Dementia introduction

Page content: Defining dementia | Prevalence of dementia | The burden of disease | The Australian context

Defining dementia

The World Health Organisation's International Classification of Diseases describes dementia in the Clinical Descriptions and Diagnostic Guidelines as:

… a syndrome due to disease of the brain, usually of a chronic or progressive nature in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation. This syndrome occurs in Alzheimer's disease, in cerebrovascular disease, and in other conditions primarily or secondarily affecting the brain.

The most common form of dementia is Alzheimer's disease, followed by vascular dementia and mixed dementia (that is, a condition with features of both Alzheimer's disease and vascular dementia). Rarer forms of dementia include dementia with Lewy bodies, dementia in Parkinson's disease, extreme alcohol abuse, AIDS dementia complex, Huntington's disease, Creutzfeldt-Jakob disease and Pick's disease.

Prevalence of dementia

Dementia predominantly affects people aged over 65 years and becomes progressively more common after that age. Around 1 per cent of people aged 65 years show evidence of cognitive impairment consistent with dementia, rising to 25 per cent in people aged 85 years. An estimated 39,800 Victorians aged over 65 years will have dementia in 2001; by 2011, this number will have increased to around 49,500.

The burden of disease

The Victorian Burden of Disease Study: Morbidity indicates that dementia is by far the most important single contributor to neurological and sense disorder burden in women, accounting for three-fifths of neurological and sense disorders. Dementia is ranked fourth in the top 20 leading causes of overall female burden. Dementia and hearing loss together account for three-fifths of the overall male burden due to neurological and sense disorders.

Dementia is projected to possibly take over from ischaemic heart disease as the largest cause of ill health in women in Victoria in 2016. Among men, dementia will rise significantly in the ranked causes of ill health-up from eleventh to fifth.

top of page

The Australian context

Since the Commonwealth Aged Care Reform Strategy commenced in 1985, the Commonwealth and State governments have increasingly recognised and supported the needs of people with dementia and their carers.

A National Action Plan for Dementia Care was developed as part of the second stage of the Mid Term Review of the Aged Care Reform Strategy. The plan covered five years, starting in 1992. The aim of the plan was to increase the extent to which the whole aged care system could care for people with dementia.

Key initiatives undertaken over the proceeding five years included:

• Support of the Demonstration Projects Program to promote and disseminate innovative and effective dementia care practices. The approaches included on-site in-service training, sharing of experiences, learning sessions and the use of other workshop environments. Consultancy and advisory services were also used, and videos/manuals were made available.
• Support of the establishment of counselling services (predominantly through the Alzheimer's Association in each State and Territory), a national toll-free help line and 24-hour access to telephone counselling.
• The development of a dementia assessment resource package for Aged Care Assessment Teams.
• The production and dissemination of pamphlets and booklets.
• The development of dementia training packages for Aged Care Assessment Teams, carers and Home and Community Care workers, and the subsequent provision of training.

In addition to the National Action Plan, other Commonwealth Government initiatives to address dementia and the mental health needs of older people included:

• Research into the care needs of people with dementia and challenging behaviour who live in residential facilities. The aim of the project was to provide information that could be used to improve services for people with dementia and challenging behaviour.
• The development of specialist psychogeriatric care and support units in each State.
• The review of the respite options pilot program initiated in 1994 to increase the use of residential respite.

The National Action Plan concluded in 1997, with an evaluation undertaken in 1998. The Commonwealth Government is considering future national dementia directions following consultations with the field.

During the early to mid-1990s, State and Territory governments were also undertaking dementia related work. Some of the States developed aged care and/or mental health policies and plans that referred to dementia care. New South Wales developed a State Action Plan on Dementia in 1996, and other States have also since developed dementia plans.

Victoria established a Ministerial Task Force in 1995 to advise on strategies for developing integrated dementia services, monitoring agency performance (via suitable measures of performance and outcomes), and ensuring workforce development, education and training. A final report was published in 1997, making recommendations in terms of the pathway of dementia experienced by the person, their networks (family, social and community), their workplace, and the health and community service providers who support them.

The major initiative in the implementation of the recommendations was the establishment of Cognitive Dementia and Memory Services (CDAMS) in each Victorian Department of Human Services' region. Other work included:

• An upgrade of the Alzheimer's Association Victoria web site.
• The development of an education resource package for use in supported residential services.
• The development of transition support protocols for assessment services and other service providers.
• The identification of evidence based best practice models of admission and discharge practices in acute hospitals.
• The development of an information booklet for carers and others on the range and availability of residential care for people with dementia.
• The review of issues related to elder abuse.
• The development of a dementia awareness training resource for direct care workers.

Some initiatives have been completed, while others are under way. Future strategies will need to incorporate relevant project outcomes from the previous initiatives where appropriate.

This framework aims to build on efforts of both State and Commonwealth Governments over the previous ten years. It recognises the respective roles of the State and Commonwealth Governments, and acknowledges the Commonwealth's predominant role in funding, regulating and monitoring standards in residential aged care.

top of page