Sample Health Care Paper on Dementia in Australia

Dementia in Australia

Dementia is mainly associated with gradual brain function impairment affecting cognition, behaviour, speech, mobility, and memory. An individual’s functional ability and health declines as the disease progresses. Their personality may also change. Although there are several forms of dementia, Alzheimer’s disease is the most common. Dementia can affect younger people; however, it is more prevalent in the aged population, occurring among individuals aged 65 and older (“Dementia,” 2020). It causes dependency and disability among the elderly. In Australia, dementia is a growing health issue that has a substantial effect on the quality of life and the health of patients with the condition, their friends, and family. Approximately 386,000 Australians have dementia, including 143,000 men and 243,200 women, translating to 15 people per 1,000 Australians (“Dementia in Australia,” 2021). The Australian Institute of Health and Welfare estimates that 246,200 of people live in the community. As these people age, they move into acute care settings or residential aged care homes; thus, the proportion of individuals in the community reduces as the age progresses. With population growth and ageing into the future, it is estimated that the number of Australians with dementia will be roughly 849,300 in 2058. In 2018, dementia accounted for about 14,000 deaths in Australia, becoming the second leading cause of death (“Dementia,” 2020).

The Importance of a Person and Family Centred-Care Approach When Caring for A Person with Dementia in Acute or Long-Term Setting

The person and family-centred approach is a socio-psychological treatment method that acknowledges the patient’s individuality based on the care practices and attitudes that surround them. The approach recognises unmet needs like isolation that may influence behavioural symptoms in patients with dementia. The PCC approach enables care providers to provide for the unmet needs (Fazio et al., 2018). The method has been widely developed and executed majorly in acute and long-term care facilities. PCC interventions involve incorporating personal knowledge of the individual with dementia, performing meaningful activities, prioritising well-being, and enhancing the relationship quality between the patient and the care provider. Agitation is common in patients with dementia, and addressing it requires appropriate intervention strategies. According to Kim and Park (2017), a therapeutic recreation program, a PCC intervention that involved tailored activities prescribed following a comprehensive examination of patients’ strengths, weaknesses, and unique characteristics, reduced agitation. During the strategy, the therapist and the research team worked with dementia patients in long-term facilities, and the participants demonstrated a decrease in agitation in 14 days after completing the interventions.

Moreover, the PCC approach has shown beneficial impacts for reducing antipsychotic drugs usage and managing challenging behaviours in patients with dementia. The findings of a study by Fazio et al. (2018) investigating the benefits of the PCC approach for dementia patients revealed that PCC improved the quality of life, reduced agitation and depression. The PCC approach emphasises the development of meaningful relationships between the staff and the patients, promoting social interactions. Creating such relationships requires effort and time; thus, PCC interventions be planned to improve the QoL of patients with dementia in long-term care facilities. The study also reported that improved QoL was more evident in patients with less severe dementia.

 

 

The Importance of Respecting and Supporting Cultural Diversity and Cultural Safety when Caring for Dementia Patients

The global dementia burden is increasing dramatically, a particular concern for Torres Strait Islander and Aboriginal Australians, as dementia prevalence is more than three times higher than the general Australian population. Smoking, low education, depression, physical inactivity, midlife hypertension, diabetes, and midlife obesity have been considered major risk factors and disproportionally affect indigenous Australians (Radford et al., 2019). As a result, this population require supportive cultural diversity programs and cultural safety when caring for dementia patients. The Australian government provides access to aged care services for older indigenous populations. It created an action plan supporting the Aged Care Diversity Framework and addressing challenges that older indigenous Australians face when accessing care. Aboriginal and Torres Strait Islander Australians prefer indigenous-based services that allow them to stay in their communities and homes, designed locally in collaboration with their communities.

Supporting cultural diversity using Indigenous-specific health care services provides appropriate care that incorporates the challenges that people with dementia and their communities face. Aboriginal Community Controlled Health Services provide culturally appropriate and holistic-based health services and are essential for Indigenous patients with dementia. The ACCHS acts as a referral point to specialist care and enables Indigenous groups in Australia to understand the aged healthcare system (“Dementia in Australia,” 2021). Aboriginal health services help manage risk factors for dementia, including offering services like follow-up care and health care checks. Besides, when cultural diversity and safety is supported, patients get the opportunity to engage in social opportunities, communicate, live according to their beliefs and values, participate in their care, and practice their traditions. They thrive in an environment that acknowledges and accommodates their way of being.

Culture support and respect comfort a dementia patient. When Indigenous dementia patients communicate in their native language and access ethno-specific care, they acquire mental and physical health benefits like lower depression rates, decreased social isolation, fewer hospitalisations, and falls. It also improves their understanding of medical decision-making and the possibility of following medication instructions. Communicating in a patient’s language reduces misdiagnosis and help with acquiring appropriate support. When dealing with dementia patients, culturally-based and supportive care acknowledges the relevance and roles of kinship ties and family among Aboriginals and Torres Strait Islanders (Supporting Cultural Diversity in Long-Term Care Needs Assessment and Work Plan for 2017-18, 2017). It recognises the role of spiritual and religious beliefs in care and health perceptions and the importance of using traditional treatments and health practices. Respecting cultural diversity among these groups allows the celebration of patients’ heritage and traditions, practices, holidays, and traditional foods. It builds a sense of community among the population.

Combined Cognitive and Physical Therapy for People with Dementia

Nurses play a fundamental role in recognising dementia among the hospitalised elderly by examining the signs and symptoms during nursing admission assessment. Dementia interventions aim to promote patient independence and function for an extended period, promote self-care activities, patient safety, reduce agitation, anxiety, and improve intimacy and socialisation. According to Karssemeijer et al. (2017), combined physical and cognitive therapy have potential benefits in adults with mild dementia or cognitive impairment. The authors suggest that exercise increases the prefrontal cortex volume, enhances angiogenesis and neurogenesis. Moreover, physical activity decreases cardiovascular risk factors. The study revealed that combine cognitive and exercise interventions improve the quality of life in patients with dementia.

Since dementia is characterised by progressive cognitive decline, the impairments in functional abilities have a significant and dramatic effect on an individual’s quality of life. Hence, improving patients’ cognitive functioning can improve their well-being, delay hospitalisation, and decrease national healthcare costs. Cognitive therapy involves using specific exercises that target particular cognitive functions to optimise functioning and enhance daily life. It has been applied widely to treat various symptoms that are associated with dementia. Okamura et al. (2018) developed a combined cognitive and exercise training strategy that aims at improving cognitive impairment in patients with dementia. In the approach, the patient receives guidance to drive one arm ergometer to accomplish a certain target speed in the system. The system is created to produce an alarm if the individual fails to achieve the target rotation rate. The study results showed that the system is effective for improving cognitive impairment. Cognitive impairment was improved through alleviating concentration and attention. Moreover, different studies have suggested a relationship between exercise speed changes and brain function improvement (Okamura et al., 2018). The researchers suggest that physical exercise that includes awareness of focused attention increases brain activity and enhance cognitive function than monotonous exercise.

Dementia prevalence in Aboriginal and Torres Strait Islander Australians is three to five times higher than the general Australian population. A better understanding of the underlying biomedical and social risk factors is needed to guide dementia prevention in Aboriginal Australians. The current study is the first to examine potential risk factors for dementia in the majority urban and regional population, with a representative sample of 336 Aboriginal Australians aged 60 years and older. Participants included 45 people with a dementia diagnosis (n = 27 probable/possible Alzheimer’s disease); and 286 people without dementia. Univariate logistic regression analyses (controlling for age) identified childhood trauma, mid-life factors (history of unskilled work, past high-risk alcohol use), and medical factors (history of stroke, head injury with loss of consciousness, epilepsy) as risk factors for dementia. Multivariable analysis revealed age, childhood trauma, unskilled work, stroke, and head injury as independent predictors of all-cause dementia. A range of comorbid factors related to dementia was also identified (i.e., functional impairment, incontinence, recent hospital admission, low body mass index, living in residential care, depression, current high-risk alcohol use, social isolation, low physical activity levels). These findings extend previous outcomes in a remote Aboriginal population by highlighting that life-course social determinants of health, in addition to neurological disorders, likely play an essential role in elevating dementia risk. Specific psychosocial and medical exposures are highly prevalent in Aboriginal Australians, similar to other indigenous populations, and should be considered when designing targeted and culturally appropriate prevention initiatives to reduce the burden of dementia.

Keywords: Aged, Alzheimer’s disease, indigenous population, neurocognitive disorders, social determinants of health

 

Conclusion

Due to the growing ageing population, the proportion of individuals with dementia or mild cognitive impairment is expected to increase. Age is considered the major risk for dementia, and the population of Australians living with dementia is expected to increase with more individuals living to older ages. The rapidly growing numbers will affect society and cause a tremendous economic burden on healthcare. As a result, the World Health Organization emphasises a global action against dementia and cognitive decline, encouraging governments to focus on prevention strategies, improving healthcare services, and disease-modifying therapies. A person-centred approach and supporting cultural diversity when addressing dementia helps reduce depression, agitation, anxiety, promotes communication, and improves the quality of life among people with dementia. Therefore, physicians and clinicians should emphasise and incorporate these strategies in their treatment and management procedures. Various factors may increase an individual’s risk of developing dementia, such as excessive alcohol consumption, tobacco smoking, physical inactivity, obesity, and social isolation. Since there is no cure for dementia exists, managing the risks is crucial when managing and preventing the condition at a population level. It is crucial to design predictive models to help decision-makers plan and allocate limited health care resources appropriately to regions that can maximise benefit most efficiently. Furthermore, an education strategy that fosters skill development and learning of internal care staff is required to improve patients’ quality of life and sustainability of behavioural problems effects. The effectiveness and feasibility of intervention approaches, intervention type, duration, and disease severity should also be considered when designing an intervention program.

 

 

 

 

References

Dementia. (2020). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/australias-health/dementia

Dementia in Australia. (2021, September 20). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/prevalence-of-dementia

Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist58(suppl_1), S10-S19. https://doi.org/10.1093/geront/gnx122

Karssemeijer, E. (., Aaronson, J. (., Bossers, W. (., Smits, T. (., Olde Rikkert, M. (., & Kessels, R. (. (2017). Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis. Ageing Research Reviews40, 75-83. https://doi.org/10.1016/j.arr.2017.09.003

Kim, S. K., & Park, M. (2017). Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clinical Interventions in Aging12, 381-397. https://doi.org/10.2147/cia.s117637

Okamura, H., Otani, M., Shimoyama, N., & Fujii, T. (2018). Combined exercise and cognitive training system for dementia patients: A randomised controlled trial. Dementia and Geriatric Cognitive Disorders45(5-6), 318-325. https://doi.org/10.1159/000490613

Radford, K., Lavrencic, L. M., Delbaere, K., Draper, B., Cumming, R., Daylight, G., Mack, H. A., Chalkley, S., Bennett, H., Garvey, G., Hill, T. Y., Lasschuit, D., & Broe, G. A. (2019). Factors associated with the high prevalence of dementia in older Aboriginal Australians. Journal of Alzheimer’s Disease70(s1), S75-S85. https://doi.org/10.3233/jad-180573

Sue Cragg Consulting and the CLRI Program. (2017). Supporting Cultural Diversity in Long-Term Care Needs Assessment and Work Plan for 2017-18.