Canada unprepared for rising rates of Dementia two reports

A report from CanAge asks the following questions:

Why does Canada, one of the wealthiest, most stable countries in the world, with universal healthcare and a social safety net, fail so profoundly in dementia care? We have a National Dementia Strategy. But where are we in our progress toward implementing that strategy?

They go on and say:

At CanAge, we wanted to get answers. We wanted to find out where Canada is on the path to making this country dementia inclusive. We wanted answers for the individuals, caregivers and social service sector workers who are increasingly raising their voices in desperation.

This report, the first of its kind in Canada, benchmarks the progress made in each province and territory to prepare for the rapidly growing rate of dementia the data show is looming on the horizon. It also looks at our National Dementia Strategy, and the role the federal government has to play in stewarding, and funding, a collaborative approach to this important work across the country.

Canada is falling behind in the global race to deal with the increasingly complex needs of a rapidly aging population–the latest census data shows people 85 and older are now one of the fastest-growing demographics in the country (861,395 people in 2021). 7,021,430 Canadians are over 65. Given that the risk of dementia doubles at age 85 (to 25%), the window of opportunity to get ahead of an inevitable healthcare crisis is growing alarmingly slim.

CanAge’s new report, Dementia in Canada: Cross Country Report 2022, benchmarks each province and territory’s progress toward providing care for Canadians living with dementia. Key findings in the report include:

1. By 2050, 1 in 6 persons globally will be over the age of 65 But in Canada, we’re already at 1 in 6 in most provinces, and in some provinces, the numbers were closer to one in four.

2. In 2020 in Canada there were: 6,491,030 children, 17 or younger, and there were 2,300 paediatricians, or 1 paediatrician for every 2,822 children. In that same year, there were 6,835,866 seniors, 65+, and only 327 geriatricians, or 1 geriatrician for every 20,905 seniors - an almost 10-fold difference!

3. Many provinces do not have a clear dementia strategy, action plans, or care pathways for those living with dementia. “There’s a common misconception that dementia is an “old people problem”, but that’s actually not true,” notes Tamblyn Watts. “Dementia is not a part of aging. In fact, 3% of dementia cases occur in someone younger than 65. The truth is that the dementia boom is coming whether we’re ready or not. And, judging by the current state, we’re simply not ready.” The full report is available for download on the CanAge website.

Dementia Strategy for Canada 1

This more information on the Dementia for Canada and looks at one of the objectives to fight Dementia in Canada.

Objective of Canada: Advance therapies and find a cure.

The aspirations for the national objective of advancing therapies and finding a cure highlight the need to improve how therapies are developed and to broaden their availability, as well as to increase Canada’s dementia research effort. The national dementia strategy notes the importance of having research priorities informed by broad stakeholder input, including from people living with dementia and caregivers, as well as including them as active participants and partners in the research itself. It calls on researchers to include elements in their work that contribute to ensuring that findings can be quickly understood and put into practice, so that the benefits of these advances are realized sooner.

Activities in support of this national objective include efforts to develop and improve therapies that help to manage the symptoms of dementia and slow its progression. Research that supports this national objective ranges from exploration of the mechanisms that cause dementia, to the development and testing of innovative therapies that address different aspects of dementia. Treatment of dementia in Canada also benefits from access to and use of expert guidance, such as evidenced-based guidelines and best practices that are periodically reviewed and updated.

EFFORTS ACROSS CANADA

Understanding dementia better

•  An examination of the impact of high blood pressure on brain health using live imaging techniques has  resulted in  a  recommendation to  combine treatments targeting both hypertension and  amyloid for better results (University of Toronto).

•  COMPASS-ND is a large-scale a clinical study designed to learn about who is at risk of developing dementia, determine how early dementia can be detected, and find out what tests are most effective at detecting dementia. COMPASS-ND data was used to support research, published in 2019,that concluded that guidelines for screening for frailty need to be improved for people living with dementia.

•  A research project investigating the role of genetic signals in the brain using brain imaging in people diagnosed with pre-dementia due to Alzheimer’s disease is focused on revealing new treatments for dementia (Douglas Mental Health University Institute).

•  Weihong Song, a Canada Research Chair in Alzheimer’s Disease, is working on new disease-modifying treatments and identifying molecular mechanisms that lead to dementia, biomarkers (indicators) and drug targets (University of British Columbia).

Innovative therapies

•  A French Music Therapy Program offers free loans of headphones, speakers and digital music players containing personalized playlists to help French-speaking Yukoners retain language abilities and promote memory (Yukon Francophone Health Network and Department of Health and Social Services).

•  Adaptive Lighting for Alzheimer and Dementia INtervention (ALADIN) is a smart light system used to promote better sleep and subsequently improve cognitive and emotional wellbeing of people living with dementia (University of Toronto).

•  Sensor-based software platforms have been developed to track and improve the physical and cognitive health of people living with dementia at home and provide engaging cognitive and physical training (University of Alberta).

•  A low-cost and portable focused ultrasound technology has been developed to improve the diagnosis and treatment of neurodegenerative diseases, using sound waves for therapy (Sunnybrook Research Institute and the University of Toronto).

•  Affordable solutions are being developed to improve pain management for people with dementia who reside in long-term care facilities including an automated system that uses facial recognition technology and artificial intelligence (University of Regina and Toronto Rehab Institute).

Inclusive dementia research

•  The Canadian Consortium on Neurodegeneration and Aging’s program, Engagement of People with Lived Experience of Dementia, enables individuals to be meaningfully and actively involved in the research process, including program direction, priority setting, conducting research and moving results into action.

•  Researchers are working with people living with dementia through participatory action research to learn how communities can “turn stigma on its ear” and promote active social participation of people living with dementia (University of British Columbia, Simon Fraser University and Lakehead University)

Canadian consensus conferences on the diagnosis and treatment of dementia

Since 1989, clinicians treating people with cognitive decline associated with ageing have been meeting periodically to review the information available in the medical literature and publish recommendations for better management of people at risk of cognitive decline, with mild symptoms, or who have dementia. These conferences bring together all health disciplines involved in the diagnosis and treatment of dementia, in partnership with the Alzheimer Society of Canada. Over the years (1998, 2006, 2012, 2019), updates and new themes have been added, such as early detection of cognitive decline, reduction of the risk of progression, and psychosocial and non-pharmacological interventions.

Themes for the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) in 2019, were as follows: (1) biological diagnostic criteria for Alzheimer’s disease; (2) diagnostic criteria for vascular cognitive impairment; (3) detection of dementia; (4) imaging and other biomarkers; (5) non-cognitive markers of dementia; (6) risk reduction; (7) psychosocial and non-pharmacological interventions; and (8) deprescription of dementia medications.

Dementia strategy for Canada

The following is from a report called “A Dementia STRATEGY FOR CANADA,“ published by Public Health Canada in 2020. I had two friends who died after getting early-onset Alzheimer’s so I have a personal interest in making sure the information about what we can do about this issue is out to as many people as possible.

 Factors affecting the risk of dementia,

There is growing persuasive scientific evidence that healthy living throughout a lifetime may prevent or delay the onset of dementia. Along with having healthy environments to live in, there are individual health behaviours and other factors that can affect the chance of developing dementia. This list outlines several of the factors identified. Research is underway to further explore the links between the risk of developing dementia, individual actions, and environmental surroundings.

From unhealthy to healthy behaviours:

•         Physical inactivity                                       Be more active.

•         Harmful alcohol use                                    Reduce or quit alcohol use.

•         Smoking in later life (over age 65)             Reduce or quit smoking.

•         Sleep disturbances (e.g., obstructive sleep apnea)  Taking steps towards sufficient and better quality sleep.

Management of these health conditions:

•         High blood pressure (hypertension)

•         Stroke, heart disease and other vascular diseases (affecting blood vessels like arteries and veins)

•          Cholesterol levels

•          Diabetes

•          Obesity

Other factors:

•          Social isolation        Social engagement and inclusion

•          Lower levels of early life education      More years of childhood education

EFFORTS ACROSS CANADA

Encouraging physical activity

 

•         The Sharing Dance initiative gets Canadians moving through dance (National Ballet School of Canada and Baycrest).

•         The Hockey Fans In Training project keeps middle-aged men across Canada at risk of chronic disease active (Western University).

•         The Let’s Get Moving Initiative encourages all Canadians to be more active (ParticipACTION).

Reducing the number of Canadians with chronic health conditions

•          The Activate: Community Hypertension Prevention Initiative increases awareness of high blood pressure and cardiovascular disease risk and how to manage risk factors (Heart and Stroke Foundation, Ontario, and British Columbia).

•          The Canadian Diabetes Prevention Program focuses on physical activity and healthy eating to reduce the risk of type 2 diabetes (LMC Healthcare and Diabetes Canada).

•          The Healthy Living in St. James Town project focuses primarily on South Asian and African populations who have a higher risk for diabetes and high blood pressure (St. James Town Family Literacy Services, Ontario).

 Promoting healthy choices

·   The Walk or Run to Quit initiative reduces tobacco use and increases physical activity (Canadian Cancer Society).

·   The Activate Your Health project encourages employees in the workplace, particularly women aged 25 to 54, to improve eating habits and physical activity (Capsana, Québec).

Picking up the PACE (Promoting and Accelerating Change through Empowerment) aims to help care providers address modifiable risk behaviours such as physical inactivity, excessive alcohol use and poor diet as a part of smoking cessation treatment (Centre for Addictions and Mental Health).

·    Food Fit: Promoting Healthy Eating and Fitness in Low-Income Communities supports increased knowledge about nutritious foods improves cooking/food preparation skills and encourages physical activity (Community Food Centres Canada).

 

Improving our understanding of what contributes to the risk of developing dementia.

·   The PURE-MIND study is investigating the link between covert (small) strokes and dementia (Heart and Stroke Foundation).

·   The New Brunswick Brain Health Initiative: Preventing Alzheimer’s by Lessening Modifiable Risk offers participants support on reducing risk while evaluating risk factors (the University of New Brunswick and Horizon Health Network).

·  Efforts are being made to better understand how lifestyle and personality factors affect the risk of developing dementia (Sylvia Villeneuve from McGill University and CIUSSS de l’Ouest-de-l’Île-de- Montreal-Douglas Hospital, Montreal).

·    Cognitive training programs are being used to learn more about how the brain’s resistance to damage and its ability to change is linked to age-related neurodegenerative diseases (Université de Montréal, Institut Universitaire de Gériatrie de Montréal, Baycrest, University of Toronto).

Improving the knowledge and skills of the health care workforce

•    Online resources are available to ensure health care professionals, professors and students working in French have the opportunity to improve knowledge about neurocognitive disorders and to support safe and effective interventions (Le Consortium national de formation en santé – Volet, University of Ottawa).