Supporting people with dementia in rural & remote aboriginal populations

September is Dementia Awareness month here in Australia. It is a good opportunity to reflect on what supports are available to indigenous people living with dementia and the services who support them to live a quality life.

I remember when starting out in aged care coordination on a remote community, I found myself grappling with how to care for and support an older lady with memory problems. Thankfully, I was able to access the support of the remote area dementia nurse. Penny provided some information and advice on what the care team and I needed to do. This support continued when another of our clients was diagnosed with dementia. For a small community of 800 people, there appeared to be a high number of our clients who developed dementia. Now there is evidence to back up this anecdotal observation as well as recognition of the special needs of this population group.

Aboriginal people in Australia over the age of 45 are three to five times more likely than the general population to have dementia. The research suggests this is due to a number of factors that also contribute to chronic health conditions such as diabetes. Factors include being overweight, having high blood pressure, lack of exercise, excessive alcohol intake and a poor diet. Trauma to the head may also be a contributing factor in acquiring dementia.

It is important for aged care services operating on remote communities to be aware of the statistics and for care staff to be able to identify the needs of people with dementia and support both them and their family to enjoy life. But the first step in meeting the needs of people is to obtain a formal diagnosis of their condition.

While there are a number of different assessment tools to assist in the diagnosis of dementia such as the Modified Mini Mental Exam (3MS) and the General Practitioner Assessment of Cognition (GPCOG), these tools that work well in a mainstream setting can fall short in diagnosing indigenous people living in rural and remote regions. Language barriers, varied life experience and cultural influences impact on the ability for a mainstream assessment to hold relevance. To overcome this, the Kimberly Indigenous Cognitive Assessment, or KICA, was developed.

The idea of the KICA was to replace the Eurocentric or Dominant Culture framework with concepts and items that indigenous people living in rural and remote areas would be familiar with, e.g. crocodile instead of a sheep or pannikin instead of a teacup. The KICA includes information from both the client and their family carer/s in the areas of medical, smoking and alcohol usage history. Although the KICA is conducted by an external health professional, by using an interpreter the assessor gains a clearer understanding of the cognitive state of the person. Family / carer feedback is equally important in the collection of information in the KICA. Family often know if the person has changed sleeping patterns or is forgetting things. This assessment has been validated as a culturally appropriate tool for identifying dementia in Aboriginal people in remote communities in Western Australia, Queensland and the Northern Territory.

With the possibility of a high number of aged clients in remote indigenous communities having dementia, services need to be responsive to the needs of this group and their family carers. Staff need to be trained in techniques that support people with dementia. Further resources for educating indigenous staff and families can be found on the Alzheimer’s Australia website.

There is also recognition from the Government of the extra support needs when caring for people with dementia. If a person with a diagnosis of dementia is receiving services through a Home Care Package, additional funds are available via a supplement. This extra payment can be used to further support the client and their family and is applicable across all levels of the packaged care program. More information can be found on the Department of Social Services website at The Dementia & Veterans Supplements Eligibility Guidelines.

With greater recognition and awareness of dementia, people on remote communities are now receiving the support and care they need and families are better supported.

References:

Validation of the Kimberley Indigenous Cognitive Assessment (KICA) report

Dementia higher in indigenous populations

Aboriginal and Torres Strait Islander People and Dementia, a review of the research