Leading the Way in Dementia Care
Medical Director of Seniors’ Health & Division Head of Geriatric Medicine,
With more than one million people in Canada expected to live with dementia by 2030, William Osler Health System (Osler) — a hospital system in the Greater Toronto Area that serves a region of over 1.3 million people in one of the fastest-growing and most culturally-diverse regions of Ontario — set out to transform how patients with this chronic and progressive illness receive care within an acute hospital setting.
“Dementia is one of the biggest health care challenges of our time,” said Dr. Sudip Saha, Medical Director of Seniors’ Health and Division Head of Geriatric Medicine at William Osler Health System. “Since there is no cure or treatment to slow the disease, we must think of other ways to support patients. Methods like The Butterfly Approach™ help us continue to provide the best possible people-centred care.”
DEMENTIA IS ONE OF THE BIGGEST HEALTH CARE CHALLENGES OF OUR TIME. SINCE THERE IS NO CURE OR TREATMENT TO SLOW THE DISEASE, WE MUST THINK OF OTHER WAYS TO SUPPORT PATIENTS. METHODS LIKE THE BUTTERFLY APPROACH TM HELP US CONTINUE TO PROVIDE THE BEST POSSIBLE PEOPLECENTRED CARE.
Connecting with patients through their emotions With dementia affecting an individual’s “logical brain” before affecting
the “feeling brain”, The Butterfly Approach™, implemented at Osler’s Acute Care for the Elderly (ACE) unit, focuses on connecting with patients through their emotions. Osler carefully selects staff not only on their qualifications and experience, but also on their emotional intelligence. Team members receive extensive training in emotion-based, person-centred care, ensuring that every interaction is an opportunity to provide meaningful support and honour who the patient was before the dementia.
When patients are admitted to the unit, they are assessed for both their medical and personal history, allowing the care team to better understand who they were before their diagnosis. Recognizing and anticipating what a person needs helps prevent emotional distress, which can reduce challenging behaviours, as well as the use of medication.
Transforming the way we think about health care
While the relationship between the patient and their health care team is the foundation of The Butterfly Approach™, an equally important and special aspect is the transformation of the space or unit. Stepping onto the ACE unit, the environment is vastly different from a typical hospital unit. The beige and neutral coloured hospital walls have been replaced by vibrant colours. Large vinyl wall decals convey the experiences of everyday life and provide orientation, wayfinding and stimulation to patients living with dementia.
“Dementia can affect a person’s ability to judge spatial relationships between objects or to see subtle colour differences – this can lead to expressive behaviours,” said Dr. Saha, “Bright colours and wall decals help patients navigate through the unit, creating a setting that is more appropriate, accessible, and enjoyable for people living with dementia. Every patient deserves exceptional care, so we strive to design health care that is the best
in the world, in a welcoming environment that personifies the human experience.”
Creating a world-class health experience
The Butterfly Approach™ has been a game-changer — not just for patients and their families, but also for the incredible staff and physicians who care for them every day. Since 2023, Osler’s ACE unit has seen steady improvements including a higher patient and family satisfaction, fewer patient falls, reduced dementia-associated behaviours, and slower functional decline. Osler’s commitment to compassionate, person-centred care has also led to greater staff and physician satisfaction, meaning patients get the best care possible.
DevelopedbyUnitedKingdom-based consultancyMeaningfulCareMatters(MCM), TheButterflyApproachTM is an emotionbased,person-centredmodelofcarefor patientslivingwithdementia,whichrecognizes thatapatient’semotionalneedsarejustas importantastheirphysicalneeds.In2023,the AcuteCarefortheElderly(ACE)Unitat Osler’sBramptonCivicHospitalbecame thefirstacutecarehealthhospitalsystem intheworldtobeaccreditedtoimplement TheButterflyApproachTM. Osler’s ACE unit wasre-evaluatedoneyearpostlaunchand achievedthehighestlevelofre-accreditation status(Level1)forexcellenceincare.The programhasbeensharingitsexpertiseand learningswithinthehealthcaresectortohelp accelerateanecessaryparadigmshiftin dementiacare,notjustinCanada,butaround
William Osler Health System set out to transform how patients with this chronic and progressive illness receive care in hospital.
Dr. Sudip Saha
William Osler Health System
I GAINED MORE CONFIDENCE ONCE I STARTED TALKING TO PEOPLE IN THE SAME BOAT. IT GAVE ME THE CONFIDENCE TO GET OUT THERE AND TAKE BACK MY LIFE.
Staying Strong with Spencer O’Brien
Canadian Olympic snowboarder and Arthritis Research Canada Spokesperson Spencer O’Brien, was diagnosed with rheumatoid arthritis, a chronic autoimmune disease, a few months before competing at the 2014 Olympics in Sochi. She first noticed aches and pains in her knees and ankles, which she attributed to a lack of stretching and old injuries. However, as the pain escalated, Spencer couldn’t lift her shoulders past 90 degrees and could barely walk down a set of stairs. Determined to compete in the Olympics, Spencer pushed through. However, when the games ended, she needed time to recover and accept her diagnosis.
Discover the critical role exercise and strength training play in her life as a professional snowboarder living with arthritis.
How did exercise and/or strength training help you get back to the top of your sport?
Initially, I tried to train and perform at the level I did prior to my diagnosis, which caused more harm than good. I had to change my perspective and work with my doctors and trainers to ease back into training differently and find my new “normal.”
Why do you feel it’s important to have strong muscles – as a professional athlete and someone living with rheumatoid arthritis?
Strength training plays a huge role in helping me stabilize my joints. Keeping my body strong and in shape is very valuable – especially for movement and mobility. As I’ve been transitioning to back- country riding, I don’t train as intensely. That said, when I back off on training, I feel the difference. I need structured training in the off-season to protect my body from my illness and sport.
What does your regular fitness/ strength training routine involve?
I do three gym sessions per week, including Olympic lifting, a lot of mobility and lengthy warm-ups as I get older. I also do tons of functional movement. I live in Ucluelet, so I surf a lot, which helps with cardio and upper
Why Chronic Insomnia Is More Than Just Sleepless Nights
Chronic insomnia affects millions of Canadians, yet it remains overlooked and poorly understood.
Tania Amardeil
Getting a good night’s sleep might seem like a luxury, but it’s a fundamental pillar of health. Chronic insomnia is marked by persistent sleep difficulties at least three nights per week for three months, accompanied by impairments in daytime functioning. It is predicted to affect 8.8 per cent of Canadian adults, or nearly 1 in 11.
Chronic insomnia has serious consequences: cognitive impairment, decreased productivity, increased accidents, and risk of complications like heart disease, depression, Alzheimer’s, and more. It also often co-exists with other health conditions making both even more difficult to manage. So why aren’t we talking about it more?
A heavy burden
Andrea Rich, a realtor and mother of three, lives with both migraine and chronic insomnia. “Sleep has been a fleeting illusion,” she says. “I lay in bed at night staring at my ceiling.”
Rich typically sleeps just three hours nightly, leaving her mentally and physically exhausted. “It impacts my work, and I feel like my relationships are strained,” she says. “I’m constantly in a fog, struggling to function.”
Sleep disturbances can be influenced by various factors, including hormonal changes. Menopause, for instance can impact sleep quality, leading to or exacerbating chronic insomnia. A Menopause Chicks study revealed that more than two thirds (71 per cent) of respondents (women primarily aged 45 to 64) experience poor sleep three or more times weekly, of which one third (28 per cent) suffer daily.
“Many women assume sleep challenges are something they need to handle on their own, or that sleep will magically get better with time,” says Shirley Weir, Menopause Chicks founder. She encourages people dealing with it to learn more about it and talk to their doctor about the best way forward.
Chronic insomnia is a real, treatable condition that deserves more attention and awareness. It’s time to make sleep a health priority.
body strength. I pepper in some Pilates, skateboarding, and running too. I try to do a variety of exercises but still include three structured sessions per week.
What resources do you turn to for exercising with arthritis?
When I was reintroducing exercise and training, I didn’t have much information. I was going by feel and working with trainers, physiotherapists, and doctors. I wish I had something like Arthritis Research Canada’s I START Tool (a research-backed tool created to help people with arthritis start and continue with strength training) to reassure me. After my diagnosis, I wondered if what I was doing was okay. There was a lot of trial and error.
What would you most want to tell people struggling to get started with exercise and strength training after an arthritis diagnosis?
Talk to your doctors. Make sure to run things by them before starting anything new. Lean on your community too. There is a lot of support out there. I gained more confidence once I started talking to people in the same boat. It gave me the confidence to get out there and take back my life.
Andrea Rich Realtor
Shirley Weir Founder, Menopause Chicks
Confronting Canada’s Chronic Pain Crisis
Chronic pain affects 8 million Canadians, yet remains overlooked. Learn how research, policy, and advocacy can drive real change.
Jamie Bissett
Chronic pain affects one in five Canadians — roughly eight million people — yet remains largely overlooked. Unlike acute pain that gradually resolves, chronic pain persists for at least three months, causing noticeable disruption to one’s livelihood. Alarmingly, chronic pain is now the leading driver of disability among Canadians, surpassing mental health.
The burden extends beyond personal suffering. Chronic pain impacts nearly every speciality within the health care system, from physicians to physiotherapists, and imposes a staggering economic cost. Dr. Hance Clarke, President of the Canadian Pain Society (CPS), stresses, “chronic pain is the largest health-related cost in Canada — surpassing cancer, HIV, and cardiovascular disease — reaching upwards of $60 billion annually.”
Despite Canada’s global leadership in pain initiatives, experts warn that a lack of integrated care and gaps in existing knowledge and policy persist. Addressing the chronic pain crisis will require a coordinated approach — one that unites health care providers, policymakers, and individuals with lived experience to reshape how pain is understood and treated.
minimized, yet nearly two thirds of kids with chronic pain continue to experience the disease as adults, increasing their risk for mental health issues and socioeconomic disparities.”
The complexities of chronic pain underscore the importance of investing in research and policy to help build understanding and inform appropriate care responses.
Lessons from Canada’s veterans
An impactful example of dedicated pain research comes from the Chronic Pain Centre of Excellence for Canadian Veterans (CPCoE). Focused on improving the well-being of veterans — a community disproportionately impacted by chronic pain — the CPCoE represents Canada’s largest, ongoing investment in pain research.
CHRONIC PAIN IS THE LARGEST HEALTHRELATED COST IN CANADA
The complex nature of chronic pain
Chronic pain may coexist with other conditions. Mental illness is estimated to impact between 40 to 60 per cent of chronic pain sufferers. Substance abuse is another prevalent concern with opioids often being blamed for fueling addiction. This, however, is an oversimplification as Dr. Clarke explains, “we’ve reduced opioid prescriptions, yet the crisis persists because our systems inadequately address underlying factors — like pre-existing trauma — that drive people to seek medication for relief.”
Marginalized groups experience additional barriers to care. Women experience higher rates of pain yet endure longer diagnostic times than men. Children, despite having similar chronic pain prevalence as adults, may go untreated. Dr. Katie Birnie, Associate Scientific Director of Solutions for Kids in Pain, warns, “pain in children is often
The centre’s strength lies in its veteran-led approach. Dr. Abhimanyu Sud, Chief Scientific Officer of CPCoE, explains, “veterans determine the centre’s research priorities to ensure we’re supporting their responsive needs.” Benefits of the centre’s research have even extended beyond the veteran community. Dr. Sud notes, “our recommendations have informed improvements in healthcare delivery within systems used by both veterans and non-veteran civilians.”
A landmark gathering for chronic pain advocacy
This upcoming May 1st-4th, the CPS will host its 45th Annual Scientific Meeting at the University of Toronto. Anticipated to be one of the largest pain-focused gatherings in history, this meeting offers a vital opportunity to raise awareness and advance solutions in chronic pain care. Not only will clinicians and researchers be in attendance but government officials, policymakers, trainees, and individuals with lived experience are invited as well.
The meeting serves as a call to action. Dr. Birnie emphasizes that, “meaningful change happens when research, lived experience, and health systems work together.” The CPS encourages you to take an active role — purchase a ticket and join the conversation shaping Canada’s future in chronic pain care.
What are the prospects in finding a cure for chronic pain?
At this time, chronic pain is not a curable disease. However, there is renewed investment in the pipeline for developing novel pain therapeutics — so I do think it’s coming. Finding a cure will come down to research dollars. Looking at the global Canadian research budget, despite this condition affecting 20 per cent of individuals, only 2 per cent of funding currently goes towards chronic pain.
Why is it crucial to address chronic pain in youth?
We have to prioritize addressing chronic pain in youth if we're ever going to tackle the issue of pain in adults. Canada was the first to publish a national health standard for pediatric pain management. As someone who’s worked in this field for a long time, this was one of our greatest recent advancements in pain care. To see the standard not only being used globally but leveraged to build momentum for the development of an adult pain standard, it’s been really transformative.
How does the current recognition of chronic pain compare to the evolution of mental health awareness?
Pain is where mental health was 10 or 15 years ago. Back then, there wasn't much recognition of mental health and its toll on Canadians. However, through visibility campaigns and investment in services, that changed. Mental health is now at the top of almost every agenda — whether in health care, government, or business. My hope, particularly for those who live with pain, is that we’ll translate increased visibility into real change with increased availability and accessibility of effective services.
Dr. Hance Clarke President, Canadian Pain Society (CPS)
Dr. Katie Birnie Associate Scientific Director, Solutions for Kids in Pain
Dr. Abhimanyu Sud Chief Scientific Officer, CPCoE
Scientific
HEART HEALTH IN CANADA: CANet’s
Innovative Platform Empowers
Getting to the heart of the matter: With a focus on patient-driven care, CANet develops a secure and interactive digital platform to help Canadians improve their heart health.
Sandra MacGregor
Heart disease continues to be a leading cause of death in Canada, affecting women and men across all demographics. While most of us understand heart disease to be a major cause of heart attacks, the reality is that the disease is responsible for a host of other ailments, including heart rhythm disorders, blood clots, strokes, and even the loss of extremities (like fingers and toes) due to poor blood flow.
Preventing heart disease
But there is hope. Heart disease is not only avoidable but also manageable. “The good news is that all of these issues are preventable,” says Dr. Anthony Tang, CEO & Scientific Director of the Cardiovascular Network of Canada (CANet). “Science has progressed to the point that even if you have these conditions — there are really good treatments. “
The key to preventing heart disease is to address key risk factors. According to Dr. Tang, major contributors to poor heart health include smoking (which includes cannabis), obesity, high blood pressure, diabetes and high cholesterol. He emphasizes that prioritizing wellness by quitting smoking, increasing exercise, eating healthy, monitoring cholesterol and blood pressure and even reducing or cutting out alcohol consumption all together can have a profound impact on heart health.
Another important factor in maintaining cardiovascular health is to understand how a variety of health conditions can overlap. “Diseases like
diabetes and hypertension and many other conditions can affect cardiovascular issues,” says Dr. Tang. “The consequences of these diseases can lead to negative cardiovascular outcomes. For this reason, we also work with many non-profit organizations like the Canadian Cardiovascular Soci ety, the Canadian Sudden Arrhythmia Death Syndromes (SADS) Foundation and the Heart and Stroke Foundation to help develop health guidelines for the healthcare givers and education for the patients and public to treat and to prevent the condition as a whole.”
Wholistic and innovative patient care
One of the overarching goals of CANet is to improve the diagnosis, awareness, and management of heart conditions by empowering patients to play a more active role in managing their own health. CANet also seeks to improve patient care by fostering more effective collaborations between patients and health care providers. To this end, CANet has developed a groundbreaking digital health platform called VIRTUES.
This platform is designed to provide people with cardiac conditions with the most relevant and up-todate medical treatment options and educational resources based on their unique health profile. VIRTUES works by taking a variety of relevant health information (input by either a patient or a medical professional), analyzing the data and then providing easy to understand treatment guidelines
Why It's Important to Know the Risk Factors of Kidney Disease
Kidney disease can affect anyone at any time. Knowing the risk factors can help you avoid its life-changing impact.
Anne Papmehl
Adecade ago, Lynn Clarke, 64, of Toronto went to her doctor for some routine bloodwork. The results showed protein in her urine, and follow-up tests confirmed she had chronic kidney disease. Kidney disease describes a variety of conditions and disorders that affect the kidney. Chronic kidney disease (CKD) is the presence of kidney damage or decreased kidney function for three months or more. CKD can range from mild to severe and, in some cases, lead to end-stage kidney disease (ESKD).1
Recent estimates suggest that over four million Canadians have chronic kidney disease or are at risk — and most are unaware of it.2 Clarke was one of them prior to her diagnosis. Other than having high blood pressure for many years, she had no known risk factors.
Disease progression leads to decreased kidney function Over the years, Clarke went for regular checks to monitor her kidney function. In 2020, one year after getting married, she learned there had been a marked decrease in her kidney function and she needed dialysis treatments until she could get a kidney transplant. She started in-hospital training treatments three times a week before switching to home hemodialysis. “It took me a while to get comfortable with it, but I
now do it myself overnight four to five nights a week,” says Clarke.
While home dialysis affords Clarke more flexibility as she waits for an eligible kidney donor, she admits “I do feel like I’m tethered to my machine.” Travelling is challenging and requires significant advanced planning. Since starting dialysis, Clarke’s travel has been restricted to mostly brief, one or twonight stays. “I did manage a trip to Jamaica, where I’m originally from, because it’s only a four-hour flight and I have connections there, but beyond that, I haven’t had the courage. There’s always the fear of what happens if there’s an emergency,” says Clarke. Aside from limiting a patient’s life, CKD imposes additional responsibilities on family members. “I went on dialysis a year after I got married, so suddenly my husband, who is very supportive, had to become a caregiver without much preparation,” she says.
Support through The Kidney Foundation Clarke turned to The Kidney Foundation of Canada for support. In addition to funding research on kidney disease, organ donation, and transplantation, the Foundation provides education, information, and support to people living with a kidney condition. “My medical team and family are great, but
(WITH VIRTUES) WE PROVIDE VERY PRECISE GUIDELINES AND TOGETHER, PATIENTS AND CAREGIVERS CAN DECIDE WHAT ADVICE TO IMPLEMENT FOR OVERALL BETTER HEALTH.
tailored to a user’s personalized health profile. Patients can then work with their health care provider to implement the best treatment option in their everyday life.
“What we are doing here is engaging Canadians to put their medical condition information into our secure online platform so they can receive detailed, data-driven recommendations that can also be shared with their healthcare providers,” explains Dr. Tang. “We provide very precise guidelines and together, patients and caregivers can decide what advice to implement for overall better health.”
If you’re concerned about your heart health, sign up for the VIRTUES Cardiac Care national research study at canetinc.ca/virtues By answering a few
MY MEDICAL TEAM AND FAMILY ARE GREAT, BUT I ALSO NEEDED TO HAVE PEOPLE AROUND ME WITH LIVED EXPERIENCE WHO UNDERSTOOD WHAT I WAS GOING THROUGH.
I also needed to have people around me with lived experience who understood what I was going through,” says Clarke. From day one, Clarke has felt welcomed and understood by her support team at the Foundation, referring to them as her kidney family. “Now as a volunteer, I’m happy to provide the same support that I received to other kidney patients,” she says. With a higher mortality rate than some forms of cancer, 3 awareness of kidney disease and its risk factors is crucial. If you are at risk, take action to learn more and get involved in programs that may assist you.
RESOURCES 1. https://kidney.ca/Kidney-Health/Your-Kidneys/Kidney-Disease
2. https://kidney.ca/Kidney-Health/Your-Kidneys/Risk-Factors
3. https://kidney.ca/Kidney-Health/Your-Kidneys/Risk-Factors
Dr. Anthony Tang CEO &
Director, Cardiovascular Network of Canada (CANet)
Lynn Clarke