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Understanding the key physiology and anatomy of the brain, and the mechanisms underlying dementia, represents essential components within a medical curriculum. This study assessed the implementation feasibility of an augmented reality (AR) three-dimensional (3D) brain visualisation learning mode and the knowledge improvements in medical students when compared to a text-based pamphlet. The pamphlet group learnt from a double-sided information pamphlet, while the AR group used an AR app. In AR, participants held a cube in front of the camera on the tablet, rendered on-screen as a 3D brain model, and received a narrated lesson containing the same information as the pamphlet verbatim. Both resources were also evaluated for perceived usefulness via pre-post tests and written survey. A total of 24 students participated in the study. A significant overall difference in knowledge scores (p < 0.001) was found for all participants but without significant differences between groups. Prior education was a significant covariate for pre-post change (p = 0.016) across all participants but had no impact on group outcomes. Positive feedback was received on both resources where the majority perceived them as easy to use, enjoyable, and helped develop their knowledge of dementia. Both the text-based pamphlet and AR delivery modes improved knowledge, although neither was significantly superior to the other. However, the AR lesson was perceived highly for learning, and has the potential for implementation within a medical programme.

Most massive open online courses (MOOCs) are offered in English, including those offered by non-English speaking universities. The study investigated an identified English language dementia MOOC's accessibility and effectiveness in improving the dementia knowledge of non-native English speaker participants. A total of 6,389 enrolees (age range 18--82 years; 88.4% female) from 67 countries was included in analyses. Dementia knowledge was measured by the Dementia Knowledge Assessment Scale (DKAS) before and after the MOOC completion. Rates of completion were also compared. Native English speakers (n = 5,320) were older, more likely to be female, less likely to be employed, and had lower educational attainment than non-native English speakers (n = 1025). Native English speakers were also more likely to care for or have cared for a family member or friend living with dementia than were non-native English speakers. Native English speakers had a significantly higher DKAS score both pre- (M = 33.0, SD = 9.3) and post-MOOC (M = 44.2, SD = 5.5) than did non-native English speakers (M = 31.7, SD = 9.1; and M = 40.7, SD = 7.7 for pre- and post-MOOC, respectively). Non-native English speakers with low pre-MOOC dementia knowledge scores gained significantly less dementia knowledge following course completion than did native English speakers (p <.001, adjusted for age and education). There was no significant difference between the two groups in their likelihood of completing the MOOC. Our findings suggest that non-native English speakers are motivated and able to complete the MOOC at similar rates to native English speakers, but the MOOC is a more effective educational intervention for native English speakers with low dementia knowledge.

The perspective of people with dementia, particularly late-stage dementia, is often excluded from research, even from methods like Participatory Action Research (PAR), which aim to democratise research. This research note outlines how a PAR project engaged with the perspective of people with late-stage dementia in a residential aged care facility. Firstly, we focus on our mistakes: methods which did not appropriately include or engage this group. Secondly, we explore how methods drawn from design thinking, creative and arts-based research were used to encourage staff and families to think about the perspective of people with dementia. Finally, we explain how only after this extensive creative consultation and through a partnership with a social enterprise was the PAR project able to engage people with late-stage dementia in meaningful ways.

The introduction of Massive Open Online Courses (MOOCs) as a vehicle for education delivery presents opportunities and challenges. In the context of the Wicking Dementia Research and Education Centre (Wicking Centre), the driver to develop a MOOC was the promise of addressing the international deficit in evidence-based dementia education, as well as the lack of research into international perspectives on dementia. The Wicking Centre's activity integrates research and education, framed by the concept of "quality of life across the trajectory of dementia." With dementia emerging as the public health issue of the 21st century, lack of dementia education at multiple levels, professional and non-professional, is of increasing concern. The disruptive character of MOOCs, with associated risks and uncertainties, warranted the application of a research-oriented project management approach to development. This included investing resources in gathering and analysing data to underpin each phase of decision-making. We used a design-based research approach incorporating the concept of "life-cycle of an e-learning design" (Phillips et al. 2012). Data collection and analysis focused on three dynamically interacting components: 1) expertise in dementia knowledge and dementia education; 2) a cohort-centric approach to design and delivery, and 3) models and designs for MOOCs currently promoted, discussed and reported in the higher education discipline. Laurillard's Conversational Framework, relating types of learning, teaching-learning activities and the digital technologies that support them (2012), informed the selection of digital technology elements for massive-scale engagement of our identified cohort. The paper describes the initial design process and the outcomes of the limited release pilot that informed the first full offering of the MOOC.

More than 20 years ago, the concept of using the Montessori Method as a treatment for dementia was discussed in the pages of "Montessori Life" (Vance, Camp, Kabacoff, & Greenwalt, 1996). At that time, research was just beginning on this topic. Since that initial article, the use of the Montessori Method with older adults with dementia has taken root on an international scale. This article reviews the development and dissemination of this concept and discusses plans for its continued evolution.

Expression of sexuality by older people, particularly those with dementia, can be challenging and confronting for aged-care staff. Education on this topic is often a low priority area for aged-care organizations, and there appears to be limited training programs available. Results from our study highlighted the value of an eLearning education intervention that significantly increased aged-care staff and nursing students' level of knowledge relating to older people's sexuality. It also improved their attitudes and permissiveness towards late life sexuality and the expression of sexuality by people with dementia. Furthermore, respondents reported the importance of existing workplace policy (if any) on the expression of sexuality, the overall signs of wellbeing and ill-being exhibited by people with dementia, and the need for guided discussions with family members. Significant improvements in staff understanding and response towards the expression of sexuality by people with dementia may enable the facilitation of a care environment that is supportive of the verbalization and expression of sexual preference, need, and desire by people with dementia. This can, in turn, improve quality of life, health, and wellbeing for people with dementia as well as reduce potential tensions between staff-resident-family when sexual expression is considered to be inappropriate.

This paper explores the impact of a student learning activity involving service learning. As part of a vocational course in the Academy of Health Sciences at a Western Australian TAFE (Technical and Further Education) institute, Allied Health Assistant (AHA) students participated in a service learning program focused on work-based learning in residential aged care. Students delivered a therapy program for residents at the facility, and then completed evaluation questionnaires on conclusion of the study. Of 121 students completing the questionnaires, 91% thought the experience challenged their way of thinking, while only two percent disagreed. The majority of students (93%) reported the experience interesting and engaging and a similar percentage (93%) reported that they felt better prepared to enter the workforce. The major themes in qualitative analysis related to the positive learning experience, increased confidence for future working career, improved knowledge and practice of aged care, and improved resident and student quality of life.

The aim of this study was to develop an Internet-based self-directed training program for Australian healthcare workers to facilitate learning and competence in delivery of a proven intervention for caregivers of people with dementia: The New York University Caregiver Intervention (NYUCI). The NYUCI is a nonpharmacological, multicomponent intervention for spousal caregivers. It is aimed at maintaining well-being by increasing social support and decreasing family discord, thereby delaying or avoiding nursing home placement of the person with dementia. Training in the NYUCI in the United States has, until now, been conducted in person to trainee practitioners. The Internet-based intervention was developed simultaneously for trainees in the U.S. and Australia. In Australia, due to population geography, community healthcare workers, who provide support to older adult caregivers of people with dementia, live and work in many regional and rural areas. Therefore, it was especially important to have online training available to make it possible to realize the health and economic benefits of using an existing evidence-based intervention. This study aimed to transfer knowledge of training in, and delivery of, the NYUCI for an Australian context and consumers. This article details the considerations given to contextual differences and to learners' skillset differences in translating the NYUCI for Australia.

Given a projected threefold increase in people living with dementia globally by 2050 (World Health Organization, 2012), attracting nurses to work in this area will be critical to meet demand. This study examined the role of age, positive ageism, negative ageism, and aged-care placement completion in predicting nursing students' intentions to work in dementia care. Perceived barriers to working in dementia care were also explored through a thematic analysis. Participants were 135 undergraduate nursing students from one regional Australian university (ages ranging from 18 to 55 years) who completed an online survey. Hierarchical multiple linear regression analysis revealed that age (p = 0.001) and positive ageism (p < 0.001) were associated with greater intentions to work in aged-care. A thematic analysis of perceived barriers to working in dementia care showed five themes consisting of 11 subthemes: profession (conditions, culture, diversity, interest); personal demands (emotional, physical); patient contact (communication, safety); experience (previous, lack); and no barriers. Younger students (<25 years of age) were more likely to nominate emotional demands as potential barriers, whereas older students were more likely to cite work conditions. Patient communication and interest in other areas of nursing were identified as barriers across age groups. The findings from this study suggest that educational providers could target students with specific characteristics associated with greater work intentions in dementia care, such as age and positive ageism. Perceived barriers to working in dementia care indicate possible areas of improvement that may attract more students to this field of practice.

Individuals with dementia carry an additional health burden of multiple comorbid conditions. Effectively assessing and treating these comorbid conditions requires the medical specialist to be aware of, understand, and manage the effects of dementia on their clinical subspecialty practice. This ecological study describes the dementia-related education available to medical specialists in Australia outside the domains of geriatrics, neurology, and psychiatry. The dementia-related content of specialist medical training curricula and dementia-related information published in high-impact medical journals between 2000-2012 was reviewed. Dementia-related education was found to be absent from the training curricula for 14 of the medical specialties within Australia. And less than 0.10% (1,921 articles) of the more than two million articles published in the 138 journals assessed were dementia related.

Medical graduates require positive attitudes toward older people with cognitive impairment, in addition to knowledge and skills in the diagnosis and management of dementia. The Student Training Project in Dementia (STriDE) project was conducted to ensure that these needs are met through curricula in Western Australian medical schools. Two medical schools in Perth, Western Australia, participated. Mixed methods were utilized comprising a) focus groups and interviews and b) a survey of teachers and students. Participants recommended clearer structure and standardization in the curriculum to ensure that all students receive similar educational experiences regardless of hospital placement. Both teachers, and to a lesser extent students, held positive attitudes toward older people. Teachers tended to be more dissatisfied with current curricula than students. Teachers and learners endorsed a broad range of teaching and learning methods, assessments, and skills/competencies. The results of this study present major challenges for professional entry dementia education given the breadth, flexibility, and depth of dementia education recommended by teachers and learners. (Contains 8 tables.)

Healthcare practitioners have suggested that interpreting person-centered care for people who have dementia to undergraduate students requires guidance in practical application. This article describes the production of a written and digital interdisciplinary educational resource for tertiary students. It uses real-life case scenarios provided by healthcare practitioners to illustrate person-centered care in practice with people who have dementia. The resource provides students with the theoretical underpinning of person-centered care and dementia as well as reflective questions that relate to the reenacted case scenarios to guide their application of this theory in practice.

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments to screen for cognitive deficits within the hospital setting. However training in how to administer this widely used tool is scarce with little, if any, formal training for nursing staff. Scores are also often misused with over reliance on results and cut-offs to support a diagnosis of dementia within the acute and sub-acute aged care context. The present study assessed the level of training and accuracy in administering the MMSE within a geriatric in-patient rehabilitation ward. Ratings of the level of knowledge, training and confidence in administering the MMSE were obtained from 16 registered nurses and two medical officers before and after an education session on the uses of the MMSE and correct administration. Objective assessment of competencies in administration was also obtained with interrater reliability scores demonstrating high accuracy in the use of this screening instrument. Knowledge improved following the training session, but confidence scores remained unchanged. Results also indicated limited knowledge regarding the necessity for cognitive screening in an aged care setting. Inconsistency in administration of certain items was also identified as a concern. Strategies for improving the quality of administration are identified and discussed.

The shift to Vocational Education and Training (VET) for the training of the Australian residential aged care workforce has resulted in significant variance in the competencies at graduation of those caring for people with dementia. Competence may be also be enhanced, or conversely, decline over time as a result of implicit learning gained from workplace experience. Evaluating the skills and knowledge of the workforce is a challenge for supervisors. A single valid assessment tool that can evaluate staff knowledge across the competence continuum, from personal care workers to registered nurses, is required. An existing case study-based summative test of knowledge was chosen to be used in conjunction with a newly-developed marking rubric. The rubric was designed to differentiate between answers from different levels of staff. The assessment task and rubric were tested on a representative sample of the competent Australian residential aged care workforce with the appropriate skills mix. Evidence of the adequacy with which the test represents the national dementia-care competency, the responses of test users to the problem-solving content of the case study and the validity of the scores have been established. The validated scores were found to establish normal distributions, or ranks of knowledge for the different levels of staff. Potentially these permit the evaluation of the performance of groups of staff in residential aged care facilities against the distributions of scores. (Contains 1 figure and 4 tables.)

Globally, society is faced with an aging population and there is an increasing interest in active aging. This involves all facets of social participation and recognizes the potential contribution older people can make to their communities. This study considers music as a way for older people to engage actively with their communities and both give and receive considerable positive benefits. This single case study focuses on a small choir, the Happy Wanderers, formed by a group of older people to perform to residents in care facilities and to sufferers of dementia. The group has a well-established and busy performance schedule. Participation in the group enhances the lives of the members as well as those of their audiences. Several significant themes emerged in this discussion of community music engagement: gaining a sense of purpose and fulfilment; maintaining relationships; and personal growth.

Background: Australia's national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the pathways they take into aged care, and gives some indications of how facilities adapt to their needs. Method: A postal survey was sent to 826 residential aged care facilities in Victoria, seeking information from directors about their residents with ID. Facilities that responded were fairly representative of all facilities in Victoria. Findings: Residents with ID were younger, had entered at an earlier age and remained longer than other residents. Their reported dependency profile was similar to the general aged care population, although the incidence of dementia was lower. Primary areas of concern identified by providers were: inability to fit into the resident community, lack of participation in activities and lack of meaningful relationships. Conclusion: This study provides a first glimpse into how older people with ID find their way into aged care and how others view their experiences once there. It suggests that further investigation is required into the accuracy of assessment undertaken prior to entry to more clearly understand whether residents with ID are inappropriately placed in residential aged as a result of a shortage of disability accommodation and inadequate resources to support aging in place for those in such accommodation.

The neuropathological correlates of suicide in older persons have received little research attention. Our recent study of elderly suicide victims from an Australian forensic medicine department (n = 143), unlike a previous case-control study, did not find an increased prevalence of Alzheimer's disease (AD) in older persons who committed suicide despite a history of dementia in 6.3%. Both studies were limited to the examination of AD-related pathology by the availability of tissue. We present clinicopathological data on three cases from our study for whom autopsy findings were available. These cases included: a community-dwelling male in his early eighties with dementia who was found to have multiple cortical and striatal lacunes and glial scars, small vessel cerebrovascular disease (SVD) and AD-related pathology; a community-dwelling male in his mid-seventies with depression and loss of concentration, with brainstem predominant Lewy body disease (LBD) and AD-related pathology; and a female nursing home resident in her nineties with a history of stroke and prior suicide attempts who was found to have infarcts and SVD in frontal regions. Neuropathological findings in elderly suicide victims may include multiple neurodegenerative pathologies. The burden and distribution of neurodegenerative diseases apart from AD, including SVD and LBD, should be assessed as possible pathophysiological factors contributing to late life suicide.

The Social Vulnerability Scale (SVS), an informant-report of social vulnerability for older adults, was piloted in a sample of 167 undergraduate students (63 male, 104 female) from the University of Queensland. Participants aged 18 - 53 (M = 25.53 years, SD = 7.83 years) completed the SVS by rating a relative or friend aged [greater than or equal to] 50 years (M = 71.65 years, SD = 12.49 years): either someone with memory problems, stroke, dementia, or other neurological condition (n = 85); or a healthy older adult (n = 82). Excellent internal consistency and test-retest reliability were demonstrated, and the SVS effectively differentiated healthy older adults from those with a neurological condition based on proxy ratings of social vulnerability. The SVS is a potentially useful adjunct measure of older adults' capacity to reside independently. (Contains 1 table and 1 figure.)

Purpose: Flexibility is an essential ingredient of person-centered care. We illustrate the potential impact of flexibility by portraying a nursing home that uses flexibility in its approach to residents and staff members. Designs and Methods: The paper describes the management strategies, principles, and environmental features used by the Adards nursing home in Australia. Results: Adards' flexibility in daily work and task scheduling promotes both resident and staff autonomy, which in turn allows for higher staffing levels, lower staff turnover, and more typical life experiences for residents than is found in many long-term-care facilities in the United States. Implications: The article provides an example and a basis for future discussion on this topic, with the hope that it will prompt other institutions to expand the level of flexibility in their policies and procedures. (Contains 1 table and 3 figures.)

This study describes Australian media portrayal of mental illnesses, focusing on depression. A random sample of 1,123 items was selected for analysis from a pool of 13,389 nonfictional media items about mental illness collected between March 2000 and February 2001. Depression was portrayed more frequently than other mental illnesses. Items about depression, eating disorders, and substance use disorders most commonly described policies or programs, whereas items about schizophrenia most frequently portrayed individuals or symptoms and treatment. A minority of items about depression presented information about symptoms, causes, treatment, or prognosis. Although such information was generally accurate, a proportion of items conveyed misleading messages. There is therefore scope for increasing the level of accurate information provided about depression in the Australian media. (Contains 3 tables.)

Background: Anxiety is common, however, the effect of chronicity of anxiety on dementia has not been explored. This study aims to assess the longitudinal relationship between chronic versus resolved versus new onset anxiety, and all‐cause dementia risk. Methods: A total of 2132 participants with mean age 76 years from the Hunter Community Study were recruited. Anxiety was measured using Kessler Psychological Distress Scale (K10). Dementia was defined as per International Classification of Disease—10 codes. The Fine–Gray subdistribution hazard model was computed to assess dementia risk, while adjusting for the competing risk of death. Results: Chronic anxiety and new onset anxiety at follow‐up were associated with all‐cause dementia risk (HR 2.80, 95% CI 1.35–5.72 and HR 3.20, 95% CI 1.40–7.45 respectively) with an average time to dementia diagnosis of 10 years (SD = 1.7) whereas resolved anxiety was not. In subgroup analyses, these results were driven particularly by chronic and new anxiety among participants below the age of 70 years (HR 4.58, 95% CI 01.12–18.81 and HR 7.21, 95%CI 1.86–28.02 respectively). Sensitivity analyses imputing missing data and addressing reverse causation gave very similar results. Conclusion: Chronic and new anxiety were associated with increased risk of all‐cause dementia, and this association was significant in those 70 years and younger. However, the resolved anxiety at follow‐up reduced the risk, similar to that of the non‐exposed group. These results suggest that timely management of anxiety may be a viable strategy in reducing the risk of dementia. See related Editorial by Karp and Lenze. [ABSTRACT FROM AUTHOR]

Aims: To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. Design: An interpretative qualitative study. Methods: Semi‐structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. Results: The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses – impacted by knowledge and lack of support; (2) Questioning decision making–underpinned by knowledge and confidence; and (3) Challenges in re‐establishing identity – impacted by ongoing concerns. Conclusion: As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. Reporting Method: This research was guided by the Consolidated Criteria for Reporting Qualitative Research. [ABSTRACT FROM AUTHOR]

Aim: To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. Design: A descriptive cross‐sectional survey was conducted between July 2022 and April 2023. Methods: An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. Results: RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self‐identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). Conclusion: The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. Implications for the profession and/or patient care: Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. Impact: Some RNs' beliefs about pain assessment in dementia were not evidence‐based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. Reporting Method: This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Patient or Public Contribution: RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre‐testing of the study's survey instrument. [ABSTRACT FROM AUTHOR]

Objectives: This explorative cross-country qualitative study aims to describe experiences of receiving a dementia diagnosis and experiences of support following a diagnosis in Australia, Canada, the Netherlands and Poland. Method: Qualitative study using projective techniques during online focus groups, online and telephone interviews with people with dementia and caregivers. Results: Twenty-three people with dementia and 53 caregivers participated. Qualitative content analysis revealed five themes; (1) 'Coming to terms with dementia' helped people deal with complex emotions to move forward. (3) 'The social network as a source of support' and (4) 'The challenges and realities of formal support' and impacted 'Coming to terms with dementia'. (2) 'Navigating life with dementia as a caregiver' highlights caregiver burden and was impacted by (4) 'The challenges and realities of formal support'. People were (5) 'Self-caring and preparing for tomorrow' as they focused on maintaining current health whilst planning the future. Despite differences in healthcare and post-diagnostic support systems, there were more similarities across countries than differences. Conclusion: Across countries, formal support and support from friends and family are crucial for people with dementia and caregivers to come to terms with dementia and maintain carer wellbeing to ultimately live well with dementia. [ABSTRACT FROM AUTHOR]

The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers. [ABSTRACT FROM AUTHOR]

Background Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. Methods This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Results Findings provide support for the intersection between PCC and Montessori with participants' descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents' strengths/abilities, maintaining function, using familiar objects, and guided repetition. Conclusions Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC. [ABSTRACT FROM AUTHOR]

Introduction: People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation. Methods: People living with dementia (n = 5) and care partners (n = 8) and health professionals (n = 13) were recruited nationally. Experience‐based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio‐ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions. Results: There was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non‐existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co‐ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended. Conclusions: Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole‐community and systems approach to ensure change. Patient or Public Contribution: People with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions. [ABSTRACT FROM AUTHOR]

Background: Primary care practitioners worldwide are urged to promote dementia risk reduction as part of preventive care. To facilitate this in Australian primary care, we developed the Umbrella intervention, comprising a waiting room survey and patient information cards for use in consultations. Educational and relational strategies were employed to mitigate implementation barriers. Methods: In this cross-sectional, non-randomised implementation study within the South East Melbourne Primary Health Network, we employed mixed-methods outcome evaluation. Antecedent outcomes (acceptability, appropriateness, and feasibility) and actual outcomes (adoption, penetration, and fidelity) were assessed from the perspective of primary care practitioners and patients. Results: Five practices piloted the intervention and implementation strategies, including 16 primary care practitioners engaging with 159 patients. The Umbrella intervention was deemed acceptable, appropriate, and feasible, but penetration was limited. Approximately half of eligible primary care practitioners used the intervention, with moderate fidelity. Engagement with implementation strategies was similarly limited. While most strategies were well-received, improvements in online peer discussions and staff readiness were desired. Conclusions: The Umbrella intervention is a viable approach to promoting dementia risk reduction in Australian general practice, supported by educational and relational strategies. Stakeholder-informed refinements to enhance uptake are recommended before advancing to a definitive trial. Primary care practitioners should be promoting dementia risk reduction as part of preventive care. Using a rigorous, theory-driven, evidence-based, stakeholder-informed approach, we developed an intervention for promoting dementia risk reduction that was acceptable, appropriate, feasible, and complemented by acceptable and appropriate implementation strategies. However, preventive interventions will not be taken up widely in general practice until they are prioritised above competing demands on resources. [ABSTRACT FROM AUTHOR]

Background: Older inpatients with dementia are at an increased risk of an adverse drug reaction (ADR) during hospitalization. Objective: To quantify the prevalence of ADRs in older inpatients according to dementia status and ADR definition approach and to identify risk factors of ADRs during hospitalization. Methods: This was a retrospective cohort study of 2000 inpatients aged ≥ 75 years admitted consecutively to six Sydney hospitals (1 July 2016 to 31 May 2017). Dementia was defined by diagnosis in electronic medical records. ADRs were defined according to two approaches: the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) and classification by a research pharmacist (subset cohort, n = 600). A binary logistic regression was conducted to determine risk factors of ADRs. Results: Among 2000 patients, 25.9% (n = 517) were reported to have dementia. ADRs defined by ICD-10-AM were identified in 8.3% (n = 43) and 14.6% (n = 217) of inpatients with and without dementia respectively (p < 0.001). A total of 13.0% (n = 260) and 12.5% (n = 75) of patients had ADRs defined by ICD-10-AM and a research pharmacist, respectively. Key risk factors of ADRs were longer hospital stay [odds ratio (OR) 1.01, 95% confidence interval (CI) 1.01, 1.02) and a greater number of regular potentially inappropriate medicines (PIMs) on admission (OR 1.17, 95% CI 1.00, 1.38). Conclusions: ADRs were more prevalent among inpatients without dementia and when assessed by a research pharmacist. Our findings underline the need for improved ADR detection in older inpatients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the national variation in government-subsidised healthcare costs of residents in long-term care facilities (LTCFs) and costs differences by resident and facility characteristics. Methods: A retrospective population-based cohort study was conducted using linked national aged and healthcare data of older people (≥65 years) living in 2112 LTCFs in Australia. Individuals' pharmaceutical, out-of-hospital, hospitalisation and emergency presentations direct costs were aggregated from the linked healthcare data. Average annual healthcare costs per resident were estimated using generalised linear models, adjusting for covariates. Cost estimates were compared by resident dementia status and facility characteristics (location, ownership type and size). Results: Of the 75,142 residents examined, 70% (N = 52,142) were women and 53.4% (N = 40,137) were living with dementia. The average annual healthcare cost (all costs in $A) was $9233 (95% CI $9150–$9295) per resident, with hospitalisation accounting for 47.2% of the healthcare costs. Residents without dementia had higher healthcare costs ($11,097, 95% CI $10,995–$11,200) compared to those with dementia ($7561, 95% CI $7502–$7620). Residents living in for-profit LTCFs had higher adjusted average overall annual healthcare costs ($11,324, 95% CI $11,185–$11,463) compared to those living in not-for-profit ($11,017, 95% CI $10,895–$11,139) and government ($9731, 95% CI $9365–$10,099) facilities. Conclusions: The healthcare costs incurred by residents of LTCFs varied by presence of dementia and facility ownership. The variation in costs may be associated with residents' care needs, care models and difference in quality of care across LTCFs. As hospitalisation is the biggest driver of the healthcare costs, strategies to reduce preventable hospitalisations may reduce downstream cost burden to the health system. What is known about the topic? Residents living in long-term care facilities have high health and care needs, but little research exists on how downstream healthcare costs vary based on facility and individual characteristics. What does this paper add? Using linked national aged care and healthcare data, this study determined that the average annual healthcare cost per resident was $9233 (95% CI $9150–$9295), with hospitalisation accounting for nearly half of these costs. Furthermore, healthcare costs varied based on facility ownership and size, as well as whether individuals had dementia. What are the implications for practitioners? Understanding sectoral variation and learning from long-term care facilities with lower hospitalisation rates could be a strategic approach to reducing healthcare costs for long-term care residents. [ABSTRACT FROM AUTHOR]

Aim: To assess the knowledge, attitudes and practices of Registered Nurses working in residential aged care facilities pertaining to pain management for residents living with dementia. Background: Sub-optimal pain management continues for people living with dementia in residential aged care. Registered Nurses are the pivotal staff responsible for complex assessment and management of people residing in residential aged care facilities. Design and methods: :This integrative literature review was informed by Whittemore (2005). Searching and screening followed the PRISMA guidelines. Results: Thirteen papers were identified, the major themes identified were gaps in knowledge and skills, uncertainty of assessment, and delays in treatment. Conclusion: Registered Nurses require education on pain management for people living with dementia in residential aged care. Broader issues in residential aged care contribute to the problem and require examination. Research pertaining to Registered Nurses' roles pain management for residents living with dementia is required. [ABSTRACT FROM AUTHOR]

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Background: Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). Methods: This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. Results: Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. Conclusion: Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this pragmatic stepped‐wedge cluster RCT was to determine the efficacy of a co‐designed dementia specialist training program (the PITCH program) for home care workers (HCWs) to improve their confidence and knowledge when providing care for clients living with dementia. Methods: HCWs who provided care to clients with dementia were recruited from seven home care service provider organisations in Australia between July 2019 and May 2022, and randomised into one of 18 clusters. The primary outcome was HCW's sense of self‐competence in providing care services to people living with dementia at 6 months post PITCH training measured by the Sense of Competence in Dementia Care Staff (SCIDS) Scale. Results: Two hundred and thirteen HCWS completed baseline assessment and almost half (48.4%) completed all three study assessments. HCWs in clusters that received PITCH training had significantly higher sense of competence (measured by SCIDS) than those who had not received PITCH training. Post hoc analysis revealed that face‐to‐face PITCH training consistently resulted in improvements in the HCWs sense of competence, dementia attitudes and knowledge when compared to online training and when compared to no training. PITCH training had no effect on the sense of strain HCWs felt in delivering dementia care. Conclusions: Given the majority of care for people living with dementia is provided at home by family carers supported by HCWs, it is essential that HCWs receive training that improves their skills in dementia care. This study is an important step towards better care at home for people living with dementia. [ABSTRACT FROM AUTHOR]

Aim: To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. Design: This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. Methods: Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. Results: A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. Conclusion: Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real‐time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision‐making in clinical practice. Impact: Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence‐based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. Reporting Method: The study adheres to the CONSORT reporting guidelines. Patient or Public Contribution: One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. Trial Registration: Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820). [ABSTRACT FROM AUTHOR]

Objectives: Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR. Methods: A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD‐10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia. Results: Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p <.001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22–1.41, p <.001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73–2.04, p <.001). Conclusions: In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment—Cognitive Component (KICA‐Cog) adapted for dementia screening in Torres Strait Islander Peoples. Methods: Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA‐Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA‐Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross‐cultural assessment. Results: A total of 255 Torres Strait residents aged 45 years and over completed a KICA‐Cog and underwent geriatric assessment. The adapted KICA‐Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. Conclusions: The KICA‐Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA‐Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA‐Cog. As with all short cognitive tests, individuals with a low KICA‐Cog scores should undergo further medical investigations before a dementia diagnosis is considered. [ABSTRACT FROM AUTHOR]

Objectives: Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video‐based, non‐immersive training. Methods: Twenty‐two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre‐ and post‐training to assess their knowledge of dementia, attitudes towards dementia and person‐centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self‐reported scales. Results: Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean.012 mV vs. video.005 mV, F[1, 20] = 8.70, p =.01; negative emotion fEMG: VR mean.018 mV vs. video.008 mV, F[1, 20] = 18.40, p <.001). Self‐ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR.1 t =.07, df = 9, p =.95 vs. video −2.3 t = −2.265, df = 11, p =.045). Conclusions: Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia. [ABSTRACT FROM AUTHOR]

Objective: To assess Chinese‐Australian carers' needs and preferences through co‐design strategies with stakeholders to embed an evidence‐based iSupport for Dementia program into routine community aged care services in Chinese ethno‐specific aged care organisations. Methods: A cross‐sectional survey was conducted from July to August 2022 in three Chinese ethno‐specific aged care organisations in Australia. We applied a univariate analysis to test variables associated with carers' needs and preferences when embedding the iSupport for Dementia program into routine practice among community aged care services. Results: A total of 101 carers completed the survey. Most carers in our study preferred the iSupport program to be provided in their first language, have a program facilitator to lead the program and would like to interact with peers in the program. Most carers indicated that they are willing to pay for the iSupport program using the budget allocated to their home care package. Younger carers (younger than 65 years), and adult children's carers are more likely to use the web‐based iSupport manual and invite their family members to the program compared to those older than 65 years. Other demographic characteristics had no significant association with their needs and preferences. Conclusions: Chinese‐Australian carers' perceived needs and preferences in this study will inform the implementation of a culturally tailored iSupport program to be embedded in community aged care services provided by Chinese ethno‐specific aged care organisations. Findings will also inform culturally and linguistically congruent iSupport programs for carers from other culturally and linguistically diverse communities in Australia. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this assessor‐blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild‐to‐moderate dementia. Methods: The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6‐month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370). Results: Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6‐ or 12‐months (between‐group differences [95% CI] for primary outcomes at 6‐months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT‐A 2.7 s [−14.1, 19.5]; TMT‐B −17.1 s [−79.3, 45.2]). At the 12‐month follow‐up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver‐rated participant quality of life and higher caregiver quality of life compared to control. Conclusions: This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia. [ABSTRACT FROM AUTHOR]

Objectives: Loneliness is common and becoming a public health concern. Although there is the clear evidence of the variable effect of temporal differences in loneliness (transient/situational and persistent/chronic) on health, their effect on dementia risk is unclear. This study aims to assess the effect of transient/situational and persistent/chronic loneliness on dementia risk. Method: Participants aged 55 years and older from the Hunter Community Study were recruited. Loneliness was measured using a single item measure. Dementia was defined as per International Classification of Disease—10 (ICD 10) codes. The Fine‐Gray subdistribution hazard model was performed to calculate dementia risk. Results: Of 1968 total participants with mean age of 66 years, (3%) 57 developed dementia and (7%) 135 died over the mean follow up of 10 years. Both persistent/chronic and transient/situational loneliness significantly increased the risk of all cause dementia in adjusted models (HR 2.74, 95% CI 1.11–6.88, p 0.03 and HR 2.35, 95% CI 1.21–4.55, p 0.01 respectively) with mean time to event of 9.7 years. Feeling lonely below the age of 70 years elevated the risk of dementia in later life (HR 4.01, 95% CI 1.40–11.50, p 0.01). Conclusions: Loneliness (both persistent/chronic and transient/situational) was associated with increased risk of all cause dementia, especially if loneliness was experienced before the age of 70 years. These results suggest that promoting coping strategies for loneliness especially in persons 70 years and younger may play a role in preventing dementia. [ABSTRACT FROM AUTHOR]

Pain recognition for culturally diverse people is complex as pain experience is subjective and influenced by cultural background. We compared the prevalence, intensity, and association of pain with neuropsychiatric symptoms (NPS) between immigrants and non-immigrants living with dementia in residential aged care homes (RACHs) who were referred to two Dementia Support Australia programs. Immigrant status was defined by the documented country of birth. Pain and NPS were assessed using PainChek® and the Neuropsychiatric Inventory, respectively. Subgroup analyses were also completed for English-speaking and non-English-speaking immigrants. A total of 17,637 referrals [immigrants, n = 6340; non-immigrants, n = 11,297] from 2792 RACHs were included. There were no significant differences for the prevalence of pain across all groups. Immigrants were slightly more likely to have moderate pain or severe pain than non-immigrants. Non-English-speaking immigrants had 0.5 points higher total pain scores on average (Cohen's d = 0.10 [0.05, 0.15], p < 0.001) than non-immigrants. Total pain score had a significant effect on total NPS severity scores in all groups. While pain prevalence is similar across groups, higher pain intensities are more common among immigrants living with dementia. Increased care staff awareness, education, and training about the potential effect of culture on pain expression is needed. [ABSTRACT FROM AUTHOR]

This exploratory descriptive study investigated barriers and enablers to the provision of leisure activities for people living in three Australian residential aged care facilities (RACFs) that operated under a household model of care. This research is unique in the international context, as few studies have explored the understandings and experiences of personal care attendants' (PCAs) perceptions of what impacts leisure provision for people living in RACFs. Qualitative data were collected from 17 PCAs via four focus groups. Barriers to leisure provision were identified as PCA–resident ratios, competing demands of the PCA role and a prioritisation of physical care tasks over leisure-related activities. The severity of residents' dementia (cognitive and functional deficits) as well as behavioural and psychological symptoms of dementia were also framed as barriers to participation in and the provision of leisure. Participants identified enablers of leisure provision as related to perceptions of leisure, the experiential knowledge of staff, organisational support and resourcing. The study findings suggest that enhancing leisure provision for people living with dementia will require attention to system issues (i.e. staffing levels, ratios, PCA role demands) as well as PCA knowledge and capability to facilitate person-centred leisure. [ABSTRACT FROM AUTHOR]

Euthanasia in the form of Voluntary Assisted Dying (VAD) is legal in all Australian States, but current eligibility criteria preclude access to people with dementia. This article discusses Australian VAD eligibility criteria that are problematic for people with dementia: (1) time until death within 12 months, (2) decision-making capacity for VAD, and (3) determination of intolerable suffering. Legislation in the Netherlands allows VAD for people with dementia. The challenges and philosophical issues raised by such cases are explored. It is proposed that the unique nature of dementia in its various forms warrants the formulation of dementia-specific VAD eligibility criteria. A case could be brought to challenge the denial of access to VAD of people with dementia on the basis that their exclusion is discriminatory and an abuse of human rights. If such a challenge was successful, it could form a common law precedent to allow people with dementia access to VAD. [ABSTRACT FROM AUTHOR]

The delivery of a dementia diagnosis, the information provided, and the practical advice and support arranged can have a long‐lasting impact on patients and their families and deserves attention equal to that given to the assessment and investigation process. Patients and their families need a constructive yet sensitive conversation about the nature and cause of their difficulties, communicated in plain language, and tailored to their main concerns and needs. This conversation should lead to the provision of high‐quality, easily accessible information. Following this, clinicians may wish to consider broaching the following dementia topics: (1) pharmacological and non‐pharmacological interventions, (2) connection and integration with relevant organisations, (3, 4) application for formal support services and engagement with support teams, (5) safety in the home, (6, 7) financial planning, guardianship and legal matters, (8) driving eligibility, (9) support and education resources to family carers and (10) research initiatives and genetic information. Addressing these topics will contribute to improved disease management, which is likely to improve the dementia journey for the patient, their carer(s), and family. [ABSTRACT FROM AUTHOR]

Objectives: To describe the perspectives of Australian medical practitioners about current practice, and the potential benefit of tools and resources to support fitness to drive assessment for older people with dementia and mild cognitive impairment (MCI). Methods: Semi‐structured interviews with 22 medical practitioners from cognitive/memory clinics, hospitals, general practice and driving fitness assessment services in Australia. Reflexive thematic analysis was conducted. Results: Two overarching themes were generated: (1) Uncomfortable decisions, describing feelings of discomfort expressed by practitioners about making fitness to drive recommendations, with two subthemes: (a) 'Feeling uncertain' and (b) 'Sticking your neck on the line'; and (2) Easing the discomfort, describing participants' desire for tools/resources to support practitioners to increase comfort with fitness to drive recommendations, with two subthemes: (a) 'Seeking certainty' and (b) 'Focusing on the process' conveying two different perspectives about how this may be achieved. There was a desire for a new in‐office assessment tool capable of accurately predicting fitness to drive outcomes and views that an evidence‐based clinical pathway could improve practitioners' confidence in decision‐making. Conclusions: Perceptions of discomfort relating to fitness to drive assessment of older people with dementia and MCI exist amongst medical practitioners from health‐care settings across Australia. In the absence of a well‐validated in‐office assessment tool, practitioners may benefit from an evidence‐based clinical pathway to guide driving recommendations. [ABSTRACT FROM AUTHOR]

Communication partner training is a recommended intervention for partners of people with acquired brain injury. In this paper we explore the past, present, and future of communication partner training (CPT) based on our 2023 Speech Pathology Australia national conference address. We focus on our research team's contributions, and highlight research knowledge across stroke, traumatic brain injury (TBI), and dementia. This work is anchored in the voice of people with communication disability. One partner in the CPT journey, Rosey Morrow, co-authors this paper. The CPT evidence base for acquired neurological conditions is growing, including in the areas of technology, co-design, and translation. However, knowledge and implementation gaps remain. The future of CPT will require us to harness co-design and technology, whilst meeting the implementation challenges of complex systems to enable communication for all. [ABSTRACT FROM AUTHOR]