Recommendations of the Landmark Study Report #1

Our first Landmark Study report, released in September 2022, showed that dementia will continue to be a growing issue in Canada.

For one, this report, Navigating the Path Forward for Dementia in Canada, projects that the number of people living with some form of dementia in Canada will triple over the next 30 years.

But if we take action now, we can change that forecast for the better. And we can also improve experiences for people living with dementia — and for their families and communities.

All people in Canada have a role to play in this challenge. And for all of us, it is important that this work is done collaboratively with people living with dementia and their care partners.

Read on for our recommendations about what health-care systems, governments, individuals, researchers and our own Alzheimer Societies can do.

What can Alzheimer Societies do?

• Reduce stigma and raise public awareness about dementia so that all Canadians know about dementia-friendly community programming and the IG Wealth Management Walk for Alzheimer's.
• Grow supports and services to fill the gaps in health care through the First Link® system navigation program, National Dementia Infoline, provincial and regional dementia infolines, Minds in Motion and other invaluable local programs.
• Increase funding for out-of-the-box research that explores radical new ways to advance our knowledge of dementia and enhances the quality of life of people living with dementia and their care partners.
• Continue building relationships and resources for diverse communities across Canada.
• Engage people living with dementia and their care partners in all aspects of advocacy and programming in keeping with "nothing for us, without us."
• Collaborate with other organizations on issues related to dementia and dementia care.

What can health-care systems do?

• Provide primary care clinicians with:
  • Better education on timely detection of dementia symptoms, diagnosis, and particularly ongoing care.
  • Better access to the right tools to diagnose dementia and provide ongoing management.
  • Support for medication review and deprescribing initiatives that are readily accessible.
  • Education on risk reduction approaches to dementia.
  • 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.
  • Provide dementia education 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 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
  • Healthy living

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 researchers do?

• Include people living with dementia and their care partners in research projects, as part of the research team and as study participants.
• Embrace a range of dementia research, including fundamental bio-medical and clinical research, dementia in health systems and services, dementia in populations, the societal and cultural dimensions of dementia, and the environmental influences on dementia.
• Support an integrated approach to dementia research that brings together researchers, health-care providers and policy-makers with industry and patient groups from across the country.
• Continue to conduct studies to understand protective effects, risk factors, and interventions for dementia over the life course.
• Support brain health-oriented research, such as further investigation into the factors that lead to resiliency and cognitive/brain reserves.
• Ensure that dementia research populations reflect the diversity in our Canadian population. Increase recruitment of heterogeneous samples to improve our understanding of differences such as socio-economic status, race, ethnicity, language, disability, and gender.
• Continue research on the COVID-19 pandemic and its association with dementia outcomes.
• Work to develop new insights on the care needs of people living with dementia, the needs of care partners, and ways to improve the health and social systems that support them.
• Study how the social determinants of health (i.e., social and environmental attributes beyond an individual’s control) affect the risk of developing dementia and the well-being of people living with dementia and their care partners.
• Foster interdisciplinary collaborations to tackle the complex problems that exist in dementia research. For example, quantitative research projects may benefit by including data scientists with expertise in areas like machine learning, artificial intelligence, or other modern data science approaches.
• Conduct research on technological and non-technological innovations aimed at improving dementia care (e.g., assistive technologies, virtual reality applications, human-based interventions). Some of this work should include harnessing sensor technology and the Internet of Things for applications in dementia management and care (e.g., remote monitoring of appliances, tracking of biometrics, medication management).
• Identify common causes of hearing loss and head trauma (e.g., occupational exposures), and work to reduce exposure to these risk factors (which have been shown to elevate dementia risk as individuals age).
• Conduct health system research on implementing better coordination and integrated care that is patient-centred and dementia friendly.

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:
  • Be physically active each day.
  • Protect your heart.
  • Stay socially active.
  • Manage your medical conditions.
  • Challenge your thinking.
  • Get a good night’s sleep every night.
  • Have depression treated.
  • Avoid excessive alcohol intake.
  • Maintain your hearing.
  • Find meaning in life.
  • Avoid all types of head injury.
  • Adopt a healthy lifestyle by making healthy food choices, reducing avoidable stress, quitting or reducing smoking, and getting regular check-ups with your doctor.

The recommendations above are found in Chapter 5 of the Landmark Study's first report, Navigating the Path Forward for Dementia in Canada. To read the complete report, visit alzheimer.ca/Landmark-Study.