The number of older Aboriginal Australians is increasing rapidly, yet little is known about their health and dementia rates. The KICA Study (WA 2008) noted a high prevalence of dementia in remote Aboriginal people. The Koori Growing Old Well Study (KGOWS) aims to determine: the prevalence and associations (potential risk factors) for dementia in urban Aboriginal settings where the majority reside; valid screening and diagnostic instruments; service use and needs; and to build capacity in dementia knowledge in Aboriginal communities and researchers. KGOWS, funded by the NHMRC, commenced in July 2008 following consultation with Aboriginal communities and Community Controlled Organisations across NSW. We further developed and established partnerships with five city and regional NSW Aboriginal communities (La Perouse, Campbelltown, Kempsey, Nambucca, Coffs Harbour) to undertake a rolling census of all Aboriginal people aged 60 years and over currently resident in each participating community within defined local government areas (N=546). This was followed by a survey of health, cognitive function, wellbeing, family history, life history and service use with all consenting participants (N=336; 61.5%; median age = 66 years). Three cognitive instruments were used to screen cognitive status and “gold standard” consensus determinations of dementia and cognition were made following (blind) clinical assessment by a geriatrician. Data collection was completed in October 2012 and data analysis is currently ongoing.
Preliminary Results: Dementia prevalence is substantially higher in majority urban Aboriginal Australians compared to the general Australian population and most other nations or ethnic groups. Crude dementia prevalence was 13.4%. When age-adjusted the rate is 21% or three times the general Australian rate of 6.8%, with Alzheimer’s dementia most common (44% of cases), then vascular dementia (17%), dementia due to head trauma (7%), and mixed dementia diagnoses (29%). Alcohol related dementia was uncommon. The prevalence of mild cognitive impairment was also high. Standardised screening tests (MMSE; RUDAS) and a culturally specific tool (mKICA) performed similarly. Key potential associations of dementia are being explored, including: age, early life factors (e.g., separation, formal/informal education; parenting; childhood trauma) & mid-life factors (e.g., social engagement, discrimination, resilience, jobs, prior stroke, vascular risks, head injury, alcohol, smoking).
Plans for 2013-14: KGOWS data on Aboriginal health and social factors will be examined for specific associations with cognitive decline in Aboriginal Australians and to compare with known risk factors for non-Indigenous ageing and dementia. KGOWS takes a life cycle approach, examining both early-life and mid-life risks for brain development and later cognitive decline. There is however an immediate need for provision of dementia education and appropriate services which we are approaching through the Koori Dementia Care Project (KDCP) funded by NSW Ageing Disability and Home Care (ADHC). We are also planning a ‘Healthy Aboriginal Brain Ageing Project’ for successful ageing, both systemic and neural, in older Aboriginal participants. In the future we hope to use KGOWS data to engage with younger Aboriginal people and the non-Indigenous community in developing educational opportunities, employment and job readiness.
We acknowledge and thank our Aboriginal partners and participants including: La Perouse Land Council and ACHC Health Link Committee; Tharawal ACMS, Campbelltown; Durri ACMS and Booroongen Djugun Kempsey; Darrimba Maarra AHC, Nambucca; Galambila AHS, Coffs Harbour; and our five Community Guidance Groups.
Please note, these pages may contain the names and images of Aboriginal and Torres Strait Islander people now deceased.
We work within the proper guidelines of respect and ethical conduct. We have obtained ethics approval from the Aboriginal Health and Medical Research Council and our University of NSW Ethics Committee and the whole study will be guided by an independent Aboriginal Reference Group.
Two workshops have been held to allow discussion between the Australian Association of Gerontology and the Aboriginal and Torres Strait Islander Ageing Committee: the first held in Sydney in 2008 and the second in Darwin in 2010. Click to view the Reports from 2008
For any questions about the Study, please contact: Study Manager, Holly Mack, on (02) 9399 1048 or email at firstname.lastname@example.org