Making sense of dementia: understanding amongst indigenous Australians

Perception and knowledge of dementia prevention and its associated socio-demographic factors in China: A community-based cross-sectional study

Background

Although considerable progress has been made on the risk factors of dementia, less is known about the extent of the gaps between the general public's understanding of dementia prevention and contemporary scientific evidence. This study aimed to determine the beliefs and knowledge of dementia prevention among the Chinese general public and examine the socio-demographic factors of the belief and knowledge of dementia prevention.

Methods

The study adopted a cross-sectional design. A total of 358 Chinese adults aged over 40 years were recruited from four healthcare centers. We designed questionnaires that include items on the belief of dementia prevention, risk factors for dementia, and health education needs regarding dementia prevention based on previous literature. Descriptive statistics and multivariate regression analyses were conducted.

Results

Only 32.4% of the respondents agreed that dementia is preventable. Less participants were able to correctly identify cardiovascular risk factors (i.e., obesity, diabetes, dyslipidemia, hypertension, unhealthy diet, smoking, and alcohol) as part of dementia risk factors. Younger age, higher education, and having contact with patients with dementia are associated with stronger belief that dementia is preventable. Older age, higher income, higher education, having memory complaint, and having contact with patients with dementia are associated with a better understanding of dementia risk factors. A total of 88.9% respondents thought that they are not well informed of dementia from public education, and most respondents (65%) prefer receiving dementia-related health advice from primary care providers.

Conclusion

The present study reveals the great gaps between the Chinese general public's knowledge of dementia prevention and the latest research evidence. Public health educational programs for all age groups are encouraged to close this knowledge gap. More attention and resources should be paid to individuals with low income and low education level as they have limited access to dementia prevention information. Researchers should work in partnership with primary care providers to help translate evidence into community practice with a special focus on the link between cardiovascular risk factors and dementia.

Dementia ECHO: Evaluation of a telementoring programme to increase dementia knowledge and skills in First Nations-led health services

Introduction

High rates of dementia among Australian First Nations’ peoples have resulted in an increased demand for dementia knowledge and skills among the primary health care professionals in these communities. The Dementia Extension for Community Healthcare Outcomes (ECHO) program aims to be a culturally safe way of increasing local health workforce capacity by facilitating dementia knowledge, skills and confidence among primary care professionals in First Nations community settings. Dementia ECHO is based on the international evidence-based telementoring programme, Project Extension for Community Healthcare Outcomes. Every Dementia ECHO session is delivered by videoconference and comprises a specialist-led presentation and a case discussion from a primary care health service participant. The aims of this study were to assess the uptake and reach of Dementia ECHO; examine the perceived importance of dementia care and dementia education among Aboriginal and Torres Strait Islander Community Controlled Health Service staff; and evaluate the potential impact of Dementia ECHO on health service staff pertaining to dementia knowledge, confidence to provide dementia care and professional isolation.

Method

Dementia ECHO service activity data maintained by the programme providers was reviewed to determine uptake and reach. A pre-implementation survey examined Aboriginal and Torres Strait Islander Community Controlled Health Service staff perspectives on the importance of dementia education and the priority of a range of health issues. After each Dementia ECHO session, a brief online survey gathered quantitative and qualitative data regarding the potential impact of the session.

Results

Of 30 completed pre-implementation surveys, all staff rated dementia education as either very important or important. Salient themes highlighting why it is important are presented. When asked to rank six different health priorities, dementia ( n = 10) and chronic disease ( n = 10) were placed as the top priority. The brief post-session feedback provided 44 complete survey responses demonstrating: perceived improvement in dementia knowledge and skills (88.4%); increased confidence to provide dementia care (83%); and a reduction in professional isolation (88%).

Conclusion

Dementia ECHO addresses a gap in dementia education that is much needed in health professionals with increasing numbers of First Nations people living with dementia. This current study shows that attending an evidence-based telementoring programme, such as Dementia ECHO, can increase dementia knowledge and confidence to care for someone living with dementia and their families.

Challenges and opportunities in providing dementia care for Aboriginal and Torres Strait Islander peoples living in rural and remote areas

Dementia rates within Australian Aboriginal and Torres Strait Islander populations are estimated to be three to five times higher than non-Indigenous populations. Geographical and cultural barriers demand creative ways of delivering culturally appropriate effective dementia care. Focus groups and interviews with people ( N = 73) from three Aboriginal Medical Services and communities explored attitudes toward, and experiences of dementia care and services. A thematic analysis highlighted the juxtaposition between biomedical and culturally appropriate models of dementia care. Services at the cultural interface can be adapted to facilitate appropriate dementia care at a local level allowing people to stay on Country, supported by people within one’s own Community.

Volume, scope, and consideration of ethical issues in Indigenous cognitive impairment and dementia research: A systematic scoping review of studies published between 2000-2021

INTRODUCTION

High quality research involving Indigenous people with cognitive impairment and dementia is critical for informing evidence-based policy and practice. We examined the volume, scope and ethical considerations of research related to dementia with Indigenous populations globally from January 2000-December 2021.

METHODS

Studies were included if they were published in English from 2000 to 2021 and provided original data that focused on cognitive impairment or dementia in any Indigenous population.

RESULTS

The search yielded 13,009 papers of which, 76 met inclusion criteria. The overall number of papers increased over time. Studies were mostly conducted in Australia with Aboriginal and Torres Strait Islander people (n = 30; 39%). Twenty-six papers directly involved Indigenous participants with cognitive impairment or dementia. Of these studies, ethics approval was commonly required from two or more committees (n = 23, 88.5%). Ethical and legal governance frameworks were rarely discussed.

DISCUSSION

There is a clear need for further robust studies examining cognitive impairment and dementia with Indigenous populations. Future research should consider the ethical aspects of involving Indigenous participants with cognitive impairment in research.

Perspectives, understandings of dementia and lived experiences from Australian Aboriginal people in Western Australia

OBJECTIVE

We explored understandings about dementia and lived experiences from carers among community-dwelling Aboriginal people in Western Australia (WA).

METHODS

In partnership with Aboriginal medical services in WA, we conducted semi-structured interviews with Aboriginal people in Perth and Bunbury. All interviews were transcribed verbatim and coded thematically.

RESULTS

We conducted 39 interviews. Dementia was associated with 'losing your memory', a 'change in behaviour' and unhealthy lifestyles. Increasing awareness about dementia in the community was noted particularly to enable people to recognise the early signs, feel safe to ask for help and know how to best support families. Families were primarily responsible for caring for people with dementia and were finding it difficult to manage. They expressed negative experiences with currently available aged care facilities.

CONCLUSIONS

Increased awareness of dementia in the community through public health messaging and by health professionals and culturally secure services focussing on dementia care is required.

Who displays dementia-related stigma and what does the general public know about dementia? Findings from a nationally representative survey

OBJECTIVES

To identify the characteristics of those who tend to hold stigmatising beliefs and behaviours towards people living with dementia to inform dementia education and the targeting of interventions to reduce dementia-related stigma.

A nationally representative telephone survey of 1000 Australians aged 18-93 years was conducted to assess general knowledge of dementia and dementia-related stigma. A single open-ended question was used to assess participants' general knowledge of dementia. Modified items from the Lay Public Dimension of the Family Stigma in Alzheimer's Disease Scale were used to assess dementia-related stigma.

Only 26% of participants demonstrated good dementia knowledge while almost half of the participants had a mixed understanding of dementia. Dementia-related negative cognitive attributions were found to be higher in (1) the older age cohorts, (2) amongst individuals who know someone with dementia, (3) speak a language other than English at home, and (4) have a better understanding of dementia. Older age cohorts, men, those who do not know someone with dementia, and those who speak a non-English language at home also reported significantly higher discriminatory behavioural reactions compared to the younger age cohorts, females, those who know someone with dementia, and those who speak English only at home.

This study identifies a need for improved public education about dementia. A structured approach to the development of strategies that is specifically tailored to different age, gender and cultural groups may provide a beneficial approach to help improve dementia knowledge and reduce dementia-related stigma in the population.

What do young Australian adults know about modifiable risk factors for dementia?

BACKGROUND

There are well established modifiable risk factors for late-life dementia. These risk factors account for over 30% of population attributable dementia risk and accrue over the lifespan. Young adults have the greatest potential to reduce their own risk for dementia. This study aimed to investigate what young Australian adults know about dementia and its risk factors, and further, how they estimated these risks.

METHODS

An online survey promoted through various social media platforms was completed by 604 young Australian adults aged 18-44 years of age.

RESULTS

Seventy percent of participants had a limited understanding of dementia (identifying cognitive or functional impairment), 25% had a good understanding, with 5% having no understanding. Twenty percent of respondents thought there were no modifiable risk factors for dementia. Less the half of participants agreed with two of the nine established dementia risk factors (hearing loss in midlife and education in early life), with over half of participants agreeing to the remaining seven risk factors. Females consistently judged the risks conferred by the nine established dementia risk factors to be higher than males. Those who were lonely judged the dementia risk conferred by loneliness to be higher than those who were not lonely; and smokers judged the dementia risk conferred by smoking to be less than non-smokers.

CONCLUSION

Young adults have the greatest potential to change their dementia risk, and these findings show that there are important gaps in knowledge of dementia and its risk factors in this group.

An integrative review of Indigenous informal caregiving in the context of dementia care

AIMS

To appraise the empirical literature on the needs of Indigenous informal caregivers caring for people living with dementia in Indigenous communities.

DESIGN

Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines, and CASP checklists for narrative analysis were followed.

DATA SOURCES

A systematic search of published empirical literature from January 2010 to August 2020 was undertaken in six databases.

REVIEW METHODS

Fifty-one studies met the research question and the inclusion criteria.

RESULTS

Five themes describe the findings: Decolonizing Western perspectives on dementia, the centrality of cultural safety, caregivers' experiences, pre-dementia community education and family and community-centred care emerged from the thematic analysis. Most of the studies used quantitative methodologies, and few studies were conducted using community-based approaches.

CONCLUSION

This review shows that Indigenous caregiving represents an emerging field in nursing and health sciences in a context of a global crisis. Researchers need to focus on Indigenous values and voices to adapt care and support informal caregivers. Our review emphasizes that working with Indigenous communities will likely translate into new care delivery models, policies and practices to support Indigenous informal caregivers and address the specific social determinants impacting caregivers' roles and tasks.

IMPACT

This review highlights the necessity of having community and family-based discussions on enhancing the delivery of dementia care for Indigenous peoples in Canada and worldwide. Decolonizing Western perspectives of dementia translate into culturally safe approaches that aim to integrate Indigenous cultural perspectives of holism, reciprocity, wisdom, respect of older people and relationality into nursing practice. The support of Indigenous informal caregivers requires future studies to address the stigmatizing Western views of dementia.

Impacts of the National Your Brain Matters Dementia Risk Reduction Campaign in Australia Over 2 Years

BACKGROUND

The number of people living with dementia is rising globally due to population aging. Mass media campaigns which aim to reduce the risk of people developing dementia have been conducted across many countries, but few have reported evaluation findings.

OBJECTIVE

The present study investigated the impact of the Your Brain Matters dementia risk reduction campaign in Australia.

METHODS

The campaign was evaluated by observational cross-sectional surveys of 1000 Australian adults aged 18-75 years before and 24 months after delivery. The national campaign utilized multiple media channels to promote messages about the importance of brain health and reducing the risk of dementia. Dementia risk reduction knowledge, confidence, intentions and actions were measured at baseline and follow-up, and analyzed 2019-2020.

RESULTS

Earned television and radio were the most common exposure channels. The proportion of people who understood that it is beneficial to take action to reduce dementia risk before middle age increased (54.1% to 59.4%, OR 1.20 95% CI: 1.01-1.44). There was also an increase (28.5% to 32.8%, OR 1.30, 95% CI: 1.07-1.59) in the proportion who reported taking action to improve brain health. There was no improvement in knowledge about vascular risk factors, or confidence to reduce personal dementia risk.

CONCLUSION

The findings showed some receptivity and positive responses to messages about the benefits of taking action to reduce the risk of dementia. The campaign demonstrated the potential for generating news coverage about this issue, which should highlight the preventive benefits of vascular health behaviors.

Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study

BACKGROUND

The prevalence of dementia is generally reported to be higher among Indigenous peoples.

OBJECTIVE

The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians.

METHODS

De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer's Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as 'unspecified' type in Indigenous Australians.

RESULTS

The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as 'unspecified' on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group.

CONCLUSION

This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.

Assessment of the Knowledge and Attitude Towards Dementia Among Undergraduate University Students in Uganda

BACKGROUND

Dementia remains a public health concern and a leading cause of disability and dependency among older people worldwide. However, the knowledge and attitudes towards dementia among university students remain unknown. This study assessed the knowledge and attitude towards dementia among university students in Uganda.

METHODS

An online descriptive, cross-sectional study was undertaken from August to November 2020, among undergraduate students from 11 Ugandan universities. A validated study questionnaire was used to collect data on socio-demographic characteristics, knowledge, and attitudes of dementia. A score <60% was considered poor knowledge while ≥80% good knowledge and more than 80% reflected positive attitudes.

RESULTS

Overall, 1005 participants with a median age of 23 (interquartile range: 18 to 35) years participated in the study. The majority of the students were male (56.5%, n=568) and nearly half were pursuing human sciences/medicine-related programs. The mean knowledge score was 65.5% (SD±18.5). Thirty-two percent of the study participants had poor knowledge and only 26.8% (n=269) had good knowledge of dementia. More than half of the study participants believed that dementia is a normal part of aging and that memory loss happens to all people as they age. Attitudes towards patients with dementia were positive with a mean score of 81.9% (SD±19.6) and 65.2% of the study participants had positive dementia attitudes. Those aged more than 24 years were significantly associated with positive attitudes (adjusted odds ratio (AOR): 1.5, 95% CI: 1.1-2.0, p=0.019). There was a weak correlation between knowledge and attitude scores (ρ=0.341, p<0.001).

CONCLUSION

Whereas the majority of university students have positive attitudes towards patients with dementia, a significant number still have poor knowledge of the same. Continuous health education is suggested to improve knowledge of dementia in this population. Further studies to understand the perception in the general population are recommended.

An integrative review of empirical literature on indigenous cognitive impairment and dementia

AIMS

To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia.

DESIGN

Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed.

DATA SOURCES

A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches.

REVIEW METHODS

Thirty-four studies met the research question and inclusion criteria.

RESULTS

Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools.

CONCLUSION

The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care.

IMPACT

This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.

Positioning ethnicity in dementia awareness research: does the use of senility risk ascribing racialised knowledge deficits to minority groups?

Over recent decades, the importance of increasing dementia awareness has been promoted by charities, researchers and governments. In response, a large body of research has emerged that evaluates the awareness of different populations. One such population are minority ethnic communities. Associated studies typically conclude that minority ethnic groups have a poor awareness of dementia and that interventions should be developed to better educate them. Operationalisations of awareness almost always reference senility - the traditional notion that dementia is a natural outcome of ageing - a widely held belief among many populations. Senility is considered incorrect knowledge in the research literature, and those participants who identify with it are deemed to have poor awareness. Despite the researchers' claims that senility is false, the scientific evidence is inconclusive, and the concept is contested. As such, a large body of research repeatedly positions minority ethnic communities as inferior and in need of re-education based on researchers' questionable assumptions. This issue is bound up with a racialised deficit-model of science communication and wider critiques of psychiatric colonialism. In response, researchers of dementia and ethnicity should reflect on their own awareness and the ways in which they position others in relation to it.

Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND

Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment.

METHODS/DESIGN

The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families.

DISCUSSION

The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment.

TRIAL REGISTRATION

ACTRN12618001485224. Date of registration: 04 of September 2019.

Aboriginal community understandings of dementia and responses to dementia care

OBJECTIVE

Aboriginal people and Torres Strait Islanders are impacted by dementia at higher rates and at a younger age of onset than the broader Australia population. Public health strategies to support this population require a thorough understanding of how Aboriginal people perceive dementia and dementia care support needs. The aim of this study was to investigate Aboriginal community understandings of dementia and their responses to dementia care.

STUDY DESIGN

This study is a community participatory action research partnership.

METHODS

The mixed method study was undertaken in 2017 with members of a discrete Aboriginal community from rural Tasmania, Australia. Participants were older than 18 years, self-identified as an Aboriginal person and were living or had lived in the community studied. Data were derived from 50 participants who completed the 27-item Dementia Knowledge Assessment Scale (DKAS). Twelve of these participants also shared their dementia care experiences in individual interviews.

RESULTS

The DKAS results showed a low overall level of dementia knowledge, with a total mean score of 27.73 (scoring 51% on average) of a possible score of 54. The salient interview theme was the cultural obligation to care for family members living with dementia. Dementia care metaphors represented ways to protect family members living with dementia and maintain their ongoing connections to home and community. However, limited understandings of dementia affected their capacity to provide quality care.

CONCLUSION

The findings contribute to public health scholarship involving Aboriginal community responses to dementia care. The study has resulted in important initiatives including a community-based dementia education program to ensure Aboriginal people impacted by dementia are provided with effective and culturally appropriate care.

Age, memory loss and perceptions of dementia in South Asian ethnic minorities

BACKGROUND

South Asian older adults are represented less frequently in mainstream mental health services or those for people with dementia. This study aimed to explore in detail the perceptions of dementia (symptoms, causes, consequences, treatments) held by South Asians and to discern how these understandings vary by age and by the self-recognition of memory problems, as these influence help-seeking behaviour.

METHODS

Participants were allocated to three groups: younger adults; older adults; and older adults with subjective memory problems. They completed the semi-structured Barts Explanatory Model Inventory for Dementia schedule, whilst older adults also completed measures of cognition (MMSE), and depression (GDS). Interviews were conducted in English, Gujarati or Urdu.

RESULTS

Groups were similar in identifying unusual forgetting and confusion as the most frequent symptoms; stress and age as the most frequent causes; and talking to your GP/nurse, taking medication, and talking to family and friends as the most frequent treatments. Younger adults more often knew about risk factors and reported practical consequences more than older adults. Older adults with subjective memory problems were more likely to describe sleep related problems or symptoms commonly associated with depression. They more often cited as causes of dementia lack of sleep, side effects of medication and medical reasons, and mentioned religion as a means to cope.

CONCLUSIONS

Findings highlight variability in perceptions of dementia across the South Asian Community and identify specific areas where dementia awareness could be raised in South Asian sub-groups to improve timely diagnosis, treatment outcomes and service access.

What Does the Australian General Public Know About Treatments for Dementia? A Population Survey

Objective: To identify the Australian general population’s awareness regarding the presence and effectiveness of treatments for dementia. Method: An online survey administered through a consumer panel provider (PureProfile). Included were people aged 18 years or above living in Australia. The survey asked participants about their knowledge of treatments for dementia and attitudes toward the effectiveness of evidence-based treatments. Results: Of the 1,001 participants, more than half (63.5%) could not spontaneously name any treatments that improved outcomes for people with dementia. When asked about the efficacy of specific treatments, “brain training” was considered to be “very likely” to be effective by approximately half (49.4%) of the participants followed by “education for caregivers” (46.2%) and “healthy diet” (43.4%). Discussion: Knowledge of treatments for dementia among the Australian public is poor. There is a need to better educate the public about treatments that have demonstrated effectiveness to improve their uptake and use.

Dementia Literacy among Community-Dwelling Older Adults in Urban China: A Cross-sectional Study

Objective

Delay in seeking diagnosis of dementia is common in China. Misinformation and poor knowledge about dementia may contribute to it. The study was designed to explore the nationwide dementia literacy among older adults in urban China and to investigate the factors associated with overall dementia literacy.

Methods

In a cross-sectional study, a convenience sample of 3,439 community-dwelling old adults aged 60 and over was recruited from 34 cities in 20 provinces between June 20 and August 20, 2014. All participants were administered the face-to-face mental health literacy questionnaire, which included the prevalence, symptoms, intention, and options for treatment of dementia. Stepwise multivariate regression analysis was used to explore factors associated with overall dementia literacy.

Results

The response rate was 87.4%. The overall dementia literacy was 55.5% (SD = 20.9%) among all respondents. The correct response rate was higher for questions on symptoms (58.7–89.6%), but lower for questions on the prevalence (22.2%) and choosing appropriate professional care personnel (22.2%). Being male [OR = 1.256, 95% CI (1.022–1.543)], having lower per capita annual income [OR = 1.314, 95% CI (1.064–1.623)], lower education [OR = 1.462, 95% CI (1.162–1.839)], and suspected depression [OR = 1.248, 95% CI (1.009–1.543)] were negatively associated with overall dementia literacy.

Conclusion

Dementia literacy among community-dwelling older adults in urban China remains very low, in particular about the impact of dementia and appropriate treatment personnel. Community educational programs aiming to close this knowledge gap are encouraged to focus on those in the population at highest risk of low dementia literacy.

Public knowledge and beliefs about dementia risk reduction: a national survey of Australians

Background

With the dramatically increasing contribution of Alzheimer’s Disease and other forms of dementia to the global burden of disease, countries are being urged to address this as a public health priority. This study investigated whether Australian adults recognise this as an important health issue, and hold beliefs and knowledge that are consistent with recommendations concerning dementia risk reduction. This research was undertaken to guide national brain health awareness and education strategies.

Methods

A cross-sectional telephone survey was undertaken of 1,003 Australians aged 20–75 years. This measured the importance placed on dementia, beliefs and confidence related to risk reduction, knowledge of risk reduction methods, and the perceived age-relevance of these. In analysis the data were stratified by sex, age, educational attainment, household income, language preference and previous exposure to dementia. Multivariable logistic regression was undertaken to identify variables independently associated with beliefs and knowledge.

Results

People aged 60 years and over identified dementia as very important (17.2%) more often than those aged 40–59 years (5.1%) or 20–39 years (2.1%). While 41.5% of respondents believed the risk of dementia could be reduced, 26.9% were very confident that they could achieve this. Mental activity (57.1%) was identified as beneficial much more often than physical activity (31.3%), healthy eating (23.3%) and other cardiovascular health behaviours. Women, people of English-speaking origin, and those having contact with a person with dementia, showed better knowledge of several health behaviours.

Conclusions

Growing attention is being given to population risk reduction to combat the dramatic increase in the burden of disease due to dementia. In Australia many people do not yet hold beliefs and knowledge that support this, which highlights the need for concerted awareness raising that dementia is not an inevitable aspect of ageing, and for education about the role of vascular health in dementia risk reduction.

The Koori Growing Old Well Study: investigating aging and dementia in urban Aboriginal Australians

BACKGROUND

Dementia is an emerging health priority in Australian Aboriginal communities, but substantial gaps remain in our understanding of this issue, particularly for the large urban section of the population. In remote Aboriginal communities, high prevalence rates of dementia at relatively young ages have been reported. The current study is investigating aging, cognitive decline, and dementia in older urban/regional Aboriginal Australians.

METHODS

We partnered with five Aboriginal communities across the eastern Australian state of New South Wales, to undertake a census of all Aboriginal men and women aged 60 years and over residing in these communities. This was followed by a survey of the health, well-being, and life history of all consenting participants. Participants were also screened using three cognitive instruments. Those scoring below designated cut-offs, and a 20% random sample of those scoring above (i.e. "normal" range), completed a contact person interview (with a nominated family member) and medical assessment (blind to initial screening results), which formed the basis of "gold standard" clinical consensus determinations of cognitive impairment and dementia.

CONCLUSION

This paper details our protocol for a population-based study in collaboration with local Aboriginal community organizations. The study will provide the first available prevalence rates for dementia and cognitive impairment in a representative sample of urban Aboriginal people, across city and rural communities, where the majority of Aboriginal Australians live. It will also contribute to improved assessment of dementia and cognitive impairment and to the understanding of social determinants of successful aging, of international significance.

'We don't have anyone with dementia here': a case for better intersectoral collaboration for remote Indigenous clients with dementia

OBJECTIVE

This paper reports on findings related to intersectoral collaboration stemming from an evaluation of a dementia awareness resource for use in remote Aboriginal communities*. The resource includes a DVD in English and three (3) Aboriginal languages of the Northern Territory.

DESIGN

A qualitative evaluation was conducted in four Northern Territory Aboriginal communities/organisations where the resource had been implemented by external dementia educators. The method included five focus groups with Indigenous aged care workers, community members and aged care service users (n = 26), individual interviews with health care professionals and service coordinators (n = 5), and observation. Data were analysed thematically.

RESULTS

Specific findings relating to intersectoral collaboration as a key enabling factor of effective dementia awareness and care are discussed in this paper. In addition to context variables such as understaffing and under-resourcing, there might be a lack of knowledge or interest on the part of some health practitioners concerning clients with dementia within remote communities.

CONCLUSION

Dementia awareness in remote communities needs to be tackled from a 'whole system' perspective and not be the exclusive domain of the aged care services. Strategies that increase the critical mass of informed caregivers as well as health professionals will contribute to better services.