Canada's Health System: Examining Seniors with Dementia
Understanding Health Systems in Canada
The Canada Health Act (CHA) was adopted in 1984 and sets the criteria and conditions that the provinces and territories must meet in order to receive federal funding for the delivery of health care services. The five criteria under the Act include: public administration, comprehensiveness, universality, portability, and accessibility (The Council of Canadians, n.d.).
The aim of the Act is to ensure “a publicly funded health care system that bases patients’ access to health care services on need, not on the ability to pay” (The Council of Canadians, n.d.). However, under the CHA “universal coverage is limited to ‘medically necessary’ hospital and physician services, to the exclusion of vital goods and services such as outpatient pharmaceuticals, dental care, long-term care, and many mental health services” (Flood & Thomas, 2016).
Definition of Health
According to the World Health Organization (WHO), health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 2018). One of the biggest criticisms of the WHO definition concerns the absoluteness of the word “complete” in relation to overall well-being (Huber, 2011). The requirement for complete health “would leave most of us unhealthy most of the time” (Huber, 2011). WHO’s current definition does not account for our growing and aging population and the prevalence of chronic disease.
Canada’s Aging Population
Canada's population is aging. Statistics Canada reports that the senior population (aged 65 and older) has been steadily increasing over the past 40 years (Statistics Canada, 2018). The proportion of seniors in our population grew from 8% to 14% from 1971 to 2010 (Statistics Canada, 2018). For the first time ever there are more seniors aged 65 and older than children aged 0-14 years in Canada. (Statistics Canada, 2016).
Image Source: Statistics Canada
Based on population projections, it is estimated that by 2036 the number of seniors could reach between 9.9 and 10.9 million people and represent 25% of the total population (Statistics Canada, 2018). Chronic disease and multi-morbidity are the main reasons seniors will use the health care system, not age (Canadian Nurses Association, 2011).
Chronic Disease Prevention and Management
Chronic diseases are long-term, develop slowly over time, and progress in severity. They can often be controlled but rarely cured. (Ministry of Health and Long-Term Care, 2007). Chronic diseases have overtaken infection diseases as the leading cause of death and disability worldwide (Ministry of Health and Long-Term Care, 2007).
There are an estimated 564,000 Canadians currently living with dementia. This number is expected to rise to 937,000, an increase of 66 per cent by 2031. Of the current number of Canadians with dementia, more than 65 per cent are women (Government of Canada, 2016).
Dementia is a major cause of disability and dependency among older adults worldwide. Dementia is a syndrome that is progressive in nature, in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities (World Health Organization, 2017). Dementia is caused by various brain diseases and injuries. Alzheimer’s disease is one of the most common causes of dementia and contributes to 60-70% of cases (World Health Organization 2017). Other types of dementia include vascular dementia (from strokes), Lewy Body disease, head trauma, frontotemporal dementia, Creutzfeldt-Jakob disease, Parkinson’s disease, and Huntington’s disease (Alzheimer Society Canada, 2017). Early detection and intervention of dementia are important. It provides an opportunity for the individual to adjust to the diagnosis, take action to slow disease progression and maintain function, and participate in actively planning for the future (Chang, Patel, & Schulz, 2015).
(This video explains the difference between dementia and Alzheimer's disease)
Determinants of Health
The social determinants of health “are the conditions in which people are born, grow, live, work and age, including the health system” (Canadian Nurses Association, 2009).
Image Source: Government of Canada
Social Support Networks
Social support networks include the relationships with family, friends and communities (Government of Canada, 2011). Dementia affects communication and how people express themselves, therefore maintaining relationships can be a complex process for people with this disease. Consequently, the risk of social isolation and loneliness are more profound in people with dementia (Kane & Cook, 2013). Having dementia can change the dynamic of a relationship, however it does not change a person’s need for love and affection (Alzheimer Society Canada, 2017). Positive social support networks are a key component in helping people deal with adversity, and can help people with dementia maintain a sense of mastery and control over their diagnosis.
Health Services
There is inequitable access to public long-term care facilities and appropriate home care services for seniors in Canada which leads to the inappropriate placement of seniors in hospitals. Alternate Level of Care (ALC) beds are used in acute care hospitals to accommodate patients while they await placement in home care, a rehabilitation facility, or long-term care facility (Canadian Medical Association, 2016). A recent study of two hospitals in New Brunswick found that thirty-three per cent of hospital beds were occupied with ALC patients, and sixty- three per cent of those patients had a diagnosis of dementia (McCloskey, Jarrett, Stewart, & Nicholson, 2014). More troubling was the average length of stay in hospital for ALC patients who had a diagnosis of dementia was 379.6 days while they waited for a long-term care bed in the community (McCloskey, Jarrett, Stewart, & Nicholson, 2014). Most of these patients experienced functional decline while hospitalized (McCloskey, Jarrett, Stewart, & Nicholson, 2014). The utilization of hospital beds by ALC patients can contribute to a decrease in acute care capacity, emergency department overcrowding, and patient flow insufficiencies throughout the health-care system (McCloskey, Jarrett, Stewart & Nicholson, 2014) driving health care costs up. Approximately 56,0000 Canadians with dementia are being cared for in hospitals even though this is not an ideal location for care (Alzheimer’s Society Canada, 2017).
Gender
Men and women suffer from different types of diseases at different ages (World Health Organization, 2018). Dementia affects women more than men. Approximately two-thirds of Canadian seniors living with dementia are women (Government of Canada, 2017).
Image Source: Government of Canada
Vulnerable Populations
The stigma associated with dementia reduces people to a series of labels or behaviours and focuses on the ways in which the person is impaired, rather than on his or her remaining strengths (Alzheimer’s Disease International, 2012). Lack of awareness and understanding about dementia can lead to false assumptions or negative stereotypes, like the widespread belief that people with dementia can no longer participate in ordinary activities (Alzheimer’s Disease International, 2012). Stigma also plays a role in preventing people with dementia and their families from acknowledging symptoms and seeking out help (Alzheimer’s Disease International, 2012).
Ontario’s Dementia Strategy focuses on increasing public awareness for combating stigma and “developing effective approaches to empower people living with dementia and their care partners to live meaningfully, to live well and to participate in their communities” (Government of Ontario, 2017).
(Jim Mann was diagnosed with Alzheimer's in 2007. He shares his story about living with dementia and building more inclusive, dementia-friendly communities).
Image Source: Alzheimer Society Canada
Improving Support for Informal Caregivers
Individuals affected by dementia can continue to live independently for some time, however as their condition progresses they require increasing levels of care (Canadian Institute for Health Information, 2011). Most often care is provided by informal caregivers including spouses, adult children, friends and neighbours. Among those living with dementia in Canada, eighty-five per cent rely, at least partly on family, friends and neighbours for assistance (Statistics Canada, 2017). On average, 74 hours per week of informal care is required for Canadians living with this condition (Government of Canada, 2017). The apparent changes in personality and the complex behaviours associated with dementia are a major source of distress not only for the person with the disease, but also their caregivers and family members (Alzheimer Society Canada, 2018). Canada’s caregivers are an integral part of dementia care in the community. They assume an unpaid role and often take leave from paid work in order to care for a family member or loved one (Canadian Nurses Association, 2016). Caregivers tend to set their own needs aside while caring for someone with dementia, and experience high levels of burnout and financial hardship. The World Health Organization believes that “strengthening caregivers requires provision of information, resources and training, support and respite, and financial support” (World Health Organization, 2015).
Dementia and the Future of Health Care
Our current health-care system is ill-equipped to deal with the staggering costs associated with dementia. The current annual cost to care for those with dementia is estimated at 10.4 billion dollars (Alzheimer Society Canada, 2017). This figure is expected to increase to 16.6 billion dollars per year by 2031 (Alzheimer Society Canada, 2017). The Canadian health system needs to shift its focus from illness to wellness-based care. “The shortage of home care nurses and lack of government support for informal caregivers for seniors means that for many of our seniors facing health challenges of aging, the only health-care option is the chain of ambulance to the emergency department to hospital admission” (Canadian Nurses Association, 2011). Focusing dementia care in the community means better patient outcomes and savings for the health-care system by re-directing patients to more affordable community and home-based services (Canadian Nurses Association, 2016).
References
Alzheimer’s Disease International. (2012). World Alzheimer Report 2012. Overcoming the stigma of dementia. Retrieved from https://www.alz.co.uk/research/WorldAlzheimerReport2012ExecutiveSummary.pdf
Alzheimer Society Canada. (2018). About Dementia. Retrieved from http://alzheimer.ca/en/Home/About-dementia
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Chang, F., Patel, T., Schulz, M.E. (2015). The “Rising Tide” of dementia in Canada. Canadian Pharmacists Journal, 148(4):193-199. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530360/
Flood, C.M. & Thomas, B.P. (2016). Modernizing the Canada Health Act. Ottawa Faculty of Law Working Paper No. 2017-08. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2907029
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Huber, M. (2011). How should we define health? British Medical Journal, 343, (7817):235-237. https://doi.org/10.1136/bmj.d4163
Kane, M. & Cook, L. (2013). Dementia 2013: The hidden voice of loneliness. Alzheimer’s Society. Retrieved from https://www.alzheimers.org.uk/download/downloads/id/1677/dementia_2013_the_hidden_voice_of_loneliness.pdf
McCloskey, R., Jarrett, P., Stewart, C., Nicholson, P. (2014). Alternate Level of Care Patients in Hospitals: What Does Dementia Have To Do With This? Canadian Geriatrics Journal, 17(3):88-94. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164681/
Ministry of Health and Long-Term Care. (2016). Developing Ontario’s Dementia Strategy: Discussion Paper. Retrieved from https://www.ontario.ca/page/developing-ontarios-dementia-strategy-discussion-paper
Ministry of Health and Long-Term Care. (2007). Preventing and Managing Chronic Disease: Ontario’s Framework. Retrieved from http://www.health.gov.on.ca/en/pro/programs/cdpm/pdf/framework_full.pdf
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Statistics Canada. (2016). An Aging Population. Retrieved from https://www.statcan.gc.ca/pub/11-402-x/2010000/chap/pop/pop02-eng.htm
Statistics Canada. (2018). Seniors. Retrieved from https://www.statcan.gc.ca/pub/11-402-x/2011000/chap/seniors-aines/seniors-aines-eng.htm
The Council of Canadians. (n.d.). Factsheet: Understanding the Canada Health Act. Retrieved from https://canadians.org/sites/default/files/publications/CHA%20Feb%202010.pdf
World Health Organization. (2015). Supporting Informal Caregivers of People Living with Dementia. Retrieved from http://www.who.int/mental_health/neurology/dementia/dementia_thematicbrief_informal_care.pdf
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