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BackgroundMost people living with dementia want to remain living in their own homes and are supported to do so by family carers. No interventions have consistently demonstrated improvements to people with dementia's life quality, functioning, or other indices of living as well as possible with dementia. We have co-produced, with health and social care professionals and family carers of people with dementia, a new intervention (NIDUS-family). To our knowledge, NIDUS-family is the first manualised intervention that can be tailored to personal goals of people living with dementia and their families and is delivered by facilitators without clinical training. The intervention utilizes components of behavioural management, carer support, psychoeducation, communication and coping skills training, enablement, and environmental adaptations, with modules selected to address dyads' selected goals. We will evaluate the effect of NIDUS-family and usual care on goal attainment, as measured by Goal Attainment Scaling (GAS) rated by family carers, compared to usual care alone at 12-month follow-up. We will also determine whether NIDUS-family and usual care is more cost-effective than usual care alone over 12 months.MethodsA randomised, two-arm, single-masked, multi-site clinical trial involving 297 people living with dementia-family carer dyads. Dyads will be randomised 2:1 to receive the NIDUS-family intervention with usual care (n = 199) or usual care alone (n = 98). The intervention group will be offered, over 1 year, via 6-8 video call or telephone sessions (or face to face if COVID-19 restrictions allow in the recruitment period) in the initial 6 months, followed by telephone follow-ups every 1-2 months to support implementation, with a trained facilitator.DiscussionIncreasing the time lived at home by people living with dementia is likely to benefit lives now and in the future. Our intervention, which we adapted to include remote delivery prior to trial commencement due to the COVID-19 pandemic, aims to address barriers to living as well and as independently as possible that distress people living with dementia, exacerbate family carer(s) stress, negatively affect relationships, lead to safety risks, and frequently precipitate avoidable moves to a care home.Trial registrationInternational Standard Randomised Controlled Trials Number ISRCTN11425138 . Registered on 7 October 2019.

Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health. [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]

Background This study investigated how different spaces within multigenerational local parks are being used by older people and other age groups. Methods Observation of park visitors occurred in six Victorian parks one month after park refurbishment. Parks were classified into six spaces based on equipment/amenities and associated expected activity. Observations were summarized descriptively, and negative binomial regression models were used to examine the association between visitor counts and classified targeted areas. Results A total of 12 501 people visited the parks with 4.1% older visitors. The number of older visitors in each park area was consistently less than other age groups, with counts of older visitors being 50% less in mixed spaces (95% confidence interval [CI] 0.38, 0.65), 40% less in adult exercise equipment areas (95% CI 0.46, 0.77) and 59% less in walking paths (95% CI 0.31, 0.55). The number of older visitors engaging in physical activity were significantly greater in walking paths (incidence rate ratios 1.75; 95% CI 1.16, 2.64) compared with children's play spaces. Conclusion The number of visitors across different age groups varied significantly between the park targeted areas. Most spaces were mainly used by the intended target age group/user, with no particular area used by all age groups in similar proportions. [ABSTRACT FROM AUTHOR]

Introduction We report a mixed-methods process evaluation embedded within a randomised controlled trial. We aimed to test and refine a theory of change model hypothesising key causal assumptions to understand how the New Interventions for Independence in Dementia Study (NIDUS)-Family (a manualised, multimodal psychosocial intervention), was effective relative to usual care, on the primary outcome of Goal Attainment Scaling (GAS) over 1 year. Methods In 2021–2022, intervention-arm dyads completed an acceptability questionnaire developed to test causal assumptions. We conducted qualitative interviews with dyads and intervention facilitators, purposively selected for diverse follow-up GAS scores. We collected observational data from intervention session recordings. We thematically analysed data, then integrated qualitative and quantitative data. Results 174/204 (85.3%) dyads allocated to NIDUS-Family, fully completed it, 18 partially completed, while 12 received no intervention. We interviewed 27/192 (14%) of dyads receiving any sessions, and 9/10 facilitators; and observed 12 sessions. 47/192 (24.5%) of carers completed the acceptability questionnaire. We identified four themes: (A) 'Someone to talk to helps dyads feel supported'; (B) 'NIDUS-Family helps carers change their perspective'; (C) 'Personalisation helps people living with dementia maintain their identity' and (D) 'Small steps help dyads move forward'. Conclusion Key causal pathway mechanisms were: a respectful, trusting and impartial relationship with the facilitator: supporting the development of meaningful goals and support to find manageable solutions. Core implementation factors were delivery of the modules from a consistent facilitator across regular sessions. Core contextual factors influencing these mechanisms were dyadic participation and understanding of abilities. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to determine the proportion of older Aboriginal and Torres Strait Islander peoples participating in cultural events and activities and determine the demographic and sociocultural characteristics associated with participation. Methods The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Social Survey (2014–2015) was used to measure the prevalence of participation in cultural events and activities. Multivariate logistic regression models were used to measure associations. Sociocultural factors were selected by matching survey items to the 12 sociocultural factors described in the Good Spirit Good Life Framework, a culturally validated quality-of-life tool for older people. Results The majority (62.0%) of survey respondents 45 years and older participated in cultural events (e.g. ceremonies, funerals/sorry business, NAIDOC week activities, sports carnivals, festivals/carnivals) or were involved in organizations. Many (58.5%) also participated in activities (e.g. fishing, hunting, gathering wild plants/berries, arts/crafts, music/dance/theater, writing/telling of stories). In regression models including demographic and cultural variables, participation in cultural events was highest among people living remotely (odds ratio [OR] = 2.71), reporting recognition of homelands (OR = 2.39), identifying with a cultural group (OR = 3.56), and those reporting having a say in their communities (OR = 1.57), with similar odds seen for participation in activities. Participation was inversely proportional to increasing age, with a greater proportion of females participating in events and males in activities. Discussion The social lives of older Aboriginal and Torres Strait Islander people were characterized by widespread participation in cultural events and activities. These findings provide important insights into services as they support older people to live a good life. [ABSTRACT FROM AUTHOR]

Background: The Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) Seniors Exercise Park program uses specialized outdoor equipment and a physical activity program to engage older people in physical activity, with multiple health benefits. We determined the cost-effectiveness of the ENJOY program. Methods: The economic evaluation compared health care utilization costs 6 months prior to and 6 months post ENJOY program participation. Incremental cost-utility analysis for the primary aim (quality of life) and incremental cost-effectiveness analysis for the secondary aim (falls) were used. Analyses took a societal perspective inclusive of Australian government-funded health care and pharmaceuticals in addition to hospitalizations, community-based nursing and allied health, and community services. Productivity costs were also calculated. Results: Fifty participants (average age 72.8 y [SD 7.4] and 78.0% [n = 39/50] women) were included. Participation in the ENJOY program reduced health care costs in the 6 months following the program: preintervention, $9764.49 (SD $26,033.35); postintervention, $5179.30 (SD $3826.64); observed postintervention reduction −$4.585.20 (95% confidence interval, −$12,113.99 to $2943.59; P =.227) without compromising quality of life (mean difference [MD] 0.011; 95% confidence interval, −0.034 to 0.056; P =.631) or increasing the likelihood of a fall (−0.5; 95% confidence interval, 0.00 to −0.50; P =.160). The ENJOY intervention is likely cost-effective. Conclusions: Planning for shared community spaces should consider the benefits of a Seniors Exercise Park as part of the built environment. [ABSTRACT FROM AUTHOR]

Objectives Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. Methods Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. Results Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent–child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. Discussion There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India. [ABSTRACT FROM AUTHOR]

This study examines how service providers in Victoria, Australia, undertook early intervention and response to elder abuse during the COVID-19 pandemic in 2020–2021. This study comprised two phases: (a) interviews with 29 staff members from 23 frontline service organizations about their experience responding to the needs of vulnerable older people during COVID-19; followed by (b) a co-design workshop with 15 service providers to discuss and endorse recommendations to improve sector preparedness for early intervention and responses to elder abuse during disasters. Participants reported that the severity and frequency of elder abuse increased during the pandemic, and that remoteness of services undermined comprehensive risk assessments, especially for older people who were not proficient in English and/or current digital platforms. Service providers endorsed a range of recommendations to improve sector preparedness for responses to elder abuse during disasters, primarily to upskill providers and improve the service system and direct support for individuals. [ABSTRACT FROM AUTHOR]

Objectives: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long‐term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India. Methods: We conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC; and (b) The Longitudinal Ageing Study in India (LASI) 2017–2018, cross‐sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households. Results: We identified three themes from qualitative data: (1) LTC as a last resort, describes how LTC could be acceptable if care at home was "impossible" due to the person's medical condition or unavailability of the family carer, for example, if family members lived overseas or interstate. (2) Social expectations of care at home from family members and paid carers and; (3) Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Of 73,396 LASI participants, 40 were considering moving to LTC; 18,281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, lived in LTC. LTC use was rare. While a third of participants with a living parent lived in urban areas, 14/24 of those with a parent in LTC lived in an urban area, supporting our qualitative findings that LTC is mainly accessed in urban areas. Conclusions: Preference for intergenerational community care combined with limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home and in the community, and bolstering respite and LTC services as a last resort. Key points: In India, the demand for long‐term care (LTC) facilities is low, with only a small number of people residing or considering residing in one. Most people prefer intergenerational community care at home.Contrary to the population as a while, more people who had a parent living in LTC were residing in urban versus rural areas; in qualitative interviews, family carers and healthcare professionals of people with dementia reported having less access to LTC in rural areas, which may be linked to increased financial challenges and limited resources for more specialised care.Given the strong preference for care at home over LTC, initiatives are needed to increase community resources for family carers of older adults with unrecognised and undiagnosed conditions such as dementia. Additionally, there should be improved access to LTC for those with fewer financial resources. [ABSTRACT FROM AUTHOR]

Elder abuse often goes unreported. Perpetrators of elder abuse are frequently the adult children of the victim and this relationship may contribute to the reluctance of older adults to seek help. This study aimed to understand older people's experiences of elder abuse and the barriers to reporting it. Twenty-eight semi-structured interviews were conducted with clients of Seniors Rights Victoria (SRV) who had a case opened and closed between 2012 and 2015, or had made two or more calls to SRV between this period. Thematic analysis was undertaken of the qualitative data. Older people who are being abused by their adult children may be reticent to seek help due to fear of adverse consequences for their adult child. The parental bond frequently prevented participants from speaking to others, asking for help, or enacting the advice provided to them. Shame and stigma surrounding the reporting of elder abuse committed by adult children needs to be addressed. Older people need to be supported to take action earlier when there is less likelihood of adverse consequences. Policy and services need to recognize the unique characteristics of the parent-child relationship and the way they can affect an older person's ability to seek help., Author(s): Briony Dow [sup.1] [sup.2], Luke Gahan [sup.1] [sup.3], Ellen Gaffy [sup.1] [sup.4], Melanie Joosten [sup.5], Freda Vrantsidis [sup.1], Meaghan Jarred [sup.6] Author Affiliations: (1) grid.429568.4, 0000 0004 0382 5980, [...]

Introduction In the first randomised controlled trial of a dementia training and support intervention in UK homecare agencies, we aimed to assess: acceptability of our co-designed, manualised training, delivered by non-clinical facilitators; outcome completion feasibility; and costs for a future trial. Methods This cluster-randomised (2:1) single-blind, feasibility trial involved English homecare agencies. Intervention arm agency staff were offered group videocall sessions: 6 over 3 months, then monthly for 3 months (NIDUS-professional). Family carers (henceforth carers) and clients with dementia (dyads) were offered six to eight complementary, individual intervention sessions (NIDUS-Family). We collected potential trial measures as secondary outcomes remotely at baseline and 6 months: HCW (homecare worker) Work-related Strain Inventory (WRSI), Sense of Competence (SoC); proxy-rated Quality of Life (QOL), Disability Assessment for Dementia scale (DAD), Neuropsychiatric Inventory (NPI) and Homecare Satisfaction (HCS). Results From December 2021 to September 2022, we met agency (4 intervention, 2 control) and HCWs (n  = 62) recruitment targets and recruited 16 carers and 16/60 planned clients. We met a priori progression criteria for adherence (≥4/6 sessions: 29/44 [65.9%,95% confidence interval (CI): 50.1,79.5]), HCW or carer proxy-outcome completion (15/16 (93.8% [69.8,99.8]) and proceeding with adaptation for HCWs outcome completion (46/63 (73.0% [CI: 60.3,83.4]). Delivery of NIDUS-Professional costs was £6,423 (£137 per eligible client). WRSI scores decreased and SoC increased at follow-up, with no significant between-group differences. For intervention arm proxy-rated outcomes, carer-rated QOL increased, HCW-rated was unchanged; carer and HCW-rated NPI decreased; DAD decreased (greater disability) and HCS was unchanged. Conclusion A pragmatic trial is warranted; we will consider using aggregated, agency-level client outcomes, including neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care‐recipients. The aim of this single‐blind randomized controlled trial was to investigate the effect of a 6‐month tailored PA program on depressive symptoms in older caregivers. Method: Caregivers were included if they had scores of ≥5 on the 15‐item geriatric depression scale (GDS‐15). Care‐recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago‐Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. Results: Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social‐control, and usual‐care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS‐15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini‐mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social‐control (p < 0.02) and usual‐care groups (p < 0.02). Conclusions: A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. Key points: Physical activity (PA) may help to reduce depression, stress and burden in caregivers.This study investigated the effects of an individually tailored, home‐based PA intervention for both caregivers and care‐recipients, of 6 months' duration, on improving depressive symptoms in older caregivers.A PA intervention may be beneficial for caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment. [ABSTRACT FROM AUTHOR]