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Canadian Journal of Public Health

, Volume 104, Issue 1, pp e39–e44 | Cite as

The Emergence of Dementia as a Health Concern Among First Nations Populations in Alberta, Canada

  • Kristen M. JacklinEmail author
  • Jennifer D. Walker
  • Marjory Shawande
Quantitative Research

Abstract

OBJECTIVES: Little is known about the prevalence and incidence of dementia in Aboriginal communities in Canada. As with the Canadian population, dementia in Aboriginal people is expected to be an increasing challenge for federal, provincial and community health care systems. To respond to a dearth of information concerning the prevalence of dementia in First Nations, this paper reports population-level data on dementia in the First Nations population in Alberta, Canada.

METHODS: Aggregate data obtained from Alberta Health and Wellness were analyzed. Physician-treated prevalence rates for dementia were calculated for First Nations and non-First Nations populations seeking treatment in Alberta (1998-2009). Trends in age-adjusted rates over time were compared using linear regression models. Age and sex effects were also examined.

RESULTS: In 2009, the age-standardized prevalence of dementia in First Nations in Alberta was 7.5 per 1,000 (95% CI: 6.6 to 8.5 per 1,000) compared to non-First Nations, at 5.6 per 1,000 (95% CI: 5.5 to 5.6). The prevalence of dementia rose more quickly for First Nations (p=0.032). The data suggest that dementia disproportionately affects younger age groups and males (p=0.017) in First Nations populations compared to non-First Nations.

CONCLUSIONS: Dementia represents an emerging health concern for First Nations. This increase may be driven by parallel trends, such as population aging, changing perceptions of dementia, and disproportionately higher rates of associated risk factors, impacts of the social determinants of health, and co-morbid illnesses. The unique epidemiological profile supports the need for responsive policies, programs and care geared specifically to First Nations.

Key words

Dementia Alzheimer disease First Nations epidemiology Canada 

Résumé

OBJECTIFS: On sait peu de choses sur la prévalence et l’incidence de la démence dans les communautés autochtones au Canada. Comme dans la population canadienne, on s’attend à ce que la démence chez les Autochtones présente un défi croissant pour les systèmes de santé fédéral, provinciaux et locaux. Pour combler le manque d’information sur la prévalence de la démence chez les Premières Nations, nous présentons des données populationnelles sur la démence dans la population des Premières Nations de l’Alberta, au Canada.

MÉTHODE: Nous avons analysé les données globales du ministère albertain de la Santé et du Bien-être. Les taux de prévalence de la démence traitée par un médecin ont été calculés pour les populations des Premières Nations et hors Premières Nations en quête de soins en Alberta (1998-2009). À l’aide de modèles de régression linéaire, nous avons comparé l’évolution dans le temps des taux ajustés selon l’âge. Nous avons aussi examiné les effets selon l’âge et le sexe.

RÉSULTATS: En 2009, la prévalence de la démence, standardisée pour l’âge, chez les Premières Nations de l’Alberta était de 7,5 p. 1 000 (IC de 95 %: 6,6 à 8,5 p. 1 000), tandis qu’hors des Premières Nations, elle était de 5,6 p. 1 000 (IC de 95 %: 5,5 à 5,6). La prévalence de la démence a augmenté plus rapidement chez les Premières Nations (p=0,032). Les données montrent que la démence touche les jeunes et les hommes de façon démesurée (p=0,017) dans les populations des Premières Nations comparativement aux populations hors Premières Nations.

CONCLUSION: La démence est un problème de santé émergent pour les Premières Nations. Son augmentation pourrait être alimentée par des tendances parallèles, comme le vieillissement de la population, l’évolution des perceptions à l’égard de la démence, ainsi que les taux démesurément plus élevés des facteurs de risque associés, les impacts des déterminants sociaux de la santé et les comorbidités. Ce profil épidémiologique singulier appelle à des politiques, des programmes et des soins plus spécifiquement adaptés aux Premières Nations.

Mots clés

démence maladie d’Alzheimer Premières Nations épidémiologie Canada 

References

  1. 1.
    Alzheimer Society of Canada. The Rising Tide: The Impact of Dementia on Canadian Society. Toronto, ON: Alzheimer Society of Canada, 2010.Google Scholar
  2. 2.
    Noojmowin Teg Health Centre and the Alzheimer Society of Ontario. Alzheimer’s Disease and Related Dementias (dementia) in Aboriginal Communities: New Visions and Understandings: Roundtable Forum Report March 2007. Aundeck Omni Kaning, ON: Noojmowin Teg Health Centre, 2007.Google Scholar
  3. 3.
    Henderson JN, Traphagan JW. Cultural factors in dementia. Alzheimer Dis Assoc Disord 2005;19(4):272–74.CrossRefGoogle Scholar
  4. 4.
    Kramer BJ. Dementia and American Indian populations. In: Yeo G, Gallagher-Thompson D (Eds.), Ethnicity and the Dementias. Washington, DC: Taylor and Francis, 1996;175–81.Google Scholar
  5. 5.
    Hulko W, Camille E, Antifeau E, Arnouse M, Bachynski N, Taylor D. Views of First Nation Elders on memory loss and memory care in later life. J Cross-Cultural Gerontol 2010;25(4):317–42.CrossRefGoogle Scholar
  6. 6.
    Jacklin K, Warry W. Diverse Experiences: Perspectives on Alzheimer’s Disease in Aboriginal Communities in Ontario. Alzheimer’s Disease International; March 27, 2011. Toronto, ON: Alzheimer’s Disease International, 2011. Available at http://www.alz.co.uk/adi-conference-2011-presentations (Accessed April 4, 2012).Google Scholar
  7. 7.
    Caron Malenfant É, Morency J-D. Population Projections by Aboriginal Identity in Canada, 2006 to 2031. Ottawa, ON: Statistics Canada, Cat No. 91-552-XWE 2011. Available at http://www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=91-552-x&lang=eng (Accessed March 7, 2012).
  8. 8.
    Health Canada. A Statistical Profile on the Health of First Nations in Canada: Self-rated Health and Selected Conditions, 2002 to 2005. Ottawa: Health Canada, 2009.Google Scholar
  9. 9.
    Loppie Reading C, Wein F. Health Inequalities and Social Determinants of Aboriginal Peoples Health. National Collaborating Centre for Aboriginal Health, 2009. Available at: http://www.nccah-ccnsa.ca/docs/social%20determinates/NCCAH-Loppie-Wien_Report.pdf (Accessed March 28, 2012).Google Scholar
  10. 10.
    Patterson C, Feightner J, Garcia A, MacNight C. General risk factors for dementia: A systematic evidence review. Alzheimer’s & Dementia 2007;3:341–47.CrossRefGoogle Scholar
  11. 11.
    Qureshi SU, Kimbrell T, Pyne JM, Magruder KM, Hudson TJ, Petersen NJ, et al. Greater prevalence and incidence of dementia in older veterans with posttraumatic stress disorder. J Am Geriatr Soc 2010;58(9):1627–33.CrossRefGoogle Scholar
  12. 12.
    Yellow-Horse Braveheart M. The historical trauma response among Natives and its relationship with substance abuse: A Lakota illustration. J Psychoactive Drugs 2003;35(1):7–13.CrossRefGoogle Scholar
  13. 13.
    Smith K, Flicker L, Lautenschlager NT, Almeida OP, Atkinson D, Dwyer A, LoGiudice D. High prevalence of dementia and cognitive impairment in Indigenous Australians. Neurology 2008;71(19):1470–73.CrossRefGoogle Scholar
  14. 14.
    British Columbia Provincial Health Officer. Pathways to Healing: 2nd Report on the Health and Well-Being of Aboriginal People in British Columbia. Victoria, BC: Provincial Health Officer’s Annual Report 2007, 2009. Available at: http://www.health.gov.bc.ca/pho/pdf/abohlth11-var7.pdf (Accessed April 3, 2012).Google Scholar
  15. 15.
    Minore B, Katt M, Hill ME. Planning without facts: Ontario’s Aboriginal health information challenge. J Agromedicine 2009;14(2):90–96.CrossRefGoogle Scholar
  16. 16.
    Oster RT, Johnson JA, Hemmelgarn BR, King M, Balko SU, Svenson LW, Toth EL. Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults. CMAJ 2011;183(12):E803–E808.Google Scholar
  17. 17.
    Indian Act, R.S.C., 1985, c. I-5. Ottawa: Minister of Justice, 1985. Available at http://laws-lois.justice.gc.ca/PDF/I-5.pdf (Accessed April 4, 2012).Google Scholar
  18. 18.
    Young TK, Reading J, Elias B, O’Neil JD. Type 2 diabetes mellitus in Canada’s First Nations: Status of an epidemic in progress. CMAJ 2000;163(5):561–66.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Health Canada. Diabetes Among Aboriginal (First Nations, Inuit and Métis) People in Canada: The Evidence. Ottawa: Health Canada, 2000.Google Scholar
  20. 20.
    Smith K, Flicker L, Dwyer A, Atkinson D, Almedida OP, Lautenschlager NT, LoGuidice D. Factors associated with dementia in Aboriginal Australians. Aust NZ J Psychiatry 2010;44:888–93.CrossRefGoogle Scholar
  21. 21.
    Lin P-J, Kaufer DI, Maciejewski ML, Ganguly R, Paul JE, Biddle AK. An examination of Alzheimer’s disease case definitions using Medicare claims and survey data. Alzheimer’s & Dementia 2010;6:334–41.CrossRefGoogle Scholar
  22. 22.
    Dilworth-Anderson P. Diagnosis of Alzheimer’s within cultural context. Alzheimer’s & Dementia 2010;6(4):S95.CrossRefGoogle Scholar
  23. 23.
    Morgan DG, Innes A, Kosteniuk J. Dementia care in rural and remote settings: A systematic review of formal or paid care. Maturitas 2011;68(1):17–33.CrossRefGoogle Scholar
  24. 24.
    Cattarinich X, Gibson N, Cave AJ. Assessing mental capacity in Canadian Aboriginal seniors. Soc Sci Med 2001;53(11):1469–79.CrossRefGoogle Scholar
  25. 25.
    Griffin-Pierce T, Silverberg N, Connor D, Jim M, Peters J, Kaszniak A, Sabbagh MN. Challenges to the recognition and assessment of Alzheimer’s disease in American Indians of the southwestern United States. Alzheimer’s & Dementia 2008;4(4):291–99.CrossRefGoogle Scholar
  26. 26.
    Jervis LL, Manson SM. Cognitive impairment, psychiatric disorders, and problematic behaviors in a tribal nursing home. J Aging Health 2007;19(2):260–74.CrossRefGoogle Scholar
  27. 27.
    Lanting S, Crossley M, Morgan D, Cammer A. Aboriginal experiences of aging and dementia in a context of sociocultural change: Qualitative analysis of key informant group interviews with Aboriginal seniors. J Cross-Cultural Gerontol 2011;26(1):103–17.CrossRefGoogle Scholar
  28. 28.
    Health Canada. Non-Insured Health Benefits (NIHB) Newsletter for Pharmacy Providers, Winter 2008–2009. Available at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/nihb-ssna/_drug-med/2009-news-winter-bull-hiver-nat/index-eng.php#b7 (Accessed April 4, 2012).
  29. 29.
    Reading JL, Kmetic A, Gideon V. First Nations Wholistic Policy and Planning Model: Discussion Paper for the World Health Organization Commission on Social Determinants of Health, 2007. Available at: http://ahrnets.ca/files/2011/02/AFN_Paper_2007.pdf (Accessed March 3, 2012).Google Scholar

Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  • Kristen M. Jacklin
    • 1
    Email author
  • Jennifer D. Walker
    • 2
  • Marjory Shawande
    • 3
  1. 1.Division of Human Sciences, Northern Ontario School of MedicineLaurentian UniversitySudburyCanada
  2. 2.School of Public Health and Health Systems, Faculty of Applied Health SciencesUniversity of WaterlooWaterlooCanada
  3. 3.Elder, Wikwemikong Unceded Indian ReserveWikwemikongCanada

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