Demographics and co-existing health conditions

2021 Census data on CALD among Australians with dementia

Census data considerations 

It is important to note that there are a number of issues with using the 2021 Census to report on people with dementia, and further for those with dementia from CALD backgrounds. 

The 2021 Census may underestimate the number of people with dementia as it relies on people self-reporting their health condition rather than a medical assessment. Issues of stigma associated with dementia may affect the likelihood that a person reports their condition in this survey, and this may vary depending on cultural background. In addition, language barriers and cultural practices may affect when people are diagnosed with dementia, meaning that people from CALD backgrounds may have greater levels of undiagnosed dementia than other Australians, especially among those who are not living in residential aged care. For further information, see Social determinants of health among culturally and linguistically diverse people in Australia.

The 2021 Census was the first time that people were asked about selected long-term health conditions, including dementia. This question had the highest non-response rate (8.1%) of any questions in the 2021 Census. Not responding to the long-term health conditions question was higher for people who were aged 85 and older (11%) and people who lived in non-private dwellings (such as residential aged care, 37%) (ABS 2022). The results should therefore be interpreted with caution.

The AIHW is currently assessing the new self-reported dementia data in the 2021 Census to help inform its use for dementia monitoring and planning (AIHW 2024a).

Region of birth

According to the 2021 Census, out of people aged 30 and over who reported living with dementia, 25% were born in a non-English speaking country (Figure 13.1; Table S13.1). People born in a non-English speaking country who reported dementia tended to be older than the cohort as a whole with a lower proportion aged 30–64 (18% compared to 26%). This difference may also reflect greater levels of undiagnosed dementia among younger people from a non-English speaking country, and/or higher levels of dementia-related stigma (AIHW 2024b).

Among people living with dementia aged 85 and over, a higher proportion of men were from non-English speaking countries (30%) than women (26%). This may partly reflect the prioritisation of male migration from some countries after World War Two (Wilson et al. 2020).

Figure 13.1: Proportion of people born in non-English speaking countries, by dementia status, sex and age, 2021

The bar chart shows similar proportions of people born in a non-English speaking country in Australians living with dementia and the Australian population aged 30 and over across sex and age. The most noticeable difference in proportion is in people aged 30–64 (where there was a smaller proportion of people with dementia born in non-English speaking countries than the general Australian population). 

The bar chart shows similar proportions of people born in a non-English speaking country in Australians living with dementia and the Australian population aged 30 and over across sex and age. The most noticeable difference in proportion is in people aged 30–64 (where there was a smaller proportion of people with dementia born in non-English speaking countries than the general Australian population). 

Country of birth

Consideration of birthplace composition is important to assess and plan for the cultural needs of people living with dementia. In the following sections, living in the “community” refers to private dwellings and self-care retirement villages, and “cared accommodation” refers to non-private dwellings such as residential aged care homes and hospitals. 

Of the people who reported having dementia in 2021, the most common countries of birth were (Figure 13.2; Table S13.1b): 

  • Australia – 56% of people in the community, 64% in cared accommodation  
  • England – 7.9% of people in the community, 7.8% in cared accommodation 
  • Italy – 4.4% of people in the community, 4.0% in cared accommodation
  • Greece – 2.8% of people in the community, 2.0% in cared accommodation. 

This birthplace composition is largely reflective of the waves of migration that have occurred since World War Two (Wilson et al. 2020). 

People with dementia who were born in non-English speaking countries were less likely to report living in cared accommodation (35%) than those born in English speaking countries (45%; Table S13.1b). Some of the reasons include cultural attitudes to formal aged care services and availability of culturally-appropriate residential aged care services. For more information on the reasons why people with dementia born in non-English speaking countries are less likely to be living in aged care, see People in residential aged care.

Figure 13.2: Top 20 countries of birth among people who reported having dementia: percentage by sex, age and place of residence, in 2021

The bar chart shows the top 20 countries of birth by place of residence (whether in the community or cared accommodation). A radio button allows the option to filter by sex and place of residence. 

The bar chart shows the top 20 countries of birth by place of residence (whether in the community or cared accommodation). A radio button allows the option to filter by sex and place of residence. 

Ancestry

Ancestry reporting provides additional detail about a person’s cultural affiliations. Respondents were able to report up to two ancestries in the 2021 Census. 

Of those who reported having dementia in 2021, 89% in the community and 91% in cared accommodation reported having English, Australian, Irish or Scottish ancestry. The next most common ancestries were: 

  • Italian – 5.9% of people in the community, 5.5% in cared accommodation
  • German – 5.0% of people in the community, 3.8% in cared accommodation
  • Chinese – 3.6% of people in the community, 1.8% in cared accommodation
  • Greek – 3.4% of people in the community, 2.5% in cared accommodation (Table S13.3). 

English proficiency and years since arrival in Australia

In 2021, among people who reported having dementia and whose main language spoken at home was not English (Figure 13.3; Table S13.4):

  • over half (52%) of those living in the community did not speak English well or at all
  • just under a third (31%) of those living in cared accommodation did not speak English well or at all 
  • a higher proportion of women than men did not speak English well or at all
  • the proportion of people who did not speak English well or at all increased with age.

Among people who reported having dementia and whose main language spoken at home was not English, English proficiency increased with the number of years since arriving in Australia:

  • 81% of recent migrants (0–5 years since arrival) did not speak English well or at all 
  • 52% of earlier migrants (15 years or more since arrival) did not speak English well or at all (Table S13.5). 

Figure 13.3: English proficiency among people who reported having dementia and speak a language other than English at home: percentage by place of residence, sex and age, in 2021

The bar chart shows that men and women of all ages with dementia who were born in a non-English speaking country were more likely to report that they did not speak English well. 

The bar chart shows that men and women of all ages with dementia who were born in a non-English speaking country were more likely to report that they did not speak English well. 

Religious affiliation

Christianity was the most commonly reported religious affiliation among people who reported having dementia in 2021, both in the community and in cared accommodation (70% and 63%, respectively) (Table S13.6). About 1 in 5 people reported no religious affiliation, with smaller proportions of people (2% or less) reporting religious affiliation with Buddhism, Islam and other religions.

Need for assistance with core activities

In 2021, people who reported having dementia who were living in the community and were born in a non-English speaking country were more likely to need assistance with core activities (83%) than people with dementia born in an English-speaking country (74%) (Figure 13.4; Table S13.7). Core activities include areas of self-care, mobility and communication. 

Among those living in cared accommodation, a higher proportion of people needed assistance with core activities (90%), with no difference by region of birth.

Figure 13.4: People who reported having dementia and needing assistance with core activities: percentage by region of birth, place of residence, and sex, in 2021

This bar chart shows that people living with dementia in cared accommodation have similar assistance needs regardless of their birth region, while those in the community have different assistance needs depending on their region of birth. 

This bar chart shows that people living with dementia in cared accommodation have similar assistance needs regardless of their birth region, while those in the community have different assistance needs depending on their region of birth. 

Co-existing health conditions

In 2021, among people who reported having dementia, the most commonly reported co-existing health conditions for those born in non-English speaking countries were: 

  • Arthritis – 34% of people in the community, 31% in cared accommodation
  • Mental health conditions – 23% of people in the community, 42% in cared accommodation
  • Heart disease – 23% of people in the community, 23% in cared accommodation
  • Diabetes – 26% of people in the community, 20% in cared accommodation. 

The above proportions are similar for those with dementia and born in English speaking countries. However, diabetes was reported more frequently among people born in non-English speaking countries than those born in English speaking countries, where 26% of those living in the community and born in non-English speaking countries reported having diabetes, compared to 18% born in English speaking countries. In cared accommodation, 20% born in non-English speaking countries had diabetes, compared to 13% born in English speaking countries. (Figure 13.5; Table S13.8). 

It is important to note that the prevalence of some conditions like diabetes, regardless of dementia status, are generally higher amongst people born in non-English speaking countries than those born in Australia. For more information see Chronic health conditions among culturally and linguistically diverse Australians, 2021.  

Figure 13.5: Common co-existing health conditions among people who reported having dementia: percentage by region of birth, place of residence, sex and age in 2021

The bar chart shows that the comparison among people with dementia by whether they were born in English speaking countries or non-English speaking countries, by the top most common co-existing health conditions.  A radio button allows the option to filter by place of residence.

The bar chart shows that the comparison among people with dementia by whether they were born in English speaking countries or non-English speaking countries, by the top most common co-existing health conditions.  A radio button allows the option to filter by place of residence.
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