Dementia, like many other chronic diseases, has a substantial impact on the people the disease affects, communities and the associated health care system. I had a wonderful opportunity to discuss this issue with my class mate Kelly. Kelly and I have compared British Columbia and Ontario dementia care system. Given the two provinces have a big population difference between them, similarities and differences were noted. Refer to the table below which compares the surveillance, management and funding for dementia.
Surveillance
Ontario:
In 2016 there were 228 000 cases of people living with Dementia. Of those 228 000 Roughly 56 000 Canadians with dementia are being cared for in hospital which is not ideal
British Columbia
From 2016 to 2017 7.7% of BC population was diagnosed with dementia:
61,000 (6.6%) people are aged 65+
5000 (1.1%) people are under age 65
Currently, 2,597,816 people in BC are at risk
Management
Ontario:
In ON, dementia testing is nonspecific but includes:
CT or MRI
Blood pressure and blood testing
MoCA (Montreal Cognitive Assessment) which is a cognitive test assessing judgement done by a Neuropsychologist
British Columbia:
No single test can rule out dementia; must run series of test to eliminate the other possibilities and these tests are:
Blood test
CT
SPECT
PET
MoCA
To diagnose Alzheimer's disease, the patient must display the following features: Cognitive changes that are of gradual onset over months to years
Two of the following cognitive domains are impaired: memory, language, visuospatial or executive function (memory is the most common)
Impairment causes a significant functional decline in usual activities or work;
Symptoms are not explained by other neurological disorder (including cerebrovascular disease), psychiatric disorder, systemic disorder or medication.
Resources
Ontario:
Given 56 000 Canadians are living with dementia in hospital, which is not ideal either for the patient nor the health care system, the MHLTC has developed a new dementia strategy. Within this strategy there are 6 key themes guiding the development of ON’s dementia strategy
Supports for people living with dementia
Accessing dementia services
Coordinating care
Support for care partners
Well trained dementia workforce
Awareness, stigma and brain health
The goal of the strategy is to get people living with dementia out of the hospital setting and to strengthen person-centered health care and support people living with dementia independently in the community
On similar strategy we noted between the provinces was:
This is a referral service in Ontario that links patients with multiple issues up with community services
British Columbia:
VGH: Special Dementia Unit – first specialized dementia care hospital unit in Canada created in 2017
Support demented patients and families
Focus at recreational activities to stimulate patient instead of isolating patient
Transition planning from hospital to home
Special trained healthcare workers
First Link is also another community resources that links patients and families to dementia support and services in the community.
Funding
Ontario:
In Ontario the total health care budget for 2017-18 was $53 billion. In 2017 the province invested more than 100 million into expanding dementia care. From 2008 – 2038 the total cost for dementia is estimated at $325 billion.
British Columbia:
Ministry of Health and Provincial Health had contributed $ 10 million since year 2007 (Government of BC, 2019)
Referring to above comparisons, the two provinces had put in great deals of effort in supporting dementia care. The only difference we see is that in Vancouver, dementia care and support may be a little bit more advance as in compare to Ontario. Regardless, there are still limitations as in what the supports can provide. Hope fully one day their will be a cure or better plan in place.
References:
Ministry of Health and Long Term Care (2017) More Support for People Living with Dementia, and Their Families. Retrieved from https://news.ontario.ca/mohltc/en/2017/05/more-support-for-people-living-with-dementia-and-their-families.html
Ministry of Health and Long Term Care (2017) Developing Ontario’s Dementia Strategy. Retrieved from https://www.ontario.ca/page/developing-ontarios-dementia-strategy-discussion-paper
Government of B.C. (2019). B.C. Commits an Additional $4 Million for Dementia Care. Retrieved from: https://news.gov.bc.ca/stories/bc-commits-an-additional-4-million-for-dementia-care
Government of British Columbia. (2016). Cognitive Impairment - Recognition, Diagnosis and Management in Primary Care. Retrieved from:
https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/cognitive-impairment#diagnosis
Vancouver General Hospital. (2018). As BC’s elderly population increases dramatically, so does the need to ensure access to high-quality holistic health care for our aging parents and grandparents. Retrieved from: http://vghfoundation.ca/2018/06/20/geriatric-health-caring-with-heart-and-hand/
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