Tailoring the tools for Indigenous assessment

Thanks to almost a decade’s research and collaboration, clinicians and service providers now have an appropriate and effective cognitive assessment tool for use with Indigenous Australians, meaning better targeted care and more accurate healthcare data.

However, while the Kimberley Indigenous Cognitive Assessment (KICA) is now broadly recognised by governments and practitioners as the most appropriate to use with Indigenous people, researchers say they are working to develop validated assessment tools for other important areas such as falls, continence and depression.

To share the latest developments in this area, the Australian Association of Gerontology (AAG) will host a webinar next week in which leading experts will discuss the barriers in assessment and the lack of clear pathways in assessment and management.

Among them will be Professor Leon Flicker, Director of the Western Australian Centre for Health & Ageing (WACHA), who was part of the 2004 project headed by Dr Dina LoGiudice that led to the development of KICA.

The webinar will also feature Dr Eddy Strivens, Clinical Director, Older Persons Health Services, Cairns and Hinterland Hospital and Health Service, who validated the KICA in Northern Queensland and will be explaining its use.

High rates found

Once the researchers had developed this validated cognitive assessment tool, they found the rates of age-specific dementia in Indigenous people were up to five times higher than in non-Indigenous.

“In general, Indigenous Australians don’t live as long as non-Indigenous Australians, but their age-specific rates are very high, so they tend to get dementia at much younger ages than non-Indigenous Australians,” says Professor Flicker.

The study has since been repeated in Sydney and in rural NSW and similar rates of dementia at younger ages in Indigenous people were found, he says.

Other ongoing research, some of which has been published, has also shown comparatively higher rates of falls, incontinence and depression at earlier ages among Indigenous Australians.

“Their falls rates and incontinence rates are probably the same as we would expect in non-Indigenous Australians who are much older,” says Professor Flicker, adding that the rates among Indigenous people aged over 45 are similar to those seen in non-Indigenous people aged in their 70s and beyond.

This apparent increased risk for syndromes associated with ageing in younger Indigenous age groups has numerous possible explanations, the most likely being the fact they have several risk factors for vascular events, diabetes and renal disease, he says.

Discussing the barriers in assessment for Indigenous Australians, which is the central theme of next week’s webinar, Professor Flicker says the standard assessment tools, such as the RUDAS cognitive assessment, do not work very well with remote Indigenous people.

“For a variety of cultural and educational reasons the assessment tools just don’t work and they have to be adapted, particularly for rural and remote Aboriginal people and older Aboriginal people generally.”

Suite of assessment tools

Much of the work developing validated tools has been done in the past decade. “Certainly there’s been some progress, but lots more to come,” he says, adding that researchers are in the process of developing “a suite of assessment tools” in areas including falls, continence, depression and pain.

Professor Flicker says Australia is at the forefront of an international collaborative research effort in this field. When asked how Australia compares internationally, he says that, in general, the gap in outcomes between Indigenous and non-Indigenous people is less pronounced in NZ and Canada, for example, than in Australia. However, he says Canada, NZ and the US have not done as much work developing assessment tools for dementia and other syndromes associated with ageing. “It’s an area we’ve been looking at internationally and collaboratively.”

That international focus will be central to next week’s webinar, which the AAG is hosting in partnership with the Australian and New Zealand Society for Geriatric Medicine and the New Zealand Association of Gerontology.

Other experts taking part include Dr Lorna Dyall, Senior Lecturer Medical, Department of General Practice, School of Population Health, The University of Auckland.

‘Indigenous Ageing: Tools for Better Practice’ will be held on Tuesday 22 October from 1pm to 2pm AESDT

For more information, visit the AAG 

Australian Ageing Agenda is the media partner of the AAG