationship between dementia and various facets of the built environment, the Canadian Institutes of Health Research funded Drs. Paul Villeneuve and Renate Ysseldyk to host a two-day workshop. They invited a diverse group of individuals from many different disciplines to come together with the intention to discuss what is known about dementia, social factors, and the built environment, and to identify emerging areas of research. Several themes arose:

Another Strike Against Air Pollution

Very few studies have evaluated the effects of air pollution on dementia, although a small number of studies in animals suggest there may be a link. However, preliminary analyses of data from the Canadian Study of Health and Aging by Dr. Paul Villeneuve and colleagues did just that鈥� his study aims to characterize the associations between long-term exposure to air pollution and the development of dementia, 础濒锄丑别颈尘别谤鈥檚 disease and cognitive impairment. The study includes 10,263 participants, 65 years of age or older with no initial cognitive problems, who were followed for 10 years with three follow-up periods. A total of 1,460 participants developed dementia, 563 participants developed 础濒锄丑别颈尘别谤鈥檚 disease and 883 developed cognitive impairment by the end of the 10 year follow-up period. To determine whether air pollution had an effect on the development of these diseases, measures of ground-level and Nitrogen Dioxide (NO₂) were assigned to each participant using their residential postal code. Initial findings demonstrated positive associations between these measures of outdoor air pollution and developing dementia and 础濒锄丑别颈尘别谤鈥檚 disease. With each increase of PM_2.5 by 10碌g/m³, the risk of developing dementia and 础濒锄丑别颈尘别谤鈥檚 diseases increases by 32% and 17%, respectively. As an annual average in 10 碌g/m³ represents, in 2011, the difference between London UK and Ottawa, or Berlin and Montreal (). 聽The strength of association for these outcomes is similar to widely reported findings between air pollution and cardiovascular disease.

Green Space, Green Space, and More Green Space

As previously discussed, there is no known cause of dementia; however, there have been several risk factors associated with its development. Both physical activity and social interactions have been identified as potential factors influencing the development of dementia. A moderate level of physical activity has been identified as a protective factor against dementia, especially in those individuals who have some type of genetic predisposition (Canadian Study of Health and Aging, 2002). Likewise, social interactions help build an individual鈥檚 sense of social identity and inclusion, resulting in positive effects on health and well-being (Haslam, Haslam, Knight, Gleibs, Ysseldyk, & McCloskey, 2014). Importantly, these factors may interact with green space. Recent studies have indicated that a greater availability of residential green space increases levels of physical activity (McMorris, Villeneuve, Su, & Jerrett, 2015), decreases exposure to air pollution (Marshall, Brauer & Frank, 2009) and provides an environment where social interactions can be upheld (Bennet et al., 2012), suggesting that green space can help decrease the development of dementia and other cognitive impairments.

Interior Design and Cognitive Health

There is also some evidence that the design of a care home may have an effect on the development of dementia as well as the quality of life and safety of individuals with dementia. Findings from these studies suggest that small-size units, with a smaller number of residents, are associated with less sadness, better quality of life, and can help residents better orient themselves (Crespo, Hornillos, & G贸mez, 2013). Interestingly, designing these spaces does not have to be performed by professional teams 鈥� in fact, in an intervention study conducted by Dr. Renate Ysseldyk and colleagues, having residents choose the design of the spaces enhanced their cognitive capabilities to an even greater extent than when staff made those design decisions, along with building their sense of social connectedness (Haslam et al., 2014). Another important feature to consider is safety, especially since individuals with dementia tend to wander 鈥� leaving their homes or facilities without knowing where they are or where they are going. To help deter residents from leaving the facility, long-term care facilities can provide unique doorway designs that mask the entrance to deter the residents from leaving (础濒锄丑别颈尘别谤鈥檚 Knowledge Exchange, 2010). Likewise, creating special interest areas away from main exits and doors helps keep residents away from these entrances (础濒锄丑别颈尘别谤鈥檚 Knowledge Exchange, 2010). Taken together, this research suggests promising avenues for the role of architecture and design, as well as empowering residents in design decisions, that may help prevent or alleviate the symptoms of dementia.

Where Do We Go From Here?

Clearly the built environment, and the social interactions it can facilitate, plays an important role in shaping our health profile. But we are only at the beginning stages of fully understanding the magnitude it can have on our psychological health and cognitive functioning. This CIHR sponsored workshop was able to identify several emerging research questions. Future studies should consider how the built environment can be designed to enhance the positive social determinants of health and prevent the development of dementia. The meeting brought together a number of experts in these different areas who are interested in working together to do just that. In the meantime, the next time you are in the market for buying a house, keep in mind how the location may affect your health鈥� and who knows, maybe keeping your bed away from the door won鈥檛 hurt either.

Based On:

Villeneuve, P., & Ysseldyk, R. (2015). The Built Environments and Dementia: An Interdisciplinary Approach. Workshop. 杏吧原创 University, Ottawa, ON, June 19-20, 2015.

Alzeihmer鈥檚 Knowledge Exchange. (2010). Retrieved from: http://alzheimersocietyblog.ca/2012/01/do-you-know-what-the-alzheimer-knowledge-exchange-ake-is/.

Bennet, S. A., Yiannakoulias, N., Williams, A. M., & Kitchen, P. (2012). Playground accessibility and neighbourhood social interaction among parents. Social Indicators Research, 108(2), 199-213. doi:10.1007/s11205-012-0062-4

Butler, R., & Radhakrishnan, R. (2012). Dementia. BMJ Clinical Evidence, 2012.

Canadian Study of Health and Aging. (2002). Retrieved from: http://www.csha.ca/.

Crespo, M., Hornillos, C., & G贸mez, M. M. (2013). Dementia special care units: A comparison with standard units regarding residents’ profile and care features. International Psychogeriatrics / IPA, 25(12), 2023. doi:10.1017/S1041610213001439

Dudgeon, S., Alzheimer Society of Canada, & RiskAnalytica. (2010). Rising tide: The impact of dementia on Canadian society: A study. Toronto, Ont: Alzheimer Society of Canada.

Elbaz, A., Dufouil, C., & Alp茅rovitch, A. (2007). Interaction between genes and environment in neurodegenerative diseases. Comptes Rendus – Biologies, 330(4), 318-328. doi:10.1016/j.crvi.2007.02.018

Haslam, C., Haslam, S.A., Knight, C., Gleibs, I., Ysseldyk, R., & McCloskey, L. (2014). We can work it out: Group decision鈥恗aking builds social identity and enhances the cognitive performance of care residents. British Journal of Psychology, 105(1), 17-34. doi:10.1111/bjop.12012

Marshall, J. D., Brauer, M., & Frank, L. D. (2009). Healthy neighborhoods: Walkability and air pollution. Environmental Health Perspectives, 117(11), 1752-1759. doi:10.1289/ehp.0900595

McMorris, O., Villeneuve, P. J., Su, J., & Jerrett, M. (2015). Urban greenness and physical activity in a national survey of Canadians. Environmental Research, 137, 94-100. doi:10.1016/j.envres.2014.11.010

Toronto Public Health. (2015). The Built Environment. Retrieved from: http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=d06e23bf6d481410VgnVCM10000071d60f89RCRD.

Follow us on !

By Parnell Davis MacNevin & Amy Bombay, Department of Psychiatry, Dalhousie University

On Wednesday, June 11 2008, Prime Minister Stephan Harper stepped up to a podium in Ottawa and delivered a long overdue speech. In this speech he acknowledged and apologized for the wrongdoings Canada openly committed against Aboriginal peoples for over 100 years through the system, which ran from the mid-1800s until the decommissioning of the last school in 1996. During this time, generations of Aboriginal children were forcibly removed from their homes, made wards of the state, and placed in under funded, government church-run schools aimed at assimilation. These schools taught children to be ashamed of their languages, cultural beliefs and traditions, and many were victims of chronic mental, physical, and sexual abuse.

Not surprisingly, Residential School Survivors are at greater risk for various health and social issues compared to Aboriginal adults whose families were not affected by these schools (Elias et al., 2012). Apologies have been made, and now government funding for healing and wellness programs for Survivors has run dry, the Aboriginal Healing Foundation has officially closed (September 30, 2014), and the is about to submit its final report and have its final gathering in June 2015. But will the legacy of the Residential Schools end with the last generation of Survivors, or are these experiences continuing to have negative effects on subsequent generations?

The intergenerational effects of Residential Schools have long been acknowledged through anecdotal evidence and personal accounts, but there had been very little empirical research documenting these effects until the last 5 years. Amy Bombay, an Ojibway (Rainy River First Nation) researcher and Assistant Professor at Dalhousie University, has been working in collaboration with Kimberly Matheson and Hymie Anisman at 杏吧原创 University to address this gap in a series of studies exploring how trauma is transmitted through Indigenous families. Consistent with intergenerational effects reported in previous qualitative accounts, quantitative analyses revealed that the adverse psychological effects of the Indian Residential Schools are not limited to Survivors, but also extend to subsequent generations (Bombay, Matheson, & Anisman, 2014).

First Nations youth who have a parent who is a Residential School Survivor are more likelty to report depressed mood than those whose parents did not attend. Also, First Nations adults from families in which multiple generations attended Residential Schools (i.e. parents and grandparents) are particularly high risk for experiencing psychological distress and these intergenerational effects often manifest before adulthood (Bombay et al., 2011). This latter finding is important because it provides evidence that the consequences of collectively experienced traumatic events can carry forward and accumulate through generations to influence well-being. The existence of this link between past government policies and continued disparities underlines government鈥檚 responsibility to implement new policies that aim to eliminate the increased risk for health and social problems faced by Aboriginal peoples.

This program of research also set out to answer the question of why children of Survivors are at greater risk for negative health outcomes. Bombay and her colleagues identified stress proliferation as playing a role in the chronic exposure to stressors reported by many Residential School offspring, which is the process by which an initial challenge or adverse experience gives rise to additional stressors (Bombay et al., 2011). In general, the children of Survivors report encountering stressors during childhood (e.g., abuse, neglect, witnessing household violence, parental substance abuse), and throughout their adulthood this increased exposure to early life stressors was predictive of higher depressive symptoms (Bombay et al., 2011).

Aboriginal War Veterans monument. Photo by Padraic Ryan

Culture and identity are important determinants of well-being, and are particularly strong predictors of health among Aboriginal populations (McIvor, Napoleon, & Dickie, 2009). For example, having cultural pride buffers against the negative impacts of discrimination. On the other hand, those who consider their heritage to be an important aspect of their self-concept appear to perceive greater levels of discrimination.

Here again, when looking at identity, we can see that past collectively experienced trauma can evoke greater vulnerability to negative outcomes, as children of Residential School survivors were more likely to consider their heritage as central to their identity. Although having high identity centrality can be protective when combined with cultural pride, the higher levels of identity centrality reported by children of Survivors was associated with increased likelihood of attributing negative encounters with non-Aboriginal people to discrimination and to appraising them as threatening to their well-being (Bombay et al., 2013). These findings highlight that culture-related factors are involved in the intergenerational transmission of collective trauma and in contributing to group-based health and social disparities.

In general, the legacy of the Residential School system continues to negatively affect today鈥檚 Indigenous population in Canada, and appears to put those who have been intergenerationally affected at risk for a trajectory that leads to poor well-being. There are many factors that contribute to this; stress proliferation, increased perceived discrimination, increased stressor encounters and sensitivity to the negative effects of stressors, but the question remains: How can we improve these outcomes? There is continued need to recognize and raise awareness about the intergenerational impacts of the Indian Residential Schools. Learning about the continuing impacts may help all Canadians to understand the complicated social factors contributing to the health of Indigenous peoples, and highlight the need for governmental and social accountability with regard to the legacy of the Indian Residential School system and other historical and contemporary forms of marginalization and systemic discrimination.

References

Bombay, A., Matheson, K., & Anisman, H. (2013). Appraisals of discriminatory events among adult offspring of Indian Residential School Survivors: The Influences of Identity Centrality and Past Perceptions of Discrimination. Cultural Diversity and Ethnic Minority Psychology, 20(1), 75-86.

Bombay, A., Matheson, K., & Anisman, H. (2013). Expectations among Aboriginal Peoples in Canada Regarding the Potential Impacts of a Government Apology. Political Psychology, 34(3), 443-460.

Bombay, A., Matheson, K., & Anisman, H. (2011). The impact of stressors on second generation Indian Residential School Survivors. Transcultural Psychiatry, 48(4), 367-391.

Bombay, A., Matheson, K., & Anisman, H. (2010). Decomposing identity: Differential relationships between several aspects of ethnic identity and the negative effects of perceived discrimination among First Nations adults in Canada. Cultural Diversity and Ethnic Minority Psychology, 16(4), 507-516.

Elias, B., Mignone, J., Hall, M., Hong, S., Hart, L., & Sareen, J. (2012). Trauma and suicide behaivour histories among a Canadian indigenous population: An empirical exploration of the potential role of Canada’s residential school system. Social Science & Medicine, 74, 1560-1569.

McIvor, O., Napoleon, A., & Dickie, K. (2009). Language and culture as protective factors for at-risk communities. Journal of Aboriginal Health, 5(1), 6-25.