Interview: Dr. Giovanni Marotta, MD, FRCP(c), Clinical Advisor to the CBAO Seniors Day Program

We sat down recently with Dr. Giovanni Marotta to talk about the CBAO Seniors Day Program, a unique pilot program now offered in Vaughan and in the Italian language for these seniors with early-stage dementia. One of only three Italian-speaking geriatricians in the city, Dr. Marotta is the clinical advisor to this program which offers a structured schedule of physical, mental and social activities. In this interview, Dr. Marotta explains the benefits of this program and its unique differences from existing programs.

What are the risk factors for dementia?
“Dementia is a chronic disease which robs people of memory, reasoning, personality and independence. Getting older is the biggest risk.  We all face a 15% chance of getting dementia with Alzheimer’s pathology where the brain plaques and tangles followed by strokes. These are responsible for more than 90% of the cases that we see.”

What are the impacts of dementia on the healthcare system, here and abroad?
“There are 360,000 cases of dementia in Canada, and every minute a new case is diagnosed. Dementia is ranked fourth in the world for disease burden and that’s increasing. The wealthy countries of the world are all aging while less wealthy countries are seeing their people live longer as they become less poor. They too are seeing an increase in cases as they have more seniors.  There are 36 million cases in the world, and poor countries shoulder half the burden with little money to cover the estimated annual cost of care that is pegged at $606 US billion.”

Tell us more about the CBAO Seniors Day Program. What is modelled after?
“The day program model has come from northern Europe, and it’s taken some of the best ideas seen scattered in other programs, putting them together in a unique fashion, I believe. The Germans showed this type of active day program can act like a medication in terms of improving intellect and maintaining function so that people taking part twice a week or more often see these benefits along with better behaviour at home and much less burden of care for their families. We know that the best rehabilitation approach is just that: mental, physical and social activity. Our program does this within a supportive environment without clients realizing how good it is for them.”

What makes the CBAO Seniors Day Program different?
“Not all day programs share the same approach. Some are more passive with activities and are more about being a safe place for people with dementia to stay so that family has a break. Our program is unusual in that we have a philosophy of creating a safe environment that gives caregivers a break, but structures the day so that clients with dementia are taking part in a rehabilitation program to help them be the best they can be with intellect, behaviour and function. What also makes our program unusual is that it has come from our generous donors from within our community. They’ve seen the gap in care, and the suffering within our Italian-Canadian families with long wait lists.”
 
On that note, access to programs can be a challenge for families and care partners. Just how difficult is it to access programs like this one?
“We have a number of day programs here in the Greater Toronto Area, but the wait lists are long. Last year, wait lists for clients in the Vaughan area were approaching one year.”

There in another unique aspect to the day program. It is delivered in Italian. Why is that?
“Having a nurturing environment with the Italian language component is an essential. The loss of second language (English) is inherent in the decline of dementia.  A return to the mother tongue (Italian) is universal in time. There are not enough Italian-language programs.”

It also sounds like considerable thought was also given on the design of the centre. What was considered when it came to the design?  
“We’ve seen the creation of a centre that looks more like a small light industrial workplace rather than a nursing home or community centre. Many individuals with dementia are afraid that the usual day programs in nursing home settings are a preparatory step to get them ready for nursing home! It is just the opposite. We also know that many of our elders with dementia were blue collar workers who had little time for hobbies. The program tries to invite them into a return to a “work environment” which is a familiar setting for them. They are more receptive to the physical, mental and social exercises inherent in the program structure.”

What’s on the horizon in terms of treatment?
“We know that maintaining intellect and functional abilities for as long as possible will allow people to hold onto independence and avoid the need for nursing home care. Our current dementia drugs can help slow some of this while pushing off the arrival of difficult behaviours like paranoia, anger and resistance to help for lost abilities. They can give about two additional years of stability. New drugs that can slow the damaging process are needed, and we hope coming in 2017. If we can increase the stability from drugs and rehabilitation programs like ours to five years of benefit, we can likely avoid the need for nursing home care.