Most seniors with dementia live at home

About 61% of seniors with dementia in Canada live at home — and they require support while staying there. There are approximately 5.8 million seniors in Canada and about 5.5 million live at home. CIHI analysis finds that of the estimated 431,000 seniors living with dementia in 2015–2016, more than 261,000 were estimated to reside outside of publicly funded long-term care or nursing homes.

Dementia in Canada

Canadians living with dementia want to maintain their independence; they want to live at home and engage with their community,” said Pauline Tardif, CEO of the Alzheimer Society of Canada.

Comprehensive home and community care are an essential part of this equation. It helps maintain the quality of life for people with dementia while also providing needed support for caregivers.

As Canada’s population ages and chronic disease rates increase, federal, provincial and territorial governments are recognizing the need to make home care more available and accessible. About 61% of seniors in Canada with dementia live outside of long-term care or nursing homes: 69% of those younger than 80 and 58% of those 80 and older.

A Common Statement of Principles on Shared Health Priorities is a recent agreement between the federal, provincial and territorial governments to provide substantial federal investment over 10 years, in part, to improving access to health care and support services at home and in the community.

Seniors with dementia living at home have complex care needs

Seniors with dementia who receive care at home may present more challenges than those without dementia because they are more clinically complex. Some of the characteristics of these individuals include the following: 

·       1 in 5 have severe cognitive impairment

·       1 in 4 (28%) require extensive assistance or are dependent for activities of daily living

·       1 in 4 exhibits any responsive behaviours

·       1 in 4 have signs of depression

Seniors with dementia who live at home score worse on behavioural and cognitive scales compared with other seniors living at home and receiving care. Seniors with dementia exhibit responsive behaviours such as verbal and physical abuse, socially inappropriate behaviour and resisting care more frequently than those without dementia (25% and 4%, respectively).

However, among all seniors with dementia receiving home care, a larger proportion does not exhibit any responsive behaviours (75%) than do (25%). Seniors with dementia score the same in health instability (as measured by the CHESS Scale) and are admitted to hospitals less frequently. The CHESS Scale (Changes in Health, End-Stage Disease, and Signs and Symptoms) detects health instability and is designed to identify individuals at risk of serious decline.

Of seniors with dementia, about one-third of those 65 to 79 and 42% of those 80 and older live in a long-term care home. Overall factors influencing long-term care admission for people with dementia were assessed with the methodology used in CIHI’s Seniors in Transition report. 6 factors significantly increase the odds of entering long-term care or nursing homes following an initial assessment to determine eligibility for long-term care for individuals with dementia:

• Seniors with dementia who receive their initial assessment in the hospital are about 5.6 times more likely to enter long-term care as those who are assessed elsewhere.
• Seniors with dementia who live alone (without a primary caregiver in the home) are around twice as likely to enter long-term care as those who live with their primary caregiver.
• Seniors with dementia who have a caregiver who is unable to continue providing care are around twice as likely to enter long-term care.
• Seniors with dementia who have a recent history of wandering are about 1.7 times more likely to enter long-term care.
• Seniors with dementia with a moderate level of cognitive impairment are about 3.8 times more likely to enter long-term care than seniors with no cognitive impairment; those with a very severe level of cognitive impairment are about 3.5 times more likely than those with no cognitive impairment.
• Seniors with dementia who are dependent on physical assistance for daily activities like personal hygiene, eating and walking are 3.8 times more likely to enter long-term care than those who are independent; this decreases slightly to about 1.4 times if they require only supervision.

These identified characteristics can help us understand some of the challenges associated with providing care to individuals with dementia in the home and can help inform strategies to better support them and their caregivers to pursue home care for longer and more safely.