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Review offers Canadian physicians guidance on caring for dementia patients, caregivers

A review published in Canadian Medical Association Journal advises community-based health care providers in Canada to be aware of local services and resources to help patients with dementia and their caregivers.

“In Canada, about 500,000 individuals are currently affected by dementia. Caring for people with dementia is complex and costs the health system $15 billion annually,” Natalie Warrick, MSc, PhD candidate at the Institute of Health Policy, Management and Evaluation, University of Toronto, and colleagues wrote. “The findings of qualitative studies involving people living with dementia and their caregivers have suggested that improvements in care and health care for these individuals would be welcomed.”

Using data from clinical meta-analyses, systematic reviews, randomized control trials and observational studies, the researchers offered guidance on caring for people with dementia and their caregivers to health care providers, health system planners and government officials.

Based on the evidence, the authors highlighted the importance of:

• early detection of dementia as a first step for accessing services by proactive identification of people at risk instead of by broad population screening programs;

• getting patient history of cognitive and functional changes, medication, cognitive screening tests, blood work and possibly neuroimaging to accurately evaluate dementia;

• community-based supports (ie, in-home support services, caregiver education and training and respite programs);

• caregiver education programs and coordination of care as an efficient and cost-effective way to delay placement in long-term care facilities; and

• reducing caregiver stress to keep people with dementia at home for a longer period.

Early identification of dementia not only helps people get the help they need faster but can also lessen stress and uncertainty for patients and caregivers, according to the release. The review also emphasized that referring patients to dementia specialists may need to be selective because there is a limited number of specialists and an increasing number of people with dementia, the release said. The authors recommended that referrals be made when there are uncertain diagnoses, notable change in behavior, challenges with medication and other complications.

To reduce the gaps in the evidence, the authors wrote that research is needed on most community-based services for dementia (especially for respite programs), the effects of case-finding approaches for detecting older adults with dementia and interventions that cut unnecessary hospital admissions and ED use.

"The identification and care of community-dwelling people with dementia and their caregivers is complex and will often involve multiple supports and services to optimize outcomes,” Warrick and colleagues concluded. “Existing guideline recommendations for dementia and high-quality evidence underscore that community-level multicomponent supports, including caregiver education and training programs, some forms of respite programs and case management approaches for dementia, are effective in delaying admission to long-term care settings for older adults with dementia and reducing caregiver stress.” – by Savannah Demko

Disclosures: Warrick reports no relevant financial disclosures. Please see the study for other authors’ relevant financial disclosures.