������ϱ�

2 out of 5 Canadian doctors feel well-prepared to manage community dementia care

The growing number of seniors living with dementiaReference1 is leaving some primary care doctors feeling less well-prepared to manage dementia care in the community.

The results of the 2015 Commonwealth Fund Survey of Family Physicians show that more than 86% of Canadian primary care doctors “often” or “sometimes” provided medical care for people living with dementia, but just 41% of all surveyed doctors felt they were well-prepared to manage this care. In comparison, 69% of surveyed doctors in Norway and 63% in the U.K. felt well-prepared, while The Commonwealth Fund average was 52%.Reference2

Doctors are more comfortable at the initial assessment and appropriate baseline testing for dementia but face more difficulties when the disease becomes more advanced and difficult for caregivers to manage.— Dr. Nicholas Pimlott

“At that stage, the care becomes more time-consuming and labour-intensive — not only are you providing medical care, but you’re also helping and caring for the family. But if you could do it, and do it well, it makes a huge difference for patients and their families,” said Dr. Nicholas Pimlott, a clinical researcher and physician at the Family Practice ������ϱ� Centre at Women’s College Hospital in Toronto and an associate professor in the Department of Family and Community Medicine at the University of Toronto.

The doctors who were surveyed in countries that have national dementia strategies felt most prepared to manage care for seniors living with dementia. On June 22, 2017, Canada became the 30th country in the world to pass a bill mandating a national dementia strategy,Reference3Reference4 in response to the increasing population age 65 and older and the related public health challenges. Notably, dementia strategies were already in place at the provincial level in some jurisdictions: Nova Scotia, Quebec, Ontario, Manitoba, Alberta and British Columbia.Reference4Reference5

Ideally, family doctors are the cornerstone of the support network for people living with dementia by facilitating early diagnosis and treatment, and by helping to manage behaviours, wandering, and falls or other injuries. They help connect seniors living with dementia with timely community and medical support, and they facilitate the transition between care settings as the stages of the disease progress.

Challenges in dementia care and potential reasons family doctors feel ill-prepared, according to studies in Canadian Family Physician,Reference6Reference7 include the complexity of dementia, difficulties diagnosing dementia, lack of access to specialists (particularly in rural and remote areas), insufficient knowledge of community-based resources, time constraints and challenges coordinating patients’ and families’ needs.

“Reduction in home visits is another potential factor for the discomfort in providing care,” said Dr. Pimlott. “Too much care is centred in the office-based practice — and in late-stage dementia, office-based practice is not the best.”

Similarly, the Canadian Home Care Association found that 78% of home care providers reported a “high” or “very high” degree of challenge providing care in the home for people living with dementia.Reference8

Examples of programs and initiatives supporting primary health care

• is a referral program to help physicians and other health and community service providers directly refer people with dementia and their families to the Alzheimer Society for services and support.
• Ontario has almost 100 to improve dementia care delivery at the family practice level through team-based collaboration.
• The in Ontario is designed to improve the quality of care provided to seniors with dementia by providing education and resources for primary care.
• The in Saskatchewan is aimed at boosting primary health care delivery for people with mild cognitive impairment and dementia and their caregivers in rural and remote communities.