Costs to soar as aging Canadians face rising tide of dementia

By: André Picard, Public Health Reporter
The Globe and Mail January 3, 2010

The annual cost of dementia is projected to soar tenfold in the next generation, a stark illustration of the impact an aging Canadian population will have on the health-care system.

By 2038, dementia will cost a staggering $153-billion a year, up from the current $15-billion a year, according to a report being released today.

From 2008 to 2038, the number of Canadians living with Alzheimer’s disease and other forms of dementia will jump to 1.1 million from 500,000 today, the new projections show.

Dementia is just one of the chronic health conditions on the rise as the grey tsunami washes across the country. The number of seniors living with diabetes, heart disease, cancer, lung disease and arthritis is also increasing.

Not only will looking after the aging population be financially costly – health already makes up more than 40 per cent of government spending – but it will place a tremendous burden on the health and social services systems and, above all, families providing care to their loved ones.

“We need to get a lot smarter about how we deal with dementia,” David Harvey, government relations officer at the Alzheimer Society of Canada, said in an interview. He noted that when people have dementia, they invariably have other health issues that complicate their care.

“If we don’t take steps now to keep people out of long-term care, we will be spending a lot of money and place a crippling burden on families,” he said.

The report, entitled “Rising Tide: The Impact of Dementia on Canadian Society,” was commissioned by the Alzheimer Society and prepared by RiskAnalytica, a Toronto-based consultancy that specializes in risk management.

The report says that the country is facing a dementia epidemic and a “comprehensive national plan” is required to contain it.

“This national plan would prepare for and mitigate the burden of dementia on Canadian society and direct health expenditures toward activities that have the greatest potential to maximize quality of life, support individuals and families, make best use of our scarce health human resources and reduce institutionalization and overall health costs,” said Richard Nakoneczny, volunteer president of the Alzheimer Society of Canada.

Dementia is already the leading cause of disability among Canadians over the age of 65 and numbers will continue to rise as baby boomers age.

According to the report, the number of long-term care beds will increase to 690,000 in 2038 from 280,000 today. Despite that large jump, there could still be a shortfall of 157,000 long-term care beds, according to the projections.

At the same time, an additional 510,000 people with dementia will be cared for at home in a generation. (Fifty-five per cent of people with dementia are currently cared for at home, and that will jump to 62 per cent.) That will translate into a substantial increase in the demand for community services such as home care, day programs and respite care to backup informal caregivers, the report says.

Katherine, a 68-year-old Toronto woman currently caring for two parents with dementia (aged 87 and 88), said her story – a senior caring for older seniors – represents the future for many Canadian families.

“We’re all going to go through this, so we need to face it now,” she said.

Katherine – who asked that her family name not be revealed because her parents could not give their consent – said her parents want to remain in the home but the availability of community-based services is limited.

“I want to respect their wishes but am worried about their safety. It creates quite a dilemma,” she said.

The Rising Tide report recommends a number of approaches to lessen the burden of dementia on both families and the economy.

The first is education to promote healthier lifestyles – particularly physical and mental exercise – that can delay the onset of dementia.

The report also calls for a big investment in skill-building and support programs for family caregivers. Caregivers spend an average of 7.4 hours daily assisting their charges with activities of daily living such as washing, dressing, toileting, laundry, shopping, cooking and household finances. About 85 per cent of caregivers are women.

Finally, the report recommends that a “system navigator” be assigned to each newly diagnosed dementia patient. This approach, used in some European countries, has been shown to improve access to community care and delay admission to long-term care facilities.

“Hope lies in making changes today that will lessen dementia’s crippling effect on Canadian families, the health-care system and the economy,” Mr. Nakoneczny said.

Alzheimer’s disease is the most common form of dementia, followed by vascular dementia and other conditions such as frontotemporal dementia, Lewy body disease and Creutzfeldt-Jakob disease.

Prevalence of Alzheimer’s
2008: 480,600
2038: 1,125,000

2008: 103,700 new cases
2038: 257,800 new cases

Informal care
2008: 231 million hours
2038: 756 million hours

Economic burden
2008: $15-billion
2038: $153-billion

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