Aboriginal and Torres Strait Islander (ATSI) people with dementia face very poor health outcomes.
Dementia is an umbrella term for over 100 diseases such as Alzheimer’s disease, affecting the memory, cognitive abilities and behaviour of an individual, impacting the person’s ability to maintain their day-to-day activities. Although age is the biggest known risk factor for dementia, it is not considered a normal part of ageing. (World Health Organization, 2019)
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The number of people being diagnosed with dementia is only increasing in Australia’s ageing population. Across the last two decades there have been a number of studies conducted to determine the prevalence of dementia in ATSI people. The results have revealed that Aboriginal and Torres Strait Islander people experience dementia at a rate 3 to 5 times higher than the general Australian population. (Flicker and Holdsworth, 2014) Nationwide dementia is the single biggest cause of disability in older Australians, aged 65 and older, and the third leading cause of disability burden overall. (Dementia Australia, 2019)
A recent study in the remote Kimberley region of Western Australia found higher rates of dementia at younger ages. (Brown, Hansnata and Anh La, 2017) The percentage of ATSI people needing dementia and aged care services before the age of 55 is far greater than people of a non-aboriginal or Torres Strait Islander background. (Department of Health, 2014) This study promotes the increased need for preventative programs and initiatives in ATSI communities, to reduces the prevalence of early onset dementia within this population.
Gaps/ Barriers in the primary health care
Aboriginal and Torres Strait Islander people experience worse health outcomes than the non-Indigenous population resulting in substantial gaps in life expectancy. ATSI populations have higher rates of health risk factors such as smoking, physical inactivity, poor diet and poor education, which have been found to be related to dementia. Prevalence rates are three to five times higher than the non-Aboriginal population due to higher risk profiles for each of the risk factors. (Flicker and Holdsworth, 2014)
It has been identified that there are significant barriers and issues in regard to dementia and aged care service provision. This includes a lack of health care and prevention services in rural and remote areas. “Geographical constraints in the provision of services, a lack of education and awareness in communities and by health workers and the prevalence of other chronic diseases have all posed considerable barriers to the recognition of dementia as an emerging health issue.” [Flicker and Holdsworth, 2014 (page. 6)]
Research has also shown that a lack of understanding of ATSI culture by health professionals is also of considerable concern and is shown to be a significant barrier to the uptake of health services.
While the prevalence of dementia is 5 times higher in ATSI communities, awareness of the disease in these communities is lower than in the overall Australian population (Department of Health, 2019a). This results in later diagnosis and poorer access to support services.
The Australian government has identified many gaps in the healthcare of the ATSI population. To improve the health status of this population policy makers have created a number of policies to ensure to optimum health such as:
- creating an implementation plan for National Aboriginal and Torres Strait Islander Health plan 2013- 2023. (Department of Health, 2015)
- The development and implementation of Aged Care Quality standards. (Department of health; 2019b)
- Indigenous health funding in the 2019-2020 national budget. (Department of Health, 2019c)
- $4.1b funding boost from 2019-20 to 2022-23
- More than $10 billion elected over a decade
- $160 million for Indigenous research fund
- The National ATSI flexible aged care program funds organisations to provide culturally appropriate aged care to older ATSI people close to their home and community. It can deliver a mix of residential and homecare services aligned to the needs of the community. (The Department of Social Services, 2015)
- The remote and ATSI aged care service development service panel (SDAP). SDAP supports aged care providers to build capacity and improve the quality of aged care services and provides culturally appropriate solutions of maintaining and delivering quality aged care services for ATSI people in remote or very remote areas. (Department of Health, 2019c)
As previously stated, there are gaps in the healthcare provided for ATSI people in rural and remote areas. Recommendations for improving the health status of ATSI people include:
- Awareness and education programs should be delivered to ATSI communities to provide greater knowledge and insight of dementia. Similar training programs should also be made compulsory for all aged care staff and community support workers within these communities, to further increase awareness and reduced prevalence of dementia. This would be implemented though the increased funding for education and training programs from the federal government. (Flicker and Holdsworth, 2014)
- Australian Government should prioritise research funding through the National Health and Medical Research Council (NHMRC). Looking at how to encourage the population to embrace dementia reduction behaviours. In particular looking at reducing risk factors in ATSI communities. (The National Health and Medical Research Council, 2019)
- Agedcare.health.gov.au. (2019). Actions to support older Aboriginal and Torres Strait Islander people. [online] Available at: https://agedcare.health.gov.au/sites/default/files/documents/02_2019/actions-to-support-older-aboriginal-and-torres-strait-islander-people-a-guide-for-aged-care-providers.pdf [Accessed 30 Jul. 2019].
- Agedcare.health.gov.au. (2019). National Aboriginal and Torres Strait Islander Flexible Aged Care Program | Ageing and Aged Care. [online] Available at: https://agedcare.health.gov.au/programs-services/flexible-care/national-aboriginal-and-torres-strait-islander-flexible-aged-care-program [Accessed 30 Jul. 2019].
- Australian Government; Department of Health. (2019). Ageing and aged care; Corporate Plan 2018-2019. [online] Available at: https://www.health.gov.au/resources/corporate-plan-2018-2019/our-performance/ageing-and-aged-care [Accessed 31 Jul. 2019].
- Dementia.org.au. (2019). Dementia Australia | Dementia statistics. [online] Available at: https://www.dementia.org.au/statistics [Accessed 27 Jul. 2019].
- Department of Health; Ageing and Age Care (2019). Support Services for Remote and Indigenous Aged Care. Canberra: Australian Government.
- Flicker, P. and Holdsworth, K. (2014). Aboriginal and Torres Strait Islander people and dementia; A review of the research. 1st ed. [ebook] Alzheimers Australia Inc. Available at: https://www.dementia.org.au/files/Alzheimers_Australia_Numbered_Publication_41.pdf [Accessed 31 Jul. 2019].
- National Framework for Action on Dementia 2015-2019. (2019). [ebook] Australia: Australian Government; Department of health; Ageing and Aged Care. Available at: https://agedcare.health.gov.au/ageing-and-aged-care-older-people-their-families-and-carers-dementia/national-framework-for-action-on-dementia-2015-2019 [Accessed 31 Jul. 2019].
- The Department of Health (2019c). Health 2019-20 Budget at a Glance – Key Initiatives. Canberra.
- The Department of health; Ageing and Aged Care (2019b). Aged Care Quality Standards. Canberra.
- The Department of Social Services (2015). Residential and Flexible Care Programme; National Aboriginal and Torres Strait Islander Flexible Aged Care Programme (NATSIFACP) Guidelines Overview.
- World Health Organization. (2019). Dementia: a public health priority. [online] Available at: https://www.who.int/mental_health/neurology/dementia/en/ [Accessed 31 Jul. 2019].
- World Health Organization. (2019). Dementia; Fact Sheet. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/dementia [Accessed 31 Jul. 2019].
- Www1.health.gov.au. (2019). Department of Health - Health 2019-20 Budget at a Glance – Key Initiatives. [online] Available at: https://www1.health.gov.au/internet/budget/publishing.nsf/Content/budget2019-glance.htm [Accessed 29 Jul. 2019].
- Department of Health (2015). Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Canberra.
- Department of Health (2014). Supporting people with dementia and their families and carers; Victorian dementia action plan 2014–18. Canberra.
- National Health and Research Council (2019). Boosting Dementia Research Initiative | NHMRC. [online] Available at: https://www.nhmrc.gov.au/research-policy/boosting-dementia-research-initiative [Accessed 4 Aug. 2019].
- Brown, P., Hansnata, E. and Anh La, H. (2017). Economic Cost of dementia in Australia. [online] Aph.gov.au. Available at: https://www.aph.gov.au/DocumentStore.ashx?id=b96b8555-aadc-452a-a05b-8bb741404eb2 [Accessed 4 Aug. 2019].
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