8 Dementia Guidelines for Northern BC

Dementia Guidelines for Regional and Indigenous Populations in Northern BC

Significant collective organizing and advocacy is required to ensure that the resources (of all kinds) are available to facilitate and make possible the implementation of these guidelines.




  1. Adherence to a diet that has been shown to decrease the risk of cognitive decline.
    1. Daily consumption of grains, legumes, vegetables, fruits and nuts
    2. Fish and seafood twice a week
    3. Poultry, eggs, cheese and yogurt 1-2 times a week (or moderate portions daily)
    4. Reduced consumption of red meat and sweets. *will add citations


  1. Consume more mono- and poly-unsaturated fatty acids and a low consumption of saturated fatty acids
    1. Monounsaturated fats: Olive oils, canola oil, safflower oil, sunflower oil, avocado, almonds, cashews, peanuts
    2. Polyunsaturated fats: Sunflower oil, walnuts, fish, canola oil
    3. Saturated fats: Butter, meat, tropical oils (coconut oil, palm oil)


  1. Include food items that are indigenous to Northern British Columbia and Canada. These locally grown and harvested foods are more sustainable, low in carbohydrates and high in fiber.
    1. Carbohydrates: Wild rice
    2. Fish: Salmon, Pacific Cod, Black cod, Ling cod, Rockfish, Sole, Flounder, Halibut, Northern Pike, Walleye, Burbot, Arctic Grayling Bass, Chub
    3. Plants: Seaweed, Stinging Nettle, Violet, Douglas fir tips
    4. Roots: Springbank clover, ‘wild sweet potatoes’, northern riceroot, edible camas, ‘wild carrot’, spiny wood fern, wapato, bitterroot, nodding onion, desert parsley, eel-grass, yellow glacier lily, spring beauty or mountain potato, and balsamroot chocolate lily, bear root, and sweet vetch.
    5. Berries: blueberries, cranberries, blue huckleberries, crowberries (mossberry), currants, bunchberries, cloudberries


Physical Exercise

  1. Aerobic exercises and/or resistance training of at least moderate intensity is recommended to improve cognitive outcomes among older adults.
    1. At least 30 minutes of exercise a day averaging to 150 minutes a week.
    2. The long winters and increasing wildfires may make it harder for people to engage in outdoor activities. This means that there should be spaces for indoor activities.



  1. Persons with cognitive complaints, Mild Cognitive Impairments (MCI), or dementia (and their care partner, if there is one) should be questioned about symptoms of hearing loss to improve cognitive outcomes and risk reduction. It is recommended that persons are asked if they have any difficulty hearing in their everyday life (rather than asking if they have a hearing loss).
  2. If symptoms of hearing loss are reported, then hearing loss should be confirmed by audiometry conducted by an audiologist meeting provincial regulations for the practice of audiology.
  3. If elderly need hearing aid, it is necessary to enhance accessibility to hearing aids. This will contribute to brain health promotion and decrease the likelihood of developing dementia.
    1. Part of this could be public medical plans for hearing aids.



  1. A careful sleep history, including assessment of sleep time, and symptoms of sleep apnea, should be included in the assessment of any patient at risk for dementia. Patients in whom sleep apnea is suspected should be referred for polysomnography and/or sleep specialist consultation for consideration of treatment.
  2. Avoiding severe (<5 hours) sleep deprivation, and targeting 7-8 hours of sleep per night, may improve cognition and decrease the risk of dementia.



  1. Include technological interventions to assist patients with dementia achieve greater independence. These could be simple solutions such as memory aids to more complex systems such as smart kitchens.
  2. Mobility access (such as bus services) for older adults who want to shop for themselves. This is of particular concern for people in rural and remove settings (including First Nations Reserves).



Cognitive Training and Stimulation

  1. Higher education has been associated with lowered risk of dementia. It would appear that cognitively challenging activities decreases the risk of dementia.
    1. Improve access to formal higher education for communities in rural and remote regions. This includes the removal of physical and financial barriers to accessing it
    2. Informal training and apprenticeships which are cognitively stimulating
    3. Traditional knowledge systems that are passed down from Elders
  2. Provide support for educational attainment, with a focus on early-life education as well as lifelong and ongoing educational opportunities.
  3. Encourage activities that stimulate cognition. These can include learning an instrument, making pottery, basket weaving, or moccasin making. Such activities engage the mind and improve cognitive load.
  4. Individuals be advised to increase or maintain their engagement in cognitively stimulating activities such as cognitively stimulating pastimes, volunteering, and long-life learning


Cognitive Assessments

  1. Make cognitive assessments more accessible.
    1. Train more healthcare professionals and social workers on the use of cognitive assessments.
    2. Develop adaptations of standardized cognitive assessments in more languages. Assessing patients whose first language is not English or French in those languages leads to unreliable or invalid data.
  2. Improve access to technologies that could be used to assess cognitive impairments in early onset dementia. This would alleviate some of the accessibility issues in getting assessed by physicians.



Social Engagement

  1. We recommend considering group cognitive stimulation therapy for people living with mild to moderate dementia.
  2. Consider the development of dementia friendly organizations/communities for people living with dementia.
  3. Consider the use of case management for people living with dementia. Case management is defined as the introduction, modification, or removal of strategies to improve the coordination and continuity of delivery of services which includes the social aspects of care.
  4. Develop programs for young people to interact with the elderly and understand their value to society. These could include
    1. Educational institutions could include course credits for community service or volunteer work with the elderly.
    2. Religious institutions and other community organizations can engage young people in programs that involve working with the elderly.



  1. Attention to social circumstances and supports across the life course is needed, including poverty reduction strategies and opportunities for social engagement.
  2. Develop ways to bring the community together for shared activities. This reduces social isolation and allows people of different age groups to interact with each other.
  3. Improve access to food in general and healthy food in particular. Grocery stores and supermarkets may not always be within walking distance for some neighborhoods creating de facto food deserts.
  4. Increase employment opportunities for young people in remote, rural and Indigenous communities so that there is not a drain of young adults from these communities to other locations. This allows for greater support for the elderly in these communities.


Caregiver support

  1. Create more initiatives that support caregivers such as temporary caretakers to allow for caregivers a break from their daily stress as well as financial support when appropriate.
  2. We recommend considering psychosocial and psychoeducational support for caregivers of people living with dementia.
  3. There is a need to provide more support to non-profit organizations serving small communities, such as Better at Home or Meals on Wheels. They require additional volunteers to sustain their activities and to expand them.


Language and Society

  1. Support language initiatives to develop terms for or the adaptation of borrowed terms (such as the Latin demens into English) dementia in the languages spoken in this region. Such initiatives will improve awareness in these communities with regards to viewing dementia as a disorder and not a normal part of aging.
  2. Create educational and learning materials on dementia available to people in their primary language.



  1. Advocate for public spaces that are cognition aware. Rather than focus on only dementia, we should collaborate with communities advocating for other cognitive impairments and the physically challenged to make common recommendations to officials who make decisions about public services. In doing so, we should collaborate with communities advocating for those experiencing other cognitive impairments or physical challenges to find common ground.
  2. Ensure that buildings are designed to be accessible and comprehensible for individuals with dementia and other cognitive impairments. Unusual shapes can cause confusion and make them inaccessible to the elderly.
  3. Ensure that public amenities such as benches and crosswalks are not confusing. For example, unusually shaped park benches or crosswalks without clear contrasts can be difficult for people with cognitive impairments to understand and use.
    1. Distinctive landmarks to help with navigation
    2. More frequent crossings on road
    3. Pedestrian islands on busy roads
    4. Provide enough time to cross roads at crosswalks
    5. More ground level crossings
    6. High contrast colours on crosswalks (yellow on black)
    7. Accessible and familiar public seating
  4. Increase availability of dementia care facilities within or closer to communities in Northern BC. At present, Indigenous communities have limited facilities for full-time dementia care and patients are often taken far from their family and friends when they need full-time care.
  5. More dementia awareness initiatives are needed specially for small towns and indigenous communities in northern BC.
  6. Utilizing various media could significantly enhance public awareness about dementia. This includes:
    1. Television
    2. Radio
    3. Social media
    4. Local newspapers
    5. Local bulletins



Mind the Gap: Dementia Guidelines for the North Copyright © by Dinesh Ramoo and Salima Somani. All Rights Reserved.

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