Social Policy in Ontario

No group has been harder hit by the coronavirus pandemic than people living with dementia.

They account for a staggering two-thirds of the nearly 9,000 COVID-19 deaths in Canada. (Here’s the math: Eighty per cent of COVID-19 deaths occurred in long-term care and 80 per cent of long-term care residents have dementia.)

As we reflect on this horrific mortality rate, we owe it to our elders to not accept the heartless and all-too-common “they were going to die anyhow” shrug of indifference.

There is no excuse – medical, political or social – for our failure to do a better job protecting the most vulnerable among us.

The lives of people with dementia have as much value as anyone else.

For that reason, we need to look beyond the immediate debacle that has unfolded in congregate care settings and ask ourselves a couple of fundamental questions:

• Why are so many people with dementia – more than 300,000 in Canada – in institutional care?
• Why do so many seniors develop dementia in the first place?

There are 6.6 million Canadians older than 65, the age at which we arbitrarily decide someone is old. An estimated 564,000 of the “golden agers” are living with Alzheimer disease and other forms of dementia (of which there are dozens), and that number is growing by 25,000 a year, according to the Alzheimer Society of Canada.

Dementia is also a global issue, affecting more than 50 million people worldwide, with 10 million new cases annually.

Beyond the health impacts on individuals, there are economic costs, about $10.4-billion in Canada, and US$1-trillion globally.

While these numbers are mind-numbing, we have to stop looking at dementia as inevitable or an automatic death sentence. While rates increase with age, dementia is not an inescapable curse of aging.

In fact, a new report, published in the medical journal The Lancet, says that 40 per cent of dementia cases could be prevented or delayed by targeting a dozen modifiable risk factors, ranging from making sure every child gets an education through to controlling high blood pressure.

The report, prepared by a blue-ribbon panel that includes Dr. Kenneth Rockwood, an Alzheimer researcher at Dalhousie University in Halifax, includes an easy-to-understand list of measures that could be adopted, individually and collectively, to reduce risk. And it even includes an approximate impact of each policy:

• Reduce rates of hypertension by aiming to maintain systolic blood pressure of 130 mm Hg or less after the age of 40, 2 per cent reduction in dementia risk;
• Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels, 8 per cent;
• Reduce exposure to air pollution, 2 per cent;
• Prevent head injury, particularly by targeting high risk occupations and transport, as well as high-impact sports, 3 per cent;
• Prevent alcohol misuse and limit drinking to less than 21 units per week, 1 per cent;
• Stop smoking uptake and support individuals to stop smoking (which the authors stress is beneficial at any age), 5 per cent;
• Provide all children with primary and secondary education, 7 per cent;
• Lead an active life into mid-, and possibly later life, 2 per cent;
• Reduce obesity, particularly after mid-life, 1 per cent;
• Reduce rates of diabetes, 1 per cent;
• Prevent and treat depression, 4 per cent;
• Reduce social isolation, particularly in seniors, 4 per cent.

None of this is new or shocking, but it’s a reminder that preventing dementia begins in childhood, not at retirement. The research also help us understand that countless lifestyle choices and public health measures can have a dramatic impact on our brains, and the health of individuals and societies more broadly.

While ambitious, all these recommendations are doable in whole or in part. It’s worth noting too that addressing these risk factors would have benefits well beyond dementia; they would reduce rates of cardiovascular disease, cancer, COPD (chronic obstructive pulmonary disease) and more.

While the focus of the new report is primary prevention, people with cognitive decline or dementia can benefit from secondary prevention such a rehabilitation, remaining active in the community, and keeping their brains busy.

COVID-19 aside, one of the worst things we can do to our elders is dispatch them off to facilities where they are isolated, inactive, treated as helpless, and forgotten.

Not all dementia is preventable. But taking our elders for granted is.

Not all dementia is preventable. But taking our elders for granted is.