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Contains fulltext : 291061.pdf (Publisher’s version ) (Open Access), BACKGROUND: Dementia-friendly communities (DFCs) are seen as key to the inclusion and participation of people with dementia and carers. Dementia-friendly initiatives (DFIs) are important building blocks for the growth of DFCs. The collaboration between different stakeholders is a central aspect in developing and sustaining DFIs. AIM: This study tests and refines an initial theory about collaborating for DFIs with special attention for the involvement of people with dementia and their carers during the collaboration for DFIs. The realist approach is used for deepening contextual aspects, mechanisms, outcomes, and its explanatory power. METHODS: A participatory case study design using qualitative data (focus groups, observations, reflections, minutes from meetings, and exit interviews) was executed in four Dutch municipalities that have ambitions to become dementia- friendly communities. RESULTS: The refined theory on the collaboration for DFIs incorporates contextual aspects such as diversity, shared insights, and clarity. It draws attention to the importance of mechanisms such as the recognition of efforts and progress, informal distributed leadership, interdependency, belonging, significance, and commitment. These mechanisms resonate with feeling useful and feeling collectively powerful in the collaboration. The outcomes of collaboration were activation, getting new ideas, and fun. Our findings address how stakeholders' routines and perspectives impact the involvement of people with dementia and their carers during collaboration. CONCLUSION: This study provides detailed information about collaboration for DFIs. The collaboration for DFIs is largely influenced by feeling useful and collectively powerful. Further research is needed to understand how these mechanisms can be triggered with the involvement of people with dementia and their carers in the heart of the collaboration.

Introduction: Normalisation Process Theory (NPT) is widely used to explore how new healthcare practices are understood, enacted, reflected upon and embedded in usual practice, typically focussing on professionals’ behaviours. NPT is less commonly used to explore patients’ experiences during implementation of new interventions. The RETurn to work After stroKE (RETAKE) trial used NPT’s four constructs (coherence, cognitive participation, collective action, reflexive monitoring) in comparing experi-ences of stroke survivors who received Early Stroke Specialist Vocational Rehabilitation (ESSVR) with recipients of usual care (UC) only.Method: Semi-structured interviews with 44 stroke survivors (23 who received ESSVR and 21 UC participants). NPT underpinned data collec-tion and analysis.Results: RETAKE OTs helped participants in the ESSVR arm make sense of stroke, accept stroke-related limitations, and develop intervention understanding (coherence) more easily than most UC participants. RETAKE OTs typically involved all stakeholders in return-to-work (RTW) plans, facilitating co-operation and engagement (cognitive participation), whereas UC participants described poor co-ordination between services and limited or no focus on RTW. ESSVR participants completed individu-ally tailored work-related tasks, with RETAKE OTs mediating workplace adjustments and monitoring employment progress (collective action). In contrast, OT involvement in work preparation and employer negotiations for UC participants was rare. RETAKE OTs supported ESSVR participants to reflect on the appropriateness of RTW post-stroke or explore alterna-tives (reflexive monitoring). However, few UC recipients were supported to consider the suitability of their current work roles; consequently, some reported feeling ‘abandoned’ by health services.Conclusion: NPT was useful in exploring participants’ perspectives of a complex intervention in the RETAKE trial.

OBJECTIVE: To examine the demographic drivers that contribute to the future growth in the population of Aboriginal and Torres Strait Islander peoples living with dementia in Australia. METHODS: Design: Multistate, Indigenous status, cohort component, population projection model. SETTING: National-level, Aboriginal and Torres Strait Islander population. DATA: Data prepared by the Australian Bureau of Statistics on births, deaths, migration and identification change. Australian Institute of Health and Welfare estimates of dementia prevalence alongside estimates from several studies. MAJOR OUTCOME MEASURES: Number of older people living with dementia alongside a decomposition of demographic drivers of growth. RESULTS: By 2051, the relative growth in the number of Aboriginal and Torres Strait Islander peoples aged 50+ with dementia ranges from 4½ to 5½ times (under three prevalence scenarios) its 2016 estimate. Cohort flow (the gradual movement of younger cohorts into the 50+ age group, and the depletion of older cohorts from death, over time) is a key driver of the growth in the number of older people living with dementia. CONCLUSIONS: High growth in the number of people living with dementia poses implications for culturally appropriate care, health-care access and support for Aboriginal and Torres Strait Islander families, carers and their communities.

The many changes that occur in the lives of older people put them at an increased risk of being socially isolated and lonely. Intergenerational programs for older adults and young children can potentially address this shortfall, because of the perceived benefit from generations interacting. This study explores whether there is an appetite in the community for intergenerational programs for community dwelling older adults. An online survey was distributed via social media, research team networks, and snowballing recruitment with access provided via QR code or hyperlink. Semi-structured interviews were undertaken with potential participants of a pilot intergenerational program planned for the Eastern Suburbs of Sydney, Australia in 2020. The interviews were thematically analyzed. Over 250 people completed the survey, and 21 interviews took place with older adults (10) and parents of young children (11). The data showed that participants were all in favor of intergenerational programs, but there were different perceptions about who benefits most and how. The study highlighted considerations to be addressed in the development of effective and sustainable intergenerational programs. For example, accessing people in the community who are most socially isolated and lonely was identified as a primary challenge. More evidence-based research is needed to support involvement of different cohorts, such as those who are frail, or living with physical or cognitive limitations.

Item does not contain fulltext, IMPORTANCE: Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. OBJECTIVE: To determine the global prevalence of YOD. DATA SOURCES: The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. STUDY SELECTION: Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. DATA EXTRACTION AND SYNTHESIS: Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. MAIN OUTCOMES AND MEASURES: Prevalence estimates of YOD for 5-year age bands. RESULTS: A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women

Background/Objectives: Coexistent seizures add complexity to the burden of Alzheimer's disease (AD). We aim to estimate the incidence and prevalence of coexistent seizures and AD and summarize characteristics. Design: A systematic review and meta-analysis (PROSPERO protocol registration CRD42020150479). Setting: Population-, community-, hospital-, or nursing home-based. Participants and measurements: Thirty-nine studies reporting on seizure incidence and prevalence in 21,198 and 380,777 participants with AD, respectively, and AD prevalence in 727,446 participants with seizures. When statistical heterogeneity and inconsistency (assessed by Q statistic and I2) were not shown, rates were synthesized using random effect. Results: Studies were conducted in Australia, Brazil, Finland, France, Ireland, Italy, Japan, Netherlands, Portugal, Sweden, Taiwan, United Kingdom, and United States. The incidence of seizures among people with clinically diagnosed AD ranged from 4.2 to 31.5 per 1000 person-years. Prevalence of seizures among people with clinically diagnosed AD ranged from 1.5% to 12.7% generally, but it rose to the highest (49.5% of those with early-onset AD) in one study. Meta-analysis reported a combined seizure prevalence rate among people with pathologically verified AD at 16% (95% confidence interval [CI] 14–19). Prevalence of seizure in autosomal dominant AD (ADAD) ranged from 2.8% to 41.7%. Being younger was associated with higher risk of seizure occurrence. Eleven percent of people with adult-onset seizures had AD (95%CI, 7-14). Conclusion: Seizures are common in those with AD, and seizure monitoring may be particularly important for younger adults and those with ADAD.

Background: Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps. Methods: Medline, Embase and PsychInfo were searched from inception to the 28th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 Results: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes. Discussion: Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

This study examined Australian primary healthcare providers' knowledge about dementia risk factors and risk reduction and their perspectives on barriers and enablers to risk reduction in practice. Primary healthcare providers were recruited through Primary Health Networks across Australia (n = 51). Participants completed an online survey that consisted of fixed-responses and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques. The results showed that Australian primary healthcare providers have good knowledge about the modifiable risk factors for dementia however, face several barriers to working with patients to reduce dementia risk. Commonly reported barriers included low patient motivation and healthcare system level limitations. The most commonly reported recommendations to helping primary healthcare providers to work with patients to reduce dementia risk included increasing resources and improving dementia awareness and messaging. While the results need to be interpreted in the context of the limitations of this study, we conclude that collaborative efforts between researchers, clinicians, policy makers and the media are needed to support the uptake of risk reduction activities in primary care settings.

Aim: This study describes baseline audit results documenting cognitive impairment not dementia (CIND) and dementia and associated risk factors in Aboriginal and Torres Strait Islander peoples aged ≥50 years attending Aboriginal Community Controlled Health Services (ACCHSs). Method: A specialised chart audit tool was designed to identify documented dementia and CIND, and relevant risk factor profiles in patient health records. The audits were conducted as part of a stepped-wedge cluster randomised controlled trial. Twelve Aboriginal Controlled Community Health Services (ACCHSs) in four states across Australia were recruited and medical records of 1,662 patients aged >50 years were audited. The primary outcome measure is documentation of CIND and dementia along with the associated risk factors. Results: The mean age was 60.2 +/-8.2 years and 56% were female. The overall prevalence of documented CIND or dementia was low, reported for only 57 (3.4%) patients audited. The prevalence of risk factors was high, with nearly two-thirds (64.1%,) having ≥4 risk factors. These included high rates of hypertension (52.5%), diabetes (44.3%), dyslipidemia (42.3%), obesity (35.3%) and current smoking (35.3%). Conclusion: Our previous work demonstrated the true prevalence of dementia was 10% and CIND was 10% in Indigenous communities. The low detection of these conditions in the primary care setting, accompanied by high prevalence of associated risk factors for cognitive impairment, demonstrates the need for dementia specific culturally responsive primary care interventions that optimise brain health and support identification of cognitive impairment and dementia, using a community wide and holistic approach across the lifespan.

Physical activity has cultural significance and population health benefits. However, Aboriginal and Torres Strait Islander adults may experience challenges in participating in physical activity. This mixed methods systematic review aimed to synthetize existing evidence on facilitators and barriers for physical activity participation experienced by Aboriginal and Torres Strait Islander adults in Australia. The Joanna Briggs Institute methodology was used. A systematic search was undertaken of 11 databases and 14 grey literature websites during 2020. The included studies reported physical activity facilitators and barriers experienced by Aboriginal or Torres Strait Islander participants aged 18+ years, living in the community. Twenty-seven studies met the inclusion criteria. Sixty-two facilitators were identified: 23 individual, 18 interpersonal, 8 community/environmental and 13 policy/program facilitators. Additionally, 63 barriers were identified: 21 individual, 17 interpersonal, 15 community/environmental and 10 policy/program barriers. Prominent facilitators included support from family, friends, and program staff, and opportunities to connect with community or culture. Prominent barriers included a lack of transport, financial constraints, lack of time, and competing work, family or cultural commitments. Aboriginal and Torres Strait Islander adults experience multiple facilitators and barriers to physical activity participation. Strategies to increase participation should seek to enhance facilitators and address barriers, collaboratively with communities, with consideration to the local context.