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The article presents several research studies related to the field of clinical medicine in Australia. One of these studies entails the prognosis of Obstructive Sleep Apnea (OSA) which is a chronic disease affecting Veteran populations using the Flinders Chronic Disease Management Program. Another is a study on the strategies used in reducing cognitive impairment associated with sedative and anticholinergic agents among older people with dementia. Models of care for OSA are also being studied.

While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and because of that, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Background: Depression is common among people with dementia. Despite most people with dementia living in the community, there have been few investigations of self‐reported depressive symptoms and suicidal ideation among community‐dwelling people with dementia in Australia. This study aimed to explore the proportion of people with mild, moderate and severe levels of depressive symptoms, and suicidal ideation among a sample of people living with dementia in Australia. Correlates of reporting depressive symptoms were also explored. Methods: Adults diagnosed with dementia by a medical professional who were English speaking and community‐dwelling were asked to complete a paper and pencil survey. Those who were unable to provide independent consent were excluded. Depression was assessed using the Geriatric Depression Scale −15, and suicidal ideation was assessed using two study‐specific items. Multivariable analyses examined quality of life, unmet needs and sociodemographic factors associated with having a score of five or more on the Geriatric Depression Scale‐15. Results: Ninety‐four people participated in the study. Thirty‐seven percent (n = 35) reported some level of depressive symptoms, with most of these (21%, n = 20) classified as having mild depressive symptoms. Five participants (5%) reported they had had thoughts of being better off dead or hurting themselves, while three (3%) reported having had a plan to end their life. For each additional unmet need, the odds of being depressed increased by 25%(P < 0.001). For each point increase in quality of life, the odds of being depressed decreased by 48% (P < 0.001). Conclusions: The high proportion of people with dementia who report depressive symptoms suggests the need to routinely assess depressive symptoms among this group. There may also be benefits in assessing unmet needs and addressing these where possible as part of an approach to reducing depression among people living with dementia in the community. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

This article argues the voice of people with dementia was missing from the Australian Royal Commission into Aged Care Quality and Safety (RCAC) Final Report. This absence was notwithstanding that the RCAC was explicitly tasked to inquire into dementia care. The RCAC Final Report is shown to marginalise the perspective and experience of people with dementia in the aged care system at the same time as prioritising substitute voices of experts, advocates, family and care partners. This absence of voice repeats and re-inscribes framing of people with dementia as "missing persons". Where people with dementia face practical and legal barriers to participate in civic and legal processes, the RCAC failed to adjust its methodologies to ensure their voices were "heard". The RCAC's re-inscription of marginalisation of people with dementia raises concerns for the legitimacy and success of its recommendations for dementia aged care reform. [ABSTRACT FROM AUTHOR]

Australians want to live at home as they age and seek support from health and social care services to achieve this. The consumer driven market‐based approach to community services in Australia has resulted in an increases in user's expectations of quality. What constitutes a quality service from the consumer's perspective is an important agenda to understand as the focus of care delivery moves to the domiciliary setting. This paper presents one aspect from a grounded theory PhD study, the aim of which was to understand the lived experience of receiving services in the home and its impact on the meaning of home. Participants were 11 people with dementia and 18 family supporters living in the state of Victoria, Australia. Data were collected between 2015 and 2017 through multiple interviews, photographic images, field notes and memos. NVIVO 10 qualitative analysis software program was used to support constant comparative analysis. Using a grounded theory approach, this study found that the decision to engage with community services was driven by the need to maintain autonomy, self‐identity and home life. Participants sought quality services but discovered a dichotomy of positive and negative aspects in the way services were delivered. The most common reaction to the experience of poor‐quality care was to reflect on their expectations for care quality; and manage the reality of what was delivered. Team work and service responsiveness were positive characteristics but were offset by service limitations and inefficiencies caused by poor communication and poor staff retention. The interpersonal relationships that participants developed with staff was highlighted; trust was an important factor whereas unreliable, task orientated and poorly trained staff would be rejected. The implications for policy and practice are described. [ABSTRACT FROM AUTHOR]

This paper explores the possibility of reparations for harms suffered by people in residential aged care, focusing on experiences of people with dementia. We first explain how systemic and structural harms occur within residential aged care and outline how they constitute human rights violations. Using Australia as a case study, we then consider the limitations of court-based approaches to pursuit of redress and the current absence of redress from policy responses. We then propose an expansive and multifaceted notion of redress as reparations, where governments, residential aged care operators, medical and legal professionals, and civil society engage in ongoing recognition of harms and specific actions to prevent recurrence. By drawing on the United Nations Convention on the Rights of Persons with Disabilities and the Van Boven Principles, we consider the application to aged care of the framework of access to justice and reparations for human rights violations. This framework encompasses inclusive and accessible processes to access reparations for individuals in such forms as compensation and rehabilitation, and collective reparations, including apologies and public education. In order to ensure that reparations support the prevention of further harm in aged care, the design of redress could form part of broader government strategies directed toward increasing funding and access to community-based support, care, and accommodation, and enhancing the human rights of people with dementia. [ABSTRACT FROM AUTHOR]

This paper responds to growing concerns in human rights practice and scholarship about the confinement of people living with dementia in care homes. Moving beyond the existing focus in human rights scholarship on the role of restrictive practices in confinement, the paper broadens and nuances our understanding of confinement by exploring the daily facilitators of confinement in the lives of people with dementia. The paper draws on data from focus groups and interviews with people living with dementia, care partners, aged care workers, and lawyers and advocates about Australian care homes. It argues that microlevel interrelated and compounding factors contribute to human rights abuses of people living with dementia related to limits on freedom of movement and community access of people living with dementia, at times irrespective of the use of restrictive practices. These factors include immobilization and neglect of residents, limited and segregated recreational activities, concerns about duty of care and liability, apprehension of community exclusion, and pathologization and subversion of resistance. It is necessary to challenge the organizational, cultural, economic, and social dynamics that shape day-to-day, microlevel, routine, and compounding factors that remove the agency of people living with dementia and in turn facilitate entrenched and systematic human rights breaches in care homes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to to describe development of a framework for use in the evaluation of the effectiveness of signage to assist people with dementia. Design/methodology/approach: The study consisted of two parts. Workshops held in both Sydney and Edinburgh using "world café" methodology with 28 knowledgeable participants produced a pool of statements. These were subsequently used in a three-round Delphi process administered to 38 participants in order to generate ideas and develop consensus content for a signage evaluation framework. Findings: This process resulted in a framework consisting of Delphi statements which had a 70 per cent level of agreement and a series of prompt questions. Both intrinsic factors and wider environmental, extrinsic factors in signage for wayfinding were identified. Research limitations/implications: Limitations of this study were the small number of participants, including only four people with dementia, and the unresolved problems inherent in designing signage that may simultaneously be universally relevant and readily understood, yet meets the idiosyncratic needs of each individual living with dementia. Originality/value: As there is little prior work in this field concerning signage use by people with dementia, this framework provides an original preliminary tool that may be used in further research on evaluating signage effectiveness. In designing signage and testing its effectiveness, it was concluded that the direct involvement of people with dementia is essential. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints. Methods: A hybrid discrete event simulation was developed to predict costs borne in Australia for people with dementia from 2015 to 2050. The costs captured included community-based care, permanent and respite residential aged care, hospitalisation, transitional care, pharmaceuticals, aged care assessments, out of hospital medical services and other programs. Results: The costs borne for people with dementia in Australia are predicted to increase from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices, ceteris paribus. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. Conclusions: This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia. What is known about the topic?: With the aging of the Australian population, the number of people living with dementia is predicted to rise markedly in the next four decades. As the number of people living with dementia increases, so too will the financial burden these debilitating and degenerative diseases place on private and public resources. These increases are likely to challenge the efficiency and sustainability of many health systems in the developed world. What does this paper add?: This research provides a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints (i.e. where the supply of resources does not meet demand). The model predicts an increase in costs for people with dementia from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. What are the implications for practitioners?: This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia. [ABSTRACT FROM AUTHOR]

Aim: To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. Design: This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. Methods: Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. Results: A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. Conclusion: Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real‐time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision‐making in clinical practice. Impact: Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence‐based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. Reporting Method: The study adheres to the CONSORT reporting guidelines. Patient or Public Contribution: One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. Trial Registration: Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820). [ABSTRACT FROM AUTHOR]

One of the most difficult challenges associated with an ageing population will be a significant increase in the number of people living with dementia. In Australia, this number is estimated to triple by 2050; a situation that is reflected globally. This will place increased demands on health and long-term care providers but it should also force an examination of the ability of contemporary cities to facilitate or constrain inclusion. Globally, designers and students of this discipline are contributing their skills to the challenge of dementia but solutions are typically proposed at a product, institutional or suburban scale. This paper will present two propositional projects, created using a speculative design methodology within a design studio at The University of Melbourne, that provoke architects to more seriously interrogate what it means for a city to support social inclusion, independence and choice for those who are ageing in place. These projects illuminate new avenues for critical and necessary research. This paper will begin with a reflection on the limitations of the Hogeweyk Dementia Village (Amsterdam), considered the current gold standard in dementia design, to highlight the value of thinking speculatively within the context of dementia; to disrupt the limitations of contemporary design thinking and ask what role the architect can play in improving the lives of those living with dementia? [ABSTRACT FROM AUTHOR]

Introduction: With an aging population and a growing prevalence of people living with dementia, the demand for best-practice dementia care in general practice increases. There is an opportunity to better utilise the nurse role within the primary care team to meet this increasing demand in the provision of care for people living with dementia. However, general practice nurses have limited knowledge in the provision of best-practice care for people living with dementia and their carer(s). A number of best-practice dementia care recommendations contained in the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia have been identified as highly relevant to the role of the general practice nurse. Aims: To explore general practice nurses' perspectives on published best-practice dementia care recommendations relevant to their role and identify barriers and facilitators to their implementation into clinical practice. Methods: Thirteen Australian general practice nurses took part in this qualitative interview study. The research questions for this study were addressed within a paradigmatic framework of social constructionism. Data were transcribed verbatim and thematically analysed. Results: There was a high level of agreement between general practice nurses that the recommendations were important, reflected best-practice dementia care and were relevant to their role. However the recommendations were perceived as limited in their usefulness to nurses' clinical practice due to being too vague and lacking direction. Four main themes were identified describing barriers and facilitators to operationalising best-practice dementia care.: creating a comfortable environment; changing approach to care; optimising the general practice nurse role and working collaboratively. Nine sub-themes were described: physical environment; social environment; complexity of care; care planning for the family; professional role and identity, funding better dementia care, education, networking and resources; different roles, one team; and interagency communication. Conclusion: This study identified several factors that need addressing to support general practice nurses to integrate best-practice dementia care recommendations into daily clinical practice. The development of interventions needs to include strategies to mitigate potential barriers and enhance facilitators that they perceive impact on their delivery of best-practice care for people living with dementia and their carer(s). The knowledge gained in this study could be used to develop multi-faceted interventions informed by theoretical implementation change models to enable the general practice nurse to operationalise best-practice dementia care recommendations. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to confirm the content validity of the domains identified during the development of the Alzheimer's disease – five dimensions (AD-5D) algorithm for the quality of life – Alzheimer's disease (QOL-AD) and to identify the rationale for stated quality of life preferences. Methods: Focus groups were conducted to elicit the priorities for quality of life in dementia from three perspectives: the person with dementia; family caregivers; and the community. Participants were recruited through industry research partners (long-term care providers) based on knowledge of their experience with dementia. Three focus groups were conducted – one each in Brisbane, Sydney and Adelaide, Australia – between November 2016 and February 2017. Each focus group included participants providing a different perspective on dementia – people with dementia (n = 3), caregivers (n = 9) and general community members or relatives of residents of a long-term care facility (n = 10), although some groups contained one participant with a different perspective. The focus groups were used to validate the AD-5D domains and examine quality of life preferences across the three perspectives. Thematic analysis was used to identify the priorities underlying preference selection. Results: All activities affecting the quality of life for people with dementia could be mapped to one of the five AD-5D domains: memory, mood, physical health, living situation and ability to do things for fun. The domains considered most important for quality of life differed between people with dementia, their caregivers and members of the community, with memory the least important domain for all three groups. The rationale for priorities also varied between groups. Conclusions: This study confirmed the content validity of the selection of the AD-5D domains and identified multiple differences in the reasons behind stated priorities for quality of life for people with dementia, their caregivers and community members. [ABSTRACT FROM AUTHOR]

Aims: To explore stakeholders' perceptions of a facilitator's role in supporting carers when embedding iSupport for Dementia psychoeducation program, in care services. Methods: A qualitative descriptive study design was applied. Data were collected from workshops and interviews with carers of people living with dementia (PLWD)and with health and social care professionals from two tertiary hospitals and two community aged care organisations across three Australian states between October 2021 and March 2022. A thematic analysis was used to analyse data. The COREQ guideline was followed to report our findings. Results: A total of 30 family carers and 45 health and social care professionals participated in the study. Three main themes and seven subthemes were identified from the data. We described the main themes as (1) the facilitator's role at the time of dementia diagnosis, (2) the facilitator's role throughout the everyday dementia care journey and (3) the facilitator's role during transition moments. Conclusions: Caring for family members with dementia is demanding and stressful for carers. Embedding a facilitator‐enabled iSupport for Dementia program in hospital and community aged care settings has the potential to mitigate sources of stress associated with care recipient factors, carer factors and care service factors, and improve the health and well‐being of carers and those for whom they care. Relevance to Clinical Practice: Our findings will inform the establishment of iSupport facilitators appointed by dementia care providers in hospital and community care settings and help determine their roles and responsibilities in delivering the iSupport program. Our findings relate to nurse‐led and coordinated dementia care in hospital and community aged care settings. Patient or Public Contribution: This study was co‐designed with stakeholders from two aged care organisations and two tertiary hospitals. The study participants were staff employed by these organisations and carers of PLWD who were service users. [ABSTRACT FROM AUTHOR]

Research involving people with dementia has been flagged as a key priority by Alzheimer's International. Dementia has been an Australian National Health Priority since 2005, yet there are no clear guidelines for seeking and obtaining informed consent from people with dementia to participate in observational research. Informed consent is an ethical requirement for the conduct of research involving humans. Although many people with dementia are able to express a desire to be involved in research, the insidious progression of the disease reduces a person's ability to understand and appreciate the consequences of involvement. This paper explores the author's journey of seeking and obtaining informed consent for a mixed methods study which involved the observation of older people with dementia. [ABSTRACT FROM AUTHOR]

The article presents a study on the effectiveness of community-based occupational therapy on the daily functioning of people with dementia in Australia. The study found that participants receiving the therapy had better outcomes than those who did not. In addition, caregivers for this therapy achieved higher competence scores than those in a control group. The study suggests outcome measures that may be sensitive and adaptable enough for clinical use for dementia patients and their caregivers.

Objectives: This systematic review and meta‐analysis aimed to examine non‐pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. Methods: The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non‐RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta‐analysis. Results: The systematic review and meta‐analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta‐analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of −1.36 (95% confidence interval: −1.84 to −0.89, p < 0.001) and on self‐feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta‐analysis, these interventions had no effect on improving the nutritional status of people with dementia. Conclusions: None of the included RCTs met the Cochrane risk‐of‐bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions. [ABSTRACT FROM AUTHOR]

Carers of people with dementia experience significant physical, emotional, and social burdens. Needs assessment can provide important information to assist services in providing support to carers to reduce these burdens. However, few studies have examined the prevalence of unmet needs experienced by carers of people with dementia using a quantitative instrument. This study aimed to examine the prevalence and type of unmet needs experienced by carers of people with dementia in Australia. This was a cross-sectional survey of carers providing support to community-dwelling individuals living with dementia. Carers were recruited through geriatric clinics, aged care providers, support services and community organisations. Consenting carers completed a survey including an 80-item study-specific unmet needs instrument for carers (UNI-C) and sociodemographic characteristics. Descriptive statistics were used to identify the most prevalent unmet needs reported by carers. A total of 169 carers (response rate 47%) completed the survey. Most (87%) carers reported at least one unmet need. Carers reported a median of 16.0 (IQR = 24.0; max = 58) out of a possible 80 unmet needs. The most frequently endorsed unmet needs spanned a range of areas including emotional wellbeing, accessing health and aged care services, managing apathy, and finding information. This study highlighted that a large proportion of carers experience unmet needs associated with caring for someone with dementia. Developing and rigorously testing interventions to meet carers' commonly reported unmet needs are warranted. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2053833. [ABSTRACT FROM AUTHOR]

Background and objectives: Global migration and an increased life expectancy led to a growing number of people with dementia from Culturally and Linguistically Diverse (CaLD) backgrounds living in long‐term residential care settings. These minority groups' wellbeing may be negatively impacted due to poor culturally appropriate care that fails to honour valued cultural traditions. This study considered culturally appropriate dementia care for older adults with an Indian heritage living in Sydney‐based residential aged care facilities. Research design and methods: The Nominal Group Technique was employed to collect data from three groups of stakeholders of Indian heritage over a period of 6 months: care staff (n = 8), family of residential care recipients (n = 8), and community‐dwelling older adults (n = 7). Results: Perspectives highlighted six concepts for consideration: (1) embracing a person‐centred approach to promote culturally appropriate dementia care; (2) training staff in culturally appropriate forms of respect; (3) the impact of staff ratios on care; (4) the importance of familiarity to meaningful engagement; (5) the importance of food; and (6) the necessity of engaging family and the wider Indian community in residential care activities. Conclusions: Culturally appropriate dementia care for older adults with an Indian heritage is an area in need of further development. To ensure that residents with an Indian heritage are respected as an ethnic minority, it remains crucial that research is generated to inform policy development on each CaLD group as a separate entity. [ABSTRACT FROM AUTHOR]

Objective: To examine the language of the behaviour assessment in the new Australian National Aged Care Classification (AN‐ACC) funding instrument. We explored whether the (BRUA) will support an inclusive and progressive approach for people living with dementia in residential aged care. Methods: Databases were searched to identify publicly available literature relating to the development of the AN‐ACC and BRUA, and hand searches of reference lists and selected websites were completed to identify additional grey literature, dementia language and best practice guidelines. Criteria for language use were extracted and compared with the BRUA in the light of the current national aged care reform agenda, as well as research with and perspectives of people with lived experience of dementia. Results: The language within the BRUA did not align with international dementia language guidelines, and the content presented was disrespectful to those with lived experience. The assessment appears inconsistent with international best practices and is potentially discriminatory within the aged care cohort. Conclusions: The BRUA is intended as a funding instrument and not as a care planning tool, yet the negative representation of the lived experience of people with dementia embedded within a mandated assessment is likely to influence industry practice by condoning unsuitable language and attitudes amongst assessors, providers and staff. For better alignment with the current positive agenda for aged care reform in Australia, we recommend continued review and updating of this tool to avoid unintended consequences. [ABSTRACT FROM AUTHOR]

The article offers news briefs dementia care. Topics include Department of Health has issued a seventh edition of its ‘National COVID-19 Aged Care Plan; the Senate Select Committee tasked with reviewing the Federal Government's response to COVID-19 published an interim report; and s the mental health impact of COVID-19 on people living with dementia, their families and carers in Australia.

The article discusses published dementia research from Australia and worldwide. Researchers from the University of New South Wales have investigated the question of what happens when a person with dementia changes general practitioner upon entry to a residential aged care facility specifically in terms of the medicines they are prescribed, in particular psychotropic medicines. It also discusses increasing continuity of GP care to improve treatment and quality of life for dementia patients.

Background: The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is increasingly being used to assess residential aged care workers' knowledge and attitudes about palliative care for people with dementia. The qPAD developers performed an exploratory factor analysis and assessed the internal consistency using a small sample. Aim: The aim of this study was to further assess the structural validity of the qPAD using a large sample of qPAD responses from staff who work in residential aged care homes in Australia. Methods: Data from 727 care staff who participated in an Australian dementia palliative care training project were used for exploratory factor analyses, assessment of internal consistency, and confirmatory factor analysis of the knowledge test and attitude scale components of the qPAD. Results: The exploratory factor analysis of the knowledge test produced a four‐factor solution. One item loaded weakly, and four items had cross‐loadings. Factor labels for the knowledge test were difficult to define. Factor analysis of the attitude scale produced a three‐factor structure with good internal consistency—Feeling valued and part of the care team (α = 0.88), Family and team engagement (α = 0.75) and Perceptions and beliefs (α = 0.83). Confirmatory factor analysis indicated improvements in model fit were needed for both the knowledge test and attitude scale. Conclusion: The findings of this factor analysis differed from the original study. The attitude scale produced a three‐factor structure, but the knowledge test requires further development due to weak and cross‐loadings of several items, inadequate internal consistency of factors and poor model fit. [ABSTRACT FROM AUTHOR]

Objectives: To explore the nature and severity of behavioural and psychological symptoms of dementia (BPSD) and outcomes for patients admitted to a specialist dementia care unit (SDCU) at a tertiary Australian hospital. Methods: This single‐centre retrospective study categorised patients into a recognised seven‐tiered model of severity of BPSD using a novel tool developed for this study. Descriptive characteristics, pharmacological management, and range and severity of BPSD were examined. Results: There were 125 patients admitted over a two‐year period reviewed, with 62% being males and a mean age of 82.4 years. Those with high severity BPSD (n = 61, 49%) had a longer length of stay (p = 0.049), were on a greater number of psychotropic medications on admission (p < 0.001) and were more likely to be trialled on a new psychotropic medication (p = 0.001). At least five behaviours on admission were demonstrated in 84% of patients. Behaviours were ameliorated with reduction in tier severity at discharge (p < 0.005). The mean number of psychotropic medications on admission was not significantly different to discharge (p = 0.14). Sixty‐seven per cent of patients living independently at admission were discharged to residential care, and 44% in residential care were discharged to a new facility. Conclusions: Multi‐disciplinary management led to optimisation of behaviours and overall reduction in BPSD severity. This was achieved without a significant increase in the use of psychotropic medications, highlighting the importance of an individualised approach by a team skilled in the behavioural management of BPSD. The study confirms the high risk of transition to residential care for patients with BPSD. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists may recommend and support technology use for facilitating independence, safety, wellbeing, and participation. There are high expectations for technology for people living with dementia. However, there is recognition that technologies will need to improve to deliver these expected benefits. People living with dementia have historically been excluded from direct involvement in research and design. A program of participatory research was undertaken to codesign technologies and technology research with people living with dementia and care partners. This work aims to capture the requirements, actions, and barriers experienced in forming these partnerships in technology research and design. Methods: A shared metareflection of experiences was conducted by members (5) of the research teams involved in three participatory research and technology design studies. The team comprising living experience experts, an occupational therapist, and interaction designer reflected on their experiences and derived recommendations. Key considerations for effective partnerships were drawn inductively by the authors from study experiences, materials, and reflexive discussion. Findings: Six core areas were identified. These were four action areas—(1) Agree on the value; (2) The time to start partnering is now; (3) Ask not assume; and (4) Push back on 'we always have'—(5) barriers and tensions, and (6) unexpected benefits. The reflections indicated that genuine partnerships and engagements were possible with living experience experts in research and design teams. These required resourcing and focussed actions to promote partnership. Despite some structural changes that encourage partnering, there are considerable barriers to this engagement; however, benefits beyond the expected ones can be realised. Conclusion: Genuine partnerships in technology research and design with living experience experts are possible and lead to benefits for the team, research outcomes, and technologies. Recommended actions could support expansion of effective partnerships with people living with dementia and care partners as well as other partnerships in research. [ABSTRACT FROM AUTHOR]

Post‐diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross‐sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six‐module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross‐sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change. [ABSTRACT FROM AUTHOR]

Spouses are at risk of poor psychosocial outcomes following placement of their partner with dementia into long-term care. The Residential Care Transition Module (RCTM) is a psychosocial intervention developed in the United States to support carers post-placement. This study aimed to test the RCTM delivered by telephone to Australian spousal carers. A small-scale RCT [N = 21] was conducted to test feasibility of recruitment, retention, acceptability, and preliminary effects on measures of stress, grief, depression, guilt, quality-of-life, and satisfaction with care, compared to a group receiving printed information. The Transition Counselor and study participants considered the intervention delivery, dose, and content as acceptable. Retention was high (91%). At follow-up, significant time effects were found for stress, depression and "nursing home hassles." A significant interaction effect was found for quality-of-life in favor of the comparison group. No effects were found for guilt or overall grief, however a promising result regarding the sub-scale of "acceptance of loss" was found in favor of the RCTM. The delivery of the RCTM to Australian spousal carers was feasible and acceptable. The RCTM shows potential for improving support to spouses of people with dementia following long-term care placement. [ABSTRACT FROM AUTHOR]

This study used a qualitative, cross‐sectional design to address a gap in understanding the perspectives and practices of care planners and case managers in supporting consumer‐ directed care (CDC) for community dwelling people living with dementia. Semi‐structured telephone interviews were conducted with a convenience sample of n = 16 planners and managers from seven providers of the Australian home care packages (HCP) program in NSW (Australia). All interviewees described the aspirations of supporting choice within CDC as synergistic with their values and with person‐centred care. Some described new flexibilities within the more open‐ended planning conversations enabled by CDC. However, most acknowledged their capacity to enable choice for clients with dementia was limited by the capped care budgets, as well as the skills and time needed to support choice and decision‐ making. Organisational practice changes associated with the shift to a market‐based system were also perceived as limiting the capacity to support choices. Reducing centralised systems, increasing individual budgets and improving staff capacity to support decision‐making by people with dementia may help to improve this situation. However, results suggest a deeper need to re‐evaluate whether the CDC model is the most appropriate for supporting the rising numbers of people with dementia to age well in place. [ABSTRACT FROM AUTHOR]

Gait aid provision is a standard approach to improve mobility and balance for older people. This research aims to understand and compare community care staff practice (health vs. non‐health professionals) for gait aid use by people with and without dementia. A cross‐sectional survey was conducted with Australian community care staff between October 2020 and February 2021. Survey items consisted of closed/open‐ended questions to explore staff practice for people with/without dementia, and assessments/procedures health professionals used for people with dementia. Likert‐scale items gauged staff agreement on factors that influenced their decisions regarding gait aid use for people with dementia. Univariate logistic regression analyses were used to examine staff practice for people with/without dementia and their interaction effects, and factors that influenced decision‐making regarding gait aid use for people with dementia. Content analyses were used to collate responses on assessments/procedures used for people with dementia. Health (n = 109) and non‐health professionals (n = 138) completed the survey. Compared with non‐health professionals, health professionals were more likely to (1) refer the person without dementia [odds ratio, 95% CI: 23.9 (12.1, 47.3), p <.01] and person with dementia [27.8 (12.5, 61.7), p <.01] to a physiotherapist for gait aid assessment, (2) agree with gait aid use if the person with dementia: (a) lives with someone who can monitor gait aid safety [coefficient, 95% CI: −0.75 (−1.29, −0.21), p =.01], (b) performs well on a cognitive functional screen [−0.68 (−1.20, −0.16), p =.01] and (c) gives feedback about gait aid use [−0.64 (−1.15, −0.12), p =.02]. No interaction effects existed between health/non‐health professionals and whether the person had dementia/no dementia on the practice options examined. Health professionals infrequently reported using single/dual task, simple/complex gait or motor sequence testing to assess people with dementia for gait aid use. Strategies such as developing decision aid tool(s) may guide mobility practice for community care staff. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore how formal social support changed after implementation of the COVID-19 public health measures and how these restrictions affected people living with dementia and their informal carers in Australia. Sixteen informal carers and two people living with dementia were interviewed between August and November 2020. Participants were asked about their experiences of the pandemic and the impact that the restrictions had on their lives and care. Thematic analysis identified four overarching themes describing (a) prepandemic limitations of the aged care system, (b) the aged care system's response to the COVID-19 restrictions, (c) changes affecting informal carers, and (d) the challenges faced by people living with dementia. The findings highlighted the challenges faced by the Australian aged care system before the pandemic and the additional burden placed on informal carers who supported people living with dementia across residential and home settings during the pandemic. [ABSTRACT FROM AUTHOR]

The article emphasizes the importance of public involvement in dementia research in Australia, highlighting the role of people with lived experience in contributing to the research process. It discusses the history of public involvement in the country and the need for stronger leadership, infrastructure, funding and support to ensure sustainable involvement. It also calls for training and support for both researchers and individuals with lived experience to facilitate meaningful collaboration.

Background and Objectives The care and well-being of an increasing number of older prisoners living with dementia require an adequate care continuum. Longstanding barriers, including limited resources and relevant expertise, necessitate an interdisciplinary approach and incorporation of external organizations in supporting prisoners with dementia. However, little is known about their perspectives and experiences. This study aimed to explore the role of external organizations in providing care for prisoners with dementia in Australia. Research Design and Methods In this qualitative descriptive study, 27 participants from legal, health, and social services rendering services in Australian prisons were recruited. Qualitative data were generated by applying the Nominal Group Technique in research group discussions. Demographic/background data were used to generate descriptive statistics through Qualtrics. Results Inductive thematic analysis of qualitative data revealed challenges and opportunities for future dementia care in Australian prisons. Six research discussion groups represented participants from Victoria, Queensland, New South Wales, Western Australia, and Tasmania. Identified themes included (a) possible models of care for prisoners with dementia, (b) uncovering the invisible issues of dementia care in prisons, and (c) proposed next steps for improved care of prisoners with dementia. Discussion and Implications This study provided recommendations for multiple stakeholders to overcome barriers in providing dementia care to prisoners. Increased collaboration between corrective services and external organizations was recommended, with a clear delineation of custodial and care priorities. External organizations highlighted the wider community's responsibility to care for older prisoners and the need to explore emerging areas of practice in this regard. [ABSTRACT FROM AUTHOR]

Aims: To describe a nurse‐led multicentre randomized controlled trial protocol developed to evaluate the effectiveness and cost‐effectiveness of a Chinese iSupport for Dementia program in Australia and Greater China including mainland China, Taiwan, Hong Kong and Macau. Design: A multicentre randomized controlled trial following the SPIRIT checklist. Methods: Participants in the study will be recruited from Australia and Greater China and will be randomly assigned to the intervention group or the usual care group. Interventions will include self‐learning of the iSupport program, virtual peer support and nurse program facilitator support for 6 months. Primary outcome measures will be the 12‐Item Short‐Form Health Survey. Secondary outcome measures will include: Revised Scale for Caregiving Self‐efficacy; Quality of Social Support Scale; Revised Memory and Behaviour Problem Checklist; the Quality of Life in Alzheimer's Disease‐Proxy; usages of care services; and cost‐effectiveness of the intervention. Outcomes will be measured at baseline, 6 months and 9 months from the baseline. Caregivers' experiences of the peer support will be explored. This project was funded by the National Foundation for Australia‐China Relations, Australian Government (Project ID: NFACR216). The total amount is $440,000 Australian dollars (or £ 236,231). Discussion: Approximately, 20% of people living with dementia in the world live in Australia and Greater China. Older Chinese are usually cared for by family caregivers at home due to the influence of Confucianism. However, free and online psychoeducation programs for this large cohort of caregivers are not available or accessible. The World Health Organization iSupport for Dementia is an evidence‐based online psychoeducation program for caregivers. Implementing a culturally adapted Chinese iSupport program will address this gap in supporting caregivers. Impact This study will provide research evidence on effectiveness and cost‐effectiveness of an online psychoeducation program for caregivers. Findings will inform policy and practice development. [ABSTRACT FROM AUTHOR]

Background: Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. Methods: The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. Results: Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic–Low Cardiovascular" (16% of the sample); "Moderate Psychotropic–High Cardiovascular" (12%); "Low Psychotropic–High Cardiovascular" (27%); and "Low Psychotropic–Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. Conclusions: Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives: Caregivers of people living with dementia play an essential role in managing medications across transitions of care. Adequate caregiver medication management guidance at hospital discharge is important to ensure optimal outcomes from medication use. This qualitative study explores the experiences and perspectives of caregivers about the medication management guidance provided at hospital discharge. Methods: A qualitative approach using semi‐structured, telephone interviews was conducted with 31 caregivers of people with dementia across Australia. Purposive sampling was used to ensure maximum variation of diverse experiences and perspectives. Results: Caregivers' experiences of medication guidance for people with dementia at discharge were described in three themes including: (a) inadequate information about medication management at discharge; (b) limited caregiver engagement in medication management decisions; and (c) difficulties ensuring medication supply post discharge. Most participants indicated they would like to be included in discussions at discharge. However, participation was influenced by caregivers being overwhelmed by discharge processes; proactively seeking information on medication‐related harm; and belief in advocacy as part of their caregiver role. Caregivers reported they would like to receive a tailored medication list for people with dementia which included information on medications that may impact on the patient's cognition, and for hospital staff to communicate with both the community pharmacist and primary care physician, to improve co‐ordination post transition. Discussion: In our study of caregivers of people with dementia, we identified key recommendations to facilitate regular participation of people living with dementia and their caregiver around medication guidance at discharge. [ABSTRACT FROM AUTHOR]

Background: Older adults living with dementia frequently transition between healthcare settings. Care transitions increase vulnerability and risk of iatrogenic harm. Aim and objective: To examine the quality of transitional care arrangements within discharge documentation for older people living with dementia. Design: Secondary analysis of cohort study data. Method: A secondary analysis of the IDEAL Study [ACTRN12612001164886] discharge documents, following the STROBE guidelines. Participants had a confirmed diagnosis of dementia and were discharged from hospital to a nursing home. An audit tool was used to extract the data. This was developed through a synthesis of existing tools and finalised by an expert panel. The analysis assessed the quality of discharge documentation, in the context of transitional care needs, and presented results using descriptive statistics. Functional ability; physical health; cognition and mental health; medications; and socio environmental factors were assessed. Results: Sixty participants were included in analyses, and half were male (52%), with a total participant mean age of 83 (SD 8.7) years. There was wide variability in the quality of core discharge information, ranging from excellent (37%), adequate (43%) to poor (20%). A sub‐group of these core discharge documentation elements that detailed the participants transitional care needs were rated as follows: excellent (17%), adequate (46%) and poor (37%). Conclusion: Discharge documentation fails to meet needs of people living with dementia. Improving the quality of discharge documentation for people living with dementia transitioning from hospital to nursing home is critical to provide safe and quality care. Relevance to clinical practice: There is a need for safe, timely, accurate and comprehensive discharge information to ensure the safety of people living with dementia and prevent adverse harm. [ABSTRACT FROM AUTHOR]

The article highlights a research which reveals a gap between what people with dementia and their partners living in the community say they need and what service providers think they need. It discusses that the information and access to respite services for people with dementia continue to not meet carers' needs; and aimed to identify what carers of people with dementia, and the person with dementia themselves, perceive they need.

'Rethink Respite' was a prospective, naturalistic cohort study conducted in the Illawarra‐Shoalhaven (NSW, Australia) to improve knowledge, attitudes and uptake of respite strategies in carers of people with dementia. A convenience sample of n = 70 carers were recruited in 2014–15 to establish a baseline for knowledge, attitudes and use of respite for a cohort of carers in the region. Carer perceived need for respite, burden and self‐efficacy were also assessed. A co‐designed multi‐component community‐based intervention was subsequently rolled at in the region from 2015 to 2016. The intervention supported: awareness raising media; carer education sessions; access to web and print respite information resources; and an option to participate in a tailored one‐on‐one in‐home coaching program. At program completion, a follow‐up survey was administered to the cohort, with n = 44/70 responding. All n = 44 respondents reported participation in and exposure to 'Rethink Respite' media, information and education during the intervention period. Eighteen of the 44 also self‐selected to receive the active tailored coaching support. At follow‐up, few positive results were reported on the assessed carer variables for the cohort over time. However, post hoc sub‐group analyses found those who also self‐selected to receive active support (provided through coaching) (n = 18), showed improvements to their respite knowledge, attitudes and self‐efficacy (p <.05). Intention to use respite, and levels of personal gain from caring in this sub‐group also increased (p <.05). In contrast, carers who only participated in the informational/educational aspects of the program (and did not self‐select to the respite coaching), experienced negative changes over time to their respite beliefs and 'role captivity'. Overall, this pilot study suggests that passive respite information and educational strategies are insufficient, without more active supports (tailored respite coaching) to address observed carer decline over time. Future research should seek to replicate these results using a larger sample and an experimental design. [ABSTRACT FROM AUTHOR]

The article focuses on the palliative care needs of individuals with dementia, highlighting the importance of providing individualized care throughout its different phases. Topics include the need for increased awareness of dementia in healthcare settings, the relevance of supported decision-making, and the introduction of the "End-of-Life and Palliative Care for People with Dementia Framework" to enhance palliative and end-of-life care for this cohort.

Aims: The aim of this study was to identify features of well‐performing residential aged care services (RACS) as experienced by family carers. Background: Family carers can have an integral role in residential aged care providing social support and are well‐placed to engage with staff and monitor care. Design: A qualitative descriptive design was used. Semi‐structured face‐to‐face and telephone interviews were conducted with family carers of current or past residents of Australian RACS between November 2018 and January 2019. Interview transcripts were analysed thematically. Results: Rather than reporting features of well‐performing RACS, participants shared stories of sub‐standard care, dysfunctional management and poor resident–staff–family interactions. An overarching theme emerged of 'having to be an advocate' for residents' needs, which covered four major categories: organisational accountability (including transparency and individualised care), good communication, connection and trust. Combined, these constitute what carers perceive are the necessary conditions for determining the features of a well‐performing RACS. Conclusion: Family carers need to feel confident and trust RACS staff when they hand over the role of carer for their relative with dementia. Relevance to clinical practice: This study provides insight into the needs and challenges of family carers when they relinquish the care of an older relative with dementia. Strategies to build confidence and trust between RACS and family carers are essential. Aged care nurses can play a pivotal role to support this through the development of open communication and relational connections with residents and their families. [ABSTRACT FROM AUTHOR]

The article discusses a new online course developed for aged care nurses on how to prevent, respond to and manage unwanted sexual behaviour. It is noted unwanted sexual behaviour between residents is undeniably complex, often involving victim-survivors and perpetrators-exhibitors with cognitive impairments. Perhaps most alarming is that the aged care staff are misjudging the impact sexual violence has on survivors.

A personal narrative is presented in which a daughter talks about how isolation during the COVID-19 pandemic has been a difficult r for his father living with dementia and suggests interventions to mitigate distress for people with dementia and their families during lockdowns in hospitals.

Objective: To determine the effects of an exercise intervention on physical performance and reported fall incidents among individuals living with dementia in nursing homes. Methods: The study was a randomized controlled trial to determine the effect of the physical activity on physical performance and reported fall incidents. A sample of 60 participants from two nursing homes in Australia were randomly allocated to either: (1) Intervention Group 1: physical exercise intervention for 45 min, once a week; (2) Intervention Group 2: physical exercise intervention for 15 min, three times a week; or (3) usual care Control Group. Physical performance was assessed before and after the intervention (12 weeks) using: Six Meter Walk test, Five-Times-Sit-to-Stand test, Timed Up and Go (TUG) test, (Modified) Functional Reach test, timed static pedaling (TSP). The number of reported falls was determined by review of incident reports completed by nursing home staff. Results: The physical performance outcome measures demonstrated positive trends over time in favor of the intervention groups, though the observed changes were only statistically significant for TSP and TUG Test. The number of reported falls demonstrated a significant difference between groups during the intervention period. Conclusions: The results demonstrated that the physical exercise intervention could be beneficial for individuals living with dementia, and as little as 45 min per week could be effective for this population group. However, cautious interpretation was drawn as the pool of participants was not sufficiently large enough to generate a meaningful effect size. [ABSTRACT FROM AUTHOR]

The article discusses that StepUp for Dementia Research is an Australian research participation and engagement service, a ‘one-stop shop' that connects individuals, both with and without dementia, with researchers conducting studies into dementia prevention, diagnosis, treatment, care and cure. It mentions that StepUp for Dementia Research's initial funding from the Australian Government Department of Health.

Background: Pain can elevate stress in people with dementia. Although salivary cortisol is used as a biomarker of stress in people with dementia, few studies have reported the feasibility of collection methods to assess salivary cortisol in nursing home residents with both dementia and chronic pain. Objective: To explore the feasibility of collecting cortisol via salivary swab as an indicator of stress in people with dementia and chronic pain. Methods: Participants (N = 43) aged ≥ 65 years and living with dementia and chronic pain were randomly assigned to the PARO (individual, nonfacilitated, 30-min sessions with the robotic seal PARO, 5 days per week for 6 weeks) or usual-care group using computer-generated random numbers. Salivary cortisol was collected in the early morning before the intervention (Week 0) and at the completion of the intervention (Week 6) for comparison. Results: There were multiple challenges associated with saliva collection and analysis, including cognitive impairment of participants, ability to obtain repeated samples with saliva volume adequate for assay, and overall cost. Ultimately, adequate saliva was collected from only 8 participants (both pre- and post-intervention) for assay and quantitative analysis. Conclusion: Considering the multiple challenges involved in obtaining valid saliva samples in this population, salivary cortisol may not be a feasible biomarker of physiological stress in people with dementia and chronic pain. [ABSTRACT FROM AUTHOR]

Background: Person-centred care (PCC) is regarded as best practice within dementia care, however there is a gap between the understanding and the implementation of this type of care practice. The Peer Enablement Program (PEP) incorporates a group problem solving model for promoting PCC of residents with moderate to advanced dementia living in care facilities. Objective: Trained PEP facilitators introduced the program to selected staff from an organisation with 99 facilities across Australia. The objective of this study was to identify what particular aspects of the PEP these facilitators valued for advancing PCC and care culture change. Method: An embedded mixed methods study design guided this investigation. The qualitative component of the study focussed on the insights of the nine PEP facilitators who presented the workshops. This information was supported and contrasted with descriptive data generated from 322 workshop feedback forms by attendees over the course of the three workshops presented nationally. Results: Facilitators identified peer support as the most valued aspect of the PEP. It promoted collaboration among attendees; supported development of their occupational identities as transformational leaders; and created communities of practice with potential to sustain advances in PCC. Conclusions: The PEP has the potential to advance PCC. Further research is needed to evaluate the long-term sustainability of these advances and to determine if this program can be utilised more widely, both in a national and international context. [ABSTRACT FROM AUTHOR]

Introduction: Dementia in adults with Down syndrome causes a progressive decline in daily occupations impacting both persons with Down syndrome and their informal caregivers. This study aimed to explore the scope of occupational therapy practice for adults with both Down syndrome and dementia and their informal caregivers living in their homes. Methods: A survey was conducted with occupational therapists having clinical experience in providing interventions for adults with Down syndrome. A web‐based survey was developed to explore occupational therapy practice for this group of people with Down syndrome and their informal caregivers. Responses to closed‐ended questions were analysed descriptively, and inductive content analysis was used for open‐ended questions. Results: Forty‐three occupational therapists from Australia, Canada, United Kingdom and the United States of America participated in the survey. Two‐thirds were from the United Kingdom, most of whom were employed in the public sector and had at least 10 years of clinical experience. Over 90% of respondents received one or more referrals in a typical month for adults with Down syndrome having dementia, 68% of which were for a decline in activities of daily living. Home environment and activities of daily living were frequently assessed areas, and the commonest interventions were compensatory strategies and environmental modifications. Only half the respondents provided interventions for informal caregivers. Risk and safety and manual handling were frequently addressed domains for informal caregivers. Collaboration and developing clinical expertise were the two key perceived enablers for providing effective occupational therapy services. Fragmentation of services and a lack of client‐centred care were the common perceived barriers. Conclusion: Occupational therapists often address decline in activities of daily living for individuals with both Down syndrome and dementia. To support participation in meaningful occupations for these people and support the needs of their informal caregivers, it is essential that services are offered in a collaborative approach. [ABSTRACT FROM AUTHOR]

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