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 . Middle stage Early stage Late stage Getting lost Memory loss Lose speech Delusions Language Moving difficult Hallucinations difficulties Incontinent Agitation Irritable Swallowing issues Aggression Withdrawn Need help with all Anxiety care Abusive language Depression Mood swings May hurt self or others
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! • A DL (BADL,IADL,AADL) • B ehaviour (BPSD) • C ognition (memory, praxis, language,etc) • D epression • E ffect on Caregiver
Expected Progression of Dementia . Middle stage Early stage Late stage Getting lost Memory loss Lose speech Delusions Language Moving difficult Hallucinations difficulties Incontinent Agitation Irritable Swallowing issues Aggression Withdrawn Need help with all Anxiety care Abusive language Depression Mood swings May hurt self or others
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 & Primary Care Giver Dementia Public Research & Crisis Health Care Support Journey Awareness Innovation Management Evaluation & Release of Writing of the Communication Strategy Implementation Strategy & Engagement Documents Planning Document
ADSAP Principles and Enablers Guiding Principles Enablers • Alberta is a leader in PERSON AND dementia research, development and use of FAMILY supportive technologies, CENTRED and translating research into practice • Alberta has a trained and COLLABORATIVE supported workforce providing dementia care AND and services INTEGRATED • A comprehensive monitoring and reporting framework is in place to guide implementation of FLEXIBLE AND the Alberta Dementia ADAPTABLE Strategy
ADSAP : Four Outcomes The Strategy recommends four outcomes 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.
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