We need a model of health and aged care services that adequately supports Australians with dementia

Low, Lee‐Fay; Laver, Kate; Lawler, Katherine; Swaffer, Kate; Bahar‐Fuchs, Alex; Bennett, Sally; Blair, Annaliese; Burton, Jason; Callisaya, Michele L.; Cations, Monica; O’Connor, Claire; Gresham, Meredith; Lewin, Gill; Messent, Petrea; Poulos, Christopher J.; Wesson, Jacqueline; Scott, Theresa; Rees, Glenn

doi:10.5694/mja2.50911

Cited by 12 publications

(7 citation statements)

References 5 publications

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“…The research-focused ISLAND Clinic is well placed to contribute to the development of seamless models of care cutting across health and aged care systems, given the inadequate state of services in Australia. 27 Primary care partnerships could expand to include clinicians from a range of allied health professions, supporting ongoing -7 of 10 upskilling of the dementia care workforce and access to rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

Alty,

Lawler,

Salmon

et al. 2023

Int J Geriat Psychiatry

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ObjectivesUnequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. ‘One‐stop’ cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one‐stop State‐wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas.MethodsA novel single‐visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross‐sectional evaluation was undertaken using the RE‐AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry.ResultsOver the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. Effectiveness: 98.5% (128/130) received a same‐day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients. Implementation: Nearly all ‘ideal’ diagnostic clinical practices were met and >90% of surveyed patients reported ‘good/very good’ clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days).ConclusionsThis ‘one‐stop’ model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.

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Section: Discussionmentioning

confidence: 99%

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

Alty,

Lawler,

Salmon

et al. 2023

Int J Geriat Psychiatry

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“…44,45 Despite this, our findings align with previous research, indicating that physical health care needs are still prioritised over wellbeing interventions such as AoP@Home. 42,46,47 There is a need for greater awareness of the power and importance of psychosocial interventions to support a person living with dementia's wellbeing and quality of life, in addition to meeting their daily care needs. 48 Moreover, a key feature of AoP@Home is the ability for programs to be dyadic, where both the person with dementia and their carer are active participants; the AoP@Home pilot indicated important benefits to carers who participated.…”

Section: Discussionmentioning

confidence: 99%

“…Another key barrier that may challenge effective implementation of AoP@Home was identified as insufficient funding to support access to programs. Barriers around limited access to allied health and psychosocial interventions are well‐reported in Australia, 42,43 and the importance of improved access and funding support for interventions that promote wellbeing in dementia are recognised internationally 44,45 . Despite this, our findings align with previous research, indicating that physical health care needs are still prioritised over wellbeing interventions such as AoP@Home 42,46,47 .…”

Section: Discussionmentioning

confidence: 99%

“…Barriers around limited access to allied health and psychosocial interventions are well‐reported in Australia, 42,43 and the importance of improved access and funding support for interventions that promote wellbeing in dementia are recognised internationally 44,45 . Despite this, our findings align with previous research, indicating that physical health care needs are still prioritised over wellbeing interventions such as AoP@Home 42,46,47 . There is a need for greater awareness of the power and importance of psychosocial interventions to support a person living with dementia's wellbeing and quality of life, in addition to meeting their daily care needs 48 .…”

Section: Discussionmentioning

confidence: 99%

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Steps to implementation: Understanding barriers and enablers for implementing Arts on Prescription at Home for people impacted by dementia

O'Connor

Poulos

Preti³

et al. 2023

Health Prom J of Aust

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Issue addressedArts on Prescription at Home (AoP@Home) involves a professional artist visiting a person with dementia and their informal carer(s) in their own home to engage them in participatory art making. While there is evidence for the use of these programs, more work is needed to facilitate effective implementation. This study explored contextual barriers and enablers to implementation of AoP@Home within a real‐world community aged care service.MethodsTwo remote focus groups were conducted at a community aged care provider in Sydney, Australia. Key stakeholders (n = 14) were recruited, representing: people with dementia, informal (family) carers, AoP artists, service referrers and community service managers. Focus group transcripts were analysed using qualitative content analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). Outcomes were reviewed against the Expert Recommendations for Implementing Change (ERIC) strategy compilation to inform development of a tailored implementation strategy.ResultsFour overarching themes described the range of barriers and enablers to AoP@Home implementation: (1) “I don't know enough about it” (awareness and engagement within the sector), (2) artists delivering programs, (3) awareness and engagement of people impacted by dementia, (4) practicalities of implementation. All five domains of the CFIR were represented across the four themes. The ERIC compilation provided a list of practical strategies for implementation of AoP@Home.ConclusionsThe implementation of psychosocial interventions for people living with dementia within a community aged care service is complex and multifactorial.So what?: Organisations planning implementation should consider conducting their own pre‐implementation analysis to identify context‐specific strategies.

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“…In compliance with federal, state, and territory government rules and similar to changes across the globe Thyrian et al, 2020;Verbeek et al, 2020), the COVID-19 pandemic has left many Australians living with dementia and their informal carers without care support because of temporary closures of day care/respite centers and restrictions to face-to-face home support and RACF visits. The pandemic has also highlighted the need for a better model of health and aged care services for older people, people living with dementia, and their carers (Low, Laver, et al, 2021;Pachana et al, 2020).…”

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confidence: 99%

How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study

et al. 2022

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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.

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We need a model of health and aged care services that adequately supports Australians with dementia

Cited by 12 publications

References 5 publications

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

Steps to implementation: Understanding barriers and enablers for implementing Arts on Prescription at Home for people impacted by dementia

How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study

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