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INTRODUCTION: Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help-seeking and care. Despite increasing population diversity in high-income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research. METHODS: We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high-income countries were included. A steering group of experts developed criteria through which high-quality studies were identified. RESULTS: Sixty-six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty-three studies translated or used a culturally validated instrument. Twenty-three articles conducted subgroup analyses based on ethnicity. Six high-quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia. DISCUSSION: We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.

BACKGROUND: Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. METHODS: The 'Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape' was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. RESULTS: Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. CONCLUSIONS: In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategie

INTRODUCTION: The number of Australian residents with dementia is projected to double by 2058, with 28% currently being migrants from non-Anglophone countries. There will be growing demand for professional interpreters for cognitive assessments and dementia-related health consultations in the future. Interpreting cognitive assessments can be challenging for interpreters; inaccurate interpreting can influence assessment outcomes. The Improving Interpreting for Dementia Assessments (MINDSET) project will upskill interpreters through an online training course in dementia and cognitive assessments. The training has been co-designed with key stakeholders from the interpreting sector, dementia-related services, and family caregivers, and has been user-tested with 12 interpreters. The training aims to improve the quality of interpreter-mediated communication during cognitive assessments, and thereby improve the accuracy and acceptability of cognitive assessments with older people who have limited English proficiency. METHODS: We are conducting a single-blinded randomized controlled trial to evaluate the effectiveness of the training. We aim to enroll 150 interpreters, and allocate them to equal parallel groups. The intervention group will receive access to the MINDSET training, which comprises 4 hours of resources covering five domains: dementia knowledge, cross-cultural communication, briefings and debriefings, interpreting skills, and interpreting ethics. The control group will be assigned to a wait list, and will receive access to the training after the trial. Participants will be assessed according to the five domains, via the Dementia Knowledge and Assessment Scale, multiple-choice questions, video-simulated assessments, and ethical scenarios. Assessments will occur at baseline (prior to the intervention group completing the training), 3 months after enrollment, and 6 months after enrollment. RESULTS: The trial is ongoing. Recruitment began in June 2022. DISCUSSION: T

BACKGROUND: Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. METHODS: This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs' sense of competence in dementia care provision. DISCUSSION: Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. TRIAL REGISTRATION: anzctr.org.au ; ACTRN12619000251123. Registered on 20 February 2019.

Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well-being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community-based care for people with dementia can be challenging. Workers often lack training in dementia-specific care for clients with increasingly complex needs, and typically work without direct supervision. As the demand for person-centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in-depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person-centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care. The findings of this study will be used to inform the essential elements of a training program aimed at enabling and empowering a skilled, specialist home care workforce to suppo

OBJECTIVE: To describe the activity of daily living and behavioural and complex care needs of residents born in non-English-speaking countries in Australian aged care facilities. METHODS: De-identified cross-sectional data were provided by the Australian Institute of Health and Welfare for all residents in government-funded facilities on 30 June 2015. Analyses included t-tests, chi-squared tests and logistic regressions. RESULTS: A total of 33 168 (19%) residents were born in one of 188 non-English-speaking countries. Compared to residents born in English-speaking countries, they were significantly younger, lived in larger facilities, were more likely to be male and live in an urban area. Their care requirements were greater for activities of daily living and behavioural and complex care. Residents from non-English-speaking countries living in ethno-specific facilities had higher levels of these needs. CONCLUSION: The needs of residents born in non-English-speaking countries should be considered when planning aged care services.

Objectives: To develop and validate a short version of the Cornell Scale for Depression in Dementia (CSDD-19) for routine detection of depression in nursing homes.Setting: Australian nursing homesParticipants & Measurements: A series of cross-sectional studies were conducted involving: 1) descriptive analysis of pooled data from five nursing home studies that used the CSDD-19 (n=671) to identify patterns of responses and missing data on individual CSDD items; 2) analysis of 4 of the 5 studies (n=556) to assess CSDD-19 for unidimensionality, item fit, and differential item functioning using Rasch modeling to develop a shorter version, the CSDD-4; 3) validation of the CSDD-4 against the DSMIV using the fifth study of 115 residents, and through expert consultations; and 4) evaluation of the clinical utility of CSDD-4 using an independent cohort of 92 nursing home residents.Results: Four items from the original CSDD-19 were found to be most suitable for depression screening: anxiety, sadness, lack of reactivity to pleasant events, and irritability. The CSDD-4 highly correlated with the original scale (n=474, r=.831, p<.001), with acceptable internal consistency (Cronbach's alpha=0.70). At the cut-offscore of less than 2, sensitivity and specificity of CSDD-4 were 81% and 51% respectively for the independent cohort (n=92), of whom 50% had dementia. The CSDD-4 had an AUC of 0.73 (z=3.47, p<.001), which was compatible with the CSDD- 19 (AUC=0.69, z=2.89, p<.01).Conclusion: The CSDD-4 is valid for routine screening of depression in nursing homes. Its adoption is feasible and practical for nursing home staff, and may facilitate more comprehensive assessment and management of depression in nursing home residents.

The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes.Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty-three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed.There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001).Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association.

Background: The Geriatric Depression Scale (GDS) is widely used and researched in various settings including hospital, community and residential care. However, the GDS has shown mixed results in people with dementia and most validation studies were conducted outside Australia. The Collateral Source version of the GDS (CS-GDS) uses the same items to derive information from an informant. However, it is uncertain how valid the CSGDS is in the context of residential aged care facilities (RACFs), where the majority of the informants are staff members. Our study aimed to examine the validity of the CS-GDS compared to the GDS in RACFs in Australia. Method(s): Participants were 92 residents (n=46 with dementia, n=46 without dementia) from 14 RACFs assessed for depression using the GDS and the CS-GDS, against the DSM-IV-TR criteria for depression or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for those with dementia. The diagnostic performances of five variations of the GDS (30-, 15-, 10-, 8-, and 4-item) and two versions of the CS-GDS (30- and 15-item) were analysed using the receiver operating characteristic (ROC) curves. Result(s): Twenty-six residents could not complete the GDS due to impaired cognitive functioning. Among residents without dementia, the various GDS measures generated larger areas under the ROC curve (AUC=0.75-0.79) than did the CS-GDS measures (AUC=0.67), suggesting that the former were more accurate in classifying depression than the latter. However, neither of them adequately identified depression among residents with dementia. Both 4- and 8- item GDS showed 100% sensitivity and 62% specificity, which were compatible with the original 30-item (sensitivity=75%, specificity=66%) . Conclusion(s): The administration of the GDS requires a certain level of cognitive functioning. Although the CS-GDS allowed us to collect information from an informant when the resident cannot be assessed directly, it did not have adequate validity i