By Howard Feldman
University of British Columbia
and Carole Estabrooks
University of Alberta
Canada needs a national action plan to address dementia and Alzheimer’s.
One of the biggest threats to quality of life and health in aging is the loss of cognitive abilities and autonomy associated with dementia, including Alzheimer’s disease. Today, 750,000 Canadians live with dementia and the projections for future suffering are staggering: the number of patients is expected to double by 2030 and related health-care costs will reach $293 billion by 2040.
Back in September 2015, a Canadian Academy of Health Sciences forum on dementia brought together social scientists, biomedical and health services researchers, health-care practitioners and technology experts. They reviewed then-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 the evidence gathered reach all Canadian communities.
So what should be done?
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 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 all critical for people 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 environments are being explored internationally. Those with dementia may also stay in their homes longer, through 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 self-driving cars come ever closer to implementation.
There’s no magic bullet. What we need is a multi-faceted approach that requires real leadership and adequate resources.
There are some key national challenges that must be addressed, including accessibility to assessment, diagnosis, treatment and comprehensive continuity of care. 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.
Home care needs national attention, too. The type of home support available across Canada varies widely. The truth is family and friends of persons with dementia provide most of the care and the health system tends to be reactive rather than guiding or integrating care.
We can address this with a national focus. There are noteworthy provincial programs that 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. That makes 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 cannot hope for simple solutions or a miracle drug to cure our dementia problem. And the status quo simply won’t hold. What we need is a national plan that facilitates prevention strategies, advances care, reshapes our living environments and mobilizes technology so that all Canadians with dementia – regardless of where they live – are supported in their communities as long as possible. And when that is no longer possible, that they receive exemplary care.
We’ve known about the rising rates of dementia – and the catastrophic costs to the health system – for years. Now is the time for government, the private sector and the community at large to come together.
Howard Feldman is professor of neurology, Faculty of Medicine, University of British Columbia. Carole Estabrooks is professor and Canada Research Chair, Faculty of Nursing, and University of Alberta.