The Health Equity Framework for Vulnerable Seniors Living with Dementia

Background: The province of Ontario, Canada, is home many culturally diverse populations, having most amount of immigrant communities, and largest population of Indigenous people, and numerous other diverse populations. It is also home to 3.0 million seniors out of 16 million people in the province. This prompts consideration of the unique age-related health challenges and needs of these intersecting communities. As Ontario accounts for over 300,000 of approximately the 770,000 dementia cases in Canada targeted resources are necessary.

 

To support these and other underserviced populations, the Alzheimer Society of Ontario developed the Health Equity Framework for Vulnerable Seniors Living with Dementia to support the 26 local provincial Alzheimer societies across the province in the development and implementation of health equity initiatives.

 

Methods: The health equity framework was developed in 3 phases. In Phase 1 an environmental scan of health equity-based frameworks that address care gaps in vulnerable populations was conducted and revealed little knowledge of frameworks targeting diversity in dementia for vulnerable seniors. Phase 2 included in-person and virtual consultations with local Alzheimer Society senior leaders and staff to gain knowledge of the current organizational status of health equity initiatives and areas of opportunities.

 

 Participants were asked semi-structured questions developed by the Health Equity and Access director that were informed by the environmental scan from phase 1, and secondary research on diversity and dementia and health status of seniors from underserved communities in Canada. Consultations with subject matter experts were also conducted to gain industry perspectives on health equity and dementia. Thematic analysis was conducted to determine themes and subthemes. In Phase 3 the implementation of the framework across the federation was conducted, and its evaluation of uptake and efficacy to address inequities is ongoing throughout phase 3 and beyond.

 

Results: Findings revealed a deficit in organizational knowledge and capacity of health equity across all societies in program delivery and intake services, a need of system level integration, and increased community partnerships including a need for more culturally based approaches to engagement and partnership.

 

Conclusion: The resulting framework identified 4 organizational values, and 6 equity-related pillars to increase organizational capacity and competency to drive health equity initiatives across the federation. Implementation has been adopted by the federation in asynchronous timelines. Successful implementations of the framework have resulted in great staff confidence and capacity. Deeper knowledge of health equity principles, and stronger and more authentic relationships. Routine evaluation are conducted to determine uptake, adherence and efficacy of the framework.