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Working with people living with dementia in residential facilities for older adults can be challenging, and this is exacerbated when staff have a limited understanding of dementia. However, the relationship between knowledge of dementia and strain in caring for people with dementia among residential facility staff is unclear. This cross-sectional study investigated the relationship between dementia knowledge and strain in caring for people with dementia. A questionnaire containing the Dementia Knowledge Assessment and Strain in Dementia Care Scales was administered in 2017 and 2019 to 141 staff in three southern Australian residential facilities for older adults. Bivariate and hierarchical regression analysis examined inter-scale relationships and the power of dementia strain to explain knowledge variance. It was found that staff had substantial gaps in dementia knowledge (mean score 32/50) and low strain in dementia care (mean score 4/16). A positive relationship was found between higher dementia knowledge and greater strain in dementia care (rs = 0.319, p <.001), particularly with feeling that residents are not receiving appropriate care from colleagues (Factor 1 Frustrated Empathy; rs = 0.392, p <.001). Frustrated Empathy explained a significant amount of variance in dementia knowledge beyond demographic variables. The findings suggest that more comprehensive dementia knowledge is associated with higher strain in care of people with dementia, particularly in the context of perceived lapses in the quality of care provided by colleagues. Arguably, organisational-wide dementia education to address identified gaps should be supported by facilitating staff enaction of their knowledge to improve care. [ABSTRACT FROM AUTHOR]

Objectives: The Consumer Access, Appraisal, and Application of Services and Information for Dementia (CAAASI-Dem) was developed to examine individuals' self-assessed confidence in their ability to access, appraise and use dementia services and information. The CAAASI-Dem is the only tool to date to measure this crucial component of dementia literacy. This study was designed to validate its structural validity. Method: Data was collected from 3277 participants enrolled in an on-line dementia course. The five-factor structure of the CAAASI-Dem, which was derived from a previous exploratory factor analysis, was evaluated using confirmatory factor analysis. Internal reliability, convergent and divergent validity, and known-groups validity were assessed. Results: The five-factor model demonstrated good fit with the observed data with the removal of 2 items and movement of 1 item across the factors. The resultant 24-item five-factor CAAASI-Dem showed very good sub-scale internal reliability and satisfactory convergent and divergent validity. There was good discrimination between groups of participants with different levels of care experience. Conclusion: The results provided evidence for the 24-item CAAASI-Dem as a valid and reliable five-dimensional scale. Limitations of the study are discussed, and recommendations are made for future research and practice. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the current NCI-CTEP recommendation and the clinical use of Calvert Formula-derived carboplatin dosing pattern in the treatment of advanced lung cancer patients and assess carboplatin-related toxicity in relation to the degree of dose fluctuation. Methodology: This retrospective study involved all histologically confirmed inoperable lung cancer patients receiving palliative-intent carboplatin or carboplatin-combination chemotherapy from 2012 to 2016 at Kingston Health Sciences Centre. The carboplatin dosing pattern and carboplatin-related toxicity were collected and analysed on SPSS IBM for Windows version 24.0 (IBM Corp., Armonk, NY, USA). Results were expressed in percentages and P values. Results: Our findings (N = 75) suggested that 24% of patients had a high-degree of fluctuation in carboplatin dose (>10% variation from initial dose) if carboplatin dose was readjusted with each new creatinine. In practice, 16% of patients had a fluctuation of greater than 10% in ordered dose in the absence of planned dose reductions. Our study found no significant association between prescribed high-risk dosing fluctuation (>10% increased from initial dose) and carboplatin-related toxicities. Discussion and conclusion: In contrast to some prescribing recommendations such as NCI-CTEP, our study suggested that most medical oncologists incorporate new serum creatinine in calculating carboplatin dose for each cycle. Only 9% of patients were treated with a fixed dosing pattern (i.e. no fluctuation). Nonetheless, no significant associations were found between high-risk carboplatin dosing fluctuation and its-related toxicity. Whether such practice was due to the forcing function of the computer order entry system (CPOE), or conscious decisions by medical oncologists was unknown. Further analysis in evaluating physicians' preferences and influencing factors on dosing pattern decision would be recommended. [ABSTRACT FROM AUTHOR]

Abstract: This feasibility study aimed to identify and address the support needs of family carers (FCs) of people living with dementia and to assess whether the use of the Carer Support Needs Assessment Tool (CSNAT) intervention in home‐based care was acceptable and relevant to FCs. The CSNAT intervention comprised two FC support needs assessment visits, 7 weeks apart, plus associated actions addressing prioritised needs by the Client Care Advisors of a community care service in Western Australia in 2015. Telephone interviews were conducted with FCs on their experience using the CSNAT at the end of the intervention. Twenty‐one FCs were involved in the intervention and 15 of them completed the feedback interviews. Care recipients had moderate to severe dementia. The top five support needs reported by FCs were: having time to yourself in the day; knowing what to expect in the future; practical help in the home; looking after your own health and dealing with your feelings and worries. Three themes summarised their experience: a straightforward structured approach; awareness, acknowledgement and acceptance of their situation; and provision of support. FCs appreciated the opportunity to be heard and acknowledged, to have their practical and psychosocial support needs facilitated, to identify what is important to them and to receive a response in a timely manner. The CSNAT approach offered a structured carer‐led, person‐centred, supportive intervention that facilitated discussion between the family carer and the service provider about support needs and strategies to address them. [ABSTRACT FROM AUTHOR]

Purpose Patients with lung cancer (LC) frequently have chronic obstructive pulmonary disease (COPD), the optimization of which improves outcomes. A 2014 Queen's University Hospitals audit demonstrated that COPD was under diagnosed and under treated in outpatients with LC. We sought to improve the diagnosis and management of COPD in this population. Methods We implemented change using a Define/Measure/Analyze/Improve/Control (DMAIC) improvement cycle. Data were obtained by chart review from the Cancer Care Ontario database and e-Patient System for patients with newly diagnosed LC, including patient characteristics, pulmonary function test (PFT) data, and bronchodilator therapies. Improvement cycle 1 included engaging stakeholders and prioritizing COPD management by respirologists in the Lung Diagnostic Assessment Program. Improvement cycle 2 included physician restructuring and developing a standard work protocol. Data were analyzed monthly and presented on statistical process control P-charts, which assessed differences over time. The x2 and McNemar tests assessed for significance between independent and dependent groups, respectively. Results A total of 477 patients were studied (165 patients at baseline, 166 patients in cycle 1, and 127 patients in cycle 2). There was no change in PFT completion over time, although respirology-managed patients were significantly more likely to undergo a PFT than patients who were not managed by respirology (56.7% v 96.1%; P , .00001). The proportion of respirology-managed patients with LC with airflow obstruction receiving inhaled bronchodilator significantly increased (baseline, 46.3%; cycle 1, 51.0%; and cycle 2, 74.3%). By cycle 2, patients with airflow obstruction were more likely to receive a long acting bronchodilator if managed by respirology (74.3% v 44.8%; P = .0009). Conclusion COPD is under diagnosed and under treated in outpatients with LC. A DMAIC quality improvement strategy emphasizing COPD treatment during LC evaluation in the Lung Diagnostic Assessment Program significantly improved COPD management. [ABSTRACT FROM AUTHOR]

Background Older adults living in residential aged care facilities ( RACFs) often experience limited opportunities for social connection despite close proximity to peers, which has implications for mental health and quality of life (QoL). The introduction of large-scale undergraduate health student placements in RACFs may enhance opportunities for meaningful engagement through social connection, although this remains unexplored. Objective This research explores whether interpersonal encounters between health students and RACF residents influence residents' opportunities for social connection and QoL. Methods A mixed methods design was employed which included questionnaire data from residents, and qualitative interview data from residents, family members and RACF staff. Data were collected during and after student placements to allow for an in-depth exploration of residents, family members and staff perspectives. Results Forty-three participants (28 residents, 10 staff and five family members) were recruited during 2014. Overall, many residents had clinical levels of depression, mild cognitive impairment and multiple morbidities, however reported moderate-to-good QoL. Thematic analysis was undertaken on interview transcripts, and three themes emerged: (i) social isolation and loneliness fostered by residents' age-related conditions, (ii) students expand socially supportive connections beyond the RACF and (iii) meaning making by sharing health experiences, which was found to help renegotiate older adults' pervasive narrative of vulnerability. Conclusion Supported and structured health student placements in RACFs enable older adults to participate in meaningful encounters with younger people. These encounters focus on sharing health experiences and address long-standing issues of isolation and loneliness by providing opportunities for social connection. [ABSTRACT FROM AUTHOR]

Background: Research on workforce development for high‐quality dementia care more often focuses on enhancing employee knowledge and skill and less on managing employee stress and coping at work. Objective: To review employee stress and coping in response to high job demands in community‐based dementia care organizations in Tasmania, Australia. Methods: Stress and coping in response to job roles of 25 community‐based dementia care workers were reviewed using self‐report questionnaire data. Data were analysed for descriptive results and at an individual case level. Individual participant scores were reviewed for clinically significant stress and coping factors to create worker profiles of adjustment. Results: Two adjustment profiles were found. The ‘global resilience’ profile, where workers showed positive adjustment and resilience indicating they found their jobs highly rewarding, were very confident in their abilities at work and had a strong match between their personal and organizational values. The second ‘isolated distress’ profile was only found in a minority and included poor opportunities for job advancement, a missmatch in personal and work values or clinically high levels of psychological distress. Conclusion: Aged care workplaces that advocate employee well‐being and support employees to cope with their work roles may be more likely to retain motivated and committed staff. Future research should consider employee stress and coping at the workforce level, and how this can influence high‐quality care delivery by applying the measures identified for this study. Comparative research across different care settings using meta‐analytic studies may then be possible. [ABSTRACT FROM AUTHOR]

Background: International evidence suggests that dementia is under-diagnosed in the community and that General Practitioners (GPs) are often reluctant to engage to their fullest capability with patients who exhibit cognitive symptoms. This is potentially reflected by a lack of GP knowledge about the syndrome. However, it is also recognised that attitudes and confidence are important in relation to how and to what extent a GP approaches a person with dementia. This research sought to develop a reliable and valid measure of GPs attitudes and confidence towards dementia. Methods: The General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) was developed via a four stage process, including initial content development, pretesting, pilot testing and psychometric evaluation, including Principal Component Analysis (PCA). Participants were recruited for pre-testing (n = 12), test-retest (n = 55), and dementia workshop pre-and post-education evaluation (n = 215). Results: The process of scale development and psychometric evaluation resulted in a 20-item measure of GP attitudes and confidence towards dementia, with 4 items removed due to poor reliability, low sensitivity, or lack of model fit. Among 55 respondents who completed the scale on two occasions with no intervening education, Kappa coefficient scores per item ranged from fair (n = 2, candidates for removal), moderate (n = 5), substantial (n = 15), and almost perfect (n = 2). A test of the sensitivity of item scores to change following dementia education among 215 GPs indicated that, with the exception of one item, all scale responses exhibited significant differences between pre-and post-workshop scores, indicating acceptable sensitivity. With one further item removed due to a low communality score, the final PCA undertaken with the remaining 20 items supports a four-component solution, which accounted for 51.9 % of the total variance. Conclusion: The GPACS-D provides a reliable and preliminarily valid measure of GP attitudes and confidence towards dementia. The scales provide useful information for medical educators and researchers who are interested in evaluating and intervening in GP perceptions of the syndrome and their capacity to provide effective care. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to examine the opinions of aged care residents with mild cognitive decline and their families about interdisciplinary student placements in the residential aged care facilities (RACF) in Tasmania. The study used a mixed methods design and participants have completed a questionnaire on the quality of life of residents. Results showed that different benefits of students provided care in RACFs had experienced by residents and their families.

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]

Background: The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector’s capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant knowledge in the performance of hygiene care in a residential aged care facility. Methods: This study was designed as an action research study. A cycle of reflection, planning, action, and evaluation is described to illustrate the carer mentor capacity to engage with and contribute to the learning of nursing students. Participants were second year student nurses (n = 10) on a four-week placement in a Tasmanian aged care facility in 2013 and their nurse/carer mentors (n = 17). Mentors participated in six action research meetings, and nursing students engaged in a parallel series of four feedback meetings during the placement. Results: At the beginning of the placement, nursing students exhibited a disregard for the clinical value of care provision. Students considered provision of hygiene care, in particular, the preserve of care workers and an inappropriate training exercise in the context of an undergraduate nursing qualification. To assist students to make links between core nursing competencies and hygiene care as well as to engender respect for their role within the aged care facility, carer mentors developed the Carer Assessment and Reporting Guide. Once implemented during the final weeks of the placement, the Guide improved student perceptions of resident hygiene care (reframed as assessment) and the role of facility care workers, as well as reinforcing carer self-esteem. Conclusion: Hygiene care is replete with nursing competencies that are valuable for undergraduate learners, including assessments of skin integrity, mobility, cognitive function, bowels and urine, and basic hygiene. Nurse education programs should strive to address student misconceptions about care work in facilities to account for population level increases in care needs. [ABSTRACT FROM AUTHOR]

The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students. [J Nurs Educ. 2014;53(7):410--414.] [ABSTRACT FROM AUTHOR]

Primary carers provide much of the day-to-day care for community-dwelling people living with dementia (PWD). Maintaining that contribution will require a more in-depth understanding of the primary carer role and the support needs that flow from that role. This study explored patterns of formal and informal support utilisation by people caring for a PWD in a rural-regional context. In-depth semi-structured interviews were conducted with 18 rural primary carers of a PWD and thematically analysed. Participant primary carers' almost total commitment to, and absorption in their role and their assumption of ultimate responsibility for the PWD's wellbeing meant that external social context, such as rurality, became less relevant. Carer networks effectively contracted to those key individuals who were central to supporting them in their caring task. External sources of support were tightly managed with strong boundaries around the provision of direct care to the PWD largely excluding all but professional providers. Primary carers are generally categorised along with other family and friends as informal care. However, in assuming primary responsible for the care and wellbeing for the PWD they effectively become the key care provider, suggesting that it would be productive in both research and practice to treat primary carers as key members of a care partnership alongside professional carers, rather than as adjuncts to formal care and/or another client. [ABSTRACT FROM PUBLISHER]

Rationale Little scrutiny has been applied to how 'cost per fall' values have been calculated and applied. This paper presents discourse discussing how the cost of fall statistic could potentially be misleading when applied to inpatient health or residential care settings and provides estimates of the cost of falls and cost of falls per person. Method Burden of disease was estimated using a decision tree approach. Data informing the decision tree were drawn from a retrospective audit of 545 falls in a residential care facility, a visual observation study of 46 residents from the same facility and a cohort study of 186 residents from nine different facilities in Australia. Acute care and transportation costs were extracted from the retrospective audit using incident reports and care note review. The distribution of falls per person and associations between falls, fractures and change in resident mobility were extracted from the cohort study. The association between resident mobility and the amount of time required to perform toileting, transfer and dressing activities was extracted from the visual observational study. Results The minimum 'cost per fall' was estimated to be $AUD 841 and the maximum was $AUD 1024. The 'cost of falls per person' estimate was $AUD 1887 (2008 base year). Conclusions This cost per fall estimate was substantially lower than three previous internationally derived estimates possibly as a consequence of how fall data were collected and modelled in these studies. Cost of falls per person may be a preferable statistic for future use. [ABSTRACT FROM AUTHOR]

Many facilities for people with dementia have been built with little translation of the substantial body of evidence available to inform design. Knowledge translation has been described as a four-stage process: awareness, agreement, adoption and adherence. This paper identifies where knowledge translation fails in the design of aged care facilities for people with dementia. Ten aged care facilities were audited using the Environmental Audit Tool. Senior managers and architects involved in the facility design were then interviewed to ascertain their knowledge of evidence-based principles of dementia design, their agreement with the principles and the nature of the obstacles they had encountered in their implementation. All architects claimed at least partial awareness of the design principles. Five facility managers claimed full awareness. Those facilities designed with the input of managers who were fully aware of the principles were of significantly higher design quality. There was little agreement on the significance of other obstacles. Once aged care providers are aware of the principles, they appear to find ways to implement them. If the next generation of residential aged care facilities is to be suitable for people with dementia, the facility managers must be made aware of the available design principles, architects encouraged to be more active in sharing their knowledge and ways found to improve the exchange of knowledge between the parties. [ABSTRACT FROM AUTHOR]

Background: Typically, dementia involves progressive cognitive and functional deterioration, leading to death. A palliative approach recognizes the inevitable health decline, focusing on quality of life. The approach is holistic, proactive, supports the client and the family, and can be provided by the client's usual care team. In the last months of life, distressing symptoms, support needs, and care transitions may escalate. This project trialed a strategy intended to support a consistent, high quality, palliative approach for people with dementia drawing close to death. The strategy was to implement two communities of practice, drawn primarily from service provider organizations across care sectors, supporting them to address practice change. Communities comprised practitioners and other health professionals with a passionate commitment to dementia palliative care and the capacity to drive practice enhancement within partnering organizations. Project aims were to document: (i) changes driven by the communities of practice; (ii) changes in staff/practitioner characteristics during the study (knowledge of a palliative approach and dementia; confidence delivering palliative care; views on death and dying, palliative care, and a palliative approach for dementia); (iii) outcomes from perspectives of family carers, care providers, and community of practice members; (iv) the extent to which changes enhanced practice and care continuity; and (v) barriers to and facilitators of successful community of practice implementation. Methods/design: This action research project was implemented over 14 months in 2010/11 in metropolitan Perth, Western Australia and regional Launceston, Tasmania. Each state based community of practice worked with the researchers to scope existing practice and its outcomes. The research team compiled a report of existing practice recommendations and resources. Findings of these two steps informed community of practice action plans and development of additional resources. Change implementation was recorded and explored in interviews, comparisons being made with practice recommendations. Changes in staff/practitioner characteristics were evaluated using survey data. Findings from semi structured interviews and survey administration established outcomes from perspectives of family carers, care providers, and community of practice members. Consideration of processes and outcomes, across the two state based settings, informed identification of barriers and facilitators. Community of practice reflections also informed study recommendations [ABSTRACT FROM AUTHOR]

This paper investigates the coding of dementia in the episode of care in a pilot study group (N=48) post hospital discharge and the possible implications of under-coding. The assigned ICD-10-AM codes and Diagnosis Related Groups were reviewed. Results demonstrate under-coding of dementia and of cognitive deficits; poor correlation between admission diagnoses and dementia codes on separation; and changes in individual patients' cognitive status across forms and assessments in the same admission. The complexities of accurately coding dementias will impact upon planning for future treatments and service provision and will have a flow-on effect for patients, hospitals, and patient care in Australia. [ABSTRACT FROM AUTHOR]