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Objective: To determine the re‐test reliability of the Health Literacy Questionnaire (HLQ) with carers of older adults discharged from hospital or attending the outpatient clinic. Methods: Carers completed the HLQ twice by telephone and rated the acceptability of completing the tool. Tool completion time was recorded. Correlations were calculated between the test occasions using intraclass correlation coefficients (ICC) and 95% confidence intervals. Results: Fifty‐one carers of older patients participated. The HLQ showed good reliability (ICC = 0.75‐0.90) for seven of the nine scales and moderate reliability (0.50‐0.74) for the other two scales. Median completion time was 16.5 minutes (range 9‐50), and acceptability was rated as 9.5/10. Conclusion: The HLQ is a reliable tool for use with carers of older adults attending hospital. However, the length of time for completion of the HLQ may limit its feasibility for use by hospital staff and carers, given the high stress and time pressures of acute care. [ABSTRACT FROM AUTHOR]

This study piloted a hospital-based delirium and falls education program to investigate the impacts on staff knowledge and practice plus patient falls. On a medical ward, staff knowledge was compared before and after education sessions. Other data - collected a day before and after program implementation - addressed documentation of patients' delirium and evidence of compliance with falls risk minimization protocols. These data, and numbers of patient falls, were compared before and after program implementation. Almost all ward staff members participated in education sessions (7 doctors, 7 allied health practitioners, and 45 nurses) and knowledge was significantly improved in the 22 who completed surveys both before and after session attendance. Patients assessed as having delirium (5 before implementation, 4 afterwards) were all documented as either confused or delirious. Small changes eventuated in adherence with falls risk management protocols for confused patients and the number of falls decreased. The program merits a stronger emphasis on staff activities relating to the detection, documentation, and management of delirium to inter-professional roles and communication. Evidence of practice enhancement from program implementation should precede rigorous testing of impacts upon falls. [ABSTRACT FROM AUTHOR]

Background Dementia is a significant issue globally, including in Thailand, and exercise is known to have health benefits for people living with dementia. However, little is known about exercise acceptable to, and feasible for, this population group in low-to-middle income countries although, more broadly, it is recognised that health-related behaviours are influenced by the perceptions of the individual, which exist within a cultural context. Objectives To explore and describe perceptions of appropriate exercise for people living with dementia in Bangkok, Thailand. Design Qualitative exploratory descriptive. Setting Bangkok, Thailand. Participants Nine professionals - experts in exercise, dementia care and relevant policy development - and nine dyads of people with dementia and their family caregivers all recruited using purposive sampling. Methods Semi-structured interviews subjected to thematic analysis. Results Three themes emerged: how exercise was defined, perceived benefits of exercise and how exercise should be implemented. Professionals recognised three exercise elements: aerobic exercise plus balance and strength training. Dyads recognised home-based activities (e.g., housework) and walking. Both groups recognised benefits of exercise in maintaining health and function and improving mood and sleep. Only health professionals identified falls risk reduction. There was limited appreciation of benefits for caregivers by maintaining function in care recipients. Professionals deemed that exercise should address all three elements, using easily accessible low-cost resources. The need for safety was emphasised, and there was agreement that in-home exercise was appropriate. Family/cultural values were evident that could present barriers to exercise implementation. Conclusion Changing health-related behaviours requires an understanding of individual perspectives, which exist within a cultural context. This study has illuminated the Thai context and has implications beyond this. Findings emphasise a need for potential benefits to be sufficiently understood by family caregivers to overcome any culturally based reluctance to promote exercise in older people. Implications for practice Nurses have a key role in supporting care givers of older persons with dementia supervise home based exercise. Nurses need to develop knowledge of aerobic exercise to teach caregivers and the older person with dementia. Muscle strength and aerobic exercise assists in the older person's ability to undertake ADL. [ABSTRACT FROM AUTHOR]

Objectives To compare the psychometric performance of the Dementia Knowledge Assessment Scale ( DKAS) and the Alzheimer's Disease Knowledge Scale ( ADKS) when administered to a large international cohort before and after online dementia education. Design Comparative psychometric analysis with pre- and posteducation scale responses. Setting The setting for this research encompassed 7,909 individuals from 124 countries who completed the 9-week Understanding Dementia Massive Open Online Course ( MOOC). Participants Volunteer respondents who completed the DKAS and ADKS before (n = 3,649) and after (n = 878) completion of the Understanding Dementia MOOC. Measurements Assessment and comparison of the DKAS and ADKS included evaluation of scale development procedures, interscale correlations, response distribution, internal consistency, and construct validity. Results The DKAS had superior internal consistency, wider response distribution with less ceiling effect, and better discrimination between pre- and posteducation scores and occupational cohorts than the ADKS. Conclusion The 27-item DKAS is a reliable and preliminarily valid measure of dementia knowledge that is psychometrically and conceptually sound, overcomes limitations of existing instruments, and can be administered to diverse cohorts to measure baseline understanding and knowledge change. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To develop a reliable and valid dementia knowledge scale to address limitations of existing measures, support knowledge evaluation in diverse populations, and inform educational intervention development. DESIGN: A five-stage, systematic scale development process was employed to construct and assess the psychometric properties of the Dementia Knowledge Assessment Scale (DKAS). SETTING: Data for the study were generated in an online environment and during clinical dementia care placements from Australian (n = 1,321) and international respondents (n = 446). PARTICIPANTS: Volunteers from a dementia-related massive open online course (n = 1,651), medical students on clinical placement in a residential aged care facility (n = 40), and members of the Australian health workforce (n = 76). MEASUREMENTS: Psychometric properties of the DKAS were established using a literature review to assess the veracity of scale items, respondent feedback during pilot testing, a Delphi study with dementia experts, construction and review by an expert panel, evaluation of item difficulty, item-total and interitem correlations. Principal components analysis (PCA) was also performed along with measures of test-retest reliability, internal consistency, construct validity, and concurrent validity. RESULTS: The pilot DKAS was reduced from 40 to 27 items during analysis. PCA identified four distinct and interpretable factors. The revised DKAS displays high levels of test-retest reliability; internal consistency; and preliminary construct, concurrent, and factorial validity. CONCLUSION: The 27-item DKAS is reliable and shows preliminary validity for the assessment of knowledge deficiencies and change in those who provide care and treatment for people with dementia. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to obtain perspectives from key stakeholders to inform the development of Australian national guidelines for a palliative approach to aged care in the community setting. Methods: A descriptive, exploratory qualitative design was used. Sampling was purposive. Data were collected during audiotaped, semistructured, individual and focus group interviews that addressed the need for the guidelines and aimed to identify practice areas for inclusion. Thematic analysis was undertaken. Results: Interviews were conducted across Australia and included 172 participants: health-care providers, consumers, volunteers and researchers/educators. Themes emerging from the data were: Provision of a Palliative Approach in Community Aged Care, Carer Support, Advance Care Planning, Physical and Psychological Symptom Assessment and Management, Psychosocial Support, Spiritual Support, Issues for Aboriginal or Torres Strait Islander People, Older People from Diverse Cultural and Language Groups, and Clients with Special Needs. Conclusion: Findings underpinned development of new guideline documents. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop recommendations and a related implementation resource ‘toolkit’ to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs). Methods: This qualitative study used written materials, focus groups and individual interviews to gather data from participants. Thirty-four health-care professionals with experience in the aged care sector were recruited from five Western Australian RACFs. General practitioners who had an interest in aged care were contacted via local general practice networks. Results: Findings indicated that focused education sessions were needed to support implementation. A tailored toolkit was developed to assist the process. Funding and workforce constraints were found to be threats to complete implementation in some facilities. Conclusions: A multifaceted approach is needed to promote the implementation of pain management strategies in RACFs. In particular, unlicensed care workers, who may have responsibility for recognising and reporting signs of pain, require further education to support their role in the pain management process. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A two-phase study was conducted to refine a version of Cleeland's Brief Pain Inventory (BPI, Short Form) for use in residential aged care facilities (RACFs). DESIGN: The Australian Pain Society modified Cleeland's BPI by changing numerical response options to word descriptors. In Phase I, this version was tested in RACFs to determine the feasibility of its use, its stability over time, and its internal consistency reliability. Minor modifications resulted. In Phase II, the refined version was abbreviated, and the internal consistency reliability of this Modified Residents' Verbal BPI was examined. SETTING: RACFs. PARTICIPANTS: Thirty-three residents of RACFs in Phase I, 149 in Phase II. INTERVENTION: The study revised and abbreviated the BPI to better fit it for use in RACFs, examining the reliability of the tool. MEASUREMENTS: Mini-Mental State Examination, Global Deterioration Scale, modified BPI. RESULTS: The abbreviated tool comprises three items assessing pain intensity and three assessing pain interference. It also includes an item to specify pain location and a movement protocol. Cronbach alpha coefficient for six intensity and interference items was 0.72 (N=106). CONCLUSION: This abbreviated tool requires further testing but has demonstrated adequate internal consistency reliability and is a brief, multidimensional tool that appears feasible for assessing pain in RACFs, including use with residents who have some cognitive impairment. It shows promise as a screening tool and may be useful to assess the effectiveness of pain relief interventions and to measure pain prevalence. [ABSTRACT FROM AUTHOR]

Huntington's disease is a genetic, neurological disorder characterized by mid-life onset, involuntary movements, cognitive decline, behavioral disturbance, and inexorable progression. The impact of Huntington's disease is devastating for individuals and their families as it is a disease with a long trajectory; many young people are aware that they may develop the illness for years before there are obvious symptoms. There is therefore ample opportunity to plan and choreograph the care and supportive services for people with Huntington's disease and their families. The present study was conducted to explore the needs for palliative (supportive) care service provision of people with Huntington's disease and their families/informal carers. Six people with the disease, 19 informal carers and seven health care workers with specialized knowledge took part in individual, semistructured interviews, which were analyzed thematically. Themes were: (i) adjusting to the impact of the illness; (ii) surviving the search for essential information; (iii) gathering practical support from many sources; (iv) bolstering the spirit; (v) choreographing individual care and; (vi) fearing the future. Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed. [ABSTRACT FROM AUTHOR]

Aim: We aimed to implement a systematic nurse–caregiver conversation, examining fidelity, dose and reach of implementation; how implementation strategies worked; and feasibility and mechanisms of the practice change. Background: Appropriate hospital care for people living with dementia may draw upon: information from the patient and family caregiver about the patient's perspective, preferences and usual support needs; nursing expertise; and opportunities the nurse has to share information with the care team. Within this context, planned nurse–caregiver communication merits further investigation. Methods: In Phase I, we established the ward staff's knowledge of dementia and Alzheimer's disease, prepared seven nurse change leaders, finalised the planned practice change and developed implementation plans. In Phase II, we prepared the ward staff during education sessions and leaders supported implementation. In Phase III, evaluations were informed by interviews with change leaders, follow‐up measures of staff knowledge and a nurse focus group. Qualitative data were thematically analysed. Statistical analyses compared nurses' knowledge over time. Results: Planned practice change included nurses providing information packs to caregivers, then engaging in, and documenting, a systematic conversation. From 32 caregivers, 15 received information packs, five conversations were initiated, and one was completed. Knowledge of dementia and Alzheimer's disease improved significantly in change leaders (n = 7) and other nurses (n = 17). Three change leaders were interviewed, and six other nurses contributed focus group data. These leaders reported feeling motivated and suitably prepared. Both nurses and leaders recognised potential benefits from the planned conversation but viewed it as too time‐consuming to be feasible. Conclusions: The communication initiative and implementation strategies require further tailoring to the clinical setting. A caregiver communication tool may be a helpful adjunct to the conversation. Implementation may be enhanced by more robust stakeholder engagement, change leader inclusion in the reference group and an overarching supportive framework within which change leaders can operate more effectively. Implications for Practice: Nurse‐caregiver communication in this context requires inititatives tailored to the clinical setting with input from all stakeholders. [ABSTRACT FROM AUTHOR]