# Dementia and Healthy Ageing Topic Map — Diagnosis, Support, Falls & Daily Living > **Purpose:** A practical guide to recognising dementia warning signs, navigating the diagnosis pathway, finding local support, preventing falls, understanding healthy ageing, and planning ahead. This map connects clinical information with the support systems available in New Zealand. > **Key contacts:** Alzheimers NZ 0800 004 001 | Dementia NZ 0800 467 846 | Healthline 0800 611 116 | Health NZ NASC 0800 855 066 --- ## 1. Warning Signs vs Normal Ageing: Comparison Table It is important to recognise the early signs of dementia so that a diagnosis can be sought. Early diagnosis means early access to treatment, support, and time to plan for the future. Many of these signs can also be caused by other, treatable conditions (e.g., depression, infection, medication side effects, vitamin deficiency), so a medical check is always important. | # | Warning Sign | What It Looks Like in Dementia | What's Normal in Ageing | | --- | --------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------- | | 1 | **Memory loss affecting daily life** | Forgetting recently learned information, important dates/events; asking for the same information repeatedly; relying heavily on memory aids or family for things once handled alone | Occasionally forgetting names or appointments but remembering them later | | 2 | **Difficulty with familiar tasks** | Struggling to complete routine tasks done for years — cooking a familiar recipe, managing a budget, using a phone; losing track of the steps involved (e.g., making tea) | Occasionally needing help with settings on a new appliance | | 3 | **Problems with language** | Forgetting simple words or substituting unusual words (e.g., "watch" → "hand-clock"); difficulty following or joining conversations; stopping mid-sentence | Sometimes having trouble finding the right word | | 4 | **Disorientation to time and place** | Losing track of dates, seasons, or passage of time; forgetting where they are or how they got there; getting lost on a familiar street or in their own neighbourhood | Forgetting the day of the week but figuring it out later | | 5 | **Impaired judgement** | Making poor decisions — giving away large sums of money, falling for scams, dressing inappropriately for weather; reduced ability to assess risk (e.g., leaving stove on) | Making a questionable decision from time to time | | 6 | **Problems with abstract thinking** | Difficulty understanding numbers, symbols, or concepts; struggling to manage finances — paying bills, balancing accounts; trouble following a logical argument | Finding some financial decisions challenging | | 7 | **Misplacing things and losing ability to retrace steps** | Putting things in unusual places (e.g., keys in the fridge); being unable to retrace steps to find lost items; accusing others of stealing | Misplacing things occasionally but able to retrace steps | | 8 | **Changes in mood or personality** | Rapid mood swings for no apparent reason; becoming suspicious, fearful, depressed, or anxious; becoming easily upset in unfamiliar situations | Developing specific preferences or routines; occasional mood changes with a clear cause | | 9 | **Withdrawal from work or social activities** | Losing interest in hobbies, social activities, or spending time with others; avoiding being around people due to changes they sense in themselves | Sometimes feeling tired of social obligations | | 10 | **Changes in visual perception** | Difficulty reading, judging distance, or determining colour/contrast; problems with balance or tripping over things; misinterpreting what they see (e.g., a pattern on the floor looks like water) | Vision changes due to aging — cataracts, needing reading glasses | > **Detailed source:** See `2026 - Alzheimers NZ - Web Capture - 10 Warning Signs and Booklets.md` in this folder for full descriptions of each warning sign and downloadable resources. --- ## 2. Diagnosis Pathway The diagnosis pathway in New Zealand typically follows these steps: ``` START: Concerned about memory or thinking changes │ ├─► Step 1: GP Visit │ ├─► Discuss concerns and symptoms │ ├─► GP takes medical history (including family history of dementia) │ ├─► GP checks for reversible causes (medication side effects, │ │ depression, infection, vitamin deficiency, thyroid issues) │ └─► GP conducts initial cognitive screening │ ├─► Step 2: Cognitive Screening │ ├─► Mini-ACE (Mini-Addenbrooke's Cognitive Examination) │ │ — a brief, validated 5-minute test commonly used in NZ │ ├─► GP may also use GPCOG (General Practitioner Assessment │ │ of Cognition) or MoCA (Montreal Cognitive Assessment) │ └─► Results indicate whether further assessment is needed │ ├─► Step 3: Blood Tests │ ├─► Full blood count, thyroid function, vitamin B12 │ ├─► Electrolytes, liver/kidney function, blood sugar │ └─► Rule out reversible/treatable causes of cognitive symptoms │ ├─► Step 4: CT Scan (or MRI) │ ├─► Brain imaging to check for: │ │ • Stroke damage (vascular dementia) │ │ • Brain tumours or bleeds │ │ • Brain shrinkage patterns (Alzheimer's) │ ├─► Usually arranged by GP or specialist │ └─► Not always required but common in diagnostic workup │ └─► Step 5: Specialist Referral ├─► To: Geriatrician, Old Age Psychiatrist, or Neurologist ├─► Specialist conducts comprehensive assessment ├─► May include: neuropsychological testing, further imaging, │ lumbar puncture (for biomarkers in some cases) └─► Formal diagnosis given — specific type of dementia identified ``` ### Types of Dementia Diagnosed in NZ | Type | Key Features | Approx. Proportion | Typical Progression | | --------------------------- | ----------------------------------------------------------------------------------------------- | ---------------------------------- | ------------------------------------------ | | **Alzheimer's disease** | Gradual onset; memory loss is the dominant early symptom | 50–70% of cases | Slow, progressive over 8–12 years | | **Vascular dementia** | Stepwise decline after mini-strokes; affects reasoning, planning, and speed of thinking | 15–25% | Stepwise; variable | | **Lewy body dementia** | Fluctuating cognition, visual hallucinations, Parkinson-like movement issues, sleep disturbance | 10–15% | Gradual but fluctuates | | **Frontotemporal dementia** | Early personality/behaviour changes or language difficulties; memory relatively preserved early | 2–5% | Progressive, often faster in some variants | | **Mixed dementia** | Combination of Alzheimer's and vascular changes | Very common (often underdiagnosed) | Varies | --- ## 3. Early Diagnosis Benefits Getting a diagnosis as early as possible provides significant benefits: | Benefit | What It Means | | ----------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Identify treatable causes** | Up to 10% of dementia-like symptoms have reversible causes (e.g., vitamin deficiency, thyroid problems, depression, medication side effects) — early diagnosis catches these | | **Time to plan** | Make legal and financial arrangements (EPA, will, advance care plan) while you still have capacity to make decisions | | **Access to support** | Medications, therapies, support groups, and services work best when started early | | **Medications** | Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) can stabilise symptoms or slow progression in Alzheimer's — most effective when started early | | **Lifestyle interventions** | Exercise, cognitive stimulation, social engagement, and managing vascular risk factors (BP, cholesterol, diabetes) can slow decline | | **Safety planning** | Address driving, home safety, falls risk, and wandering before they become crises | | **Family support** | Whānau can access education, carer support, and plan for care needs | | **Clinical trials** | Early-stage patients may be eligible for research studies and clinical trials | > **Source:** See `2026 - Alzheimers NZ - Web Capture - 10 Warning Signs and Booklets.md` for downloadable booklets including "Getting a Diagnosis" and "Dementia — A Guide for Families." --- ## 4. Local Support ### National Organisations | Organisation | Contact | What They Offer | | -------------------------------- | ----------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Alzheimers New Zealand** | **0800 004 001** | National body with local member organisations (Alzheimers NZ groups in most regions). Offer: helpline, education programmes, support groups, counselling, booklets and factsheets, community education, and advocacy. | | **Dementia New Zealand** | **0800 467 846** | Provider of dementia-specific services including: information and education, dementia advisory service, support groups for people with dementia and families, day programmes, and residential dementia care. | | **Healthify (Health Navigator)** | **0800 611 116** (Healthline) | Online health information at healthify.nz — comprehensive pages on dementia types, symptoms, treatments, and managing daily living. Healthline provides 24/7 nurse advice. | | **Health NZ (Te Whatu Ora)** | **0800 855 066** | Needs Assessment and Service Coordination (NASC) for accessing funded home support, day programmes, carer support, and residential care. | ### Local Organisations - **Alzheimers NZ local member organisations** — 21 local groups across New Zealand providing region-specific support, programmes, and education. Find your local group at alzheimers.org.nz. - **Dementia NZ local services** — dementia advisory services and day programmes in many regions. Check dementianz.org.nz for services near you. - **Your local DHB (now Health NZ district)** — Older Persons Health Services, Memory Clinics, and Psychogeriatric Services. - **Age Concern** — local branches offer support for older people, including those with dementia and their carers. - **Community health services** — district nursing, occupational therapy, and physiotherapy (referral through your GP or NASC). ### Booklets and Resources Alzheimers NZ offers free downloadable booklets: - **"Getting a Diagnosis"** — What to expect in the diagnostic process - **"Dementia — A Guide for Families"** — Practical advice for whānau - **"Dementia — A Guide for People with Dementia"** — Written for the person with the diagnosis - **"What is Dementia?"** — Basic information about different types of dementia - **"10 Warning Signs of Dementia"** — Early signs and what to do - **"Carer Support and Respite Care"** — Looking after the caregiver Available for download at: alzheimers.org.nz/about-dementia/booklets-and-factsheets/ > **Detailed source:** See `2026 - Alzheimers NZ - Web Capture - What is Dementia.md` and `2026 - Dementia NZ - Web Capture - Getting a Diagnosis.md` in this folder. --- ## 5. Falls Prevention Falls are the **most common cause of injury** for people aged 65 and over in New Zealand. One in three people over 65 falls each year; this rises to one in two for those over 80. Many falls are preventable. ### Risk Factors | Category | Risk Factors | | ---------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Balance & mobility** | Poor balance, muscle weakness (especially legs), reduced flexibility, gait problems (shuffling, unsteady walk), use of poorly fitted walking aids | | **Medications** | Taking **4+ medications** (polypharmacy), sedatives/sleeping pills, blood pressure meds (postural hypotension), antidepressants, antipsychotics, any recent medication change | | **Vision** | Reduced visual acuity, cataracts, glaucoma, macular degeneration, incorrect glasses, bifocals/varifocals affecting depth perception | | **Health conditions** | Dementia (increased fall risk 2–3x), Parkinson's disease, stroke, arthritis, diabetes (peripheral neuropathy), incontinence (rushing to bathroom) | | **Environment** | Loose rugs or mats, poor lighting, slippery floors, clutter, uneven surfaces, cords across walkways, lack of grab rails, poorly fitting footwear | | **Previous falls** | **Having fallen before is the strongest predictor of falling again** — even if not injured | ### Strength and Balance Exercises Simple exercises done regularly can significantly reduce fall risk: | Exercise | How Often | Benefit | | ----------------------------------------------------------- | ------------------------------ | --------------------------------------- | | **Heel raises** (stand on tiptoes, hold onto chair) | Daily, 10–15 reps | Calf strength, ankle stability | | **Sit-to-stand** (stand up from a chair without using arms) | Daily, 5–10 reps | Leg strength, functional mobility | | **Tandem stand** (one foot directly in front of the other) | Daily, hold 10–30 seconds | Balance improvement | | **Single leg stand** (hold onto chair, lift one foot) | Daily, 10–30 seconds each side | Balance and hip strength | | **Side leg raises** (stand holding chair, lift leg to side) | Daily, 10 reps each side | Hip strength, lateral stability | | **Walking** (even short, regular walks) | Daily, aim for 15–30 min | Overall mobility, cardiovascular health | | **Tai Chi** | Once or twice weekly classes | Proven to reduce fall risk by ~30% | > **Tip:** Start slowly and use a sturdy chair or wall for support. Stop any exercise that causes pain. Check with your GP before starting a new exercise programme. ### Home Safety Checks Use this checklist to identify and fix fall hazards in the home: | Area | Check For | Action | | ---------------- | ---------------------------------------------- | -------------------------------------------------------------------- | | **Floors** | Loose rugs, mats, or carpet edges | Remove loose rugs or use non-slip backing | | **Lighting** | Dim areas, no night lights | Add brighter bulbs, night lights in hallway and bathroom | | **Stairs** | Loose handrails, uneven steps, poor lighting | Fix handrails both sides, improve lighting, mark edges | | **Bathroom** | Slippery floors, no grab rails, low toilet | Install grab rails, non-slip mats, raised toilet seat, shower chair | | **Bedroom** | Path to bathroom cluttered | Clear paths, add night light, keep phone and torch by bed | | **Kitchen** | Items stored high or low, slippery floor | Keep frequently used items at reachable height, non-slip mat | | **Outdoor** | Uneven paths, moss/algae on paths, loose steps | Repair surfaces, remove moss, add handrails to steps | | **Footwear** | Slippers with no grip, ill-fitting shoes | Wear well-fitting shoes with non-slip soles — avoid walking in socks | | **Walking aids** | Worn tips, wrong height, poorly maintained | Check and replace rubber tips annually, get professionally fitted | | **Pets** | Pet that moves underfoot | Be aware, consider a bell on collar, keep pathways clear | > **Detailed source:** See `2026 - Health NZ - Web Capture - Fall Prevention.md` in this folder for comprehensive fall prevention advice. --- ## 6. Healthy Ageing — Body System Changes Ageing involves gradual changes to the body and mind. Some changes are a normal part of growing older, while others may signal an underlying health condition. ### Cardiovascular System | Normal Ageing | When to See a Doctor | | ---------------------------------------------------------------------------- | ---------------------------------------------------------------------------------- | | Blood vessels stiffen → blood pressure (especially systolic) rises gradually | New or worsening chest pain, tightness, or discomfort | | Heart wall thickens slightly; maximum heart rate during exercise decreases | Shortness of breath with minimal activity or at rest | | Takes longer for heart rate to return to normal after activity | **Dizziness or fainting** — especially when standing up (fainting is never normal) | | | Swollen ankles or legs not related to known injury | | | Blood pressure consistently above 140/90 mmHg | ### Bones, Joints and Muscles | Normal Ageing | When to See a Doctor | | ---------------------------------------------------------------------------------- | --------------------------------------------------------------- | | Bone density loss (especially women after menopause) → increased osteoporosis risk | Sudden or severe joint pain after a fall or injury | | Joint stiffness and cartilage thinning; some mild aching after activity | Joint swelling, redness, or warmth | | Muscle loss (sarcopenia) → reduced strength and balance | Morning stiffness lasting longer than 30 minutes | | Height loss of 2–5 cm over lifetime | Difficulty standing from a chair without using arms | | Slower reaction time and movement | **A fall** (even if not injured) | | | Loss of >2–3 cm height in short period; curved spine (kyphosis) | ### Digestive System | Normal Ageing | When to See a Doctor | | ---------------------------------------------------------------- | ------------------------------------------------------------- | | Slower digestion, reduced stomach acid production | Unexplained weight loss | | Constipation becomes more common (slower bowel motility) | Blood in stool or black/tarry stools | | Reduced sense of taste and smell (food may seem less flavourful) | Difficulty swallowing (dysphagia) | | | Persistent diarrhoea or constipation (change in bowel habits) | | | Severe abdominal pain | ### Brain and Nervous System | Normal Ageing | When to See a Doctor | | ---------------------------------------------------------- | ------------------------------------------------------------------------------- | | Slower processing speed — takes longer to learn new things | **Memory loss that disrupts daily life** (see Warning Signs section above) | | Occasional word-finding difficulty | Getting lost in familiar places | | Mild decline in multitasking ability | **Sudden** confusion, speech problems, or weakness (signs of stroke — call 111) | | Reduced dexterity and coordination | Tremors that interfere with daily activities | | | Significant personality changes | > **Detailed source:** See `2026 - Healthify - Web Capture - Ageing What is Normal.md` in this folder for comprehensive information on all body systems. --- ## 7. Future Planning — Key Documents and Actions Planning ahead is especially important after a dementia diagnosis, while the person still has capacity to make decisions. ### Key Planning Documents | Document | Purpose | When to Do It | Where to Get Help | | ----------------------------------------------- | ------------------------------------------------------------------------ | ---------------------------------------------------------------- | ------------------------------------------------------------------------------------------ | | **Enduring Power of Attorney (EPA)** — Property | Appoint someone to manage your finances if you lose capacity | **As soon as possible** — requires capacity to create | Office for Seniors (EPA forms), lawyer, Public Trust 0800 371 471 | | **EPA — Personal Care & Welfare** | Appoint someone to make health and living decisions if you lose capacity | **As soon as possible** — requires capacity to create | Same as above — both EPAs should be done together | | **Advance Care Plan** | Record your wishes for future health care and treatment | While you can still think clearly about your preferences | Your GP, Healthify (advancecareplanning.org.nz), hospice | | **Will** | Decide who inherits your property and assets | **Before diagnosis or early in the journey** — requires capacity | Lawyer, Public Trust 0800 371 471, Community Law | | **Driving assessment** | If dementia affects driving ability — safety concern | After diagnosis — discuss with GP | Your GP, NZ Transport Agency (onroad safety test), occupational therapy driving assessment | > **Important:** Once capacity is lost, you cannot create an EPA, change your Will, or make certain legal decisions. Plan **early** while you still can. ### Driving and Dementia - Dementia significantly affects driving ability — reaction time, judgement, navigation, and hazard perception are all impaired - **It is a legal requirement** to inform the NZ Transport Agency (Waka Kotahi) if you have a condition that may affect your ability to drive safely - The GP will assess fitness to drive and may recommend an **on-road driving assessment** through an occupational therapy driver assessor - Many people with early dementia stop driving voluntarily; for others, family or the GP may need to have a difficult conversation - Alternatives: Total Mobility transport scheme (subsidised taxis), community transport services, family support **Related resource:** See `06_Legal_and_Financial_Planning/2026 - Office for Seniors - Web Capture - Creating an EPA.md` for complete EPA guidance. --- ## 8. Transitioning into Residential Care Moving into residential care is a significant decision. For people with dementia, this is often necessitated by safety concerns, caregiver burnout, or increasing care needs that can no longer be met at home. ### When to Consider Residential Care - Safety concerns (wandering, falls, leaving stove on, unable to manage medications) - Caregiver exhaustion or health problems — carer cannot continue - Care needs exceed what home support services can provide - Behavioural and psychological symptoms of dementia (agitation, aggression) that are difficult to manage at home - 24-hour nursing care required - The person with dementia is no longer safe or happy at home ### Transition Checklist | Step | Action | Who Helps | | ---- | ------------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------------- | | 1 | **NASC assessment** — arrange a needs assessment through your local NASC (0800 855 066) | GP, hospital discharge team, or self-referral | | 2 | **Funding approval** — determine eligibility for Residential Care Subsidy (RCS) through Work and Income (0800 552 002) | Work and Income, NASC coordinator | | 3 | **Choose a facility** — visit potential rest homes/dementia units; consider location, level of care, staff-to-resident ratio, activities, cultural fit | Eldernet.co.nz, Health NZ certified provider list | | 4 | **Trial stay** — short-term respite or trial stay before permanent move | Chosen facility, NASC coordinator | | 5 | **Plan the move** — personalise the room, prepare the person, involve family | Facility staff, family/whānau | | 6 | **Settle in** — regular visits, monitor adjustment, communicate with staff | Family, facility staff, GP | > **Related resources:** See `02_Aged_Residential_Care/` folder for: `2026 - Health NZ - Topic Map - Aged Care Assessment and Audit Pathway.md` (end-to-end pathway), `2026 - Health NZ - Web Capture - Residential Care Overview.md` (care levels and options). --- ## 9. Cross-Links | Folder / Topic | Relevant Resources | | ---------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **06 Legal and Financial Planning** | `2026 - Office for Seniors - Web Capture - Creating an EPA.md` — Setting up EPA while you have capacity. `2026 - Legal Planning Topic Map - EPAs Capacity Wills and Protection.md` — Full legal planning guide. | | **08 Elder Abuse and Advocacy** | `2026 - Elder Abuse Topic Map - Warning Signs Financial Abuse and Help Pathways.md` — People with dementia are at higher risk of abuse — recognise warning signs and know reporting pathways. `2026 - Age Concern NZ - Web Capture - Elder Abuse Information.md` — Abuse information and support. | | **04 Home Care and Community Support** | `2026 - Health NZ - Web Capture - Home Support Services.md` — Personal care, home help, day programmes, and carer support that can delay or prevent residential care. | | **05 Funding and Subsidies** | `2026 - Older Person Financial Support Map.md` — Financial support options including RCS, Accommodation Supplement, Disability Allowance. `2026 - Work and Income - Web Capture - Residential Care Subsidy.md` — Detailed RCS information. | | **02 Aged Residential Care** | `2026 - Health NZ - Topic Map - Aged Care Assessment and Audit Pathway.md` — End-to-end pathway from NASC assessment to choosing a provider. `2026 - Health NZ - Web Capture - Residential Care Overview.md` — Levels of care and provider certification. | | **13 Consumer Guides** | Consumer navigation guide — where older New Zealanders and whānau should look first for help on any topic. | | **07 Dementia and Health (this folder)** | All web captures: `2026 - Alzheimers NZ - Web Capture - 10 Warning Signs and Booklets.md`, `2026 - Alzheimers NZ - Web Capture - What is Dementia.md`, `2026 - Dementia NZ - Web Capture - Getting a Diagnosis.md`, `2026 - Healthify - Web Capture - Alzheimers Disease.md`, `2026 - Health NZ - Web Capture - Fall Prevention.md`, `2026 - Healthify - Web Capture - Ageing What is Normal.md`. |