January 25, 2022

The global pandemic marked Canada as an outlier in one significant, tragic way. While seniors in most countries were hit hard, in Canada, a whopping 81 per cent of all deaths in the initial months of the pandemic happened in long-term care, compared to a mean of 42 per cent in other OECD countries

Transformative Change Needed in Senior’s Care
-Major investments and significant changes should be made in the long-term care sector, according to a new report from the C.D. Howe Institute.
-Author Rosalie Wyonch recommends expansions in both residential and homecare so Canadian seniors can receive care when they want it, where they want it. The report also recommends major investments in long-term care and retirement homes, to mitigate the risks of future infectious disease outbreak and improvement of quality-of-life needs for seniors.
-Prior to the pandemic, Canada had long waitlists for long-term care homes and had fewer homecare providers than the international average. These existing shortfalls will be compounded by Canada’s ageing population as babyboomers surpass 80 years of age. Making necessary changes to improve the quality of long-term care—such as reducing occupancy per room, increasing staffing levels, supporting higher wages for care workers, constructing new facilities—would require nearly every new dollar of health spending be directed to seniors care, with annual costs projected to increase to 4.2% of GDP by 2040. This level of investment in seniors’ care is unprecedented and fiscally infeasible. Innovative approaches will be required.

Residents in Canada’s long-term care (LTC) homes have been disproportionately impacted by COVID-19 infections and deaths. While the pattern of infections among LTC residents mirrors the first 3 COVID-19 waves observed in the community, those in LTC experienced more COVID-19 deaths. In Canada, LTC residents accounted for 3% of all COVID-19 cases and 43% of COVID-19 deaths. This analysis, which includes data from both CIHI and the National Institute on Ageing, provides a picture of the impact the pandemic has had on LTC residents.

BACKGROUND: Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. METHODS: We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. FINDINGS: We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4-65·1) million cases globally in 2019 to 152·8 (130·8-175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [-7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64-1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52-1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. INTERPRETATION: Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. FUNDING: Bill & Melinda Gates Foundation and Gates Ventures.

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Older adults, particularly those with declining health, have frequent hospitalizations. These hospitalizations can result in cognitive and functional decline and many are considered potentially avoidable with appropriate care. Many countries have invested in services that help older individuals with declining health to live at home longer, including home care package support and respite care for carers, but also long-term residential care for those who no longer can live at home. Studies in New Zealand, Germany, and Canada have shown a substantial increase in hospitalizations in the months prior to entry into long-term care, which demonstratively decrease after entry into care. This suggests that entry into long-term care itself is a significant intervention that can reduce hospitalizations, with important consequences for individuals’ well-being and likely of cost of care. Our study examined whether a similar pattern of increasing hospitalization before entry into long-term care and subsequent decline in hospitalization after, was observed in Australia.