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Preparing for the impact of dementia

Preparing for the impact of dementia

Advice on legislation or legal policy issues contained in this paper is provided for use in parliamentary debate and for related parliamentary purposes. This paper is not professional legal opinion.
Briefing Paper No. 04/2006 by Talina Drabsch
Dementia is increasingly a reality for many Australians. Almost 200,000 Australians are believed to have dementia and many more are involved in caring for a family or friend with dementia. Its social and economic impacts are significant. It is estimated that dementia costs the community $6.6 billion a year. The prevalence of dementia is growing, largely as a result of people living longer than ever before and as the effects of the ageing of Australia’s population start to be felt.

There are many forms of dementia and many illnesses/diseases with which it is associated. Alzheimer’s disease is the most common form of dementia and perhaps also the best known. The major forms of dementia are identified in section one (pp 1-6). The symptoms of dementia and the various risk and protective factors are noted. An overview of the prevalence of dementia in Australia as a whole, and in the states and territories is provided in section two (pp 7-9). This section also examines the projected increase in the number of people with dementia over the next 50 years, and compares its prevalence per age group.

Section three (pp 10-14) discusses the economic and social costs of dementia, including direct and indirect financial costs, as well as non-financial ones. The particular impact on the health and aged care systems is highlighted. Dementia is generally of a disabling rather than a fatal nature, and is a major cause of disability burden in Australia, second only to depression.

As dementia progresses, an individual’s capacity to make decisions may be affected. Section four (pp 15-33) details the various ways an individual may prepare for this reality. In relation to health and lifestyle decisions, individuals may utilise guardianship mechanisms, particularly by appointing an enduring guardian. Advance care directives may also be formulated to indicate the individual’s preferences regarding future medical treatment. This section also considers enduring powers of attorney, which may be used for financial decision-making once the principal has lost capacity.

The complexities of housing and care needs are discussed in section five (pp 34-54). More than half of those with dementia live in the community and are key users of such services as Home and Community Care, Community Aged Care and Extended Aged Care at Home. A significant proportion of users of residential care have dementia. The possible impact of building and landscape design on the experience of a person in residential care is highlighted. This section also explores the role of carers and the factors that are likely to influence the pool of available carers in the future. A sample of the various programs that exist to support the needs of people with dementia and their carers are discussed. Section six (pp 55-57) considers the particular issues that may arise in relation to driving. It notes the applicable standards that apply to licensing and discusses the results of a study funded by the Australian Transport Safety Bureau on the impact of early dementia or mild cognitive impairment on the driving competence of older people.

Finally, the problems of elder abuse are examined in section seven (pp 58-67). People with dementia and their carers have been found to be particularly vulnerable to such abuse. Various preventive strategies are identified, with special consideration given to the issue of mandatory reporting