Abstract
BackgroundDementia is common, particularly among older adults, and is one of the major causes of dependency later in life. We sought to provide an overview and comparison of key services related to dementia care as the disease progresses in three large Canadian healthcare centres.MethodsWe identified family physicians, geriatric specialists, and dementia case managers from three major population centres in Canada with universal healthcare coverage. Using a standardized longitudinal dementia case vignette, participants were interviewed on services they would provide at each stage of the disease. We used principles of content analysis to generate codes and identify themes; appropriate time frames from the vignette fitting the necessary provision of services were derived from the Canadian consensus statement and determined in consultation with clinical experts. Proportions of participants that identified dementia-related care services were analyzed at each time point of the vignette using chi-square tests.ResultsThirty-four healthcare providers from Calgary (Alberta), Edmonton (Alberta), and Ottawa (Ontario) participated. Review of our data identified seven overarching themes of dementia-related care services. Services provided in the community setting include future planning and related services, educational and social support services, and home care and respite services. Although all providers consistently identified educational and social support services (e.g. the Alzheimer Society) within the appropriate time frame, the provision of other services was variable. The proportion of providers reporting potential access of future planning services was significantly different across the three sites (Calgary, 91.7 %; Edmonton; 58.3 %; and Ottawa, 30.0 %), p = 0.012. Also, the proportion of providers that identified day program services were significantly different across the three sites (Calgary, 100.0 %; Edmonton, 91.7 %; and Ottawa, 60.0 %), p = 0.023 according to a chi-square test.ConclusionsWe found important types of variability in service delivery among different regions in Canada for a typical patient with dementia and their family caregiver. Health systems can be calibrated by aligning services from different settings to appropriate time points in the vignette, which illustrates the dynamic course of service delivery and opportunities for improvement throughout the disease trajectory.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1435-1) contains supplementary material, which is available to authorized users.
Highlights
Dementia is common, among older adults, and is one of the major causes of dependency later in life
Approximately 24 million people aged 60 years or older live with dementia across the globe, 40 % of which reside in higher income settings such as Canada [1, 2]
We found that participants from Calgary generally reported accessing future planning services earlier, by the latest time in the vignette according to guidelines, and proportionately more than other sites
Summary
Among older adults, and is one of the major causes of dependency later in life. 24 million people aged 60 years or older live with dementia across the globe, 40 % of which reside in higher income settings such as Canada [1, 2]. Life-limiting, and one of the major causes of dependency later in life [3]. 7.7 million new cases of dementia are reported each year; a new case every four seconds [2]. Alzheimer’s disease, vascular dementia, and mixed dementia (exhibiting elements of Alzheimer’s and vascular dementia) represent the great majority of dementias in community settings [4]. In Canada, about 62 % of all dementias are identified as Alzheimer’s disease, % are vascular dementia, and a further % are identified as mixed Alzheimer’s and vascular dementia [4]
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