Caregiving and dementia/Topics/ATSI

This NPA focuses on dementia care for Aboriginal and Torres Strait Islander Australians.

Overview
Aboriginal and Torres Strait Islander Australians are diverse peoples with dynamic and evolving cultural and social histories. While most have been influenced by the best and worst of the dominant European way of life, there are few who do not remain strongly associated with their aboriginal attitudes, values, beliefs and philosophical heritage. Cultural and philosophical perspectives influences health and health care outcomes for Indigenous people and within mainstream health services there continues to be a reluctance to recognise that these beliefs and practices differ from those of European Australians in significant ways (Morgan, Slade & Morgan, 1997).

Contrary to popular belief most Indigenous people live in major cities (32%), inner regional areas (21%), outer regional areas (22%) and just 25% in remote and very remote areas. Approximately 60% of Indigenous people live New South Wales and Queensland, with a further 13% living in Western Australia, that is 70,966 individuals in 2006 (Australian Bureau of Statistics (ABS), 2010).

In 2006, Indigenous people comprised 2.5% of the total Australian population (ABS, 2010). The Indigenous Australian population is beginning to age with a trend towards increased longevity in the 45 to 64 year old age group (Arkles et al., 2010). Information about use of aged care and dementia services is limited by poor and inconsistent data collection, however it appears that the number of Indigenous people accessing such services is less than it could or should be (Arkles et al., 2010). Possible reasons for poor access could include:
 * confusion and memory loss in elders not recognised as a medical condition,
 * the removal of elders from their community for medical or residential care has been experienced as a cultural threat or trauma,
 * difficulties accessing services that are culture-friendly or families fear the medical system (Arkles et al., 2010; Morgan, Slade & Morgan, 1997).

Communication with Indigenous individuals, networks and service providers within Western Australia confirm these findings. For example, inquiries to residential aged care facilities within metropolitan and regional Western Australia have identified that some facilities have one indigenous resident and a very small number have a clusters of 4 to 8 ATSI residents. The majority of health professionals lack the knowledge and skills required to provide culturally appropriate care for residents or their families. ATSI elders are often cared for by the extended family rather than placed in care. Families may engage community services and care workers however these sectors also identify a lack of knowledge and understanding to provide culturally sensitive care.

While there is an increasing awareness of the special requirements for the care of ATSI people with dementia work to date has been carried out in an ad hoc manner, relying on the efforts of a few enterprising individuals and service groups such as Frontier Services, NT, |SA/NT DTSC], and Queensland Health. Finding appropriate resources and accessing training relies heavily on word of mouth (van der Wetering & Batenburg, 2009). Most resources have been developed for the care of aboriginal people living in traditional communities.

Developing an integrated National approach to improve the skills of health professionals to provide culturally sensitive care for ATSI people living dementia is a long term aim with many challenges. A realistic target, based on a broad consultation and needs analysis and to meet the most important needs of the majority of Indigenous people living with dementia, is to address the professional and workforce development needs of health professionals working in mainstream health facilities in the following key areas:
 * Recognise the influence of Indigenous cultural and philosophical perspectives on the recognition and treatment of elders with dementia.
 * Develop principles to guide the provision of culturally sensitive and accessible dementia care in community, acute care and residential care contexts.