Choosing the right home

GOVERNMENT: Canada Needs a National Dementia Strategy

dementia plan

Dr. Chris Simpson, a panelist at a conference on dementia made front page news by just stating the following obvious comments.

“He said the reason there is a nine-month waiting time in this country for a hip replacement is because there are so many patients with dementia taking up acute-care hospital beds.

Why are they there?

Because there is nowhere else for them to go.

This problem may be old news to physicians and policy-makers but it is a real issue for hundreds of thousands of Canadian families who struggle to care for loved ones battling dementia. Just as is the case for health care generally in our country, the care and support you get from the system depends largely on where you live.

Canada and France were co-hosts last week to something called a Global Dementia Legacy Event growing out of last year’s G8 meeting in London. It was one of four global dementia “Legacy Events” being held to gather international dementia experts and come up with solutions.

Make no mistake, this international focus is good news. But Canada’s doctors and the patients we serve are interested in how this meeting will translate into strategic action to address a disturbing dilemma in our health care system here at home.

The health care system euphemistically calls people stranded in acute care hospital beds “alternate level of care patients.” Through no fault of their own, so-called ALC patients occupy 3 million bed days a year in our hospitals. They don’t have acute disease; they have chronic diseases. Fully one third suffer from dementia.

If this situation sounds urgent it is because it is. In fact, dementia numbers are staggering — and set to rise even higher — in most of the developed world. This is why 13 countries around the world have some form of national dementia strategy.

Strangely, Canada is not among them.

Sure, Ottawa has (since 2006) invested more than $860 million through the Canadian Institutes of Health Research to support neuroscience research with $182 million earmarked for prevention, diagnosis and care of dementia. And the 2014 federal budget allocated new funding to CIHR for a consortium on neurodegeneration in aging. This investment in research is appropriate and welcomed. But it is only part of what we need to be doing to address this impending crisis.

No doubt organizers of the Canada-France conference will have plenty to report back to their (now G7) partners next year. But the time for discussing dementia in opaque, abstract language at high-level conferences is over.

The federal government needs to be doing some things — now — like sitting down with the provinces to develop a dementia strategy that aims to give Canadians with dementia the care they deserve, at home and in their communities, while freeing up expensive acute care hospital beds to serve the patients for whom they are intended.

Ottawa, the provinces and territories should be talking about more support for families and other caregivers, home-care support where possible and addressing a serious deficit in long-term care facilities.

Or, Ottawa could be taking the lead in helping to develop a comprehensive health human resources plan that assembles the right mix of health care providers to properly care for the 747,000 Canadians with dementia. We need more geriatricians (there are only 260 in Canada) and we need to fully harness the great potential of multi-professional primary care teams. Canada’s family physicians speak eloquently and passionately about the “Medical Home” — the concept that all patients deserve a home base with professionals to care for their complex needs in their homes and communities. Canadians with dementia need this support and dedication.

The Alzheimer Society of Canada projects there will be 1.4 million Canadians suffering from dementia by 2031. This group, as well as CARP and others are united in calling for more political leadership to battle this terrible disease and to support families in their battle against it.

Canada today has almost as many diagnosed dementia patients as the United Kingdom does at 847,000, despite a difference in population of 30 million.

The United Kingdom has a dementia strategy. Why don’t we?

Dr. Chris Simpson is the new president of the Canadian Medical Association and chair of the Wait Time Alliance, a coalition of 18 specialist associations dedicated to eliminating unnecessary waits for medical tests, treatments and procedures.”



HEALTH: Sleeping and Anxiety pills increase Alzheimer’s risk

pills causing dementia

A new study has evidence that drugs seniors use to help with insomnia and anxiety can actually increase the chances of getting Alzheimer’s.

“Long-term use of sleeping pills may be linked to Alzheimer’s according to this study whose authors say unneeded use of the drugs is a public health concern.

The French and Canadian research published in the medical journal, BMJ, on Wednesday found taking benzodiazepines – popular drugs to treat anxiety and insomnia – are associated with an increased risk of Alzheimer’s disease.

The risk is particularly strong for long-term users of the widely prescribed drugs, and the researchers suggest people should not be using the drugs for longer than three months.

The research team tracked the development of Alzheimer’s in elderly Quebec residents using the drugs, using data from the Quebec health insurance program database.

They compared 1796 cases of Alzheimer’s disease to results of 7184 healthy people of the same age and gender over a six-year window.

This revealed that the longer people took the drugs, the worse the results were. People were up to 51 per cent more likely to get Alzheimer’s after a period of three months, particularly when they were taking long-acting benzodiazepines.

The authors said the drugs were indisputably useful for managing anxiety disorders and transient insomnia but warned that unwarranted use over long periods should be a public health concern.

The head of the Neurodegeneration Research Laboratory at the Garvan Institute of Medical Research in Sydney, Dr Bryce Vissel, said doctors should more carefully consider prescribing the drugs.

He said dementia was a growing problem in Australia and the study highlighted a serious health concern when such high numbers of older adults were using the drugs.”


DIAGNOSED: Ten Early Signs of Alzheimer’s

memory loss

The following article from CNN has a list of helpful signs to watch for in detecting the onset of Alzheimer’s.

“More than 5 million Americans are living with Alzheimer’s today, with another person developing the disease every 68 seconds. By 2050, the number of people living with Alzheimer’s disease is expected to triple.

As if those numbers weren’t staggering enough, consider this: Alzheimer’s disease is the only cause of death among the top 10 (it’s currently ranked No. 6) in the United States that can’t be prevented, cured or slowed down.

Ask any expert, and he or she will tell you that early diagnosis is key to helping patients live better day to day, so even though the disease is still progressing, the symptoms are less harsh.

“Our hope is that if we could identify patients who are developing the disease early, it would give us a much better opportunity to intervene with treatments, and it’s much more likely for those treatments to be effective,” says Dr. Keith Black, chairman of neurosurgery at Cedars-Sinai Medical Center.

But while early diagnosis leads to early intervention, some news out of the 2013 Alzheimer’s Association International Conference is troubling: An expert panel found 16 online tests for Alzheimer’s disease scored poorly on scales of overall scientific validity, reliability and ethical factors.

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“Self-diagnosis behavior … is increasingly popular online, and freely accessible quizzes that call themselves ‘tests’ for Alzheimer’s are available on the Internet,” says Julie Robillard, who presented the data this week in Boston. “However, little is known about the scientific validity and reliability of these offerings and ethics-related factors, including research and commercial conflict of interest, confidentiality and consent.”

“Frankly,” Robillard adds, “what we found online was distressing and potentially harmful.”

Robillard and her colleagues at the University of British Columbia found that unique monthly visitors for the parent sites hosting the online tests reached as high as 8.8 million.

At the same conference, another study concluded that the misdiagnosis of Alzheimer’s disease in Medicare patients who actually have vascular dementia or Parkinson’s disease leads to substantial excess costs of care. The study, conducted by Analysis Group, Inc. and Eli Lilly and Co., found the costs of erroneous care to be in excess of $14,000 a year per patient .

The silver lining: Those excess costs decline and eventually dissipate following a correct diagnosis.

“Recent developments in technology have greatly improved our ability to properly diagnose patients with cognitive impairment,” said Analysis Group’s Noam Kirson. “Our results suggest that there are economic benefits to properly diagnosing — as early as possible — the cause of the cognitive impairment.”

If you suspect a family member or friend is developing Alzheimer’s, take a look at these 10 warning signs of Alzheimer’s Disease, put together by the Alzheimer’s Association:

1. Memory changes that disrupt daily life

2. Challenges in planning or solving problems

3. Difficulty completing familiar tasks at home, at work, or at leisure

4. Confusion with time or place

5. Trouble understanding visual images and spatial relationships

6. New problems with words in speaking or writing

7. Misplacing things and losing the ability to retrace steps

8. Decreased or poor judgment

9. Withdrawal from work or social activities

10. Changes in mood and personality

The importance of early detection and early intervention can’t be stressed strongly enough. It could mean added years of lucidity and life for you or someone you love.”



GOVERNMENT: Canadian Healthcare Needs to Tackle Dementia

dementia crisis

The following article outlines the future crisis coming in the near future.

“News that Spirit of the West vocalist, John Mann, has early onset Alzheimer’s is the latest in a series of wake up calls that Canada needs to get ready for a burgeoning incidence of dementia as the population ages. The percentage of people afflicted may not be increasing but the sheer size of the boomer generation reaching the vulnerable age bands is a challenge that Canada’s healthcare system has yet to meet.

It is already on the minds of many: three-quarters of CARP members polled were touched by dementia, and most (81 per cent) think Canada is not prepared for it as boomers age. But when an icon of the generation reveals his diagnosis, then it touches all of us.

Certainly the numbers are daunting: 750,000 Canadians were living with dementia in 2011. In fewer than 20 years, that number is expected to double to 1.4 million. 1-in-10 Canadians say they are the primary caregiver for someone with dementia — so a potential 3.5 million Canadians are shouldering the burden of dementia care.

But it’s not just the numbers, it’s how the disease robs you of the person you know, bit by bit, that is the most frightening. John Mann now has a tablet attached to his microphone to cue him on lyrics he wrote himself and has performed countless times. He can’t remember how old his children are but he still knows he loves them, he says. The family may yet feel the pain when that changes.

And just as families struggle to care for someone whom they no longer know or understand, our long-term care system has not found a way to meet the challenge of growing numbers of people who will need specialized care. The default has been locked units and chemical restraints.

We can replace a hip, install a new heart, kill cancer cells and soon enough, equip people with an exoskeleton to let even paraplegics walk. But so far, we haven’t been able to repair or replace the brain.

There is learning, however, about how to care for people in the meantime but are we applying it? Sundowning programs, for example, provide activities at night when some dementia sufferers are most active and most likely to wander. Yet care homes have the most staff on the day shift and the bare minimum at night. What would it take for funding and staffing protocols to be reversed?

Medical personnel rely heavily on patients reporting their symptoms to make a diagnosis. Dementia patients who can’t identify the source of their pain could be treated for their agitation and aggression instead. Have medical practitioners been taught how to uncover the underlying condition without asking the patient? There are too many stories of people with an easily diagnosed problem — a fracture or a lump — who suffer unnecessarily because their caregivers could not see beyond the confusion and distress.

Unable to communicate what’s wrong and losing all freedom of movement is the stuff of nightmares and the reason that Yee Hong was established to provide culturally appropriate care for people who were unable to communicate their care needs in English language nursing homes. The isolation and fear accelerated their deterioration. Yee Hong not only has staff who speak several language including Chinese but three different types of kitchens, including woks and tandoori ovens — all evidence of the resident-centred care that is more than a catch phrase. Staffing and resources are adjusted, even within the existing funding envelopes, to maximize attention for those who need it. And while they haven’t solved entirely the puzzle of dementia care, at least they have a psychiatrist on staff — a rarity among nursing homes.

There must be a paradigm shift in how we deal with people who could be said to be living in an alternate universe. We can only help them in that universe and not keep trying to drag them back into ours. And we know it can be done.

Hogeway , Netherlands is an entire village inhabited by people with dementia, the caregivers doubling as the shopkeepers and barbers.

Maybe we can’t build dementia villages all over Canada but at least we can help those we love to live in a world that treats them as proper denizens.”


HEALTH: 101 year old javelin thrower

101 year old athlete

In “Alberta News” last week it was reported that Florence Storch who is 101 years old, won the silver medal in javelin linac the seniors games.

“After two throws, the 101-year-old athlete called it quits for the day but still took home a silver medal.

“I didn’t put that much energy into it,” the centenarian said Thursday at the Canada 55-Plus Games in Strathcona County, east of Edmonton.

Still, she said, it “felt good” being out on the field.

“Better than sitting in my room doing nothing.”

Storch is the oldest athlete at this year’s seniors games and has held the title, both at the provincial and national levels, the last few years.

She doesn’t remember exactly when but started competing in the sport at least a decade ago. She was helping organize the seniors games in her home town of Hanna, Alta., and signed up for javelin because no one else was on the list.

Over the years, she improved her skills and collected various medals, some of them gold.

And she has continued to practise each year, when the weather’s good, outside the seniors lodge where she lives.

Storch admits she isn’t as athletic as she used to be.

Instead of getting a running jump on her throw, she now stands still. And because she doesn’t see well anymore, someone helps to get her pointed in the right direction.

Although the javelin athletes each got to throw six times Thursday, Storch thought she had done her best in two and needed a rest.

In the end, she was bested by the only other female athlete in the over-85 category, 87-year-old Doreen Erskine of Moose Jaw, Sask., who threw slightly more than 5.24 metres.

Storch’s best throw measured 3.18 metres.

“She had good form, threw her good average throw,” said her 70-year-old son, Ed, a former competitor in the games sprint event.

He was worried about his mother and ready to jump in if she took a tumble during the competition. But there was also a warm spot in his heart, he said, because he was so proud of her.

Storch said she has no plans to retire yet and will keep competing for “as long as a I can.”

“Why stop?””