On June 17, 2019, Canada published its first National Dementia Strategy, joining many other countries worldwide who have already developed and implemented National Dementia Strategies. Canada’s strategy is centered around its vision to create “a Canada in which all people living with dementia and caregivers are valued and supported, quality of life is optimized, and dementia is prevented, well understood, and effectively treated”.
“Key to achieving this vision are 5 principles setting out values to guide the implementation of efforts in support of the national objectives and their areas of focus. In implementing the strategy, governments, non-governmental organizations, community organizations and others working on dementia should:
- Prioritize quality of life for people living with dementia and caregivers;
- Respect and value diversity to ensure an inclusive approach, with a focus on those most at risk or with distinct needs;
- Respect the human rights of people living with dementia to support their autonomy and dignity;
- Engage in evidence-informed decision making, taking a broad approach to gathering and sharing best available knowledge and data; and
- Maintain a results-focused approach to tracking progress, including evaluating and adjusting actions as needed.”
Taken from “A Dementia Strategy for Canada: Together We Aspire”: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy.html
We had the privilege and opportunity to ask Professor Nathan Herrmann for his expert opinion and commentary on these 5 principles which the National Dementia Strategy are based around.
Professor Herrmann is the Richard Lewar Chair in Geriatric Psychiatry at Sunnybrook Health Sciences Centre and the University of Toronto. At Sunnybrook, he is Head of the Division of Geriatric Psychiatry, co-director of the Clinical Neuropharmacology Laboratory, and a scientist in the Hurvitz Brain Sciences Research Program and the Center for Stroke Recovery. With over 700 publications and 150 research grants, Dr. Herrmann is a world leading expert on dementia and Alzheimer’s.
Clinician’s Perspective
A year before release of Canada’s national dementia strategy introduced above, Selina Chow and I published a review in the Canadian Geriatric Journal titled: National Dementia Strategies:
What Should Canada Learn? (DOI: https://doi.org/10.5770/cgj.21.299). In that paper, we reviewed the national dementia strategies of the other 29 countries that had previously developed such strategies. That’s right – at least 29 other countries beat Canada to the punch in terms of planning for these neurodegenerative disorders that have such devastating effects on patients, their families and on society as a whole. In spite of that, I’m pleased to say “better late than never” and for the most part, the strategy hits on most of the aspects that all good, comprehensive plans to deal with these illnesses should include. These aspects include increasing awareness of dementia, reducing its stigma, identifying support services, improving the quality of care, as well as improving training and education and promoting research.
The 5 principles described above might seem self-evident to people whose lives have been touched by dementia, but they are worth reflecting on. The principle of quality of life is crucial when considering dementia. While there is still no cure in sight for Alzheimer’s disease and other dementias, there is much that can be done to improve quality of life for patients and their families and a focus on “living well with dementia” must take priority over pessimistic and nihilistic attitudes that pervade many in our society, including health care workers like physicians and nurses. As a scientist and clinician looking after patients with dementia, I am particularly pleased with the principle of evidence-informed decision making. This implies that management of these illnesses should be based on solid research studies that consider both the efficacy and side-effects of all treatments. When patients and families are faced with Alzheimer’s disease, they will often look to unproven treatments they hear about from friends or read about on the internet, which is problematic from many perspectives. These treatments can be costly, are likely to be ineffective, and they may result in unexpected and dangerous side-effects. They can cause the patient to avoid or delay treatment with proven (though only modestly effective) standard therapies. Finally, the false hope they engender in patient and caregiver can be devastating. I firmly believe that patients would be better off participating in a clinical trial under close supervision, and contributing essential knowledge to science, rather than wasting their time with unproven treatments. The principles of valuing diversity and human rights are hard to argue with. Finally, adopting a “result-focused” approach to evaluating the dementia strategy is crucial, in order to ensure we are spending our money wisely and actually improving the care of people with dementia and their families.
Nathan Herrmann MD FRCPC
Professor, Faculty of Medicine, University of Toronto
Lewar Chair, Geriatric Psychiatry
Head, Division of Geriatric Psychiatry
Sunnybrook Health Sciences Centre
