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Let’s CHAT – Dementia: Primary care model of care to optimise detection and management of dementia in Aboriginal and Torres Strait Islander older people: Determination of the risk factor profile in this population
Author(s) -
Hughson JoAnne,
Flicker Leon,
Smith Kate,
Bradley Kate,
Belfrage Mary,
Strivens Edward,
Bessarab Dawn,
Atkinson David,
Radford Kylie,
Russell Sarah G,
Quigley Rachel,
Allan Wendy,
Malay Roslyn,
Sullivan Kylie,
Ducker Belinda,
LoGiudice Dina
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.041319
Subject(s) - dementia , medicine , polypharmacy , gerontology , population , risk factor , audit , disease , psychiatry , environmental health , intensive care medicine , management , economics
Background Rates of dementia and cognitive impairment in Australian Aboriginal and Torres Strait Islander populations are 3‐5 times higher than in the overall population. In addition, under‐detection of these conditions has been consistently confirmed, particularly in primary care. A national co‐design project called the Let’s CHAT (Community Health Approach To) Dementia aims to optimise detection rates and management of dementia and cognitive impairment in Indigenous primary care contexts. This will occur through the co‐development of a model of care, and outcome measures include data profiling the dementia risk of older Indigenous persons and current management of patients with confirmed or suspected cognitive impairment or dementia Method Six‐monthly medical record audits of patients aged 50 and over recording: basic demographic information, presence of dementia risk factors, current care practices in relation to dementia and co‐morbid conditions of ageing. Result Audits were conducted on patients (n=1675) in 12 primary health services across Australia. The mean age of patients was 60.3 (8.3). The top ten risk factors documented overall were: hypertension (50.9%), polypharmacy (46.7%), current smoking (43%), diabetes (42.9%), dyslipidaemia (41.1%), obesity (35%), depression (30%), mental health concerns (25.9%) cardiovascular disease (25.6.%) and low physical activity (19.1%), but there was some inter‐service variation in risk factor profiles. Documented evidence of health service assessment for, and investigation of, cognitive impairment was limited. Use and type of diagnostic tools varied widely between services (e.g. MMSE used with 0.6%‐45.9% of sample, KICA (culturally appropriate cognitive assessment tool) used with 0.0%‐5.0% of sample). Diagnoses of dementia and cognitive impairment (combined = 3.8%) are well below known prevalence rates in these populations (∼20%), although there is variation from service to service (range = 0.8% ‐8.9%). Conclusion The audit data confirm low rates of detection and low levels of assessment activity for cognitive impairment and dementia in Indigenous primary care contexts, while the population displays a high risk for developing these conditions. These findings underscore the need for more focus on detection activities in primary health care, as well as reinforcing the importance of preventive health care strategies.