Research from the University of Auckland shows mental health and dementia may be two fronts in the same war - a war New Zealand may well be losing
As baby boomers get on in life, New Zealand faces a whole new range of public health problems.
The uneven age distribution of New Zealand’s population and an increasing life expectancy means more and more Kiwis are living to a ripe old age.
Fewer than 500,000 Kiwis were over the age of 65 back in 2006. Now that number is over 700,000, or more than 15 percent of the population. And the old are getting older - in 2018, just under 85,000 people were aged over 85. By 2043, this number is expected to triple.
As more of us live further into our golden years, the specific health challenges of being elderly become more and more vital to explore and solve.
Despite this, dementia remains under-diagnosed and under-researched, according to Alzheimers NZ chief executive Catherine Hall.
“The numbers of people living with dementia are increasing rapidly and they are going to continue to do so as New Zealand's population is ageing at an unprecedented rate,” she said. “There aren’t enough services for people now.”
Around 70,000 New Zealanders are affected by dementia, with that number expected to more than double by 2050.
On top of this, a report by Alzheimer’s Disease International showed 75 percent of all dementia cases worldwide (over 41 million cases) go undiagnosed, making effective support all the harder to access, meaning the number in New Zealand may in fact be higher.
Hall said if you are worried about yourself or somebody you know having dementia, it is very difficult to get a diagnosis. And if you do, it’s another battle to get the help and support you might need, and you will almost certainly experience the stigma and discrimination faced by people with dementia.
She wants to know why more attention isn’t being paid to the issue.
“The numbers are going up because we've got an ageing population - but the fact that we've got an ageing population isn't a surprise to anyone,” she said. “What is a real surprise is that we as a country are not ready for what that means.”
Dementia is the gradual loss of brain function due to physical changes to the structure of the brain - most commonly experienced by people over the age of 65, but also possible for people as young as 45.
While scientists know dementia is caused by some kind of damage to brain cells, they have yet to pin down the exact cause.
Hall says New Zealand needs to focus more on prevention and recognition of the connection between our brains and bodies.
But prevention is difficult when the causes of the disease remain murky.
Recent research from the University of Auckland may help to shed some light on how people can manage their risk of dementia.
According to the study, which looked at 1.7 million New Zealanders who engaged in government health services over 30 years, people who had been hospitalised for mental health issues had three and a half times the risk of later developing dementia than those who hadn’t.
Associate Professor Barry Milne of the University of Auckland said the fact that mental health was a stronger indicator of dementia risk than physical health was unexpected - and that any kind of mental health problem, including those outside of the oft-cited depression, can raise the risk.
“The biggest ramification is that it’s not just limited to depression,” he said. “That's where most of the research has been in the mental health to dementia connection. We’ve shown that it's across a range of mental health disorders - whether it’s mood disorders, anxiety disorders, substance abuse or psychotic disorders.”
Milne stressed that having mental health issues earlier in life did not make you a “shoo-in” for dementia, with only 6.1 percent of people in this cohort developing the disease.
However, this correlative link still serves to highlight the importance of maintaining brain health in all ways across a lifetime. Milne pointed out several factors linked to both conditions, such as alcohol abuse, physical inactivity, smoking and social isolation.
“Having mental health problems doesn’t mean you are doomed to have dementia,” Milne said. “What you can do is cut back on alcohol use, cut back on the smoking, increase physical activity, and try and get some social connectedness.”
And just as dementia is an overlooked area, mental health has proven to be a woolly beast to wrestle down in public discourse despite more attention over the past couple of decades.
The study suggests addressing the causes of the mental health crisis could potentially help New Zealand in its growing battle with dementia.
“There should be strong focus on mental health anyway, for lots of different reasons,” Milne said. “We published a paper last year that showed people with mental health problems die earlier and are more likely to have chronic health conditions.”
Studies in this area that have come before have tended to assess mental health amongst the middle-aged and older, and been restricted to a smaller range of mental health conditions.
This study, however, shows that the link is there even among young adults experiencing problems with their mental health.
This kind of research could increase public awareness and stimulate further attempts to expand our knowledge in this area - something Hall says is desperately needed.
She said the sector needed leadership and direction, as well as something done about the stigma and discrimination faced by those diagnosed with dementia.
“Often it's friends and family withdraw or treat them differently,” she said. “People can be very isolated in a time when they need the most help.”
And with social isolation being a potential cause and exacerbating factor for the disease, it’s a vicious cycle, which Hall said can be “soul-destroying” for those affected.
Her advice to anybody who knows somebody with dementia is to stay connected with them and be patient.
“They need a lot of time to think and process things,” she said. “That’s something shops and banks don’t give them.”
As the group of New Zealanders living with dementia grows, this may be something every Kiwi is forced to think about before too long.
