One of the biggest threats to quality of life and health in ageing is the loss of cognitive abilities and functional autonomy that are associated with dementia, including Alzheimer’s disease. The projections of the number of Canadians living with dementia are staggering, with over 750,000 individuals affected today, an attendant doubling by 2030 – and with health care costs of $293B by 2040.
In September 2015, the Canadian Academy of Health Sciences (CAHS) held a Forum on dementia in Canada. This brought together social scientists, biomedical and health services researchers, healthcare practitioners and technology experts to review current knowledge about prevention and care of dementia with the goal of advancing 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.
So what should be done? Canada needs a national action plan to address dementia and Alzheimer’s. And we need one soon. Here’s why.
Drugs are not presently the answer, and imminent pharmaceutical solutions seem unlikely with more than 200 drug development failures in the last 30 years.
Prevention is promising but challenging. The recently reported FINGER study shows that dietary counselling, exercise training, blood pressure control and cognitive training achieved significant benefits in cognition and well-being. Unfortunately there is no clear way to scale-up these important findings for the population as a whole.
Then there’s quality of life, mobilization and sustaining a safe environment which are also critical for people already living with dementia in their homes and community settings. There are promising solutions, ranging from age friendly community design to technology – much that Canada could learn from.
Dementia-friendly communities and optimizing built environments are being explored internationally enhance accessibility, way-finding and engagement in community life. Those affected with dementia may also stay in their homes longer, through “smart” technologies that prompt tasks and collect data that can be relayed to family and healthcare 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 resourcing for implementation.
There are some key challenges across the country that 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 center of an interdisciplinary team, coordinating care and supporting affected individuals and their families through their disease course.
Homecare 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 persons with dementia provide most of the care and the healthcare 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 within provincial boundaries but which have not yet spread to other jurisdictions.
In Saskatchewan, for example, researchers and clinicians have created a “one stop shop” 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 across the country 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. What we need is a strategic action plan for the country that facilitates prevention strategies, advances systems of care delivery, re-shapes our living and built environments and mobilizes technology so that all Canadians with dementia – regardless of who they are or where they live – are supported in their communities as long as possible, and when that is no longer possible, receive exemplary quality care.
We’ve known about the rising rates of dementia – and the catastrophic costs to the healthcare 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 advisor with EvidenceNetwork.ca and Professor of Neurology, Faculty of Medicine, University of British Columbia.
Carole Estabrooks is Professor & Canada Research Chair, Faculty of Nursing, and University of Alberta.
