Dementia and Alzheimer's disease in Australia is a major health issue. [1] Alzheimer's disease is the most common type of dementia in Australia. [1] Dementia is an ever-increasing challenge as the population ages and life expectancy increases. [2] As a consequence, there is an expected increase in the number of people with dementia, posing countless challenges to carers and the health and aged care systems. [1] In 2018, an estimated 376,000 people had dementia; this number is expected to increase to 550,000 by 2030 and triple to 900,000 by 2050. [1] [2] The dementia death rate is increasing, resulting in the shift from fourth to second leading cause of death from 2006 to 2015. [3] It is expected to become the leading cause of death over the next number of years. [3] In 2011, it was the fourth leading cause of disease burden and third leading cause of disability burden. [1] This is expected to remain the same until at least 2020. [1]
Dementia primarily affects older people, approximately 95% of all dementia deaths occur after the age of 74. [3] People aged 75 and over accounted for the majority (72%) of the burden due to dementia. [1] It was the leading cause of death for women and third leading cause of death for men. [2] [4] There is a sex bias, as women have higher mortality rates, morbidity and burden of dementia than men. [1] [2] In 2018, 61% of people with dementia were women. [2] The rate of dementia differs between population subgroups. Aboriginal and Torres Strait Islander people experience risk factors and prevalence at a higher and earlier rate than non-indigenous Australians. [2]
Dementia is the ninth National Health Priority Area. [1] For this reason, health and service policy and expenditure is especially focused on this significant burden of disease. [5] Since dementia is typically not reversible, its extended illness and disability poses a significant financial burden to Australia. [1] [3] In 2016, total costs continued to increase to an estimated A$14.25 billion. [6] Future costs are projected to reach $33.6 billion in 2050 (estimated from 2013–2014 total costs). [7]
A study of the epidemiology of a disease, such as dementia, identifies the predominant patterns (mortality and burden of disease), distribution (morbidity), determinants and specified populations or characteristics in a population. [8] Studies of the epidemiology of the Australian population identified dementia as a major health problem, due to the high mortality, morbidity and burden of disease. [1] [2]
Year | Male | Female | Persons |
---|---|---|---|
2001 | 1,177 | 2,563 | 3,740 |
2002 | 1,390 | 2,974 | 4,364 |
2003 | 1,351 | 2,924 | 4,275 |
2004 | 1,414 | 3,192 | 4,606 |
2005 | 1,434 | 3,219 | 4,653 |
2006 | 2,076 | 4,474 | 6,550 |
2007 | 2,414 | 4,904 | 7,318 |
2008 | 2,708 | 5,464 | 8,172 |
2009 | 2,787 | 5,492 | 8,279 |
2010 | 2,920 | 6,083 | 9,003 |
In 2017, dementia and Alzheimer's disease remained the second leading cause of mortality or death and ischaemic heart diseases remained the leading cause of death. [4] In 2017, dementia and Alzheimer's disease was responsible for 13,729 deaths. [4] Over the past decade the death rate has increased by 68.0%, from 33.1 deaths per 100,000 people in 2008 to 41.6 deaths per 100,000 people in 2017. [4] Dementia deaths have increased, remaining in the top five leading causes of death for both sexes. [4] In 2017, it was the leading cause of death for women and third leading cause of death for men. [4] 64.5% of dementia deaths are attributed to women. [4]
In 2018, the morbidity or prevalence was estimated as 376,000 people. [2] In 2018, approximately 8.7% of the population aged 65 and over had dementia. [2] The prevalence is estimated to increase to 550,000 by 2030 and triple to around 900,000 by 2050. [1] [2] The national prevalence is similar to the OECD member country average. [2] Women have a higher prevalence than men. In 2018, 61% of people with dementia were women. [2] Estimations propose that in 2050, women will continue to account for roughly 60% of people with dementia. [1]
Incidence is the number of new cases of a particular disease which occur in a specified period. [1] There are major gaps in the incidence data for dementia. [1] [2] In 2003, there was an estimated 37,100 incident cases. [1] In 2011, the number of incident cases increased to 63,300. [1] Since dementia is typically not reversible, in time, these incident cases are included in the prevalence data. [1]
Burden of disease is the measure of premature death and non-fatal health outcomes of a particular disease. [1] In 2011, it was the fourth leading cause of burden of disease. [1] People aged 75 and over, accounted for the majority (72%) of the burden due to dementia. [1] More of the burden due to dementia is attributed to women than men. [1] In 2011, among people aged 65 and over, it was the leading cause of non-fatal burden of disease such as disability and the second leading cause of total burden of disease. [2]
There are numerous risk factors that have been identified as likely determinants. [1] Age, genetics and family history are unmodifiable risk factors. [2] Australia has an ageing population with increasing life expectancy. [9] The majority of modifiable risk factors are related to vascular diseases and contribute to the burden of dementia and Alzheimer's disease. [2] These risk factors include vascular diseases (stroke, diabetes, chronic kidney disease and atrial fibrillation), metabolic risk factors (high blood pressure and obesity) and behavioural risk factors (physical inactivity and tobacco use). [2] Vascular risk factors were accountable for approximately 5.2–8.4% of the dementia and Alzheimer's disease burden. [2] In 2011, chronic kidney disease, physical inactivity, stroke and high blood pressure were the specific vascular risk factors most responsible for the dementia burden. [2]
Dementia and Alzheimer's disease is more prevalent among older people. [2] Late onset dementia (diagnosed from 65 years and over) is far more prevalent than early-onset Alzheimer's disease (diagnosed before 65 years). [1] People aged 75 and over accounted for the majority (72%) of the burden due to dementia. [1] Between 2014 and 2016 it was the second leading cause of death and second leading cause of disease burden for older people (aged 75 and over). [2] In 2015, the median age of death from dementia was 88.6 years, compared to 81.9 years for all deaths. [3] Approximately 20% of all dementia deaths occurred in people aged 75–84 and 70% in those 85 years of age and over. [3] Dementia mostly affects the elderly with approximately 95% of all dementia deaths occurring after the age of 74. [3]
Women have higher mortality rates, morbidity and burden of dementia than men. [1] [2] In 2018, 61% of people with dementia were women. [2] Dementia was the leading cause of death for women. [2] In 2015, women died from dementia at a rate 1.2 times greater than that of men. [3] In 2017, it was the cause of death of 8,859 women, compared to the cause of death of 4,870 men. [4] Women have a longer life expectancy (84.5 years compared to 80.4 years for men) and given the increased risk of dementia at older ages, is a contributing factor to the sex bias. [3] In 2011, more of the burden due to dementia was attributed to women than men (63% compared with 37%). [1]
The rate of disease differs between population subgroups such as Aboriginal and Torres Strait Islander people. [2] Aboriginal and Torres Strait Islander people encounter risk factors for dementia and Alzheimer's disease at a higher rate than non-indigenous Australians. [2] These risk factors include tobacco use, diabetes and heart disease. [2] The prevalence for Aboriginal and Torres Strait Islander people is projected to be at a 2–5 times higher rate than the general Australian population. [2] Aboriginal and Torres Strait Islander people are also identified to be affected at an earlier age (from 45 to 69 years) then the general Australian population. [1]
Dementia and Alzheimer's disease poses a significant financial burden to Australia. In 2011, the cost to Australia was an estimated $11.8 billion. [7] The total costs increased in 2016, to an estimated $14.25 billion. [6] Future costs are projected to increase to an estimated $33.6 billion in 2050 (estimated from 2013–2014 total costs). [7] Healthcare and related costs are rapidly rising with residential aged care and hospitalisation costs as the primary direct costs. [7] The types of costs associated with residential aged care and hospitalisation costs are the care recipient's expenditure, federal government expenditure and residential aged care capital and maintenance costs. [7] The care recipient's expenditure or patient expenditure can include housing payments, basic daily fees and additional service fees. [7] Other associated costs include anti-dementia medications, transport, palliative care, alternative medications and therapies. [7]
Dementia and Alzheimer's disease poses a significant social burden and cost to the Australian population. [1] Particularly, to the people with dementia, their carers, family and friends. Australian family carers of people living with dementia often experience social exclusion and a reduced or removed capacity to work. [10] People with dementia living in Australian residential care, often have significantly worse activities of daily living (Modified Barthel index) and fewer weekly social interactions than people without dementia. [11]
The Minister's Dementia Advisory Group and Dementia Working Group are the two key national bodies involved in consultation and planning for dementia policy and services. [1] In 2005, the Australian Federal Government funded the four year Dementia Initiative or Dementia—A National Health Priority Initiative. [1] In 2006, the National Framework for Action on Dementia 2006–2010 (NFAD) was implemented. [1] In 2011, a ruling was made to continue using the existing NFAD, until the development of a second Framework. [1] The 2011–2012 Federal Budget introduced the inception of Flexible Funds, including Aged Care Service Improvement and Healthy Ageing Grants Fund. [1] Dementia was a priority area of this fund. [1] Flexible Funds came into effect in July 2011, altering the system for funding health and aged care programs. [1] In August 2011, the Australian Government issued 'Living Longer. Living Better'. [1] This aged care reform package included $268.4 million over five years for dementia-related programs and services. [1] In August 2012, dementia was recognised as the ninth National Health Priority Area. [1] In 2015, the NFAD was replaced by a second framework: National Framework for Action on Dementia 2015–2019 (the Framework). [12] The Framework works in consideration with the National Disability Insurance Scheme (NDIS). People with a diagnosis of dementia may be eligible for certain services through the NDIS. [12] [13] Between 2014 and 2016 the Federal Government redesigned dementia care in aged care and dementia programs and services. [14] Changes included the establishment of the Specialist Dementia Care Program and a single national provider for Dementia Behaviour Management Advisory Services (DBMAS) and the Dementia Training Program. [14]
In 2003, the total health and aged care system expenditure for dementia was an estimated $1.4 billion. [15] In 2009–2010, the total direct governmental health and aged care system expenditure on people with dementia was more than $4.9 billion, with an estimated $2.0 billion of the expenditure credited to dementia. [1] In 2016, the direct expenditure was an estimated $8.8 billion. [3] The Australian Federal Government committed a new investment of $185 million in the 2019–2020 Health Budget. [16] This investment is for the long-term Ageing, and Aged Care and Dementia Mission. [16]
The following health and aged care services are the formal services provided to and utilised by people with dementia and their carers: consumer support programs, general practice services, hospital services, aged care assessments, community aged care packages, community aged care services, flexible aged care services, respite care, residential aged care services, specialised mental health care services and medications (Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme). [1]
Dementia Australia is a national initiative for dementia and Alzheimer's disease. Dementia Australia is the new coordinator of Alzheimer's Australia Association. [17] Dementia Australia is a national peak body, national advocacy organisation and registered non-profit charity that provides national dementia programs and services. [17] [18] Each state and territory also has specific services and programs for their region. [17] Certain Dementia Australia programs and services are funded by the Australian Commonwealth Government such as the early intervention program: Living with Memory Loss Programme. [18] Living with Memory Loss Programme is a seven-week course for primary carers and persons with dementia. [18] Dementia Australia is also involved in research. The Dementia Australia Research Foundation formerly Alzheimer's Australia Research Ltd delivers grants and scholarships for dementia and Alzheimer's research. [18]
My Aged Care is a phone line and a website that provides information on Australia's aged care system and services such as dementia care options and support services. [19] [20] My Aged Care is a free health service under Healthdirect Australia for consumers, service providers and health professionals. [21] [22] My Aged Care is the start point to access Australian Government funded services. [23] In order to access funded services, My Aged Care organises assessments wherein a trained assessor works out care needs, service eligibility and respite care for people with dementia and their carers. [23] [24] [25]
The National Disability Insurance Scheme (NDIS) is a national program that provides supports, through an NDIS plan, to people under the age of 65 with a permanent disability, such as early-onset dementia. [26] If eligible for an NDIS plan, funding is provided on an annual basis for the purchase of aids, equipment and services. [27] The NDIS and the Department of Social Services funds the National Younger Onset Dementia Key Worker Program for people with early-onset dementia. [28] This program is a dementia consumer support service that is an extension of the National Dementia Support Program. [28] The National Younger Onset Dementia Key Worker Program provides information, support, counselling, advice and assistance with engagement and access of appropriate services, particularly NDIS supports and plans. [26] [28]
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affects a person's ability to function and carry out everyday activities. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Consciousness is not affected. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.
Lifestyle diseases can be defined as diseases linked with one's lifestyle. These diseases are non-communicable diseases. They are caused by lack of physical activity, unhealthy eating, alcohol, substance use disorders and smoking tobacco, which can lead to heart disease, stroke, obesity, type II diabetes and lung cancer. The diseases that appear to increase in frequency as countries become more industrialized and people live longer include Alzheimer's disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, colitis, irritable bowel syndrome, type 2 diabetes, heart disease, hypertension, metabolic syndrome, chronic kidney failure, osteoporosis, PCOD, stroke, depression, obesity and vascular dementia.
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.
Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to so-called "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.
A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, cancer, chronic obstructive pulmonary disease, Lyme disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.
The Alzheimer Society of Ontario (ASO) is a care and research charity committed to helping people living with Alzheimer's disease and other dementias by:
The prevention of dementia involves reducing the number of risk factors for the development of dementia, and is a global health priority needing a global response. Initiatives include the establishment of the International Research Network on Dementia Prevention (IRNDP) which aims to link researchers in this field globally, and the establishment of the Global Dementia Observatory a web-based data knowledge and exchange platform, which will collate and disseminate key dementia data from members states. Although there is no cure for dementia, it is well established that modifiable risk factors influence both the likelihood of developing dementia and the age at which it is developed. Dementia can be prevented by reducing the risk factors for vascular disease such as diabetes, high blood pressure, obesity, smoking, physical inactivity and depression. A study concluded that more than a third of dementia cases are theoretically preventable. Among older adults both an unfavorable lifestyle and high genetic risk are independently associated with higher dementia risk. A favorable lifestyle is associated with a lower dementia risk, regardless of genetic risk. In 2020, a study identified 12 modifiable lifestyle factors, and the early treatment of acquired hearing loss was estimated as the most significant of these factors, potentially preventing up to 9% of dementia cases.
As populations age, caring for people with dementia has become more common. Elderly care giving may consist of formal care and informal care. Formal care involves the services of community and medical partners, while informal care involves the support of family, friends, and local communities, but more often from spouses, adult children, and other relatives. In most mild to medium cases of dementia, the caregiver is a family member, usually a spouse or an adult child. Over time, more professional care in the form of nursing and other supportive care may be required medically, whether at home or in a long-term care facility. There is evidence that case management can improve care for individuals with dementia and the experience of their caregivers. Furthermore, case management may reduce overall cost and institutional care in the medium term. Millions of people living in the United States take care of a friend or family member with Alzheimer’s disease or a related dementia.
Australia is a high income country, and this is reflected in the good status of health of the population overall. In 2011, Australia ranked 2nd on the United Nations Development Programme’s Human Development Index, indicating the level of development of a country. Despite the overall good status of health, the disparities occurring in the Australian healthcare system are a problem. The poor and those living in remote areas as well as indigenous people are, in general, less healthy than others in the population, and programs have been implemented to decrease this gap. These include increased outreach to the indigenous communities and government subsidies to provide services for people in remote or rural areas.
Health care services in Nepal are provided by both public and private sectors and are generally regarded as failing to meet international standards. Prevalence of disease is significantly higher in Nepal than in other South Asian countries, especially in rural areas. Moreover, the country's topographical and sociological diversity results in periodic epidemics of infectious diseases, epizootics and natural hazards such as floods, forest fires, landslides, and earthquakes. A large section of the population, particularly those living in rural poverty, are at risk of infection and mortality by communicable diseases, malnutrition and other health-related events. Nevertheless, some improvements in health care can be witnessed; most notably, there has been significant improvement in the field of maternal health. These improvements include:
The major causes of deaths in Finland are cardiovascular diseases, malignant tumors, dementia and Alzheimer's disease, respiratory diseases, alcohol related diseases and accidental poisoning by alcohol. In 2010 the leading causes of death among men aged 15 to 64 were alcohol related deaths, ischaemic heart disease, accident, suicides, lung cancer and cerbrovascular diseases. Among women the leading causes were breast cancer, alcohol related deaths, accidents, suicides, ischaemic heart disease and lung cancer.
Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.
The Alzheimer Society of Canada (ASC) is a Canadian health charity for people living with Alzheimer's disease and other dementias. Active in communities right across Canada, the Society partners with Alzheimer Societies in every Canadian province to offer information, support and education programs for people with dementia, their families and caregivers. The Alzheimer Society of Canada acts as the national voice for the thousands of Canadians living with dementia and advocates on their behalf for positive change. The Society also funds young and established Canadian researchers working to find the causes and a cure through the Alzheimer Society Research Program.
Caregiver syndrome or caregiver stress is a condition that strongly manifests exhaustion, anger, rage, or guilt resulting from unrelieved caring for a chronically ill patient. This condition is not listed in the United States' Diagnostic and Statistical Manual of Mental Disorders, although the term is often used by many healthcare professionals in that country. The equivalent used in many other countries, the ICD-11, does include the condition.
The National Disability Insurance Scheme (NDIS) is a scheme of the Australian Government that funds costs associated with disability. The scheme was legislated in 2013 and went into full operation in 2020. The scheme is administered by the National Disability Insurance Agency (NDIA) and overseen by the NDIS Quality and Safeguards Commission.
Indigenous health in Australia examines health and wellbeing indicators of Indigenous Australians compared with the rest of the population. Statistics indicate that Aboriginal Australians and Torres Strait Islanders are much less healthy than other Australians. Various government strategies have been put into place to try to remediate the problem; there has been some improvement in several areas, but statistics between Indigenous Australians and the rest of the Australian population still show unacceptable levels of difference.
Lung cancer in Australia has killed more than 9,000 people and there are estimated to be over 12,500 new cases as of 2018. Lung cancer is the leading cause of cancer death in Australia and is responsible for one fifth of cancer diagnosis in the nation. It is differentiated into two different types: Non-small cell lung cancer and small cell-lung cancer. There are a range of diagnostic and treatment options available to treat both disease types. Smoking tobacco cigarettes is considered the leading risk factor of lung cancer in Australia, and Government-led public health schemes have aimed to reduce smoking and minimise its lung cancer risk. There has been relative success in these campaigns, and in treatment, as survival rates have improved from 9.2% to 17% as of 2014.Attitudes towards habitual smoking in youth and young adult groups have also subsequently changed in response to this. However, there is a growing stigma surrounding people living with Lung Cancer, and a large portion of work conducted by the Lung Foundation Australia is directed towards supporting the health and welfare of those affected.
Cerebrovascular diseases in Australia are a major health issue. Cerebrovascular disease is a significant challenge to Australia due to it being a prominent cause of death in Australians and the difficulties it poses for carers and the health system in addition to individuals with cerebrovascular disease. Stroke is the deadliest cerebrovascular disease in Australia accounting for 84.24% of all deaths caused by cerebrovascular diseases. The death rate of cerebrovascular diseases is decreasing, with cerebrovascular disease in 2008-2018 falling from the third to fourth leading cause of death for men and second to third leading cause of death for women during this time period. In 2015, stroke was the tenth leading cause of burden of disease, accounting for 2.7% of the overall burden. This cause of disease burden has decreased from 2003-2015 with stroke falling from the second leading cause of disease burden to the tenth during this time period. Aboriginal and Torres Strait Islander people and people from low-socioeconomic areas experience higher rates of prevalence and mortality from stroke than non-Indigenous Australians.
The Women's Healthy Ageing Project (WHAP) is the longest ongoing medical research project examining the health of Australian women. Its landmark studies concern women's heart and brain health, a long-neglected area of specialised research.
Alzheimer's disease (AD) in African Americans is becoming a rising topic of interest in AD care, support, and scientific research, as African Americans are disproportionately affected by AD. Recent research on AD has shown that there are clear disparities in the disease among racial groups, with higher prevalence and incidence in African Americans than the overall average. Pathologies for Alzheimer’s also seem to manifest differently in African Americans, including with neuroinflammation markers, cognitive decline, and biomarkers. Although there are genetic risk factors for Alzheimer’s, these account for few cases in all racial groups.