Ageing of nineteenth-century Australia resulted in increasing asylum admissions of older people with dementia. Dementia prevalence in the colonial population is estimated to have increased from eight hundred in 1861 to nine thousand in 1901. Dementia diagnosis had broader usage in the lunatic asylums than in current practice. Examination of medical casebooks from three asylums found 50–60% concordance with current dementia diagnoses. Lunatic asylums were reluctant to admit people with dementia but lack of alternatives for those with challenging behaviour, inability to self-care, and with limited or no family support meant admissions increased. Dementia care in benevolent asylums focused on those who were cooperative. Quality of dementia care was poor with badly designed built environments, few trained staff, and high use of restraints.
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