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Analysis: Dementia in Australia

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Dementia

Dementia has for a long time caused problems to those suffering from the syndrome as well as the family members of the affected individuals. The syndrome mostly affects individuals over the age of 65 years. As such, the elderly people are the most affected lot in the population. Research done in the past shows that dementia is one of the major causes of disability in Australia. It ranks first as far as disability is concerned. Dementia is a major public health concern in Australia, with deleterious effects on the health and quality of life (Brodaty, Seeher, & Gibson, 2012, p. 1034)

            Dementia is a syndrome characterized by impairment of brain function, which includes the loss of memory, linguistic, cognitive, personality, and perception skills. The Australian Institute of Health and Welfare has estimated that cases of dementia would increase to 900,000 by 2050 (Alzheimer's Australia, 2017). Currently, more than 413,106 Australians are living with dementia, and this number is expected to rise to 536,164 by 2025. About 55% (228,238) of Australians living with dementia are female whereas 45% (184,868) are male. Additionally, dementia is the second leading cause of death in Australia, accounting for 5.4% of all deaths in males and 10.6% of all deaths in females annually (Brown, Hansnata, & La, 2017, p. 6). Younger onset dementia has been reported in approximately 25,938 people. Cases of younger onset dementia could increase to 29,375 by 2025 and 42,252 by 2056 (Alzheimer's Australia, 2017).

 Dementia affects one in every five Australians from a culturally and linguistically diverse (CALD) background. The risk of dementia reported in Aboriginal and Torres Strait Islanders is 3-5 times higher compared to the one reported among non-Indigenous persons. Language barriers and limited knowledge of the service system present a significant barrier to accessibility and utilization of dementia care services among the CALD (Alzheimer's Australia, 2017). Additionally, dementia affects 1,663 people in the Northern Territory and 138,721 people New South Wales. The northern Territory will experience the greatest percentage increase of dementia cases in the next forty years followed by Western Australia (Brown et al., 2017, p. 7). Thus, the purpose of this paper is to analyze dementia based on four concepts: poverty, health care delivery, cultural safety and patient-centered care. In essence, this paper seeks to explore how Australia deals with cases of dementia, as one of the conditions identified in Australian National Healthcare Priorities. 

Question A: Poverty as a Social Determinant of Health

Poverty is both a cause of ill health and a barrier to accessibility and utilization of health care.  Low-income families cannot access quality health care to understand the financial association between poverty and health. Furthermore, chronic health conditions affect the poor disproportionately (Chaplin & Davison, 2016, p.147). Research done in the past posits that early life adversities are major causalities of Dementia. Such adversities include factors like hunger, poverty, high-stress levels, and poor nutrition. These factors contribute to the impairment of a good number of the brain regions. Cognitive impairment as such is likely to arise in such instances.

Moreover, given the fact that majority of the affected individuals are the elderly who are past the prime of their careers, the affected individuals do not have sufficient finances to enable them to cater for medical expenses. As such they are at a very high risk of succumbing to deaths as well as living in miserable conditions.It also imposes a heavy financial burden on families, communities, and healthcare systems. Thus, the population cannot access specialist dementia care and other support services if they continue living in poverty (Callander, Schofield, Callander, & Schofield, 2015, p. 1547; Phillips, Miranti, Vidyattama, & Cassells, 2013, p. 8).

Australians incurred approximately $8.8 billion in 2016 in annual direct costs expected to increase to $9.1 billion in 2017 (Brown et al., 2017, p. 23). Direct costs include direct medical expenses (hospitalization, pharmaceuticals, and GPs and specialists), and direct non-medical related expenses (nursing homes or home care). Specifically, the costs of care and hospitalization constitute the greatest component of direct costs of dementia. Hospitalization costs accounted for 52.6% of all direct costs while care costs represented 37%. People with dementia incurred $4.8 billion and $3.4 billion in costs of hospitalization and care respectively in 2017 (Brown et al., 2017, p. 23). Secondly, indirect costs arising from the potential loss of income because of lost productivity. Both patients and their caregivers incurred a loss of $5.5 billion in 2016 and $5.6 billion in 2017 because of lost productivity and career. These costs would increase to $9.1 billion by 2036 and $12.8 billion by 2056. In particular, caregivers will forego $103 million in earning in 2017 while patients with dementia withdrawing from the workforce will incur $44 million (Brown et al., 2017, p. 30). Dementia reduces income for both patients and their primary caregivers, which increases the risk of poverty and poor health outcomes.

Question B: Case Study

The Wilson's Story of Living with Dementia presents the experiences of a family living with dementia. The family consists of Derek (Father), Yvonne (Mother), Kim (Daughter) and Josh (Grandson). Derek is living with dementia although his first diagnosis was Alzheimer's disease. Derek realized that something was wrong when he started experiencing episodes of forgetfulness. Derek was worried because his mother had the same symptoms before being diagnosed with dementia. Yvonne, Derek’s wife, took her husband for medical assessment but the doctor thought that forgetfulness is a common phenomenon in the elderly. Yvonne was persistent until his husband got the correct diagnosis and drugs. A major theme that has emerged from this case study is the role of support from family members and formal organizations. The greatest challenge that the family faced was navigating the complex healthcare systems, as well as inadequate support to deal with caregiver burden effectively. Nonetheless, the situation changed when they enrolled in a support group formed by the Alzheimer’s Society. The formal support that Derek received was very important as Kim and Yvonne attest. (Alzheimer's Society, 2013).

The experiences presented in the case study fits with the principle of culturally safe and person-centered care in the following ways. First, the principle of cultural safety is the provision of a safe, positive and nurturing environment (Alzheimer's Australia, 2008). Derek’s family has provided a safe and supportive environment for him to deal with dementia effectively. The video clip has shown various instances where the family shares chores and spends time with each other. The video starts and ends with the acknowledgment that the family members are close and love each other. Specifically, Kim has highlighted the fact that they are a family that functions well together, as well as enjoy each other’s support and company. The attention the family is giving Derek is a clear example of a patient-centered care. Every aspect of care that Derek receives revolves around the family. The formal support that the family receives also focuses on the unique needs of this family. As such, the role that family support has on a member recovering from the ailment cannot be overemphasized. 

Question C: Health Services and the Australian Health Care System

The Australia Health Care System (HCS) considers dementia a terminal illness and thus, the country’s HCS prioritizes three approaches three approaches to care: palliative care, person-centered, and supportive care. Models of care specific to patients with dementia include primary care & community services; secondary & tertiary services; and long-term & continuing care. These models of care do not operate in isolation but they overlap and contain similar principles (McMurray & Clendon, 2015, p. 48). For example, primary and community services are the patients’ first point of contact, as well as a gateway to secondary and tertiary services. Primary health services are delivered in multiple settings (including general practices, community health centers, Aboriginal and Community Controlled Health Services and others), and may include health promotion and prevention. Patients are then referred from primary care to secondary/tertiary and long-term/continuing care for specialist and long-term care (Alzheimer's Australia, 2013).

The two models that predominate in the Australian HCS for people with dementia include the Primary Care & Community Services and Long-Term & Continuing Care. Firstly, Primary Care & Community Services focuses on meeting immediate and short-term needs by prioritizing person/family centered care, equity, holistic care, and value for money. This model of care reduces health care inequalities by removing barriers that prevent patients from accessing and utilizing formal dementia care services. The principles of equality patient/family centeredness and equity reduce disparities and exclusion by ensuring that patients receive comprehensive, culturally sensitive and competent care (McMurray & Clendon, 2015, 49). Secondly, Long-Term & Continuing Care focuses on ensuring that individuals receive the required care as their dementia progressive to the terminal stage. Patient/family centeredness shared responsibility, and holistic care is important values that underpin this model. This model acknowledges the need of involving families and communities in dementia care. In summary, the care that patients receive in both models focuses on meeting their unique and personal care needs (Martin & Sabbagh, 2011, p. 24). 

Question D: Cultural Safety (CS) and Person-Centered Care (PCC)

The nursing and midwifery board of Australia has established standards of practice for registered nurse and midwives. The practices that the nurses and the midwives carry out are required to be person centered, and evidence based practices that include preventive, curative, restorative, formative and palliative elements (Cusack, 2015, p.12). Also, these set standards for both nurses and midwives in Australia have brought about a rich mixture of linguistic and cultural diversity within the board and the community. Additionally, the board requires the nurses to provide care to the dementia patients that is considerate to their culture. Doing so increases the chances of given care being more responsive. This is in light of the Torres Strait Islander people and he Aboriginals as indicated by Murphy (2015, p.14). The nurses and midwives board of Australia, (NMBA) has a code of ethics that must be followed during practice. The code advocates for commitment to their profession and to respect, protect, promote and uphold the rights of both the patients and the caregivers (Scanlon, 2016, P129-137). To be duly noted is the third value statement that needs caregivers to acknowledge the value of patients and their diversity. Through this, they appreciate how different cultural backgrounds and ethnicities affect the mode of healthcare delivery through both nurses and midwives. (NMBA, 2017).

As is stated in the NMBA codes and standards, the principles and values underlying the Australian Heath Care System, support the safety and diversity of one’s culture and person centered care in a myriad of methods. First off, the general direction of the Health Care System in Australia is geared towards promoting delivery of people-centered care to family-centered care (Wilson, 2013, p. 458-471). Through the said principle, it requires that nurses to give services along the lines of the needs of the patient. This is inclusive of their families and the surrounding communities. The healthcare givers should be considerate of the singularity of each patient, the diversity of their cultures and the various preferences.

Second, the Health Care System of Australia requires nurse to aid the patients in giving support throughout the various programs and complicated health care system. Through this, it is ensured that the patients have unlimited access to information, backed up with evidence. This practice is parallel with NMBA’s understanding of carrying out practice that is based on evidence and centered on patient care (Scanlon, 2016, p.42).

Third, the Health Care System of Australia cultivates a strong sense of responsibility among its members. This prompts nurses to be involving with the patients during caregiving practice. It enables them to equip the patients with up to date information that allows them to make informed decisions about their health choices (Wilson, 2013, p.24). It is therefore imperative for the nurses to follow the code of conduct to ensure the health care system of the country is considerate and upholds cultural safety and person centered care. 

Conclusion

This paper has analyzed dementia in Australia by reviewing its effects and the role of the Australian health care system. First, this paper has established a positive relationship between poverty and dementia. In essence, poverty limits access to dementia care, especially for patients from a CALD background. Second, Australia provides fragmented health care services even though the various healthcare delivery models are interrelated (Nay, 2015, pg 23).  These issues bring to the forefront a number of recommendations for future practice. Firstly, the Australian health care system should adopt an integrated approach to dementia. The accomplishment of this goal will necessitate the colocation of healthcare services within the community to increase accessibility. The action by the government to subsidize medication for old patients must be applauded and the same tempo must be maintained. Secondly, continuous professional development is necessary for all nurses to uphold NMBA’s principle of patient-centeredness and evidence-based practice. Continuous professional development through training and other educational interventions will enable nurses to enhance the delivery of dementia care that is responsive to the diverse needs of patients and their families. In conclusion, the government should prioritize the delivery of equitable and quality dementia care regardless of patients’ socioeconomic status.

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