Dementia treatment must be holistic

A positive ageing approach to dementia care requires carers and medical professionals to go back to basics and know the person, move away from overcomplicating care and prioritise person-centred care, say dementia sector leaders at the Positive Ageing Summit in Adelaide.

The early morning discussion included HammondCare general manager for growth and innovation Marie Alford, Dementia Doulas International managing director Wendy Hall, HammondCare general manager Dr Duncan McKellar and Dementia Support Australia living experience associate consultant William Yeates.

With Ms Alford as moderator, the Reimagining Dementia Support Through Compassion, Rights & Reablement panel emphasised the importance of empowering people living with dementia – with Dr McKellar emphasising evidence-based pathways recommend against over-medicating people living with dementia.

“Medications are useful,” he told delegates. “We all use them at different times in our life for different things, but usually to treat something that needs treating, and behaviour is not so much something that needs treating. It’s kind of a consequence of something else being out of balance.”

Dr McKellar said providers should instead look at the environment the care is being delivered in, especially in residential care.

Things like lighting, noise levels and the amount of people in the space can all be drivers of behavioural changes amongst people living with dementia and should be considered before prescribing psychotropics.

“We need to have people who are able to come and walk alongside them rather than stand in front of them and tell them what to do,” he said.

“Now, if we did those things, we’d actually find that it’s a very different landscape, and we wouldn’t be feeling the need to reach for the sedative medications at all.

“And when we do use medications, it should be because the person with dementia, or anyone in actual fact, actually has a clinical issue that the medication is going to treat – they have pain that we can improve by using a pain medication, or if we’re going to use a psychotropic medication, it’s because that person is living with depression, and that’s something that we can actually treat and see a significant difference for them from doing that.”

Ms Hall said it’s also important that people have conversations about dementia care as early as possible, because the key to setting a foundation for families moving forward – or for the person with a dementia diagnosis – is making sure there is a solid foundation early on.

“And certainly, through my experience, is that we disable people with dementia well before dementia does,” she told the audience at the breakfast masterclass session.

“We take so much away from them so early on, and we know the best treatment at this point in time for someone living with dementia is routine and to stay socially connected – and they’re the two things that get wiped out from under them very, very quickly.”

Dignity of risk doesn’t mean avoiding all risk

For Mr Yeates – who was diagnosed with early onset dementia at 59 years old – it is vital carers remember that people living with dementia have the right to decide what type of care they want and how they want to live.

“If I had a wish, if I could change everything for people living with dementia, it would really be about asking people to walk alongside me, to talk to me, to discuss things with me in a collaborative way and make decisions accordingly,” he said.

“What I wouldn’t want is for a person to be in front of me and make decisions for me. So, in terms of the New Aged Care Act and the standards, I actually feel encouraged.

“I actually feel that if it’s used correctly, if it’s put into practice, I think it’s a really good thing for people living with dementia.”

Although largely in agreement with this, Ms Hall explained that while walking alongside people living with dementia is important, it is equally important that carers don’t try and “bubble wrap” them from the world.

“Care is what we do, but care is actually also our big weakness,” she said. “By not letting people take risks, we actually increase the risks,” Ms Hall added.

Dignity in risk and dignity in care go hand-in-hand in ensuring older people are able to make informed decisions, and OneCare chief executive officer Peter Williams told PAS day 2 attendees that health literacy in staff must be prioritised to achieve that.

Safe conversations and explaining things in ways the consumer understands means they feel included in the care, not rejected. But this also applies to the workforce and ensuring board members and executives are fostering safe conversations with staff.

“Workforce health literacy is well beyond knowledge. It is about this confidence and navigation skills. Thinking about our communities, English is not the primary first language for many, many people. So, making sure that we take those things into consideration [is important],” he said.

The World Health Organisation recognises workforce health literacy as a critical determinant of health equity and access, because staff then know what’s available to them in their communities and can explain things and connect people outwards if necessary, Mr Williams also reminded the day 2 PAS audience.

It’s a system responsibility but also the responsibility of individuals, communities, organisations, and the government, Mr Williams said.

“With improved workforce health literacy, we know it’s about increasing the health knowledge and awareness and increasing the understanding of basic conditions.

“When we do that, all of our staff are better placed to support an individual with their health needs and their health journey.”

Positive Ageing Summit is an initiative of Australian Ageing Agenda and Community Care Review – read our coverage of the event here and find out more on the Positive Ageing Summit 2025 website