Meeting the challenge of preventing dementia in Australia
An estimated 472,000 Australians are currently living with dementia, which is expected to exceed 1,000,000 by 2058.
From a global perspective, a person develops dementia every three seconds and the estimated cost of dementia (US $ 818 billion in 2015) makes it equivalent to the gross domestic product (GDP) of the eighteenth largest country in the world – between the two GDPs of the Netherlands (17th place) and Switzerland (18th place).
Recognition of the importance of preventing dementia has increased internationally. The World Health Organization has played a leading role in publishing Reduced risk of cognitive decline and dementia directives in 2019.
Given that we are now in the United Nations Decade for Healthy Aging to 2030, it is a good time for us to ask ourselves: what can we do to prevent dementia?
While we recognize that dementia is not completely preventable because some risk factors – like our genetics – cannot be changed, the good news is that, according to current knowledge, about 40% of our risk for dementia can be. potentially be treated.
And that comes under public health policy.
Our team, along with other professional colleagues, recommend an eight-step dementia prevention action plan for Australian health policy:
1. Create public health and clinical practice guidelines for the prevention of dementia throughout the lifespan in Australia;
2. Equipping and resourcing primary care providers to be the clinical spearheads of lifelong dementia prevention;
3. Support multidisciplinary memory clinics and specialists to implement secondary prevention programs for people at high risk;
4. Fund research into evidence-based interventions for modifiable risk factors for dementia throughout the life cycle to reduce the gap between evidence and practice;
5. Implement the results of research on dementia risk reduction and implementation through translation into health promotion programs;
6. Strengthen public health dementia prevention campaigns taking into account the diversity of Australians, in particular Aboriginal Australians and Torres Strait Islanders;
7. Resource and coordinate a community approach including government, public and private health care, community services and education sectors to operationalize multi-faceted dementia prevention guidelines and programs throughout life. life ;
8. Mobilize key health advocacy organizations to promote and coordinate public health messages on dementia risk factors that cut across chronic diseases.
If we look at the situation in Australia, the population-attributable risk factors for dementia (PAR) are physical inactivity (17.9%), midlife obesity (17.0%), low level early life education (14.7%), mid-life hypertension (13.7%), depression (8.0%), smoking (4.3%), and diabetes mellitus (2.4%).
PAR refers to the percentage of dementia that could be avoided if the risk factor were completely eliminated. For example, if all Australians engaged in the recommended amount of physical activity, 17.9% of dementias in Australia could be prevented.
It’s great to quantify these risk factors, however, there are significant challenges.
First, it is difficult to identify these risk factors in individuals, especially in middle-aged adults, who are much less likely to see health professionals and undertake preventive health care.
On top of that, translating this knowledge into action isn’t as easy as it should be – many of us know from experience that being aware that we should be physically active doesn’t necessarily translate into something. in action.
But there is a growing body of research in the area of ”behavior change”, which is an essential part of translating knowledge into action.
CHANGE OUR BEHAVIOR
Our team from the Academic Unit of Psychiatry in Old Age has looked at reducing the risk of dementia through a number of different research projects.
We recently published physical activity guidelines for older Australians with memory problems. One intervention approach was the INDIvidual GOal-setting study or (INDIGO). This study examined the effectiveness of a physical activity program with individual goal setting and volunteer mentors for physically inactive seniors at risk for cognitive decline.
Eunice Cooper, 78, participated in the INDIGO project in 2013 and looks back on her participation.
“I needed to improve my walking strength so I could take a basic swimming refresher course, and also to prepare for having a dog.
“Because of the way the exercise started, I would recommend it to anyone. After the program finished I joined a walking group for four years and later due to hip problems and not wanting an operation I took a physiotherapy course for two years.
“Then COVID came along and I found out how adaptable I am. The INDIGO course for me was definitely a step in the right direction. And if I feel like I’m not going to do anything all day I put on Gold FM and jog in place with my hands on the bookshelf to keep my balance until the record is finished. at my maximum speed. It’s a real change of mood, a fresh energy flowing through my veins.
TOOLS TO TAKE CARE OF YOU
Two of our new research projects also approach dementia prevention in different ways.
The EXercise for Cognitive Health (EXCEL) project funded by the Medical Research Future Fund (MRFF) aims to deliver personalized physical activity interventions remotely to people living in the community, aged 45 to 80, who present with symptoms of mild to moderate depression. or anxiety, as well as concerns about their memory.
The goal is to improve mental health and reduce the risk of dementia by using behavior change techniques to encourage physical activity.
This remote intervention not only addresses the challenges of COVID-19, but also helps reduce the ‘tyranny of distance’ in Australia, as it increases accessibility for people living in rural or remote areas.
Our other study, funded by the National Board of Health and Medical Research (NHMRC), is the Leaving Evidence into Action on Dementia (LEAD) project. This is a collaboration with researchers from the University of New South Wales and other institutions.
The project aims to co-design a tool that can estimate an individual’s risk for multiple conditions at once – including dementia, diabetes, heart disease and stroke. This would streamline risk assessment and help facilitate preventive health care, especially in primary care.
Currently, we are interviewing general practitioners and conducting a community survey to find out opinions and preferences to guide the co-design of this tool.
We invite interested potential participants to contact us regarding the EXCEL and LEAD projects.
Australia has many examples of very successful public health prevention campaigns. For example, the Stop Smoking and Swipe, Slop, Slap campaigns have been so effective that most of us are aware of it.
Part of the success of these campaigns can be attributed to their “whole-of-society” approach, empowerment in health facilities and schools, the community at large and the mass media.
Australia has no more time to waste in applying its tremendous public health expertise to dementia prevention now so we can start to reverse the disturbing estimates of increasing prevalence, disability, mortality. and future costs.
If you are interested in getting involved in the COGNITIVE HEALTH EXERCISES (EXCEL) and Leveraging the Evidence in Action on Dementia (LEAD) projects, you can find more information on the projects websites.
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