The dementia affected community would benefit from a shift in focus, from clinical diagnosis to the broader recognition and management of cognitive impairment and decline, says Michael Perkins, in this reflection on his impressions and learning from the two-day National Dementia Conference 2023 that took place in Melbourne in June 2023.
For me, the most notable statement of the conference was ‘Most of the consequences of a dementia diagnosis are non-medical’. While collaborative, multi-disciplinary approaches are readily applied to the medical consequences of dementia, there was no counterpart support offered for the non-medical consequences of a dementia diagnosis. When I raised this issue, the reply was that this is a difficult issue we are not funded to address.
I believe the dementia-affected community would benefit from a shift in focus, from clinical diagnosis to recognition and management of cognitive impairment and decline. This includes extending to all professions engaging with clients as they age, an appreciation of and appropriate common practices dealing with:
- Evaluating the competence of a person to instruct or engage with a supplier or professional
- Practicing the National Decision Making Principles
- Documenting the will and preference of a person for their care, wealth conservation, estate governance and administration and succession.
- Establishing cognitive responsive, values based care plans in conjunction with the appointment of personal representatives.
Reflections As a Delegate
My introduction to this annual conference started in 2022 when Jane Lonie and I were asked to speak about our work in dealing with evaluating decision making ability and cognition.
My purpose of attending as a delegate this year was to evaluate how the dementia support community attending the conference had evolved since last year and to learn more about the community and how our firm may constructively work with dementia community members.
When describing the steps taken to manage the post-diagnosis medical issues. I was none the wiser from the speakers about best practices for dealing with non-medical issues post-diagnosis, let alone the role of lawyers as first responders to a dementia diagnosis and the role they could or should have in dealing with the post-diagnosis phase of dementia.
The conference included interesting medical research sessions that demonstrated how early intervention with cognitive therapies can mitigate the impact of dementia.
There was also discussion of the emerging range of non-pharmacological therapies that can assist a person post-diagnosis.
Mitigating dementia risk factors in the pre-diagnosis phase of dementia was introduced and well explained.
There was no discussion of how the services being demonstrated could be assessed for impact by using the state-based human services outcomes frameworks in force across the country.
There was, in contrast, much talk of using audio-visual stimulation to support the dementia-affected person and their carers. This is an emerging area of service that is moving into home, community and facility-based care situations.
Personal conclusions
Non-medical professionals such as lawyers and financial planners were underrepresented at this conference.
Dementia Training Australia, an organisation with the remit for workforce training on dealing with dementia, has no funding or focus on dementia-responsive training for the wider community of professionals.
Whilst there is interest in the idea of early intervention in cognitive management pre-diagnosis, there is no funding or policy focus that I could discern.
There was little interest in discussing how the legal profession could help provide better outcomes for those with dementia.
ISO 44001 processes will have a valuable role in managing multi-disciplinary teams across all professional groups in dealing with the pre-diagnosis and post-diagnosis phases of dementia.
There is no overarching alignment of State and Federal resources to the Care Economy focus of government presented at the conference.
There was no competitive approach for behaviour-based decision-making evaluation to that as implemented by Autonomy First.
Advocating for the implementation of the National Decision-Making Principles in professional practice generally drew interest in conversation but was not part of the conference agenda.
Giving voice and support for the will and preference of the person under care was well advocated. There remains the issue of discerning strategies for high-stakes and low-stakes decisions against which the Lonie 5 Factor Framework for behaviour based decision making ability evaluation remains applicable for managing the decision making ability of a person.
There was no pathway I could discern for recognising innovation in professional practice in dealing with dementia pre- and post-diagnosis by non-medical professionals.
Dementia-focused policy remains tarred with the National Health Priority brush. Policy focus on non-medical outcomes seems to be a policy vacuum, yet to be resolved.
Final thoughts
Attending this conference was a worthwhile exercise in benchmarking our work in continuing to operate as a cognitive responsive law firm.
The Lonie 5 factor framework retains its validity for dealing with the consequences of cognitive decline in both the pre and post diagnosis phases of dementia.
We have the opportunity to continue to apply the work of the firm directly and in conjunction with a range of financial services and accounting firms. Business System level collaboration should guide the execution of this work.
Steady as she goes seems to be the guiding thought coming out of the conference. The validity of our work is clear, we just need to build adoption and utilisation.
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