Epidemiological Study: Dementia in Elderly Aboriginal Australians

This report presents an epidemiological study on dementia in the elderly Aboriginal population of Australia. It begins with an abstract outlining the scope and key findings. The introduction defines dementia, its prevalence, and the specific focus on the Aboriginal community. The report investigates the issue of dementia, highlighting the health inequalities between indigenous and non-indigenous Australians, with figures illustrating prevalence rates. It then delves into the determinants, including global risk factors like low education and smoking, and identifies specific factors like smoking, illiteracy, diabetes, hypertension, and depression as predominant in the Aboriginal population. The report explores multifactorial causation, discussing how dementia is a syndrome with various causes, including Alzheimer's, vascular damage, and traumatic brain injury. Preventative strategies and interventions are then examined, such as vascular risk factor control, cognitive activity, diet, and social engagement. The conclusion emphasizes the need for effective strategies to address risk factors and reduce vulnerability to dementia within the Aboriginal community. The report highlights the importance of understanding history, cultural, and linguistic diversity, and the role of the elderly in indigenous society. The report aims to provide a vivid understanding of the issue, with the goal of promoting better health outcomes.

Running head: DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
Name of the Student:
Name of the University:
Author’s Note:

1DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
Abstract
Dementia is stated to be a syndrome and not a disease, which is caused due to various
factors. It involves slow deterioration if the cortical function with respect to language, speech,
movement, memory, comprehension, judgment and learning. The course of the disease is
dependent on a wide range of risk factors. It can be seen that dementia is more prevalent
among the older population of Aboriginal Australia. This is because there is a distinguishable
health disparity between the indigenous and non-indigenous groups in Australia that result in
such inequality in the healthcare sector. The discussion of dementia focusing on the target
population was done that included determinants, causation, and interaction that offered more
information related to the poor health outcome. Therefore, based on the findings,
interventional strategies have been formulated that will critically address the risk factor
among the elderly people of Aboriginal communities in Australia.
Introduction
Dementia is a broad term that is used for describing conditions characterised with a
decline in cognitive ability, language, decision-making, problem-solving and other thinking
skills, thus, affecting the capability of a person to conduct daily activities. An example of
dementia is memory loss and the most common cause of dementia is Alzheimer's 1. It causes
a change in brain function and thus, triggering a decline in the thinking ability, severely
impairing the daily life and the function of being independent. It also affects feelings,
behaviour and relationship. Approximately 400000 people in Australia are suffering from
dementia and of these, 55% are female 2. Most of the residents of the residential aged care
home in Australia have dementia. As per the record, one out of ten people above the age of
65 years have experienced varied signs of dementia and it is predicted that 589000 people
will have the disorder by 2028 and a million people by the end of 2058 2. Dementia is stated

2DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
to be the greatest cause of disability among people over the age of 65 years in Australia and it
is considered as the third leading cause of disability burden. The family members can identify
the signs and symptoms of dementia three years prior to its actual diagnosis. The aim of the
essay is to conduct an epidemiological study on a current health issue, dementia among the
older people in Australia and assess the potential prevention and interventional strategies
adopted to mitigate the issue. The focus of the issue will be direct to the Aboriginal
community in Australia.
The issue
The prevalence of dementia in the Aboriginal and Torres Strait Islander Australians is
found to be three to five times higher than the general population. One of the major public
health issues in the country is the health inequality between the indigenous and non-
indigenous people, which require immediate focus from both governmental and non-
governmental sectors 3. One of the key elements of the healthy disparity can be seen in the
case of the high prevalence of dementia, especially among the older indigenous people and its
increasing frequency among both men and women.

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Figure 1: Prevalence of dementia among indigenous and non-indigenous people in
Australia
From figure 1, it can be clearly noted that the frequency of dementia is negligence
among t below the age of 45 years and significantly increase above the age of 65 years in
both the population. The reason because of which, the prevalence of dementia is higher in the
age group 75 to 84 years and above 85 years is due to the poor healthcare service of the
indigenous people 4. The life expectancy of the indigenous people is found to be less as
compared to the non-indigenous population in Australia due to the predominant
discrimination in the health-related aspect.
Determinants
The global burden of dementia is increasing all over the world in a dramatic manner
and it particularly concerns Aboriginal Australians because of the high prevalence rate. Most
of the Australian population suffers from Alzheimer’s, which is stated to be a common type
of dementia; however, treatment is still unknown 5. The researches and evidence state that the
identification of the underlying risk factors has been made of the epidemic that can be
modified in order to treat the patient. The identifiable global risk factors are low level of
education, depression, smoking, physical inactivity, obesity, hypertension and diabetes.
According to a systematic review, it was noted that the predominant risk factors among all
types of dementia indicate that there is a strong link between depression and type 2 diabetes
mellitus. In addition to this, two newly observed risk factors that are associated with the
disorder is social contact and misuse of benzodiazepine 6.

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Figure 2: Factors that have an impact on dementia prevalence among the Aboriginal
Australian
As per the risk scale of the Alzheimer’s disease, the risk and protective factors include
age, body index, sex, depression, diabetes, brain injury, trauma, cholesterol, smoking, alcohol
consumption, physical activity, social engagement, intake of fish, cognitive activity and
exposure to chemicals such as pesticides as noted in figure 2. Among the identified risk
factor, the most predominant in the case of the older population of the Aboriginals
Australians as smoking, illiteracy, diabetes, hypertension and depression 7. In a cross-
sectional, it was found that the risk factors among the population include Aboriginal
Australian above the age of 45 years residing in remote Kimberley areas of Western Australia
were age factor, no formal education and being male. After managing these factors, the
disease was associated with smoking, epilepsy, stroke, poor mobility, head injury, falls, and
incontinence 8. In the follow-up study of the same population, it was found that the two
emergent factors for the decline in cognition were age and head injury. Even though these
factors were thought to increase dementia among remote Aboriginal Australia however, the
Factotrs
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5DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
urban people have a similar rate of dementia, which is 21% vs. 23.8% among people above
the age of 60 years that indicate that education has a slight significance in preventing the
disease 9. However, there is a broader array of social factor that is in play that requires further
investigation in order assess the specific factors that led to high rates of dementia cases
among the older population in Aboriginal Australia.
Figure 3: Various factors potentially associated with dementia
Multifactorial causation and interactions

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Dementia is not a disease, it is a syndrome and thus, the clinical manifestation of
dementia, which is also known as a neurocognitive disorder, can be due to one or more types
of injuries, diseases, or infections 10. The symptomatic demonstration of dementia includes
failure to remember things reduced ability to conduct multiple tasks at a time in the mind due
to division of attention for each, issue in language expression or comprehending, the problem
in spatial orientation, impairment in execution ability and inaccurate decoding of nonverbal
cues of others. These symptoms can be caused due to multiple reasons and in multiple
manners. For example, one might suffer from cognitive impairment due to chronic illness
such as HIV infection, due to interference of short-term memory loss and comprehension 11.
In some cases who were recognised to have, frontotemporal dementia it led to difficulty in
controlling behavioural action and aphasia, where the individual is unable to express or
understand speech. The cause of vascular cognitive impairment can be caused due to stroke
or cardiovascular disorders. There are different types of dementia that occur among people
and the difference of cause is huge and requires thorough investigation as there are no
specific causes that lead to the destruction of the brain cells. As per various studies, it can be
demonstrated that the common causes of dementia are Alzheimer’s disease, Huntington’s
disease, vascular damage, HIV infection, dementia caused due to Lewy bodies, brain injury
causing trauma, frontotemporal dementia and Parkinson’s disease 8, 10, 11. The causes are not
limited to these only; there are various diseases where the brain cells are damaged,
demonstrating clinical features of dementia.

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Figure 4: Various causes of Dementia
Over several years, researches are being conducted that links traumatic brain injury
with a high risk of Alzheimer’s disease or other dementia. In one of the studies, it was
showed that there is an increased risk among older people who have a moderate traumatic
brain injury of developing dementia, which is about 2.3 times greater than elders without any
brain injury are. In case of severe brain injury, the frequency of the risk increase by 4.5 times;
however, in other studies, such association was not found 12. It can be seen that there is no
evidence that shows that a single traumatic injury in the brain increases the risk of dementia.
However, the recent evidence clearly stated that it had been linked with a risk of developing
chronic traumatic encephalopathy, which is a form of dementia. There is evidence that
indicates that a history of brain injury may have an elevated impact on the age of onset of
impairment in the cognitive behaviour among elderly people. A study was conducted by the
researchers of the Umea University in Sweden that can affirm traumatic brain injury is one of

8DEMENTIA IN ELDERLY POPULATION IN AUSTRALIA
the risk factors for dementia and thus, diagnosis of it was found to be highest at the first five
years of the injury 13. It can be stated that the chance of acquiring dementia increase by six
times. However, it needs to be opined that further researches need to be done in order to
understand the relation and interaction of brain injury and dementia and about the severity
level associated with increased risk of the disease.
Preventative strategies/interventions
From the previous studies, it can be stated that there is a need for effective and
sustainable strategies for addressing the risk factors and reduce the vulnerability if dementia.
This can be done by gaining an in-depth understanding of the history, cultural, linguistic
diversity as well as the role of the elderly people in the indigenous society 14. The promising
strategies that would help in preventing dementia among older populations are vascular risk
factor control, physical activity, enhanced cognitive activity, diet, social engagement and
recognition of depression. According to one of the studies, it was found that vascular risk
factors include hypertension, diabetes, obesity, and dyslipidaemia that are found to increase
the risk of dementia in old age 15. The use of statin therapy can be useful in reducing the risk
of dementia.

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Figure 5: Mechanism associated between vascular risk factors and the risk of
developing dementia
In some of the reports, it was found that older people in the indigenous community
with more education have a lower chance of dementia. This is because people who are
engaged in mentally stimulating activities are less prone to acquire the disorder. The
cognitively active elders have a high degree of neuropathology, thus, limiting the symptoms
16. A community-based awareness strategy can be adopted with the implementation of the
policy of equal healthcare services among the target population in both urban and remote
areas in Australia. This will allow in disseminating knowledge as well as preliminary
precautionary steps that would allow the people to be aware of the disease, take necessary
steps to prevent it and early identification of the symptom for treatment. In addition to this,
the importance of diet and physical activity needs to be highlighted that are potential
protective factors against the risk of the disorder.
Conclusion
It can be inferred from the essay that the issue of dementia among the older
population of Aboriginal Australia is predominant and affect most of the people in the
society. It has a significant impact on the health and mental wellbeing of people; thus, it is
essential to discuss it and gain more knowledge. The risk factors, cause and interaction of
dementia have been critically addressed in the essay for gaining a vivid understanding of the
disorder and the associated aspects linked with it. The lack of education, social factors,
socioeconomic factors and sedentary lifestyle among the Aboriginal society are found to be
significant in the development of dementia. Thus, the preventive strategies such as statin
therapy, more education, improving the health status of the population, and promoting

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awareness programs in the specific community can be taken into consideration for mitigating
the issue.
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