Analysis of Dementia Healthcare Delivery, Cultural Safety, and Poverty

This essay analyzes dementia healthcare delivery in Australia, examining various healthcare models like primary and tertiary services, and their underpinning values. It explores the impact of social determinants of health, particularly poverty, on dementia outcomes, highlighting how it affects access to services and increases vulnerability. The essay emphasizes the significance of cultural safety and person-centered care in improving patient engagement and outcomes. It critiques instances of discrimination and stigma within healthcare, referencing ethical codes and standards, such as the International Council of Nurses Code of Ethics and the NSQHS standards, and stresses the need for nurses to cultivate empathy and cultural sensitivity. The analysis underscores the disproportionate burden of dementia on elderly and female populations and the importance of addressing negative attitudes towards patients to enhance care and support.

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Introduction:
Dementia is chronic mental health condition associated with cognitive impairment,
decline in memory, communication and language, reasoning and visual perception. It is
progressively disease whose symptoms initiate slowly and gradually worsens. Elderly people are
mostly affected by the disorder and the burden of dementia is understood from the fact that 50
million people worldwide are affected by the disorder and 10 million new cases are detected
every year (World Health Organization, 2019). In case of Australia, dementia is the second
leading cause of death as it contributes to 5.8% of deaths in males and 11.3% of deaths in
females per year. The population group of elderly and females are disproportionately affected by
the disease as females account for 64.5% of deaths and three in every 10 people above the age
group of 85 years suffer from dementia (Dementia Australia, 2019). According Australian
Institute of Health and Welfare (2016), nearly one in every 10 people above 65 years had
dementia in 2016 and the prevalence rate for the same in permanent residential aged care was
52%. Hence, with the increase in ageing population in Australia, the manner in which elderly
people are rapidly being diagnosed with dementia is an urgent health issue.
Apart from age and gender, the incidence of dementia is also high for ethnic population
group of indigenous Australian as the prevalence rate is about 2- times higher among indigenous
people compared to non-indigenous people (Australian Institute of Health and Welfare, 2018).
However, the prevalence of the disease does not differ based on different geographical locations.
The main purpose of this essay is to analyse the health care delivery methods in dementia and
evaluate impact of poverty on the health issue. The essay will also analyse the principles
underpinning cultural safety and person centred care based on review of documents and
standards.

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Types of health care delivery:
There are different types of health care delivery process and the process and assumptions
for each type differ. Health promotion and disease prevention is one of the types of health care
delivery and it is based on the assumption that reducing the impact of preventable illness and
injury is critical to increase quality of life of people in the community. Disease prevention is
targeted either for the entire population or for high risk groups based on age or risk factors.
Health promotion is an important part of disease prevention activities where education, social
marketing and changes in regulation are targeted to build appropriate physical environment and
support target group to adapt healthy behaviours (Australian Institute of Health and Welfare,
2016). Some example of activities implemented under this type of delivery process includes
immunization and vaccination, delivery of health promotion campaign, tailored health education
and screening programs. Hence, the values and principles that guide current health practice
includes positive health concept, participation and involvement, action, a settings perspective and
equity in health (Grabowski et al., 2017). These values play a role in developing and integrating
cost effective and sustainable models for disease management and preventions.
Types of health care delivery in dementia and their underpinning values:
Two types of health care that is available for treatment of dementia in Australia include
primary health care service such as the National Dementia Helpline and the tertiary health care
services. Primary health care services are the first point of contact with the health system and it is
related to activities like health promotion, treatment of acute health conditions and early
intervention. This type of health care service is based on community health and patient-centred
care principles. It involves participation of various health professionals such nurse, GP, dentist,

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midwives and indigenous health workers. It can be delivered in community health centres and
through communication technology. For example, the National Dementia Helpline is a telephone
based support service that support people with dementia and their family members and provide
referral and relevant advice to people (Better Health Channel, 2018). However, the disadvantage
associated with this service is that it cannot address cultural gaps in care and preserve the values
of person-centred care as telephone based services are not delivered by culturally competent
group and it does not have the scope to fulfil person-centred care expectation.
Another type of health care service available for dementia in Australia includes tertiary
health service focussed on treating and supporting people already suffering from dementia. The
values of this type of service are to provide advanced diagnostic support and specialized medical
service to influence health outcome of the group. For example, the Carers Victoria provides
counselling service and other direct support needed by patients, carers and family members
(Better Health Channel, 2018). The significance of this type of service is that as this service is
provided for long term period, there is a scope for meeting cultural needs of client and taking
patient’s preference regarding service or expectation with the service. Goldberg et al. (2018)
gives the insight that cultural safe healthcare service are critical to prevent risk for people,
counter discrimination and provide appropriate care. Skilled aboriginal workforces are working
to address health needs of diverse people with dementia.
Social determinants of heath: poverty
Social determinants of health play a vital role in influencing health outcome and health
status of an individual. One of the social determinants health include income and employment
which influence the way people live their life and how they are exposed to risk factor of disease.

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Poverty is one of the SDOH that negatively influences health outcome of people. Poverty is a
condition associated with lack of shelter, hunger, lack of medical care and poor access to basic
education. It is one of the common risk factor linked to ill-health and disease as obesity force
people to live in dirty environment and experience additional stressors that have direct impact on
their health. There is relation between poverty and dementia too as poverty diminishes access to
health services and create gaps in health outcomes between indigenous Australians and non-
indigenous Australians.
There are many evidences which shows how poverty because of poor socioeconomic
status lead to burden dementia. Russ et al. (2013) gives the evidence that dementia etiology is
influenced by poor socioeconomic status as socioeconomic hardship results in delayed diagnosis
of dementia and early death because of lack of treatment. Although very strong relation between
poverty and dementia is not found, however some indirect link between poverty and access to
dementia service has been found. Tóth, Gavurová and Barták (2018) revealed that low level of
education and low socioeconomic status is linked with risk of dementia, poor access to health
service and high rate of mortality in patients. Deckers et al. (2017) gives the evidence that
differences in dementia risk in people are seen by socioeconomic groups due to difference in
lifestyle factors. Hence, it can be said that poverty is not a direct risk factor of developing
dementia. However, it plays a role in increasing vulnerability for people because of delayed
diagnosis and poor access to treatment for dementia. It indirectly influences rate of dementia
related mortality.

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Cultural safety and person centred care:
The utilization of health service for dementia or any other health issue is directly
influenced by provision of cultural safety, delivery of person centred and delivering culturally
appropriate care. The significance of applying cultural safety and person-centered is that it can
promote engagement of patient’s in care, increase their satisfaction with care and achieve
positive health outcome for patient. However, the issue found in current health care system is
that culturally appropriate care is not provided and issues of racism and discrimination prevent
many vulnerable population group from effectively utilizing health care services. Ben et al.
(2017) supports that racism and health service use is interlinked with each other as racism delays
access to healthcare, increases lack of adherence to treatment uptake. Therefore, it can be said
that racism is associated with negative patient experiences and low level of healthcare trust and
communication between patient and care staffs.
The direct relationship between racial discrimination and use of health service by
aboriginal Australians is understood by the several research evidences. Molden and Maxfield
(2017) revealed that dementia is mainly seen in elderly patient, ageing related stereotype is one
of the factor that lead to poor experience of care for elderly people with dementia. The article
explored the impact of positive and negative stereotype words on dementia and indicated that
exposure to negative aging stereotypes increases level of distress for patients and lead to poor
outcomes in care. The discriminatory practices as described above does not fit with the
principle 3 of the code of conduct for nurse as this principle mentions about the responsibility of
nurse to engage in cultural safe and respectful practice. This involved creating an inclusive
environment for safety, respecting diverse culture, avoiding bias and discrimination while
providing care. However, the evidence above shows use of discriminatory words which goes

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against cultural safety principles and contribute to biased during care delivery. Instead of
showing respect to patient, dementia people suffer from negative emotions because of experience
of discrimination while accessing health care services.
According to the International Council of Nurses Code of Ethic for nurses, one inherent
responsibility in nursing practice is to respect cultural rights, disability, dignity, cultural and
racial status while providing care (International Council of Nurses, 2012). However, cultural
sensitivity is not maintained by health care staffs while dealing with dementia patients. Dementia
patients have to endure discrimination based on their condition as well ageing. Evan (2018) gives
the insight that people with dementia often experience both dementia related stigma as well as
ageist discrimination. This is associated with negative emotions in patient such as shame, poor
self-esteem, disgust and humiliation. Hence, instead of empowering patients and respecting their
disability, health care staffs often became the individual who engage in discriminatory attitude
towards this people. The evidence shows that discriminatory experience does not fit with the
Nurse Code of Ethics, as according to this document respectfulness and cultural sensitivity is
necessary for nurse. However, the evidence shows contrasting professional behaviour shown by
staffs in health care. Hence, there is need to address impact of stigma on dementia patient as well
as their families so that high level of care and support is provided to patients.
According to the NSQHS standard 2, partnership with consumers is necessary to provide
high quality care and this is dependent on preserving patients right while delivering care. This
increases patient’s satisfaction with care and lead to cost effectiveness of service too (ACSQHC,
2019). Kilduff (2014) argues that stigma is one factors that affected individuals ability to live
well with dementia. Because of ageism and age related discrimination, dementia patients are
vulnerable to non-involvement in decision, marginalization and negative self-perception. Hence,

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as this negatively influence health outcome and patient’s satisfaction and trust with the health
care system, taking steps to address stigma related to dementia diagnosis is critical to meet the
standard 2 of partnering with consumers in care. Therefore, as nurse needs to develop therapeutic
relationship with dementia patient, it is critical that nurse develop empathy and cultural
sensitivity while interacting with dementia patient. This will help nurse to avoid judging and
labelling patients based on their condition and instead using empathy to support patients to
overcome challenging behaviour during care (Digby, Williams & Lee, 2016).
Conclusion:
To conclude, the essay provided a discussion regarding the prevalence of dementia in
Australia and the disproportionate burden of the disease in elderly and female population group.
The review of different types of health delivery service for dementia patient indicates who such
patients are supported in Australia to maintain appropriate health and seek appropriate referral
advice for health care. In addition, the review of practices related to dementia care suggest that
stigma and discrimination is a negative attitude that is highly displayed by health care
professionals and dementia patients are negatively affected by stereotypes. As this affects their
well-being, care experience and trust with the health care system, it is critical that nurses in
Australia be trained regarding cultural safety and developing empathy to display respect towards
such patient.

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References:
ACSQHC (2019). Partnering with Consumers Standard 2. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/NSQHS-Standards-
Fact-Sheet-Standard-2.pdf
Australian Institute of Health and Welfare (2016). Australia’s health 2016. Retrieved from:
https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787-
AH16.pdf.aspx?inline=true
Australian Institute of Health and Welfare (2016). Older people. Retrieved from:
https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/dementia/
overview
Australian Institute of Health and Welfare (2018). Australia’s health 2018. Retrieved from:
https://www.aihw.gov.au/getmedia/bcf051e3-8f52-4399-8a52-790c507b3c53/aihw-aus-
221-chapter-3-14.pdf.aspx
Ben, J., Cormack, D., Harris, R., & Paradies, Y. (2017). Racism and health service utilisation: a
systematic review and meta-analysis. PloS one, 12(12), e0189900.
Better Health Channel. (2018). Services to support people with dementia and their carers.
Retrieved from: https://www.betterhealth.vic.gov.au/health/servicesandsupport/dementia-
and-memory-loss-services
Deckers, K., Cadar, D., van Boxtel, M. P., Verhey, F. R., Steptoe, A., & Koehler, S. (2017).
Socioeconomic Inequalities in dementia risk explained by modifiable risk factors:
Findings from the English Longitudinal Study of Ageing.

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Dementia Australia (2019). Dementia statistics. Retrieved from:
https://www.dementia.org.au/statistics
Digby, R., Williams, A., & Lee, S. (2016). Nurse empathy and the care of people with
dementia. Australian Journal of Advanced Nursing, The, 34(1), 52.
Evans, S. C. (2018). Ageism and dementia. In Contemporary perspectives on ageism (pp. 263-
275). Springer, Cham.
Goldberg, L. R., Cox, T., Hoang, H., & Baldock, D. (2018). Addressing dementia with
Indigenous peoples: a contributing initiative from the Circular Head Aboriginal
community. Australian and New Zealand journal of public health, 1-3.
Grabowski, D., Aagaard-Hansen, J., Willaing, I., & Jensen, B. (2017). Principled promotion of
health: implementing five guiding health promotion principles for research-based
prevention and management of diabetes. Societies, 7(2), 10.
International Council of Nurses (2012). THE ICN CODE OF ETHICS FOR NURSES. Retrieved
from:
https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_
%20eng.pdf
Kilduff, A. (2014). Dementia and stigma: a review of the literature on the reality of living with
dementia. Retrieved from:
https://pdfs.semanticscholar.org/f795/187940e2bda19ed59fa9a533e71dd4334056.pdf
Molden, J., & Maxfield, M. (2017). The impact of aging stereotypes on dementia
worry. European journal of ageing, 14(1), 29-37.

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Russ, T. C., Stamatakis, E., Hamer, M., Starr, J. M., Kivimäki, M., & Batty, G. D. (2013).
Socioeconomic status as a risk factor for dementia death: individual participant meta-
analysis of 86 508 men and women from the UK. The British journal of
psychiatry, 203(1), 10-17.
Tóth, P., Gavurová, B., & Barták, M. (2018). Alzheimer’s Disease Mortality according to
Socioeconomic Factors: Country Study. International Journal of Alzheimer’s
Disease, 2018.
World Health Organization (2019). Dementia. Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/dementia