Dementia is a leading cause of death and burden of disease within Australia, yet its far-reaching influence does not come with consistent healthcare and dementia care access in Australia.
New findings released by the Australian Institute of Health and Welfare (AIHW) have explored how geographical variation impacts the care people living with dementia access and receive. With almost 160,000 people included in the dementia study cohort, from 2019, it shows how location plays a role in dementia care in the community and in residential aged care.
Key points
- Dementia-specific medication is less likely to be dispensed to people living in remote or lower socioeconomic areas
- Residential respite care is frequently used in the year before entry to residential aged care, although respite care was used the least in remote areas
- Emergency department visits and hospital stays are highest in low socioeconomic areas, while hospital stays are more common than ED presentations in remote areas
Specialist visits and medication dispensation depend on the location
A recurring trend impacting dementia care is remoteness and socioeconomic influence, including specialist attendance. The percentage of people living with dementia in the community with one or more specialist attendances in 2019 steadily decreased with increasing remoteness and increasing disadvantage:
- Percentage rates are highest in major cities at 68% and 62% for inner regional areas
- Remote and very remote areas had the fewest specialist attendances at 45% of people living with dementia
- The highest socioeconomic areas saw 73% attendance rates while the lowest areas sat at 61%
- Overall, people living with dementia in the highest socioeconomic areas of major cities averaged 4.8 specialist visits while people in remote and very remote areas averaged 2.5
Interestingly, those same patterns appear in residential aged care settings, although specialist attendance is lower overall due to the increased support available through trained aged care staff.
Likewise, there were similar trends in medication dispensation, including donepezil, galantamine, rivastigmine and memantine, as dispensation rates decreased within care settings.
Reduced access to medical specialists could be the cause of both issues. Limited General Practitioner availability means early signs of cognitive decline may be picked up later, while specialist availability would impact how often someone living in a regional or remote area can visit them.
Financial barriers may also be of concern as delayed visitations mean healthcare, or even in-home aged care services, are not sought out when preventative treatments could be of the most benefit.
Less medication but more antipsychotics in aged care
Although medication dispensation rates for dementia were lower in aged care, AIHW reported that one in three people living with dementia in aged care received antipsychotics.
At the time, the Royal Commission into Aged Care Quality and Safety was ongoing and it was a top issue raised by those involved. It was ultimately addressed in the final Recommendations where they called for the PBS to be amended to restrict the prescription of antipsychotics, which has since occurred.
However, at the time of this data collection:
- One-third (33%) of residents with dementia had been dispensed antipsychotics at least once
- Almost one-quarter (23%) received antipsychotics at least four times
- Men were relatively more likely to be given antipsychotics than women
Respite consistently leads to permanent admittance
Access to respite care varied across Australia, however, it was ultimately used by 70% of people living with dementia shortly before entry to permanent residential aged care. Interestingly, remoteness had very little influence with just under seven percentage points between remote areas and major cities:
- In total, 71% of people with dementia in major cities and outer regional areas used respite care in the 12 months prior to entering aged care
- The figure was 68% for inner regional areas and 65% for remote and very remote regions
- Even socioeconomic status in major cities proved to have little impact with figurines ranging from just 69-to-75%
- Respite care was utilised less outside of major cities, although regional and remote settings saw more people from lower socioeconomic areas access additional support for people living with dementia and their carers
This data highlights the importance of residential respite care with just 5.4% of people accessing it not entering permanent care in the following 12 months. Therefore, providers do have a strong chance to establish relationships with consumers and their families, particularly those living in regional and remote areas who may not have consistent access to dementia care prior to engaging with an aged care service provider.
