But there are preventive steps people can take, and GPs have been described as the ‘clinical spearhead’ who can lead the charge.
Older Australians fear dementia more than any other health issue.
And yet, many people don’t know just how much can be done to try and prevent the debilitating symptoms associated with it.
Dr Terence Chong, a psychiatrist and Senior Research Fellow at the University of Melbourne, told newsGP ‘approximately’ 40% of dementia risk is modifiable. But despite the steps that can be taken, Australia is predicted to have more than one million residents with dementia by 2056.
‘Dementia is now the greatest cause of disability in Australians aged over 65 and also the second leading cause of mortality and the highest in women,’ he said.
‘It’s a huge challenge in terms of the number of people affected by it, as well as the distress and disability it causes, as well as the economic costs to the country.’
Dr Chong recently co-authored a new opinion piece in the Medical Journal of Australia (MJA) that shines a light on dementia prevention that he hopes will spread the message to both clinicians and patients alike.
Ms Maree McCabe, CEO of Dementia Australia, has welcomed the paper.
‘Right now we’ve got around 1.6 million Australians involved in the care of people living with dementia,’ she told newsGP.
‘So we absolutely support calls for a prevention plan.’
According to Dr Chong, risk factors for dementia can be graded in descending order as being:
- physical inactivity (17.9%)
- mid-life obesity (17%)
- low educational attainment in early life (14.7%)
- mid-life hypertension (13.7%)
- depression (8%)
- smoking (4.3%)
- diabetes (2.4%).
As such, Ms McCabe says preventive health measures should focus on maintaining normal blood pressure and cholesterol levels, staying physically and socially active, avoiding smoking and not drinking ‘to excess’.
Other preventive measures include having a healthy diet, with Dementia Australia recommending adherence to the Mediterranean Diet, while the role of hearing loss should not be overlooked either.
‘Hearing loss can actually increase our risk of developing dementia, so getting that treated can then reduce our risk,’ she said.
‘So that’s really important.’
Overall, the advice regarding reducing dementia risk is similar to advice regarding cardiovascular risk factors, which Dr Chong says is ‘helpful’ for GPs.
‘It can be used to our advantage in terms of getting increased bang for your buck,’ he said.
‘If you address physical inactivity, for example – which is the single largest modifiable risk factor for dementia in Australia and many other developed nations – you actually address risk for lots of different conditions, not just dementia.
‘So there is that opportunity to be able to target a person’s risk of many different outcomes and conditions.’
While many of these risk factors have been established for some time, Dr Chong says some clinicians may not be aware of the evidence that demonstrates their key role in dementia prevention.
‘The information that is potentially a bit newer might be around how much of the proportion of risk factors are actually modifiable; the fact we can actually do more about it,’ he said.
‘There is a lot more evidence around dementia prevention now than there may have been when many of us were going through medical school.’
Dr Chong and his co-authors have utilised that evidence to formulate eight recommendations for dementia prevention:
- create public health and clinical practice guidelines for dementia prevention across the lifespan for the Australian setting
- equip and resource primary care providers to be the clinical spearheads for dementia prevention throughout life
- support multidisciplinary memory clinics and specialists to implement secondary prevention programs for those at high risk
- fund research for evidence-based interventions for modifiable risk factors for dementia across the lifespan to reduce the evidence-to-practice gap
- implement findings from dementia risk reduction and implementation research through translation into health promotion programs
- strengthen dementia prevention public health campaigns embracing Australians’ diversity, particularly Aboriginal and Torres Strait Islander people
- resource and coordinate a whole-of-community approach including government, public and private healthcare, community services and education sectors to operationalise guidelines and multifaceted dementia prevention programs throughout life
- mobilise peak health advocacy bodies to promote and coordinate public health messaging on dementia risk factors that cut across chronic conditions.
Dr Chong says general practice ‘features high’ on the list for good reason.
‘We put general practice second on the list because of the importance of GPs in being the clinical spearhead for dementia prevention [due to] their integral part in coordinating [and caring for patients for] their lifespan, from cradle to grave,’ he said.
Even though Dr Chong says clinicians are well aware dementia is not a normal part of ageing, he is concerned the public does not always understand this message.
‘It’s a disease process with pathology, but we can reduce our risk,’ he said.
‘GPs are in a really prime position to start that conversation with patients about prevention and what can be done around prevention.’
Dr Chong is currently working on two research projects at the Academic Unit for Psychiatry of Old Age at the University of Melbourne which, in combination with spreading awareness about current strategies, he hopes will further aid dementia prevention.
‘In Australia we’ve had some really effective public health campaigns that target risk factors for disease like, “slip, slop, slap” and the “Quit Smoking” campaign,’ he said.
‘[Now] we need the whole of society’s attention on [dementia as well].
‘As a nation, we need to pay more attention to dementia prevention and what we can do to reduce risk.’
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