Hospital care for First Nations people with dementia
This section aims to provide an overview of how Aboriginal and Torres Strait Islander (First Nations) people used Australia’s hospital systems. It presents information on the number and characteristics of dementia-related hospitalisations for First Nations Australians between 2016–17 and 2023–24. Refer to Hospital Care for a detailed discussion of the impact of dementia on Australia’s hospital systems.
Each hospitalisation is assigned a principal diagnosis (the main reason for being admitted to hospital) and can also be assigned one or more additional diagnoses (conditions that impact the provision of care but are not the main reason for being admitted to hospital). Unless otherwise stated, this section focuses on hospitalisations with a principal diagnosis of dementia, or ‘hospitalisations due to dementia’. See Box 9.1 for key terms for hospitalisations for people with dementia.
Box 9.1: Key terms for hospitalisations related to dementia
The following terms are used to distinguish dementia hospitalisations:
- Hospitalisations due to dementia are hospitalisations where dementia was recorded as a principal diagnosis (the main reason for admission).
- Hospitalisations with dementia are hospitalisations where dementia was recorded as an additional diagnosis (where dementia impacted the hospitalisation but was not the main reason for admission), or where dementia was recorded as a ‘supplementary code’ (when dementia is identified as a chronic condition that is part of a patient’s current health status), and was not recorded as a principal diagnosis.
- Hospitalisations due to or with dementia are hospitalisations where dementia was recorded as a principal diagnosis and/or an additional diagnosis (where dementia impacted the hospitalisation but was not the main reason for admission), or where dementia was recorded as a ‘supplementary code’ (when dementia is identified as a chronic condition that is part of a patient’s current health status).
- Other Australians includes both non-Indigenous Australians and people whose Indigenous status is not known.
Information on the number and characteristics of dementia-related episodes of admitted patient care (referred to as ‘hospitalisations’) for First Nations people between 2016–17 and 2023–24 are from the National Hospital Morbidity Database.
Refer to the Technical notes for further information on hospitals data.
It is important to note that the presence of dementia may not always be included in the hospital separation data compiled for the National Hospital Morbidity Database, and the count of hospitalisations with dementia may therefore be underestimated. The National Hospital Morbidity Database only includes conditions that were significant in terms of treatment, investigations needed and resources used during the ‘episode of care’, or when chronic conditions that are part of a patient’s current health status are identified but don’t meet the inclusion criteria as a principal or additional diagnosis. This means that hospitalisations among people with mild dementia may be under-recorded because the early stages of dementia are less likely to affect the care provided in hospitals, or dementia may not be identified as a chronic condition that is part of a patient’s current health status.
Further, specific dementia types may be misclassified or simply attributed to Unspecified dementia by medical professionals in the hospital setting (Crowther et al. 2017). As a result, the number of hospitalisations for a specific dementia type may not be accurate. The most reliable data are likely to be for the most common types of dementia. Caution should be taken when interpreting hospital statistics by dementia type.
In addition to the work being done to improve reporting on dementia hospitalisations (see Hospital Care), work is required to better identify First Nations people in the National Hospital Morbidity Database. In 2025, the AIHW began a project which explores First Nations identification among people with dementia in linked data. The aim of this work is to support analysis of service use and health outcomes for First Nations Australians living with dementia. See 9: First Nations people-specific health care data on dementia of the National Dementia Data Improvement Plan 2023–2034 for information on current developments and future activities aimed at improving identification of First Nations people in linked data (AIHW 2024).
There are many reasons why First Nations people may not want to use hospital services, such as: competing family and cultural obligations; distrust in the health system due to negative past and present experiences; a lack of culturally safe care options; communication barriers with medical staff, including barriers for some First Nations people for whom English is a second language; limited access to health services in regional and remote locations requiring patients to receive care away from their community; high travel and other out-of-pocket costs, especially for people living in regional and remote locations (AHMAC 2017; Shaw 2016).
In 2018–19, 30% of First Nations Australians reported that they needed to, but did not see a health care provider in the 12 months prior. About one-third (33%) of those who did not see a health care provider when they needed to reported a reason related to service availability or transport/distance: waiting time too long or the service was not available at time required (21%); they did not have transport or the service was too far away (13%); or the service was not available in the area (7%). The questions in the survey did not focus on Dementia care access.
More information can be found in the Access to Services Compared to Need measure within the Aboriginal and Torres Strait Islander Health Performance Framework.
Hospitalisations due to dementia
In 2023–24, there were nearly 480 hospitalisations due to dementia (where dementia was the principal diagnosis or the main reason for the hospital admission) where the patient identified as Indigenous.
First Nations women were just as likely to be hospitalised due to dementia (17 hospitalisations per 10,000 First Nations women) as First Nations men (16 hospitalisations per 10,000 First Nations men) (Table S12.15).
Refer to Hospital care for more information on overall hospitalisations for dementia in Australia and see the Technical notes for further information on hospitals data. For information about the quality of First Nations identification in hospitals data, see Indigenous identification in hospital separations data: quality report.
In 2023–24, the average length of stay among First Nations people for hospitalisations due to dementia was 16.4 days, slightly longer than that for other Australians (15.1 days) (Table S12.16).
How did hospitalisations due to dementia end for First Nations people?
In 2023–24, 45% of First Nations people hospitalised due to dementia were discharged to their usual residence in the community or residential aged care, 30% had a ‘statistical discharge’ (meaning they remained in hospital, but the intent of care changed), 8.8% were transferred to another acute hospital, 7.4% entered a new residential aged care home and 3.8% died (Figure 12.7; Table S12.17). This pattern was somewhat similar to hospitalisations due to dementia for other Australians, except that the percentage of First Nations people separated to a residential aged care service that was not their usual place of residence or died was lower than that of other Australians, and the percentage of First Nations people who remained in hospital or who were transferred to another acute hospital was slightly higher. The percentage of First Nations people who left against medical advice or discharge at own risk are much higher at 3.4% compared with other Australians at 0.6%.
Figure 12.7: First Nations hospitalisations due to dementia compared with other Australians: percentage by mode of separation in 2023–24
The bar chart compares the percentage of hospitalisations for First Nations people against other Australians for each mode of separation.
| Mode of separation | First Nations people hospitalised due to dementia | Other Australians hospitalised due to dementia |
|---|---|---|
| Discharged home | 36.3% | 37% |
| Statistical discharge (including from leave) | 30.5% | 28.6% |
| An(other) acute hospital | 8.8% | 8.2% |
| Residential aged care service (usual place of residence) | 8.8% | 9.7% |
| Residential aged care service (not usual place of residence) | 7.4% | 9.4% |
| Died | 3.8% | 5.1% |
| Left against medical advice/discharge at own risk | 3.4% | 0.6% |
| Other health care accommodation | 1.1% | 1.1% |
| An(other) psychiatric hospital | 0% | 0.2% |
Source:
AIHW analysis of National Hospital Morbidity Database
Notes:
- Hospitalisations only include persons aged 40 and over.
- Statistical discharge is an administrative process that occurs within an inpatient stay when the care type changes (for example, a patient is admitted under Acute Care but is then transferred to Palliative Care).
- Hospitalisations due to dementia only include all hospitalisations where dementia was recorded as the principal diagnosis.
When First Nations people were hospitalised due to dementia, what other conditions did they have?
When First Nations people were admitted to hospital due to dementia, the most common diagnoses (additional and supplementary diagnoses) other than dementia were:
- hypertension
- Type 2 diabetes mellitus
- problems related to care-provider dependency
- ischaemic heart disease (also known as coronary heart disease)
- other functional intestinal disorders, for example, constipation
- other disorders of urinary system, for example, urinary tract infection
- problems related to lifestyle, for example, tobacco use
- depression
- arthritis and osteoarthritis.
Some of these diagnoses are closely related to the modifiable risk factors for dementia, including hypertension and diabetes. Problems related to care provider dependency may include reduced mobility or need for assistance with personal care. For further information on the top 10 other diagnoses, see Table S12.18.
How did hospitalisations due to dementia for First Nations people vary by geographic area?
Given the small number of hospitalisations due to dementia for First Nations people in a given year, the rates of hospitalisations due to dementia presented in this analysis were aggregated over a 3-year period (2021–22, 2022–23 and 2023–24).
After adjusting for population differences, between 2021–22 and 2023–24 the rate of hospitalisations due to dementia for First Nations people aged 40 years and over varied by people’s usual residence:
- by state, the rate of hospitalisations ranged from 8 hospitalisations per 10,000 First Nations people in Victoria, to 19 hospitalisations per 10,000 First Nations people in Queensland
- by remoteness, the rate of hospitalisations ranged from 15 hospitalisations per 10,000 in Inner and outer regional areas to 17 hospitalisations per 10,000 First Nations people in Remote and very remote areas (Figure 12.8; Table S12.19)
- by Indigenous Region, the rate of hospitalisations ranged from 7 hospitalisations per 10,000 First Nations people in Melbourne to 33 hospitalisations per 10,000 people in Cairns - Atherton (Table S12.20).
Figure 12.8: First Nations hospitalisations due to dementia: number and rate, by state and territory and remoteness area of usual residence between 2021–22 and 2023–24
A bar graph showing the number and rate of hospitalisations due to dementia among First Nations people between 2021–22 and 2023–24 in Australia and by remoteness area and state or territory of usual residence.
Notes:
- It is important to note that data in this table is aggregated over 3 financial years (2021–22, 2022–23 and 2023–24) and uses a different age structure (population aged 40+) than for the total population. Data in this table should not be compared with data in Table S9.8
- Rates for the Australian Capital Territory are not published due to small numbers.
- Hospitalisations due to dementia only include hospitalisations when dementia was recorded as the principal diagnosis.
- See Technical notes for further information on the data source and methodology.
First Nations hospitalisations due to or with dementia
Previous sections have presented hospitalisations due to dementia (that is, when dementia was recorded as the principal diagnosis), but understanding hospitalisations due to or with dementia (that is all hospitalisations with a record of dementia, whether as the principal and/or an additional diagnosis and/or a supplementary diagnosis) provides important insights on the wide-ranging conditions that can lead people living with dementia to use hospital services.
There were over 3,800 hospitalisations due to or with dementia among First Nations people in 2023–24, a 67% rise from 2016–17. The age-standardised rate also rose during this time from about 221 to 238 per 10,000 First Nations people (Figure 12.9; Table S12.21).
Figure 12.9: First Nations hospitalisations due to or with dementia by sex: number, crude and age-standardised rate, between 2016–17 and 2023–24
The line graph shows the number, crude, and age-standardised rate of First Nations hospitalisations due to or with dementia for both men and women and for all persons.
Notes:
- Hospitalisations only include persons aged 40 and over. Rates apply to the Australian population aged 40 and over, based on the relevant population data.
- Age-standardised rates were standardised to the Australian population aged 40 and over, as at 30 June 2001.
- Hospitalisations due to or with dementia include all hospitalisations with a record of dementia, whether as the principal and/or an additional diagnosis and/or supplementary diagnosis.
- See technical notes for further information on the data source and methodology.
What were the most common principal diagnoses for First Nations people when dementia was an additional or supplementary diagnosis?
In 2023–24, there were almost 3,400 hospitalisations of First Nations people where dementia was an additional or supplementary diagnosis (hospitalisations with dementia).
The most common principal diagnoses among these hospitalisations for First Nations people aged 40 years and over were:
- Problems related to medical facilities and other health care (9.7%)
- Other disorders of urinary system (3.9%)
- Other chronic obstructive pulmonary disease (3.6%).
Problems related to medical facilities and other health care (Z75.8) is a broad code that indicates that First Nations people hospitalised with dementia had an issue related to their available health care service or facilities that was not any of the following: medical services not available at home, awaiting admission to adequate facility elsewhere, unavailability or inaccessibility of health care facilities or other helping agencies. The specific issues that First Nations people hospitalised with dementia are facing is not clear from the data, and further research is needed.
Common principal diagnoses among hospitalisations with dementia for First Nations people were similar for First Nations men and women, but First Nations men were more likely to have a principal diagnosis of Pneumonitis due to solids and liquids and heart failure, while First Nations women were more likely to have a principal diagnosis of a femur fracture, chronic obstructive pulmonary disease and disorders of the urinary system. (Figure 12.10; Table S12.22).
Figure 12.10: Most common principal diagnoses for hospitalisations of First Nations people where dementia was an additional or supplementary diagnosis: percentage of hospitalisations, by sex in 2023–24
The bar chart shows the most common principal diagnosis where dementia was an additional diagnosis, breakdown by First Nations men, women and all First Nations people.
| Principal diagnosis | Men | Women | Persons |
|---|---|---|---|
| Problems related to medical facilities and other health care | 10.2% | 9.3% | 9.7% |
| Other disorders of urinary system | 2.5% | 5% | 3.9% |
| Other chronic obstructive pulmonary disease | 2.5% | 4.6% | 3.6% |
| Pneumonia, organism unspecified | 3.6% | 2.5% | 3% |
| Fracture of femur | 1.7% | 4% | 3% |
| Type 2 diabetes mellitus | 2.5% | 2% | 2.3% |
| Pneumonitis due to solids and liquids | 2.9% | 1.4% | 2.1% |
| Other Sepsis | 2.4% | 1.7% | 2% |
| Delirium, not induced by alcohol and other psychoactive substances | 1.7% | 2.3% | 2% |
| Pain in throat and chest | 1.7% | 2.1% | 1.9% |
| Heart failure | 2.3% | 1.4% | 1.8% |
| Other cataract | 1.7% | 1.7% | 1.7% |
- Hospitalisations only include persons aged 40 and over.
- Hospitalisations where dementia was an additional diagnosis (or referred to as hospitalisations with dementia) refer to hospitalisations with a record of dementia only as an additional diagnosis and/or supplementary diagnosis. It excludes hospitalisations with a record of dementia as both the principal and additional diagnosis.
See Technical notes for further information on the data source and methodology.
Source:
AIHW analysis of National Hospital Morbidity Database.
AHMAC (Australian Health Ministers’ Advisory Council) (2017) Aboriginal and Torres Strait Islander Health Performance Framework 2017 report, Australian Health Ministers’ Advisory Council, Australian Government, accessed 17 August 2022.
Shaw C (2016) An evidence‑based approach to reducing discharge against medical advice amongst Aboriginal and Torres Strait Islander patients, The Deeble Institute for Health Policy Research, Australian Healthcare and Hospitals Association, accessed 17 August 2022.