Voices of Dementia Healthcare Professionals: Dr Patrick Chu

This month, we had the great opportunity to interview Dr. Patrick Chu about his experiences as a geriatrician and how his work with the elderly has changed in light of the COVID-19 pandemic. Dr. Chu works at both North York General Hospital and his community office, and he is here with us today to share his personal experiences and insights on dementia.

1.  Tell us about yourself – who you are, what you do, and what your day to day work looks like.

I graduated from Medical School in University of Hong Kong in 1981. I passed my Membership of Royal College of Physicians of UK in 1985 and received further training in Internal Medicine and Geriatrics in University of Glasgow, Scotland.  I moved to Canada in 1990 and has worked in Geriatrics at North York General Hospital since 1997.  I spend two and a half work days at North York General for Geriatrics and I spend the rest of my time in my office.  My practice is also geriatric biased, with 60% of my patients are over the age of 65.

2.  What sparked your interest in healthcare and specifically geriatrics? What made you choose to pursue a career working with seniors with dementia? 

To enjoy working in health care, one must be ready to SERVE and have a PASSION for life.   These are the 2 major reasons for me to go into the field.  I cannot imagine myself doing anything else.  Medicine is getting very very specialized in the past 40 years and it is very difficult to get doctors who are interested in being a generalist.  To be a good geriatrician one has to be a very sharp generalist before you can help your senior patients.

3.  What is it like working with individuals with dementia? What are the most rewarding and challenging moments you have encountered?

Dementia is one of the major part of my day to day work.  Making a diagnosis of dementia is not hard.  There are guidelines to follow in the diagnostic pathway that facilitate all professionals to make the diagnosis.  Revealing the diagnosis, working with patients and family, and to follow up and providing support for an incurable disease is the most challenging part.

To be able to provide support to patients and family and to receive a positive feedback from the family is the biggest reward One can have.  When patients and family members almost treat you as a friend it indicates you are doing a good job.

4. How has the COVID-19 pandemic affected your work and the elderly you work with? 

It is hard for seniors during COVID and the number one enemy is ISOLATION.  Many seniors are depressed.  The majority of my consults in the past 6 months are related to these 2 problems.  It is easy for us to say we doctors can assess you Virtually, and convert in person visits to a visit by a laptop or IPad.  Too many seniors have extreme difficulty with the internet and gadgets, and many of them cannot afford wifi at home.  Most seniors love the face to face contact to meet with a doctor or health care professional.  Using Virtual is just not something they feel comfortable with.

5. Given the impact of dementia on both the individual and their family/caregivers, what advice would you give to those who have a loved one with dementia? 

The most important advice to Dementia patients is to keep active, both physically and mentally.  Provide appropriate stimulation for the seniors, such as art, pets, enjoying their hobbies, learn something new that is within their capacity, Music, playing bridge, mahjong........  The list is endless.   Take them out to visit more nature and meet with more people and increase their socialization. 

 

We would like to sincerely thank Dr. Chu for taking the time to share with us about his experiences working with individuals with dementia.

 

Voices of Dementia Family Members: Erika Friesen

We are excited to be launching our new blog series featuring the voices of dementia healthcare professionals and caregivers or family members, to share their perspective on what it's like working with individuals with dementia. For our first blog post, we were fortunate to speak with Erika Friesen about her family experiences with dementia.

Erika Friesen has been our wonderful teacher supervisor from Havergal College for our program. She has supported and mentored our group of student volunteers since 2016. On a personal level, her beloved father and several other dear relatives lived with dementia in their last years of life. She was not a caregiver for any of them - just a family member. She is here with us today to share her experiences with individuals with dementia.

 

 

1.     If you are comfortable sharing, can you tell us about your loved ones’ journey with dementia?

 

My father developed dementia after he moved into full-time intermediate care due to mobility loss. My cousin Else began to show signs while she still lived in her house independently. My aunt Eva also lived independently through the first year or so of her illness. In all these cases, it was first noticeable to me with the loved one's short-term memory loss and confusion about people in their lives.

 

2.     Can you share with us about your experience as a friend/relative for someone with dementia? 

It was disconcerting at first to realize that Dad was mixing up parts of his life, or that Else began talking to me as though I were my mother. But I got used to it pretty quickly because it was clear that they still loved me and were so happy to see me, even if our interactions changed drastically.

 

3.     What were the most rewarding and challenging moments you encountered in your interactions and relationships? 

Rewarding

Seeing a different version of the essential character of the loved one: Dad's joyful love of music and connecting with people; his pride in his work; his curiosity and wonder. Else's sweet natured conversation and delight in sharing food. Her happiness at seeing me arrive, even when she didn't know my name.

Challenging

Watching Mom's confusion at the change in her interactions with Dad; the loved one's pain and confusion at their awareness of decline; the confusion of timelines that in one case led to an endless reliving of past pain as though it had just happened; not being known.

 

4.     What advice would you give to others who have a loved one with dementia? 

Focus on the love! Try not to worry about details.

 

 

 

We would like to sincerely thank Erika Friesen for taking the time to share with us about her personal experiences and take-aways from her relationships with individuals with dementia. 

Welcome Back for our Fifth Year of the Dementia Awareness Program

We are excited to announce that we are launching the fifth year of our Dementia Awareness Program this school year – a community partnership led by Professor Nathan Herrmann and a group of high school students and alumni at Havergal College in Toronto, Canada. 

Our monthly blog series, beginning next month, will feature the voices of dementia healthcare professionals and caregivers – who will be sharing their perspective on what it’s like to work with individuals with dementia. We hope that you are as excited as we are for this new blog series, so be sure to follow our blog and check back in on the first Monday of every month. 

In the meantime, we would like to share some highlights from exciting new dementia research from: Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (posted with the permission of Professor Gill Livingston and The Lancet). 

“Key messages

·      Three new modifiable risk factors for dementia

o   New evidence supports adding three modifiable risk factors – excessive alcohol consumption, head injury, and air pollution – to our 2017 Lancet Commission on dementia prevention, intervention, and care life-course model of nine factors (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact).

·      Modifying 12 risk factors might prevent or delay up to 40% of dementias.

·      Be ambitious about prevention

·      Specific actions for risk factors across the life course

o   Aim to maintain systolic BP of 130 mm Hg or less in midlife from around age 40 years (antihypertensive treatment for hypertension is the only known effective preventive medication for dementia).

o   Encourage use of hearing aids for hearing loss and reduce hearing loss by protection of ears from excessive noise exposure.

o   Reduce exposure to air pollution and second-hand tobacco smoke.

o   Prevent head injury.

o   Limit alcohol use, as alcohol misuse and drinking more than 21 units weekly increase the risk of dementia.

o   Avoid smoking uptake and support smoking cessation to stop smoking, as this reduces the risk of dementia even in later life.

o   Provide all children with primary and secondary education.

o   Reduce obesity and the linked condition of diabetes. Sustain midlife, and possibly later life physical activity.

o   Addressing other putative risk factors for dementia, like sleep, through lifestyle interventions, will improve general health.

·      Tackle inequality and protect people with dementia”

Thank you very much to Professor Gill Livingston and The Lancet for allowing us to share their recent work here on our blog.

 

It’s been amazing to see how far our blog and program have come since its inception in 2016. In September 2016, we created this two-pronged program with the goals of raising awareness and de-stigmatizing dementia through: 1) our blog, which has reached over 3,000 readers from around the world; and 2) weekly visits by a group of Havergal students to a local seniors’ residence to engage individuals with dementia and develop intergenerational relationships. Since then, we have been fortunate to be mentored by Professor Nathan Herrmann from Sunnybrook Health Sciences Centre, who has generously given of his time and expertise to mentor and supervise our student leaders with dementia advocacy. You can also follow Professor Herrmann’s “Memory Doctor” blog for dementia caregivers, with his latest post on “Caring for a person with dementia during the COVID-19 pandemic” at: http://health.sunnybrook.ca/memory-doctor/

 

 

 

Professor Nathan Herrmann and Student Executive Team

Chair               Selina Chow
Vice-Chair       Zoë Stevens

Nathan Herrmann MD FRCPC
Professor, Faculty of Medicine, University of Toronto
Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

 

Concluding Remarks for Another Year of the Dementia Awareness Program

As we come to the end of our fourth year of the Dementia Awareness Program, we are happy to say that we have been able to carry on our vision of raising awareness and addressing the stigma surrounding dementia through this blog and our dedicated student team who volunteer at a local seniors’ residence weekly. 

We are now in our fourth year of the community partnership between Havergal College and Briton House retirement home in Toronto, Canada. A group of six students and two dedicated advisors visited residents living with dementia weekly. Throughout our time together, we got to know the residents by chatting one and one with them and in small group settings. This year, we added some new popular activities during our visits, such as knitting, board games, and mail delivery. Knitting was new for some of the students, but the residents were great teachers! By delivering mail - such as letters, magazines, and postcards - to the residents' rooms, we were also able to reach out and have a great conversation with other residents at the retirement home that we did not get to interact with during our weekly visits. The residents seemed to really enjoy this time with us! Another exciting activity this year was a singing performance by our students that turned into a sing-along with the residents' favourite childhood songs like "Unto the Hills". This was a big hit and many residents came up to us afterwards to say how much they enjoyed and appreciated the sing-along. Interestingly, some of the residents were alumni from our school, Havergal College, and we were able to hear fun stories about their time at Havergal and favourite school events. Our weekly visits to Briton House impacted not only the seniors' lives, but also our lives significantly. It was such an amazing opportunity and we cannot wait to come back next year!

On behalf of the Dementia Awareness Program, we would like to thank all of our student volunteers and teacher advisors from Havergal College for their dedication and ongoing support this year. We would also like to sincerely thank the residents and staff at Briton House for allowing us to visit weekly and create countless memories together. 

To our readers, thank you for following our monthly blog series this year, and we hope that you have been able to learn more about the resources and support available for dementia patients and caregivers through Canadian organizations, as well as the National Dementia Strategy. For those of you who are affected by dementia directly or indirectly, we hope that our blog series has introduced you to helpful resources that you can use or get involved with. 

Lastly, we would like to sincerely thank Dr. Herrmann for his continued support and guidance over the program and this blog for the past four years. Most notably, we would like to thank him for sharing his insight with all of us and providing a clinician / researcher’s perspective on Canada’s first ever National Dementia Strategy.  For more information on dementia, you can also follow Dr. Herrmann’s “Memory Doctor” blog for dementia caregivers at:http://health.sunnybrook.ca/memory-doctor/

On behalf of all the Havergal College students involved in this program, thank you for your continued support and engagement with the Dementia Awareness Program!

Professor Nathan Herrmann and Student Executive Team

Chair                Selina Chow

Vice-Chair        Sae Furukawa

Vice-Chair        Katie Taub

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair, Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

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

Expert Commentary: Canada’s National Dementia Strategy – 3 National Objectives

Canada’s national dementia strategy is aimed at advancing dementia prevention, research, and care provided to individuals with dementia and their caregivers. This strategy is guided by 5 principles, which we covered in a previous post in December 2019, as well as 3 national objectives – which are as follows:

“ 1. Prevent dementia

   2. Advance therapies and find a cure

   3. 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

We were fortunate to have the opportunity to ask Professor Nathan Herrmann for his expert opinion and commentary on these 3 national objectives outlined in Canada’s national dementia strategy.

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 3 national objectives from Canada’s dementia strategy mentioned above are certainly laudable, though one could be forgiven for being somewhat cynical. After all, the era of Alzheimer’s disease therapeutics is now over 40 years old, and all we have to show for these efforts are 4 drugs (donepezil, galantamine, rivastigmine, memantine) that are modestly effective at best. These drugs do not prevent Alzheimer’s disease, nor do they halt progression of the illness. Unfortunately, there have also been a very large number of drugs and vaccines that have failed in spite of promising preliminary results and sound theoretical basis. We are constantly reminded that what works in rat brains, may not necessarily work in human brains! These failures have had significant consequences, and a number of the large pharmaceutical companies have decided to withdraw from Alzheimer’s disease research believing it is too risky.

And yet, there is reason to remain optimistic. There is good reason to believe that non-drug treatments like exercise, mentally stimulating activities, dietary changes, management of cardiac risk factors including blood pressure, alone and in combination, can improve cognition and perhaps delay onset of dementia. It is estimated that by finding a treatment which delays the onset of Alzheimer’s disease by as little as 5 years, we could cut the prevalence of the illness in half!

Improving the quality of life of for people with dementia and their caregivers is an equally important objective. There will not be a cure found tomorrow, and so we must still deal with the over half a million Canadians that already suffer from the disease. Being a caregiver for people with dementia is a ‘hazardous profession’ as these individuals are at high risk for burn-out, depression and multiple medical illnesses. We must work to discover the best way to provide education and support for patients and their families in order to ease the burden and optimize their quality of life.

Nathan Herrmann MD FRCPC

Professor, Faculty of Medicine, University of Toronto

Lewar Chair, Geriatric Psychiatry

Head, Division of Geriatric Psychiatry

Sunnybrook Health Sciences Centre

Featured Organization: Canadian Consortium on Neurodegeneration in Aging

We recently had the opportunity to interview Victor Whitehead from the Canadian Consortium on Neurodegeneration in Aging on the work their organization does in Canada to drive research in this field. We would like to sincerely thank Mr. Whitehead for taking time out of his busy schedule to speak with us.


1. Tell us about your organization – who you are, what you do, and what your mission is.

We are the Canadian Consortium on Neurodegeneration in Aging (CCNA). This entity has been in existence since 2014 and is a network of over 310 Canadian scientists in 19 teams that are collaborating on research aimed at preventing, treating, and curing age-related neurodegenerative diseases (NDD), and on improving the quality of life of people living with dementia.  

2. Why is dementia research important, and what are the current areas of focus for research in this field today?

While tremendous strides have been made in understanding the development and presentation of dementia, an effective treatment has not yet been developed. As the segment of the population over 65 grows, the number with dementia will also grow. According to the Alzheimer Society of Canada, it is expected that by 2031, 937,000 Canadians will be living with dementia, a 66% increase over the present day. The cost of caring for those with dementia is expected to increase from $10.4 billion per year at present to $16.6 billion by then. These statistics highlight the urgency to find effective ways to prevent and treat dementia.

At CCNA, we believe that it is important to approach the challenge of dementia from as broad a perspective as possible, so we have people working on discovering the mechanisms of dementia and how to block them, others are working on ways to identify dementia markers before symptoms occur, and others are looking for ways to minimize its impact once it is present. As well, we have programs focussed on prioritizing certain aspects within our research such as how dementia impacts the sexes differently and why (Alzheimer’s disease affects more women than men, while Parkinson’s disease, especially with cognitive decline, affects more men than women); how to eliminate the stigma associated with dementia; and how to help improve the awareness and involvement of indigenous peoples in our research program.

3. What programs and resources are available through your organization?

We have a website (http://ccna-ccnv.ca) where people can learn more about who we are and the work we are doing. On there, we have a “contact us” link where one can ask for specific information and we will respond with what we know and pertinent programs and resources that may help.

4. How can interested individuals or groups support your organization and the amazing work you are doing?

The government recently introduced a National Dementia Strategy which aims to greatly increase Canada’s response to the challenge of dementia through increased funding of care and research. We encourage everyone to let their local government representatives and candidates know that they support the National Dementia Strategy and wish to see it fully funded (https://alzheimer.ca/en/Home/Get-involved/Advocacy).

As well, we are presently recruiting participants for a study we are doing across the country to extend our understanding of what is occurring as dementia develops and progresses. The study is called the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study and more information about it can be found at http://ccna-ccnv.ca/compass-nd-study/. In addition, we will soon be beginning a study looking at different ways to prevent the development and progression of dementia to determine which method, or combination of methods, is the most effective. The details of this study and how/where to enroll will be on our website in the coming months.