Dementia for healthcare providers

Māori are 8.5 and 3.3 years younger than Pākehā and Pasifika, respectively when they are diagnosed. Māori understandings of mate wareware differ from the main Western conceptions of dementia. Whānau are generally inclusive of their whānau member’s changes in their daily functioning and new emerging behaviours. Whānau are crucial for the care of a kaumātua (older person) with mate wareware, so they need to be included in treatment discussions and decisions, along with the person with mate wareware.

Te oranga wairua (spiritual wellbeing) has been identified as central to Māori thinking about health, and effective care for someone with mate wareware must, therefore, include cultural practices to strengthen wairua of the whole whānau.

Read more: Dudley M, Menzies O, Elder H, Nathan L, Garrett N, Wilson D. Mate wareware – understanding ‘dementia’ from a Māori perspective(external link) NZ Med J. 2019 Oct 4;132(1503).

Listen: Dementia in Māori – optimising care(external link) Goodfellow Unit, NZ, 2020

As health clinicians we are under an obligation to consider the driving safety of our patients and to deal with any risk to themselves or others from unsafe driving, especially in those who suffer from mild cognitive impairment (MCI) or dementia. However, the decision as to whether a person with dementia is fit to drive is complex, and often traumatic for the person with dementia. This guideline was developed in the Northern Region to assist all clinical staff in assessing the driving safety of a person who wish to continue driving in the context of having cognitive impairment. 

Dementia and driving safety – a clinical guideline(external link) Northern Region DHBs, NZ, 2014 
Medical aspects of fitness to drive – a guide for health practitioners(external link) New Zealand Transport Agency, 2014

Cognitive stimulation therapy (CST) is a structured group treatment developed for people with mild to moderate dementia. It consists of 14 sessions with a range of activities and discussions aimed at general enhancement of cognitive and social functioning. The sessions actively engage people with dementia, while providing an optimal learning environment, and the social benefits of being part of a group. CST has been found to be an acceptable psychological therapy for older people with a clinical diagnosis of mild to moderate dementia. Cognitive stimulation therapy – a New Zealand pilot(external link) Te Pou, NZ, 2014

Personalised music programmes for people in residential care facilities(external link) Music & Memory, US
Wall M, Duffy A. The effects of music therapy for older people with dementia.(external link) Br J Nurs. 2010 Jan 28-Feb 10;19(2):108-13.
Skingley A, Vella-Burrows T. Therapeutic effects of music and singing for older people.(external link) Nurs Stand. 2010 Jan 13-19;24(19):35-41.
Hulme C, Wright J, Crocker T, Oluboyede Y, House A. Non-pharmacological approaches for dementia that informal carers might try or access – a systematic review.(external link) Int J Geriatr Psychiatry. 2010 Jul;25(7):756-63. 
Seitz DP, Brisbin S, Herrmann N, et al. Efficacy and feasibility of nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care – a systematic review.(external link) J Am Med Dir Assoc. 2012 Jul;13(6):503-506.e2.

Assessing dementia in primary care,(external link) The Good GP, 2022 NZ
18 short podcasts(external link) Dementia Training Australia website, AUS
Management of dementia in primary care(external link) BMJ Learning, (subscription required)
Education and courses(external link) NZ Dementia Foundation
Dementia care for Māori (external link)Goodfellow short course, 2019
Driving assessment for patients with dementia – a how-to guide(external link) Goodfellow MedCase, 2020Dementia in Māori - optimising care(external link)

• This course is heavily informed by the Waitematā DHB pilot of GPs and practice nurses assessing, diagnosing and managing mild cognitive impairment (MCI) and typical dementia.
• Dementia requires chronic care management. There is strong evidence that primary care is the right place for its assessment, diagnosis, and management.
• This resource summarises the literature and provides the evidence that informs Cognitive Impairment Pathways used across New Zealand. It is designed to build primary care confidence, competence, and consistency in assessing, diagnosing, and managing MCI and typical dementia.
• This course cites Northern Region pathways, however, links to Cognitive Impairment Pathways used in each district health board across NZ are provided.

Dementia care for Māori(external link) Goodfellow Unit, NZ, 2019
Rational prescribing in dementia(external link) Goodfellow Unit, NZ, 2020

Professor Henry Brodaty from New South Wales who is presently Scientia professor of ageing and mental health and director of the Dementia Collaborative Research Centre: 14 essentials in the practice and art of diagnosis and management of dementia [PDF, 1.5 MB] 

Dr Alan Davis, clinical director health of older people and clinical support at Northland District Health Board and clinical lead for the Northern Region health of older people network: Computerised decision support and dementia [PDF, 2.3 MB] 

Karen Holland, project manager for health of older people projects at Waitematā District Health Board: Waitematā DHB cognitive impairment pathway [PDF, 207 KB]

Dr Mark Fisher, clinical head and consultant psychiatrist at mental health services for older people at Counties Manukau Health: The memory team review [PDF, 1.9 MB] and Dementia and driving 2014(external link) 

Dr Richard Worrall, clinical director for mental health of older people at Auckland District Health Board: The ADHB dementia network [PDF, 3.4 MB] 

1. PHARMAC seminar: Dementia update, Early screening and assessment in Primary Care (30 minutes) – Rebecca Casey

(PHARMAC Seminar, NZ, 2017)

2. PHARMAC seminar: Dementia update, 2a. Managing dementia, the next steps, part 1 (31 minutes) – Dr Jan Gregson

 (PHARMAC Seminar, NZ, 2017)

3. PHARMAC seminar: Dementia update, 2a. Managing dementia, the next steps, part 1 (28 minutes) – Dr Jan Gregson

(PHARMAC Seminar, NZ, 2017)

For more videos of the same series, visit PHARMAC seminars(external link).

Professor Ngaire Kerse talks about living well with dementia. Ngaire is a GP in Auckland, Professor of General Practice and Primary Health Care and the Joyce Cook Chair in Ageing Well at the University of Auckland.

(external link) 

(Goodfellow Unit podcast, NZ, 2020)

This resource(external link) provides information and tools around communicating with Māori patients and their whānau, as well as information around diagnosing dementia and long term care of dementia patients – all of which will make it easier for you to support and care for your patients and their whānau.

Dementia Learning Centre(external link) Alzheimers NZ
Caring for someone living with dementia can be extremely stressful and challenging, both mentally and physically. Now, a unique online Caring for the Carers programme aims to help care partners take better care of themselves – and the person for whom they are caring. The programme has a range of tips, resources and advice around mental and physical wellbeing, rest and relaxation, diet and lifestyle to ensure carer partners can better deal with the stresses of their role. 

The three dementia-specific NGOs (or non-governmental organisations) are:

Dementia New Zealand(external link)

Dementia New Zealand’s member organisations provide support and education services to about 70% of New Zealand’s population affected by dementia, particularly in our larger cities, from Christchurch to Auckland. They are a key national voice to develop and promote better services to help people live well with dementia.

Alzheimer's NZ(external link)

Alzheimer’s New Zealand’s national office in Wellington has a respected history of working to educate and support government and other organisations to give the right priority and the right support to people living with all kinds of dementia and their whānau/families. Its member organisations provide grassroots support and education to about 30% of New Zealand’s population affected by dementia, particularly in our key regional areas, from Invercargill to Whangarei.

NZ Dementia Foundation(external link)

New Zealand Dementia Foundation exists to support the dementia workforce to do its job at its top potential – the health-care professionals, support workers, researchers, educators and managers who work with people affected by dementia. The Foundation takes the voice of the workforce into every leadership meeting we attend and bring messages from the sector’s governance back to you.

The key players from the public health sector are:

The Ministry of Health

The Ministry provides overarching leadership to the whole dementia sector, setting the policy and goals and monitoring the outcomes.

District health boards

The DHBs fund all publicly funded dementia services, and include their key managers of health of older persons and mental health services, and their specialist services.

The NZ Dementia Framework Collaborative

This group of Health of Older People leaders from all four DHB health regions of the country (Northern, Mid-central, Central and Southern) is active in encouraging and ensuring there is a coordinated approach from the DHBs to put the aspirations of the “New Zealand Framework for Dementia Care” (2013) into action.

There are many other groups involved as well, including other key NGOs providing services, New Zealand’s Aged Residential Care and Home and Community Support Service providers, other cross-DHB committees such as the Mental Health of Older Persons Service Leaders Forum, professional interest groups such as the NZ Psychologists of Older People, and local Dementia Stakeholders groups in some DHBs and health regions.

Source: NZ Dementia Foundation(external link) 2019

Dementia