campusreview. com. au faculty focus this information so people understand the critical role carers play. Also, things like access to suitable and affordable care, information for carers in a timely manner, the importance of families receiving support, and the need for more trained staff and aged-care facility places.
Although we are trying to support people living in their homes longer, it’ s inevitable that a lot of people will end up being in nursing homes and we need to make sure we have a dementia-aware community, including a workforce that’ s adequately trained to deal with these issues.
[ This leads into the topic of ] dementia-friendly communities. As a society, we need to be able to respond to people with cognitive impairment. We need to be aware of the kinds of deficits they face in their community and how we can best address them so [ they can ] function in the community for a long time. In the early stages, people may still be functional, but certainly as the cognitive impairment becomes more pronounced, we need to be able to adapt to their needs more effectively as a society.
By the 2060s, spending on dementia is set to outstrip that for any other health condition.
Can you tell us about your latest research into dementia? What are you looking at and what interventions are you recommending? At the Brain & Mind Research Institute, my group is looking at many different aspects – you could say my research is multifaceted. One component of it looks at what we call biomarkers. [ We examine ] early changes in the antioxidant systems and structure of the brain, and how they may predict dementia. Also, a major focus is on interventions, to see whether tackling key dementia risks can improve cognition and other markers of brain degeneration. One interesting area I am investigating is sleep and circadian rhythms. We believe that not only does sleep decline alongside cognitive decline, but also it may even play a direct role in mediating the cognitive decline we see in dementia.
We know sleep is important in laying down our memories overnight, and this is an exciting area to look at. If we can identify exactly how the brain is doing that, and how this changes with ageing, then we may be able to target sleep as a way of improving memory in older people.
That’ s one form of biomarker assessment linked with the interventions we do. But we’ re certainly looking at a whole range of different things. I am conducting a large scale, National Health and Medical Research Council-funded trial, looking at what omega 3 fish oils do in the brain, as well as things like antidepressants. We know that antidepressants are neuroprotective for the brain. This means they can help the brain withstand disease, and can facilitate the promotion of neurotrophins – protective chemicals – in the brain. And we’ re looking at whether antidepressants can do that in older people.
The final thing we’ re doing, as a broader collaboration across many investigators at the university, is looking at eHealth. We’ re trying to develop a new eHealth platform that will target 40,000 people across Australia who may be concerned about their cognition. This is a way we can reach many more people from a public health perspective, to screen them for cognitive decline and also to offer cost-effective interventions targeting their many risk factors, whether they be nutrition, exercise, sleep, depression or physical activity.
Then, only for those people who show persistent cognitive decline would we offer the opportunity to come in and participate in larger scale, more intensive, randomised control trials.
In terms of research, obviously there’ s a lot on dementia. What specific areas do you believe researchers should be focusing on? I feel one of the biggest challenges we have is being able to foster or promote that behavioural change at an individual level.
It’ s easy to say,‘ You need to be exercising, and you need to be keeping your brain active, and you need to be dealing with your stress, and you need to be sleeping properly.’ But getting individual people to foster that change is challenging.
I think we need to tackle this problem at a systems or societal level, to look at what we can be doing in the community, in the workplace, for example, to be facilitating behaviour change.
People are working long hours these days, so we need to think about the reason people can’ t exercise and what kinds of systems we can put in place in the workplace to enable people to take those breaks and incorporate more exercise into their daily routines. [ We also need to look at ] how we get people past the barriers of,‘ I just can’ t do it. I just don’ t have time.’
[ The challenge ] we face is how to reach people across the range of socioeconomic backgrounds. We need to reach those from lower socioeconomic backgrounds who are less educated and have less access to health professionals – and also less opportunity, motivation, time and resources to change behaviour. We need to work out how to get this message across and facilitate the implementation of changes we know are vital for dementia prevention.
Besides the impact dementia has on the individuals dealing with the disease, what are its other consequences? There are huge implications for society, public health, healthcare use and expenditure. By the 2060s, spending on dementia is set to outstrip that for any other health condition. It’ s projected to be around $ 83 billion in 2006 – 07 dollars and will represent about 11 per cent of all health and residential aged-care sector spending.
As I mentioned, we’ re going to have more than a million people with dementia by the middle of the century. We are going to need to address this from a health perspective, and an expenditure perspective, but also in terms of being able to care for the number of people who will have the disease.
We also need to consider the implications for the workforce, particularly with the rise in retirement ages. We need to be able to recognise and adapt to people with early forms of cognitive impairment within workplaces.
We know that dementia is the leading single cause of disability in Australians aged over 65. It’ s already having a profound impact, not only on individuals but on families. [ Women in particular ] are already finding themselves having dual roles as parents and unpaid carers for family members with dementia.
This is going to continue to be a problem, and certainly will contribute to women not being able to participate in the workforce to the extent that we would like.
Overall, dementia will continue to have a profound effect on individuals, families and society, as well as on healthcare use and expenditure. We need to start addressing the tsunami of dementia before it hits us. n
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