9. Dementia and older Australians

The number of people with dementia is increasing in Australia as more people live to an age where the prevalence of dementia is highest. Dementia is characterised initially by the development of difficulties with everyday tasks of daily living, by personality changes and by a later progression to the loss of the capacity to act independently. Estimates vary depending on definition but, given this proviso, the number of people with dementia in Australia in 1996 has been estimated at 134,800 (6% of the population aged 65 years and over). While approximately half of those with dementia live in the community, higher levels of cognitive loss are generally associated with greater use of residential care.

Aged Care Assessment Teams provide services aimed at assessing and identifying the support needs of people with dementia and other conditions relating to ageing, as well as determining eligibility for Commonwealth-funded hostel and nursing home care. Psychogeriatric Community Teams provide services which relate to the psychiatry of old age for people with dementia or functional psychiatric and behavioural disorders.

Home and Community Care (HACC) services provide a range of general supports to frail older persons living in the community including those with dementia. The most recent survey of HACC clients found that 19% of clients (all ages) exhibited behaviours such as confusion or disorientation. Ten per cent of clients aged 70 years and over were assessed as having these behavioural problems. It is likely that most of this group or around 18,000 clients of the HACC program will have a dementia. HACC also supports a number of people with dementia through day care (including dementia-specific options) and respite care.

Community Options Projects provide case management and individually designed service packages for around 7,000 people throughout Australia. It has been reported that around 16% of these clients or 1,000 people need assistance because of dementia. Community aged care packages, another form of intensive case-managed home-based care, provide support to around 6,000 people. Around 26% of this client group have questionable mild dementia and 9% have moderate to severe dementia. Including around three-quarters of the people with questionable dementia and all with moderate to severe ratings of dementia suggests that 29% or around 1,700 people with dementia are supported by this program.

Using the baseline estimates presented above for the HACC, community options and care package programs, it is likely that around 20,000 people, or 30% of those with dementia living in the community, are receiving some level of ongoing formal support services.

Within the two major levels of residential care provided for older people in Australia (hostels and nursing homes), a variety of approaches to dementia care has been used. Residents with dementia are supported in both mainstream (where residents with dementia and those without are integrated) and separated accommodation. Separation is achieved via dementia-specific wings attached to a 'mainstream' facility, dementia-specific 'units' co-located on the same site as a mainstream facility or in stand-alone dementia-specific facilities. For hostel care, 4.8% of all beds are in the dementia-specific category. For nursing home care, 5.9% of all beds are in the dementia-specific category. In 1996, there were 37.5 mainstream and 1.9 dementia-specific hostel places per 1,000 people over 70 years of age, and 46.5 mainstream and 2.9 dementia-specific nursing home beds per 1,000 people over 70 years of age. Special dementia programs are available in many mainstream and dementia-specific aged care facilities.

The overall prevalence of dementia in hostels was 28% and in nursing homes 60%. Estimates of the level of cognitive impairment are, however, a better indicator of subsequent care needs than a simple diagnosis of dementia. Estimates for the level of cognitive impairment in hostel residents were 46% none, 35% mild, 17% moderate and 3% severe and for nursing home residents, 10% none, 22% mild, 27% moderate and 41% severe.

While the dementia-specific accommodation areas of both hostels and nursing homes support a much higher proportion of residents with dementia, cognitive impairment and challenging behaviour compared with mainstream care areas, the overwhelming majority of people in these categories are supported in mainstream hostels and nursing homes. For hostels, 85% of all residents with dementia are supported in mainstream areas while 15% are supported in dementia-specific accommodation. For nursing homes, the comparable figures were 92% and 8%, respectively.

Living arrangements of people with dementia, Australia 1996

Distribution of hostel and nursing home beds, Australia 1996

References/further reading

Henderson A, Jorm A, MacKinnon A, Christensen H, Scott L, Korten A, Doyle C 1994. A survey of dementia in the Canberra population: experience with ICD-10 and DSM-111-R criteria. Psychological Medicine 24:473 - 482.

Jorm A, Henderson A 1993. The problem of dementia in Australia. 3rd edition, Canberra: Department of Health, Housing and Community Services.

Rosewarne R, Opie J, Bruce A, Doyle C, Ward S, Sach J 1997. Care needs of people with dementia and challenging behaviour living in residential facilities. Aged and Community Care Service Development and Evaluation Reports Nos 24 - 31. Canberra: Australian Government Publishing Service (AGPS).

Data sources

Data presented here are drawn from Australian Bureau of Statistics 1997, Australian Demographic Statistics. Cat. 3101.0. Canberra: AGPS; Henderson et al. 1994; Jorm et al. 1987; Rosewarne et al. (1997).

Prepared by Richard Rosewarne