One of the biggest threats to quality of life and health in aging is the loss of cognitive abilities and functional autonomy associated with dementia, including Alzheimer’s disease. The projections of the number of Canadians living with dementia are staggering, with more than 750,000 people affected today, a figure expected to double by 2030, with health-care costs to hit $293 billion by 2040.
Last fall, a Canadian Academy of Health Sciences forum on dementia brought together social scientists, biomedical and health services researchers, health-care practitioners and technology experts. The aim was to review knowledge about prevention and care of dementia and advance solutions.
The overarching message of the forum was that while we have seen many successful pilot projects across the country, there is no mechanism to ensure that these best practices and evidence are scaled up so that all communities in Canada benefit.
Canada needs a national action plan to address dementia and Alzheimer’s. And we need one soon. Here’s why.
Drugs are not currently the answer, and imminent pharmaceutical solutions seem unlikely, with more than 200 drug-development failures in the past 30 years.
Prevention is promising but challenging. A widely reported Finnish study shows that dietary counselling, exercise training, blood-pressure control and cognitive training achieved significant benefits. Unfortunately, there is no clear way to scale up these important findings for the population as a whole.
Then there are quality of life, mobilization and sustaining a safe environment, which are also critical for people already living with dementia. There are promising solutions, ranging from age-friendly community design to technology — much that Canada could learn from.
Dementia-friendly communities and optimizing environments are being explored internationally to enhance accessibility, way-finding and engagement in community life. Those affected by dementia may also stay in their homes longer, through “smart” technologies that prompt tasks and collect data that can be relayed to family and health-care providers. Robotics, too, may support an individual’s cognitive strength while futuristic self-driving cars come ever closer to implementation.
In other words, there’s no magic bullet. What we need is a multi-faceted approach that requires real leadership and adequate resources.
Some key challenges across the country need addressing for starters. Accessibility to assessment, diagnosis, treatment and comprehensive continuity of care is a major challenge in all jurisdictions across the country.
Quebec offers a promising model with the family doctor at the centre of an interdisciplinary team, co-ordinating care and supporting affected individuals and their families through their disease course.
Home care needs national attention, too. The type of home support available across Canada varies widely, with limited provision being the common feature. The truth is, family and friends of people with dementia provide most of the care and the health-care system tends to be reactive, rather than guiding or integrating care.
We can address this with a national focus. There are noteworthy programs that have been developed by provinces, but which have not yet spread to other jurisdictions.
In Saskatchewan, for example, researchers and clinicians have created a “one stop” dementia-intervention clinic using telehealth, allowing more care to be provided in the home community, making it easier for those living in rural areas — a major challenge in Canada.
A national plan also needs to address the later stages of living with dementia. Right now, we are highly dependent on residential-care settings where there are significant challenges in providing consistent quality of care, quality of life and quality end-of-life care.
We can no longer hope for simple solutions or a miracle drug to cure our dementia problem in this country (if we ever could). And the status quo simply won’t hold.
We need a strategic action plan for the country that facilitates prevention strategies, advances systems of care delivery, reshapes our living and built environments and mobilizes technology so that all Canadians with dementia are supported in their communities as long as possible. And when that is no longer possible, they should receive exemplary quality care.
We’ve known about the rising rates of dementia — and the catastrophic costs to the health-care system — for years. What we need now is a multi-faceted action plan with government, the private sector and the community at large coming together.
Howard Feldman is an adviser with EvidenceNetwork.ca and a professor of neurology in the faculty of medicine at the University of British Columbia. Carole Estabrooks is a professor and Canada Research Chair in the faculty of nursing at the University of Alberta.
