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Tackling Dementia Will Require a Fast Sprint

New federal strategy on prevention and care has fine goals, but needs a lot more than $81 million for any hope of success.

Crawford Kilian 20 Jun 2019TheTyee.ca

Tyee contributing editor Crawford Kilian blogs at The Politics of Dementia.

On June 17, Health Minister Ginette Petitpas Taylor issued A Dementia Strategy for Canada: Together We Aspire. When so many governments have endorsed their “aspirational” support for this or that good but impossible cause, cynics might be forgiven for dismissing this plan for its title alone.

But we have learned just enough about Alzheimer’s and the other dementias to realize how ignorant we really are. The human brain is a highly complicated system, and it breaks down in highly complicated ways. We lack answers to most of our key questions, and we don’t even know if they’re the right questions.

Still, the new strategy reflects the best current thinking on the subject, and points out three “national objectives” for Canadians. We can aspire to meet them, but we can’t be assured of easy, early victories.

The first objective is common sense: to prevent dementia in the first place. We’re to achieve this by more “research to identify and assess modifiable risk and protective factors.” In other words, how do we expose ourselves to dementia, and how do we protect ourselves?

We know nine likely risk factors: lower levels of education, midlife high blood pressure, obesity, hearing loss, smoking over age 65, depression, physical inactivity, diabetes and social isolation. But they’re likely, not ironclad, causes. As Damon Runyon famously observed, “The race may not always be to the swift nor the victory to the strong, but that’s how you bet.”

Improving the odds of that bet would be politically challenging. How do we keep young people in school when they’re screaming to get out? How do we discourage terrible eating habits, smoking and physical laziness, when whole supermarket aisles are dedicated to junk food and sugary drinks? How do we diminish mental health issues like depression and social isolation, when we’ve rebuilt our society to encourage screen addiction?

Dementia-prone attitudes

Overcoming such dementia-prone attitudes is foreseen in the strategy, which recommends we: “Support measures that increase the contribution of social and built environments to healthy living and adoption of healthy living behaviours.”

Short of revolution, it’s hard to imagine what those measures might be. Millions of Canadians kicked back on the La-Z-Boy with a bowl of chips and a six-pack to watch superbly fit athletes win the NBA final for Canada. Banning abusable substances, whether coke or Coke, is a fool’s game and only enriches those willing to meet what the market demands.

The second objective is to advance therapies and find a cure. This again is common sense, but we’re a small player in the dementia-research game. Sure, we were even smaller when Banting and Best discovered insulin, but they didn’t face the bureaucratic funding obstacles that today’s researchers do.

The plan asks us to “establish and review strategic dementia research priorities for Canada.” That sounds like steady work for ministry officials and deans of medical schools, but politics is likely to set the priorities. The bureaucracies of Big Pharma endorsed the spending of billions on ineffective anti-dementia drugs before recently pulling the plug. Therapies, and especially a cure, are more likely to be found by accident, or by a maverick who doesn’t play well with bureaucrats.

Third, we’re urged to “improve the quality of life of people living with dementia and caregivers.” No argument there, at least until we start talking money. Health care is premised on the hope of saving lives; dementia care can only hope to lose them less painfully. We can’t rely on an endless supply of saints to look after our grandmothers and husbands. We will need to recruit them aggressively, train and equip them superbly, and pay them like the rare professionals they will be.

But however grateful the families of the demented may be for the new strategy, that gratitude is unlikely to pay off in the next election. For the foreseeable future, improving quality of life is likely to depend on small-scale, volunteer-driven support programs, or subsidies for expensive adult daycare programs staffed by relatively inexpensive and untrained caregivers.

Such programs, however expensive, will not interest the wealthy donor class on which political parties depend. The donors can afford their own resources.

Dementia villages too costly

In Britain, one “hotel” for dementia cases charges US$3,000-$3,500 a week and has a six-month waiting list. A famous Dutch dementia village, Hogeweyk, costs families US$7,000 a month. In Langley, The Village will soon offer a similar environment from $6,950 a month for meals, laundry and help with bathing and medication, to $7,800 for all that plus “advanced, 24-7 nursing care.”

Such gated communities may improve the quality of the last months of life for very rich old people. But the simple act of moving people with dementia out of their homes and into special-care environments tends to accelerate their decline. No matter how congenial the surroundings, most will last only a few months.

Improved support for caregivers is more likely to improve the quality of life for both them and those they care for. It won’t be as expensive as dementia villages, but skilled and compassionate professionals will be hard to find without robust funding and aggressive recruitment — especially from poor countries that value elder care more than we do.

Petitpas Taylor promised $50 million over five years, plus $31.6 million to support research by a national consortium. Her report predicts that by 2031 the total costs to health care and caregivers will reach $16.6 billion. By that time $81.6 million will look less than pathetic — especially in the 2030s, when we’re likely to be contending with climate catastrophes, refugees and countless other sorrows.

As the old saying reminds us, a journey of a thousand miles begins with a single step. The Trudeau government has taken that step. Now it has to cover the rest of the thousand miles at a sprint.  [Tyee]

Read more: Health, Federal Politics

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