Towards a a Public Health approach to dementia

Dr David Lie gave a presentation to the DCRC's National Dementia Research Forum on the Dementia And Population Health Needs Evaluation (DAPHNE) Project, based on research undertaken by Dr Catherine Travers and colleagues from the University of Queensland. As part of the project, the group have been examining policy and literature aimed at the application to dementia of public health approaches such as preventive health, health promotion and early intervention strategies in the Australian context. They found that dementia is not mentioned in almost all of Australia’s health promotion and preventive health websites, chronic disease frameworks, healthy ageing policies and national mental health plans. The presentation posed a number of questions e.g.: Why has there not been a health promotion campaign for dementia of the scale applied to other major illnesses? Should we spend more resources in educating people about reducing their risk of dementia? Should we place more investment into specialist diagnostic centres to enable early intervention?

Although research suggests that the risk of developing dementia may be reduced by addressing risk factors (smoking, diabetes, midlife hypertension, midlife obesity, and head injury) and increasing protective factors (higher education, physical activity, cognitive engagement, social activity, Mediterranean diet, and light-moderate alcohol consumption) there is debate around the strength of this evidence. Addressing these factors at a population level could delay the onset of dementia and may reduce the population-wide prevalence but how strong does the evidence have to be before we invest in major public education campaigns? Will we wait too late if we only start intervention when evidence becomes “strong”?

Another barrier to a public health approach to dementia is difficulty in early recognition. It is often difficult to diagnose dementia at an early stage particularly because early symptoms of Alzheimer’s disease (AD) are frequent events in older age. Expertise is required for detection of AD in early stages and the existing biomarkers which may provide a means to improve detection of AD are difficult to interpret, unpleasant, inaccurate or hard to access.

Lastly, the authors argued that stigma and ignorance may have led to the current silence around population health and its application to dementia. If Arthritis, an incurable condition, and depression, a disorder that is hard to diagnose, both have national public health strategies, then Australia, especially in an ageing demographic, surely needs to consider dementia policy that incorporates a national public health strategy.

Implications for knowledge translation
The findings of DAPHNE will inform the Department of Health and Ageing (DoHA) in relation to dementia policy development. In particular, the current National Framework for Action on Dementia (NFAD), expires at the end of 2011 and is currently being reviewed. The aim of the framework was to improve the quality of life of people living with dementia, their families and their carers and depending on the outcome of the review, a new framework may be developed that may include a population health approach.
The main challenges to applying such an approach, however, will be to overcome the identified barriers.

A copy of Dr Lie's presentation is available on the link below:

Dementia and public health: Promise, pitfalls and progress


Reported by Sarang Kim, DCRC - Early Diagnosis and Prevention, Australian National University.