Is Canada prepared for rising rates of Dementia Two reports

 Dementia in Canada: Summary from a report by the  Canadian Institute for Health Information. Better data. Better decisions. Healthier Canadians reflect the first report

The number of people living with dementia continues to rise. This increase is due to growth in Canada’s senior population, which is expected to rise 68% over the next 20 years. This rise will result in demands on Canada’s health care systems.

Caring for seniors with dementia presents many complex issues and challenges, which differ as the disease progresses:

• Since most seniors with dementia reside in the community, primary care doctors and unpaid caregivers need proper support to help them manage dementia care.
• In long-term care, seniors with dementia continue to experience increased use of restraints and potentially inappropriate antipsychotics, despite a policy focus that is helping to improve the trends.
• Seniors with dementia are hospitalized more frequently and for a longer time. Their longer hospital stays make them more susceptible to hospital harm, including urinary tract infections, pneumonia and falls.

This report uses data and information from a number of sources to highlight dementia’s impact on Canada’s health systems and on family members or others who provide care at home. It’s also a part of CIHI’s larger commitment to focus on issues related to seniors and aging in order to help those who make decisions about healthcare planning for future needs. The report explores access to and use of health services such as home care, long-term care or nursing homes, emergency departments, hospitals and end-of-life care. It also examines young-onset dementia, family doctor preparedness, and prevention and treatment.

Key findings

• About 1 in 4 seniors age 85+ have been diagnosed with dementia
  The population of Canadians aged 65 and older is increasing; as a result, so is the number of people living with dementia.

The prevalence of dementia more than doubles every 5 years for Canadians aged 65 and older, from less than 1% for those aged 65 to 69 to about 25% for those 85 and older. Dementia is more prevalent among women than men, and the gap increases with age.

Go to How dementia impacts Canadians  

• Seniors with dementia who live at home require support to do so comfortably
  About 261,000 seniors with dementia in Canada live outside of publicly funded long-term care or nursing homes. A larger proportion of these seniors have a severe cognitive impairment, exhibit responsive behaviours and show signs of depression than other seniors.

Go to Dementia in-home and community care  

• Use of antipsychotics and restraints declining for seniors with dementia in long-term care
  In 2015–2016, more than two-thirds of residents in long-term care or nursing homes had dementia. These residents have a higher risk of being given antipsychotics without a diagnosis of psychosis and of being restrained compared with other residents. Policy changes and educational support in this area have led to improvements in many jurisdictions that submit data to CIHI.

Go to Dementia in long-term care  

• Seniors with dementia wait longer in emergency departments, are more likely to be admitted and more prone to harm
  Because patients with dementia need complex care, they stay longer in emergency departments, have higher hospitalization rates and have longer hospital stays than other seniors. Longer stays contribute to the fact that 1.5 times as many seniors with dementia experience hospital harm as those without.

Go to Dementia in hospitals  

• Canadians diagnosed with dementia before age 65 face unique challenges
  Regardless of the type of care received, the proportion of Canadians with young-onset dementia is approximately 3%. Many of these people have rarer genetic forms of the disease. Canadians with young-onset dementia may face more stigma related to the disease and have unique challenges because they are likely still working.

Go to Young-onset dementia  

• Family doctors in Canada feel less prepared than those in other countries to manage care for seniors with dementia
  Caring for seniors with dementia can be complex. Data from the 2015 Commonwealth Fund Survey of Family Physicians shows that only 41% of Canadian doctors feel properly prepared to care for these patients. The survey, which includes international comparisons, found that doctors in countries with national dementia strategies feel the most prepared to care for and to manage care for seniors with dementia.

Go to the Family doctor preparedness  

• Rates of injuries from falls are higher for seniors who have dementia and who live in lower-income neighbourhoods
  While all seniors are susceptible to falls, hospitalization rates are 23% higher for seniors with dementia in lower-income neighbourhoods than in more affluent areas. The analysis looks at hospitalizations related to falls by 5 income levels.

Go to Dementia and falls  

• Seniors with a dementia diagnosis are less likely to receive end-of-life care
  Seniors with dementia have a higher mortality rate than other seniors but are less likely to be referred for palliative and/or end-of-life care, which includes proper pain medications and hospice care.

Go to Palliative and end-of-life care  

• Higher distress, and longer hours reported by unpaid caregivers
  Unpaid caregivers of seniors with dementia spend more time caregiving and face higher levels of distress than those caring for other seniors. CIHI data shows that unpaid caregivers of seniors with dementia spend an average of 26 hours a week caring for their loved ones, compared with 17 hours for caregivers of other seniors.

Of greater concern, almost twice as many caregivers of seniors with dementia exhibit symptoms of distress, such as anger, depression or feeling unable to continue (45% versus 26%).

This section of the report also includes the stories of 2 caregivers who spoke to us about the challenges they face in their role.

Go to Unpaid caregiver challenges and supports  

On June 17, 2019, Canada became the 30th country to launch a national dementia strategy. With the passing of Bill C-233, An Act respecting a national strategy for Alzheimer’s disease and other dementias, the government of Canada is working to address the scale, impact and cost of dementia. The information and data included in this report are intended to support decision-making around the issues in dementia care that are important for people living with this illness, their caregivers and their healthcare providers.