We start this book in a ‘traditional’ way, outlining the ‘problem of dementia’ as it is commonly thought to exist, and as it frequently appears in policy documents – a strategy that provided a convincing and familiar rationale for our study. What follows here constitutes, in some sense, the ‘facts’ of the matter, defining a context that works to make dementia, in its many manifestations, a matter of strategic concern for health service planners and policy-makers. So to begin somewhat starkly, a familiar argument goes like this.

In Canada, as in many nations, population ageing is accelerating, and with this trend there is an increased prevalence of chronic diseases such as dementia. The need to provide responsive care services for older Canadians, particularly those living with Alzheimer's disease and other dementias, is arguably the biggest challenge in healthcare policy and practice today. Alzheimer's disease and other dementias are among the most feared problems of ageing (CIHR, 2013, 2017; Lock, 2013; Latimer, 2018), as well as being the most significant cause of disability in those over the age of 65, placing a ‘long-term progressive burden’ on those who care for them (Dudgeon, 2010, p 3). It is estimated that 500,000 Canadians are living with dementia, a number that is anticipated to increase to over one million as the population ages over the next 25 years.

Currently, more than half of those diagnosed with a dementia are living at home with family and community support. By 2038, this proportion will increase to 62 per cent, or approximately 510,000 Canadians living at home with moderate to severe cognitive impairments (Dudgeon, 2010). With more people living at home, the need for home-based care will increase, and it is primarily family carers who will provide this critical care to family members. It is clear, then, that family carers make, and will continue to make, through their practices of supporting daily life with dementia, a substantial contribution to the overall sustainability of health and social care systems.