Most Australians are familiar with dementia as a term encompassing several disorders characterized by declines in memory, language, and cognitive function. However, recent data reveals a more alarming reality: dementia has become the leading cause of death in Australia.
According to the Australian Institute of Health and Welfare, dementia claimed the lives of 17,400 Australians in 2023, accounting for 9.5% of all deaths. Furthermore, it was an associated factor in an additional 15,000 deaths, categorized as dying with dementia. Experts suggest that these figures might be underreported due to common inaccuracies in death certificates.
Understanding Dementia’s Fatal Progression
Dementia is a neurodegenerative condition marked by the progressive death of brain cells. Alzheimer’s disease, the most prevalent form, represents 60–70% of all dementia cases. Individuals with dementia experience cognitive declines that disrupt daily life, including memory loss, communication difficulties, and impaired thinking. Additionally, mood, behavior, and personality changes are common.
As the disease advances, brain cell loss extends to critical areas such as the brainstem, responsible for vital functions like breathing and swallowing. This progression can directly cause death or lead to fatal complications.
Secondary Complications and Their Lethal Consequences
In the later stages of dementia, swallowing difficulties can result in severe complications. Inhalation of food or liquid into the lungs may cause bacterial infections like aspiration pneumonia. A 2019 review of 19 studies indicated that people with dementia have twice the risk of dying from pneumonia compared to those without the condition.
Pneumonia accounted for over 29.69% of dementia-related deaths, and autopsy-confirmed cases showed this figure could be as high as 49.98%.
Swallowing issues can also lead to dehydration, weight loss, and malnutrition, exacerbated by appetite loss, further weakening the immune system. Consequently, individuals with dementia are more susceptible to infections like pneumonia or the flu, which often result in complications.
Urinary tract infections (UTIs) are another concern, stemming from incontinence and hygiene challenges. Communication difficulties may prevent early detection of these infections. If untreated, infections can progress to sepsis, a severe response where the body attacks its own tissues, potentially leading to septic shock, organ failure, and death.
Beyond infections, dementia increases frailty, impairing balance and coordination and doubling the risk of falls. Such incidents often lead to severe outcomes, including fractures, hospitalization, and even death.
The Role of Age and Coexisting Conditions
Age is the most significant risk factor for dementia. Among Australians aged 30–59, only one in 1,000 have dementia, but this figure rises dramatically to 210 in 1,000 for those aged 85–89. Older individuals often face additional age-related health issues like heart disease, diabetes, and hypertension, which dementia can exacerbate, leading to further complications such as strokes or heart attacks.
In 2023, the leading causes of death among those who died with dementia included heart disease (over 1,900 deaths), stroke (almost 1,500 deaths), COVID-19 (around 1,200 deaths), accidental falls (almost 1,100 deaths), and diabetes (around 1,000 deaths).
Preventive Measures and Future Outlook
Without medical breakthroughs, the number of Australians living with dementia is projected to exceed one million by 2065, partly due to the aging population. However, dementia is not an inevitable part of aging.
The Lancet Commission on dementia has identified 14 modifiable risk factors, including less education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol consumption, social isolation, air pollution exposure, and vision loss.
Addressing these factors could prevent up to 45% of dementia cases, potentially allowing individuals to live longer and healthier lives.
Efforts at both individual and governmental levels are crucial to mitigating these risks. As the nation grapples with this growing health crisis, understanding dementia’s complexities and implementing preventive strategies remain vital to improving public health outcomes.
