With dementia now the leading cause of disease burden among Australians over the age of 65 years, advocates say it is vital that medical practitioners have access to the right information to help them support their patients.

A new report from the Australian Institute of Health and Welfare (AIHW) shows dementia has seen a 62% increase since 2011 and has overtaken coronary heart disease as the leading cause of disease burden for older Australians.

“Dementia was responsible for 4.4% of Australia’s disease burden in 2022, which includes both the impact of living with the condition (the non-fatal burden of disease) and dying prematurely (fatal burden), and was the second leading cause of death in Australia in 2020, accounting for 9.6% of all deaths,” AIHW spokesperson Melanie Dunford said in a statement.

The report shows more than 400 000 Australians are currently living with dementia and the number is expected to increase to more than 800 000 by 2058.

Dementia Australia Chief Executive Maree McCabe said dementia is the chronic disease of the 21st century.

“It is imperative that we have an informed system where staff working across health care industries have education in dementia and that all health and aged care workers and Australians know to contact Dementia Australia for support and information,” Ms McCabe said.

Not enough early career support

According to Dementia Support Australia (DSA) Head of Clinical Services, Associate Professor Steve Macfarlane, early career doctors do not get enough dementia training.

“New doctors are really only taught how to prescribe for dementia, with a lack of consideration for other approaches that may be safer and more effective, including the deprescribing of psychotropics,” he explained.

The Aged Care Act 1997 specifies that psychotropic medications should be used as a last resort. However, the Royal Commission into Aged Care highlighted concerning levels of people living with dementia in residential aged care being prescribed psychotropics.

“These numbers show that prescribers are often unaware of the alternatives, which can be shown to be safer and more effective than psychotropics,” Professor Macfarlane said.

More training on alternatives to prescribing psychotropics could be beneficial to new doctors

The alternatives to psychotropic medication

One goal of DSA is to educate on the alternatives.

It has received funding from the Australian Government to operate a 24 hours a day GP Advice Service to offer GPs with access to a team of geriatricians and pscyhogeriatricians who specialise in the care of people with dementia.

Specifically, it can give advice on patients who are experiencing behavioural and psychological symptoms of dementia such as psychosis, agitation and aggression, appetite and eating changes, sleep disturbance, distress during personal care and way-finding difficulties.

GPs can access the service by emailing gpadvice@dementia.com.au and can leave a phone number for a call back if they would prefer a private and confidential one-on-one discussion.

GPs could previously access a full behavioural assessment from DSA.

“Often, however, a full assessment is not what GPs want or need. Provision of direct advice from another specialist colleague around issues related to dementia in general, and behaviour management in particular, has been a gap in the service system to this point, which it is hoped [DSA’s] GP advice service will address,” Professor Macfarlane explained.

The strategies suggested will be tailored to the individual and will look at the cause of behaviour such as pain, incorrect staff approach, underlying mood disturbances, over- or understimulation, loneliness and boredom.

“Our strategies are highly personalised, and although numerous different non-pharmacological interventions exist (sleep hygiene, provision of meaningful activities, avoidance of triggers, music therapy and many more), these cannot be applied in a ‘one size fits all’ fashion,” Professor Macfarlane said.

Early diagnosis is another factor

Dementia Australia Honorary Medical Advisory Associate, Professor Michael Woodward, said part of the disease burden of dementia is because it is being diagnosed earlier.

“I think we are getting better at diagnosing dementia, [but] it still has a long way to go. And I think also that the other diseases that dementia has replaced as the highest cause of disease burden are being better controlled. So cardiovascular disease and cancer are being better controlled through risk reduction and treatments. Therefore, dementia is left at the top of the pile because we have no really effective treatments for dementia,” Professor Woodward said.

Hopefully, earlier diagnosis will make a difference in future therapies, particularly some promising medications that are in the pipeline.

“The drugs are exciting. It is the first, truly disease-modifying therapy that removes amyloid and they also reduce the levels of tau, the other toxic protein. By removing or reducing the toxic proteins that we think cause the symptoms of Alzheimer’s, they do slow down the symptoms,” Associate Professor Woodward said.

However, he called for cautious optimism.

“I do not think they are going to reduce the overall disease burden for quite some time because they are expensive. They will only be used in a small number of people, and they only have a relatively modest effect,” he said.

Risk reduction education

Until these and other therapies become more effective, Associate Professor Woodward said the main thing people can do is reduce their risk of developing dementia with the advice of their GP.

“I think increasingly people know that if they do sudokus, they might give their brain a bit of a train. But I do not [think they] know there’s a full platform … Don’t rely on doing the crossword and Sudoku … it will help but it’s not the only thing.

“You should also make sure that you are eating a Mediterranean diet, that you have physical exercise, at least 40 minutes of [moderate] exercise five times a week.

“It is also important to keep socially engaged, do not let yourself become socially disconnected from your community. Increasingly, we are recognising deafness as a risk factor.

“Finally, controlling cardiovascular risks, blood pressure, cholesterol, diabetes, weight etc and reducing excess alcohol,” he concluded.

For support from Dementia Australia, visit dementia.org.au or call 1800 100 500.

To contact the GP Advice Service, email gpadvice@dementia.com.au and leave a phone number for a call back.

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