The Problem of Dementia in Australian Aboriginal and Torres Strait Islander Communities: An Overview

Abstract

The concept of dementia in old age in Australian Aboriginal and Torres Strait Islander communities is intrinsically paradoxical. Firstly, few indigenous people reach old age. Secondly, from some indigenous points of view, dementia is either not recognized as a condition or as a problem, or, in the case of the more disruptive manifestations of cognitive impairment, is perceived as ‘madness’. Moreover, in the wider context of profound political, social and economic inequality experienced by most indigenous people, the western medical category of dementia may appear to be of relatively minor importance. However, government initiatives in aged care generally and dementia care in particular which are designed to address the ageing of the Australian population as a whole also include the nation's older indigenous people. This article—based on a review of published work, supplemented by discussions with indigenous and non‐indigenous individuals involved in indigenous aged care and mental health—examines some of the issues surrounding cognitive decline in old age for Aborigines and Torres Strait Islanders. More specifically, it looks at the problems involved in assessing and diagnosing cognitive decline and dementia, especially among people who follow more traditional ways of life, and in providing services to sufferers and their carers. In doing so, it considers some of the relative meanings of ‘old age’, ‘abnormal old age’, ‘mental disorder’, ‘sickness’ and ‘dementia’. © 1997 John Wiley & Sons, Ltd.

Moving towards culturally competent dementia care: have we been barking up the wrong tree?

“…30 A diagnosis of dementia is not dissimilar to that of 'having a learning difficulty', in that whilst it can open doors to specialist services and treatment provision, both are over-arching diagnoses which can shape identities and exclude people from mainstream opportunities and services. Similar reports 35,36,37 warn about the absence of a descriptor for dementia in Aboriginal and Torres Strait Islanders. 31,32 Epidemiologists 33 using biomedical criteria demonstrate variations in reported dementias by world geography.…”

Needs of Aboriginal and Torres Strait Islander clients residing in Australian residential aged-care facilities

“…A study examining the prevalence of dementia in rural and remote regions identified that it was five times more frequent in Western Australia and Northern Territory than the general Australian population; however, it was limited in its design by geographical limitations 22 . This was hypothesized by another study to be indicative of their strong belief systems that physical and mental wellbeing are so closely linked, and cultural rituals such as hitting their head after the death of a relative or lifestyle diseases associated with alcohol or petrol sniffing 23 . Access Economics reported that dementia studies have concluded that language that is acquired most recently, is lost first; however, this was unable to be validated 24 .…”

Interventions for Family Caregivers of People with Dementia

“…122-124 Contributing factors include a lack of understanding about dementia, language barriers, or other communication barriers, lack of GP knowledge of cultural differences in expression of mental illness and distress, distrust of Western medicine, ethnocentric attitudes and incorrect assumptions (for instance that certain ethnic groups will look after their relatives and do not require services). 62,122 …”