Caring for seniors with dementia and their caregivers: A guide for physicians

Community-based health care providers, such as physicians, nurse practitioners and others, should be aware of services and resources to help people living at home with dementia as well as their caregivers. A review in CMAJ (Canadian Medical Association Journal) aims to provide guidance to health care providers as well as government and health system planners, based on recent evidence.

"All health care providers should be aware of their local resources for dementia and which services may be most beneficial for their patients and caregivers," writes Dr. Dallas Seitz, Queen's University, Kingston, Ontario, with coauthors. "Health system planners and policy-makers should be aware of services that have been shown to be beneficial for people and plan to meet the increasing demand for these services in the future."

In Canada, over 500 000 people are affected by dementia, and society spends $15 billion annually caring for this population.

Highlights of the review:

• Early detection of dementia is an important first step for accessing services by proactively identifying people at risk (case finding) rather than through broad population screening programs. Identifying dementia early can relieve stress and uncertainty for patients and their caregivers and facilitate early connection to supports.
• Evaluation for dementia should include patient history of cognitive and functional changes, medication review, cognitive screening tests, blood work and neuroimaging in some situations.
• Community-based supports, such as in-home support services, caregiver education and training, respite programs and more, have been shown to delay admission to long-term care facilities.
• Caregiver education programs and coordination of care have been effective at delaying placement in homes and are cost-effective.
• Reducing caregiver stress is important for keeping people at home as long as possible.
• Referral to dementia specialists may need to be selective, given the limited number of specialists and the increasing number of people with dementia. Referrals should be made when there is diagnostic uncertainty, marked change in a person's behaviour, challenges with medication and other complicating problems.

Some parts of Canada may currently have limited access to supports mentioned in the review.

"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. 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," the authors conclude.

"Care of community-dwelling older adults with dementia and their caregivers" is published July 3, 2018.