Aboriginal populations in the Kimberley region of Western Australia are increasingly living well into older age. However, with population ageing comes a known increase in the prevalence of age-related conditions, including dementia. This paper examines ageing and dementia for Aboriginal people in the Kimberley 2021–51. Australian Bureau of Statistics Census data (2011, 2016 and 2021) were modelled using the Wilson-Grossman variation of the Hamilton-Perry projection method (Hamilton and Perry 1962; Wilson and Grossman 2022) to estimate the size and age structure of the Aboriginal population in the Kimberley. To determine the number of people living with dementia during 2021–51, estimates were modelled from prevalence rates reported in a Kimberley dementia cohort study by Smith et al. (2008) and self-reported rates from the 2021 Census. It was found that the Aboriginal population in the Kimberley is projected to grow by approximately 45% for the period 2021–51 from 20,245 people to 29,276, with the greatest growth in older age groups, particularly 85 years and older. Dementia prevalence scenarios (5%, 10% decrease, fixed, 5% and 10% increase) project the number of Aboriginal people living with dementia in the Kimberley will at least double by 2051. In the scenario of a 10% increase in dementia prevalence, a 3.5-fold increase is projected. As part of research knowledge exchange, a data literacy session was conducted with the Kimberley Healthy Adults Project: Indigenous Elders Data Governance group, where these data were presented and Elders' advice around sensemaking and interpretation was sought. Elders emphasised their concerns around the findings and highlighted the important implications of these data in the planning and delivery of health, social and aged care services, workforce, and policy, now and into the future.

OBJECTIVE:Older Aboriginal and Torres Strait Islander Australians are central to their communities, providing cultural leadership and care. However, colonisation and systemic inequities have led to significant health disparities, with chronic diseases and dementia disproportionately affecting those aged over the age of 55 years. This study aimed to develop a strengths-based framework to support healthy ageing in the Torres Strait and Northern Peninsula Area. METHODS:A participatory action research approach was conducted across five communities, involving yarning circles with 45 community members, clinical audits of 1128 residents using the Healthy Ageing Audit Tool (HAAT) and continuous quality improvement (CQI) initiatives. Findings informed the co-design of an Ageing Well Framework, refined through stakeholder workshops and community feedback. RESULTS:The HAAT audit revealed high rates of chronic disease and multimorbidity among adults aged over 55 years, alongside gaps in preventive care, including low rates of cardiovascular risk and dementia screening and limited follow-up for abnormal findings. Continuous Quality Improvement (CQI) activities highlighted opportunities to improve culturally appropriate care, such as increased use of Indigenous Health Workers, validated screening tools and comprehensive health assessments. The co-designed Ageing Well Framework outlined strategies at community, primary health care and individual levels to promote cultural and social connectedness, independence and ageing in place. CONCLUSION:The Ageing Well Framework provides a culturally responsive, evidence-based guide to improving health and well-being for older Aboriginal and Torres Strait Islander Peoples. It fosters collaboration across sectors and prioritises cultural determinants of health, supporting holistic care and addressing health inequities in the Torres Strait and Northern Peninsula Area (NPA).

Australia’s Aboriginal Community Controlled Health Organizations are under-resourced and too few. As a result, older Aboriginal and Torres Strait Islander peoples needing dementia-related care frequently receive services from mainstream organizations and non-Indigenous care providers unfamiliar with or unsure about providing culturally safe care. This paper presents reflections of Aboriginal Elders following their initial visit to a rural mainstream residential care community in Trouwerner/Lutruwita (Tasmania) prior to initiating an innovative series of podcasts and vodcasts focused on culturally safe care. Elders spent two days to appreciate and learn about the area and then two days at the residential care community, beginning with a Smoking Ceremony. Elders yarned with staff, individually and in small groups, moving freely about the center. Elders then met to yarn and de-brief. Thematic analysis identified both positive and challenging issues. Six themes were identified: (1) Importance of truth telling, (2) Value of staff interest, (3) Impact of the Smoking Ceremony, (4) Appreciation of the care environment; (5) Lack of Acknowledgement and understanding, and (6) Contribution of an Elder-in-Residence program. Elders’ initial experiences and reflections provided valuable insight into the need for their project and important baseline data from which to measure its impact.

Menstrual health and hygiene are important to address both nationally and internationally for women's health equity, due to the known impacts on social participation, health and well-being, and the barriers that women who are from marginalized, or minority groups experience in accessing menstrual health resources and management. Evidence is scarce globally regarding the sociocultural influences on experiences of menstruation for Aboriginal women in Australia. This qualitative study utilized two yarning groups, separated according to younger and older age groups, conducted with 20 participants to explore the experiences of menstruation and engagement with healthcare providers for Aboriginal women in a metropolitan setting in Perth, Western Australia. The women's lived experiences highlighted the social and well-being impacts of menstruation, the generational and life course differences in experiences of menstruation, and the importance of implementing holistic approaches to support and address barriers to menstrual care and promote well-being. These findings can inform the international knowledge base surrounding sociocultural influences on menstruation and directions for place-based development of menstrual well-being resources. Additionally, women's health policy in Australia should account for the culturally specific and diverse needs of Aboriginal women related to menstrual health.

Objectives Dementia prevalence is higher among Aboriginal and Torres Strait Islander peoples than in the non-Indigenous population, however, reported risk factors vary across studies. This study aimed to elucidate factors associated with dementia and Cognitive Impairment Not Dementia (CIND) in a harmonised dataset of Aboriginal and Torres Strait Islander participants. Design Univariable and multivariable logistic regression was used to assess cross-sectional factors associated with dementia and/or CIND diagnoses (N = 898). Multinomial logistic regression was applied in a longitudinal subsample (n = 354) to account for the competing risk of death when examining incident dementia/CIND. Results Of 898 participants, 13% had a diagnosis of dementia and 15% had CIND. Cross-sectional risk factors included age, lower educational attainment, stroke, head injury with loss of consciousness, epilepsy, no obesity and antidepressant use. Hearing impairment, urinary incontinence, mobility impairment and difficulties with certain activities of daily living were associated with a greater risk of incident dementia/CIND. Conclusions This study identified several factors associated with dementia and CIND among Aboriginal and Torres Strait Islander peoples. Findings from this observational study may support clinical awareness and inform future research; however, causal relationships cannot be inferred. Further longitudinal studies are needed to clarify these associations.

Background: In partnership with Aboriginal Elders and Aboriginal community-controlled organisations, we developed a dementia risk management and prevention program for Aboriginal Australians aged >= 45 years. In this study, we report neuropsychological assessment data for people who underwent eligibility screening and baseline assessment and explore associations between the cognitive assessment tools used. Methods: Fifty Aboriginal people living in metropolitan Perth, Western Australia without known dementia were assessed with the Kimberley Indigenous Cognitive Assessment dementia screening tool (KICA-Cog) and a battery of standard neuropsychological tests. Results: Participants were aged 45-80 years (mean 63.5; standard deviation [SD] 9.4 years). Eleven participants (22.0 %) were male and 39 (78.0 %) were female. Of 49 participants with complete data, 13 (26.5 %) had a GAD7 score indicating a possible anxiety disorder and 20 (40.8 %) had a KICA-Dep score indicating possible depression. All participants were screened with the KICA-Cog and 44-49 were screened with the other tests. The mean KICA-Cog score was 37.2 (SD 1.7; range: 33-39) and the mean Montreal Cognitive Assessment (MoCA) score was 22.2 (SD 4.5; range: 13-30). There were moderate correlations between the KICA-Cog and MoCA, Symbol Digit Modalities Test (oral version), and Hopkins Verbal Learning Test total immediate recall and delayed recall scores. There were weak or no correlations between the KICA-Cog and other cognitive assessment tools. Four participants had previously been told they had cognitive impairment. The KICA-Cog and MoCA scores for these participants were 37.0 (SD 2.2; range: 34-39) and 18.8 (SD 1.5; range: 17-20), respectively. Discussion: A high prevalence of possible depression and anxiety suggest mental health support may be required for people participating in dementia prevention programs. The KICA-Cog is the only valid screening tool for dementia in Aboriginal and Torres Strait Islander people, but its clinical utility could potentially be improved to better detect mild neurocognitive disorder.

INTRODUCTION:Dementia is prevalent within Aboriginal and Torres Strait Islander communities but clients attending primary care often remain undiagnosed. This project aimed to develop a rapid dementia screen for primary care. METHODS:Logistic regression was used to identify candidate items from the Kimberley Indigenous Cognitive Assessment (KICA-Cog). The psychometric properties of different scales were assessed using receiver operating characteristic curve analysis and validated in a separate cohort. RESULTS:Four items in the KICA-Cog demonstrated high sensitivity (82.6%), specificity (83.2%) and area under the curve (AUC = 0.90; 95% CI: 0.87-0.94) for dementia at a cut-off point of 7/8 out of 10. This scale has favourable psychometrics (sensitivity 87.5%, specificity 80.9%, AUC = 0.92; 95% CI: 0.85-0.98) when validated in separate cohort. DISCUSSION:The proposed prototype tool, ready for community piloting and validation, may be useful in primary care to enable rapid cognitive screening as part of routine health care.

Purpose of research Data show that many Aboriginal and Torres Strait Islander peoples experiencing dementia receive services at mainstream health organizations and from non-Indigenous health care providers. It is imperative that non-Indigenous health care providers are educated about culturally respectful and safe care for Aboriginal and Torres Strait Islander peoples with dementia. The purpose of this research was to partner with Aboriginal Elders to co-design and implement an online unit on culturally respectful and safe care to educate non-Indigenous health care providers. Principal results Twelve Aboriginal Elders from four Australian states, along with state-based Aboriginal project officers, partnered with the national, interdisciplinary research team to co-create and co-deliver the 13-week unit. Elders formed a Governance Group to guide the research team and ensure the content, delivery and methods of assessment of the unit privileged the spirit, voices, and diverse cultures of Aboriginal and Torres Strait Islander peoples. A team of Aboriginal markers, including Elders and project officers, was established to evaluate students’ assessments. The unit commenced in late July 2024 with 375 students enrolled. Major conclusions Comments from both Elders and students affirmed the importance of Elders’ presence in the unit through their weekly zoom sessions with students and participation in evaluation of students’ learnings. Elders’ guidance in the co-creation and co-delivery of the unit has been recognized at program, college and university levels. The unit is available nationally and internationally through the online Diploma of Dementia Care offered by the University of Tasmania, Australia.

ISSUES ADDRESSED:Menstrual health literacy is an important aspect of improved engagement, management and social participation linked to menstrual health and wellbeing. There is stark evidence surrounding culturally appropriate menstrual health literacy for Aboriginal women in Australia. METHODS:This scoping review sought to explore current menstrual health literacy programmes and resources in Australia with further interrogation of how these relate to Aboriginal women specifically. This project used the Joanna Briggs Institute (JBI) scoping review methodology to systematically map and explore menstrual health literacy programmes and resources in Australia and for Aboriginal women. CONCLUSIONS:Seven research articles and nine grey literature reports from Australia met the inclusion criteria. The grey literature was insightful in relation to community based and culturally appropriate approaches to improving menstrual health literacy. SO WHAT?: Further research is required to demonstrate how culturally safe menstrual health programmes and health literacy resources that address the psychosocial and cultural needs of Aboriginal women, can be appropriately co-designed, evaluated and adapted to the diverse geographical contexts, in partnership with and for Aboriginal women.

OBJECTIVES:Dementia is the leading cause of burden of disease in older Australians. Older Aboriginal and Torres Strait Islander people experience an increased risk of cognitive impairment and dementia. This article describes the clinical profile of the first patients seen at a memory clinic established in an Aboriginal community-controlled health service (ACCHS) in metropolitan Perth, Western Australia. METHODS:This was an audit of 64 patients attending a memory clinic between March 2020 and February 2023 (inclusive). RESULTS:The median age of patients was 67.7 years (range 35-95 years; interquartile range [IQR] 13.4 years) and 34 (53%) were female. The majority (94%) were living independently. Thirty-four patients (53%; 95% confidence interval 41%-65%) were diagnosed with cognitive impairment. A further six (9%) were diagnosed with depression without cognitive impairment. The most common diagnoses in cognitively impaired patients were cognitive impairment not dementia (CIND; 27%); mild neurocognitive disorder (21%); dementia due to Alzheimer's disease (15%); Alzheimer's disease dementia, mixed type (9%); and other mixed dementias (9%). Women were slightly more likely than men to have cognitive impairment (56% vs. 52%), although this was not statistically significant (p = 0.74). The number of Aboriginal people seen in the clinic's first 3 years of operation was over 12 times that seen at a nearby hospital-based service during the same period. CONCLUSIONS:A memory clinic located within an ACCHS was well-attended and fulfilled a need not met by mainstream services. The successful model described in this article could be adopted by other Aboriginal health services.

A co-designed, Aboriginal health practitioner-led dementia risk management program (DAMPAA) was implemented from 2021 to 2024 to address the growing concern of dementia among Aboriginal and Torres Strait Islander peoples in Western Australia. Key features of DAMPAA included group walking and yarning sessions incorporating health and well-being education twice a week, alongside a six-month home program. A theory of change framework guided a parallel process evaluation, co-developed with Aboriginal Community-Controlled Health Services and an Elders Governance Group. The evaluation involved two distinct groups: Elders who participated in the program and staff involved in its design and delivery. Qualitative data were collected through yarning interviews, focusing on the program's implementation and impact. A brain health program for Elders was highly valued. Through group walking and yarning, the program supported a deeper connection to Country and strengthened community connection enhancing social and emotional well-being for Elders as well as program staff. A key learning was the significance of an Elders-informed health program, delivered by local Aboriginal people at an Aboriginal Community Controlled Health Service, creating a space that strengthens connection and a sense of belonging for Elders. The process evaluation validated the importance of the DAMPAA program. The DAMPAA program and resources have since been integrated into Elders' health programs across all service partners, demonstrating its relevance and potential for broader application.

Background:Dementia and cognitive impairment not dementia (CIND) are under-detected amongst First Nations peoples attending primary care. This trial implemented a culturally adapted best-practice model of care to increase detection and optimise management of CIND/dementia. Methods:This closed cohort open-label, stepped-wedge, cluster-randomised trial recruited 12 Aboriginal community-controlled primary health care services (ACCHSs) across urban, regional and remote settings in Australia. ACCHSs were eligible to participate if they conducted annual health checks, engaged in continuous quality improvement processes and had ≥55 clients aged ≥50 years. After a baseline control period, four ACCHSs were scheduled to enter the intervention phase every six months. During the intervention phase, ACCHSs were supported to embed best-practice dementia care through staff education and practice change initiatives. Co-primary outcomes were: (i) documented detection of CIND/dementia and, (ii) evidence of uptake of the diagnostic pathway measured as presence of ≥2 of: use of cognitive assessment tools, relevant pathology investigations, neuroimaging, and/or referral of clients with cognitive concerns to specialist services. Data were analysed with mixed effects complementary log-log regression. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12618001485224. Findings:Between September 2018 and January 2019, 12 ACCHSs were recruited, comprising a sample of 1655 ACCHS clients aged ≥50 years (mean 60.3 ± 8.2 years), of whom 935 (56.5%) were female. One ACCHS withdrew during the study. After adjustment for time, the intervention did not show evidence of an effect for the first co-primary outcome (detection of CIND/dementia): HR = 1.53 (95% CI 0.64, 3.65). However, the intervention improved the second co-primary outcome (uptake of diagnostic pathway): HR = 2.34 (95% CI 1.05, 5.25). Intention-to-treat analyses yielded similar results. Interpretation:The co-developed best-practice model of care for cognitive impairment and dementia for Aboriginal and Torres Strait Islander people attending primary care improved the diagnostic CIND/dementia management process. Funding:National Health and Medical Research Council (Australia) and Dementia Training Australia.

INTRODUCTION:We aimed to explore the performance of the Kimberley Indigenous Cognitive Assessment - Cognitive component (KICA-Cog) and the Clock Drawing Test (CDT) in older Aboriginal and Torres Strait Islander adults with dementia and without dementia in the Let's CHAT Dementia study. METHODS:In this cross-sectional diagnostic test accuracy study, participants completed Comprehensive Geriatric Assessments. Demographic, health, cognitive, and functional histories, and cognitive assessments (KICA-Cog and CDT) were recorded. The reference standard was consensus diagnosis by two geriatricians blinded to KICA-Cog and CDT performance. Binary logistic regression and receiver operating characteristic curve analyses explored accuracy against a diagnosis of dementia. RESULTS:Seventy-five adults with a median age of 74 years (interquartile range 65, 78) were assessed, of whom 39 (52.0%) were women. Forty-seven (62.7%) had normal cognition, 15 (20.0%) had cognitive impairment no dementia, and 13 (17.3%) had dementia. Sixty-one (81.3%) participants had completed primary school, and 13 (17.3%) had completed secondary school. People with dementia were older (p = 0.046), but no differences were found for gender, comorbidities, or education. KICA-Cog and CDT scores were inversely associated with dementia in unadjusted and fully adjusted models (adjusted odds ratio [OR] = 0.43, 95% CI [0.26-0.71] and OR = 0.18 [0.07-0.51], respectively). The KICA-Cog was superior to the CDT for classifying dementia in participants, with area under the curve (95% CI) = 0.98 (0.95-1.00); versus 0.79 (0.64-0.93), respectively, p < 0.001. The optimal KICA-Cog cutpoint for classifying dementia was ≤34, with 92.3% sensitivity and 90.3% specificity. CONCLUSIONS:KICA-Cog is superior to CDT at classifying dementia when used with older Aboriginal and Torres Strait Islander adults and should, therefore, be prioritised over the CDT for cognitive screening in older Aboriginal and Torres Strait Islander peoples.

The Good Spirit, Good Life (GSGL) assessment tool was co-developed in urban and regional Australia to address quality of life (QoL) for older Aboriginal and Torres Strait Islander peoples and inform culturally responsive care. This study aimed to determine the acceptability and validity of the GSGL tool in Australian remote settings. A co-design methodology was applied to this study. Yarning groups were conducted in 5 communities across 2 remote regions of Australia with older Aboriginal and Torres Strait Islander people. Required adaptations to the tool were refined with governance groups in each region. Forward and back translation was performed for the adapted tool with consensus achieved through an expert committee. Adaptations to the GSGL tool involved small wording changes to two items (Country/Island Home and Elder role). Five items were adapted through additional prompts and examples (culture, respect, supports and services, safety and security, basic needs). The remaining five items were retained (family and friends, community, health, spirituality, future planning). During forward and back translation, translation errors were identified with an expert language committee highlighting the importance of clear translation methods. The adapted GSGL tool is an acceptable QoL tool for use in health and aged care with urban, regional and remote-living Aboriginal and Torres Strait Islander Australians. When translating a tool, forward-back translation with an expert language committee is recommended to reach concordance in meaning. The adapted GSGL tool is suitable for use with an interpreter when required.

OBJECTIVE:Aboriginal and Torres Strait Islander peoples experience high rates of dementia, cognitive impairment not dementia (CIND) and associated risk factors. The objective of this paper is to outline baseline audit results of documented dementia, CIND and associated risk factors in patients attending Aboriginal Community-Controlled Health Organisations (ACCHOs). METHODS:Twelve ACCHOs in urban, regional and remote locations across Queensland, New South Wales, Victoria and Western Australia participated in the study. A specialised audit tool identified documented CIND, dementia and risk factors. Medical record audits of 1655 clients aged 50 years or older for the period from 1 September 2016 to 31 January 2019 were completed. RESULTS:The mean age of patients was 60.3 ± 8.2 years, and 57% were female. The overall prevalence of documented CIND or dementia was low, noted for only 67 (4%) patients. The prevalence of risk factors was high, with over two thirds (71%, n = 1168) of the cohort having ≥4 risk factors associated with dementia and CIND. These included high rates of hypertension (56%), diabetes (45%), dyslipidaemia (48%), obesity (40%) and current smoking (42%). CONCLUSIONS:There was a low detection of CIND and dementia accompanied by a high prevalence of associated risk factors in this primary health-care setting. These findings highlight the need to improve dementia and CIND detection in Aboriginal and Torres Strait Islander patient groups across varied geographical settings. The findings also provide insights into risk factor prevalence to inform management strategies. Responsive models of cognitive care that are culturally appropriate and co-designed with ACCHOs are required to address this need.

Purpose The Good Spirit, Good Life (GSGL) framework is a culturally informed quality of life (QoL) model co-designed with and for older Aboriginal people in Australia. The framework comprises twelve domains: family and friends, Country, community, culture, health, respect, safety and security, supports and services, Elder role, spirituality, future planning, and basic needs. The framework has been validated for urban and regional-living older Aboriginal people. It is unknown if the framework is valid in remote-living Aboriginal and Torres Strait Islander populations. This study aimed to determine the acceptability of the GSGL framework for older Aboriginal and Torres Strait Islander people living in remote areas and explore how the GSGL factors contribute to the QoL of this population. Methods A qualitative co-design study was conducted in five communities in the remote Kimberley and Torres Strait regions of Australia. Eight yarning groups comprising 36 people explored participants’ views about the framework. Data were analysed using thematic analysis. Results All participants agreed that the GSGL framework broadly reflected the Indigenous conception of what it means for older Aboriginal and Torres Strait Islander people to have a good life. Participants in the Torres Strait felt that the connection to Country domain did match in conceptualisation, although the term Island Home was preferred. Participants in the Kimberley region reported that no changes were required. Conclusions The GSGL framework, with a minor adjustment to include Torres Strait Islander perspectives, has been found to reflect the quality of life needs of older Aboriginal and Torres Strait Islander peoples living in urban, regional, and remote areas. The GSGL framework can be applied to inform planning and delivery of health and aged care to support the culturally informed quality of life needs of older Aboriginal and Torres Strait Islander peoples Australia-wide.

PurposeTo explore community and workforce perspectives on how the Home Care Package (HCP) program supports the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander peoples.MethodsThis qualitative design study included semi-structured interviews and a focus group with Aboriginal and Torres Strait Islander peoples receiving an HCP (n = 15) and aged care workers providing service coordination to Aboriginal and Torres Strait Islander peoples (n = 7) across metropolitan, rural and remote areas of South Australia. Semi-structured interviews and the focus group took place between March 2022 and February 2023. Data were analysed using thematic analysis.Main findingsTwenty-two participants were involved in this study. Seven themes representing how the HCP program supports, or could better support, the SEWB of clients were identified: 1) maintaining independence, 2) supporting grief and loss, 3) facilitating social connections, 4) promoting choice and control, 5) assessment and funding, 6) cross-sectoral support and 7) strengthening the workforce.Principal conclusionsThe findings contribute to a deeper understanding of the unique SEWB needs of Aboriginal and Torres Strait Islander peoples accessing home-based aged care services and have significant implications for current and future aged care reforms in Australia.