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Evaluation of the Public Health Agency of Canada’s Aging, Seniors and Dementia Activities

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Organization: Public Health Agency of Canada
Date published: July 2024
Cat.: HP5-247/2024E-PDF
ISBN: 978-0-660-72699-1
Pub.: 240349

Prepared by the Office of Audit and Evaluation
Public Health Agency of Canada
January 2024

Table of contents

List of acronyms

AFC
Age-Friendly Communities
ASU
Aging and Seniors Unit
CIHR
Canadian Institutes of Health Institutes
CSAR
Centre for Surveillance and Applied Research
DASD
Division of Aging, Seniors and Dementia
DCI
Dementia Community Investment
DPU
Dementia Policy Unit
DSF
Dementia Strategic Fund
ESDC
Employment and Social Development Canada
IFA
International Federation of Ageing
G&Cs
Grants and Contributions
HPCDPB
Health Promotion and Chronic Disease Prevention Branch
HSPP
Healthy Seniors Pilot Project
MAB
Ministerial Advisory Board
NGO
Non-governmental Organization
NSC
National Seniors Council
O&M
Operations and Maintenance
PGO
Performance, Governance and Operations Unit
PHAC
Public Health Agency of Canada
PTs
Provinces and Territories
WHO
World Health Organization

Executive summary

Context

The Division of Aging, Seniors and Dementia (DASD) was established in 2017 to improve the physical and mental health of older adults, and to fulfill its role as the federal lead on the development and implementation of Canada's first national dementia strategy, referred to as "the national strategy" in this report.

DASD activities are carried out by four units: the Aging and Seniors Unit (ASU), the Dementia Policy Unit (DPU), the Dementia Community Investment (DCI) Unit, and the Performance, Governance and Operations Unit (PGO). DASD's main activities include policy and program development, building policy capacity, engagement, knowledge mobilization, building community capacity and raising awareness to promote and enhance healthy behaviours. DASD also promotes the United Nations Decade of Healthy Ageing (2021 to 2030) and the Age-Friendly Communities (AFC) model, and applies an older adult and healthy aging lens on a wide range of programs and policies. To carry out its activities, DASD works with a variety of internal and external stakeholders.

This evaluation covered DASD activities from April 2018 to July 2023, and used several lines of evidence to assess its roles and responsibilities, achievement of its results, governance, consideration of health inequities in program design, and resource use.

What we found

DASD's dementia and healthy aging activities are aligned with the Government of Canada's priorities and international commitments. While the roles and responsibilities related to dementia are generally clear and well understood given the legislation and national strategy, the ASU's roles and responsibilities need further clarification. On occasion, there is even some confusion between the Public Health Agency of Canada (PHAC), Health Canada, and Employment and Social Development Canada (ESDC) in terms of who is the lead on certain files. These questions are easily resolved through conversations. However, not all of DASD's partners and stakeholders have a clear understanding of the nuances between the roles.

Dementia

DASD oversaw the development and has undertaken the implementation of the national strategy, as well as the administration of two dementia funds. Both funds have made progress in contributing to DASD's short-term results, and there are indications that projects are well positioned to contribute to the achievement of medium- and long-term outcomes. There is an opportunity for the two dementia units to more closely coordinate messaging with stakeholders and potential partner organizations.

Aging and seniors

The Pan-Canadian Age-Friendly Communities (AFC) Reference Group was the most cited success for DASD because it helped raise awareness of issues from around the country. Still, the evaluation found that several partners did not know ASU's priorities, which has led to missed opportunities for collaboration on ageism, social isolation, falls prevention, among other topics. ASU would benefit from having a clear strategic plan of their priorities and activities and communicating this plan to stakeholders.

DASD overall

Enhanced collaboration in terms of dementia activities could be expanded to find synergies with ASU activities. Literature and interviewees highlighted areas such as populations and risk and protective factors common to both dementia and healthy aging, which represent opportunities for increased collaboration within DASD, as well as with external partners. As DASD-funded projects are completed, the Division needs to ensure the dissemination of results to its stakeholders to support knowledge transfer.

Recommendations

Several lines of evidence were reviewed as part of the evaluation. This includes files and documents, performance data, and data from interviews with internal and external key informants. As a result, the following three recommendations emerged:

Recommendation 1: Clarify and communicate DASD roles and responsibilities.

There is a lack of understanding of DASD's healthy aging roles and responsibilities. Although its dementia roles and responsibilities are clearer, there is still some confusion for external stakeholders.

Recommendation 2: Clarify and communicate DASD priorities in support of effective internal and external collaborations.

While DASD benefits from a well-established governance structure and positive relationships for addressing both dementia and healthy aging, several partners are unaware of the Division's priorities, specifically as they relate to heathy aging and older adults, which they believe has led to missed opportunities to collaborate on shared goals. There are also opportunities for DASD to integrate the work of its units around common populations better, as well as protective and risk factors. In addition, limited funding for the Division makes integration and collaboration more important for achieving the full range of objectives.

Recommendation 3: Expand knowledge transfer of the results of funded projects.

DASD has funded several promising projects, and stakeholders have identified a desire to learn more from these projects. Dissemination of results associated with these projects to various PHAC stakeholders will be important to support lessons learned and best practices to raise awareness and advance work in these areas.

Overview and program description

This report presents the results of the Evaluation of the Activities of the Public Health Agency of Canada (PHAC)'s. Division of Aging, Seniors and Dementia (DASD).

Program context

In 2022, there were seven million people aged 65 and older in Canada, representing nearly one-fifth (18.8%) of the total population. This is an increase from 16.9% in 2016.Footnote 1 It is estimated that, by 2051, the number of Canadians aged 65 and older could reach almost 12 million and that the number of persons aged 85 and older could triple from 861,000 to 2.7 million.Footnote 2

Dementia has a significant and growing impact in Canada. According to the latest national data from 2020-21, almost 477,000 people aged 65 and older have been diagnosed with dementia in Canada.Footnote 3 Of those living with the condition, nearly two-thirds are women. In the last two decades, the number of Canadians living with dementia more than doubled, and as the Canadian population ages, this number is expected to continue to increase. The likelihood of being diagnosed with dementia is more than six times higher in people aged 80 and over when compared to those aged 65 to 79.Footnote 4 In Canada, about 3% of all people living with dementia are younger than age 65. Since young onset dementia is less common, it often goes unnoticed or undiagnosed.Footnote 5

As Canada's population ages, the burden of illness and disease is expected to be significant for older adults, especially as this is happening within the context of a lack of sufficient health and social system supports. A renewed focus on promoting healthy behaviours, increasing prevention activities, increasing support for older adults and caregivers, as well as increasing awareness of the abovementioned areas, could help improve the physical and mental health of older adults. This would enable them to live independently for longer periods and enjoy a higher quality of life.

Program profile

DASD is housed within PHAC's Health Promotion and Chronic Disease Prevention Branch (HPCDPB) and seeks to improve the physical and mental health of older adults, including those living with dementia. This is achieved through policy and program development, building community and policy capacity, engagement, knowledge mobilization, and raising awareness aimed at enhancing healthy behaviours.

DASD is comprised of the Aging and Seniors Unit (ASU), the Dementia Policy Unit (DPU), the Dementia Community Investment (DCI) Unit, and the Performance, Governance and Operations Unit (PGO).

ASU

ASU is the federal lead on coordinating seniors' health promotion work. ASU develops policies, strategies, and information in areas related to healthy aging, including fall and injury prevention, older adult physical and mental health, and age-friendly communities (AFC). ASU supports the work of the National Seniors Council (NSC) and monitors the New Brunswick Healthy Seniors Pilot Project (HSPP).

DCI

The unit supports community-based projects through the administration of the Dementia Community Investment (DCI) fund, which seek to improve the wellbeing of people living with dementia and family/friend caregivers and increase knowledge about dementia and its risk and protective factors. Projects undertake intervention research to assess the effectiveness of the initiative and apply this knowledge to support the expansion of projects' reach.

DPU

DPU led the development of the national dementia strategy, launched in 2019, and tracks its implementation. DPU responsibilities include annual reporting to Parliament on the strategy, administering the Dementia Strategic Fund (DSF) for awareness and guidance projects, and delivering a national public education campaign. DPU supports dementia policy development, initiates public opinion research, and engages with stakeholders for sharing and gathering intelligence.

PGO

PGO supports the Division in three main streams:

Within PHAC, DASD carries out its activities in collaboration with the Centre for Mental Health and Wellbeing (CMHW), the Centre for Surveillance and Applied Research (CSAR), the Centre for Chronic Disease Prevention and Health Equity (CCDPHE), the Communications and Public Affairs Branch (CPAB), and the Strategic Policy Branch.

Externally, DASD works closely with domestic and international partners, such as other federal departments like CIHR and Health Canada, provincial and territorial governments, academics, non-governmental organizations, international organizations like the World Dementia Council and the World Health Organization (WHO), persons with lived experience, and governance committees, including the Ministerial Advisory Board on Dementia, the FPT Coordinating Committee on Dementia, and the DG Interdepartmental Committee on Dementia. DASD also works in collaboration with Employment and Social Development Canada (ESDC) to support the Minister of Health and the Minister of Seniors, called the Minister of Labour and Seniors since July 2023, to support the work of the NSC.

DASD's planned spending from 2018-19 to 2023-24 totalled $25.7 million in salaries and Operations and Maintenance (O&M). Over the same period, the program administered and monitored a total of approximately $149 million in grants and contributions (G&Cs). This included a $75 million grant to New Brunswick for the HSPP in 2018-19, $20 million for the DCI, and $40 million for the DSF. DASD also provided three one-time grants to the WHO to support work on AFC as well as the United Nations Decade of Healthy Ageing.

Evaluation description

Purpose

The evaluation was conducted to satisfy Financial Administration Act requirements. It assessed the overall appropriateness and relevance of PHAC's activities on aging, older adults, and dementia, as well as identifying what is working well and areas for improvement pertaining to the design and delivery of these activities, including PHAC's role and achievement of outcomes.

This is the first evaluation of DASD's activities.

Evaluation scope and approach

The scope of this evaluation covered DASD activities from April 2018 to July 2023. Multiple lines of evidence were used. See Appendix 1 for further details.

Activities of the Centre for Aging and Brain Health Innovation, the Safe Voluntary Isolation Sites Program, which have both been funded and managed by DASD over the period of this evaluation, as well as aging, seniors, and dementia activities that fall outside the HPCDPB were not in scope.

Evaluation questions

Evaluation findings

Question 1: Roles and responsibilities

Division of Aging, Seniors and Dementia (DASD) activities are aligned with the roles outlined in its program authorities. While dementia roles and responsibilities were generally well understood by DASD staff and partners, the Aging and Seniors Unit's (ASU) roles and responsibilities were less clear for most internal and external interviewees, who were unaware of its key priorities.

DASD's activities are aligned with the Public Health Agency of Canada (PHAC)'s health promotion, protection, and surveillance roles as outlined in various Acts, program authorities, departmental plans, and terms and conditions for grants and contributions programs. The sections below provide further details on clarity of roles and responsibilities when addressing healthy aging, as well as identification of duplication or complementarity with stakeholders.

Clarity of roles and responsibilities

Dementia

Clear roles and responsibilities for dementia are outlined in various documents. These include being the federal policy lead on dementia and overseeing the development and implementation of Canada's first national dementia strategy (the national strategy). DASD plays a lead role in advancing the priorities of the national strategy through its funding of dementia-related projects across Canada. It also leads various dementia governance tables and committees, bringing together stakeholders and partners in the national strategy.

Most staff and partner interviewees indicated that DASD's dementia roles were clear and well understood, although a few external stakeholders reported some minor confusion on its roles vis-à-vis other government departments.

Aging and seniors

There are multiple actors addressing aging and seniors issues in Canada. See Table 1 for further details.

In addition to these federal government departments, provinces and territories are responsible for the management, organization, and delivery of health care services for their residents.Footnote 6 Furthermore, many of the non-governmental organizations (NGOs) engaged in this area work at the national level promoting specific issues such as frailty, injury prevention, healthy living, and technology, to name a few.

Table 1: Actors addressing aging and seniors issues in Canada
PHAC Health Canada Canadian Institutes of Health Research (CIHR) Employment and Social Development Canada (ESDC)
The Aging and Seniors Unit (ASU) is the federal public health lead coordinating older adult health promotion work, developing policy, strategies, information and courses of action. Health Canada is responsible for ensuring seniors have access to appropriate and effective health care. CIHR supports research to better understand aging, as well as the health challenges faced by older Canadians and their caregivers. ESDC's Minister of Seniors (now the Minister of Labour and Seniors) is responsible for enhancing the wellbeing and quality of life of older adults in Canada.

Even within PHAC, there are centres other than DASD that are responsible for older adults' activities. For example, the Centre for Mental Health and Wellbeing (CMHW) has projects related to older adults and mental health and funds organizations to deliver and test health promotion interventions to prevent and address family violence, including for older people. The Centre for Surveillance and Applied Research (CSAR) is responsible for collecting and analyzing national surveillance data across the life course, including for seniors. The Vaccination Program is responsible for the vaccination needs of all Canadians, including older adults.

Documents reviewed identified clear roles and responsibilities for DASD related to healthy aging for the Healthy Seniors Pilot Project (HSPP) and the United Nations Decade of Healthy Ageing and Age-friendly Communities (AFCs).

Overall roles and responsibilities within each of the federal departments were well understood, and good relationships between departments supported clarification when confusion occurred.

That said, having multiple governments and organizations in this area contributes to a lack of clarity for some external stakeholders on the differences between the roles and responsibilities of PHAC, Health Canada, and ESDC. For example, in the past, ASU was seen as a focal point for aging and seniors issues; however, some interviewees no longer see it this way and do not know who fills that role. In general, there is a lack of understanding of ASU's activities and priorities.

Complementarity, duplication, overlap and gaps

As mentioned, there are several federal government departments, including PHAC, Health Canada, CIHR, and ESDC, provinces and territories (PTs), international organizations, academics, and NGOs involved in dementia and healthy aging. Each of these has their own area of responsibility. While ASU's role was not as well understood, most internal and external interviewees felt that PHAC's dementia and healthy aging roles and responsibilities were complementary to those of others in the field.

A few interviewees reported gaps in areas such as ageism, social isolation, falls prevention, knowledge mobilization, and sustainability of successful funded projects.

Question 2: Achievement of outcomes

DASD's activities and its funded projects are contributing to its short-term outcomes and are well positioned to support medium- and long-term outcomes. As funded projects are completed, DASD needs to ensure the dissemination of project results to its stakeholders in support of knowledge transfer.

The governance in place and existing working groups support positive exchanges of information between DASD and PHAC internal partners and external stakeholders. There are opportunities to increase collaboration and to work with these partners and stakeholders on clear priorities and objectives as identified by the program.

Program's intended outcomes

The following subsections identify DASD's contributions to following outcomes:

Short term

Medium term

Long term

For dementia activities

Funded projects

The Dementia Strategic Fund (DSF) has funded 36 projects to date. Twenty-five projects focus on raising awareness of dementia, including sharing information on preventing dementia, reducing risks of developing dementia, and addressing stigma. Eleven projects focus on improving access to, and use of, high-quality dementia guidance, such as guidelines and best practices on topics including risk reduction, diagnosis and care, management and treatment. DSF projects with PT governments are expected to improve the quality of online dementia resources.Footnote 7

Between 2019 and 2022, the Dementia Community Investment (DCI) supported 22 community-based projects across 78 project sites in Canada. DCI projects reached 8,820 individuals, including those living with dementia, as well as their family and caregivers. According to 2021-22 data, 86% of DCI project participants reported a gain in knowledge and skills as a result of programming. See Appendix 2 for further details on DCI and DSF funded projects.

Projects funded through the DCI and the DSF have been encouraged to expand their collaboration with partners to increase the reach of initiatives and support sustainability. In 2021-22, DCI projects increased the number of partnerships by 43% from the previous year.

DCI also supports the Canadian Dementia Learning and Resource Network (CDLRN), which was launched in 2020. CDLRN is a knowledge hub that facilitates a community of practice for all DCI projects, enabling them to build capacity, amplify findings, learn from each other, and collaborate.Footnote 8, Footnote 9, Footnote 10

Due to the reporting cycle of results associated with funded projects, the evaluation was not able to fully assess how these projects are contributing to DASD's medium- and long-term results. Even so, there are indications that DASD activities are contributing to lowered risk, improved protective factors, improved wellbeing, supportive physical and social environments and sustainability of successful interventions.

While results were not available for all funded projects, Box 1 provides an example of early results.

Box 1: DSF funded project – Dancer not dementia

Canada's National Ballet School's Dancer not Dementia initiative developed workshops on how to deliver community-based dance and creative movement programs for people living with dementia. Working closely with partners, the School engaged over 25,000 individuals directly during the project including community consultations, attendance at various knowledge translation events, training and workshops, dance demonstrations and classes, Dancer Not Dementia film screenings, and unique viewers online. The School also developed a research-based film that challenged stigmatizing assumptions about dementia, by highlighting the ability of people living with dementia to be creative, playful, and imaginative.

  • 93% of respondents articulated actions they plan to take or continue to do because they participated in the event. This includes actions that may contribute to making their community more dementia inclusive.
  • 96% of respondents who work with people living with dementia reported that the event they attended was informative or very informative on the value of dance for people living with dementia, with the majority indicating they were very likely to recommend the event to others.
  • 85% of respondents reported that the event they attended either changed their knowledge or reinforced their positive way of thinking about people living with dementia, including:
    • the ability of people living with dementia to experience a good quality of life; and
    • whether they feel comfortable interacting with someone living with dementia.

A need to support knowledge transfer

DASD has funded many promising projects through DCI and DSF, and stakeholders have identified a desire to learn more from these projects. As projects are completed and results become available, DASD will need to ensure that results are disseminated to stakeholders.

PHAC's publications on dementia

There are many dementia resources available on the PHAC website. These include an overview on dementia, symptoms and treatment, as well as risk factors and prevention. There is also information on how Canada is addressing dementia through the national dementia strategy, annual reports to Parliament, funding, research, data and programs, and services broken down by area, including PTs, the Government of Canada, non-governmental and international organizations, among others. Resources also touch upon other areas of interest, such as understanding dementia, confronting stigma, how to communicate with persons living with dementia, community support, and dementia-inclusive communities.Footnote 11, Footnote 12, Footnote 13, Footnote 14, Footnote 15

DASD has produced four annual reports to Parliament on the national dementia strategy to date. These reports have shared examples of the variety of activities taking place across the country and how these are related to progress being made on the strategy's objectives. Notably, these reports have included data points that shed light on the state of dementia in Canada, including tracking changes over time. This includes data points on dementia incidence and prevalence, risk factor prevalence, quality of life and dementia research spending.

Age-standardized data shows that dementia incidence has decreased between 2008-09 and 2017-18 at 1,576 and 1,418 respectively.Footnote 16

Age-standardized prevalence of known dementia risk and protective factors are monitored over time among Canadians. Statistically significant improvements have been observed in the general population for four out of eleven risk and protective factors for dementia. These include heavy drinking, having less than a high school education, diagnosed hypertension, and smoking.

DASD's Performance, Governance and Operations Unit (PGO) also works with CSAR to coordinate data collection for the Global Dementia Observatory. The Observatory collates data from WHO member states on 35 key dementia indicators to share on a web-based data and knowledge exchange platform. This information aims at strengthening countries' abilities to respond to the needs of people with dementia, as well as their caregivers and families. The data collection for that web platform was put on hold due to the impacts of COVID-19, so it is not possible at this stage to know where Canada sits compared to other countries.

Over the last five years, PHAC also conducted seven public opinion research projects to monitor the knowledge, perspectives, and experience of dementia care providers, dementia guidance and Indigenous populations, quality of life and dementia, dementia prevention, official language minority communities and dementia, stigma related to dementia, and dementia-inclusive communities. Their results are highlighted in their annual reports.Footnote 18, Footnote 19, Footnote 20, Footnote 21

While public opinion research results indicate that knowledge gains have been made on several fronts, gaps still exist. For example, when asked to identify risk factors for dementia, the most common factor mentioned at 34% of respondents was genetics even though genetics is not a significant risk factor for most cases of dementia. More than one-quarter (28%) could not identify any risk factors even though several modifiable risk factors are noted in current dementia guidance.Footnote 22

Public opinion research conducted in 2021 measured the quality of life of individuals living with dementia and their caregivers. Quality of life data points were relatively stable in 2020-21, when compared with 2019-20 data, except for the percentage of people living with dementia receiving home care experiencing reduced social interaction, which increased from 19.1% in 2019-20 to 21.1% in 2020-21.Footnote 23 At the same time, the percentage of caregivers providing home care to people living with dementia experiencing distress remained relatively stable in 2020-21,Footnote 24 when compared with 2019-20Footnote 25 at 36.6% and 37.1% respectively.

Public education campaign

The DSF supported the development and implementation of a national public education and awareness campaign, with one phase focused on reducing stigma and another on dementia risk factors and actions to help reduce the risk of dementia.

Stigma

The first phase of the national public awareness campaign focused on stigma and took place between 2021 and 2023. The campaign included a number of outreach activities, such as local, regional and national media and digital advertising campaigns. This content reached millions of Canadians from a variety of audiences, including older adults, Indigenous populations and ethnic audiences.

A survey conducted following the national public education campaign on dementia revealed that:

The post-campaign survey showed negligeable increases regarding the ability of individuals to identify persons living with dementia 'to a large extent' (12% to 13% post-campaign), and 'by a moderate extent' (36% to 38% post-campaign). In addition, a few more (1%) service providers felt well equipped to best communicate and support a person living with dementia. Results also identified a 6% increase for all other respondents who felt they would know how to help a person with dementia, should they need to. While this last increase is promising, the post-campaign survey results indicate that more needs to be done to further inform the population about these issues.

Risk reduction

The second phase of the national public awareness campaign, which focused on risk reduction, took place in 2023 and will continue into 2024. In winter 2023, it included various outreach activities, such as a national, multi-media digital advertising campaign, a media tour, and a social media influencer campaign. It resulted in millions of Canadians receiving messaging on risk reduction. The fall 2023 campaign includes a national media and digital advertising campaign.

Unlike the first phase of the campaign, there are currently no post-campaign survey results available. Still, findings from public opinion research conducted in 2023 indicate that the number of Canadians who are intentionally taking steps to reduce their risk of developing dementia has risen from 22% in 2020 to 34% in 2023. Such steps include preventing or managing health conditions like diabetes, depression, high blood pressure and high cholesterol; maintaining a healthy weight; and socializing regularly.

For aging and seniors activities

Given the common protective and risk factors between dementia and healthy aging, such as physical activity, healthy eating and falls prevention, progress made towards dementia outcomes also help contribute to healthy aging outcomes.

Funded projects

In 2018, the Government of Canada announced a $75 million investment to the HSPP, which was a grant agreement between PHAC and the Government of New Brunswick. The province was selected for this grant because it has one of the highest percentages in Canada of people aged 65 and over.Footnote 26 HSPP supports community and government applied research initiatives in New Brunswick, to explore how governments, communities and private sectors can better support seniors. The HSPP is currently supporting 67 projects focused on healthy aging for seniors in their homes, communities, and care facilities. Table 2 details the reach of HSPP projects as of June 2022. At that time, reach had already surpassed the target of 5,000 participants by 2024.

Table 2: HSPP Projects and individuals reached (June 2022)
Focus area Projects Reach
Improving social and built environments to foster healthy aging 11 1,002
Using community approaches to reduce health inequalities 9 971
Increasing independence, quality of life and promoting healthy lifestyles. 12 2,424
Developing innovative care pathways 23 1,512
Using supportive technologies to foster healthy aging at home and in communities 12 660
Totals: 67 6,569

A 2022-23 Q1 overview of HSPP results showed that 97.4% of applied research projects reported increased knowledge and skills among participants, surpassing the target of 80%.

While HSPP projects are not yet completed, they are well positioned to support medium- and long-term outcomes. HSPP projects fall under five focus areas: supportive technologies to foster healthy aging at home, community approaches to reduce health inequalities, increasing independence, quality of life and promoting healthy lifestyles, improving social and built environments to foster healthy aging, and developing innovative care pathways.

Four of 67 HSPP projects have been completed, and two of these have secured provincial funding. For example, Radiography on Wheels is a mobile X-ray service that started as a pilot project in the Saint John area and served 360 residents at select long-term care homes from May 2022 to March 2023. The program allows long-term care residents to be tested in place, thereby improving access to care, enhancing patient experiences, and reducing the stress and physical challenges of travelling to a hospital. The program also reduced the number of home-to-hospital transfers, which freed up ambulances and helped ease congestion in emergency departments. As a result, the Government of New Brunswick decided to provide an additional $1.1 million in funding to expand the service across the province.Footnote 27

The HSPP also provided funding to Nursing Homes Without Walls, which began in 2020 as a pilot project in four locations across southeastern New Brunswick and the Acadian Peninsula. Following the success of the project, the Government of New Brunswick announced that the program would be expanded to 16 locations by 2023. The Nursing Homes Without Walls model uses existing infrastructure and resources within communities and promotes these services to older adults who are living in their own homes. These services include guidance to access community support and services, transportation to medical appointments, shopping or social outings using a nursing home's minibus, and using specialized equipment or facilities in nursing homes.Footnote 28

A need to support knowledge transfer

Similar to dissemination of results for funded activities on dementia, HSPP results should be communicated by DASD to its stakeholders in order to support knowledge transfer.

Supporting inclusive communities

As of January 2020, it is estimated that more than 1,400 communities in 10 provinces across Canada have taken steps to become more age-friendly.Footnote 29 "Thus far, PHAC has played a significant role in advancing the WHO's AFC Initiative. PHAC provided funding towards the development of the original WHO Age-Friendly Cities Guide and the Pan-Canadian Age-Friendly Communities Milestone Guide to help communities implement age-friendly requirements in their local settings".Footnote 30 To help support AFCs in Canada, ASU held 32 meetings of the AFC Reference Group between January 2018 and November 2022.

Increasing knowledge and awareness

There are several aging and seniors publications available on the PHAC website that provide information on AFCs, ageism, emergency preparedness, healthy aging, injury prevention, and abuse. Some of these issues are now the responsibility of other government departments or other areas of PHAC, such as ageism at ESDC, and abuse within the CMHW. Even so, most of these publications are out of date.Footnote 31, Footnote 32 See Appendix 3 for further details.

Internal and external interviewees noted a gap in falls prevention information coming out of ASU. For example, in 2014, ASU was directly involved in drafting the Seniors' Falls in Canada Report; however, the unit is currently not involved. CSAR is currently doing some work on falls for the Canadian Longitudinal Study on Aging, but they are doing so without DASD collaboration. Even NGOs working in this area are looking for PHAC to be more involved, because falls are not only the leading cause of injury and death among older adults,Footnote 33 but the issue is also connected to AFCs, dementia, and other chronic diseases.

At the 2018 National Fall Prevention Conference, ASU sponsored an Indigenous Fall Prevention Symposium to bring together key stakeholders and representatives from the Canadian Indigenous population to discuss fall prevention initiatives and promising approaches.

In 2020, 22 member consultations were conducted with the Pan-Canadian Age-Friendly Communities Reference Group. Interviews with members revealed that the main benefits of the group include having an overview of what is happening across the country, sharing information, solutions, and resources, as well as expanding members' professional networks.

For the 2021 International Federation of Ageing (IFA) Conference, ASU hosted a pre-conference event entitled "The Age-Friendly Communities Summit" in collaboration with the WHO and the IFA. Subsequently, the IFA was contracted to organize and facilitate two 90-minute roundtable discussions that brought together diverse stakeholders to discuss and inform future actions and recommendations to support PHAC in the development of Canada's approach to the UN Decade of Healthy Ageing.

DASD also promotes the UN Decade of Healthy Ageing (2021-2030) through WHO funding and the interdepartmental working group. Of note, a commitment was made in the Minister of Health's Mandate Letter to support the UN Decade of Healthy Ageing by "promoting seniors' physical and mental health to enable them to live longer at home, including by supporting the Minister of Seniors (now the Minister of Labour and Seniors) in their work to establish an expert panel to provide recommendations for establishing an Aging at Home Benefit".Footnote 34 This work is led by Health Canada and ESDC.

Governance and collaborations in support of results

DASD engages and collaborates with a variety of partners and stakeholders to help advance the implementation of the national dementia strategy and share information on a variety of issues involving aging and older adults through both formal mechanisms, such as e.g. governance tables, and informal ones, such as ad hoc bilateral meetings.

Dementia

The national strategy was intentionally designed with a broad scope to encompass the many types of organizations working on dementia. PHAC's efforts to identify and track dementia-related activities underscores that its successful implementation relies on the efforts of multiple organizations: all levels of government, advocacy groups, researchers, people living with dementia and their caregivers, health care providers, and academics. A significant expansion in the number of individuals and organizations engaged in the area of dementia since 2018 is a notable accomplishment for DASD and establishes a collaborative foundation for future efforts.

Governance tables were established by DASD to help with the development and implementation of the national strategy. These tables were essential to the development and launch of the national dementia strategy and must now be used to support the implementation of the objectives set out in the strategy. There are opportunities for theses tables, particularly the Ministerial Advisory Board on Dementia (MAB), to support PHAC in developing a plan and identifying priorities for its future role in implementing the strategy.

The following section identifies the various governance tables and their key mandates. Outside of these official tables, there are also bilateral engagement with PT colleagues on specific issues.

Dementia governance tables and mandates

Aging and seniors

Mechanisms are in place to coordinate healthy aging policy initiatives across different ministries, government departments and within PHAC, including the Pan-Canadian Age-Friendly Communities Reference Group, the Decade of Healthy Aging Interdepartmental Working Group, and the Later Life Team with PHAC regional representatives. ASU also participates in the FPT Ministers Responsible for Seniors Forum and is the Health Portfolio lead for the NSC. ESDC is the secretariat for both groups. The following section outlines the various aging and seniors governance tables and their mandates.

ASU Governance tables and mandates

The various tables are important mechanisms for sharing information, but need to move beyond information sharing to build collaborative working relationships with partners and stakeholders.

Even though interviewees reported positive engagement or collaborations with DASD, the following challenges were identified:

DASD overall

CIHR-PHAC monthly meetings

Since 2017, PHAC has met regularly with CIHR to discuss dementia, aging, and seniors issues. Between March 2020 and March 2023, 30 information-sharing meetings were held between DASD and CIHR, where participants shared updates on various initiatives, national strategy consultations, the annual report to Parliament, DCI and DSF solicitations, and aging and seniors issues.

Internal and external interviewees identified what was working well with regard to DASD's engagement and collaboration, including:

Some internal interviewees noted particularly good collaborations with the CMHW, CPAB, CSAR, as well as Health Canada, and ESDC, likely due to well-established relationships between DASD and these centres and departments.

A small number of external interviewees highlighted a recent HSPP site visit by two ASU staff as an opportunity to learn more about funded projects. It was described as a good way to create contacts, build relationships, and bring in another level of collaboration.

Even though several interviewees reported positive engagement or collaboration with DASD, such as working together on public opinion research, others highlighted some challenges, including:

Impact of the COVID-19 pandemic

COVID-19 influenced the achievement of DASD's intended outcomes in multiple ways. The HSPP grant agreement between PHAC and the Government of New Brunswick was extended from March 31, 2022, to March 31, 2025. Due to the pandemic and lockdowns, HSPP suspended project activities taking place in long-term care facilities or those requiring seniors to congregate together in any setting. The pandemic also affected project progress by hindering staffing and participant recruitment.

DCI funding recipients reported challenges with recruiting and engaging participants, connectivity to support virtual interactions, personnel changes, and withdrawal of project partners, to name a few. This resulted in delays in project timelines, adjustments to project plans and budgets, cancellation of face-to-face meetings and limited data collection and reporting. However, DCI funding recipients also reported that COVID-19 provided several opportunities for creative adaptations, such as new recruitment strategies, the development of unplanned content and activities, and virtual connections with other funding recipients through the CDLRN.

DSF projects also experienced delays due to COVID-19 restrictions on in-person activities and related difficulty in recruiting people. Additionally, there were very few MAB meetings between 2021 and 2023.

The pandemic also reduced opportunities for physical activity and social interaction, increasing social isolation and stress for older adults. According to public opinion research conducted in 2021, 84% of people living with dementia felt that COVID-19 negatively affected their quality of life, with many not able to meet with family and friends because of public health restrictions. Some key informants noted that, while the pandemic increased attention to the needs of older adults, this momentum was temporary.

Like most of PHAC, DASD staff helped with the COVID-19 response, with some staff taking on assignments within the response. DASD also took on surge support for COVID-19 by running the Safe Voluntary Isolation Sites Program. This resulted in fewer staff being available to advance day-to-day activities. A few internal and external interviewees also noted that COVID-19 delayed program activities, such as the MAB meetings, Ministerial approval of new MAB membership appointments, and the launch of some communications activities, such as the public education campaign. The data collection for the Global Dementia Observatory was also delayed from 2020 until 2023-24.

Question 3: Effectiveness – health inequities

Health inequities are considered in program design and activities. People with lived experience have been part of various governance and working group tables, ensuring their involvement in program design. The program also shared its expertise related to aging with various internal partners and federal stakeholders by applying an older adult lens.

Engaging with people with lived experience

The evaluation found DASD values the views of people with lived experience. As such, people with lived experience frequently provide valuable input that was integrated into the development of the national strategy on dementia. Their input also contributes to funding opportunity decisions for both the DCI and DSF.

Lived experience was also valued in a number of HSPP projects that engaged older adults in the planning and development of its projects to help address ageism.

Official governance for the program also ensured representation of people with lived experience at the various tables.

Dementia strategy

The national strategy calls for a focus on individuals and communities identified as those who are likely to be at higher risk of developing dementia or who face barriers to equitable care. These groups include, but are not limited to, Indigenous peoples, individuals with intellectual disabilities, individuals with existing health issues, older adults, women, ethnic and cultural minority communities, 2SLGBTQIA+ individuals, official language minority communities, rural and remote communities, and individuals experiencing young onset dementia.

Focus on these groups also informs the development of funding priorities and opportunities for both the DCI and DSF.

Funded projects

Projects funded through the DCI and DSF are required to demonstrate how sex, gender, and other identity factors are incorporated into the design, implementation, and evaluation of projects. Projects are also required to demonstrate how they incorporate the views of people living with dementia and their family and friends, and caregivers in the project design and implementation.

Spotlight: Language and cultural needs

There is recognition that a lack of information on dementia in diverse languages as well as culturally appropriate access to care for people living with dementia and their caregivers can have an impact on quality of care received, diagnosis, treatment, and patient safety. To address this, several DCI and DSF projects have highlighted the importance of language and cultural needs of people living with dementia and their caregivers.

For example, funding from the DSF has helped support the Culturally Appropriate Dementia Awareness and Education Project for Diverse Immigrant Communities. This project delivers culturally appropriate dementia awareness and educational workshops in Cantonese, Mandarin, Korean, and Farsi to immigrant communities in British Columbia.

All applicants for HSPP project funding were required to complete Sex and Gender-Based Analysis+ (SGBA+) training, and submit a copy of their training certificates as part of their application package. The application had a section devoted to SGBA+ to ensure that all applicants incorporated SGBA+ analysis into the project design. Additionally, as part of the application and review process, the HSPP team collaborated with the Government of New Brunswick's Women's Equality Branch, which implements SGBA+ on a provincial level.

Community initiatives funded under HSPP that are focused on using community approaches to reduce health inequalities must promote awareness of healthy choices and access to health and social supports and resources among:

Awareness campaign and public opinion research

SGBA+ also formed part of the national public education campaign on dementia strategy planning, including target audience selection, media strategy, creative development, and messaging. All messaging was tailored to various segments of target populations and advertising tactics were selected accordingly. Where data allowed, ads were evaluated based on reach and impact on gender.

PHAC's public opinion research projects on dementia included an SGBA+ lens and deepened understanding of the following topics in Canada: knowledge, perspective, and experience of dementia care providers, dementia guidance and Indigenous populations, quality of life and dementia, dementia prevention, official language minority communities and dementia, stigma related to dementia, and dementia-inclusive communities.

Public opinion research on healthy aging conducted by PHAC included focus groups segmented by PTs to ensure adequate coverage across the five regions of Canada: the Atlantic, Ontario and Quebec, the Prairies, British Columbia and the North, as well as location with respect to urban and rural areas. Nine focus groups were conducted nationwide with diverse sub-groups of the population, including by gender (men/women), socio-economic status (higher SES/lower SES), racialized Canadians, newcomers, Indigenous peoples, people living with disabilities and members of LGBTQ2S+ communities.

Aging and seniors and dementia lens

In addition to the program outcomes discussed in the previous section, DASD acts as an expert resource in the areas of aging and dementia. As such, it provides advice internally and to federal partners to ensure that issues affecting older adults and people living with dementia are considered and addressed through government policy and programming.

As the federal public health lead on healthy aging, ASU applies a healthy aging lens on a wide range of PHAC and other Government of Canada programs and policies. Partner interviewees praised the expert advice they obtained from the Division and were grateful for ASU's expertise in this area.

ASU has also collaborated with DPU, DCI Unit, and the Health Equity Division to develop an Older Adults and Persons Living with Dementia checklist to assist in the review of broader government policy papers. ASU is planning to work with the Centre for Chronic Disease Prevention and Health Equity in fall 2023 to finalize this checklist and discuss its wider distribution across PHAC.

Question 4: Objectives and resources

There are opportunities for DASD to prioritize its activities and objectives to ensure efficient use of resources and capitalize on potential synergies with internal partners and external stakeholders.

Resources used

DASD's actual spending from 2018-19 to 2022-23 totalled $22 million in salary, and in operations and maintenance (O&M). During this time, the program also administered a total of $149 million for grants and contributions (G&Cs). This includes:

Over the last five years, the variance between actual and planned spending for DPU, DCI Unit, PGO, and the Director's Office remained within an average of about 3%. Over the same period, ASU underspent its planned budget of about 9%, recording a surplus in salaries and O&M, which can be explained by vacant positions not having been filled. See Appendix 4 for further details.

Dementia

The DCI has annual ongoing funding of four million dollars a year, whereas DSF funding is set to end in March 2024. While staff from both units shared information with potential funding applicants on a consistent basis, communication to these applicants could have been better coordinated to enhance clarity of messaging. Going forward, whether or not DSF funding is renewed, there will be an opportunity for the two dementia units to coordinate more closely on objectives and messaging to these applicants.

Aging and seniors

ASU is a small team with six full-time equivalent employees. Funding for aging and seniors is limited, despite a commitment in the Minister's mandate letter to promote the physical and mental health of older adults as part of the UN Decade of Healthy Ageing. Still, ASU is responsible for the one-time grant ($75 million) to the Government of New Brunswick for the HSPP, with projects set to be completed in March 2024, with reporting continuing until March 2025.

ASU also works with internal partners who have funding programs, including the Healthy Canadians and Communities Fund, and funding related to COVID-19 and mental health, as well as available surplus funding to support priorities. Since 2018, ASU has provided grants using lapsed G&Cs funds from other programs to support the work of the WHO. Specifically, three projects related to Age-Friendly Communities and one project on including the voices of older people as part of the Decade of Healthy Ageing. In 2019, ASU funded Parachute Canada to create an online hub for individuals and health professionals to access tools, resources and information related to fall prevention and recovery.Footnote 35

A review of ASU tasking requests for 2021-22 and 2022-23 showed an increase from 260 to 386. These requests came from a variety of sources, including the Minister's Office, the Vice President's Office, the DG's Office, CPAB, ESDC, the Office of International Affairs, and the Strategic Policy Branch. Most of these requests required a response, typically consisting of review and input. ASU spends considerable time responding to these important requests, which means resources are not available to work on strategic planning and advancing some healthy aging files through collaboration with partners.

DASD overall

Limited resources and funding affects DASD's ability to advance its work. Within this context, establishing a clear set of priorities and objectives, and leveraging internal and external collaboration in support of these priorities and objectives could support a more effective use of resources.

Conclusions and recommendations

Conclusions

The Division of Aging, Seniors and Dementia (DASD)'s dementia and healthy aging activities are aligned with the Government of Canada's priorities and commitments to international efforts. While the roles and responsibilities related to dementia are generally clear and well understood, the Aging and Seniors Unit (ASU)'s healthy aging roles and responsibilities were not well understood by all stakeholders and needs further clarification. For example, there is some confusion among internal and external interviewees related to the roles of the Public Health Agency of Canada (PHAC), Health Canada, and Employment and Social Development Canada (ESDC).

Dementia

DASD set up governance structures and processes that supported the development and implementation of the national strategy, as well as the administration of two dementia funds. Both have made progress in contributing to DASD's short-term results. There are also indications that funded projects are well positioned to contribute to the achievement of medium- and long-term outcomes. As funded projects are completed, DASD needs to ensure the dissemination of project results to its stakeholders in support of knowledge transfer. In addition, whether or not the funding for the Dementia Strategic Fund (DSF) is renewed after it sunsets in March 2024, there will be an opportunity for the two dementia units to coordinate more closely on messaging to partner organizations.

Aging and seniors

The most often cited success for DASD was its work with the Pan-Canadian Age-Friendly Communities (AFC) Reference Group. However, several partners do not know enough about the Division's priorities in terms of healthy aging and older adults. As a result, this has led to missed opportunities for collaboration with regards to ageism, social isolation, falls prevention, and knowledge mobilization. ASU would benefit from having a clear strategic plan that can be communicated to stakeholders in support of potential collaborations. Communicating this plan would also support stakeholders' understanding of PHAC's role in relation to healthy aging.

DASD overall

DASD benefits from a well-established governance structure and positive relationships with stakeholders. Enhanced integration in terms of the dementia activities discussed above could be expanded to include synergies with ASU activities. Literature and interviewees highlighted areas common to both dementia and healthy aging, which represent opportunities for increased collaboration between DASD units, as well as collaboration with external partners. Furthermore, while the governance in place supports positive information sharing, there are opportunities to increase collaboration and to work with partners and stakeholders on clear priorities and objectives identified by the program. Prioritizing DASD activities and objectives can help ensure efficient use of resources and capitalize on potential synergies.

Recommendations

The evaluation reviewed several lines of evidence. This includes documents and files, academic and grey literature, performance measurement data, interviews with internal and external stakeholders, and financial data. As a result, three recommendations emerged.

Recommendation 1: Clarify and communicate DASD roles and responsibilities.

There is a lack of understanding of DASD's healthy aging roles and responsibilities. Although its dementia roles and responsibilities are clearer, there is still some confusion for external stakeholders.

Recommendation 2: Clarify and communicate DASD priorities in support of effective internal and external collaborations.

While DASD benefits from a well-established governance structure and positive relationships for addressing both dementia and healthy aging, several partners are unaware of the Division's priorities, specifically as they relate to heathy aging and older adults, which they believe has led to missed opportunities to collaborate on shared goals. There are also opportunities for DASD to integrate the work of its units around common populations better, as well as protective and risk factors. In addition, limited funding for the Division (particularly if DSF is not renewed), makes integration and collaboration more important for achieving the full range of objectives.

Recommendation 3: Expand knowledge transfer of the results of funded projects.

DASD has funded several promising projects, and stakeholders have identified a desire to learn more from these projects. Dissemination of results associated with these projects to PHAC's various stakeholders will be important to support lessons learned and best practices in order to raise awareness and help advance work in these areas.

Management Response and Action Plan

Recommendation 1

Clarify and communicate DASD roles and responsibilities.

Management response

Management agrees with this recommendation.

As noted in the evaluation, there are multiple actors addressing aging and seniors issues in Canada. The Aging and Seniors Unit (ASU), overseeing healthy aging, is actively developing its strategic plan which will outline key priority areas, as well as the unit's roles and responsibilities. Once completed, the plan will enable clear communication of roles and responsibilities in this area.

DASD's units focusing on dementia include the Dementia Community Investment (DCI) unit and the Dementia Policy Unit (DPU). Recognizing that there is always an opportunity to improve communication with stakeholders, DCI and DPU will continue to seek opportunities to share information about DASD roles and responsibilities through existing mechanisms, such as the annual Report to Parliament and stakeholder engagement tables, as well as maximize opportunities to engage through new and returning forums, such as in-person conferences.

Action plan

Accountability: Director General, Centre for Health Promotion (CHP) and Vice President, Health Promotion and Chronic Disease Prevention Branch (HPCDPB)

Resources: Existing resources will be leveraged.

Recommendation 2

Clarify and communicate DASD priorities in support of effective internal and external collaborations.

Management response

Management agrees with this recommendation.

DASD will build on collaboration with both internal and external stakeholders through existing mechanisms, such as the annual Report to Parliament and engagement tables, and will explore opportunities for enhanced collaboration.

Collaboration in the context of the pandemic was reduced due to the absence of in-person events, such as round tables and conferences. As these forums are re-established, there will be more opportunities to re-engage.

Action plan

Accountability

Director General, CHP and Vice President, HPCDPB

Resources

Existing resources will be leveraged.

Recommendation 3

Expand knowledge transfer of the results of funded projects.

Management response

Management agrees with this recommendation.

The dissemination of knowledge on best practices and learning emerging, as well as relevant resources and tools, arising from funded projects is an important component of fulfilling DASD's objective to promote healthy behaviours, increase awareness, increase prevention activities, and increase support for older adults and their caregivers.

Action plan

Accountability

Director General, CHP and Vice President, HPCDPB

Resources

Existing resources will be leveraged.

Appendix 1: Data collection and analysis methods

Evaluators collected and analyzed data from multiple sources. Data collection started in May 2023 and ended in August 2023. The evaluation examined the activities of the Division of Aging, Seniors and Dementia (DASD). The activities of the Centre for Aging and Brain Health Innovation, the Safe Voluntary Isolation Sites Program, and any aging, seniors, and dementia activities that fall outside the Health Promotion and Chronic Disease Prevention Branch (HPCDPB) were not in scope. Data was analyzed by triangulating information gathered from the different methods listed below. The use of multiple lines of evidence and triangulation were intended to increase the reliability and credibility of the evaluation findings and conclusions.

Performance data review

The evaluation reviewed a series of annual reports submitted to Parliament, as well as reports from funded projects reports to inform findings related to effectiveness.

File and document review

Program file and document reviews included documents available on the website. Approximately 400 files and documents were reviewed.

Key informant interviews

Key informant interviews were conducted to gather in-depth information related to needs, roles, collaborations, achievement of results, resources, and health inequities. Interviews were conducted based on a predetermined interview guide. In total, 38 interviews were conducted with 48 respondents. Respondents included:

Emerging themes from interviews were identified and quantified using NVIVO qualitative analysis software.

Even though data collected by these various methods was analyzed by triangulation, the evaluation faced constraints that affected the validity and reliability of evaluation findings and conclusions. The following outlines the limitations encountered during the implementation of the selected methods for this evaluation and mitigation strategies put in place to ensure that the evaluation findings are sufficiently robust.

Limitations, impacts and mitigation strategies

Limitation: Key informant interviews are retrospective in nature, providing only a recent perspective on past events.

Impact: This can affect the validity of assessments of activities or results that may have changed over time.

Mitigation strategy: Triangulation with other lines of evidence substantiated or provided further information on data captured in interviews. Document review also provided corporate knowledge.

Limitation: Funding data was not broken down by units, with the exception of the Aging and Seniors Unit (ASU).

Impact: This can limit the analysis of financial data.

Mitigation strategy: Triangulation with other lines of evidence provided further information on financial data.

Limitation: Limited availability of medium and long-term outcome data of funded projects due to the timing of the evaluation and the funding schedule.

Impact: The evaluation was not able to fully assess all of the medium and longer-term outcomes.

Mitigation strategy: Recognizing this data limitation, the evaluation was still able to highlight results from a few medium and long-term outcomes.

The evaluation applied an SGBA+ lens in its assessment of DASD's activities, including a discussion of health inequities considered in program design and an examination of program activities helping to reach older adults experiencing health inequities. Although official languages were not specifically examined, the evaluation did not find any issues for the program's activities. Furthermore, it was found that official languages were considered as part of the Healthy Seniors Pilot Project (HSPP). A detailed examination of the Sustainable Development Goals was not applicable for this evaluation; however, findings associated with the application of the SGBA+ lens highlighted that this program supports goals related to good health and well-being, and reduced inequalities.

Appendix 2: DCI, DSF and HSPP funded projects

For a list of HSPP funded projects, consult the University of New Brunswick website.

Table 3: DCI funded projects (2018 to 2023)
Project name Recipient Total funding ($) Program description
Dementia-Friendly Canada Alzheimer Society of Canada 940,000 The Dementia-Friendly Canada project is a partnership between the Alzheimer Societies of Canada, British Columbia, Saskatchewan, Manitoba, and Ontario and is intended to foster the creation of dementia-friendly communities across the country. A dementia-friendly community is a place where people living with dementia, their families, and care partners feel included and supported. While creating dementia-friendly communities, individuals and organizations should focus on both the physical and social environments to ensure they are fully accessible. The Dementia-Friendly Canada project provides educational opportunities for the general public and professionals working in the community to mobilize them to champion dementia-friendly principles wherever they go.Footnote 36
Communities in support of the life trajectory of non-Aboriginal and non-Aboriginal people with dementia who qualify for assistance according to the program Integrated University Center for Health and Social Services of Estrie - Center Sherbrooke University Hospital 937,538 The objectives of this project are as follows:
  • To establish, in collaboration with key partners, local committees in each community to ensure access to target populations. Work with partners, people with dementia and their caregivers to the development, implementation, and evaluation of action plans to respond to the needs of the target population.
  • Identify obstacles to the implementation of action plans, and develop approaches and strategies to eliminate them.
  • Undertake intervention research, including surveys, observations, and interviews, to assess the impact of interventions on targeted communities.
Evaluating co-designed tools for strong partnerships in the dementia care triad Saint Elizabeth Health Care 199,592 Dementia Journey Journal is an interactive resource that enables sustainable relationship building between caregivers and care providers of persons living with dementia through information-sharing and care-role negotiation along the dementia journey. Dementia Journey Journal is available as a mobile app, a digital file, and an analog tool.Footnote 37
Ce qui nous lie~ What connects us: A mixed methods ethnography to evaluate an intersectoral participatory approach for sustainable community-based initiatives to destigmatize dementia Le Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre Ouest-de-L'île de Montréal- McGill University 939,116 What connects us~Ce qui nous lie is a collaborative partnership of healthcare, community-based organizations, government, media, and academic organizations whose aim is to create an interconnected community for all. Through shared activities, designed to cultivate social and cultural environments worth living in, the project:
  • Establishes an enriched web of resources in the local community;
  • Links the arts and culture, mental health, and academic sectors; and
  • Helps decrease stigma at the intersection of Alzheimer's and other related disorders, mental illness, and aging.Footnote 38
Cummings Centre Therapeutic Dementia Care Project Cummings Jewish Centre for Seniors 922,025 The Therapeutic Dementia Care Program (TDCP) is a community-based program that aims to optimize the quality of life and wellbeing of people living with dementia and their caregivers. Through this program, older adults participate up to one day per week in a wide range of therapeutic program activities to enhance quality of life and optimize wellbeing, with the goal of providing caregivers a respite from their caretaking responsibilities.Footnote 39
The Pleasure Approach in Community Settings: Creating Welcoming Environments for People with Cognitive Impairment Société Alzheimer de Granby et Région 939,854 The project aims to mobilize expertise to implement the program in ten community settings offering leisure activities to seniors in Quebec and Nova Scotia in order to evaluate its impact. The "Together for Pleasure Program!" is aimed at rural, urban, French-speaking, and English-speaking areas in order to counter the stigma against people suffering from neurocognitive disabilities. It will be distributed in community contexts that offer leisure activities to seniors. The objective of the project is to select approaches to adapt and support the implementation of the program in a community center.Footnote 40
Mobilizing & Equipping Community-Based Organizations to Promote Awareness and Support for Person-Centered Care for People Living with Dementia and Family Caregivers Institute For Health System Transformation and Sustainability 699,933 The project aims to mobilize and equip community-based organizations to promote awareness and support for person-centred care for people living with dementia and their care partners through engagement in advance care planning. Building on the success of an existing community-led Advanced Care Planning model, co-developed by the BC Centre for Palliative Care in 2016, the model involves partnering with community organizations and providing them with training, tools, and coaching to deliver Advance Care Planning programs and resources to the public.Footnote 41
Living with Dementia in rural First Nation Communities: A Health and Wellness project The University of Manitoba 769,957 This partnership between the University of Manitoba and six First Nations communities is working to help informal caregivers and people living with dementia lead fulfilling and happy lives. The project wants to spread knowledge by creating training materials that are appropriate for using in other Indigenous communities with the goal of lessening the impact of risk factors for developing dementia.Footnote 42
The Integration, Optimization and Promotion of Inclusive Approaches for LGBTQI2S PLWD and their Caregivers Egale Canada Human Rights Trust 726,006 Recognizing that there is a gap in current understandings of people who are living and caring for others at the intersections of LGBTQI2S identities and dementia, the goal of this research project is to connect to and explore individual experiences of care and support as lived by LGBTQI2S PLWD, unpaid caregivers, and LGBTQI2S caregivers of someone living with dementia, through a series of online focus groups.Footnote 43
New Brunswick Dementia Friendly Initiative The New Brunswick Association of Nursing Homes Incorporated 397,251 This project seeks to support and assist New Brunswick communities that have an interest in better supporting people living with dementia, through the introduction and implementation of dementia-friendly approaches such as education and awareness raising, to their local context. The project engages two distinct groups: communities that are recognized as age friendly, and those who are interested in becoming so. The two cohorts will enable an understanding if existing age-friendly initiatives affect the integration of dementia friendly approaches.Footnote 44
Ethno-Cultural and Linguistically Based Support Services for People Living with Dementia (PLWD) COSTI Immigrant Services 732,048 COSTI's new initiative will conduct evaluation research focused on two key elements of programming, language, and culture for people living with dementia and their caregivers. The research will evaluate COSTI Seniors Day program for people living with dementia and evaluate caregivers support and education groups in five ethno- linguistic communities. The evaluation will produce important knowledge of how language-specific and culturally-based programming influence and affect the functioning of people living with dementia while in a program and at home. The evaluation will also inform the development of a blueprint for organizing and implementing an Education and Support group for family and caregivers of people living with dementia from ethno- cultural families.Footnote 45
Empowering Dementia Friendly Communities - Hamilton and Haldimand Hamilton Council on Aging 810,471 The Hamilton Council on Aging is working in both Hamilton and Haldimand to develop dementia-friendly action plans. The project explores how a community with an existing Age-Friendly Plan (Hamilton) versus a community without one (Haldimand) can become a dementia inclusive community. A Dementia-Friendly Community is a place where people living with dementia are understood, respected, and supported; an environment where people living with dementia will be confident that they can contribute to community life. The development of dementia-friendly communities helps reduce stigma and create inclusive environments.Footnote 46
Dementia Dialogue Podcast Network Lakehead University 204,868 This podcast provides people with lived experience a way to share their stories with each other and the broader community. Listeners who have dementia, care partners, and others gain insight and strengthen their adaptive skills. Episodes also help the broader community understand what it means to live with dementia and how they can support people.Footnote 47
Canadian Dementia Learning and Resource Network Schlegel-UW Research Unit for Aging Foundation 1,054,500 The purpose of the Knowledge Hub for the DCI is to facilitate a community of practice for community-based projects funded by the DCI, and to translate and disseminate their program findings and best practices to the dementia policy and program community across Canada. The Knowledge Hub project must engage with PLWD and family, friends and caregivers in project design and implementation to be considered for funding.Footnote 48
Moving, Eating, and Living Well with Dementia University of Waterloo 573,342 The project will promote the health and wellbeing of people living with dementia and caregivers by building community capacity through wellness services in both rural and urban communities.Footnote 49
Ten Online Modules Over Ten Weeks for Adult Learners (TOTAL) eLearning for Family/Friend Caregivers of Persons Living with Dementia (PLWD) The Royal Institution for the Advancement of Learning/McGill University 758,430 TOTAL eLearning is an online dementia education program that is being developed to address the multidisciplinary concerns of informal family and friend care partners of people living with dementia (PLWD), based on existing in-person workshops offered by the McGill Dementia Education Program. In addition to offering Ten Online modules over Ten weeks for Adult Learners, TOTAL eLearning will support care partners by creating a virtual support community comprised of peers, community service providers, and health professionals during and following the program.Footnote 50
Implementing Computer Interactive Reminiscing and Conversation Aid in Canada - CIRCA-CA University Health Network 353,203 CIRCA-CA is a conversation support tool for people with neurocognitive disorders and their caregivers. The tool uses carefully chosen multimedia, including photos, short videos, and audio, to stimulate conversation and social engagement, and promote memories and relationship building. Created in 2001, this current project has worked with older adults to create content suitable for a Canadian audience. CIRCA-CA is web-based and can be accessed from a tablet or computer to use one-on-one, in a small group, or as an engaging independent activity.Footnote 51
Building Capacity for Meaningful Participation by People Living with Dementia University of British Columbia 999,888 This project aims to adapt, implement, and evaluate an asset-based community development approach that will grow innovative initiatives in the areas of arts, social, fitness, and volunteer activities. Focusing on two communities in British Columbia and Ontario, this project will build on existing partnerships with a community group to develop capacity and create meaningful opportunities for PLWD and their family, friends and caregivers to remain active and connected in their communities.
Supporting a Circle of Care Native Women's Association of Canada 837,448 This project will engage Elders that are members of the Board of NWAC and regional affiliates to identify underserved communities in need of support. Four communities will be chosen from each of the four directions, namely: North (Nunavut), West (Saskatchewan), South (Ontario), and East (Maritimes), for a total of 16 communities involved in the project. NWAC's regional affiliates will work with these sub-communities to identify individuals to participate in the development, implementation, and evaluation of the work.
Enhancing Minds in Motion®as a Virtual Program Delivery Model for People Living with Dementia and Their Care Partners Alzheimer Society of Ontario 940,000 The Enhancing Minds in Motion as a Virtual Program Delivery Model for people living with dementia and their care partners. It offers evidence-based physical activity, cognitive stimulation, and socialization for people living with dementia and care partners. This project builds on the existing in-person program offered by the Alzheimer Society of Ontario by offering the program virtually and in both French and English. Offering the program virtually expands the reach of the project and allows the program to be accessible to individuals who may otherwise be unable to participate due to their geographical location and pandemic-related concerns. Participants engage for 90 minutes once a week for the 8-week program.
Inuvialuit Settlement Region Dementia Awareness and Intervention Inuvialuit Regional Corporation 939,500 This project aims to optimize the health and wellbeing of people living with dementia and family and friend caregivers in Inuit communities of the Inuvialuit Settlement Region of the Northwest Territories. Community engagement sessions will be held to help inform the creation of culturally sensitive educational resources, which will then be tested through in-community and in-home workshops. The work of the IRC will provide these communities with culturally appropriate resources aimed at increasing the knowledge among family and friend caregivers of the various stages of dementia, and how to support people living with dementia.Footnote 52
Supporting Family Caregivers of Persons Living with Dementia: Effectiveness and Sustainability of My Tools 4 Care-In Care University of Alberta 888,051 The purpose of this project is to implement and evaluate MT4C-In Care to assess its effectiveness, and the influence of participant factors (i.e., gender, cultural background, age) on the use of MT4C-In Care across four Canadian provinces (Alberta, Saskatchewan, Manitoba, and Ontario). The ability of MT4C-In Care to improve hope, self-efficacy, quality of life, social support, and mental health, and decrease grief and loneliness will be rigorously assessed in a pragmatic effectiveness trial with a large sample. The rigorous pragmatic trial, with in-depth mixed methods, will demonstrate whether MT4C-In Care works across four Canadian provinces as well as the reasons and mechanisms underlying its effects.Footnote 53
Table 4: DSF funded projects (2018 to 2023)
Project name Recipient Total funding ($) Program description
Stigma: An Exploration of Lived Experiences, Understandings and Behaviours of Dementia within Indigenous Communities The Native Women's Association of Canada (NWAC) 312,966 There are two phases to this program: capacity building, and raising awareness. The program is using a distinctions-based approach to build understanding of the needs, experiences, knowledge, attitudes, and behaviours of Indigenous communities around stigma. The program will then leverage existing strengths and resources to establish strength-based, distinction-based, community-led, and culturally relevant resources designed to combat stigma and encourage dementia inclusiveness.Footnote 54
Awareness Builds Connections in Dementia-Friendly Communities (ABCD Initiative) Rural Development Network Society 627,113 RDN's ABCD Project aims to provide rural Albertan communities with a selection of evidence-based, dementia-friendly initiatives adaptable to rural settings. Through an expression of interest focused on rural Alberta communities looking to create dementia-inclusive environments, the ABCD Project team and Advisory Committee selected five communities to receive funding and additional project implementation support. RDN understands that rural communities are presented with unique barriers when it comes to having the capacity to fund, develop, implement, and evaluate community initiatives. A key component of the ABCD project is to provide support to the selected rural pilot communities in each of these areas in hopes of establishing a sustainable, dementia-friendly community.Footnote 55
Mind Over Matter®- A Comprehensive Brain Health Awareness Campaign Women's Brain Health Initiative 716,000 This project will enhance the existing Mind Over Matter®(MOM) program that highlights unique risks for women 35 and over by adding a virtual coaching mobile app, podcasts, and videos that encourage users to adopt healthy behaviours, educate Canadians on dementia risk factors, reduce stigma, and provide practical tips, tools, and rewards. Once complete, the MOM app will address the Six Pillars of Brain Health (physical exercise, healthy eating, mental stimulation, proper sleep, stress reduction, and social interaction), automatically track activities, and provide tailored curated content.Footnote 56
Artful Moments: Sharing Our Learning The Art Gallery of Hamilton 275,160 Artful Moments is an arts-based program created specifically for people living with dementia that provides a space for program participants to discuss art and explore art-making activities. This new funding will support expansion of the existing Artful Moments program through the development and sharing of a series of best practices and approaches to support provincial museums and galleries in implementing similar programs at other sites. Public art institutions that participate in this project will help raise awareness of dementia and reduce stigma by becoming more visibly inclusive, accessible, and welcoming of people living with dementia.Footnote 57
Sharing Dance with People with Dementia Canada's National Ballet School 716,000 This project will promote and highlight the ability of people living with dementia to be creative, playful, and imaginative in an effort to reduce stigma and promote dementia-inclusive communities across Canada. The project will also help build a culture where dance practices are included in daily life for people living with dementia and help increase opportunities for people living with dementia to access dance. Through this project, communities will be better informed about the abilities of people living with dementia and able to offer dementia-inclusive dance activities in a non-stigmatizing environment. Canada's National Ballet School will also produce a research-based film to challenge stigmatizing assumptions about how people living with dementia engage with and thrive as dancers.Footnote 58
Culturally Appropriate Dementia Awareness and Education Project for Diverse Immigrant Communities S.U.C.C.E.S.S (United Chinese Community Enrichment Services society) 715,813 This project will develop and deliver a culturally appropriate awareness and educational workshop series in various languages, including Cantonese, Mandarin, Korean, and Farsi, to immigrant communities in British Columbia. The workshop series will include modules and resources on brain health and dementia risk factors, as well as mental health, social isolation, diet, exercise, smoking, hypertension, and diabetes. It is hoped that this project will encourage the adoption and maintenance of healthy behaviours and will help reduce or delay dementia among immigrants.Footnote 59
ABCs of a Healthy Brain – Dementia Awareness in the West and North RésoSanté Colombie-Britannique 681,162 This project aims to inform, equip and support Francophone minorities living in British Columbia, Alberta, Saskatchewan, and Yukon on preventing and reducing the risk of developing dementia, and deals with the stigma faced by people living with dementia. The tools and resources developed, based on scientific progress, will be shared through awareness campaigns, regional resource directories, and a community-based support program to promote healthy lifestyle habits. The research aspect of the project will first be used to document dementia in Northern and Western Francophone minority communities. As a result, this population's needs will be identified, which will enable the engagement of health authorities to assess potential solutions for optimizing dementia diagnosis and treatment processes for the target groups.Footnote 60
Partnering for Dementia Friendly Communities Health and Community Services and the Minister for Intergovernmental Affairs 716,000 This project will create a more dementia-friendly province by building on the Dementia Care Action Plan. The key goals of this initiative led by government, with funding from PHAC, in partnership with the Newfoundland and Labrador Health Services and the Alzheimer Society of Newfoundland and Labrador, include:
  • Increasing awareness of dementia;
  • Supporting stigma reduction; and
  • Encouraging dementia inclusive communities.
Eight communities will work with community engagement coordinators and local partners to create action plans that will guide their efforts to become dementia friendly. These communities represent a diverse geography, including both rural and urban communities: Clarenville, Corner Brook, Mary's Harbour, Placentia, Roddickton-Bide Arm, Springdale, Stephenville, and Twillingate.Footnote 61
Reducing dementia-related stigma by using person-centred language to describe responsive behaviours in hospital admissions Regional Geriatric Program of Toronto 714,350 This project will develop and deliver an education and coaching program for health professionals working in acute care settings to reduce stigma linked to behaviours, language, and practices, including how patients are identified and tracked in medical records. This project will also develop guidelines to support the implementation of person-centred language in various forms of communication, such as progress notes, consultation notes, and other areas within patient charts. By reducing the use of stigmatizing language and focusing instead on the use of person-centred language, the project is hoping to improve the experience of patients who enter the health system in Toronto's Academic Health Science Network hospitals.Footnote 62
Luci: a personalized, coach-assisted mobile application LUCILAB INC 716,000 This project will produce a national coaching app to educate at-risk Canadians aged 45 to 70 about dementia risk factors and motivate them to adopt healthy lifestyle habits with ongoing support from tele-counsellors. The app will focus on exercise, nutrition, and cognitive engagement, and be available in both official languages on smartphones, tablets, and computers.Footnote 63
Acquainting Canadian Seniors with State-of-the-Art Dementia Prevention Strategies: Up Close and Personal Cyber Seniors: Connecting Generations 692,604 This project, focused on Ontario and New Brunswick, offers a mix of awareness-raising activities. Those activities include online training on how to prevent dementia through healthy behaviours and intergenerational discussions on how to include people living with dementia within the community. An app will be developed to facilitate access to learning modules. Participants will be able to try out the latest technologies designed to facilitate the adoption and maintenance of healthy behaviours through active learning centres where they will be shown how games and other methods can be used to boost cognitive activity and physical exercise. Devices such as steering wheels and pedallers will be used to generate input signals for game software and provide exercise opportunities for players.Footnote 64
Stronger Together: Making Ottawa and Renfrew County Dementia Friendly The Dementia Society of Ottawa and Renfrew County 693,296 This project enhances, evaluates and extends the existing Dementia Inclusive program within the National Capital Region and surrounding counties. It will also serve as a scalable model for elsewhere in Canada. Working with a large number of community partners, the project will create a media campaign and training that includes new content on brain health, how to reduce risk, and ways to help protect against dementia, as well as videos featuring personal stories of people living with dementia and caregivers to build awareness and reduce stigma. An interactive virtual reality component will enhance existing Dementia Friendly training and new training modules will be developed for specific sectors (i.e., paramedics, fire services, public transportation, banks and retail). The project will enhance the Dementia 613 app to help locate, promote, and rate businesses that are dementia-inclusive in the region.Footnote 65
Open Minds, Open Hearts The Conestoga College Institute of Technology and Advanced Learning 611,720 This project will help to combat stigma and increase dementia inclusiveness by fostering social relationships and a sense of belonging between college students, people living with dementia and caregivers. To do this, students from three colleges in British Columbia, Ontario, and Quebec, and people living with dementia within those surrounding communities will participate in a 10-week program with guided intergenerational group activities, including those focused on celebrating culture and languages, promoting physical wellbeing and encouraging creative expression. During the activities, meaningful moments and interviews between college students, people living with dementia and caregivers will be captured and used to create up to 18 docufilms that will be shared publicly across local community organizations, public transportation systems, nursing, retirement homes and hospitals, high schools, and online.Footnote 66
Developing Supportive Neighbourhood Built Environment to foster Mobility, Engagement and Social Participation among Community-dwelling Adults living with Dementia Simon Fraser University 715,801 This project will identify features of neighbourhoods that affect the mobility of people living with dementia and develop an easy-to-use tool to assess environments supportive of people living with dementia. Guidelines for dementia-inclusive communities that can be used by the public, as well as decision makers, will also be developed. By supporting dementia-inclusive community design and providing a supportive neighbourhood environment, it is hoped that people living with dementia will be able to remain engaged in their communities, which is crucial to enhancing their quality of life.Footnote 67
Promote practices to prevent or counter the stigmatization of seniors with dementia in their community and promote their inclusion Centre collégial d'expertise en gérontologie du Cégep de Drummondville 378,597 This project will identify best practices for stigma reduction and dementia-inclusive communities that will be used as the basis for videos and online training to raise awareness and increase understanding about dementia among the general population and first responders in St-Jean-sur-Richelieu. Videos will be projected on screens strategically placed in St-Jean-sur-Richelieu, focused on areas where a new neighbourhood that integrates specialized dementia housing may be developed. Training programs for nurses and first responders offered by the Cégep de Drummondville, the Campus Notre-Dame-de-Foy, and Le Centre RISC would integrate the materials and knowledge gained from this project, which will help future care providers respond better to the needs of caregivers and people living with dementia.Footnote 68

Appendix 3: Aging and seniors publications Footnote 69

Age-friendly communities

Ageism

Emergency preparedness

Healthy aging

Injury prevention

Abuse

Appendix 4: Variance between planned and actual spending

Table 5: Variance between planned vs actual spending (2018-19 to 2022-23) for DCI Unit, DPU, PGO and the Director's Office
Fiscal year Planned spending Actual spending Variance % planned budget spent
Salary G&Cs O&M Total Salary G&Cs O&M Total
2018-19 1,299,436 12,000,000 542,734 13,842,170 1,728,100 12,000,000 499,585 14,227,685 -385,515 103%
2019-20 2,217,930 13,400,000 495,823 16,113,753 2,592,487 11,609,022 263,345 14,464,854 1,648,859 90%
2020-21 2,644,373 10,175,000 796,352 13,615,725 3,152,581 10,729,955 533,144 14,415,680 -799,954 106%
2021-22 2,786,169 10,032,986 2,250,003 15,069,158 2,763,603 16,486,031 329,853 19,579,487 -4,510,329 Footnote * 130% Footnote *
2022-23 2,826,973 26,759,962 2,871,010 32,457,945 2,981,677 22,346,076 2,393,176 27,720,929 4,737,016 85%
Total 11,774,881 72,367,948 6,955,922 91,098,751 13,218,448 73,171,084 4,019,103 90,408,635 -690,116 99%

Source: DASD and the Chief Financial Officer and Corporate Management Branch

Footnote *

In 2021-22, DASD transferred $2.2 million in O&M to Health Portfolio Shared Services for the Dementia Advertising Campaign, which was then sent to Health Canada using the Shared Service Partnership; thus this expenditures do not appear under DASD's actual spending.

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Table 6: Variance between planned vs actual spending (2018-19 to 2022-23) for ASU
Fiscal year Planned spending Actual spending Variance % planned budget spent
Salary G&Cs O&M Total Salary G&Cs O&M Total
2018-19 1,285,680 75,000,000 144,695 76,430,375 731,576 75,125,000 93,681 75,950,257 480,118 99%
2019-20 698,394 125,000 271,400 1,094,794 966,252 547,964 36,696 1,550,912 -456,118 142%
2020-21 754,477 - 439,815 1,194,292 744,988 77,036 25,358 847,382 346,910 71%
2021-22 804,211 - 972,664 1,776,875 875,424 - 100,941 976,365 800,511 55%
2022-23 930,247 - 699,452 1,629,699 871,099 200,000 388,079 1,459,178 170,521 90%
Total 4,473,009 75,125,000 2,528,026 82,126,035 4,189,339 75,950,000 644,755 80,784,094 1,341,941 98%

Source: DASD and the Chief Financial Officer and Corporate Management Branch

End notes

Footnote 1

Statistics Canada. In the midst of high job vacancies and historically low unemployment, Canada faces record retirements from an aging labour force: number of seniors aged 65 and older grows six times faster than children 0-14. 2022; Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427a-eng.htm

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Footnote 2

Statistics Canada. In the midst of high job vacancies and historically low unemployment, Canada faces record retirements from an aging labour force: number of seniors aged 65 and older grows six times faster than children 0-14. 2022; Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427a-eng.htm

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Footnote 3

Government of Canada. Canadian Chronic Disease Surveillance System. 2023; Available from: https://health-infobase.canada.ca/ccdss/data-tool/Index

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Footnote 4

Public Health Agency of Canada. Dementia: Risk Factors and Prevention. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia/risk-factors-prevention.html

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Footnote 5

Canadian Institute for Health Information. Young-onset dementia. 2023; Available from: https://www.cihi.ca/en/dementia-in-canada/spotlight-on-dementia-issues/young-onset-dementia#:~:text=Young%2Donset%20dementia%20is%20diagnosed,in%20those%20younger%20than%2065

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Footnote 6

Government of Canada. Canada's health care system. 2023; Available from: https://www.canada.ca/en/health-canada/services/canada-health-care-system.html

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Footnote 7

Public Health Agency of Canada. A Dementia Strategy for Canada – 2022 Annual Report. 2023; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2022.html

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Footnote 8

Canadian Dementia Learning and Resource Network. About. 2023; Available from: https://cdlrn.the-ria.ca/about/

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Footnote 9

Canadian Dementia Learning and Resource Network. Get Involved. 2023; Available from: https://cdlrn.the-ria.ca/get-involved/

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Footnote 10

Research Institute for Aging. Dementia. 2023; Available from: https://the-ria.ca/dementia/

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Footnote 11

Public Health Agency of Canada. Dementia: Overview. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia.html

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Footnote 12

Public Health Agency of Canada. Dementia: Symptoms and treatment. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia/symptoms-treatment.html

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Footnote 13

Public Health Agency of Canada. Dementia: Risk factors and treatment. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia/risk-factors-prevention.html

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Footnote 14

Public Health Agency of Canada. Dementia: What Canada is Doing. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia/what-canadas-doing.html

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Footnote 15

Public Health Agency of Canada. Dementia: Tips on how you can help. 2022; Available from: https://www.canada.ca/en/public-health/services/diseases/dementia/tips-how-you-can-help.html

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Footnote 16

Public Health Agency of Canada. A Dementia Strategy for Canada: Together We Achieve - 2022 Annual Report. 2023; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2022.html

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Footnote 17

Public Health Agency of Canada. A Dementia Strategy for Canada: Together We Achieve - 2022 Annual Report. 2023; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2022.html

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Footnote 18

Public Health Agency of Canada. Dementia Survey – Final Report. 2020; Available from: https://publications.gc.ca/collections/collection_2020/aspc-phac/HP10-36-2020-eng.pdf

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Footnote 19

Public Health Agency of Canada. Qualitative Research on Dementia Awareness, Knowledge, and Behaviours for Public Education Campaigns Executive Summary. 2020; Available from: https://publications.gc.ca/collections/collection_2020/sc-hc/H14-352-2020-1-eng.pdf

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Footnote 20

Public Health Agency of Canada. Quality of Life and Dementia Qualitative and Quantitative Research – Final Report. 2021; Available from: https://publications.gc.ca/collections/collection_2021/aspc-phac/H14-375-2021-eng.pdf

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Footnote 21

Public Health Agency of Canada. Dementia Guidance and Indigenous Populations in Canada – Findings Report. 2021; Available from: https://publications.gc.ca/collections/collection_2021/aspc-phac/H14-374-2021-eng.pdf

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Footnote 22

Public Health Agency of Canada. Survey of Canadians Regarding Dementia Prevention: Final Report. 2022; Available from: https://publications.gc.ca/collections/collection_2022/sc-hc/H14-414-2022-eng.pdf

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Footnote 23

Public Health Agency of Canada. A Dementia Strategy for Canada – 2022 Annual Report. 2023; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2022.html

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Footnote 24

Public Health Agency of Canada. A Dementia Strategy for Canada – 2022 Annual Report. 2023; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2022.html

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Footnote 25

Public Health Agency of Canada. A Dementia Strategy for Canada – 2021 Annual Report. 2022; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-2021.html

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Footnote 26

Statistics Canada. Population estimates on July 1st, by age and sex. 2022; Available from: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501&pickMembers%5B0%5D=1.1&pickMembers%5B1%5D=2.1&cubeTimeFrame.startYear=2018&cubeTimeFrame.endYear=2022&referencePeriods=20180101%2C20220101

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Footnote 27

Government of New Brunswick. Mobile X-ray service extended to long-term care residents provincewide. 2023; Available from: https://www2.gnb.ca/content/gnb/en/news/news_release.2023.05.0269.html

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Footnote 28

Government of New Brunswick. Nursing homes invited to be part of new community services for seniors. 2022; Available from: https://www2.gnb.ca/content/gnb/en/news/news_release.2022.11.0641.html#:~:text=The%20government%20later%20announced%20the,Social%20Development%20Minister%20Dorothy%20Shephard.

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Footnote 29

Public Health Agency of Canada. A Dementia Strategy for Canada – 2020 Annual Report. 2020; Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-strategy-annual-report-parliament-june-2020.html

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Footnote 30

National Seniors Strategy. Enabling the Creation of Age-Friendly Physical Environments and Spaces. 2023; Available from: http://nationalseniorsstrategy.ca/the-four-pillars/pillar-1/age-friendly-environments/

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Footnote 31

Public Health Agency of Canada. Aging and Seniors Publications. 2023; Available from: https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/aging-seniors-publications.html

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Footnote 32

Public Health Agency of Canada. Aging and Seniors. 2023; Available from: https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors.html

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Footnote 33

Public Health Agency of Canada. Surveillance report on falls among older adults in Canada. 2022: Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/surveillance-report-falls-older-adults-canada.html

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Footnote 34

Prime Minister of Canada. Minister of Health Mandate Letter. 2021; Available from: https://www.pm.gc.ca/en/mandate-letters/2021/12/16/minister-health-mandate-letter

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Footnote 35

Public Health Agency of Canada. Public Health Agency of Canada Supports Fall Prevention Among Canadian Seniors. 2019; Available from: https://www.canada.ca/en/public-health/news/2019/02/public-health-agency-of-canada-supports-fall-prevention-among-canadian-seniors.html

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Footnote 36

Alzheimer Society. Dementia Friendly Canada: What is Dementia Friendly Canada? 2023; Available from: https://alzheimer.ca/en/take-action/become-dementia-friendly/dementia-friendly-canada

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Footnote 37

Canadian Dementia Learning and Resource Network. Evaluating co-designed tools for strong partnerships in the dementia care triad. 2023; Available from: https://cdlrn.the-ria.ca/projects/evaluating-co-designed-tools-for-strong-partnerships-in-the-dementia-care-triad/

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Footnote 38

Canadian Dementia Learning and Resource Network. What connects us~Ce qui nous lie. 2023; Available from: https://cdlrn.the-ria.ca/projects/what-connects-usce-qui-nous-lie/

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Footnote 39

Canadian Dementia Learning and Resource Network. Cummings Centre Therapeutic Dementia Care Program. 2023; Available from: https://cdlrn.the-ria.ca/projects/cummings-centre-therapeutic-dementia-care-program/

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Footnote 40

Canadian Dementia Learning and Resource Network. The pleasure approach in a community setting: creating welcoming environments for people with cognitive impairments. 2023; Available from: https://cdlrn.the-ria.ca/projects/lapproche-par-le-plaisir-en-milieu-communautaire-creer-des-environnements-accueillants-pour-les-personnes-avec-des-atteintes-cognitives/?lang=fr

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Footnote 41

Canadian Dementia Learning and Resource Network. Community-led advance care planning programs for people living with dementia and family caregivers. 2023; Available from: https://cdlrn.the-ria.ca/projects/community-led-advance-care-planning-programs-for-people-living-with-dementia-and-family-caregivers/

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Footnote 42

Canadian Dementia Learning and Resource Network. Living with Dementia in Rural First Nations Communities: A Health and Wellness Project. 2023; Available from: https://cdlrn.the-ria.ca/projects/living-with-dementia-in-rural-first-nations-communities-a-health-and-wellness-project/

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Footnote 43

National Institute on Ageing. From the inside out: The integration, optimization, and promotion of inclusive approaches to supporting LGBTQI2S PLWD and their unpaid primary carers. 2020; Available from: https://www.niageing.ca/commentary-posts/2020/12/14/ram12ml57vwrnywj7xqxp7q2q86p2h

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Footnote 44

Canadian Dementia Learning and Resource Network. The New Brunswick Dementia Friendly Initiative. 2023; Available from: https://cdlrn.the-ria.ca/projects/the-new-brunswick-dementia-friendly-initiative/

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Footnote 45

Canadian Dementia Learning and Resource Network. Ethno-Cultural and Linguistically Based Support Services to People Living with Dementia. 2023; Available from: https://cdlrn.the-ria.ca/projects/ethno-cultural-and-linguistically-based-support-services-to-people-living-with-dementia/

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Footnote 46

Canadian Dementia Learning and Resource Network. Empowering Dementia-Friendly Communities Hamilton, Haldimand. 2023; Available from: https://cdlrn.the-ria.ca/projects/empowering-dementia-friendly-communities-hamilton-haldimand/

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Footnote 47

Dementia Dialogue. About Dementia Dialogue. 2023; Available from: https://www.dementiadialogue.ca/about

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Footnote 48

Public Health Agency of Canada. Call for proposals: Description of the application process for the Knowledge Hub for the Dementia Community Investment. 2019; Available from: https://www.canada.ca/en/public-health/services/funding-opportunities/grant-contribution-funding-opportunities/knowledge-hub-dementia-community-investment.html

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Footnote 49

Public Health Agency of Canada. Government of Canada Invests in Dementia Data and Community-based Projects: Moving, Eating, and Living Well with Dementia. 2021; Available from: https://www.canada.ca/en/public-health/news/2021/01/government-of-canada-invests-in-dementia-data-and-community-based-projects.html

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Footnote 50

McGill University Steinberg Centre for Simulation and Interactive Learning. TOTAL eLearning: Ten Online Modules over Ten Weeks for Adult Learners (TOTAL) eLearning for Family/Friend Care Partners of People Living with Dementia. 2023; Available from: https://www.mcgill.ca/medsimcentre/community-outreach/dementia/total-elearning'

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Footnote 51

Réseau canadien d'apprentissage et de ressources sur les troubles neurocognitifs. Implementing Computer Interactive Reminiscing and conversation aid in Canada: CIRCA-CA. 2023; Available from: https://cdlrn.the-ria.ca/projects/implementing-computer-interactive-reminiscing-and-conversation-aid-in-canada-circa-ca/?lang=fr

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Footnote 52

Public Health Agency of Canada. Dementia Community Investment: Current Recipients and Project Descriptions. 2020; Available from: https://www.canada.ca/en/public-health/news/2020/01/backgrounder-dementia-community-investment.html

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Footnote 53

UCG Center Watch. Supporting Family Caregivers of Persons Living With Dementia: Effectiveness and Sustainability of MT4C-In Care. 2023; Available from: https://www.centerwatch.com/clinical-trials/listings/234975/supporting-family-caregivers-of-persons-living-with-dementia-effectiveness-and-sustainability-of-mt4c-in-care/

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Footnote 54

Native Women's Association of Canada. Aging and Dementia: Stigma: An Exploration of Lived Experiences, Understandings and Behaviours of Dementia within Indigenous Communities. 2023; Available from: https://nwac.ca/policy/aging-and-dementia

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Footnote 55

Awareness Builds Connection in Dementia-Friendly Communities. Awareness Builds Connection in Dementia Friendly Communities (ABCD) Project. Rural Development Network. 2023; Available from: https://www.rdndementia.ca/

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Footnote 56

Public Health Agency of Canada. Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 57

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 58

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 59

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 60

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 61

Governments of Newfoundland and Labrador. Governments of Newfoundland and Labrador and Canada Partner to Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2023; Available from: https://www.gov.nl.ca/releases/2023/health/0713n01/

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Footnote 62

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 63

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 64

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 65

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 66

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 67

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 68

Government of Canada Invests in Projects that Raise Awareness of Dementia and Promote Dementia-inclusive Communities. 2022; Available from: https://www.canada.ca/en/public-health/news/2022/01/government-of-canada-invests-in-projects-that-raise-awareness-of-dementia-and-promote-dementia-inclusive-communities.html

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Footnote 69

Public Health Agency of Canada. Aging and Seniors – Publications. 2023; Available from: https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/aging-seniors-publications.html

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2024-07-18