There are ways to stem the rising tide of cases in an aging population
More than a million Canadians are forecast to be living with dementia by 2030, when it is estimated that approximately 21 people will be diagnosed every hour. This is expected to rise to 1.7 million Canadians living with dementia by 2050.
These are some of the key findings of “Navigating the Path Forward for Dementia in Canada,” the first volume of the new Landmark Study series released September 6 by the Alzheimer Society of Canada.
The report, authored by Alzheimer Society of Canada scientist Dr. Joshua J. Armstrong, is the first significant update of Canada’s dementia landscape in a dozen years. It is the first of three volumes of the Landmark Study, with volumes two and three to address issues such as the economic and social impact of dementia. These volumes will be released over the coming months.
“As the baby boomer generation continues to age, Canadians will face a number of challenges to ensure that people living with dementia continue to live their best possible lives,” Armstrong said. He said the study also demonstrates the power of risk reduction.
“With effective mitigation efforts on the parts of individuals, combined with increased supports from all levels of government, the potential exists to drastically reduce the number of Canadians who will develop dementia in the next three decades. This would have a positive impact on our healthcare system and on the family members and care partners of people living with dementia.”
The report outlines three scenarios in which the onset of dementia in Canadians is delayed by one, five, or 10 years. A delay of just one year could result in almost 500,000 fewer new diagnoses by 2050; and if the onset of dementia could be delayed by 10 years, Canada could see 4 million fewer diagnoses by 2050.
Dementia affects not only the person living with the condition, but also family members who care for them. The study found that in 2020 there were 350,000 friends and family members serving as care partners, averaging 26 hours of care per week. That is the equivalent of 235,000 full-time unpaid jobs, valued at more than $7.3 billion annually.
If current trends continue, the number of hours provided annually by caregiving partners could reach almost 1.4 billion by 2050, equivalent to 690,000 full-time jobs.
Bob Neufeld, acting communications manager for the Alzheimer Society of Canada, says the new study updates the society’s 2010“report on aging populations and the continuing rise in dementia cases.
“What we’ve been trying to do here, and what we’ll be trying to do with the next two levels of reports coming out in 2023, will be to provide people with a real scope of the problem and the circumstances we’re going to be facing,” Neufeld said. “The last report that was done on this by the Alzheimer’s Society was called The Rising Tide Report. It was done back in 2010 and looked forward only to about 2030. This report looks forward to 2050, which is when the last of the baby boomer generation will have passed the age of 85.”
He said the upcoming surge of cases should serve as a wake-up call for everyone—not just governments, but health care agencies, dementia advocacy organizations, researchers, and individuals.
The forecast is worse for Alberta than other provinces. This is primarily because has Alberta has a younger population which is still entering the age of highest risk. Statistics indicate the number of people living with dementia in Alberta will increase by nearly 300 per cent in the next 30 years. In 2020, there were 52,000 Albertans living with dementia; under current trends, the projections are for as many as 200,900 cases by 2050. Meanwhile the 2020 numbers showed 30,300 unpaid caregivers providing 40.1 million hours per year; by 2050 that could rise to 118,200 people giving 161.4 million hours per year.
Dr. George Andrews, CEO of Alzheimer Society of Alberta/Northwest Territories, has mixed feelings about whether or not there is cause for optimism.
“I’m not sure that we’re optimistic; I’m not very optimistic at all,” he said.
“I think there’s good intentions. But politicians are on four-year cycles, so how do you manage through that process? I can tell you from having personal conversations with senior people in the ministries of health and seniors, they’re all very seriously worried about this and they’re taking proactive steps. The minister of health actually pushed really hard to have the home care system reviewed. So for the first time in my experience, the government of Alberta is looking beyond the next election and looking at the future of the province and how it’s being impacted. So that gives me some optimism.”
“But it’s competing interests,” he added.
The study offers room for encouragement if people do what they can to delay or prevent the onset of dementia symptoms. Anderson says individual action can be affected by individual—and public—attitudes.
“I think our biggest challenge as a society is the stigma,” he said. “There’s still a lot of people who don’t want to talk about this disease.
“About half of the referrals we receive every year for services or programming have come directly from medical professionals, which we’re pleased to see. But the other half are people who self-identify. They are living with a diagnosis, but on average they don’t approach us until 11 months after they’ve been diagnosed—and almost always because they’re in crisis, there’s some challenge.”
In such cases, he says there is a missed opportunity to help people get access to important networks and to understand the trajectory of the disease. He called on media “to encourage people to talk about the disease and not to be ashamed of having it.”
Based on the model estimates, a one-year delay in the onset of dementia in individuals would prevent approximately 47,300 new cases of dementia occurring by 2050 in Alberta.
A 10-year delay of onset for dementia would result in 2050 dementia prevalence (58,000) being only slightly higher than the 2020 estimates—effectively flattening the curve. This represents 392,800 cases of dementia that can be avoided in Alberta by 2050.
What can health-care systems do?
• Provide primary care clinicians with:
o Better education on timely detection of dementia symptoms, diagnosis, and particularly ongoing care.
o Better access to the right tools to diagnose dementia and provide ongoing management.
o Support for medication review and deprescribing initiatives that are readily accessible.
o Education on risk reduction approaches to dementia.
o Changes to fee structures so that clinicians have the right time allocation and remuneration to provide proper support to people living with dementia and their care partners.
o Provide training to a broader circle of allied health professionals who can support management of dementia, including pharmacists, nurses, social workers and personal support workers.
• Increase the dementia workforce and the resources available to all allied health professionals who care for people living with dementia, regardless of where they live in Canada.
• Grow capacity for dementia-specialized community clinics, community and home care systems, and long-term care. Home and community care is the more affordable and requested option by people living with dementia.
• Recognize the specific needs and supports of care partners and people living with dementia to improve care.
• Work to address barriers for access to care among underserved populations, including rural communities, Indigenous Peoples, and other diverse communities.
• Require that health records indicate mild cognitive impairment and early, middle or late-stage dementia.
• Provide effective support for dementia care partners through primary care and health professionals. This includes connecting care partners with local Alzheimer Societies and other local supports, asking about care partner stress, making sure that a primary care partner is identified, assessing care partners prior to hospital discharge, and considering care partner status when determining care transition plans.
What can the federal government do?
• Cost out and fully fund the National Dementia Strategy to optimize the work done toward the three national objectives: (1) prevent dementia; (2) advance therapies and find a cure; (3) improve quality of life of people living with dementia and care partners.
• Furthermore, develop key performance indicators, benchmarks or metrics for the strategy so that the successes and failures can be evaluated.
• Increase investments in dementia research to reach the goal set in the National Dementia Strategy of 1% of dementia care (approximately $105 million annually), including work in health systems and health promotion.
• Actively work to reduce stigma against dementia through national awareness campaigns, and promote measures toward creating dementia-friendly communities.
• Support the development of national dementia clinical guidelines, and fund the development of clinical tools related to dementia care.
• Empower and fund the Public Health Agency of Canada to do what is called “dementia surveillance”—that is, making sure every case of dementia in Canada is counted and tracked.
• Recognize modifiable risk factors for dementia and integrate health promotion strategies across non-communicable diseases of aging, including neurological disorders, heart disease, cancer, and diabetes.
• Provide additional targeted funding for technological solutions to the challenges that come with dementia, clinical dementia care, and caregiving.
• Enhance strategies to improve the mental health of older Canadians, with the specific targeting of reducing depression in people over the age of 65.
• Support implementation of care partner leave more widely—put it in Canadian law—including paid leave for long-term conditions.
What can individuals in Canada do?
• Support care partners within your families and social networks.
• Grow your awareness about dementia and how it impacts people, support dementia research and enhanced services for people with dementia, and be prepared to act as a care partner.
• Advocate for your community to become dementia friendly and for more funding for the National Dementia Strategy or your provincial dementia strategy.
• Access programs available through your local Alzheimer Society if you or anyone you know is concerned about or living with dementia.
• No matter what your age group, from youth to older adults, actively improve your brain health and take dementia risk reduction measures:
o Be physically active each day.
o Protect your heart.
o Stay socially active.
o Manage your medical conditions.
o Challenge your thinking.
o Get a good night’s sleep every night.
o Have depression treated.
o Avoid excessive alcohol intake.
o Maintain your hearing.
o Find meaning in life.
o Avoid all types of head injury.
o Adopt a healthy lifestyle by making healthy food choices, reducing avoidable stress, quitting or reducing smoking, and getting regular check-ups with your doctor.
What can municipal governments do?
• Work toward developing age-friendly and dementia-friendly action plans.
• Work closely with public health units to support their messaging and programming around brain health.
• Support intergenerational social interaction and physical activity for all ages through suitably funded and maintained parks and recreation programs, community centres, and public health programs.
• Reduce air pollution and encourage more green space.
• Support existing community cultural organizations in delivering brain health programs appropriate to their members and target audiences.
• Support accessibility initiatives in urban planning and design that include clear wayfinding signage and transit accessibility.
• Consider health impacts in all policy making, and support health promotion efforts by other levels of government.
• Encourage all city staff to take a dementia-friendly course via alzheimer.ca/DementiaFriendlyCanada.
• Fund local support networks for people living with dementia and their care partners.
• Encourage more dementia-friendly spaces and parks and recreation programming.
What can provincial and territorial governments do?
• Create new community care and long-term care spaces that are dementia friendly, and encourage dementia-friendly community developments.
• Plan for increases in spending for home care, social supports, and long-term care to match the expected increases in the number of people living with dementia and their care partners.
• Improve access to memory clinics, with additional focus on underserved urban regions and rural areas.
• Take a World Health Organization “Health in All Policies” approach to public policy that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts of all new provincial policies.
• Continue to improve efforts by public health agencies in the following areas: prevention and treatment of vascular conditions; discouraging smoking and heavy alcohol use; and encouraging healthy lifestyles.
• Develop policies that encourage social, cognitive and physical activity across the life course for all. This process should include robust efforts to effectively address the social determinants of health.
• Enhance strategies to improve the mental health of older adults, with the specific targeting of reducing depression in people over the age of 65.
• Improve education for all ages—from primary school to adult education—to enhance the brain health of all Canadians.
• Consider how annual brain health checkups for people over 50 might work within each province or territory. The science of brain health has evolved to a point where biomarkers and imaging technologies could be used in health system-level risk reduction activities.
• Support federal efforts in dementia surveillance—provinces must urgently start to enhance the tracking of diagnoses more accurately.
• Create policies and processes that support culturally safe dementia care and public health initiatives for people of all backgrounds, including Indigenous Peoples, Black Canadians, and other racialized and intersectionally oppressed groups.
• Destigmatize and enhance supports for younger care partners.
• Respond to care partner challenges, specifically in rural and remote settings where supports are often lacking.
• Support workplaces in providing flexible supports for employed care partners.
• Build up a system of interventions designed to assist care partners that may include Case management; Psychoeducational approaches; Counselling; Psychotherapeutic approaches; Respite; Support groups; Multicomponent approaches; and Healthy living
close-up of an elderly man consoling his wife