Dementia now greatest burden of disease in over-65s

Dementia now causes the greatest burden of disease of any chronic illness among Australia’s older residents, according to the Australian Institute of Health and Welfare (AIHW).

An updated AIHW report, Dementia in Australia, released on Thursday 23 February, indicates the disease has a more far-reaching impact on those aged over 65 than coronary heart disease (CHD), which historically has affected the most people in the age-group.
 
According to the AIHW’s latest Burden of Disease study, dementia caused an estimated 229,831 years of healthy life to be lost among people aged 65 and over in 2022, with coronary heart disease standing at 219,780.
 
For dementia, that represents a 61% increase in the overall impact since 2011.
 
To arrive at the figures, the AIHW uses a calculation that incorporates both the time lived with disability caused by the disease and the years of life lost due to premature death.
 
It is the first time the overall burden has been highest for dementia in that age group, with the last report released in 2018. While CHD currently causes more years of life to be lost in the over-65s, dementia is substantially higher than any other condition for the years lived with disability.

The report also confirms dementia as the second leading cause of death in Australia, and the leading cause among women, accounting for around 9100 deaths among females in 2020.

For Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, the statistics reinforce the increasing impact the condition is having on general practice.

‘I believe it remains important to recognise the fact that dementia is a leading and growing cause of death and burden of disease in Australia, rather than focus on whether it has overtaken another equally as important burden such as coronary heart disease,’ he told newsGP. 

‘However, these new AIHW statistics further highlight dementia as an increasingly common and important condition for GPs to be aware of.’
 
Among those older than 65, an estimated one person in every 12 is affected by the illness, with that number rising to two in every five for those aged over 90.  
 
The disproportionate representation of dementia in aged care homes is also cited in the AIHW report, with 54% of residents thought to have had the illness in 2019–20.
 
The AIHW currently estimates the number of people with dementia in Australia at 401,300, but notes that other calculations are considerably higher.  
 
The report authors explain the different figures stem from the fact that ‘no single authoritative data source’ exists for the disease.
 
‘Work is under way to improve the accuracy of dementia estimates and new approaches will likely supersede the estimates shown in this report in coming years,’ the authors write.
 
Burden set to increase
While there may be variation in calculations of the number of people with dementia, the upwards trend is likely to remain, according to the AIHW.
 
Authors of this latest report state that the number of people with dementia will more than double by 2058, with a predicted 849,300 people in Australia likely to have the disease by that date.
 
In that context, Dr Marinucci says a nationwide strategy for tackling dementia is ‘an absolute priority’.

He was among the contributors to the RACGP submission for the National Dementia Action Plan, which the Department of Health and Aged Care (DoH) hopes will facilitate more coordinated care, early diagnosis, and better support for carers over the next 10 years.
 
As well as the increasing number of people who have dementia, the AIHW report highlights the related impact on carers, estimating that between 137,600 and 354,200 people are providing consistent unpaid care. Of those, half are believed to be spending more than 60 hours a week doing so.

Feedback for the DoH consultation document closed last month, with the department stating its aim as providing a ‘national vision’ for tackling the disease, as well as to encourage ‘a society that’s more understanding and more inclusive of people living with dementia’.
 
The college feedback included a call for GPs to receive free dementia training.
 
‘GPs are often the first contact for people experiencing early signs of dementia,’ the RACGP submission states.
 
‘It is important that GPs are trained to properly recognise early signs of dementia so that they can refer people to a specialist for diagnosis when it is appropriate.’
 
According to the DoH, the national plan will guide actions ‘so health, acute and aged care systems work more seamlessly and broader policies and programs consider dementia’.
 
Dr Marinucci agrees that greater coordination is needed.
 
‘GPs play an important role in recognising, assessing, diagnosing, and managing dementia,’ he said.

‘However, an integrated health system is required to support and improve diagnosis and care between services.’

AIHW spokesperson Melanie Dunford said the burden of disease for dementia is increasing while other illnesses are going down.

‘It is an increasing cause of disease burden in Australia, largely due to our ageing population but also from declines in burden from other leading causes, such as coronary heart disease,’ she said.

The report also highlights ‘a lack of up-to-date and robust data’ on new diagnoses of the disease, including how many general practice and specialist services are used for diagnosing and managing dementia.
 
‘Our understanding of dementia in the [general practice] and specialist settings remains a key data gap for monitoring dementia in Australia,’ the authors wrote.
 
The AIHW says the organisation is developing a national dementia data improvement plan to address the information gaps.
 
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