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Objective To investigate the effect of a social robot intervention on sleep and motor activity in nursing home residents living with dementia and chronic pain. Method A pilot randomized controlled trial was conducted with 41 residents from three Australian nursing homes. People living with dementia and chronic pain were randomized into either a 30-minute daily social robot (PARO) condition or a usual care condition for six weeks. Sleep and motor activity were assessed by actigraphy at four-time points: week 0 at baseline, week one, week six, and after the intervention. Data were reduced into daytime (8:00am - 7:59pm) and night-time (8:00pm - 7:59am) summaries. Change scores for each time point compared with baseline were computed for data analysis and the generalized estimating equation model with imbalanced baseline values added as covariates were performed. Results At week one, residents in the PARO group had a greater increase in the night sleep period (1.81, 95 % CI: 0.22–3.84, p = 0.030, Cohen’s d = 0.570). At week six, residents in the PARO group showed a greater increase in daytime wakefulness (1.91, 95 % CI: 0.09–3.73, p = 0.042, Cohen’s d = 0.655) and a greater reduction in daytime sleep (-1.35, 95 % CI: -2.65 to -0.05, p = 0.040, Cohen’s d = 0.664). No significant results were found for motor activity. Conclusion PARO could improve sleep patterns for nursing home residents living with dementia and chronic pain, but the effect of PARO on motor activity needs further research. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202).

Given the reduced ability of people with dementia to self-report pain, this study examined the feasibility of using a portable electroencephalography (EEG) headband (MUSE 2) as a pain measurement tool for long-term care residents with dementia. Ten minutes of resting-state EEG was acquired by MUSE 2 from people with dementia experiencing ongoing pain (n = 3) and without current pain (n = 1) over three days. The MUSE 2 was acceptable and feasible for use in people with dementia while challenges regarding software, data collection and analysis in using this device are reported. Compared to the resident not experiencing pain, EEG signals of residents with ongoing pain showed different EEG patterns, and this could be a potential biomarker to support pain measurement in people with dementia. Further research with larger sample size is warranted to verify study results.

Aims and objectives To explore hospital healthcare professionals' knowledge and attitudes towards dementia care in China. Background Hospital healthcare professionals deliver most diagnosis and treatment for people with dementia in China. Literature shows that healthcare professionals' knowledge and attitudes are of great importance in providing optimum dementia care. However, there is limited research of healthcare professionals' dementia knowledge and attitudes within hospital contexts in China. Design A cross-sectional survey was conducted between April and December 2019. Methods A self-report questionnaire composed of demographics and knowledge and attitude scales related to dementia was used for doctors and registered nurses working in settings where people with dementia are cared for in eleven public tertiary hospitals in Hebei Province, China. The STROBE checklist was adhered to in this study. Results In total, 603 healthcare professionals completed the study. The majority of respondents were registered nurses (71.3%). The overall mean knowledge score was 20.7 (SD = 2.9) out of a maximum possible score of 30. The overall mean score for attitudes was 91.3 (SD = 15.9) out of a maximum possible score of 140. Standard multiple linear regression analysis revealed that the highest level of education, the experience of searching for dementia-related information and willingness to receive dementia training or education were significant predictors of knowledge scores. The department, the experience of working with people with dementia, length of dementia care, interest in dementia care and training type were significant predictors of attitude scores. Conclusions Deficits in the knowledge of dementia and a low level of positive attitude were identified among the healthcare professionals who work in hospital settings where people with dementia are cared for in China. Relevance to clinical practice Education and training in dementia care should be integrated into undergraduate nursing and medical programmes and provided for healthcare professionals after commencing employment.

The co-design of a mobile health (mHealth) application for family caregivers of people with dementia to address functional disability care needs is presented. Participants included family caregivers of people with dementia, aged care nurses, physicians, occupational therapists, and information technology (IT) experts. The co-design process involved two phases: (1) needs assessment phase (an online survey and in-depth interviews with family caregivers and expert consultation); and (2) development of an mHealth application (content and prototype development). Data triangulation from phase one informed the content of the application. Data triangulation resulted in three content modules: "an overview of dementia and care," "management of daily living activities," and "caregivers' health and well-being." The content was based on contemporary literature, and care guidelines with input from family caregivers and dementia care experts. IT engineers developed the mHealth application. In this study, an Android-based mHealth application was designed to address the functional care needs of family caregivers and the co-design process ensured the incorporation of end-users' real-world experiences and the opinions and expertise of key stakeholders in the development of the application prototype.It is to be noted that before releasing the application into the app store, testing its feasibility and effectiveness is essential.

Background Family carers of people with dementia face different challenges in providing care for daily living activities of their care recipients. Today, mHealth applications are widely used in healthcare. Aim To examine the needs of family carers of people with dementia concerning the management of functional disability of their care recipients, carer burden and use of mHealth applications when seeking health information. Methods A total of 166 family carers, who were recruited through leading dementia support organisations in Australia, research institutes, and social media, completed an online survey. In data analysis, descriptive statistics, Pearson’s Chi-square test, Mann-Whitney U test and Kruskal-Wallis H test were used. Findings People with dementia were dependent on family carers for complex activities (e.g. taking medication) (99.4%), domestic activities (e.g. washing clothes) (97%), and self-care (e.g. bathing) (79.5%). Family carers reported a moderate-to-high need for education in functional disability care (62.6%). Bathing was reported as the most difficult activity to perform (30.1%). Three-quarters of carers reported carer burden (74.1%). Most carers (98.8%) owned a smart-device, and 51.2% of family carers reported having an mHealth application. Educational needs for functional disability care were associated with age (highest among those between 36–65 years) and eHealth literacy of carers (greater among carers with adequate eHealth literacy). Carer burden was associated with stage of dementia (highest in advanced dementia) and experiencing chronic medical problems of care recipients. Possession of an mHealth application was associated with employment status (currently employed), adequate eHealth literacy and higher educational needs. Conclusion Providing functional disability care is one of the priority needs for education. These educational needs can potentially be provided via mHealth applications. Health professionals can use these findings to plan educational interventions to address family carers’ needs.

Objectives:To investigate the effect of a social robot intervention on depression, loneliness, and quality of life of older adults in long-term care (LTC) and to explore participants’ experiences and perceptions after the intervention.Design:A mixed-methods approach consisting of a single group, before and after quasi-experimental design, and individual interview.Participants:Twenty older adults with depression from four LTC facilities in Taiwan were recruited.Intervention:Each participant participated in 8 weeks of observation and 8 weeks of intervention. In the observation stage, participants received usual care or activities without any research intervention. In the intervention stage, each participant was given a Paro (Personal Assistive RobOt) to keep for 24 hours, 7 days a week.Measurements:The Geriatric Depression Scale, the UCLA Loneliness Scale Version 3, and the World Health Organization Quality of Life Questionnaire for older adults were administered at four time points. Individual qualitative interviews with thematic analysis followed.Results:A repeated multivariate analysis of variance and Friedmanʼs test showed no significant changes during the observation stage between T1 and T2 for depression and quality of life (p>.5). For the intervention stage, statistically significant changes in decreasing depression and loneliness and improving quality of life over time were identified. Three themes emerged from the interviews: (i) humanizing Paro through referring to personal experiences and engagement; (ii) increased social interaction with other people; and (iii) companionship resulting in improved mental well-being.Conclusions:There were significant improvements in mental well-being in using Paro. Further research may help us to understand the advantages of using a Paro intervention as depression therapy.

Informal care is recognised as a significant resource in the care of older adults living with a chronic life-limiting illness. This review aims to assess the existing literature on how informal care can support older people living with chronic life-limiting illness in Africa. An integrative review framework was used. Three themes emerged to focus on chronic illness management as a social and clinical matter; cultural obligations contingent on the availability of people and resources; and burden of care relieved by connection with the church. Social policies should be structured to support caregivers and older adults to strengthen the ties between community social organisations and their families.

Objectives To outline development of the Intimacy and Sexuality Expression Preference (ISEP) tool that elicits preferences for the expression of intimacy and sexuality of older people, living with and without dementia, in residential aged care. Methods Using two rounds of the Delphi technique involving 14 panelists, tool items were evaluated for importance, usefulness, relevancy and clarity on a 5-point Likert scale. Results All tool items achieved a mean score of ≥3.4 across the four areas of evaluation with an overall average tool-level content validity index of 0.89. Instructions were deemed appropriate (M=4.6; SD=0.8), easy to understand and simple to follow (M=4.6; SD=0.6). Discussion The ISEP tool can improve care and support older people's expression of intimacy and sexuality from a person-centered approach. Further research into the use of the tool in ‘real’ residential aged care settings is required to establish external validity prior to implementation.

International audience; The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias.This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations.Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.

Background and purpose Despite Tai Chi and resistance training being recommended as suitable exercise for older adults, there are no systematic reviews synthesizing the effectiveness of a combination of Tai Chi and resistance training on health promotion of older adults. This study aimed to review the existing literature regarding the effect of Tai Chi and resistance training on physical health, mental health, pain, health-related quality of life, and age-related impairment in adults aged 50 years and older. Methods A systematic review was conducted to report the health outcomes of Tai Chi combined with resistance training research in adults aged 50 years and older. Articles were identified by searching PubMed, Scopus, Web of Science, CINAHL, MEDLINE, Physiotherapy Evidence Database (PEDro), and the Cochrane library using search terms representing "Tai Chi" and "resistance" and "older adults." Quantitative experimental studies with participants aged 50 years and older, where one of the interventions was Tai Chi and resistance training, were included. Results and discussion The literature search yielded 648 articles from which 7 met the inclusion criteria. Collectively, the studies involved 703 participants aged 50 years and older, including healthy older adults, older adults with history of falls, postmenopausal women, and people diagnosed with end-stage hip osteoarthritis. Studies included different Tai Chi forms in combination with various types of resistance training. Training sessions were 2 to 7.5 h/wk and lasted between 12 weeks and 12 months. After long-term Tai Chi and resistance training, the participants showed significant improvement in upper and lower extremity muscle strength, aerobic endurance, balance, and mobility. However, 1 study failed to show improvement in Functional Movement Screening compared with traditional Tai Chi and nonexercise groups. No study examined the effects of Tai Chi and resistance training on health-related quality of life, fear of falling, or mental health in adults aged 50 years and older. Conclusions The review supports that Tai Chi in combination with resistance training improves physical function and muscle strength in adults aged 50 years and older.

Background Interacting with social robots, such as the robotic seal PARO, has been shown to improve mood and acute pain for people with dementia. Little attention has been paid to the effect of PARO on people with dementia and chronic pain. Objective To explore how people with mild to moderate dementia and chronic pain perceive PARO as an alternative intervention to manage their pain and mood. Design A descriptive qualitative approach nested within a pilot randomised controlled trial. Methods Participants with dementia and chronic pain were recruited from three residential aged care facilities. They interacted with PARO for 30 min, 5 days a week over a 6-week period. A sample of 11 participants completed individual semi-structured interviews at the end of the intervention. Data were collected from January 2018-January 2019. Inductive thematic analysis was undertaken. Reporting of findings followed the COREQ checklist. Results Four themes emerged from the data: (a) perceptions of PARO; (b) therapeutic effects of PARO; (c) limitations of PARO; and (d) programme improvement. Residents with dementia expressed positive attitudes towards the use of PARO and acknowledged the therapeutic benefits of PARO on mood improvement and relaxation for pain relief but also mentioned the limitations of its weight, voice and characteristics. Residents' responses could also fluctuate during the intervention process, and individual preferences need to be considered. Conclusions The PARO intervention is a promising intervention to improve positive emotion, and there is some anecdotal evidence that pain may be decreased from the perspectives of people living with chronic pain and dementia. Relevance to clinical practice Long-term care staff may incorporate PARO therapy into daily dementia care. Understanding of individual's preferences may enhance the implementation of PARO for pain management in this group.

Insufficient physical activity is widespread amongst older office workers and has adverse effects on their physical fitness and psychological wellbeing, as well as being a cause of pain and of pain intolerance. Health challenges in older office workers may have an impact on their work productivity, quality of life, and involvement in the workplace. Differing exercise interventions have been employed to improve older workers’ health conditions, with Tai Chi being reported to be a suitable physical activity intervention for this purpose. Tai Chi appears to improve older adults’ physical function and psychological wellbeing, and to reduce pain in older adults. Additionally, many studies have found the benefits of resistance training in the workplace for older adults, especially for work-related pain issues. However, a systematic review found that few studies have examined the use of combined Tai Chi and resistance training to improve the physical function of older adults, and there is a lack of studies regarding the effects of this combined programme on psychological wellbeing and pain. Further to this, no study has examined the use of Tai Chi combined with resistance training in older office workers. This study aimed to investigate the effectiveness of a 12-week Tai Chi combined with resistance training programme in improving physical fitness and psychological wellbeing, and in reducing pain in older office workers. This programme was compared to a Tai Chi exercise only programme in a group of 40 older office workers (i.e., ≥ 55 years) who engaged in less than 60 minutes of accumulated moderate intensity physical activity per week and were employed by a university in Australia. A pilot randomised controlled trial (RCT) design was applied in this study. The first 10 movements of the 24-step simplified Tai Chi was chosen for use in this study, combined with Thera-band training using the hands. Prior to the pilot RCT study, an online survey was conducted to investigate the physical activity involvement, psychological wellbeing, and pain of older office workers aged 55 years and older, which could provide an insight into the physical activity intervention and workplace health promotion. The online survey reported that 27.3% of the older office workers had low levels of physical activity. Also, depression and anxiety were identified as two common major health issues in older office workers. In the pilot RCT study, 40 office workers aged 55 years and older, who met the inclusion and exclusion criteria, as well as provided signed consent forms, were randomly allocated into either the Tai Chi combined with Thera-band training (intervention) group or the Tai Chi exercise only (control) group. Outcome assessments were conducted at baseline, week 6, and week 12, using the 30-Second Chair Stand Test for lower limb strength, Grip Strength Test for upper limb strength, Function Reach Test for balance, 2-Minute Walk Test for walking endurance, Perceived Stress Scale for stress, Centre for Epidemiological Studies Depression Scale for depression, Geriatric Anxiety Inventory for anxiety, and Visual Analogue Scale for pain. The majority of the participants were female (77.5%), had achieved a higher education qualification (55%), worked full-time (77.5%), were married (62.5%), and recorded as being right-handed (92.5%). A significant difference in pain at baseline was found among participants in the control and intervention groups (p < 0.05). Nine out of the 40 participants withdrew their participation during the study. An overall average attendance rate of 66.7% was recorded across the 40 participants, with 64.3% in the intervention group and 69.1% in the control group. After adjusting for the baseline pain scores and the attendance rate, analysis of data found that there was a statistically significant interaction between intervention type and time with anxiety scores (p = 0.04) and pain scores (p = 0.02). In addition, there were significant differences between groups in the improvement of lower limb strength (p = 0.01) and right upper limb strength (p = 0.04). No significant differences were found in other outcomes; however, the odds ratio estimation indicated that a higher percentage of participants in the intervention group had improvement in balance and walking endurance, and reduction in stress and depression compared with the control group. This study is the first known trial to test the effectiveness of Tai Chi combined with Thera-band training for health promotion in older sedentary office workers when compared to Tai Chi exercise only, with regard to physical fitness, psychological wellbeing, and pain. This study suggested that Tai Chi combined with Thera-band training has the potential to improve lower limb strength and upper limb strength compared to Tai Chi exercise only in older sedentary office workers. Limitations and recommendations from this study may be helpful in designing a large-scale RCT study regarding the effects of the Tai Chi combined with Thera-band training programme on health promotion in older office workers.

This study aims to describe a protocol to develop a conceptual design for a technological device based on theoretical knowledge to improve medication adherence in people with dementia. The six steps of the intervention mapping approach will be systematically applied. Step 1 will be a needs assessment using a mixed-methods approach: a survey and interviews with carers to identify determinants of medication non-adherence. Device outcomes and objectives will be set in Step 2 followed by the selection of practical theory-informed methods in Step 3. In Step 4, the structure of the conceptual design will be determined through a Delphi technique. Finally, the implementation and evaluation plans for the design will be developed in Steps 5 and 6. To improve medication adherence in this population, the design should address the condition, patients’ and caregivers’ needs and factors contributing to the problem. Involvement of end-users and a multidisciplinary team will ensure a practical and fit-for-purpose design bridging the gap between research and practice.

Improving perception of gerotranscendence can increase life satisfaction in older adults to achieve successful aging. The purpose of this study was to evaluate the feasibility and effect of a multidimensional support program (MSP) on gerotranscendence and depression in community-dwelling older adults. Using a cluster–randomized control trial design, four sites (98 participants) were randomly assigned to a MSP or control group. The Gerotranscendence Scale and Geriatric Depression Scale were administered pre- and postintervention. A total of 91 participants completed the study. The mean attendance rates in the MSP and control groups were 85.5% and 84.3%, respectively. The MSP was found to significantly enhance the perception of gerotranscendence in older adults but not their level of depression. This study demonstrated the MSP is a feasible and effective program to improve perception of gerotranscendence and may potentially lead to positive psychological well-being for older adults. [Res Gerontol Nurs. 2019; 12(3):148–158.]

Background The progressive and complex nature of dementia demands carers have specific knowledge and training. However, often carers do not have adequate knowledge and skills, particularly for functional disability care. Aim This study aims to develop and test the feasibility of an educational and supportive mHealth/smartphone application that addresses the needs of family carers of people with dementia related to functional disability of care recipients. Methods This mixed method study consists of three phases. In phase one, an online survey and individual interviews with carers will be conducted to assess their needs related to management of functional disability and the development of an mHealth application. Additionally, experts will be consulted to identify their opinions on application development. In phase two, using information from phase one, an mHealth application will be designed and developed. In phase three, a feasibility study will be conducted with carers to identify usability, user adherence, acceptance and experiences with the application. Discussion This study will generate new knowledge about the needs of carers related to the management of functional disability of people with dementia and the use of smartphones for health-seeking behaviours, and will develop an mHealth application for carers to address the needs related to functional disability care. Conclusion A mixed method study was designed to develop a user-centred educational and supportive mHealth app for family carers to address needs related to the functional disability of people with dementia consisting of three phases: needs assessment, the designing of the app and a feasibility study.

IntroductionThere are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers’ health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers’ health-related quality of life (HRQOL) after care recipients’ hospital discharge.Methods and analysisA multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient’s discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30–45 min telephone support sessions over 6 months. The primary outcome is caregivers’ HRQOL measured using the Assessment of Quality of Life—eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements.Ethics and disseminationParticipants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences.Trial registration numberACTRN12620000060943.

Background: Lack of effective treatments for chronic conditions is associated with high rates of complementary medicine (CM) use. However, little is known about CM use for dementia. Aims and Objectives: The aim of this study was to explore the experiences, motivations, and attitudes towards CM use by people living with dementia in an Australian setting. Design: This study had a qualitative research design; quantitative demographic information was also collected. Methods: In-depth interviews were conducted with people living with dementia and their caregivers (N = 18). A thematic (inductive) analysis approach was taken to interpret data. Results: Three in four participants used CM for dementia, spending ~AUD$100/month (USD$70/month). Within three overarching themes, a range of sub-themes was identified: (1) CM knowledge and use: people living with dementia and caregivers understanding of CM, types of CM used, and CM usage patterns; (2) Self-determined reasons for use/non-use: maintain or improve quality of life, hope, management of dementia symptoms, level of awareness, willingness and evidence, perceptions on efficacy and safety of CM, experiences of conventional medicine, and holistic approach to wellness; (3) External determinants of use: information on CM, relationship influences on CM use, and experiences with General Practitioners (GPs) and CM. Conclusion: Findings highlight that CM use is widespread and positively viewed by people living with dementia and their caregivers. Decisions regarding CM use were based on personal opinions. Findings have important implications for conversations with health professionals regarding CM use by people living with dementia to improve communication, health literacy, and reduce the risk of adverse effects through polypharmacy. Implications for Practice: This study showed that CM is a valued approach for dementia management by people living with dementia, their families, and healthcare providers. Future international research is required to evaluate the efficacy and safety of these approaches and promote accurate advice in nursing care.

Objectives To provide qualitative insight into the experiences of compassion (to self, to others and from others) among family carers of older adults by exploring the written responses provided within a cross-sectional survey that asked about carers' levels of compassion, mindfulness, emotion regulation, coping strategies and psychological health. Methods Family carers of adults aged ≥65 years from around the world completed the survey between July and December 2019. To provide carers with an opportunity to describe experiences in their own words and expand on issues beyond the limits of closed-response items, the survey included eight free-text boxes. These appeared after each self-report measure and at the end of the survey. From a total of 127 carers providing 504 written responses, inductive qualitative content analysis identified and evaluated 245 comments from 105 family carers' that were about their experiences of compassion (to self, to others and from others). Results Some family carers perceived a lack of compassion, both for themselves and from others, and several barriers to carers' openness to receiving compassion were identified. Factors influencing carers' compassion to others in general included how carers were feeling themselves, the person it was directed towards and the situation. Within the caregiving relationship specifically, this included care recipients' level of need and behaviour. Conclusions Findings provide qualitative understanding about family carers' realities of compassion (to self, to others and from others) within their role and highlight the applicability and warranted focus of compassion-based approaches within family caregiving research and practice.

We thank you for the opportunity to respond to the comments raised in Atee et al.’s letter to the editor [1] and thank Mr Atee and his colleagues for their interest in our paper [2]. 1) Mr Atee et al. are concerned about the confounding effect of prescribed psychotropic medications on sleep outcomes. In our paper, we had shown that participants’ medication usage, as measured by the Medication Quantification Scale-III (MQS-III), at baseline was similar in both the intervention and control groups (Table 1). While we acknowledge that medication can have an impact on both groups, in this instance we believe that medication use had minimal impacts on the study outcomes. However, future larger-scale studies should be mindful of this potential issue and, if necessary, appropriately adjust for its effect during data analysis.

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.

Objectives As medication experts, pharmacists can play a significant role in helping people living with dementia and their informal carers make the best use of medications. However, little is known about this population’s needs and expectations of their pharmacists. The objective of this study was to report informal carers’ perceptions about the role of their pharmacists. Methods In a previous study, informal carers were interviewed to explore factors influencing medication adherence in older people living with dementia. The interview transcripts from the previous study were analysed thematically using an inductive approach to explore carers’ perceptions about the role of community pharmacists in helping carers and people living with dementia use medications as prescribed. Key findings The interviews of 20 informal carers were analysed. Carers were primarily females (85%), married (60%), completed university (60%) and unemployed (70%). The majority of care recipients had comorbidities (75%), and the number of medications ranged from 1 to 20. Three significant roles emerged: (1) provision of medication information, (2) advising on medication organisation and (3) conducting medication reviews. Conclusions Informal carers face several challenges in administering the medications to older people living with dementia. Pharmacists are expected to play a more active role in helping people living with dementia, and their carers make safe and effective use of medications.

Objectives:To confirm the factor validity of the Compassionate Engagement and Action Scales (CEAS), as set out in the original development study, when used with a sample of family carers of older adults.Design:A series of confirmatory factor analyses were undertaken to test the previously proposed factor solutions of each scale.Setting:As part of a larger cross-sectional survey, the scales were completed online or via hard copy between July and December 2019.Participants:An international sample of 171 family carers of adults aged 65 years or older.Measurements:The CEAS are three measures that individually assess Compassion for Self, Compassion to Others, and Compassion from Others. All scales measure two aspects, “engagement” and “actions” (two-factor solution), and Compassion for Self also measures two further dimensions within engagement: “sensitivity to suffering” and “engagement with suffering” (three-factor solution).Results:Results were largely consistent with the two-factor solutions proposed for the three orientations of compassion, with acceptable fit and good internal reliability. There was some support for the three-factor solution of Compassion for Self; however, despite model fit comparable to the two-factor solution, internal reliability of the delineated “engagement” dimensions was low, and there was a weak factor loading for item 5 that measured distress tolerance.Conclusions:Use of the CEAS with family carers of older adults is promising. Further research is recommended with larger samples and to explore distress tolerance as a competency within conceptualization and measurement of compassion.

To provide information about the effectiveness of topical analgesic and local anesthetic agents for reducing pain associated with chronic leg ulcers.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant will:1. Distinguish adverse reactions to topical analgesics and local anesthetic agents.2. Evaluate the effectiveness of topical analgesics and local anesthetic agents for pain associated with chronic leg ulcers.3. Identify substances used as topical analgesics and local anesthetic agents and the application of those agents.To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers.A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019.A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomized controlled trials; however, the reported methodology for most of studies was poor, so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved wound-related pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective.Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers.To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers. A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019. A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomized controlled trials; however, the reported methodology for most of studies was poor, so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved wound-related pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective. Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers.

Background: Pain can elevate stress in people with dementia. Although salivary cortisol is used as a biomarker of stress in people with dementia, few studies have reported the feasibility of collection methods to assess salivary cortisol in nursing home residents with both dementia and chronic pain. Objective: To explore the feasibility of collecting cortisol via salivary swab as an indicator of stress in people with dementia and chronic pain. Methods: Participants ( N = 43) aged ≥ 65 years and living with dementia and chronic pain were randomly assigned to the PARO (individual, nonfacilitated, 30-min sessions with the robotic seal PARO, 5 days per week for 6 weeks) or usual-care group using computer-generated random numbers. Salivary cortisol was collected in the early morning before the intervention (Week 0) and at the completion of the intervention (Week 6) for comparison. Results: There were multiple challenges associated with saliva collection and analysis, including cognitive impairment of participants, ability to obtain repeated samples with saliva volume adequate for assay, and overall cost. Ultimately, adequate saliva was collected from only 8 participants (both pre- and post-intervention) for assay and quantitative analysis. Conclusion: Considering the multiple challenges involved in obtaining valid saliva samples in this population, salivary cortisol may not be a feasible biomarker of physiological stress in people with dementia and chronic pain.

Aims and objectives To establish an understanding of healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' perceptions of dementia care in China. Background Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' dementia care perceptions has been conducted in China. Methods An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists. Results Thirty-eight primary research papers were included in the review. Three themes were identified from the synthesis: (a) knowledge and competency; (b) attitudes towards dementia care; and (c) carers' burden and unmet needs. Healthcare professionals' dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses. Conclusions There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers. Relevance to clinical practice Nurses, and particularly community nurses, are well-positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programmes and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed.

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.

Objectives: To explore the feasibility of using the video-conferencing program, Skype, on iPads with older adults living in long-term care (LTC) facilities.Method: Using a mixed-method design, six residents from one LTC facility in Queensland, Australia participated in a one-off interactive intervention session, followed by post-session semi-structured interviews. The intervention session involved a 15-minutes training session in using Skype, and 30-minutes interactive practise in making and receiving a call using Skype. Residents were interviewed after the intervention session to explore their experience and perceptions of using Skype on the iPad. Reflections about the intervention session were written as study notes by the research team. Qualitative data were analysed using an inductive, thematic analytic approach.Results: Four broad themes emerged: (1) Video-conferencing on iPads is inhibited by age-related cognitive decline and physical frailty; (2) Video-conferencing is an unfamiliar technology for many older residents, and practice and staff assistance are required; (3) Video-conferencing is regarded positively, and seen as a good way of communicating with family/friends; and (4) Use of video-conferencing highlights general concerns held about privacy and cyber security issues.Conclusion: Without adequate staff assistance, video-conferencing via iPads may be challenging for an older population in LTC. Alternatives such as telepresence robots may assist with these challenges.

This review sought to synthesize published evidence about the role of self-compassion on health outcomes for family carers of older adults, to describe the current state of knowledge.Using an integrative review method that permitted any research design, eight databases were searched. Extensive searching of gray literature sources was also undertaken. Studies included in the review underwent processes of methodological quality assessment (Mixed Methods Appraisal Tool - Version 2011), data extraction, analysis, and syntheses.Four studies were included: two randomized controlled trials, a descriptive cross-sectional survey, and a qualitative study. There was preliminary evidence to show the potential of self-compassion to help family carers cope and reduce levels of burden. However, efficacy of self-compassion interventions to improve family carer health outcomes could not be determined.Self-compassion in family carers of older adults is a new and emerging research area, and there is very little published evidence about how self-compassion might be developed to improve health outcomes for family carers.To inform clinical understanding within this population, future quality research is needed, particularly regarding proof-of-concept, moderating effects of carer and care recipient factors, reliability of self-compassion measures, and the development and testing of self-compassion based interventions.

This paper reports on a mixed methods project entitled Playful Engagement aimed at improving the quality of life (QoL) of individuals living with dementia through engagement with two relational clowns. Analysis of the quantitative data was unable to identify QoL improvements, whilst the qualitative data revealed positive affective outcomes within individual visits. In light of these outcomes, literature focused on the perceptions of QoL by individuals living with dementia was employed to generate an alternate reading. This alternate reading suggests that while the visits may not have improved the participants’ overall quality of life, they nevertheless generated ‘quality moments of life’ characterised by connectedness, relationships, agency and happiness.

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

Objectives: To explore the acceptability of telepresence robots in dementia care from the perspectives of people with dementia, family carers, and health professionals/trainees, and investigate the...

Purpose In recent years, there has been an increase in the number of studies using social robots to improve psychological well-being. This systematic review investigates the effect of social robot interventions for depression in older adults. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method was used to identify and select existing studies. Nine electronic databases were searched for relevant studies. Methodological quality was assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Screening, data extraction, and synthesis were performed by three reviewers. Inclusion criteria covered original quantitative studies investigating social robots for depression in older adults. Findings Seven studies were identified-six randomized controlled trials and one comparison study-with all classified as good quality. Social robot interventions consisted of companion, communication, and health-monitoring robots. Three studies presented promising outcomes for reducing depressive symptoms in older adults following social robot interventions, and three studies showed decreased, but nonsignificant, trends in depression scores. Conclusions The results highlight the potential of social robot interventions for reducing depression in older adults. However, the evidence is not strong enough to formulate recommendations on clinical effectiveness. Clinical relevance Social robots are being used with increasing frequency to potentially provide personal support to older adults living in long-term care facilities. Social robots can be used to help alleviate depressive symptoms when used in group activities.

Prolonged sitting time has been reported among university workers which can have adverse health effects. The aim of this study was to examine the sitting time, physical activity, and psychological well-being reported by older university office workers. An online self-reported survey was distributed to all office workers 55 years and older at one university in Australia. Sixty-six office workers were recruited. They reported an average sitting time of 7.5 hours per day on weekdays. In all, 72.7% of the sample reported both moderate and high physical activity levels. A high percentage of the office workers reported depression (25.8%) and anxiety (12.1%). Lower education levels were significantly related to higher perceived stress and more depressive symptomatology ( p = .03 and .02, respectively). Significant associations were found between stress, depression, and anxiety ( p < .001) among this group of workers.

Aim To evaluate the effect of a targeted community-based psychosocial intervention on self-efficacy outcomes for care recipient/carer dyads living with early-stage dementia. Background There is increasing interest in the role of self-efficacy and self-management structures in determining positive outcomes for people with dementia. The assumption is that care recipient/carer dyads who receive early support to identify and adjust to dementia-related changes will cope better in the long term. Design An explanatory sequential mixed-method design was employed. Primarily quantitative with qualitative data providing a supportive secondary role to expand on and illuminate the quantitative findings. Methods Eighty-eight dyads were recruited and allocated on a regional basis to an intervention or control group. Intervention group dyads received the Early Diagnosis Dyadic Intervention. Control group dyads received two information manuals. Quantitative data were collected at three time points. Qualitative data were collected via evaluation questionnaires and semistructured interviews. Results Intervention structure, content, and delivery were acceptable to the dyads but few quantitative self-efficacy findings reached statistical significance. Improvements in self-efficacy were evident in the postintervention evaluation qualitative responses where dyads expressed greater confidence in identifying and accessing community support. Conclusion There is an urgent need for effective psychosocial interventions to help reduce the impact of dementia symptoms on patients, carers, and society. This study makes an important contribution to our understanding of the capacity of psychosocial interventions to improve self-efficacy outcomes for care recipient/carer dyads with early-stage dementia while also illustrating the challenges associated with measuring self-efficacy in the early stages of the condition.

Background:Adherence to treatment is a primary determinant of treatment success. Caregiver support can influence medication adherence in people with cognitive impairment. This study sought to characterize medication adherence in older people with dementia from the caregivers’ perspective, and to identify influencing factors.Methods:Caregivers caring for a person with dementia and living in the community were eligible to complete the survey. Bayesian profile regression was applied to identify determinants of medication adherence measured using the Adherence to Refills and Medication Scale.Results:Out of the 320 caregivers who participated in the survey, Bayesian profile regression on 221 participants identified two groups: Profile 1 (55 caregivers) with a mean adherence rate of 0.69 (80% Credible Interval (CrI): 0.61–0.77), and Profile 2 (166 caregivers) with a mean adherence rate of 0.80 (80% CrI: 0.77–0.84). Caregivers in Profile 1 were characterized with below data average scores for the following: cognitive functioning, commitment or intention, self-efficacy, and health knowledge, which were all above the data average in Profile 2, except for health knowledge. Caregivers in Profile 1 had a greater proportion of care recipients taking more than five medications and with late-stage dementia. Trade, technical, or vocational training was more common among the caregivers in Profile 1. Profile 2 caregivers had a better patient–provider relationship and less medical problems.Conclusions:Bayesian profile regression was useful in understanding caregiver factors that influence medication adherence. Tailored interventions to the determinants of medication adherence can guide the development of evidence-based interventions.

ObjectivesThe robotic seal, PARO, has been used as an alternative to animal-assisted therapies with residents with dementia in long-term care, yet understanding of its efficacy is limited by a paucity of research. We explored the effects of PARO on motor activity and sleep patterns, as measured by a wearable triaxial accelerometer. Study designCluster-randomised controlled trial, involving 28 facilities in Queensland, Australia. Nine facilities were randomised to the PARO group (individual, non-facilitated, 15-min sessions three afternoons per week for 10 weeks), 10 to a plush toy (PARO with robotic features disabled) and nine to usual care. Main outcome measuresChanges in day- and nighttime motor activity and sleep after the 10-week intervention, as measured by SenseWear® armbands, worn by participants continuously for 24 h at baseline, during two single intervention days in weeks 5 and 10 respectively, and post-intervention (week 15). Analyses followed intention-to-treat, using repeated-measures mixed-effects models. ResultsAfter 10 weeks, the PARO group showed a greater reduction in daytime step count than usual care (p = 0.023), and in nighttime step count (p = 0.028) and daytime physical activity (p = 0.026) compared with the plush toy group. At post-intervention, the PARO group showed a greater reduction in daytime step count than the plush toy group (p = 0.028), and at nighttime compared with both the plush toy group (p = 0.019) and the usual-care group (p = 0.046). The PARO group also had a greater reduction in nighttime physical activity than the usual-care group (p = 0.015). ConclusionsPARO may have some effect on motor activity of older people with dementia in long-term care, but not on sleep patterns.Australian New Zealand Clinical Trials Registry (ACTRN12614000508673).

Objectives To map the current state-of-knowledge about the effectiveness of smart home technologies to support the health outcomes of community-dwelling older adults living with dementia. Design A scoping review following the methodological frameworks described by Arksey and O’Malley (2005) and Levac et al. (2010). Data sources Electronic databases and online sources were searched in April 2020 using database specific medical subject headings and keywords about ‘smart homes’ and ‘dementia’. Methods Empirical peer-reviewed articles were included if they were written in English; used a quantitative, qualitative, or mixed method design; and presented the effects of a smart home technology on the health outcomes of community-dwelling adults living with dementia. Methodological and reporting quality of studies was assessed using the Mixed Methods Appraisal Tool – Version 2018. Results Five studies described evaluations of five smart home technology systems with a total of n = 617 community-dwelling people living with dementia. Collectively, studies showed potential effectiveness of the technologies on a range of health outcomes (physical activity, activities of daily living, sleep, anxiety, depression, agitation, irritability, risk of falls, cognitive functioning, night-time injury, unattended home exits). However, the overall methodological and reporting quality of studies was low and profiled a research field lacking in rigorous evaluation. Conclusions Based on current evidence, the success of smart home technologies to support people with dementia to live at home remains unclear. Recommendations are provided to inform future research into smart home technologies for community-based dementia care.

We undertook a cluster-randomised controlled trial exploring the effect of a therapeutic companion robot (PARO) compared to a look-alike plush toy and usual care on dementia symptoms of long-term care residents. Complementing the reported quantitative outcomes , this paper provides critical reflection and commentary on individual participant responses to PARO, observed through video recordings , with a view to informing clinical practice and research. A descriptive, qualitative design with five participants selected from the PARO intervention arm of the trial. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000508673). The five participants and their responses to PARO are presented in terms of three issues: i.) Different pre-intervention clinical presentations and different responses; ii.) Same individual, different response - the need for continual assessment and review; and iii.) The ethics of giving and retrieving PARO. Implications for clinical practice and future research are discussed in relation to each issue. The findings suggest that one approach does not fit all, and that there is considerable variation in responses to PARO. A number of recommendations are discussed to aid the delivery of psychosocial interventions with PARO in practice, as well as to guide future research.

Background and objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia, and many show promising potential. In this study, we sought to explore family members' perceptions of the Japanese-developed baby harp seal, Paro (version 9), and a look-alike, nonrobotic Plush Toy, when used by their relative with dementia for 15 min, 3 afternoons per week for 10 weeks. Research design and method The study employed a descriptive qualitative approach, which was nested within a larger cluster randomized controlled trial. A convenience sample of 20 family members (n = 10 each from the Paro and Plush Toy conditions) with relatives in 9 long-term care facilities in Queensland, Australia, completed individual semi-structured interviews (telephone or face-to-face). Inductive, data-driven thematic analysis of the data was undertaken with the assistance of the qualitative management software, ATLAS.ti®. Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro, perceiving that it improved mood, reduced agitation, and provided opportunity for communication for their relative. Negative perceptions of the Plush Toy were given by family members, primarily because of its lack of movement and engagement. Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them, and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life. However, the current cost of Paro was identified by family members as a major limitation to use.

Objective To undertake an integrative review of the literature on relationships between community aged care recipients, family carers and care providers under consumer-directed care (CDC). Methods Seven databases were systematically searched. Peer-reviewed and grey literature on CDC between 1998 and 2014 were assessed using an integrative literature review (ILR) framework. Search terms included CDC, self-directed care, direct payments, community aged care, community dwelling and older adults. Full-text copies were assessed against the inclusion criteria. Results Fifteen studies met the inclusion criteria. This ILR found no research with a specific focus on caregiving relationships for older adults. The literature did however identify relational issues such as support, planning and provider attitude as fundamental to the success of CDC. Conclusion Relationships within the caregiving triad have important implications for the way CDC is enacted, particularly when the care recipient has dementia, suggesting this population as a priority for future research.

Aims and objectives To evaluate the effect of an educational programme on registered nurses’ knowledge and attitude in delirium care for hospitalised older adults with and without dementia, and to examine the strengths and weaknesses of the programme from the participants’ perspectives. Background Providing care for patients with delirium or delirium superimposed on dementia often poses particular challenges such as distinguishing between delirium and dementia for nurses. Design A descriptive qualitative study was used. Methods A delirium educational programme based on adult learning principles was provided to the participants. A purposive sample of 12 registered nurses who participated in the educational programme undertook individual interviews. Content analysis was conducted to identify unique and common themes indicative of registered nurse perceptions. Results Registered nurses reported improved knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. Active learning in the programme facilitated the participants’ learning processes. This active learning included deep learning, collaborative learning and application of new concepts to practice. Most participants felt that they had inadequate management support to apply their new knowledge in practice, and this included staff resource and policies and protocols. Conclusion The qualitative findings indicated that the delirium education had benefited the participants by improving their knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. This study provided an understanding of the strengths and limitations of the educational programme delivered to registered nurses in South Korea. Relevance to clinical practice Registered nurses in South Korea should need not only appropriate education, but also adequate resources, policies and guidelines as well as support from managers and from all other healthcare professionals.

Purpose of the Study: To measure and describe the effectiveness of a Virtual Reality Forest (VRF) on engagement, apathy, and mood states of people with dementia, and explore the experiences of staff, people with dementia and their families. Design and Methods: A mixed-methods study conducted between February and May 2016. Ten residents with dementia, 10 family members, and 9 care staff were recruited from 2 residential aged care facilities, operated by one care provider, located in Victoria, Australia. Residents participated in one facilitated VRF session. Residents’ mood, apathy, and engagement were measured by the Observed Emotion Rating Scale, Person–Environment Apathy Rating Scale, and Types of Engagement. All participants were interviewed. Results: Overall, the VRF was perceived by residents, family members, and staff to have a positive effect. During the VRF experience, residents experienced more pleasure (p = .008) and a greater level of alertness (p < .001). They also experienced a greater level of fear/anxiety during the forest experience than the comparative normative sample (p = .016). Implications: This initial, small-scale study represents the first to introduce the VRF activity and describe the impact on people with dementia. The VRF was perceived to have a positive effect on people with dementia, although, compared to the normative sample, a greater level of fear/anxiety during the VRF was experienced. This study suggests virtual reality may have the potential to improve quality of life, and the outcomes can be used to inform the development of future Virtual Reality activities for people with dementia.

Objectives: This research aims to validate the Healthy Beat Acupunch (HBA) exercise program, determine the feasibility of the HBA exercise program protocol and gain an understanding of the effects on well-being for older adults with sarcopenia. Design, Setting & Intervention: Validation of the HBA exercise program was conducted using two rounds of Delphi communication among eight experts. A one-group, pre-post experimental study was conducted with 17 older adults with probable sarcopenia and/or low gait speed at an Australian retirement village. The HBA exercise program lasted 40 min per session, three sessions per week for four weeks. Outcome Measures: Muscle mass, muscle strength, gait speed and health-related quality of life were assessed before and after the intervention. The HBA exercise program was evaluated via a questionnaire and individual interviews. Results: Experts validated the HBA exercise program and deemed it to be simple, safe, suitable and helpful for practice by older adults with sarcopenia. Participants enjoyed the HBA exercise program, planned to continue and would recommend to friends. Frequency, duration and size of the exercise class were appropriate, and they appreciated the trainer's support and directions when mastering the exercise motions. Improvement in participants’ gait speed was found post-exercise intervention (p

Objectives Frailty is an increasingly common health condition and is seen more often due to the ageing population. This study reviews the evidence on the development and validation of these automated frailty measurement tools. Design Six databases: PubMed, EMBASE, MEDLINE, CINAHL, Scopus, and Web of Science were electronically searched. Selected studies must have developed and validated a new frailty measurement tool using administrative health data and published results in a peer-reviewed, English-language journal. Selected studies were synthesized narratively. Setting and participants The review focused on large scale studies using administrative health data in developed countries. Participants included older people aged 65 years and above. Measures The main measures of review studies include discrimination power and the prediction ability of adverse health outcomes; performance against established frailty measures; and validation records. Results Five studies were selected for narrative synthesis after screening the full-text. All frailty measurement tools in the selected five studies produced strong discrimination power with C-statistics ranging from 0.61−97. Two studies were independently validated in studies by other authors or conducted in other locations; one study developed an early prediction model, and no study has been applied in practice. Conclusions and implications Automated frailty measurement tools using administrative health data are still in the early development stage with five tools developed since 2016. Selected studies have strong prediction of adverse health outcomes. Future studies should include validation and refinement of these tools in other countries and assessment of their clinical utility and capacity to inform cost-effective policy and practice.

This feasibility study examined Dreampad™, a sleeping device, on sleep, wandering and agitated behaviors in people living with dementia. Four nursing home residents (2 males and 2 females; mean age = 89.8 years (SD = 7.2); mean MMSE scores = 9.3 (SD = 8.7)) used Dreampad™ daily over 4-weeks when they slept. Agitation was assessed pre- and post-intervention. Wandering and sleeping patterns were assessed using a wearable actigraphy device over 24 hours at baseline and every week during the intervention. Dreampad™ was deemed acceptable and feasible for use with people living with dementia by family and care staff. No support for Dreampad™ in improving sleep or behaviors of agitation and wandering was found. Challenges in using the wearable actigraphy device are reported. Attention is needed to ensure consistent use of Dreampad™ by people living with dementia and their wear adherence of the actigraphy device. Further rigorous research is warranted and can be guided by the study outcomes.

Education prepares gerontological nurses to assess, treat, and care for older adults and their families. However, it is not clear whether they are prepared for what has been described by the media as a future tsunami of older adults with dementia (Russell, 2015). In 2015, approximately 46.8 million individuals 60 and older had dementia and, alongside population aging, this figure is expected to double every 20 years (Alzheimer's Disease International, 2015). With no imminent cure in sight, a significant nursing focus has been on improving quality of life of individuals with dementia through a person-centered approach to symptom management within a supportive living environment. However, an often-neglected aspect of dementia care, and one that gerontological nurses may be less prepared for, is the sexual health and expression of sexuality by older adults, as ageist perceptions continue to promote older adults as being asexual (Bauer, Haesler, & Fetherstonhaugh, 2016).

Objectives: To evaluate the effect of interaction with a robotic seal (PARO) on pain and behavioral and psychological symptoms of people with dementia and chronic pain. Design: A parallel pilot randomized controlled trial conducted between January 2018 and January 2019. Setting: Three long-term care facilities in Australia. Participants: Forty-three participants aged ≥65 years living with dementia and chronic pain. Intervention: Participants were randomized to the PARO group (individual, nonfacilitated, 30-minute sessions, 5 days per week for 6 weeks) or a usual care group using a computer-generated random number. Measurements: The primary outcome was researcher-rated observational pain behaviors before and after each session. Secondary outcomes were staff-rated pain level, agitation, depression, and anxiety measured at baseline and the end of week 6. Medications regularly prescribed and as needed were recorded weekly. Analyses followed intention-to-treat, using the generalized estimating equation model. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202). Results: Participants in the PARO group had a significantly lowered level of observed pain [−0.514, 95% confidence interval (CI) −0.774 to −0.254, P < .001] and used fewer pro re nata medications (−1.175, 95% CI −2.205 to −0.145, P = .025) than those in usual care after controlling for age, sex, cognitive function and medications. There were no significant differences in staff-rated pain, agitation, anxiety, and depression, nor regularly scheduled medications between intervention and control group. Conclusions and Implications: PARO shows promise in reducing pain and medications for individuals with dementia and chronic pain in long-term care facilities. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Larger randomized controlled trials with longer time frames are needed to identify further and test the use of PARO in long-term care settings.

Objectives This paper aims to confirm the content validity of the domains identified during the development of the Alzheimer’s disease – five dimensions (AD-5D) algorithm for the quality of life – Alzheimer’s disease (QOL-AD) and to identify the rationale for stated quality of life preferences. Methods Focus groups were conducted to elicit the priorities for quality of life in dementia from three perspectives: the person with dementia; family caregivers; and the community. Participants were recruited through industry research partners (long-term care providers) based on knowledge of their experience with dementia. Three focus groups were conducted – one each in Brisbane, Sydney and Adelaide, Australia – between November 2016 and February 2017. Each focus group included participants providing a different perspective on dementia – people with dementia ( n = 3), caregivers ( n = 9) and general community members or relatives of residents of a long-term care facility ( n = 10), although some groups contained one participant with a different perspective. The focus groups were used to validate the AD-5D domains and examine quality of life preferences across the three perspectives. Thematic analysis was used to identify the priorities underlying preference selection. Results All activities affecting the quality of life for people with dementia could be mapped to one of the five AD-5D domains: memory, mood, physical health, living situation and ability to do things for fun. The domains considered most important for quality of life differed between people with dementia, their caregivers and members of the community, with memory the least important domain for all three groups. The rationale for priorities also varied between groups. Conclusions This study confirmed the content validity of the selection of the AD-5D domains and identified multiple differences in the reasons behind stated priorities for quality of life for people with dementia, their caregivers and community members.

Aims and Objectives: To explore the effectiveness of nurse-led interventions to prevent urinary tract infections in older adults living in residential aged care facilities. Background: While most empirical studies focus on the treatment of urinary tract infections, few studies have examined the effectiveness of nurse-led interventions in preventing urinary tract infections. Design: Systematic review. Methods: Eight electronic databases were searched for relevant studies published between 2008–2018. The inclusion criteria were as follows: (a) a focus on older adults, (b) evaluation of nurse-led interventions, focusing on prevention of urinary tract infection, (c) implemented in residential aged care facilities, and (d) outcomes reported as incidence or prevalence of urinary tract infection. The selected papers were critically appraised using the Mixed Methods Appraisal Tool. The data were analysed with narrative synthesis, and findings were reported following the PRISMA guidelines. Results: A review of 1,614 titles and abstracts identified four studies that met the inclusion criteria. Three types of nurse-led interventions were identified: (a) the appointment of advanced practice nurses, (b) those focused on a single specific nursing intervention, and (c) implementation of a multicomponent nursing intervention. All included studies reported at least some positive outcomes. However, the included studies were highly heterogeneous and it was impossible to determine the most effective intervention approach. Conclusions: Nurses are leaders in health care and are well placed to lead prevention of urinary tract infections in residential aged care; however, evidence of the effectiveness of a nurse-led approach is limited. High-quality randomised controlled trials are warranted to address the knowledge gap and advance practice in this area. Relevance to clinical practice: When developing an effective nurse-led intervention programme, the programme should be grounded in nurse-led principles and consider the complex staffing factors to ensure that nurse-led programmes are tailored to an effective level.

Dementia is a leading cause of disability, and the prevalence of dementia is steadily increasing. Although people with dementia are living longer lives in the community, without adequate support for their declining physical and psychological needs, the majority of these individuals end up in nursing homes. With no cure in sight, and in the context of population ageing, we must consider how to care for these individuals in the future. Technologies that augment existing care can maintain a person comfortably in their community, maximize individual autonomy and promote social participation. However, to date, such technologies have rarely been used in dementia care. This Perspectives article highlights the need for affordable and appropriate technologies to assist future dementia care, outlines some of the technologies currently available and describes the many challenges to integration of such technologies. Finally, guidelines are suggested for the development and implementation of new technologies in dementia care.