Applied Public Health: Assessment Task 3

This article discusses the public health issue of dementia, including its prevalence, impact, and management strategies. It also explores the historical, economic, political, and social context of dementia in Australia. The article proposes a community-based initiative to create dementia-friendly communities and implement multifactorial interventions to delay the progression of the condition. The strengths, weaknesses, and expected outcomes of the initiative are also discussed.

Running head: APPLIED PUBLIC HEALTH 1
Applied Public Health: Assessment Task 3
Student’s Name
Institution

APPLIED PUBLIC HEALTH 2
Applied Public Health: Assessment Task 3
Justification of the Public Health Issue
Dementia is not a specific disease and there are no treatments to the condition. Rather,
this condition impairs the brain functioning and affects an individual’s cognitive ability including
their reasoning and remembering. Although the condition mostly affects the aged populations,
dementia should not be taken as a characteristic for aging populations (Cations et al., 2018).
Most worryingly is the fact that this condition is irreversible and degenerative with no prevention
or cure. Currently, enhancing quality care for managing dementia and provision of aid to
caregivers and relatives are the frequently used forms of management and care (Rakes et al.,
2017).
In the period between 2006 and 2013, dementia was the 4th leading cause of death
resulting in thousands of deaths of people most of whom were the elderly aged above 65 years
(Jones, 2014). Available evidence indicates that in Australia 1in 10 Australians aged 65 years
and above lived with dementia. More than 42% of people diagnosed with dementia were in the
latter stages of life at age 85 or above (AIHW, 2016). At the time, a total of 354,000 people
had dementia with the condition contributing to 11,000 deaths in a year thereby becoming the 2nd
leading cause of death. For females however, dementia became the leading cause of death
surpassing cardiovascular disease which had previously resulted in the most fatalities in
females and males over the past decades (ABS, 2018).
In 2018, dementia prevalence across Australia rose to more than 436,000 whereas
more than 240 people were being diagnosed with dementia on a daily basis (Dementia
Australia, 2019). This number exceeded the previous estimations that were made in 2013

APPLIED PUBLIC HEALTH 3
whereby it was anticipated dementia cases would rise to an all-time high of 400,000 (Jones,
2014). The most recent evidence indicates that three in ten people aged between 85 and above
lived with dementia although this number remained at one in ten for people aged between 65 and
over. Also, in 2018, dementia led to the deaths of 13,126 people 8,477 of which were females
(Dementia Australia, 2019).
Public health ideally encompasses the organized reaction by the public to enhance
and uphold health of people. Furthermore, such responses are confounded on population-level
data and the development of evidence-based approaches that will help to prevent a disease
(Jones, 2014). In this light, given the prevalence of dementia related cases and its rise, there is
need for the public or society to protect the health of dementia affected populations, prevent
associated injuries and disability and encourage healthy behaviors that will contribute towards
building healthier communities.
Additionally, Australia has also been faced with a policy struggle since 2005 which has
led to limited funding and change in government priorities both of which have exacerbated
dementia prevalence across different care settings (Jones, 2014). Thus, new approaches that
prioritize health promotion and overcoming the disease ought to be sorted. The need to engage
the community in such programs is also confounded on the fact that dementia poises diverse and
devastating impacts on the affected individuals and their families most of which cannot be
managed by authoritative bodies such as the government.
Historical, Economic, Political and Social Context of the Public Health Issue
The onset of dementia can be traced back to the 1980s when it was declared as a public
health issue. This led to intense sensitization of the public and as such, the emergence of support

APPLIED PUBLIC HEALTH 4
groups such as Dementia Australia. As of 2013, this condition was acknowledged as the 9th
National Health Priority Area. Aside from resulting in the worst death cases in Australia,
dementia is the most number of disability cases among the elderly in Australia. 52% of all the
people in residential aged care facilities are those diagnosed with either form of dementia
(AIHW, 2018). Hence, the aged populations are the marginalized groups in Australia who are
most affected by dementia.
The economic cost of dementia has been burdensome for the Australian population
amounting to more than $15 billion in 2018. The cost if further expected to increase with the
increase in dementia populations and it could exceed $20 billion and $40 billion in 2030 and
2060 respectively (Dementia Australia, 2019). The incurred expenses have been realized over the
past few years since the government of Australia acknowledged the prevalence of dementia and
prioritized the condition as a public health issue. In 2005, the government of Australia rolled
out more than $300 million in a five year plan to fund the Dementia Initiative that aimed at
supporting people living with dementia and their carergivers (Jones, 2014). This initiative was
however terminated in 2011 by the federal government.
Politically, the federal government through multiple institutions lifted the profile of
dementia across Australia. For instance, the ministry of health in Australia developed the
national framework for action in 2005 to offer a chance to generate a premeditated and
collective reaction towards dementia across the country. This program focused on five key
areas including; care and support services, information and education, workforce and training,
and access and equity (Jones, 2014). An addition, Australian States and territory governments
initiated their own strategies in support of the framework.

APPLIED PUBLIC HEALTH 5
The federal government of Australia in 2012 allocated another $268 million under the
Living Longer Living Better aged care reform to help address the dementia epidemic. These
funds were subdivided to cater for dementia management in acute and primary care settings,
behavioral issues connected with severe dementia in residential care, and Australians with
dementia in home care packages (Innes, 2016). Thus, millions of dollars were channeled towards
timely diagnosis of dementia, improve staff training and procedures to facilitate best practice,
and establish new dementia supplement.
The federal government also pledged another $200 million in 2013 over a five year
strategy to support scientists/researchers in Australia and medical practitioners who were
working on prevention and cure for dementia (Hunter & Doyle, 2014). It is worthy to note that
all these policies primarily initiated by the government comprise public health initiatives since
they reflect they reflect the people’s response to enhance or improve health through dementia
management.
Community-Based Initiative
As mentioned above, dementia currently does not have a cure or prevention and as such,
management as well as prevention practices aim at delaying the onset or progression of the
condition. Such initiatives are known to provide health, societal and cost benefits. The
community-based initiative will likewise be tailored towards delaying the progression of this
condition (WHO, 2018). Most importantly, this strategy will focus on sensitizing the society on
the prevalence of dementia and how affected individuals should be assisted within their environs.
The initiative will in this light be multi-faceted in creating dementia friendly communities and
employing multifactorial intervention.

APPLIED PUBLIC HEALTH 6
Description of the Initiative
Dementia friendly communities ideally aim at creating a dementia friendly nation where
the society is sensitized on the issue and encouraged to provide support to people living with
dementia. As such, this strategy highlights the activities that community members could
undertake in a bid to make their communities more dementia friendly (Innes, 2016). A
committee made up of various stakeholders including government representatives,
representatives from the local authority/council, and people with dementia, carers and service
providers. This committee will be the advocacy action group that will be tasked with developing
the goals and strategies for the initiative (WHO, 2018). On this note, the primary goal would be
to increase awareness of the condition and reduce the progression of the condition.
This program will also be an embodiment of strong government support and community
leadership with support coming from the local governments and advocacy extended to the
national level. This strategy will in this case develop a local dementia alliance to guide activities
such as awareness training, a carer support network and designing the information dissemination
plan (Cations et al., 2018). For instance, local publications such as journals will be made
available containing photos of people living with dementia alongside their stories. Such
publications will be distributed across various businesses in order to increase awareness of the
condition and also enlighten the society about the affected individuals. Similarly, researchers will
also be engaged to disseminate their findings regarding dementia and this can be achieved by
liaising with the mainstream media.
The community will further work towards creating inclusive and supportive
environments for people living with dementia. Such inclusion will mainly be achieved through

APPLIED PUBLIC HEALTH 7
social engagement activities. For instance, a dementia friendly garden program will be
established for individuals who are diagnosed with dementia and are under residential care or
home care. It is expected that this program will create a sensory stimulating and relaxing garden
for the affected individuals. Educating the public will also be a pivotal aspect under the initiative
for purposes of enhancing awareness. The notion behind this is that the lack of accurate
understanding of dementia results in stigmatization. This consequently contributes to social
isolation and distress for people living with dementia and their carers (Skladzien, Bowditch &
Rees, 2011). Thus, a well-educated society will prove to be a key factor towards supporting
inclusion of people diagnosed with this condition.
The multifactorial intervention will comprise regular exercise and healthy dieting. It is
one of the primary preclusion approaches that incorporate lifestyle changes such as nutrition,
exercises, stress minimization and treatment of major depressive disorder (MDD) (Rakesh et al,
2017). Hence, this component of the initiative will be the primary plan that helps to reduce the
progression of dementia. Exercises under this approach will further incorporate cognitive
training in addition to aerobic and resistance exercise. These forms of exercises are expected to
last for at 60 minutes a day for three days within a week.
The dementia friendly communities’ initiative will thus incorporate a work plan that
contains dementia friendly concepts and principles by making an inclusion of the lifestyle factors
that impact positively on people living with dementia. Specifically, the local council will be
expected to embed the dementia friendly principles of physical exercises, cognitive training and
nutrition exercises within their planning (WHO, 2018). The idea behind this planning is that the
authorities can assign sufficient amount of money to be used by service providers and carers in
training, developing and implementing multifactorial interventions.

APPLIED PUBLIC HEALTH 8
Strengths of the Initiative
Dementia friendly communities discourage isolation of people diagnosed with dementia
and further encourage greater social interaction by bringing together different members of the
society rallied towards a common goal. This initiative will reduce isolation by creating inclusive
activities for people living with dementia. Also, dementia enabling environments takes into
account the contributions made by all members of the community by relying on established
collaboration between all the stakeholders including; local authority, people living with dementia
and their carers, and partnerships with local businesses (Hunter &Doyle, 2014). In addition, the
initiative will draw its strength from educating members of the society regarding dementia and
how they can associate with them in their community settings.
Evidence reveals that multifactorial intervention is one of the most promising prevention
measures for the prevention of cognitive decline. Simulation studies have further revealed that
this form of prevention is capable of delaying dementia for up to 2 years thereby resulting in
substantial economic, societal and public health benefits. Physical exercises in particular have
been found to improve cognition in older adults with different levels of cognitive impairment
(Rakesh et al., 2017). Studies have also indicated that exercises are effective in slowing down
cognitive decline and it can further improve multiple cognitive domains including; verbal and
spatial memory (Hunter & Doyle, 2014). In such cases, this form of intervention can therefore,
be used in slowing down the progression of dementia by positively affecting various brain
functions.
Weaknesses of the Initiative

APPLIED PUBLIC HEALTH 9
Given the sensitization efforts and reduction of social isolation, it is expected that some
of the community members will perceive dementia as part of the aging process. Furthermore, a
considerable portion of the public already hold the belief that cure for dementia is available and
hence, the implementation of multifactorial intervention will incline carers to perceive the
intervention as a form of cure or treatment and not necessarily a prevention plan (Cations et al.,
2018).
Outcomes of the Initiative
The primary outcome under creating dementia friendly communities would be to increase
awareness and understanding of dementia. This would in turn reduce stigmatization and social
isolation. It would also improve the physical environments for patients with this condition. The
main outcome under multifactorial intervention would be decline in progression of dementia
through improvement in cognitive function. This aspect of the initiative will also increase patient
engagement thereby increasing their access to social activities. In general, this initiative will
create a community culture and environment that is not only supportive but also easily accessible
for Australians diagnosed with dementia.

APPLIED PUBLIC HEALTH 10
References
Australian Bureau of Statistics (ABS). (2018). Dementia and Death in Australia. Retrieved from
http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main
%20Features~Dementia~10002
Australia Institute of Health and Welfare Canberra (AIHW). (2016). Dementia in Australia.
Retrieved from https://www.aihw.gov.au/getmedia/199796bc-34bf-4c49-a046-
7e83c24968f1/13995.pdf.aspx?inline=true
Australian Institute of Health and Welfare (AIHW). (2018). Dementia Overview. Retrieved from
https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/dementia/
overview
Cations, M., Radisic, G., Crotty, M., & Laver, K. E. (2018). What Does the General Public
Understand about Prevention and Treatment of Dementia? A Systematic Review of
Population-Based Surveys. PLoS One, 13(4). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908164/
Dementia Australia. (2019). Dementia: Key Facts and Statistics. Retrieved from
https://www.dementia.org.au/files/documents/2018_Dementia_Key_facts%2526stats.pdf
Hunter, C., & Doyle, C. (2014). Dementia Policy in Australia and the Social Construction of
Infirm Old Age. Health and History, 16(2), 44-62. Retrieved from
https://www.jstor.org/stable/10.5401/healthhist.16.2.0044#metadata_info_tab_contents

APPLIED PUBLIC HEALTH 11
Innes, A. (2016). The Social and Political Context of Formal Dementia Care Provision. Aging
and Society, 83(22), 483-499. Retrieved from
https://pdfs.semanticscholar.org/a54b/f1fdddd78909a98360785ec3bbc188075195.pdf
Jones, B. (2014). Public Health Interventions – Dementia. Australian Journal of Dementia Care.
Retrieved from https://journalofdementiacare.com/public-health-interventions-dementia/
Rakesh, G., Szabo, S. T., Alexopoulos, G. S., & Zannas, A. S. (2017). Strategies for Dementia
Prevention: Latest Evidence and Implications. Therapeutic Advances in Chronic
Diseases, 8(9), 121-136. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546647/
Skladzien, E., Bowditch, K., & Rees, G. (2011). National Strategies to Address Dementia: A
Report by Alzheimer’s Australia. Retrieved from
https://www.dementia.org.au/files/20111410_Paper_25_low_v2.pdf
World Health Organization (WHO). (2018). Towards a Dementia Plan: A WHO Guide.
Retrieved from https://apps.who.int/iris/bitstream/handle/10665/272642/9789241514132-
eng.pdf?ua=1