Dallas Seitz

Background: The number of people affected by dementia in Canada is anticipated to increase significantly in coming years. The province of Alberta is expected to have the largest relative increase in the number of people affected by dementia among all provinces in Canada. We determined the prevalence and incidence of diagnosed all‐cause dementia in Alberta, Canada between 2014 and 2022 using population‐based health data. Methods: Population‐based administrative health data were used to identify all individuals ages 65 years and older who were diagnosed with dementia between 2014 and 2022 in Alberta, Canada. A validated case ascertainment algorithm was used to identify cases of dementia. The prevalence of all‐cause dementia was reported for all individuals on April 1, of each year. Annual numbers of incident cases of dementia were reported on April 1 for each year using individuals newly diagnosed with dementia in the preceding year. Results: The overall prevalence of dementia in Alberta increased from 30,050 in 2014 to 43,802 in 2022 (45% relative increase). The number of incident cases of dementia increased from 6,884 individuals in 2014 to 8,741 in 2022 (27% relative increase). The incidence rate of dementia declined during this time period from 1.48/100 person years in 2014 to 1.37/100 person years in 2022 ( p <0.001). Conclusion: The number of prevalent and incident cases of dementia increased significantly in Alberta between 2014 and 2022 although the incidence rate of dementia is decreasing during this time. This information has important implications for the planning supports and services for this population.

Background: Dementia is a syndrome with a high global prevalence that includes a number of progressive diseases of the brain affecting various cognitive domains such as memory and thinking and the performance of daily activities. It manifests as symptoms which often include significant mood and behaviour changes that are highly varied. Changed moods and behaviours due to dementia may reflect distress and may be stressful for both the person living with dementia and their informal and formal carers. To provide dementia care support specific to mood and behaviour changes, the Behaviours in Dementia Toolkit website (BiDT) was developed using human-centred design principles. The BiDT houses a user-friendly, digital library of over 300 free, practical, and evidence-informed resources to help all care partners better understand and compassionately respond to behaviours in dementia so they can support people with dementia to live well. Objective: (1) To characterize the users that visited the BiDT; and (2) to understand the platform’s early impact on these users. Methods: A multi-method, descriptive study was conducted in the early post-website launch period. Outcomes and measures examined included the following: (1) reach: unique visitors, region, unique visits, return visits, bounce rate; (2) engagement: engaged users, engaged sessions, session duration, pages viewed, engagement rate per webpage, search terms, resources accessed; (3) knowledge change; (4) behaviour change; and (5) website impact: relevance, feasibility, intention to use, improving access and use of dementia guidance, recommend to others. Data was collected using Google Analytics and an electronic survey of website users. Results: From 4 February to 31 March 2024, there were 76,890 unique visitors to the BiDT from 109 countries. Of 76,890 unique visitors to the BiDT during this period, 16,626 were engaged users as defined by Google Analytics (22%) from 80 countries. The highest number of unique engaged users were from Canada (n = 8124) with an engagement rate of 38%. From 5 March 2024 to 31 March 2024, 100 electronic surveys were completed by website users and included in the analysis. Website users indicated that the BiDT validated or increased their dementia care knowledge, beliefs, and activities (82%) and they reported that the website validated their current care approaches or increased their ability to provide care (78%). Further, 77% of respondents indicated that they intend to continue using the BiDT and 81.6% said that they would recommend it to others to review and adopt. Conclusions: The BiDT is a promising tool for sharing practical and evidence-informed information resources to support people experiencing dementia-related mood and behaviour changes. Early evaluation of the website has demonstrated significant reach and engagement with users in Canada and internationally. Survey data also demonstrated high ratings of website relevance, feasibility, intention to use, knowledge change, practice support, and its contribution to dementia guidance.

This paper uses privacy preserving methods to link over 235,000 records in the housing and homelessness system of care (HHSC) of a major North American city. Several machine learning pairwise linkage and two clustering algorithms are evaluated for merging the profiles for latent individuals in the data. Importantly, these methods are evaluated using both traditional machine learning metrics and HHSC system use metrics generated using the linked data. The results demonstrate that privacy preserving linkage methods are an effective and practical method for understanding how a single person interacts with multiple agencies across an HHSC. They also show that performance differences between linkage techniques are amplified when evaluated using HHSC domain specific metrics like number of emergency homeless shelter stays, length of time interacting with an HHSC and number of emergency shelters visited per person.

Background: Disease modifying therapies (DMTs) for Alzheimer’s disease (AD) have been approved in some countries although these treatments will require substantial health resources for their implementation. Initial capacity planning to identify the resources required to support DMTs begins with estimating the number of people with dementia who may be eligible for DMTs. We estimated the potential number of individuals with dementia who are eligible for DMTs using population‐based data in Alberta, Canada.Method: We used provincial administrative health databases in Alberta, Canada (population ∼4.5 million) to identify all people newly identified with dementia between April 1, 2013 and March 31, 2022 using a validated dementia case ascertainment algorithm. The characteristics of this population were then described at the time of diagnosis including demographics, conditions potentially contributing to the diagnosis of dementia (e.g. stroke, parkinsonism), and medical contraindications to treatment (e.g. cancer, seizures). The characteristics of individuals with dementia were then compared to the inclusion criteria used in AD DMT trials to estimate the proportion of individuals with dementia who may be eligible for DMTs. We then compared the characteristics of individuals who were determined to be eligible for DMTs compared to those who were not eligible.Result: A total of 77,479 individuals were identified with incident dementia during the study period with a mean age of 80.6 years and 58% were female. In this group, 15,044/77,479 (19%) had conditions other than AD as a potential cause of their dementia. Medical contraindications to DMTs were present in 24,580/62,435 (39%) of all individuals who had AD as their probable cause of dementia. Overall, 37,855/77,479 (49%) of the entire dementia population could potentially go on to receive biomarker testing to determine DMT eligibility. Individuals who were younger and women were more likely to be potentially eligible for DMTs at the time of dementia diagnosis.Conclusion: Approximately half of all people diagnosed with dementia in Alberta could be eligible for DMTs based on their health history. Additional information on cognitive test scores, neuroimaging, and biomarker results are required to further refine estimates of the number of individuals potentially eligible to receive DMTs in Canada.

This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.

Introduction: Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence of polypharmacy or factors associated with polypharmacy. We aimed to estimate the pooled prevalence of polypharmacy and factors associated with polypharmacy in a systematic review and meta-analysis. Methods: MEDLINE, EMBASE, and Cochrane databases were searched for studies with no restrictions on date. We included observational studies that reported on the prevalence of polypharmacy among individuals over age 19. Two reviewers extracted study characteristics including polypharmacy definitions, study design, setting, geography, and participant demographics. The risk of bias was assessed using the Newcastle-Ottawa Scales. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy prevalence. The pooled prevalence estimates of polypharmacy with 95% confidence intervals were determined using random effects meta-analysis. Subgroup analyses were undertaken to evaluate factors associated with polypharmacy such as polypharmacy definitions, study setting, study design and geography. Meta-regression was conducted to assess the associations between polypharmacy prevalence and study year. Results: 106 full-text articles were identified. The pooled estimated prevalence of polypharmacy in the 54 studies reporting on polypharmacy in all medication classes was 37% (95% CI: 31-43%). Differences in polypharmacy prevalence were reported for studies using different numerical thresholds, study setting, and publication year. Sex, study geography, study design and geographical location were not associated with differences in polypharmacy prevalence. Discussion: Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. Clinicians should be aware of populations who have an increased likelihood of experiencing polypharmacy and efforts should be made to review the appropriateness of prescribed medications and occurrence of adverse effects potentially associated with polypharmacy. Conclusions and implications: Clinicians should be aware of the common occurrence of polypharmacy and undertake efforts to minimize inappropriate polypharmacy whenever possible.

Background and Objectives: The multiple sclerosis (MS) population’s survival from breast cancer and colorectal cancer is compromised. Cancer screening and timely diagnoses affect cancer survival and have not been studied in the MS cancer population. We investigated whether the diagnostic route, cancer stage, or diagnostic interval differed in cancer patients with and without MS. Methods: We conducted a matched population-based cross-sectional study of breast (2007-2015) and colorectal cancers (2009-2012) in patients with MS from Ontario, Canada using administrative data. Exclusion criteria included second or concurrent primary cancers, no healthcare coverage, and, for the patients without MS, those with any demyelinating disease. 1:4 matching of MS to non-MS was based on birth year, sex (colorectal only), postal code, and cancer diagnosis year (breast only). Cancer outcomes were diagnostic route (screen-detected versus symptomatic), stage (stage I versus all others), and diagnostic interval (time from first presentation to diagnosis). Multivariable regression analyses controlled for age, sex (colorectal only), diagnosis year, income quintile, urban/rural residence, and comorbidity. Results: We included 351 patients with MS and breast cancer, 1404 matched patients with breast cancer without MS, 54 patients with MS and colorectal cancer, and 216 matched patients with colorectal cancer without MS. MS was associated with less screen-detected cancers in breast (OR [95%CI] 0.68 [0.52, 0.88]) and possibly colorectal (OR 0.52 [0.21, 1.28]) cancer. MS was not associated with differences in breast cancer stage at diagnosis: stage I cancer (OR 0.81 [0.64, 1.04]). MS was associated with greater odds of stage I colorectal cancer (OR 2.11 [1.03, 4.30]). The median length of the diagnostic interval did not vary between people with and without MS in either the breast nor colorectal cancer cohorts Controlling for disability status attenuated some findings. Conclusion: Breast cancers were less likely to be detected through screening and colorectal cancer more likely to be detected at early stage in people with MS than without MS. MS-related disability may prevent people from getting mammograms and colonoscopies. Understanding the pathways to earlier detection in both cancers is critical to developing and planning interventions to ameliorate outcomes for people with MS and cancer.

Background: The aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery. Methods: Participants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes. Results: Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring. Conclusions: Interdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation.