Official journal of the Pacific Rim College of Psychiatrists

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Asia-Pacific Psychiatry ISSN 1758-5864

ORIGINAL ARTICLE

Dementia literacy in older adults Samantha M. Loi1,2 BMedSc (Hons) MBBS MPsych FRANZCP Grad Cert POA & Nicola T. Lautenschlager1 MD FRANZCP 1 Academic Unit for Psychiatry of Old Age, St Vincent’s Health, Department of Psychiatry, The University of Melbourne, St George’s Hospital, Kew, Vic., Australia 2 Melbourne Health/North Western Aged Persons Mental Health Program, Parkville, Vic., Australia

Keywords dementia literacy, mental health literacy, older adult Correspondence Samantha M. Loi BMedSc (Hons) MBBS MPsych FRANZCP Grad Cert POA, Academic Unit for Psychiatry of Old Age, St Vincent’s Health, Department of Psychiatry, The University of Melbourne, St George’s Hospital, 283 Cotham Road, Kew, Vic. 3101, Australia. Tel: +61 3 9816 0485 Fax: +61 3 981 6 0477 Email: [email protected] Authors’ roles: S.M. Loi contributed to the study design, recruitment of participants, analyzed the data, and wrote the paper. N.T. Lautenschlager contributed to analyzing of the data and writing of the paper.

Abstract Introduction: With the increasing aging population, it is predicted that there will also be a rise in the number of people with dementia. Although there is no definitive cure, early detection and access to treatment and services remains the cornerstone of management. Misinformation and poor knowledge about dementia may lead to delayed diagnosis. A study of dementia literacy was undertaken to explore current knowledge in a metropolitan city in Australia. Methods: A vignette describing an older person with symptoms of cognitive impairment was posted out to volunteers at the local hospital. Results: The majority of participants surveyed correctly identified that the person in the vignette was suffering from symptoms of dementia or cognitive impairment. However, there was more variation with regard to types of treatment available and appropriate help-seeking behavior. Discussion: Although people are able to identify symptoms of dementia when they are presented in a scenario, the reality is often not as clear. More education to improve knowledge with regard to this increasingly common disorder is required so that appropriate interventions can be made available.

Received 3 April 2014 Accepted 18 August 2014 DOI:10.1111/appy.12153

Introduction There is an increasing aging population worldwide. In Australia, the proportion of people aged over 65 years is expected to double from 13% to 25% of the total population between 2007 and 2051 (Access Economics, 2011). Australia is expected to experience a large rise in the prevalence of dementia, from 266,574 (1% of the population) in 2011, to 942,624 (2.8% of the population) by 2050 (Access Economics, 2011). Despite this, there appears to be a delay from initial symptoms of cognitive decline to the time of diagnosis. This may be due to inadequate knowledge about symptoms of the disease, the assessment process, and possible interventions. Jorm et al. (1997) first introduced the term “mental health literacy (MHL)” in Australia to refer to knowledge and beliefs about mental disorders

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which aid their recognition, management, or prevention. MHL includes: (i) the ability to recognize specific disorders; (ii) knowing how to seek mental health information; (iii) knowledge of risk factors and causes of self-treatments; (iv) knowledge of professional help available; and (v) attitudes that promote recognition and appropriate help seeking (Jorm et al., 1997). There is a paucity of research investigating MHL in older adults. The few studies conducted have found that there is lower level of MHL in older adults compared with younger adults (Fisher and Goldney, 2003; Robb et al., 2003; Connery and Davidson, 2006; Farrer et al., 2008; Wetherell et al., 2009). Many of these studies have used a vignette devised by Jorm et al. (1997) describing a young person with classical features of depression or schizophrenia. These studies have shown that older people were significantly less

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likely to detect there was anything wrong with the person described in the vignette (Fisher and Goldney, 2003; Farrer et al., 2008), were less likely to seek help, and were less certain who would be appropriate sources of support (Farrer et al., 2008; Mackenzie et al., 2010). The reasons for lower MHL in older people have included lack of perceived need and lack of insight (Mackenzie et al., 2010), stigma, embarrassment, or thoughts that feeling emotionally unwell might be a “normal part of aging” (Werner, 2003). Practical barriers such as lack of accessibility and availability of services, and low rates of referrals by general practitioners (GP) have also been suggested (Robb et al., 2003). There have also been few studies exploring MHL in dementia (Werner, 2003). These studies have mainly focused on family members and carers (Graham et al., 1997; Werner, 2001); however, the few that have looked at community samples have had inconsistent results. Ethnic minorities (Ayalon and Arean, 2004; Connell et al., 2007; Purandare et al., 2007) and people with lower education levels (Ayalon and Arean, 2004) appear to have lower levels of dementia literacy. Cultural reasons may play a role in explaining why people with dementia present very late. For example, studies in India showed that dementia was not perceived as a disease, but instead as a normal part of aging (Patel and Prince, 2001). There are currently no definitive cures for dementia, and so early assessment and diagnosis is important so that people can access available services. Hence, it seemed appropriate to undertake an exploration of dementia literacy in the community.

Methods The MHL questionnaire was posted to the group of volunteers at the local hospital, which specialized in services for the older population, including geriatric, rehabilitation, and psychiatric facilities. This hospital is located in a middle class socioeconomic metropolitan suburb in Melbourne, Victoria, Australia. The questionnaire was packaged with a brief covering letter that provided an explanation about the research, with a postage paid envelope for return. These were posted out in June 2012, over a 2-week period, and responses were returned within a month. There were no reminder questionnaires posted out. Participants in this study were volunteers at this local hospital. This group lives locally and volunteers their time to assist the hospital in any way. As a

Asia-Pacific Psychiatry 7 (2015) 292–297 © 2014 Wiley Publishing Asia Pty Ltd

Dementia literacy in older adults

general guide, volunteers do not provide any service which a paid staff member is employed to do. Roles are varied and can include basic administration like folding leaflets and distributing newspapers. Ethics approval was granted by the local hospital ethics committee. Questionnaires were packaged and given to the Volunteer Coordinator, who posted these out to the volunteer names on the database. MHL Jorm’s original MHL questionnaire (1997) was used and was altered so that the person involved in the vignette was an older person who had symptoms which may be consistent with dementia. John is a 71 year old who has been living at home with his spouse. For the past year, he has become more absent-minded and become more forgetful. In the last six months, he has become more so. He can’t remember where he puts his keys and papers. When he goes to the shops, he forgets what he wanted to buy. Sometimes he has forgotten to pay the bills and has been threatened to have his electricity and gas disconnected. He doesn’t feel like going out much anymore. His family are very concerned about him. Following the vignette were a series of questions to determine knowledge and opinions about people who could help, possible treatments, prognosis, and risk factors. Interventions included: a GP or family doctor; a lecturer; a telephone counselor; a psychologist; or a psychiatrist. Responses were rated using a five-point Likert scale (helpful, harmful, neither, depends, don’t know). Demographic information such as age, gender, level of education, and language spoken other than English were also added to the questionnaire. Data analysis Data were collected during the period of July–August 2012 and was entered into Statistical Package for Social Sciences version 20 (IBM, New York, United States). Descriptive statistics were used to describe the sample. Counts and percentages were used to summarize categorical variables.

Results A total of 251 questionnaires were posted out to the volunteers, which contained a letter explaining the

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purpose of the research, the questionnaire, and a postage-paid envelope. Fifty-six (22.3%) were returned. This percentage is comparable with other responses in mailed surveys. There were 18 male (27.3%) and 47 female (71.2%) respondents. Ages of respondents were grouped into decade ranges; three (4.5%) were aged

Dementia literacy in older adults.

With the increasing aging population, it is predicted that there will also be a rise in the number of people with dementia. Although there is no defin...
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