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Aim: This study aims to test the feasibility of the PainChek app to assess pain for people with dementia living in residential aged care facilities (RACFs). It will also identify the optimal dosage and efficacy of a social robot (personal assistant robot [PARO]) intervention on chronic pain for people with dementia. Design: This is a feasibility randomized controlled trial with three groups. Methods: Forty-five residents living with dementia and chronic pain will be recruited from one RACF. The intervention consists of an individual 15-min non-facilitated session with a PARO robot twice a day (Group 1), a PARO robot once a day (Group 2), or a Plush-Toy (non-robotic PARO) once a day (Group 3) from Monday to Friday for 4 weeks. Participants will be followed at 4 and 8 weeks after baseline assessments. The primary outcome will be the feasibility of using the PainChek app to measure changes in pain levels before and after each session. Secondary outcomes include staff-rated pain levels, neuropsychiatric symptoms, quality of life and changes in psychotropic and analgesic medication use. Participants, staff and family perceptions of using PARO and the PainChek app will be collected after the 4-week intervention. Discussion: This study will test the use of the PainChek app and PARO to improve pain management for people with dementia. Results from this study will help determine its usefulness, feasibility and acceptability for pain management in people with dementia living in RACFs. Impact: As pain is a significant problem for people with dementia, this project will generate evidence on the use of the PainChek to measure the efficacy of a social robot intervention that has the potential to improve the quality of pain care in people with dementia. Trial Registration: Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820) date registered 30/06/2021.

Background: Pain is a common problem but often undiagnosed and untreated in people with dementia. Aims: This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. Design: A qualitative study. Settings/participants: Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. Method: Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. Results: Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. Conclusions: Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.

Tai Chi, combined with Thera-band (TCTB) exercise may be associated with an improvement in health where it increases physical fitness, improves psychological well-being, and decreases pain. This paper aimed to determine the feasibility of TCTB exercise in older sedentary office workers. Forty office workers aged over 55 years participated in a pilot randomized controlled trial (i.e., 12-week TCTB exercise or Tai Chi exercise only). Feasibility of the TCTB exercise approach was ascertained through the recruitment and enrolment rate, acceptability of the study intervention by participants including retention and adherence rates, participants&rsquo, learning process, the appropriateness of data collection as well as the participants&rsquo, evaluation of the intervention. Recruitment took longer than planned, with a low recruitment rate of 2.0% (42/2020), but a high enrolment rate of 95.2% (40/42). Thirty-one participants (i.e., 77.5%) completed the intervention. Of those who completed the trial, the overall average attendance was reported as 85.2%, 84.7% in the TCTB group and 85.7% in the Tai Chi only group. A total of 58.3% of participants (n = 21) could independently practice the TCTB or Tai Chi exercise motions at the end of the learning stage. There were no missing data except for the nine participants who withdrew during the intervention. No adverse events or effects were reported, and all participants were satisfied with the 12-week exercise intervention. Results support the feasibility of a large-scale randomized controlled trial to explore the efficacy of a TCTB program for improving health in older sedentary office workers.

Highlights • Most activity interventions for people with dementia in long-term care are facilitated. • Non-facilitated meaningful activities included music/stimulated family presence, animal-like social robot, lifelike dolls. • Some beneficial effects for agitation, emotional wellbeing, feelings of pleasure, engagement and sleep quality. • Future research into the potential benefits of non-facilitated meaningful activities is needed in rigorously designed RCTs., This systematic review sought to evaluate the effectiveness of non-facilitated meaningful activities for older people with dementia in long-term care facilities. Searches were conducted in PubMed; CINAHL; EMBASE; Web of science; PsycINFO; Cochrane; ProQuest; and ClinicalTrials.gov to identify articles published between January 2004 and October 2019. A total of six studies were included. Results implied that current randomised controlled trials or controlled trials about non-facilitated meaningful activities for people with living dementia in long-term care facilitates are limited, but those included in this review were of adequate methodological quality. Meaningful non-facilitated activities, such as music, stimulated family presence, animal-like social robot PARO/plush toy and lifelike dolls, may have beneficial effects on agitation, emotional well-being, feelings of pleasure, engagement, and sleep quality. However, there remains a lack of conclusive and robust evidence to support these psychological and physiological effects of non-facilitated meaningful activities for older people with dementia living in long-term care facilities by care staff.

The current study focuses on the short-term effect of MARIO, a social robot, on quality of life, depression, and perceived social support in persons with dementia (PWD) and evaluates their acceptability of MARIO. Ten PWD in one nursing home took part in a 4-week pilot study, where each participant had up to 12 sessions with MARIO. Sessions comprised engagement in music, news, reminiscence, games, and calendar applications. Standardized questionnaires were administered before and after the 4-week period. Participants had a sustained interest in MARIO during their interactions and an acceptance of MARIO's appearance, sound, and applications. Consequently, participants spent more time socially engaged. No statistically significant differences were found in quality of life, depression, and perceived social support. PWD can engage with a social robot in a real-world nursing home. Future research should incorporate a larger sample and longer intervention period. Funding received from European Union Horizons 2020—The Framework Programme for Research and Innovation (2014–2020) (grant agreement 643808). The authors acknowledge all members of the MARIO Project Advisory Board and the Irish Research Council Government of Ireland Postdoctoral Fellowship scheme (project ID: GOIPD/2017/1301). peer-reviewed 2020-06-25

AimTo explore the experiences and challenges for residential care home staff when managing the healthcare needs of their residents, in particular those living with dementia.BackgroundIncreasing number of older people, with complex health and social care needs are living in residential care homes. Yet there is limited appreciation of why staff sometimes struggle to manage residents’ healthcare needs, or understanding of their working relationship with district nurses (DNs), whose responsibility it is to provide nursing support.MethodsThis PhD study, in a metropolitan area in the United Kingdom, was conducted by an experienced DN and involved three phases. This paper focuses on the first two phases. Phase 1 data included: semi-structured interviews (n=8), reflective field notes based on non-participant observation, documentary analysis of policies, procedures and assessment tools and other contextual data from one care home (case study site). The practitioner researcher reflected on the findings from the case study, in relation to her own knowledge and experience as a DN, focusing in particular on findings that were familiar, or which surprised. In Phase 2 she fed these findings back to other care homes (n=11) to check whether the findings from the single case study were unique or resonated with others. She gathered their feedback through semi-structured interviews with senior care staff (n=14). Data were analysed using thematic data analysis.FindingsFindings highlight the complexity facing residential care homes: high levels of healthcare needs amongst residents, the demands of caring for residents living with dementia, variations in the knowledge and skill set of care staff, inequity in the level of healthcare support, the challenges of building a good relationship with DNs, and funding pressures facing care homes.ImplicationsAny, or all of these factors can prevent care home staff from managing the healthcare needs of their residents.

Purpose The purpose of this paper is to explore the experience of older people and their sense of developing wellbeing, including consideration of the strategies they employ to respond to perceived risk. Design/methodology/approach An Appreciative Inquiry study was used, which collected data with 58 participants in focus group and individual interviews. Interviews focussed on ways in which older people in South Africa, Australia, Germany and the UK understand and seek to maintain wellbeing. Findings The changing time horizons of older people lead to perceptions of risk and concerns that embrace societal as well as individual concerns. Often, this leads to a sense of societal responsibility and desire for social change, which is frustrated by a perceived exclusion from participation in society. Social implications In mental health practice and education, it is imperative to embrace the shift from ageist concerns (with later life viewed as risky and tragic in itself) towards a greater sensitivity for older people’s resilience, the strategies they deploy to maintain this, and their desire for more control and respect for their potential to contribute to society. Originality/value Variation in time horizons leads to changes in temporal accounting, which may be under-utilised by society. Consequently, societies may not recognise and support the resilience of older people to the detriment of older people as individuals and to the wider society.

The complexity of dementia, and the differing care services, makes it difficult to establish best practices for managing behavioural and psychological symptoms of dementia (BPSD). Our team have been trialling robots in the community and a social robotic laboratory. This presentation will demonstrate what we have learnt to date about the impact of using the robots in dementia care. Findings related to improvements in engagement, socialisation and mood as well as the feasibility of using social and telepresence robots from three studies will be outlined: 1) A cluster-randomised controlled trial (n=415, people with dementia living in long-term care), with three treatment groups – a robotic animal (PARO), a non-robotic animal (Plush-Toy), and usual care (control); 2) A case study of five dyads (people with dementia and family) using telepresence robots in a 6-week intervention; and 3) family, people with dementia and health professionals acceptance of telepresence robots in a laboratory trial.

New as well as existing technologies can help the person with dementia and family carers to reduce social isolation and behavioral and psychological symptoms of dementia (BPSD), and therefore help to make the disease more manageable. This symposium, presented by leaders in the field of technology and social robots aims to assist participants to recognise the benefits of technology use in dementia care. An introduction to new online platforms to support family and community dwelling older people will demonstrate the relationship between independence and technology, while an overview of three social and telepresence robot projects will demonstrate the importance of these technologies in reducing social isolation and BPSD. The three symsposium presentations will be complemented by the introduction of a new measurement of engagement - an important concept when measuring the effect of technology and persons with dementia.

This presentation reports on the recruitment and implementation stages of a community based early-intervention support model for older people with Mild Cognitive Impairment (MCI)/early-stage dementia and their caregivers (the dementia dyad, n=96). Detailed records on non-participation and withdrawal reasons were maintained throughout the study, and intervention acceptability was evaluated using a mixed method analysis. The study findings highlight some key issues regarding the acceptability of early intervention/forward planning approaches to people dealing with a progressive incurable condition. Public impressions of dementia heavily influenced dyad participation in the study, with nearly half (45%) of those who initially expressed interest abstaining. A significant barrier to participation was inter-dyadic disagreement, commonly related to one member’s apprehension over involvement in a study for people with dementia. Stigma continued to have an impact post-recruitment. Two dyads in the intervention group and one in the control group withdrew from the study because they found talking about dementia and associated deficits confronting. Among intervention group dyads’ that completed the intervention (n=35), the majority of dyads’ (75%) stated they felt better informed and identified tangible actions taken to plan for the future. A key challenge in intervening early with people with dementia is how to refute stigma myths and accommodate a positive perspective to adjustment to declining function. The significant impact that stigma has on the decision to engage in research activities associated with dementia may prove insurmountable, until dementia treatment options improve.

BACKGROUND: Neuropsychiatric symptoms of dementia are often treated through the prescription of one or more psychotropic medications. However, limited efficacy and potential harmful side-effects has resulted in efforts to reduce the use of psychotropic medication in this population, particularly for those living in long-term care. OBJECTIVES: This study sought to describe the pattern of central nervous system medication usage in older adults with dementia living in long-term care; assess the appropriateness of prescribing against Beers criteria; and detect potential drug interactions from co-administered medications. METHODS: A retrospective descriptive audit of the medical records of n=415 residents, aged >60 years with a diagnosis of dementia, from 28 long-term care facilities in Queensland, Australia. Information extracted included the types and usage of regular and Pro Re Nata central nervous system medications. RESULTS: Of those taking medication (n=317), 68% were prescribed at least one potentially inappropriate medication, and there was a significant positive correlation between the number of medications prescribed and the number of potentially inappropriate medications. Two-hundred potential interactions with variable severity were identified from 130 residents on ≥1 medication - 38% were potentially severe interactions, 46% were moderate. CONCLUSIONS: This medication audit raises concerns that prescription of medications may still be the first resort to treat behavioural and psychological symptoms of dementia. There is a need for effective and sustainable person-centred interventions that address barriers for appropriate prescribing practice, and involve the collaboration of all healthcare professionals to optimise prescribing and improve the quality use of medicines in older people with dementia. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org. KEYWORDS: Dementia; Drug interactions; Geriatrics; Long-term care; Medication; Prescribing PMID: 28183240 DOI: 10.2174/1574886312666170209113203 NHMRC Australia

Aim: This study aimed to explore the effect of a social robot Paro intervention on depression and well-being in older adults with depression living in long-term care facilities in Taiwan. Methods: This study was adopted a single group and quasi-experimental with repeated measures design. Each participant participated in two stages: observation and Paro intervention stages. Stage 1 was an 8-week observation stage in long-term care facilities where the purpose was to observe the normal mood, behaviour and activities of older adults with depression. In stage 2, each participant was given a Paro by the researcher to keep for 24 hours for 7 days in for 8 weeks. Outcome measurements were obtained 4 times: a week before the intervention (T1), immediately the end of 8-week observation (T2), mid-point of Paro intervention (T3), and immediately the end of 8-week Paro intervention (T4). Instruments included the Geriatric Depression Scale, the UCLA Loneliness Scale version 3, and the World Health Organization Quality of Life Questionnaire-OLD. Results: There were 20 participants completed the study. The mean age of participants was 81.1years (SD = 8.2). After 8-week Paro intervention, statistically significant differences in changes were found on depression, loneliness, and quality of life from pre-intervention to post-intervention. Conclusion: This study was found that Paro intervention has beneficial effects on depression and mental well-being for older people with depression in long-term care facilities. Paro Intervention might be a suitable psychosocial intervention for older people with depression and should be considered as a useful tool in clinical practice.

Objectives To objectively measure over a 24-hour period the daytime and nighttime levels of physical activity and sleep patterns of older people with dementia living in long-term care facilities. Study design Nested within a larger research program, this cross-sectional study involved 415 residents, aged ≥60 years, with a documented diagnosis of dementia, from 28 long-term care facilities in south-east Queensland, Australia. Main outcome measures Residents wore SenseWear® activity armbands continuously for 24 hours, with data recorded for: step count; total energy expenditure; metabolic equivalent of task (MET); and the amount of time spent physically active, lying down, awake and asleep. Residents’ levels of cognitive impairment (assessed using the Rowland Universal Dementia Assessment Scale) and agitation (assessed using the Cohen-Mansfield Agitation Inventory-Short Form), and demographic data were also collected. Results From a total of 415 residents monitored with the SenseWear® activity armbands, 192 met the valid wear-time of 21 hours or more, and had activity and sleep data recorded. These residents were largely inactive during the daytime (engaged in an average of 1.8 hours of light physical activity), but achieved recommended amounts of sleep at night (average of 6.8 hours). There was considerable variation within the sample, and activity and sleep differed by sex (p

The development of companion animal robots is of growing interest. These robots have recently been marketed to older adults with dementia as a means of encouraging social engagement and reducing behavioural and psychological symptoms of dementia. This paper outlines the results of a pilot study that sought to assess the feasibility and effect of using a robotic companion animal called CuDDler on engagement and emotional states of five older adults with dementia living in nursing home care. CuDDler is a prototype robot developed in Singapore. Despite their cognitive decline, the study participants raised a number of concerns regarding the feasibility and tolerability of CuDDler. The effectiveness of CuDDler was also limited in these participants, although one participant with visual agnosia benefited greatly from the one-on-one experience. The findings demonstrate the importance of companion robots being developed that are of an appropriate size, weight and shape for older people, including those with dementia, and a realistic animal shape that does not encourage thoughts of it being a toy. Our conclusions indicate the need for further studies on the development and use of companion robots, and investigation of the comparative benefits of social robots both compared to and in association with human interactions.

The development of a body of knowledge, gained through research and theory building, is one hallmark of a profession. This paper presents the "Partnering with Patients Model of Nursing Interventions", providing direction towards how complex nursing interventions can be developed, tested and subsequently adopted into practice. Coalescence of understanding of patient-centred care, the capabilities approach and the concept of complex healthcare interventions led to the development of the model assumptions and concepts. Application of the model to clinical practice is described, including presentation of a case study, and areas for future research including understanding both patients' and nurses' perceptions and experiences when the model is in use, and testing the effect of nursing interventions based on the model are recommended.

Background: Over half of the residents in long-term care have a diagnosis of dementia. Maintaining quality of life is important, as there is no cure for dementia. Quality of life may be used as a benchmark for caregiving, and can help to enhance respect for the person with dementia and to improve care provision. The purpose of this study was to describe quality of life as reported by people living with dementia in long-term care in terms of the influencers of, as well as the strategies needed, to improve quality of life. Methods: A descriptive exploratory approach. A subsample of twelve residents across two Australian states from a national quantitative study on quality of life was interviewed. Data were analysed thematically from a realist perspective. The approach to the thematic analysis was inductive and data-driven. Results: Three themes emerged in relation to influencers and strategies related to quality of life: (a) maintaining independence, (b) having something to do, and (c) the importance of social interaction. Conclusions: The findings highlight the importance of understanding individual resident needs and consideration of the complexity of living in large group living situations, in particular in regard to resident decision-making.

Background Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods Knowledge levels were investigated via the validated 30-item Alzheimer’s Disease Knowledge Scale (ADKS). All health service district staff with e-mail access were invited to participate in an online survey. Knowledge levels were compared across demographic categories, professional groups, and by whether the respondent had any professional or personal experience caring for someone with dementia. The effect of dementia-specific training or education on knowledge level was also evaluated. Results A diverse staff group (N = 360), in terms of age, professional group (nursing, medicine, allied health, support staff) and work setting from a regional health service in Queensland, Australia responded. Overall knowledge about Alzheimer’s disease was of a generally moderate level with significant differences being observed by professional group and whether the respondent had any professional or personal experience caring for someone with dementia. Knowledge was lower for some of the specific content domains of the ADKS, especially those that were more medically-oriented, such as ‘risk factors’ and ‘course of the disease.’ Knowledge was higher for those who had experienced dementia-specific training, such as attendance at a series of relevant workshops. Conclusions Specific deficits in dementia knowledge were identified among Australian health care staff, and the results suggest dementia-specific training might improve knowledge. As one piece of an overall plan to improve health care delivery to people with dementia, this research supports the role of introducing systematic dementia-specific education or training.

Background Caring for a person with dementia can be physically and emotionally demanding, with many long-term care facility staff experiencing increased levels of stress and burnout. Massage has been shown to be one way in which nurses’ stress can be reduced. However, no research has been conducted to explore its effectiveness for care staff working with older people with dementia in long-term care facilities. Methods This was a pilot, parallel group, randomized controlled trial aimed at exploring feasibility for a larger randomized controlled trial. Nineteen staff, providing direct care to residents with dementia and regularly working ≥ two day-shifts a week, from one long-term care facility in Queensland (Australia), were randomized into either a foot massage intervention (n=9) or a silent resting control (n=10). Each respective session lasted for 10-min, and participants could receive up to three sessions a week, during their allocated shift, over four-weeks. At pre- and post-intervention, participants were assessed on self-report outcome measures that rated mood state and experiences of working with people with dementia. Immediately before and after each intervention/control session, participants had their blood pressure and anxiety measured. An Intention To Treat framework was applied to the analyses. Individual qualitative interviews were also undertaken to explore participants’ perceptions of the intervention. Results The results indicate the feasibility of undertaking such a study in terms of: recruitment; the intervention; timing of intervention; and completion rates. A change in the intervention indicated the importance of a quiet, restful environment when undertaking a relaxation intervention. For the psychological measures, although there were trends indicating improvement in mood there was no significant difference between groups when comparing their pre- and post- scores. There were significant differences between groups for diastolic blood pressure (p= 0.04, partial η2=0.22) and anxiety (p= 0.02, partial η2=0.31), with the foot massage group experiencing greatest decreases immediately after the session. The qualitative interviews suggest the foot massage was well tolerated and although taking staff away from their work resulted in some participants feeling guilty about taking time out, a 10-min foot massage was feasible during a working shift. Conclusions This pilot trial provides data to support the feasibility of the study in terms of recruitment and consent, the intervention and completion rates. Although the outcome data should be treated with caution, the pilot demonstrated the foot massage intervention showed trends in improved mood, reduced anxiety and lower blood pressure in long-term care staff working with older people with dementia. A larger study is needed to build on these promising, but preliminary, findings. Trial registration ACTRN: ACTRN12612000659808.

© 2017 The Author(s). Background: With an ageing population, the number of people with dementia is rising. The economic impact on the health care system is considerable and new treatment methods and approaches to dementia care must be cost effective. Economic evaluation requires valid patient reported outcome measures, and this study aims to develop a dementia-specific health state classification system based on the Quality of Life for Alzheimer's disease (QOL-AD) instrument (nursing home version). This classification system will subsequently be valued to generate a preference-based measure for use in the economic evaluation of interventions for people with dementia. Methods: We assessed the dimensionality of the QOL-AD to develop a new classification system. This was done using exploratory and confirmatory factor analysis and further assessment of the structure of the measure to ensure coverage of the key areas of quality of life. Secondly, we used Rasch analysis to test the psychometric performance of the items, and select item(s) to describe each dimension. This was done on 13 items of the QOL-AD (excluding two general health items) using a sample of 284 residents living in long-term care facilities in Australia who had a diagnosis of dementia. Results: A five dimension classification system is proposed resulting from the three factor structure (defined as 'interpersonal environment', 'physical health' and 'self-functioning') derived from the factor analysis and two factors ('memory' and 'mood') from the accompanying review. For the first three dimensions, Rasch analysis selected three questions of the QOL-AD ('living situation', 'physical health', and 'do fun things') with memory and mood questions representing their own dimensions. The resulting classification system (AD-5D) includes many of the health-related quality of life dimensions considered important to people with dementia, including mood, global function and skill in daily living. Conclusions: The development of the AD-5D classification system is an important step in the future application of the widely used QOL-AD in economic evaluations. Future valuation studies will enable this tool to be used to calculate quality adjusted life years to evaluate treatments and interventions for people diagnosed with mild to moderate dementia.