Healthcare, Affordability, and Dementia: Can All Three Coincide?

By Kateryna Maksyutynska

There are over 402,000 senior Canadians living with dementia and the count increases by approximately 76,000 cases each year.1 Dementia is an umbrella term used to describe a condition in which an individual loses cognitive function and experiences symptoms such as impairment of memory, problem-solving, attention, and thinking. There are a variety of diseases and conditions that put individuals at greater risk of developing dementia, ranging from cardiovascular disease to traumatic brain injury, that damage brain cells and signaling in the brain. Alzheimer’s disease, which is the leading cause of dementia contributing to 60-70% of cases, is a highly heritable neurodegenerative disease that is marked by progressive brain atrophy and memory loss. Dementia is a complex disorder that must be explored from various perspectives to be able to provide the best care to patients.

There is currently no cure for dementia, but there are pharmacological and non-pharmacological treatments designed to manage symptoms arising from the underlying diseases and disorders. However, the drugs that have been approved in Canada to treat cognitive impairment, including Donepezil, Rivastigmine, Galantamine, and Memantine, do not target all the symptoms associated with dementia and are not always effective in severe cases of dementia.3 This results in some individuals still requiring additional supports to manage their symptoms. As a result, many individuals with dementia are transferred to long-term care facilities or taken care of in their community by their family members or personal support workers, where they can be closely monitored throughout the day. This puts significant financial burden on both caregivers and the healthcare system as they incur higher treatment costs which amount to more than any other disease, including heart disease and cancer.4 on the type of accommodation (basic, semi-private, or private). Although there are government financial supports and insurance programs available to offset the costs and make the care more affordable, not all individuals qualify for the programs or coverage. Two thirds of costs remain to be paid out-of-pocket by seniors or their caregivers.5 The total annual out-of-pocket costs to dementia caregivers in Canada are projected to rise to the billions by 2031.5 In addition to the monetary costs, caregivers

Annually, dementia costs the Canadian economy and healthcare system about $10.4 billion.5 This encompasses a variety of costs generated by ambulatory care, rehabilitation, prescription drugs, physician and healthcare services, and inpatient hospital care.6 However, the most significant costs stem from long-term care, home care, and complex continuing care where individuals with dementia are monitored and/or treated for a longer duration of time.6,7

To put this into perspective, long-term care accommodation costs in Ontario range from $63 to $91 per day, depending of individuals with dementia experience significant stress which often comes at the cost of social isolation, and physical and psychological health problems.8 There are significant costs associated with symptom management and care for individuals with dementia.

Despite this, as of May 2021, over 38,000 individuals were waiting to access a long-term care bed in Ontario, with wait times averaging up to 171 days.9 It is evident that costs associated with healthcare for individuals with dementia does not eliminate the need for such services, especially since 69 percent of long-term care patients are diagnosed with dementia.10 With a growing prevalence of dementia in the population, this may put a significant strain on long-term care services and impact the healthcare system, while also impacting economic development because of the costs associated with dementia treatment.

Women with dementia tend to have greater costs associated with their care due to comorbid health conditions that present more frequently in women than men.11 Interestingly, there is a disparity in spending such that the prevalence of dementia is higher in low- and middleincome countries, but dementia spending costs are greatest in high-income countries where dementia rates are lower.12 This may be due to a difference in use of long-term care homes because of their significant costs and varying cultural norms. Often, in low- and middle-income countries, caregivers tend to the dementia patients themselves which limits their ability to work, and in turn presents as an economic burden. These are additional considerations that must be reviewed when making reforms to ensure affordability of healthcare for individuals with dementia. Such healthcare disparities must lead future research and policies to optimize the treatment and care of individuals with dementia around the globe.

In 2017, the World Health Organization released the Global Action Plan on the Public Health Response to Dementia

2017–2025 which states that universal health coverage and social care must be provided to protect individuals with dementia and their caregivers from financial risk while offering access to resources to promote their care. Furthermore, dementia research must be prioritized to keep up with the demands for novel therapies and treatments to mitigate the various stressors of the disorders, ranging from the affected individual to the community. This effort must be well-funded and supported. Specifically, research in this field requires $359 million to translate dementia-treating drugs from bench to bedside.5 Thus, further advances are urgently needed in this field to optimize the care of patients and their caregivers.

With the population aging and the life expectancy increasing in Canada, dementia is a growing topic of concern. Healthcare and supports for individuals with dementia must be made affordable and this should be prioritized due to its significant impact on a multifaceted network of individuals, starting from the patient and branching out to their caregivers, community, and healthcare system.

References

1. Public Health Agency of Canada. Dementia in Canada, including Alzheimer’s disease [Internet]. 2017. Available from: https://www. canada.ca/en/public-health/services/publications/diseases-conditions/dementia-highlights-canadian-chronic-disease-surveillance. html#shr-pg0

2. Shepherd H, Livingston G, Chan J, et al. Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Med. 2019;17(1):130.

3. Li DD, Zhang YH, Zhang W, et al. Meta-Analysis of Randomized Controlled Trials on the Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer’s Disease. Front Neurosci. 2019;13:472.

4. Kelley AS, McGarry K, Gorges R, et al. The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life. Ann Intern Med. 2015 Oct 27;163(10):729–36.

5. Alzheimer Society of Canada. Prevalence and Monetary Costs of Dementia in Canada. Toronto; 2016.

6. Bronskill SE, Maclagan LC, Mondor L, et al. Phase-specific health system costs of dementia in Ontario, Canada: A propensity score-matched cohort study. Alzheimer’s Dement. 2021 Dec 1;17(S10):e055003.

7. Schaller S, Mauskopf J, Kriza C, et al. The main cost drivers in dementia: a systematic review. Int J Geriatr Psychiatry. 2015 Feb 1;30(2):111–29.

8. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009;11(2):217–28.

9. Ontario. Ontario Welcomes New Long-term Care Development Proposals [Internet]. 2021. Available from: https://news.ontario.ca/ en/release/1001009/ontario-welcomes-new-long-term-care-development-proposals

10. Canadian Institute for Health Information. Dementia in long-term care. 2022.

11. Azad NA, Al Bugami M, Loy-English I. Gender differences in dementia risk factors. Gend Med. 2007 Jun;4(2):120–9.

12. Velandia PP, Miller-Petrie MK, Chen C, et al. Global and regional spending on dementia care from 2000-2019 and expected future health spending scenarios from 2020-2050: An economic modelling exercise. EClinicalMedicine. 2022 Mar;45:101337.