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Objectives: Frailty is common in hospitalised older people. Clinical practice guidelines for the management of frailty provide recommendations for identification and management; however, adoption into practice in hospitals is limited. This study identified and quantified the evidence‐practice gap between frailty guidelines and clinical practice in two hospitals using an audit tool. Methods: A cross‐sectional audit of medical records of frail older patients admitted to two hospitals was conducted. Data were collected using an audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management. Data were analysed using descriptive statistics and inter‐rater reliability of the tool was assessed. Results: Auditing of n = 70 electronic medical records showed that assessment of frailty in the acute setting did not regularly occur (17%). Few participants received guideline‐recommended interventions. Physiotherapy treatment was limited, with 23% of participants receiving progressive resistance strength training. Gaps exist in provision of nutritional supplementation (26%) with limited recordings of weight during the admission for 10% of participants. Pharmacy review of medications was consistently documented on admission (84%) and discharge (93%). Vitamin D was prescribed for 57% of participants. Inter‐rater reliability showed a high level of agreement using the audit tool. Conclusions: An audit tool was feasible to assess frailty evidence‐practice gaps in the hospital setting. Further understanding of the contextual barriers is needed to inform implementation strategies (dedicated staffing, education and training and ongoing audit of practice cycles) for the uptake of frailty guidelines in hospital settings. [ABSTRACT FROM AUTHOR]

Objective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods: Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results: Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's =.31–.37, p <.001), and ACP engagement (r's = −.41 to −.37, p <.001) indicated convergent validity. Conclusion: A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution: The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life‐limiting conditions and five current or former care partners. [ABSTRACT FROM AUTHOR]

Background: To support informal dementia carers, the World Health Organization (WHO) developed 'iSupport for Dementia' online skills training program, culturally adaptable to local contexts. Several WHO Member States are adapting the program. This study was conducted to draw lessons about iSupport adaptation in Australia, Brazil, Indonesia, New Zealand, and Qatar. Method: A short questionnaire regarding modifications made to the WHO iSupport adaptation methodology, changes made to the WHO iSupport manual, and the enablers of and barriers to the iSupport adaptation process was sent to the iSupport adaptation research teams in the five countries. Data were analysed thematically. Result: Countries modified the WHO adaptation methodology, undertaking more focus group discussions (FGDs) than recommended. Prior to the FGDs, iSupport manual was divided into smaller, more manageable sections. Individual participants only reviewed a section rather than the entire manual to reduce burden. Common adaptation includes changes to language and terminology used in the manual to be more empathetic and person‐centred. In Australia, and later New Zealand, an additional module was added about person‐centred care principles and access to formal care services. In Brazil, additional topics such as fall prevention were suggested. Four countries identified short video clips as a method to increase usability of and real‐time access to the iSupport manual. In Australia, scenarios from the Australian adapted iSupport manual were translated into scripts then storyboards and 50 animations were produced via an iterative, ongoing stakeholder feedback process. Themes emerged include an emphasis on carers understanding of the disease, validating their experiences and emotions and creating authentic content that genuinely reflects caring for someone with dementia. In New Zealand and Indonesia, Australian animations were used and adjusted to suit the local contexts through modifications to terminology and animation characters. Qatar developed five short videos, each reflecting a module of the iSupport, to encourage carers to seek further information in the adapted iSupport program. Conclusion: Modifications of the current WHO iSupport Adaptation and Implementation Guidelines are needed. There is a need to improve the accessibility and usability of the iSupport online program, with the inclusion of short video clips being one possible solution. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and safety of StandingTall—an individually tailored, progressive exercise program delivered through tablet computers—in community‐dwelling older people with dementia. Methods: Fifteen community‐dwelling older people with dementia (mean age = 83 ± 8 years; Montreal Cognitive Assessment 16 ± 5) received StandingTall for 12 weeks with caregiver assistance. Feasibility and safety were assessed using the System Usability Scale (SUS; scores = 0‐100; a priori target >65), Physical Activity Enjoyment Scale (PACES‐8; scores = 8‐56), adherence (exercise minutes) and adverse events. Results: Mean SUS scores were 68 ± 21/69 ± 15 (participants/caregivers). The mean PACES‐8 score was 44 ± 8. In week 2, week 7 and week 12, mean (bias‐corrected and accelerated 95% CI) exercise minutes were 37 (25‐51), 49 (30‐69) and 65 (28‐104), respectively. In week 12, five participants exercised >115 minutes. One participant fell while exercising, without sustained injury. Conclusions: StandingTall had acceptable usability, scored well on enjoyment and was feasible for participants. These results provide support for further evaluation of StandingTall in a randomised controlled trial with falls as the primary outcome. [ABSTRACT FROM AUTHOR]

Objective: To foster a national dialogue on addressing dementia as an emerging public health problem and formulating a strategy for developing Vietnam's national dementia plan. Methods: In September 2018, the Vietnamese National Geriatric Hospital supported by University staff in Australia and the United States organised the first Vietnam National Dementia Conference in Hanoi. Results: Over 270 Vietnamese dementia stakeholders and international dementia experts participated in the conference. The participants agreed dementia was a public health priority in Vietnam and identified the need for the development of Vietnam's national dementia plan. Policymakers supported positioning dementia as a priority in the national health agenda. Research institutions created collaboration to generate scientific information for policymaking process. Funding and international supports were obtained to develop Vietnam's national dementia plan. Conclusion: Strong leadership, stakeholder engagement and international support are critical in raising awareness and advocating for the development of Vietnam's national dementia plan. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the implementation of a model of care known as the Confused Hospitalised Older Persons (CHOPs) program to improve recognition, assessment and management of older persons with cognitive impairment (delirium and/or dementia) admitted to acute hospitals. Methods: The model of care was implemented in six selected hospitals across New South Wales. Pre‐ and postimplementation medical record audits, environmental audits, and staff knowledge and care confidence surveys were performed. Interviews with clinical leads postimplementation identified enablers and barriers. Results: There were significant increases in cognitive screening within 24 hours (OR = 3.32 [2.50‐4.91]), delirium risk identification (OR = 4.04 [2.89‐5.64]), assessment of cognitive impairment (OR = 2.55 [1.90‐3.43]) and interaction with families (OR = 2.81 [2.09‐3.79]). Staff education and care confidence were improved, and positive environmental changes occurred in all hospitals. Barriers and enablers to implementation were identified. Conclusion: The CHOPs program improved identification, risk assessment and management of cognitive impairment in older hospitalised patients. [ABSTRACT FROM AUTHOR]

Objective: This study outlines development of an instrument for measuring attitudes of medical students towards older people, the Australian Ageing Semantic Differential (AASD). Methods: Words for AASD scales were derived from the reflections of 151 third year medical students attending two Australian medical schools. A pilot study of the AASD was then undertaken with third year students at another medical school to confirm usability and reliability of the instrument. After slight modification, a larger study using the AASD was then undertaken of medical students attending the three institutions, in order to obtain sufficient data for exploratory factor analysis. Results: n = 321 (response rate 73%). Mean AASD score 73.2/114. Cronbach's α = 0.86. There was no evidence of sequence bias. Exploratory factor analysis (EFA) demonstrated four factors: Instrumentality; Personal Appeal; Experience; and Sociability. A lower mean instrumentality subscore for all students and a higher mean experience subscore for female students were noted. Conclusions: The AASD instrument proved internally reliable, and its use was generalisable to different groups of medical students. Its design ensured construct and face validity, and responses were not affected by sequencing bias. This study has revealed positive student attitudes towards older people. Variation in attitudes requires further investigation. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including use of medication in residential aged care facilities; effect of dementia on daily life; and improvements in the care for older cognitively impaired patients with benefits for families.

Objective: The aim of this article was to review the literature around Australian medical student attitudes towards older people. Methods: An Ovid cross-search and SCOPUS search were performed using keywords such as 'Attitude', 'Medical Student' and 'Aged or Older or Elderly'. Results: Several recent studies have investigated the attitudes of Australian medical students towards older people. Baseline attitudes at two medical schools were positive. Three studies quantified attitude improvement after curriculum intervention. All the studies used USdeveloped instruments, which have not been validated in Australia. Qualitative studies have described mixed attitudes towards older people: negative themes included nihilism, paternalism, communication issues, greater morbidity and reduced quality of life. Positively, students placed value on clinical decision-making and critical reflection during residential aged care placements. Conclusion: Australian medical students' attitudes towards older people are mixed and not well understood based on quantitative measures developed for use in the US and on qualitative evidence. Future research in this area requires a reliable and locally-validated instrument. [ABSTRACT FROM AUTHOR]

More than half of the patients in adult hospitals are over 65 years of age. Although not a normal part of ageing, many older people will present to hospital with cognitive impairment (dementia or delirium) along with other complex comorbidities. Older people, and particularly those with dementia, are also at increased risk of developing delirium during their hospital stay. Delirium has serious short and long term consequences, such as increased mortality, falls, accelerated functional and cognitive decline, and earlier entry to residential care. Appropriate delirium care consists of introducing evidence-based prevention strategies for all patients at risk. For patients with delirium, it is crucial that delirium is not missed and that the underlying causes are identified and treated. Screening, assessment and a systematic workup is vital. As well as treating the underlying medical and surgical causes, the involvement of family members and a calm, safe environment are important. Patients with cognitive impairment should receive person-centred, goal-directed care so that their particular risks of harm are identified and minimised, and their care is aligned with their preferences and is medically appropriate for their circumstances. Three de-identified, composite case scenarios illustrate, respectively, the role of medicines in causing delirium, how family members can assist in evaluation, and the importance of the appropriate management of post-operative delirium. [ABSTRACT FROM AUTHOR]

Background: As part of the effort to gather research evidence for the development of Vietnam's National Dementia Plan, a systematic review was conducted to map dementia research in Vietnam or among the Vietnamese diaspora. This paper aimed to report the qualitative research evidence on the life experiences of people with dementia in Vietnam and among the Vietnamese diaspora. Method: Systematic searches were conducted in June 2019 using Medline, Embase, Emcare, PsycINFO and Cochrane electronic databases, as well as grey literature. Keywords and Medical Subject Headings [MeSH terms] for dementia and associated terms were combined with keywords for Vietnam and its provinces. Qualitative research articles published in English or Vietnamese were included to examine evidence on the life experiences of Vietnamese people with dementia using thematic analysis. Result: Our searches resulted in 3,940 papers, from which 21 qualitative research studies were included for final analysis. The majority of research has not been undertaken in Vietnam but with the Vietnamese diaspora in Western countries and has taken a cultural perspective to analyses. Research in Western countries has focused on the need for culturally adapted and culturally sensitive models of care. Emerging themes about the life experiences of Vietnamese people with dementia identified from the studies included: many people do not have diagnostic terms for dementia but use the descriptive language of symptoms; stigma was a reported problem and on occasions can be observed in the descriptive language used for people with dementia; cultural and traditional values create both an opportunity and a barrier, supporting compassion, family care and relaxation, but creating barriers to accessing health services or long‐term residential care. Conclusion: This is the first systematic review reporting evidence on the life experiences of people with dementia in Vietnam and among the Vietnamese diaspora. Future research is needed on the voice of people with dementia themselves and their caregivers particularly in low and middle‐income countries with regards to living with dementia, pathways to care from diagnosis, treatment, care and support, additional social care and preparedness for end of life care for people with dementia. [ABSTRACT FROM AUTHOR]

The rehabilitation of people with frailty takes time,5 and hospitals are under pressure to reduce patients' stays in hospital (the median rehabilitation length of stay reported by Soh and his co-authors was 20 days1). Key priorities are to build the capacity and competence of primary health services to provide general rehabilitation services to older people, and to improve networking of and collaboration between primary care and specialist rehabilitation units. Some health services have worked through these intersectoral problems and have articulated a model that could be implemented broadly in Australia.11 Australia urgently needs a national rehabilitation strategy to reduce overreliance on hospital services for functional recovery and rehabilitation treatments. [Extracted from the article]

Background: Vietnam is facing rapid population ageing, with one in four Vietnamese citizens being over 60 years old by 2050. This has contributed to a boom of chronic and non‐communicable diseases, such as dementia. In order to develop a national dementia plan as recommended by the World Health Organization (WHO) and increase the preparedness of the healthcare system to tackle dementia, a situational analysis of the current healthcare services related to dementia is needed. Method: In late 2019, we conducted a situational analysis desk review of the healthcare system in Vietnam, focusing on health service delivery for the elderly, using the guidance developed by the Strengthening Responses to Dementia In Developing Countries (STRiDE) project. The WHO's six‐building‐block framework was used to analyse the healthcare system in Vietnam, followed by the thematic and SWOT (Strengths, Weaknesses, Opportunities and Threats) analyses of dementia‐related healthcare services. Result: Although Vietnam has achieved significant improvement in healthcare in general, there are still inefficiencies in health service delivery. There are also discrepancies in health service readiness and quality across areas of healthcare. Despite of extensive primary healthcare system, grassroots‐level facilities have inadequate infrastructure required for basic care delivery and none for dementia. There are few healthcare facilities at central and provincial levels, mainly located in the three biggest cities of Hanoi, Ho Chi Minh and Danang, providing services for people with dementia. There is limited training in dementia diagnosis and management for health professionals. Conclusion: Developing a national dementia plan, including transforming the current healthcare services to better cope with rapid population ageing and dementia disease is urgently needed in Vietnam. Integrating dementia services into existing health and social services for the elderly and the disabled, making use of the extensive primary healthcare system in detection, early interventions, management and support for people with dementia at community level are strategic solutions to deal with dementia in a sustainable way. To this end, a whole‐system approach in transformation and operation with implementing a patient centred care model is necessary. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes. Cluster-randomized controlled trial. Forty-five nursing homes in Germany. Three hundred thirty-three residents who were being restrained at the start of the intervention. Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used, the adverse effects, and alternatives to their use. Technical aids, such as hip protectors and sensor mats, were provided. The training was designed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints. The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention. Secondary outcomes were partial reductions in restraint use, percentage of fallers, number of psychoactive drugs, and occurrence of behavioral symptoms. The probability of being unrestrained in the intervention group (IG) was more than twice that in the control group (CG) at the end of the study (odds ratio=2.16, 95% confidence interval=1.05-4.46). A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG. No negative effect was observed regarding medication or behavioral symptoms. The percentage of fallers was higher in the IG. The intervention reduced restraint use without a significant increase in falling, behavioral symptoms, or medication. [ABSTRACT FROM AUTHOR]

About 9% of Australians aged 65 years and over have a diagnosis of dementia. Clinical practice guidelines aim to enhance research translation by synthesising recent evidence for health and aged care professionals. New clinical practice guidelines and principles of care for people with dementia detail the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council. The guidelines emphasise timely diagnosis; living well with dementia and delaying functional decline; managing symptoms through training staff in how to provide person-centred care and using non-pharmacological approaches in the first instance; and training and supporting families and carers to provide care. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to investigate the feasibility of using an accelerometer to measure the physical activity of older people with cognitive impairment in hospital and community settings. Researchers evaluated the use of the accelerometer with two groups of Australian patients. They found that it was feasible to measure physical activity using accelerometry in older people with cognitive impairment in hospital and community settings.

Background: Vietnam has decided to develop an integrated national action plan that integrates dementia into existing non‐communicable diseases (NCD) initiatives. Prior to formulating an effective plan, however, reliable information on current situation of dementia care, treatment and support in Vietnam is needed. This study was conducted to better understand the context, barriers and opportunities for improving dementia care, treatment and support in Vietnam and guide the plan development. Method: A desk review was conducted using the Situational Analysis Desk Review Topic guide developed by the Strengthening responses to dementia in developing countries (STRiDE) project. Key WHO Global Dementia Observatory (GDO) indicators were collected, focusing on Policy, Service Delivery and Epidemiological assessments. Result: Vietnam has a high level institutional and policy framework on aging, NCD, mental health and disability including the 2009 Law on the Elderly, which provides the legal umbrella for policies on older people. However, no dementia‐specific policy exists and policies to promote healthy brain remain weak. Rapid aging significantly contributes to the explosion of NCD including dementia in Vietnam. There are 660000 Vietnamese people estimated to be living with dementia, with resultant dementia related costs of US$ 960 million. The healthcare system is not yet prepared for the shift to NCD from an acute, communicable disease burden in the past. Health service delivery is hospital‐centric, with over‐reliance on hospitals and under‐utilization of primary care system that in turn is fragmented and poorly prepared to address the rising challenge of dementia. Social care and support specific for dementia is lacking although there is an impressive grassroots organisation of older people with nearly 100,000 branches. Conclusion: To allow for a more harmonized response across the health sector and more effective use of limited resources, an integrated national action plan for dementia is sensible. However, Vietnam should take into consideration the potential for fragmentation and lack of dedicated resources being allocated to dementia. A new, integrated model of care focusing on a stronger primary healthcare system, community‐based social care and a healthy aging approach is needed to improve dementia prevention, care, treatment and support in Vietnam. [ABSTRACT FROM AUTHOR]

The authors reflect on the Transition Care Program legislation established by the government of Australia. It states that the program aims to help patients recover from illness and optimize usable capacity to avoid the need for residential aged care. Furthermore, the legislation provides additional support and time to older people outside hospitals and residential care, and attempts to address problems that occur due to the difference in governance arrangements.

A letter to the editor is presented which discusses the costs and health outcomes of restricted weight bearing after hip fracture surgery (HFS) of older people at the Hornsby Ku-ring-gai Hospital in Sydney, New South Wales.

A letter to the editor is presented which is concerned with the use of hip protectors in older patients.

Objective: To determine the effectiveness of interdisciplinary rehabilitation for women with hip fracture who were residents of nursing homes. Design: Randomised controlled trial. Subjects: Eleven cognitively impaired women with hip fracture who were previously ambulant. Methods: Participants were randomly allocated to usual care (discharge back to the nursing home soon after surgery to the hip fracture) or an inpatient interdisciplinary rehabilitation program. Results: Participants were severely cognitively impaired and the majority used a walking aid prior to fracturing their hip. There was one early death, and at final follow up (4 months after hip fracture) median (range) Barthel Index was 28 (0–82) for control group and 68 (0–88) for the intervention group. Conclusion: No definite conclusion can be drawn about the effectiveness of the intervention because of its premature termination. However, the study established that it is feasible to provide an interdisciplinary rehabilitation for older people with hip fracture and severe disablement. [ABSTRACT FROM AUTHOR]