Handout version Duncan Robertson Medical Adviser to ADSAP and PHC - - PowerPoint PPT Presentation

Alberta Dementia Strategy & Action Plan: Handout version

Duncan Robertson Medical Adviser to ADSAP and PHC IGSI ARTA Advocacy Retreat 2018 Canmore, Alberta, May 28, 2018, 09:00-10:00

Overview

• Longevity – then and now
• Context- Anticipating an Aging Alberta
• Major Neurocognitive Disorder (Dementia)
• Memory and related aging changes
• Alberta Dementia Strategy & Action Plan
• Summary and Discussion

Life Expectancy: Then , Now & Future

Life Expectancy & Demographic Pyramid Canada 1921-2006

Alberta Dementia Strategy And Action Plan: Work started October 2014

Overview of the Strategy

• 5-year Strategy and Action Plan
• Steering Committee, Advisory Committee, 6 Working Groups
• Full-Spectrum Focus: From healthy brain aging and prevention to

end-of life palliative care

• Strong focus on caregivers in addition to persons living with

dementia

Expected Progression of Dementia

.

Late stage Lose speech Moving difficult Incontinent Swallowing issues Need help with all care Middle stage Getting lost Delusions Hallucinations Agitation Aggression Anxiety Depression May hurt self or others

Early stage

Memory loss Language difficulties

Irritable

Withdrawn Abusive language Mood swings

Memory Function:101

Attention a prerequisite to memory

(focussed, sustained, selective, alternating, divided)

Steps in memory

Registration ( Encoding): receiving, processing, linking Storage Retrieval ( recall- free or cued) Factors adversely affecting memory function: Delirium, Drugs, Alcohol, Fatigue, Sleep deprivation, Stress, Anxiety, Depression, Preoccupation

Saving Normal

Allen Frances MD. 2013

The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), will turn our current diagnostic inflation into hyperinflation by converting millions of "normal" people into "mental patients." Alarmingly, in DSM-5, normal grief will become "Major Depressive Disorder"; the forgetting seen in old age is "Mild Neurocognitive Disorder"; temper tantrums are "Disruptive Mood Dysregulation Disorder"; worrying about a medical illness is "Somatic Symptom Disorder"; gluttony is "Binge Eating Disorder"; and most of us will qualify for adult "Attention Deficit Disorder.“ What's more, all of these newly invented conditions will worsen the cruel paradox of the mental health industry: those who desperately need psychiatric help are left shamefully neglected, while the "worried well" are given the bulk of the treatment, often at their own detriment.

Dementia ABC…s It’s more than memory!

• ADL (BADL,IADL,AADL)
• Behaviour (BPSD)
• Cognition (memory, praxis, language,etc)
• Depression
• Effect on Caregiver

Expected Progression of Dementia

.

Late stage Lose speech Moving difficult Incontinent Swallowing issues Need help with all care Middle stage Getting lost Delusions Hallucinations Agitation Aggression Anxiety Depression May hurt self or others

Early stage

Memory loss Language difficulties

Irritable

Withdrawn Abusive language Mood swings

Areas for Improvement in Dementia Care

Recommendations From Those Impacted

• Strengthen public communications

– Ensure public understands dementia – Reduce stigma

• Enhance supports for caregivers
• Support acute care’s ability to care for those with

dementia

• Boost the capacity within primary health care
• Augment the workforces’ knowledge, understanding

and expertise related to care and support

• Develop a comprehensive dementia research plan
• Implement a measurement, monitoring and reporting

framework to guide implementation of the strategy

Working Groups

Acute Care & Crisis Management Care Giver Support Dementia Journey Primary Health Care Public Awareness Research & Innovation Writing of the Strategy Documents Communication & Engagement Evaluation & Implementation Planning Release of Strategy Document

ADSAP Principles and Enablers

• Alberta is a leader in

dementia research, development and use of supportive technologies, and translating research into practice

• Alberta has a trained and

supported workforce providing dementia care and services

• A comprehensive

monitoring and reporting framework is in place to guide implementation of the Alberta Dementia Strategy

PERSON AND FAMILY CENTRED COLLABORATIVE AND INTEGRATED FLEXIBLE AND ADAPTABLE

Enablers Guiding Principles

ADSAP : Four Outcomes

The Strategy recommends four

• utcomes that support our stated

vision:

• Outcome 1 Albertans understand the

impact of dementia and actively work towards optimal brain health

• Outcome 2 Albertans living with dementia

and their caregivers are supported in communities

• Outcome 3 Albertans living with dementia

and their caregivers receive timely recognition, diagnosis and clinical management through primary health care, supported by specialized services

• Outcome 4 Albertans living with dementia

and their caregivers experience timely, accessible, integrated and high quality care and services

ADSAP: Three Enablers

The Strategy also recommends three enablers that address the system changes needed to ensure high quality dementia care and services

• Enabler A Position Alberta as a

leader in dementia research, the development of supportive technologies and translating research into practice

• Enabler B Ensure Alberta has a

trained and supported workforce to provide dementia care and services

• Enabler C Implement a

comprehensive measurement, monitoring and reporting framework to guide implementation of the Strategy

ADSAP Outcome 1: Albertans understand the impact of dementia

and actively work towards optimal brain health.

How we will achieve this:

• Elevate public consciousness and understanding of

dementia.

A strong and coordinated effort to share information regarding dementia is needed to expand Albertans’ understanding of the disease, what it means for people’s daily experiences, and how to relate to individuals living with dementia.

• Promote steps Albertans can take to optimize their

brain health and reduce the risk of dementia.

Although research on risk reduction is still in the early stages, physical exercise, socialization and a diet rich in vegetables and fruits are related to improved brain

• health. Albertans can take action to proactively protect themselves from the impact of

declining brain health and reduce the risk of dementia

Healthy Brain Aging- Some ideas…………. Mediterranean Diet. olive oil, limit red meat and eat more fish and chicken. Stay active for a half hour, five times a week. Don’t smoke. If you do smoke, stop now. Moderate use of alcohol Maintain social connections in the community, volunteer work, or try a new hobby. Get plenty of sleep. Manage treatable conditions and reduce vascular risk factors.

ADSAP Outcome 2: Albertans living with dementia and their caregivers are supported in communities.

How we will achieve this:

• Increase access to flexible and available respite options

that meet the needs of Albertans living with dementia and their caregivers.

• Increase the capacity of health and social organizations to

establish and provide meaningful services for persons living with dementia and their caregivers.

• Develop a central access point for trusted, user-friendly

brain health and dementia information and resources

• Review public policy options that reduce the negative

financial impacts experienced by persons living with dementia and their caregivers

ADSAP Outcome 3: Albertans living with dementia and their caregivers receive timely recognition, diagnosis and clinical management through primary health care, supported by specialized services.

• Support case finding to ensure accurate and

timely diagnosis of dementia.

• Build capacity, and spread evidence-informed

best practices in recognizing, diagnosing and clinically managing dementia among primary health care teams.

• Ensure that primary health care teams have

timely access to specialist consultation for dementia diagnosis and advice on clinical management

ADSAP Outcome 4: Albertans living with dementia and their caregivers experience timely, accessible, integrated and high quality care and services. How we will achieve this:

• Ensure everyone with a diagnosis of dementia receives assistance to

navigate the health and social systems and coordinate services

• Involve persons living with dementia, caregivers, as well as the care

team, in developing and updating individual care and service plans.

• Reduce the number of health care transitions experienced by Albertans

with dementia and ensure transitions are only undertaken when in the best interests of the individual.

• Improve the prevention, early identification and management of

delirium, depression and frailty in all care settings.

• Expand access to mental health supports for individuals living with

dementia and their caregivers.

• Create dementia-friendly health and care settings.
• Support development of a single electronic health record.

PHC IGSI

Specialized Services Geriatric Services embedded in PHC to support comprehensive care Primary Health Care Team is well prepared to recognize, diagnose, manage and support people living with dementia Integrated community-based health and social services, organized around the needs of People Living with Dementia Level 3 Level 2 Level 1 Anticipating the Future

Summary

In the last hour we have touched on:

• Longevity and implications for society
• Context- Anticipating an Aging Alberta
• Major Neurocognitive Disorder (Dementia)
• Memory and related aging changes
• Alberta Dementia Strategy & Action Plan

and now

• Discussion and Questions