Access to Dementia Care in Canada

 Increasing access to dementia care

•    Dementia Assessment Units assess the needs of individuals with home care support and those living in publicly funded Special Care Homes to stabilize individuals and develop a personalized care plan (Saskatchewan Health Authority).

•    Manitoba’s My Health Teams plan and deliver coordinated, comprehensive primary care focused on geographic areas or specific communities to ensure that people living  with  dementia  and  their families have access to care built around their health needs.

•     The summer school at Glendon College in Ontario brings together health stakeholders working in Francophone university and community sectors to improve day-to-day practices and share best practices in cognitive health and dementia.

•    The Home Dementia Care Program in Newfoundland and Labrador helps people with moderate to advanced dementia live well at home by increasing access to medical care.

•    Across Ontario, Multispecialty Interprofessional Team (MINT) Memory Clinics provide dementia care in primary care settings within communities. In addition to primary care memory clinics, the central-eastern region has developed the Geriatric Assessment and Intervention Network (GAIN), a  coordinated network of  interprofessional teams who support high-risk seniors and their families  with comprehensive, specialized assessments and targeted interventions in their own homes.

Person-centred care

•    Upon admission to a long-term care home in Yukon, the Continuing Care Therapy Services program offers individualized assessments by an occupational therapist, physiotherapist, recreation therapist and/or speech-language pathologist.

•    In the Northwest Territories, the Supportive Pathways model of care uses a person-centred approach that fosters respectful, compassionate dementia care and trains care providers in delivering care that is responsive to individuals in a home-like supportive environment.

•    Co-designing Dementia Care in New Brunswick: Building the Future Together aims to improve the knowledge of primary care providers around diagnosis and delivery of dementia care, as well as awareness of services among seniors at-risk for dementia and care partners (UNB Saint John and Horizon Health Network).

Behavioural symptoms

•    Behavioural Supports Ontario provides comprehensive behavioural assessments and person-centred support plans focused on responsive  behaviours/personal expressions (e.g., repetitive questions, apathy, pacing, screaming, grabbing) associated with dementia and other neurological conditions.

•    In Montreal, a specialized interprofessional team has been set up to assist in complex situations involving people living with Alzheimer’s disease and other neurocognitive conditions to reduce problematic behaviours and find strategies to improve the quality of life of those living with these conditions and of caregivers (Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal).

•    The Behavioural and Psychological Symptoms of Dementia (BPSD) Algorithm is available to all care providers in British Columbia—it is an electronic interactive tool that supports interdisciplinary, evidence-based and  person-centred clinical assessment and  care decisions with a  specific focus  on non-pharmacological interventions and the appropriate use of antipsychotic drugs in long-term care settings.

•    The Appropriate Use of Antipsychotics approach, used in more than 300 long-term care homes across Canada engages people living with dementia, families and staff to understand underlying causes of behaviours and consider safely reducing or discontinuing medication (Canadian Foundation for Healthcare Improvement).

Skills, training, and tools for care providers

•    Alberta’s Health Care Aide (HCA) curriculum, updated in 2019, describes required skills, knowledge, behaviours and attitudes to help HCAs better understand and  support the needs of people living with dementia (Alberta Health).

•    The Dementia Care Pilot Project is evaluating an online dementia education program and screening tools for primary care providers to use in family practice (Nova Scotia).

Dementia-inclusive communities

In a dementia-inclusive community, people living with dementia feel respected, safe, and supported to live well, interact comfortably with community members and participate in community activities. Community members are aware of and understand dementia, and the care and support provided within the community is culturally safe and culturally appropriate, and mindful of diversity. Dementia-inclusive communities help to reduce and eliminate barriers, including those resulting from stigma.

The Alzheimer Society of Canada, supported by PHAC’s Dementia Community Investment, is engaging people living with dementia, caregivers, and key sector groups to build on the work of the Alzheimer Societies in British Columbia, Manitoba, Ontario, and Saskatchewan towards a Dementia-Friendly Canada (DFC). The Dementia Friendly Canada (DFC) project will develop and refine a national  DFC vision through the development of training tools, the expansion to new geographic communities, and the development of an evaluation structure and indicators of success. A national DFC toolkit will also be developed to help guide the creation of dementia-friendly communities across Canada. This includes the development and testing of guides and tools to educate and train professionals in housing, legal, finance, recreation, libraries, transportation, retail, restaurants, and emergency response sectors.

As well, a general dementia-friendly public module will be developed, which will build on tips and strategies for the service industry and the public.

Other organizations have also created resources to help communities become more dementia friendly. For example, the Brenda Strafford Foundation published A Guide for Creating Dementia Friendly Communities in Alberta which outlines the steps and lessons learned from its Dementia Friendly Communities pilot project.

Dementia Strategy for Canada 2

Improve the quality of life of people living with dementia and caregivers.

There are many aspects to improving quality of life for people living with dementia and caregivers. Aspirations for this objective include eliminating stigma; timely and compassionate diagnosis that comes with access to supports; care that is tailored to the needs of everyone; care providers that are well-trained and have access to the resources they need to provide quality care, and resources for caregivers to help protect their own wellbeing and to provide them with supports that will assist their efforts to care for those living with dementia.

Initiatives that support this broad objective touch on areas such as access to diagnostic tools and quality health care provided by a skilled and knowledgeable workforce, community-based services and supports, actions to reduce stigma, and work to share and scale up efforts to make communities more dementia-inclusive. These are activities that make a significant difference every day in the lives of people living with dementia and caregivers. Whether it is improving the experiences in the health care system of people living with dementia, supporting life at home, or making it easier to stay engaged, active and express preferences, these initiatives support living in a way that creates quality of life.

The 2020 public opinion survey found that about one-fifth of respondents did not know enough to share their views when it comes to access to health care and the quality of health care in their communities, perhaps due to a lack of experience. Most respondents (70%) rated access to care for people living with dementia as moderate to excellent in their communities, with 66% rating the quality of that care from moderate to excellent. There are countless other efforts being made across Canada to improve the quality of life of people living with dementia and caregivers by a wide cross-section of organizations.

Efforts Across Canada

Staying active and engaged and supporting inclusion.

•  The Dementia-Inclusive Choices for Exercise initiative aims to increase accessible exercise opportunities by developing dementia-specific evidence-based tools and training for exercise providers (pilots in Kitchener-Waterloo, Halifax and northern British Columbia).

•  Voices in Motion and NoteWorthy Singers are intergenerational choirs for people living with dementia, caregivers, friends and students in Victoria and Vancouver, helping to create a more dementia-inclusive community.

•  Research is using the lenses of shared decision-making, feminist care ethics and social citizenship to look at how people living with dementia could become more active collaborators in shaping

End-Of-Life Decision-Making (University of British Columbia).

•  The Volunteer Companion Program in Prince Edward Island is a one-on-one home visiting program for people living with dementia and their caregivers who are at risk of social isolation.

•  Cracked: new light on dementia is research-informed theatre production and film seen across and outside Canada that is focused on the challenges of stigma; work is underway to develop an interactive web-based learning platform.

•  The Supporting Inclusion through Intergenerational Partnerships Collective Impact initiative promotes the social inclusion of seniors with mild to moderate dementia and caregivers by creating opportunities to engage with youth (Waterloo, Ontario).

The Alzheimer Society of Canada’s nationwide anti-stigma campaign, “Yes. I live with dementia. Let me help you understand”. highlights the diverse lived experience of Canadians living with Alzheimer’s disease and other forms of dementia to address misconceptions and reduce stigma.

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.