What can we learn about dementia from research in Indigenous populations?

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.

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.

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.

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.

Understandings of dementia in low and middle income countries and amongst indigenous peoples: a systematic review and qualitative meta-synthesis

Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia.Methods: A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out.Findings: Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving.Conclusions: There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.