July 16, 2025
As dementia prevalence rates continue to increase across Ontario, clinical leaders are taking bold steps to prepare the province’s healthcare system for the complex needs of aging populations. Work led by Provincial Geriatrics Leadership Ontario (PGLO) outlines a comprehensive approach to preparing health systems for future dementia clinical pathways, aiming to improve care quality and system readiness.
More than 334,500 Ontarians currently live with dementia (1). In 2023 alone, over 173,000 individuals aged 66 and older with dementia were prescribed an average of 11 medications, made frequent physician visits, and nearly half required home care (2). Many also experienced emergency department visits and hospitalizations, often compounded by co-morbid conditions (2).
Recognizing the urgency, PGLO began a multi-pronged strategy to support the implementation of forthcoming dementia clinical pathways. This work includes:
- Understanding the Population: Analyzing the holistic needs of older adults living with dementia and related conditions.
- Mapping Clinical Assets: Maintaining a provincial inventory of over 1,800 health professionals across 349 specialized geriatric and seniors’ mental health programs.
- Defining Clinical Activities: Drawing from 41 dementia strategies and a 2025 expert consultation with over 130 participants (3) to define key care activities such as prevention, screening, assessment, diagnosis, and treatment.
- Designing for Complexity: Identifying 13 essential design elements through a scoping review to guide service planning and delivery.
- Preparing the Workforce: Launching a blended training program for health and social care professionals, combining self-paced learning with live virtual sessions led by interprofessional geriatric experts.
“Dementia clinical pathways can significantly enhance diagnosis and intervention,” said Dr. Kelly Kay, Executive Director of PGLO. “But for these pathways to succeed, the system must be ready—clinically, structurally, and culturally.”
PGLO’s work is funded by the Ontario Ministry of Health, through the Dementia Strategy. This work includes tools such as an implementation rubric, a systems-level logic model, and preliminary indicators to guide health system transformation (see sidebar for links to additional resources).
As Ontario continues to grapple with the growing demands of dementia care, PGLO’s leadership offers a model for other jurisdictions seeking to build integrated, responsive, and sustainable health systems for older adults living with complex health conditions like dementia.
References:
(1). Alzheimer Society of Canada. (2024). Landmark study volume 2: The many faces of dementia in Canada.
(2) Warren C, Mondor L, Bronskill S, Paterson M, Plumptre L, An D. Characteristics and Utilization of Physician Specialist Services among Older Adults with Dementia and Frailty in Ontario – 2023 Update, Applied Health Research Questions (AHRQ) # 2024 0800 263 001. Toronto: Institute for Clinical Evaluative Sciences;2023.
(3) This event was co-hosted by PGLO, the Alzheimer Society of Ontario and the Behavioural Supports Ontario Provincial Coordinating Office. Report pending.