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Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care., Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances., Methods: Retrospective cohort study (2011-2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and permanent residential aged care (PRAC) facility variation., Results: CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02-1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10-1.14). GP mental health treatment plans increased from 0.04 to 0.07/1000 person-days (aIRR = 1.13, 95% CI 1.12-1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03-1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and PRAC facility variation was observed (0-92%)., Conclusion: Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.

Introduction: Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes., Methods: Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively., Results: Twenty-seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial., Conclusion: Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia., (© 2021 Occupational Therapy Australia.)

Background and Objectives: The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services., Research Design and Methods: An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre-post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation., Results: Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre-post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002)., Discussion and Implications: This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The World Health Organisation has called for the implementation of evidence-based interventions that enhance function and capability in people with dementia. In response, the Boosting Dementia Research Initiative in Australia has funded a number of projects aimed at improving such outcomes for people with dementia and their caregivers. What is not known is the economic and societal outcomes of these projects and of program implementation to the Australian healthcare system. The purpose of this study was to identify the costs and benefits of implementing an evidence-based reablement program within Australian health context. A well-used methodology familiar to governments and decision-makers was used to calculate the costs and benefits of implementing the program in Australia. Four different perspectives: market, private, efficiency (social) and referent group (key stakeholders) were considered in the cost-benefit evaluation. Almost A$6.2 million societal gain is presented through a social cost-benefit analysis. The referent (stakeholder) group analysis is used to demonstrate that people with dementia and their caregivers are the bearers of the costs and the Australian health and social care system gains the most from the program implementation. The results of this cost-benefit analysis suggest that there is a need to plan and provide subsidies or other financial incentives to assist people with dementia and their caregivers to engage in reablement programs in Australia; thus the whole society can be advantaged. Funding bodies and decision-makers are urged to recognise the potential societal benefits that can be achieved from participating in such reablement programs., (© 2020 John Wiley & Sons Ltd.)

Background/aim: Randomised trials have demonstrated that occupational therapy can delay functional decline, improve quality of life and increase leisure participation in people with dementia. However, surveys conducted with occupational therapists suggest that clinical practice does not reflect the type of intervention shown to be effective in research studies. Case note audits can be used to quantify practice and demonstrate how and where provision of care could improve without the potential bias associated with self-report., Method: A total of 87 occupational therapy case notes were audited from different service contexts in two states in Australia. The case notes were reviewed against criteria including duration of service, assessments conducted and interventions used. Descriptive statistics were used to present the data and examine associations between intervention, age of the person with dementia and whether or not the person lived alone., Results: Services tended to be short-term with an average of 2.1 consultations per referral. The most common assessments related to home safety, falls risk and function. Intervention most commonly focussed on referrals to other services, environmental modification advice and assistive device prescription., Conclusion: This audit reveals that current occupational therapy practice for people with dementia focusses on assessment and management of risk and is usually limited to a couple of consultations. Future work should seek to evaluate if such approaches to care are effective for people with dementia., (© 2018 Occupational Therapy Australia.)

Background: There are effective non-pharmacological treatment programs that reduce functional disability and changed behaviours in people with dementia. However, these programs (such as the Care of People with dementia in their Environments (COPE) program) are not widely available. The primary aim of this study is to determine the strategies and processes that enable the COPE program to be implemented into existing dementia care services in Australia., Methods: This study uses a mixed methods approach to test an implementation strategy. The COPE intervention (up to ten consultations with an occupational therapist and up to two consultations with a nurse) will be implemented using a number of strategies including planning (such as developing and building relationships with dementia care community service providers), educating (training nurses and occupational therapists in how to apply the intervention), restructuring (organisations establishing referral systems; therapist commitment to provide COPE to five clients following training) and quality management (coaching, support, reminders and fidelity checks). Qualitative and quantitative data will contribute to understanding how COPE is adopted and implemented. Feasibility, fidelity, acceptability, uptake and service delivery contexts will be explored and a cost/benefit evaluation conducted. Client outcomes of activity engagement and caregiver wellbeing will be assessed in a pragmatic pre-post evaluation., Discussion: While interventions that promote independence and wellbeing are effective and highly valued by people with dementia and their carers, access to such programs is limited. Barriers to translation that have been previously identified are addressed in this study, including limited training opportunities and a lack of confidence in clinicians working with complex symptoms of dementia. A strength of the study is that it involves implementation within different types of existing services, such as government and private providers, so the study will provide useful guidance for further future rollout., Trial Registration: 16 February 2017; ACTRN12617000238370 .

Introduction Methods Consumer and Community Involvement Results Conclusion Plain language summary The purpose of this study was to examine the feasibility of adapting and translating an evidence‐based occupational therapist‐delivered program shown to be effective in the community to residential aged care (RAC). The program aims to improve quality of care and quality of life for people living with dementia and the wellbeing of the family care partner.This study took place in a not‐for‐profit RAC home in Adelaide, South Australia. Mixed methods, specifically questionnaires, activity logs, focus group, and one‐on‐one interviews were used to evaluate the feasibility of the program implementation. Staff working in the participating home, occupational therapists trained to deliver the program, and residents and their family carer partners were included. Quantitative data were analysed using proportions, means, and standard deviations. Qualitative data were analysed using a thematic approach.This study was conducted together with a consumer (person living with dementia) and a carer representative (family member of someone residing in RAC). These representatives provided input towards the study design, interpretation of study data, discussion of results, and recommendations for future consideration.Small changes to the program improved feasibility and acceptability for delivery in RAC. While the care home staff required added support during implementation, the intervention therapists felt that the program could be delivered in this setting. Family care partners of residents with dementia felt that the program may be better suited if provided upon entry to RAC or in early stages of dementia.Adapting a community‐based dementia care program to RAC can be safe and feasible. Program adaptations are necessary for feasibility. Further adaptations and evaluations of associated outcomes (related to residents with dementia and their family care partners) are needed to assess the program effectiveness in larger scale.Spending quality time with family members in residential aged care is important. However, many struggle to know what to say or do when visiting a family member who lives with dementia. Programs that teach families about how to communicate with people living with dementia, how to support them to take part in important everyday living activities, or how to understand why changes in behaviours may occur have not been available in residential aged care. This paper describes how we adapted one such evidence‐based program from community to residential aged care settings. We consulted with people living with dementia, carers, and families and found that the program could also be valuable in this care setting. Residential aged care staff described how the program is very different to what is usually available in residential aged care, but they were optimistic that with the right support, it could be a valuable way to support residents with dementia and their families. Family members of residents with dementia and therapists delivering the program felt that residents in early stages of living in residential aged care and/or early stages of dementia could benefit the most from these programs. We found that including family members in the intervention process can be useful and empowering for families and residents. Future work should also focus on involving other staff members caring for residents in the process. Communication between staff and families is the key for program delivery and success and treating each person as an individual. [ABSTRACT FROM AUTHOR]

People with changes in cognition and changes in sensory function often feel uncomfortable in hospital and residential care home environments. Understanding the person's sensory preferences and aversions is important in providing high-quality care but current assessments have limitations. Our objective was to develop a tool to identify the sensory preferences and aversions of people experiencing cognitive changes while staying in hospital or residential care homes. The working group developed a tool comprising 11 items, which was named the "Sensory Preferences and Aversions questionnaire for the Care of older adults with dementia in residential Environments" (SPACE) tool. The tool was administered with 56 people with cognitive changes (mean age 78, mean MMSE score 16/30). Data elicited from the tool revealed the varied preferences of individuals, which demonstrates the importance of eliciting this information. For example, while 82% of participants liked listening to music, the remainder did not. Information elicited from the tool was useful in guiding care planning including identifying activities that may be of interest to the person. It was able to effectively elicit information about preferences, aversions, and strategies that could be applied when the person became distressed. [ABSTRACT FROM AUTHOR]

Background Most evidence for reablement comes from community-based interventions. Objective To determine the effect of reablement interventions provided in permanent residential aged care (PRAC) homes on residents' level of function in activities of daily living (ADL) and quality of life (QoL). Design Systematic review and meta-analysis. Setting PRAC homes. Subjects Residents in PRAC. Methods Six databases and grey literature were searched until November 2021. Quantitative studies involving a control group or pre-post evaluation were included. Outcomes of interest were the effectiveness of the reablement intervention on overall ADL or QoL in the last available follow-up. Results Twelve studies involving 2,620 residents were included. The reablement interventions varied; the primary focus areas were organisational approaches (e.g. educating staff; n  = 10) and improving physical function (e.g. increasing physical activity; n  = 9). Not all studies could be pooled in the meta-analysis due to reported data and heterogeneity. There was no significant effect of reablement intervention versus usual care on ADL function (five studies, standardised mean difference (SMD): 0.17, 95% confidence interval (CI): −0.25 to 0.59, very low quality evidence). Reablement appeared more beneficial than usual care in improving QoL; however, the overall effect was not statistically significant (four studies, SMD: 0.73, 95% CI: −0.07 to 1.52; very low quality evidence). Conclusions Few studies focus on reablement in PRAC homes and their clinical heterogeneity is considerable. There is insufficient evidence for reablement in terms of improving ADL or QoL for residents in PRAC. Tools that are more sensitive to change may be beneficial. [ABSTRACT FROM AUTHOR]

Rationale: Evidence-based reablement programs for people with dementia and their caregivers are not routinely implemented in practice. These programs have been shown to be effective in delaying functional decline and improving caregiver wellbeing. Yet, little is known about the experiences of those participating in such programs. Aim: To describe experiences and outcomes of participating in a dementia reablement program, the Care of Persons with dementia in their Environments (COPE), in Australia. Methods: Purposeful sampling was used and semi-structured interviews were completed with people with dementia and their caregivers who received the COPE program in two different states in Australia. The interviews explored the participants' experiences with the program as well as how they are managing after program completion. Thematic analysis was used to identify themes from the interviews. A Likert scale was used to rate the value of the program. Results: Ten dyads (person with dementia and/or their caregiver) were interviewed. Participation in the program was rated (mostly) very valuable. The ongoing collaboration between the therapist and caregiver was considered empowering. The program promoted participation in everyday activities for the person with dementia and appeared to give a 'second chance' to remain in their own homes and communities. Conclusion: Participation in reablement programs (such as the COPE program) has the potential to re-engage people with dementia in meaningful roles and activities in their chosen environments. A therapeutic relationship and individualized intervention approaches tailored to the participants' needs and readiness foster positive experiences and confidence. [ABSTRACT FROM AUTHOR]

Objective: To identify the Australian general population's awareness regarding the presence and effectiveness of treatments for dementia. Method: An online survey administered through a consumer panel provider (PureProfile). Included were people aged 18 years or above living in Australia. The survey asked participants about their knowledge of treatments for dementia and attitudes toward the effectiveness of evidence-based treatments. Results: Of the 1,001 participants, more than half (63.5%) could not spontaneously name any treatments that improved outcomes for people with dementia. When asked about the efficacy of specific treatments, "brain training" was considered to be "very likely" to be effective by approximately half (49.4%) of the participants followed by "education for caregivers" (46.2%) and "healthy diet" (43.4%). Discussion: Knowledge of treatments for dementia among the Australian public is poor. There is a need to better educate the public about treatments that have demonstrated effectiveness to improve their uptake and use. [ABSTRACT FROM AUTHOR]