Dementia is mainly associated with gradual brain function impairment affecting
cognition, behaviour, speech, mobility, and memory. An individual’s functional ability and
health declines as the disease progresses. Their personality may also change. Although there are
several forms of dementia, Alzheimer’s disease is the most common. Dementia can affect
younger people; however, it is more prevalent in the aged population, occurring among
individuals aged 65 and older ("Dementia," 2020). It causes dependency and disability among
the elderly. In Australia, dementia is a growing health issue that has a substantial effect on the
quality of life and the health of patients with the condition, their friends, and family.
Approximately 386,000 Australians have dementia, including 143,000 men and 243,200 women,
translating to 15 people per 1,000 Australians ("Dementia in Australia," 2021). The Australian
Institute of Health and Welfare estimates that 246,200 of people live in the community. As these
people age, they move into acute care settings or residential aged care homes; thus, the
proportion of individuals in the community reduces as the age progresses. With population
growth and ageing into the future, it is estimated that the number of Australians with dementia
will be roughly 849,300 in 2058. In 2018, dementia accounted for about 14,000 deaths in
Australia, becoming the second leading cause of death ("Dementia," 2020).
The Importance of a Person and Family Centred-Care Approach When Caring for A
Person with Dementia in Acute or Long-Term Setting
The person and family-centred approach is a socio-psychological treatment method that
acknowledges the patient's individuality based on the care practices and attitudes that surround
them. The approach recognises unmet needs like isolation that may influence behavioural
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symptoms in patients with dementia. The PCC approach enables care providers to provide for the
unmet needs (Fazio et al., 2018). The method has been widely developed and executed majorly
in acute and long-term care facilities. PCC interventions involve incorporating personal
knowledge of the individual with dementia, performing meaningful activities, prioritising well-
being, and enhancing the relationship quality between the patient and the care provider.
Agitation is common in patients with dementia, and addressing it requires appropriate
intervention strategies. According to Kim and Park (2017), a therapeutic recreation program, a
PCC intervention that involved tailored activities prescribed following a comprehensive
examination of patients' strengths, weaknesses, and unique characteristics, reduced agitation.
During the strategy, the therapist and the research team worked with dementia patients in long-
term facilities, and the participants demonstrated a decrease in agitation in 14 days after
completing the interventions.
Moreover, the PCC approach has shown beneficial impacts for reducing antipsychotic
drugs usage and managing challenging behaviours in patients with dementia. The findings of a
study by Fazio et al. (2018) investigating the benefits of the PCC approach for dementia patients
revealed that PCC improved the quality of life, reduced agitation and depression. The PCC
approach emphasises the development of meaningful relationships between the staff and the
patients, promoting social interactions. Creating such relationships requires effort and time; thus,
PCC interventions be planned to improve the QoL of patients with dementia in long-term care
facilities. The study also reported that improved QoL was more evident in patients with less
severe dementia.
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The Importance of Respecting and Supporting Cultural Diversity and Cultural Safety
when Caring for Dementia Patients
The global dementia burden is increasing dramatically, a particular concern for Torres
Strait Islander and Aboriginal Australians, as dementia prevalence is more than three times
higher than the general Australian population. Smoking, low education, depression, physical
inactivity, midlife hypertension, diabetes, and midlife obesity have been considered major risk
factors and disproportionally affect indigenous Australians (Radford et al., 2019). As a result,
this population require supportive cultural diversity programs and cultural safety when caring for
dementia patients. The Australian government provides access to aged care services for older
indigenous populations. It created an action plan supporting the Aged Care Diversity Framework
and addressing challenges that older indigenous Australians face when accessing care.
Aboriginal and Torres Strait Islander Australians prefer indigenous-based services that allow
them to stay in their communities and homes, designed locally in collaboration with their
communities.
Supporting cultural diversity using Indigenous-specific health care services provides
appropriate care that incorporates the challenges that people with dementia and their
communities face. Aboriginal Community Controlled Health Services provide culturally
appropriate and holistic-based health services and are essential for Indigenous patients with
dementia. The ACCHS acts as a referral point to specialist care and enables Indigenous groups in
Australia to understand the aged healthcare system ("Dementia in Australia," 2021). Aboriginal
health services help manage risk factors for dementia, including offering services like follow-up
care and health care checks. Besides, when cultural diversity and safety is supported, patients get
the opportunity to engage in social opportunities, communicate, live according to their beliefs
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and values, participate in their care, and practice their traditions. They thrive in an environment
that acknowledges and accommodates their way of being.
Culture support and respect comfort a dementia patient. When Indigenous dementia
patients communicate in their native language and access ethno-specific care, they acquire
mental and physical health benefits like lower depression rates, decreased social isolation, fewer
hospitalisations, and falls. It also improves their understanding of medical decision-making and
the possibility of following medication instructions. Communicating in a patient's language
reduces misdiagnosis and help with acquiring appropriate support. When dealing with dementia
patients, culturally-based and supportive care acknowledges the relevance and roles of kinship
ties and family among Aboriginals and Torres Strait Islanders (Supporting Cultural Diversity in
Long-Term Care Needs Assessment and Work Plan for 2017-18, 2017). It recognises the role of
spiritual and religious beliefs in care and health perceptions and the importance of using
traditional treatments and health practices. Respecting cultural diversity among these groups
allows the celebration of patients' heritage and traditions, practices, holidays, and traditional
foods. It builds a sense of community among the population.
Combined Cognitive and Physical Therapy for People with Dementia
Nurses play a fundamental role in recognising dementia among the hospitalised elderly
by examining the signs and symptoms during nursing admission assessment. Dementia
interventions aim to promote patient independence and function for an extended period, promote
self-care activities, patient safety, reduce agitation, anxiety, and improve intimacy and
socialisation. According to Karssemeijer et al. (2017), combined physical and cognitive therapy
have potential benefits in adults with mild dementia or cognitive impairment. The authors
suggest that exercise increases the prefrontal cortex volume, enhances angiogenesis and
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neurogenesis. Moreover, physical activity decreases cardiovascular risk factors. The study
revealed that combine cognitive and exercise interventions improve the quality of life in patients
with dementia.
Since dementia is characterised by progressive cognitive decline, the impairments in
functional abilities have a significant and dramatic effect on an individual's quality of life.
Hence, improving patients' cognitive functioning can improve their well-being, delay
hospitalisation, and decrease national healthcare costs. Cognitive therapy involves using specific
exercises that target particular cognitive functions to optimise functioning and enhance daily life.
It has been applied widely to treat various symptoms that are associated with dementia. Okamura
et al. (2018) developed a combined cognitive and exercise training strategy that aims at
improving cognitive impairment in patients with dementia. In the approach, the patient receives
guidance to drive one arm ergometer to accomplish a certain target speed in the system. The
system is created to produce an alarm if the individual fails to achieve the target rotation rate.
The study results showed that the system is effective for improving cognitive impairment.
Cognitive impairment was improved through alleviating concentration and attention. Moreover,
different studies have suggested a relationship between exercise speed changes and brain
function improvement (Okamura et al., 2018). The researchers suggest that physical exercise that
includes awareness of focused attention increases brain activity and enhance cognitive function
than monotonous exercise.
Conclusion
Due to the growing ageing population, the proportion of individuals with dementia or
mild cognitive impairment is expected to increase. Age is considered the major risk for dementia,
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and the population of Australians living with dementia is expected to increase with more
individuals living to older ages. The rapidly growing numbers will affect society and cause a
tremendous economic burden on healthcare. As a result, the World Health Organization
emphasises a global action against dementia and cognitive decline, encouraging governments to
focus on prevention strategies, improving healthcare services, and disease-modifying therapies.
A person-centred approach and supporting cultural diversity when addressing dementia helps
reduce depression, agitation, anxiety, promotes communication, and improves the quality of life
among people with dementia. Therefore, physicians and clinicians should emphasise and
incorporate these strategies in their treatment and management procedures. Various factors may
increase an individual’s risk of developing dementia, such as excessive alcohol consumption,
tobacco smoking, physical inactivity, obesity, and social isolation. Since there is no cure for
dementia exists, managing the risks is crucial when managing and preventing the condition at a
population level. It is crucial to design predictive models to help decision-makers plan and
allocate limited health care resources appropriately to regions that can maximise benefit most
efficiently. Furthermore, an education strategy that fosters skill development and learning of
internal care staff is required to improve patients' quality of life and sustainability of behavioural
problems effects. The effectiveness and feasibility of intervention approaches, intervention type,
duration, and disease severity should also be considered when designing an intervention
program.
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References
Dementia. (2020). Australian Institute of Health and
Welfare. https://www.aihw.gov.au/reports/australias-health/dementia
Dementia in Australia. (2021, September 20). Australian Institute of Health and
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health-impacts-of-dementia/prevalence-of-dementia
Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care
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Karssemeijer, E. (., Aaronson, J. (., Bossers, W. (., Smits, T. (., Olde Rikkert, M. (., &
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Radford, K., Lavrencic, L. M., Delbaere, K., Draper, B., Cumming, R., Daylight, G.,
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