Can a national dementia plan reduce seniors home violence?

The death of a 91-year-old woman after an altercation at a Nova Scotia seniors home earlier this week is renewing calls for a national strategy to care for seniors with dementia.

"It shouldn't be the luck of the draw if you happen to live in a province that has a provincial dementia plan," said Mary Schulz, director of education at the Alzheimer Society of Canada.

"We believe that there are elements that need to be common across the country and that requires a national response."

Last Saturday, Joyce Renouf fell during a dispute with a 74-year-old woman at Evan Hall, a facility attached to the Parkstone Enhanced Care nursing home in Halifax, a large complex for seniors with dementia.

Renouf was sent to hospital with serious injuries and died Sunday night.

On Tuesday, Halifax Regional Police ruled her death a homicide, after an autopsy concluded that it resulted from injuries received during the altercation, according to the police release.

"This is a very, very tragic situation, but unfortunately it's not at all uncommon," Schulz said.

Renouf's death comes after another incident this summer involving patients with dementia.

John Furman, a 95-year-old war veteran, is facing charges for allegedly killing his 85-year-old roommate at a residential care home in Vernon, B.C., in August. The crown attorney said Furman has advanced Alzheimer's disease and is undergoing a psychiatric assessment.

There have been other examples in recent years. In October 2012, an 84-year-old woman died at a care home in Vancouver after she was pushed by a resident with dementia and hit her head.

A similar incident killed Frank Alexander, 87, who was pushed and fell after a confrontation with a resident with Alzheimer's at a care home in Winnipeg in 2011.

In 2009, a homicide charge was laid after at an 88-year-old man was found dead in his room at the Peter D. Clark Long Term Care Centre in Ottawa. Another resident, who has Alzheimer's, was charged with second-degree murder.

Dementia 'a priority'

Schulz says that with their memory loss, people with dementia may become suspicious, irritable or anxious, and that may lead to outbursts of aggression.

The Alzheimer's Society is asking the federal government to set up an Alzheimer's disease and dementia partnership, modelled after existing federally funded health initiatives such as the Canadian Partnership Against Cancer, Canadian Blood Services and the Mental Health Commission of Canada.

"That plan needs to be a national plan that can be supported by provincial and local plans which, of course, meet the unique needs of the population living in these communities," Schulz said.

"There are national issues at stake here and lots of commonalities."

Frank Alexander, 87, was allegedly attacked by a resident with Alzheimer's at a Winnipeg care home in 2011. He hit his head after falling backward and later died. (Courtesy of the Alexander family)

A national plan is also one of the main recommendations of the 2013 World Alzheimer Report, published last month by Alzheimer's Disease International, a federation of 79 associations around the world.

"All governments should make dementia a priority. This should be signified by developing national dementia plans to ensure that health and social care systems are adequately structured and funded to provide high-quality care and support to people throughout the dementia journey," the report suggests.

Research strategy in place

Globally, half of all seniors who need personal care have dementia, according to the World Alzheimer Report. The number is more staggering in nursing homes: 80 per cent of seniors in nursing homes are living with the degenerative disorder.

A 2010 report by the Ontario Health Quality Council, an arms-length agency of the Ontario government, paints a similar picture, with about 70 per cent of long-term care residents living with dementia.

'Some people still think it's a natural part of getting older. It's not. It's a horrific, devastating, progressive neurological condition.'- Mary Schulz, director of education at the Alzheimer Society of Canada

One national research plan currently in place is the international collaborative research strategy for Alzheimer's disease, one of the signature initiatives at the Canadian Institutes of Health Research (CIHR). The initiative, led by CIHR's Institute of Aging, supports Canadian research in neurodegenerative diseases, as well as Canadian researchers in international projects.

"This strategy is certainly already contributing to a national strategy in terms of research and can be capitalized that way," said Yves Joanette, scientific director of the Institute of Aging.

Joanette explained that CIHR's strategy focuses specifically on research, and that non-research aspects — such as training for caregivers and the design of long-term care facilities — are currently a provincial responsibility.

A full-fledged national plan, he said, should be a political discussion.

Political engagement

In Ottawa, the talk of a national strategy is already gaining ground. Claude Gravelle, an NDP member of Parliament, introduced a private member's bill for a national dementia strategy in 2011. The bill is expected to have its second reading next year.

Canada is the only G8 country without a national plan for dementia care, according to Gravelle, whose late mother lived with Alzheimer's for more than a decade.

A Canada-wide plan would mean more research funding and more training for caregivers, he said.

"What I'd like to see is to have the same rules from coast to coast to coast," he said.

Gravelle said he has received support from his Conservative and Liberal counterparts.

"Alzheimer's doesn't recognize parties," he said. "This is not a political issue. It's a medical issue."

Dementia dilemma

However, there are other challenges.

Benoit Mulsant, clinical director of the geriatric mental health program at the Centre for Addiction and Mental Health, describes dementia as "not a sexy topic."

Ageism can make research and fundraising for disorders like dementia – which primarily affects older people – less appealing than other health conditions, he said.

There have been "more discussions, but not a lot of funding and not a lot of action," he said.

Stigmas and a lack of awareness may also play a role, the Alzheimer's Society's Schulz said.

"Some people still think it's a natural part of getting older. It's not. It's a horrific, devastating, progressive neurological condition."