Dementia over distance

Dementia is devastating to both patients and caregivers, but it is especially so for people living in rural and remote areas, said cognitive neurologist Dr. Andrew Kirk.

"If you live 40 kilometres from the nearest town and you have to go there to get groceries, it can be very difficult not to be able to drive, for example," he said. "Children of the patient are more likely to live elsewhere, so that can be dfficult too. As well, these are often elderly folk, frail people, so it's hard to travel four hours to Saskatoon for a medical appointment."

Kirk is part of the Rural Dementia Care team at the College of Medicine. Formed in 2003 and led by rural health delivery specialist Debra Morgan, the team conducts research and shares knowledge around the province aimed at improving diagnosis, treatment and care of both people with dementia and their caregivers.

Morgan explained that rural people identify a whole spectrum of issues around dementia care, such as lack of awareness that prevents people from recognizing symptoms, diagnostic uncertainty among health-care providers, and difficulty accessing post-diagnostic supports and services.

"In rural settings the family physician might be the only health-care provider," she said. "Perhaps they don't want to be the one to tell the person they can't drive, for example, because it could a effect their relationship. Patients and families need those relationships with their local health-care providers."

The Saskatchewan team is one of 20 involving 340 researchers across Canada working on dementia under the Canadian Consortium on Neurodegeneration in Aging (CCNA). The goals are to prevent or delay the onset of dementia and related illnesses, advance treatments, and improve the quality of life of patients and caregivers.

One of the Saskatchewan team's achievements is the Rural and Remote Memory Clinic on campus, at the Canadian Centre for Health and Safety in Agriculture. For the last 10 years, rural patients have been able to access the specialists they and their families need to get a diagnosis. The one-stop clinic uses telehealth for pre-clinic assessment and follow up to reduce repeated travel over long distances.

"One of the things we have now are rural practitioners referring cases to us they couldn't diagnose themselves," Kirk said. "It's a perennial problem and it's not just rural practitioners; it's hard to diagnose dementia. ere are many, many reasons why people believe a specialist should do it."

Dementia is a collective term for diseases that affect the brain, interfering with the ability to think and to form and hold memories.

While the memory clinic has the expertise to diagnose the toughest cases, Morgan said there are simply not enough resources to serve the entire province. This means developing programs to empower local health-care professionals to recognize and diagnose dementia, and providing tools to set up support programs in rural communities.

"For the more typical, uncomplicated cases of dementia, we want to be able to increase the capacity of rural health-care providers to do more diagnosis and support on their own," she said.

Kirk and colleague neuropsychologist Meagan O'Connell hope to develop ways to support family doctors to diagnose and treat patients with more confidence.

"When you actually have a patient in front of you, that's when you care," O'Connell said. "It's a strength of the family physician and one we want to build on."

This could take the form of specialist support via telepresence and professional development for rural doctors.

Morgan explained that the team's main project is to develop models for rural primary health care for dementia, a particular challenge for Saskatchewan.

"Compared to Canada as a whole, we have a larger rural population and rural populations are older in Saskatchewan," she said. "Where we have few specialists, where we have a small population in a large geographic area, how do you take existing best practices in dementia care and make them work in rural settings?"

The CCNA initiative could help this happen faster, said Morgan. Expertise is shared among groups—Kirk is a member of two other teams, for example. She also cites their work with a Quebec and Ontario team whose principal investigator wrote Quebec's provincial dementia plan.

"They already have a lot of primary health-care interventions developed, so we can learn from their experience," she said. "But we want to nd out what works here rather than just applying a model from somewhere else.

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