Implementation and evaluation of a dementia awareness and risk reduction intervention “Brain Bootcamp Frontiers” for rural and regional older adults

Abstract

Dementia is the second leading cause of death and disease burden amongst the Australian general population, and primary cause of mortality in women aged 65 years and over. Of increasing concern, is the impact of dementia in rural and regional communities which house 28% of the Australian population. These areas experience a disproportionately high burden of dementia, with an estimated two in five people living with the condition and the remainder are up to three to five times more likely to develop dementia compared to major cities in Australia. This disparity is exacerbated by factors such as geographic isolation, economic and educational disadvantage, and accessibility challenges, which can lead to underdiagnosis and misrepresentation of dementia prevalence in these regions. Dementia has no cure, and pharmacological treatments require further research to ensure they are a safe, equitable and viable option for the population. A growing body of research has adopted a preventive lens, with evidence suggesting that about 45% of dementia cases could be prevented theoretically by addressing 14 modifiable risk factors. Given that some of these factors are currently pre-existing at higher rates in rural and regional areas (e.g., lower education, physical inactivity, obesity, excessive alcohol use, depression), there is an urgent need for targeted interventions to address modifiable risk factors within these communities. This thesis seeks to address this gap by developing, implementing and evaluating an intervention for rural and regional communities aimed at assessing and increasing dementia awareness and literacy, reducing modifiable dementia risk, and improving cognitive functioning, among older adults (aged 55 years and above) in rural and regional areas of Australia. This thesis provides critical insights into a combined approach to dementia risk reduction in rural and regional settings. It highlights the importance of combining precision dementia risk reduction - through incorporating inter-disciplinary evidence from behaviour change psychology and implementation science, and addressing modifiable risk and protective factors with specific, locally relevant and practical recommendations - hand in hand with population level risk reduction efforts to address the engrained socio-political, structural and socioeconomic inequities that persist in rural and regional communities by eliminating the likelihood of modifiable risk factors emerging. Findings reinforce the need for larger, long-term studies that objectively track behaviour change in response to such interventions to assess the sustainability of these outcomes as well as extending these dementia risk reduction efforts to underserved populations.

Date of Thesis submission	2025
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Joyce Siette (Supervisor), Kay Deckers (Supervisor) & Celia Harris (Supervisor)