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Improving aged-care services in the Cook Islands

Dr Colin Patrick, a specialist psychiatrist (psychogeriatrician) visiting with the Cook Islands mental health team.

There are many current population health challenges, one of these is the challenge of ensuring suitable health care for our elderly.

For a long time, many health services around the world have known that there is a growing aged population. This is for many reasons. People mostly live longer than they used to due to the improvements in general health care. With better care there was a surge in the world population in the second half of last century and people born then are now starting to reach older age. In many communities, people have had fewer children than in the past. This has resulted in a greater proportion of our population being older.

The Cook Islands census data from 2016 indicated some 13% of Cook Islanders were over age 60 years. Based on trends elsewhere in the world, we can expect this figure to increase gradually possibly to some 20-25% of the population by 2040. This means that a larger proportion of our communities will comprise older people and a smaller proportion will comprise younger working age adults. The outcome from this results in a higher number of frail elderly and an increasing number of people suffering with conditions such as dementia especially Alzheimer’s type dementia.

Dementia is a chronic, slowly progressive condition causing changes in the brain. This condition can occur at any age but is much more common in older people. It is a significant cause of disability among people world-wide –this not only has physical, emotional and social impacts but also economic impact on carers, families and society generally.

The conditions that cause dementia produce changes in a person’s mental capacity, their personality and their behaviour. People with dementia commonly experience problems with memory and the skills required to undertake every day activities. Despite what many people think, dementia is not part of normal ageing.

Alzheimer’s disease is the most common type of dementia but the condition can be caused by a wide variety of diseases and brain injuries. People with dementia often present with forgetfulness or feeling depressed. Other symptoms may include change in control of their emotions, change in their social behaviour or loss of motivation. They may be totally unaware of these changes so don’t seek help. Family members most often notice the memory problems, changes in personality or behaviour, the confusion, perhaps unsafe wandering or incontinence. Over time, dementia results in a decline of functioning and usually interferes with activities of daily living such as washing, dressing, eating and toilet activities. This places an increasing burden on caregivers and family. There is currently no cure for dementia, however early recognition of the condition, and supportive treatment can significantly improve the quality of life for people with dementia and their caregivers.

Right now in the Cook Islands a challenge for our services is to think about what is important and what is appropriate social health care services and community-based services can be provided. People with dementia often benefit by attending day care activities in some form, which allow them to socialise with others and have some mental stimulation – there is very good evidence that this definitely slows down the dementia process. Day-care programs also allow the usual carers and family to have a regular break. Funding for home care supports can help carers to manage for longer at keeping their loved ones in the home. It is clearly best for sufferers of dementia to live in their own home environment, which is familiar to them, living with the family they know well, if this can be adequately supported.

However, at times of course there are some people with dementia who can no longer be cared for at home, so it is important that planning for longer term care options is also available.  Whilst placement of people with dementia in hospital is sometimes necessary, especially to provide respite to the families caring for them, this can only be a short-term option. I feel there is a greater need for community-based facilities for longer term care of our elderly, especially those who for a variety of reasons can no longer be safely supported at home with their families.

There also needs to be provision of education about ageing and dementia to all of our community but especially to those family members caring for people with dementia. Having a better understanding of what is happening to their loved ones will enable the whole community to better meet their care needs and help them to maintain best possible quality of life in their final years.

The changes in the population will impact significantly on healthcare services generally. The Cook Islands National Health Road Map from 2017 wisely recommended starting a process of planning what needs to be done to prepare for these changes in our communities.

Over the past two years, the local Mental Health team has been screening for dementia in the Cook Islands and is finding rates much in common with the rest of the world.   Some 24% of our elderly are presenting with dementia compared to 15% internationally, and once over age 80, some 70-80% compared to 25% internationally have dementia in some form.

Some ways of reducing your risk of dementia include:

  • Maintaining an active social life with regular conversations
  • Physical exercise
  • Healthy sleep
  • Regular stimulation of brain functioning by seeking new learning, keeping your mind active with puzzles, and quiz, singing and learning new dance moves or languages.  Or anything new!  In many ways it’s like the Maeva Nui and Cook Islands culture, choreographing new dances, new imene, and joining together in regular komakoma!  

I hope that we can create age-friendly communities that ensure quality health care for all. After all, we are all growing older and may need these services ourselves one day!  Meitaki maata e Kia manuia