The number of people living with dementia continues to rise. This increase is due to growth in Canada’s seniors population, which is expected to rise 68% over the next 20 years. This rise will result in demands on Canada’s health care systems.
Caring for seniors with dementia presents many complex issues and challenges, which differ as the disease progresses:
- Since most seniors with dementia reside in the community, primary care doctors and unpaid caregivers need proper supports to help them manage dementia care.
- In long-term care, seniors with dementia continue to experience increased use of restraints and potentially inappropriate antipsychotics, despite a policy focus that is helping to improve the trends.
- Seniors with dementia are hospitalized more frequently and for a longer time. Their longer hospital stays make them more susceptible to hospital harm, including urinary tract infections, pneumonia and falls.
This report uses data and information from a number of sources to highlight dementia’s impact on Canada’s health systems and on family members or others who provide care at home. It’s also a part of CIHI’s larger commitment to focus on issues related to seniors and aging in order to help those who make decisions about health care planning for future needs. The report explores access to and use of health services such as home care, long-term care or nursing homes, emergency departments, hospitals and end-of-life care. It also examines young-onset dementia, family doctor preparedness, and prevention and treatment.
About 1 in 4 seniors age 85+ have been diagnosed with dementia
The population of Canadians age 65 and older is increasing; as a result, so is the number of people living with dementia.
The prevalence of dementia more than doubles every 5 years for Canadians age 65 and older, from less than 1% for those age 65 to 69 to about 25% for those 85 and older. Dementia is more prevalent among women than men, and the gap increases with age.
Seniors with dementia who live at home require support to do so comfortably
About 261,000 seniors with dementia in Canada live outside of publicly funded long-term care or nursing homes. A larger proportion of these seniors have severe cognitive impairment, exhibit responsive behaviours and show signs of depression than other seniors.
Use of antipsychotics and restraints declining for seniors with dementia in long-term care
In 2015–2016, more than two-thirds of residents in long-term care or nursing homes had dementia. These residents have a higher risk of being given antipsychotics without a diagnosis of psychosis and of being restrained compared with other residents. Policy changes and educational supports in this area have led to improvements in many jurisdictions that submit data to CIHI.
Seniors with dementia wait longer in emergency departments, are more likely to be admitted and more prone to harm
Because patients with dementia need complex care, they stay longer in emergency departments, have higher hospitalization rates and have longer hospital stays than other seniors. Longer stays contribute to the fact that 1.5 times as many seniors with dementia experience hospital harm as those without.
Canadians diagnosed with dementia before age 65 face unique challenges
Regardless of the type of care received, the proportion of Canadians with young-onset dementia is approximately 3%. Many of these people have rarer genetic forms of the disease. Canadians with young-onset dementia may face more stigma related to the disease and have unique challenges because they are likely still working.
Rates of injuries from falls are higher for seniors who have dementia and who live in lower-income neighbourhoods
While all seniors are susceptible to falls, hospitalization rates are 23% higher for seniors with dementia in lower-income neighbourhoods than in more affluent areas. The analysis looks at hospitalizations related to falls by 5 income levels.
Seniors with a dementia diagnosis are less likely to receive end-of-life care
Seniors with dementia have a higher mortality rate than other seniors but are less likely to be referred for palliative and/or end-of-life care, which includes proper pain medications and hospice care.
Higher distress, longer hours reported by unpaid caregivers
Unpaid caregivers of seniors with dementia spend more time caregiving and face higher levels of distress than those caring for other seniors. CIHI data shows that unpaid caregivers of seniors with dementia spend an average of 26 hours a week caring for their loved ones, compared with 17 hours for caregivers of other seniors.
Of greater concern, almost twice as many caregivers of seniors with dementia exhibit symptoms of distress, such as anger, depression or feeling unable to continue (45% versus 26%).
This section of the report also includes the stories of 2 caregivers who spoke to us about the challenges they face in their role.
On June 22, 2017, Canada became the 30th country to launch a national dementia strategy. With the passing of Bill C-233, An Act respecting a national strategy for Alzheimer’s disease and other dementias, the government of Canada is working to address the scale, impact and cost of dementia. The information and data included in this report are intended to support decision-making around the issues in dementia care that are important for people living with this illness, their caregivers and their health care providers.