#healthcare. i will never be considerate towards the royals. they need to go

[dandelionjack]

england we are in shambles

[sleepymccoy]

ALRIGHT YOU ASKED FOR IT

Well, a couple people did. It's absurdly long, 2,500 words, so it's going under a readmore. But, basically, here's is my presentation on public health initiatives to address the intersectional needs of first nations Australians living with dementia.

I haven't included the slides or references list, cos I I never sent them to my phone. Also, this version is before I finished putting all my references in text so it's a bit under referenced. I chose to do that so it'd be easier for me to read out at the time. But yeah, here's my homework lol

Tldr: codesign is the thing, y'all

Introduction

I'd like to begin by acknowledging the Wurundjeri Woi-wurrung people of the Kulin Nation as the Traditional Owners of the land I am presenting from today. I pay my respects to their Elders past, present and emerging.

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Dementia care and healthcare delivery to first nation’s people are two complex areas. Both have recent research investigating best practice and approach, but there is less that approaches the intersection of both groups.

In my presentation today I will discuss some of the political and historical contexts that impact first nation’s people in Australia and their access to healthcare delivery. I cannot cover everything in full, but will be focusing on some of the reasoning behind the more recent impetus for codesign and why that has come to the forefront.

I will touch on the increasing dementia rates in indigenous Australian communities and why these numbers may be increasing. The purpose of noting why is that some of the likely exacerbating factors are modifiable, so the topic may have an impact.

I will briefly look into dementia statistic on a wider front and how they relate to first nation’s relationship with dementia. I will also refer to some public health initiatives and some novel dementia care delivery concepts in the wider population, where I think they are relevant to first nation’s peoples.

I will also look into some examples of small scale codesigned dementia initiatives already in Australia. Many of these are reactive and have come about to fulfil a need in a community. I found that very few are receiving sufficient funding, although they are providing culturally appropriate aged care.

My intention with my presentation is that you will come away with an understanding of the severity of the future of dementia in the aboriginal and Torres strait islander populations, and a hope-filled recognition that these communities have been uplifting their own for generations without government support and funding. With increased codesign, recognition of rights, and funding support there can be quick action in culturally respectful aged care for first nations people.

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Political and Historical Contexts

Aged care delivery has been under the microscope in recent years since the Royal Commission into aged care. Novel styles of service delivery have been suggested and begun to be explored, including the Alzheimer’s village concept and relationship centred care. The Royal Commission includes consideration of first nations people in their recommendations, with the advice given being focused on consultation with community members as this vital step has not been prioritised yet.

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In current political events there is the referendum for a Voice to Parliament. This request from the first nations people of Australia to have an avenue of giving advice and a method to be heard by shows how pervasive this national habit of not asking and not understanding first nationers culture is. The Voice to Parliament was requested years ago in the Uluru Statement.

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Looking even further back in time, a reflection on first Australian’s lifestyle before colonisation may indicate a direction for indigenous aged care to move towards (Blyton 2009). Blyton critically investigates contemporary writings on early meetings with first Australians and the age, health, and care provision they provide to their elderly. He contends that the early writings of the first fleet lack the propaganda and genocidal intention behind later communications, and are more written in the dehumanising but honest style of nature observation.

In this description first nation’s people are described as appearing 60 years old while remaining very fit and able to provide to their community. Those that age with disability or develop weakness are cared for in community, remaining at home.

Self-determination comes up time and time again in conversation with first Australians about their healthcare. They do not ask for and do not want solutions conceived without them. First Australians must be part of the conversation. Indeed, many times in consultation it can be seen that first Australians raise considerations that otherwise are not considered.

Slide (4 min)

In a co-designed study that investigates patient response surveys in cancer treatment rather than dementia, Green et al investigate the current topics the surveys focus on (Green et al. 2021). They find that cultural safety is not considered in any of the patient response surveys. Culture is vitally important to first Australians, and a failure to even include this in patient response forms shows that the system is not built with aboriginal cultural priorities in mind.

We see similar occurrences in dementia policy in recent years. Codesigning dementia care with people who are living with dementia has changed the approach, with recent added focus on increasing agency, improving the process of receiving a diagnosis, and lowering barriers to care. In a similar parallel to first Australians prioritising cultural considerations, the problems around receiving a diagnosis is an area of service delivery that has a greater impact than people without dementia were aware.

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The description of the indigenous elderly continuing to be an active part of the community into their old age is paralleled in non-indigenous communities. It is a pervasive data point in broad dementia research that people wish to remain at home as long as possible. Some acknowledge the time may come when they must move into 24 hour facility care, but others wish for death to preclude that. 

Basically, any good dementia program in an aboriginal community must include both aboriginal people and people living with dementia to be robust. Too much is missed without this codesign.

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Dementia in Aboriginal communities

So, what the current situation?

Dementia rates are high in aboriginal communities. There is no national average as no large-scale study has attempted to track dementia diagnosis rates in first nation’s people, but the Australian Bureau of Statistics has evaluated a collection of smaller studies and formally states that dementia prevalence rates are about 3–5 times as high in First Nations populations as rates for Australia overall.

Slide (6 min)

This may be due to any number of things, and likely many at once. The broad truth of ageing population is true for first nations people as well, with life expectancy creeping up as the years go by. Risk factors for dementia such as educational attainment, hypertension, and isolation are reported as higher among first nation’s populations.

Of course, a timely diagnosis is hard to find and made harder by remote living. First nations people live, broadly speaking, in more rural communities and access healthcare less than the nations average. People underreport both their cognitive decline and their aboriginal or Torres strait islander status. This shows us that even these extreme statistics in dementia rates are likely low-balling it.

Urgent action is required and based on the requests first nations people have made of the Australian government and people, I believe that action must be in support of existing community and culture.

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Education and empowerment

So, what’s can be done?

I’ll cover two main conceptual thrusts. One is in education and empowerment. The other, specific solutions that have shown promise.

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General awareness of the clinical factors and care recommendations in dementia isn’t great across the country, but it’s improving (Smith et al. 2014). Does this translate to Aboriginal people too?

A 174 participant strong survey of aboriginal people found that knowledge of dementia is low in the community (Garvey et al. 2011). The study was completed at a sport festival, so participants may have been more health conscious than the general aboriginal community. However, even with this, general engagement was low, with optional questions being left blank or filled out very briefly. This indicates to me a possible failing on the surveys part, as Green et al (who I mentioned earlier with the survey response forms lacking a question of culture) found that response rates are lower when the wrong questions are asked.

In this survey, the statisticians grouped the cohort demographics of age and education due to their strong correlation. They correlated such that younger people had completed year twelve and older people only to year ten. However, young people, the more educated, had not heard of Alzheimer’s disease at all. No one identified a difference between dementia and Alzheimer’s disease. Findings generally followed the same trend as other communities who had taken this study, but the indigenous respondents had larger gaps of knowledge across the board

A smaller survey focusing on young participants with high school education performed the same study in an aboriginal community (Cox et al. 2019). They found better results in direct comparison, but some of the participants had formal dementia training so this may not be scalable.

(8 min)

The smaller study, however, reported an interesting difference in language use that permeated the free form answers. That the decline of cognitive impairment was referred to as a change in state, from one person to the next, rather than a loss of personhood. While this does err rather close to the false idea that dementia is a natural part of ageing rather than a potentially treatable disease, it does show a cultural approach to dementia as a known and accepted facet of life. This changed version of self is still respected as a whole person.

One of the main concerns raised by participants in their free-form answers was of training and knowledge, with participants pointing out that access to healthcare and understanding of the disease was low across their community.

This concern of access to healthcare is seconded by a semi-structured interview with 34 older aboriginal people (Wettasinghe et al. 2020). In these conversations concepts such as empowerment and agency are used. These concepts come up in most co-design discussions around healthcare for aboriginal communities.

Education is a form of empowerment. We find in studies in the broader population that people report increased knowledge will change their behaviour.

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In 2022 there was a paper published that followed the experience of eight aboriginal women who underwent dementia training at The University of Tasmania (Goldberg et al. 2022). This was codesigned and involved support from an elder throughout the education. The students undertook a certificate three in individual support, and various subjects from the bachelor’s degree of dementia care.

The involvement of codesign from the beginning, the adjustment to normal service delivery to be more accessible for the first nations women involved, and the positive results all speak very well of this initiative. The students report some concerns around internet connectivity and teaching style  being unfamiliar, but they mostly describe pride in their study and intention to use their new knowledge.

What I take from this initiative is there is measurable strength in teaching knowledge without issuing instructions.

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Examples of dementia care across communities

Parella et al had a look at what is cultural safety and consideration in aged care (Parrella et al. 2021). In loosely formed interviews with 36 South Australian First nations people they identified the repeating themes that came up in interviews. These themes were:

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Maintaining cultural identity

Culturally informed and appropriate service provision

Culturally appropriate workforce – this one comes up in many different studies. I’ll quote Parella et al again here, “No, I don’t want a non- Aboriginal worker. I'd rather have an Aboriginal worker.”

Culturally supportive environments

Building partnerships and collaboration

Cultural safety in aged care principles

Many of the examples the participants gave revolved around food or activity. That food be made in a familiar way, from familiar ingredients, is important to many cultures. The uniqueness of a culture can often be seen through its food.

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Activities being relevant, too, is vital. We see this in dementia research all over the world, that a familiar environment lessens distress. With a quick google search I found aged care facilities that supply Greek or Jewish cultural care. I even found an LGBTI+ friendly aged care facility. The understanding that culture requires a change in service delivery is firm, it is just not yet offered appropriately to first Australians.

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Dementia care initiatives that already exist

Finding resources that are already being used and further supporting them is, to me, a promising direction. This leaves the agency of finding a function system with the individual communities, but supplements them with added help from the government. In some cases it may be appropriate to imitate successful community-level interventions in other areas that have none of their own, but in others cases it may be that this works for that one community. And that is well, we do not need a homogenised aged care system, we simply need one that responds to needs and is sufficiently oversighted to not fall into the abuse and neglect the Royal Commission uncovered.

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An investigation into the use of art centres across remote, mostly indigenous communities found that many of the art centres have a relationship with an aged care facility (Mackell et al. 2022). However, many of these relationships are informal so there are few reportable avenues for funding.

The staff describe their struggle with informal care. None were trained in aged care or individual support and expressed concerns around assisting people with physical disability safely or not understanding the complexities of a strong emotional reaction. They describe their role as respite carers for family members needing a break during the day, but have no formal support to fulfil this role.

They discuss their involvement in cultural safety and connection to land and culture. These art centres appear to be fulfilling the area of aged care that first nations people report is lacking. A purposeful, supported integration of these two services may show a positive impact.

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Mateo-Arriero found similarly to me that codesign is the way forward in dementia care for indigenous Australians. They put together a framework through which they intend to lower the modifiable risks of dementia in community. They shifted their service delivery to include aboriginal culture, including time for elder yarning and flexible response time to allow for conflicting commitments.

It was built in collaboration with local indigenous elders and respects their customs, but also relies on the plethora of prior studies in dementia throughout the world. There is accepted proof that (for example) not taking medication for chronic illnesses, educational attainment, or physical inactivity can increase dementia risk. Finding a codesigned way to introduce these proven healthier habits in a culturally relevant way is likely to lead to greater success.

Unfortunately, this study was halted due to the coronavirus pandemic lockdowns. I’m hopeful we’ll see more in the coming years as we can return to interacting in person.

Slide (14 min)

Conclusion

I think it’s clear that Indigenous Australians are capable of expressing their needs and finding solutions to the increasing threat of dementia. With support and education, the community has the capacity to succeed. We must share all the knowledge we have and allow them the agency to use it as they wish, to see the solutions that we miss.

Codesign, in all aspects, is vital moving forwards.

Thanks very much!

I need to WRITE about DEMENTIA in ABORIGINAL POPULATIONS but I just keep thinking about MCCOY from STAR TREK and I'm WASTING TIME

[beauzilr336-blog]

Anxiety: Feeling More Than Simply Bla'se' Fair

"I have the benefit, as a doctor, of meeting with women in my workplace every day to talk about symptoms and concerns related to the natural aging procedure. The consultations that I provide can enter lots of instructions whether it hormonal agents, emotions, physical requirements, or psychological needs. I ought to also preface this post by saying that these ladies I meet services in every walk of life and are in every phase of life from young to old. I offer care to executives, local celebs, healthcare providers, school instructors, stay-at-home mommies, ministry better halves, building and construction workers, and almost any function you can envision. After years of doing this, I can say without a doubt that nobody, despite professional status or responsibility, is exempt from the effect of anxiety. Each time I do an assessment, I constantly touch on the concern of anxiety and anxiety to fully assess the factors for different issues. The ""cause"" of depression is in some cases recognizable, however frequently is not. For some, depression can be explained as an intrinsic propensity to depression due to a strong family history of the disorder; for others it's induced by tension and psychological injury; for others it's a slow downward decrease due to unhealthy relationships and bad social media networks; for others it's the consistent sensations of failure or not meeting expectations; and for others it's due to endocrine and biological shifts of the body due to some other illness state. The reality is that whatever the cause, the results can be significant and lasting for some women who battle with clinical depression.

These are the hardcore stats about anxiety so you have an understanding of how considerable this is:

- The World Health Organization identified anxiety as the 3rd most important cause of disease burden worldwide in 2004, and it is approximated that, internationally, depression will be the second leading cause of special needs by the end of 2020.

- In the U.S., depression is the most common kind of mental disorder (affecting 26% of grownups).

- Ladies experience anxiety two times more than males.

- Bringing the stats ""closer to house"" (so to speak), I did an audit of charts that I keep in the office and realized that 88% of my clients reacted ""Yes! I have experienced depression"". Twenty-five percent mentioned they had actually experienced it one or two times in their life. Twenty-three percent stated they experienced anxiety once or twice a year.

- Then to bring it ""actually near to home"", I found that anxiety amongst those that I occur to understand are in ministry (or simply ministry partners) experienced a typical age onset of anxiety in their early thirties. That's our YOUNG WOMEN in MINISTRY. WOW!!! The bulk experienced depression at or near 5 to 6 years in their ministry profession. Mentoring young women in ministry are clearly needed and crucial. The first five years have a SUBSTANTIAL impact psychologically for those starting their journey in ministry.

What should a lady do if she has constant feelings of depression?

Talk with your partner, talk with your most trusted mentor or good friend, and go see your physician. One of the most significant mistakes made by well-meaning individuals is to provide someone who is crying out for help the old ""it'll get better"" pat of dismissal on the shoulder. That, sadly, is often what takes place when someone tries to reveal the sensations of being children in care transport in a deep blue sea fair state. Many women and particularly young women become puzzled that anxiety is a state of weak point and find themselves extremely vulnerable in reaching out because of the viewpoints and recommended antidotes of others. Or, they simply quickly realize that it's the ""thing I dare not speak of"" because of the actions of the past. If there is something I've found out over the years, it is to take these discussions about anxiety very seriously and ask the ideal questions to direct each female, as a specific, towards the proper help. Frequently having an outlet to share feelings and disappointments is all that is required (along with excellent research studies of the Word obviously), but constantly bear in mind that from time to time, there requires to be medical intervention.

In covering this up, I want to end on the power that faith keeps in the battle with depression. Maybe it's more easy to understand to explain the impact of a manipulated perspective in this way. I once had a restroom scale that was certainly broken and unreliable. I could step on the scale and it would show 108 pounds. That seemed terrific till my seven-year-old child and my spouse each stepped on it and it exposed the precise same number. The scale was clearly broken, however I believe we as ladies wish to utilize a malfunctioning scale to determine our status in life. Plain and basic, you can't utilize society's undependable ""self-regard"" scale to figure out YOUR own self-regard. I constantly inform ladies not to get their hands captured in the contrast trap. It will fracture you and your spirit in a heart beat. The scripture is clear on the reality that we are each highly preferred by God. No doubt, our earthly life will bring with its trials, temptations, loss, and in some cases defeat, but God's view people does not change and is not defective in any way. The bible says that He is the magnificence and the lifter of our heads. (Ps. 3:3) There will be times when we need to utilize the scripture to re-evaluate and re-calibrate our view of ourselves.

I want to inform you what God has to say about you (By the way, His scale is never broken).

Mark: we are to be believers and not doubters.

John: Christ's pal, designated, and a recipient.

Romans: Justified, redeemed, without regret, and holy

Corinthians: A new production, fixed up.

Ephesians: blessed selected, redeemed, forgiven, God's workmanship

Timothy: conserved and called

Peter: a living stone, developed, chosen, royal, God's own, and a partaker.

Each people might state that ""He loves me the most!"" and we would be right. I strongly think that God is our ultimate Source and we constantly need to be wanting to Him. I likewise believe that he has called and equipped pastors, leaders, coaches, and health care specialists to minister to others who require a helping hand and a gracious heart as they struggle through the anxiety. I believe it's the time we become sensitive to others and especially to those that are more youthful in ministry. Our actions and suggestions could mean all the difference ""IN THE WORLD"". Actually."