Expert Commentary: Canada’s National Dementia Strategy – 5 Implementation Pillars

In our last two posts in December and February, we partnered with Professor Nathan Herrmann to showcase Canada’s first ever National Dementia Strategy and he provided a clinician’s perspective on the strategy’s 5 fundamental principles and 3 national objectives. In our final post of this series featuring Canada’s national dementia strategy, we have invited Professor Herrmann to provide his input and commentary on the 5 underlying pillars which are identified in the strategy as “essential for implementation, for upholding the principles and achieving the national objectives.

1. Collaboration — Achieving progress on the strategy is a shared responsibility among governments, researchers, community organizations, people living with dementia, caregivers and many others
2. Research and innovation — Promoting research and innovation will address knowledge gaps and develop therapies that will improve the quality of life of people with dementia and caregivers, and move us towards a cure
3. Surveillance and data — Enhanced surveillance and data will help us to understand the scope of dementia in Canada, and focus our efforts and resources where they are most needed and will be most effective
4. Information resources — The development of culturally appropriate and culturally safe information resources on dementia will facilitate the work of care providers to provide quality care and will help all Canadians to better understand dementia
5. Skilled workforce — Having a sufficient and skilled workforce will support dementia research efforts and provide evidence-informed care, which will improve the quality of life of people living with dementia and caregivers”

Taken from “A Dementia Strategy for Canada: Together We Aspire”: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy.html

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 530 publications and 130 research grants, Dr. Herrmann is a world leading expert on dementia and Alzheimer’s.

Clinician’s Perspective

The importance of the development of culturally appropriate information resources on dementia may not seem self-evident at first glance. After all, aren’t the problems associated with dementia including memory and cognitive deficits, impairment in activities of daily living and potential behavioral issues such as agitation and depression, the same for everyone regardless of culture? The answer is, definitely not. While many cultures have significant negative stigmatizing beliefs associated with dementia, others may normalize the symptoms of dementia and therefore not search out treatment. Two populations which require far more emphasis on developing appropriate information and data are the Indigenous and the LGBTQ populations. Little is known about the effects of dementia in Indigenous populations and they are a seriously under-serviced population when it comes to mental health in general, and particularly cognitive disorders in late life. There has recently been particular concerns raised about the stigma and its negative consequences on care which can occur when people from the LGBTQ community are admitted to long-term care facilities. In extreme situations, this has even led to some people having to go “back into the closet” in order to receive appropriate compassionate care.

Which leads to considering the last pillar – the skilled workforce. All professionals and non-professional caregivers will benefit from special training to deal with patients who have cognitive impairment. This includes special communication skills, techniques to ensure optimizing their activities of daily living while allowing them to be as independent as possible, and interventions to deal with behavioral problems if they arise. Nowhere is this more important than it is with staff in long-term care facilities like nursing homes. Residents of nursing homes tend to be moderately to severely effected with dementia, have the greatest physical care needs, and are most likely to develop problems with agitation and aggression. Numerous studies have shown that caregiver and staff education can lead to improvement in behavior in people with dementia, the avoidance of psychiatric medications, and improvements in caregiver stress. These educational interventions however require adequate funding and an investment of time and resources which to date have not been sustainable in many places in Canada. 

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair, Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre