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Spargo C, Laver K, Berndt A, Adey-Wakeling Z, George S. Australian medical practitioners' perspectives about current practice relating to fitness to drive assessment for older people with dementia and mild cognitive impairment: A qualitative study. Australas J Ageing 2024; 43:323-332. [PMID: 38343276 DOI: 10.1111/ajag.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/28/2024]
Abstract
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.
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Affiliation(s)
- Claire Spargo
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angela Berndt
- University of South Australia, Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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2
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Ssonko M, Hardy A, Naganathan V, Kalula S, Combrinck M. Dementia subtypes, cognitive decline and survival among older adults attending a memory clinic in Cape Town, South Africa: a retrospective study. BMC Geriatr 2023; 23:829. [PMID: 38071284 PMCID: PMC10709983 DOI: 10.1186/s12877-023-04536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There are no published longitudinal studies from Africa of people with dementia seen in memory clinics. The aim of this study was to determine the proportions of the different dementia subtypes, rates of cognitive decline, and predictors of survival in patients diagnosed with dementia and seen in a memory clinic. METHODS Data were collected retrospectively from clinic records of patients aged ≥ 60 seen in the memory clinic at Groote Schuur Hospital, Cape Town, South Africa over a 10-year period. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to identify patients with Major Neurocognitive Disorders (dementia). Additional diagnostic criteria were used to determine the specific subtypes of dementia. Linear regression analysis was used to determine crude rates of cognitive decline, expressed as mini-mental state examination (MMSE) points lost per year. Changes in MMSE scores were derived using mixed effects modelling to curvilinear models of cognitive change, with time as the dependent variable. Multivariable cox survival analysis was used to determine factors at baseline that predicted mortality. RESULTS Of the 165 patients who met inclusion criteria, 117(70.9%) had Major Neurocognitive Disorder due to Alzheimer's disease (AD), 24(14.6%) Vascular Neurocognitive Disorder (VND), 6(3.6%) Dementia with Lewy Bodies (DLB), 5(3%) Parkinson disease-associated dementia (PDD), 3(1.8%) fronto-temporal dementia, 4(2.4%) mixed dementia and 6(3.6%) other types of dementia. The average annual decline in MMSE points was 2.2(DLB/PDD), 2.1(AD) and 1.3(VND). Cognitive scores at baseline were significantly lower in patients with 8 compared to 13 years of education and in those with VND compared with AD. Factors associated with shorter survival included age at onset greater than 65 (HR = 1.82, 95% C.I. 1.11, 2.99, p = 0.017), lower baseline MMSE (HR = 1.05, 95% C.I. 1.01, 1.10, p = 0.029), Charlson's comorbidity scores of 3 to 4 (HR = 1.88, 95% C.I. 1.14, 3.10, p = 0.014), scores of 5 or more (HR = 1.97, 95% C.I. 1.16, 3.34, p = 0.012) and DLB/PDD (HR = 3.07, 95% C.I. 1.50, 6.29, p = 0.002). Being female (HR = 0.59, 95% C.I.0.36, 0.95, p = 0.029) was associated with longer survival. CONCLUSIONS Knowledge of dementia subtypes, the rate and factors affecting cognitive decline and survival outcomes will help inform decisions about patient selection for potential future therapies and for planning dementia services in resource-poor settings.
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Affiliation(s)
- Michael Ssonko
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa.
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | | | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Education and Research On Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Sebastiana Kalula
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marc Combrinck
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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3
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Naismith SL, Michaelian JC, Low LF, Arsenova V, Mehrani I, Fyfe K, Kochan NA, Kurrle SE, Rowe C, Sachdev PS. Characterising Australian memory clinics: current practice and service needs informing national service guidelines. BMC Geriatr 2022; 22:578. [PMID: 35836238 PMCID: PMC9281346 DOI: 10.1186/s12877-022-03253-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. Methods The ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. Results Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. Conclusions In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03253-7.
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Affiliation(s)
- Sharon L Naismith
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia. .,Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Johannes C Michaelian
- School of Psychology, Charles Perkins Centre and the Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Valerie Arsenova
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katrina Fyfe
- School of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
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Cations M, Keage HAD, Laver KE, Byles J, Loxton D. Intimate Partner Violence and Risk for Mortality and Incident Dementia in Older Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2605-NP2625. [PMID: 32713246 DOI: 10.1177/0886260520943712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to assess the long-term risk for mortality and incident dementia associated with exposure to intimate partner violence (IPV) at any time over the life course. Data were taken from the Australian Longitudinal Study of Women's Health, a population-based cohort study initiated in 1996. Analysis is based on 12,085 community-dwelling women aged 70 to 75 years at baseline from all states and territories. Self-reported exposure to violence was separated into historical (any time before baseline), current (past 12 months), or both. Date of death was obtained from the National Death Index, and dementia status was self-reported or obtained from administrative data. We modeled mortality risk using Cox regression, and risk for incident dementia using Fine-Gray proportional hazards modeling with death as a competing risk. Follow up continued to December 2017. At baseline, 728 women (6.0%) reported historical IPV, 121 (1.0%) reported current violence, and 38 reported both (0.3%). Historical IPV increased 20-year mortality risk after controlling for demographic, socioeconomic, and lifestyle variables (hazard ratio 1.10, 95% confidence interval = [1.00, 1.20]). There was no relationship between current violence and mortality (hazard ratio 1.04, 95% confidence interval = [0.85, 1.29]). There was also no association between IPV and risk for incident dementia (hazard ratio 1.02, 95% confidence interval = [0.89, 1.17]). Older women who self-report exposure to IPV over the lifespan die significantly earlier than women who do not. Further research that considers the mediating role of psychological trauma is needed to examine the relationship between IPV and dementia.
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Affiliation(s)
- Monica Cations
- Flinders University, Adelaide, South Australia, Australia
- University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Kate E Laver
- Flinders University, Adelaide, South Australia, Australia
| | - Julie Byles
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah Loxton
- The University of Newcastle, Callaghan, New South Wales, Australia
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5
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Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users. Sci Rep 2021; 11:10674. [PMID: 34021203 PMCID: PMC8140144 DOI: 10.1038/s41598-021-89646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
Care quality has important implications for people with dementia. We examined trends and geographical variation of four clinical quality indicators (CQIs) in Australia. This retrospective cohort study included all people with dementia using Australian government-subsidised aged care in 2008-2016 (n = 373,695). Quality indicator data were derived from linked national aged care, health, and pharmaceutical datasets. Negative binomial regression modelling assessed trends in CQI performance over time (2011-2016) and funnel plots examined geographical variation in performance. The incidence rate of antipsychotic medicine dispensing decreased slightly from 1.17/1000 person-days to 1.07/1000 person-days (adjusted incidence rate ratio (aIRR) = 0.98, 95%CI 0.98-0.99). Cholinesterase inhibitors and memantine dispensing did not change (aIRR = 1.02, 95%CI 1.00-1.04), while exposure to high sedative load increased slightly from 1.39/1000 person-days to 1.44/1000 person-days (aIRR = 1.01, 95%CI 1.00-1.01). Dementia and delirium-related hospitalisations increased slightly from 0.17/1000 person-days to 0.18/1000 person-days (aIRR = 1.02, 95%CI 1.01-1.03). There was marked variation in cholinesterase inhibitor and memantine dispensing by geographical area (0-41%). There has been little change in four indicators of dementia care quality in Australian aged care users over time. Cholinesterase inhibitor and memantine dispensing varied substantially by geographical region. Existing strategies to improve national performance on these indicators appear to be insufficient, despite the significant impact of these indicators on outcomes for people with dementia.
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Mehrani I, Kochan NA, Ong MY, Crawford JD, Naismith SL, Sachdev PS. Organisational aspects and assessment practices of Australian memory clinics: an Australian Dementia Network (ADNeT) Survey. BMJ Open 2021; 11:e038624. [PMID: 33563617 PMCID: PMC7875292 DOI: 10.1136/bmjopen-2020-038624] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Conducting a national survey of clinicians and administrators from specialised dementia assessment services (memory clinics) in Australia to examine their current organisational aspects and assessment procedures and inform clinical tool harmonisation as part of the Australian Dementia Network-memory clinics project. DESIGN A cross-sectional survey. SETTING Public and private memory clinics across Australia. PARTICIPANTS 150 individual clinicians completed the survey between May and August 2019. Responses could be given anonymously. Most clinics were publicly funded services (83.2%) and in metropolitan regions (70.9%). OUTCOME MEASURES Descriptive data on organisational aspects of memory clinics (eg, waiting times, staffing); the three most commonly used assessment tools per assessment type (eg, self-report) and cognitive domain (eg, attention). RESULTS Since the last national survey in 2009, the number of memory clinics across Australia has increased substantially but considerable variability has remained with respect to funding structure, staffing and assessment procedures. The average clinic employed 2.4 effective full-time staff (range 0.14-14.0). The reported waiting time for an initial assessment ranged from 1 week to 12 months with a median of 7 weeks. While most clinics (97%) offered follow-up assessments for their clients, only a few (31%) offered any form of cognitive intervention. We identified over 100 different cognitive assessment tools that were used at least 'sometimes', with widespread use of well-established core screening tools and a subset of common neuropsychological tests. CONCLUSION This paper presents a current snapshot of Australian memory clinics, showing considerable heterogeneity with some common core elements. These results will inform the development of national memory clinic guidelines. Furthermore, our data make a valuable contribution to the international comparison of clinical practice standards and advocate for greater harmonisation to ensure high-quality dementia care.
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Affiliation(s)
- Inga Mehrani
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Min Yee Ong
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, Charles Perkins Centre and the Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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7
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Cations M, Lang CE, Ward SA, Crotty M, Whitehead C, Maddison J, Inacio M. Cohort profile: Dementia in the Registry of Senior Australians. BMJ Open 2021; 11:e039907. [PMID: 33526495 PMCID: PMC7852970 DOI: 10.1136/bmjopen-2020-039907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Clinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all Australian states and territories identified using routinely collected aged care assessment data. In ROSA, assessment data are linked to information about aged and health service use, medicine dispensing, hospitalisations and the National Death Index. The ROSA dementia cohort was established to capture people for the Australian dementia CQR currently in development who may not be identified elsewhere. PARTICIPANTS There were 373 695 people with dementia identified in aged care assessments from 2008 to 2016. Cross-sectional analysis from the time of cohort entry (e.g. when first identified with dementia on an aged care assessment) indicates that individuals were 84.1 years old on average, and 63.1% were female. More than 44% were first identified at entry to permanent residential aged care. The cohort recorded more severe cognitive impairment at entry than other international dementia registries. FINDINGS TO DATE The cohort has so far been used to demonstrate a declining prevalence of dementia in individuals entering the aged care sector, examine trends in psychotropic medicine prescribing, and to examine the impact of dementia on aged care service use and outcomes. FUTURE PLANS The ROSA dementia cohort will be updated periodically and is a powerful resource both on its own and as a contributor to the Australian dementia CQR. Integration of the ROSA dementia cohort with the dementia CQR will ensure that people with dementia using aged care services can benefit from the ongoing monitoring and benchmarking of care that a registry can provide.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - John Maddison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Low L, Laver K, Lawler K, Swaffer K, Bahar‐Fuchs A, Bennett S, Blair A, Burton J, Callisaya M, Cations M, MC O'Connor C, Gresham M, Lewin G, Messent P, Poulos CJ, Wesson J, Scott TL, Rees G. We need a model of health and aged care services that adequately supports Australians with dementia. Med J Aust 2021. [DOI: 10.5694/mja2.50911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Katherine Lawler
- Wicking Dementia Research and Education Centre University of Tasmania Hobart TAS
| | - Kate Swaffer
- Dementia Alliance International Ankeny IA United States of America
- University of South Australia Adelaide SA
| | | | | | - Annaliese Blair
- Southern NSW Local Health District NSW Health Queanbeyan NSW
| | | | - Michele Callisaya
- Menzies Institute for Medical Research University of Tasmania Hobart TAS
- Monash University Melbourne VIC
| | | | | | | | | | | | | | | | | | - Glenn Rees
- Alzheimer’s Disease International London United Kingdom
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Lin X, Wallis K, Ward SA, Brodaty H, Sachdev PS, Naismith SL, Krysinska K, McNeil J, Rowe CC, Ahern S. The protocol of a clinical quality registry for dementia and mild cognitive impairment (MCI): the Australian dementia network (ADNeT) Registry. BMC Geriatr 2020; 20:330. [PMID: 32894049 PMCID: PMC7487842 DOI: 10.1186/s12877-020-01741-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Dementia was identified as a priority area for the development of a Clinical Quality Registry (CQR) in Australia in 2016. The Australian Dementia Network (ADNeT) Registry is being established as part of the ADNeT initiative, with the primary objective of collecting data to monitor and enhance the quality of care and patient outcomes for people diagnosed with either dementia or Mild Cognitive Impairment (MCI). A secondary aim is to facilitate the recruitment of participants into dementia research and trials. This paper describes the Registry protocol. Methods The ADNeT Registry is a prospective CQR of patients newly diagnosed with either dementia or MCI. Eligible patients will be identified initially from memory clinics and individual medical specialists (e.g., geriatricians, psychiatrists and neurologists) involved in the diagnosis of dementia. Participants will be recruited using either an opt-out approach or waiver of consent based on three key determinants (capacity, person responsible, and communication of diagnosis). Data will be collected from four sources: participating sites, registry participants, carers, and linkage with administrative datasets. It is anticipated that the Registry will recruit approximately 10,000 participants by the end of 2023. The ADNeT registry will be developed and implemented to comply with the national operating principles for CQRs and governed by the ADNeT Registry Steering Committee. Discussion The ADNeT Registry will provide important data on current clinical practice in the diagnosis, treatment and care of people with dementia and MCI in Australia as well as long-term outcomes among these people. These data will help to identify variations in clinical practice and patient outcomes and reasons underlying these variations, which in turn, will inform the development of interventions to improve care and outcomes for people with dementia and MCI.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
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Cations M, Lang C, Ward SA, Crotty M, Inacio MC. Dementia case ascertainment using aged care assessment data. Aust N Z J Public Health 2020; 44:517-518. [PMID: 32865838 DOI: 10.1111/1753-6405.13026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Monica Cations
- South Australian Health and Medical Research Institute, South Australia.,College of Medicine and Public Health, Flinders University, South Australia
| | - Catherine Lang
- South Australian Health and Medical Research Institute, South Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, New South Wales.,Department of Geriatric Medicine, The Prince of Wales Hospital, New South Wales.,School of Public Health and Preventative Medicine, Monash University, Victoria
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, South Australia
| | - Maria C Inacio
- South Australian Health and Medical Research Institute, South Australia.,Division of Health Sciences, University of South Australia, South Australia
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11
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Ng NSQ, Ayton D, Workman B, Ward SA. Understanding diagnostic settings and carer experiences for dementia diagnosis in Australia. Intern Med J 2020; 51:1126-1135. [PMID: 32359111 DOI: 10.1111/imj.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/26/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Australian guidelines advocate referral to comprehensive memory services for dementia diagnosis, but many patients may be diagnosed elsewhere. AIMS To determine common settings for dementia diagnosis in Australia and to compare patient and carer experience between settings. METHODS Exploratory cross-sectional study of patients with dementia admitted to a Melbourne sub-acute hospital. Patients who had capacity to participate were included; carers were recruited for patients without capacity. Participants completed an interviewer-administered survey which asked them to recall the diagnostic setting, discussions about diagnosis and management (clinical care) and overall experience of diagnosis. Descriptive statistics were applied and open-ended questions were analysed using inductive and deductive coding approaches. RESULTS From 81 eligible participants, 74 consented to participate (one patient, 74 carers). Participants reported dementia diagnosis occurred a median of 24 months before interview, in the following settings: hospitals (31.3%), private specialist clinics (29.7%), memory clinics (14.9%), general practice (13.5%), community health services (9.5%) and residential care (1.4%). Recall of discussions about dementia-modulating medications was higher in participants diagnosed in memory clinics and private specialist clinics (70%) compared to other settings (15%) (P < 0.001). Discussion about living circumstances was highest in hospitals (87% vs 40%) (P < 0.001). One third of participants reported dissatisfaction with their experience. Reported satisfaction was highest for memory clinics. CONCLUSION Results suggest majority of people with dementia are diagnosed outside memory services. Significant variability exists in experiences between services, with a high proportion of participants expressing dissatisfaction with their experience with dementia diagnosis. Strategies to standardise diagnosis of dementia, measure and improve quality of care across all settings are required.
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Affiliation(s)
- Natalie Su Quin Ng
- Rehabilitation and Aged Care Services, Kingston Centre, Monash Health, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health Services Research Unit, Division of Health Services, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Barbara Workman
- Rehabilitation and Aged Care Services, Kingston Centre, Monash Health, Melbourne, Victoria, Australia.,Monash Ageing Research Centre (MONARC), Monash University, Melbourne, Victoria, Australia
| | - Stephanie Alison Ward
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Cations M, Radisic G, de la Perrelle L, Laver KE. Post-diagnostic allied health interventions for people with dementia in Australia: a spotlight on current practice. BMC Res Notes 2019; 12:559. [PMID: 31484587 PMCID: PMC6727518 DOI: 10.1186/s13104-019-4588-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/21/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The Clinical Practice Guidelines for Dementia in Australia provide evidence-based recommendations for the assessment, diagnosis, and care of people with dementia and their informal carers. The extent to which current Australian post-diagnosis care reflects these recommendations is not well understood. This brief report provides a snapshot of current practice related to three key recommendations from the Guidelines: occupational therapy, exercise, and informal carer support. Results Nursing (n = 3) and allied health clinicians (n = 29) provided data about 1114 consultations with people with dementia and/or informal carers over a 9-month study period. Results showed that delivery of evidence-based dementia care remains a significant challenge in Australia. Clinicians found it difficult to tailor exercise interventions to overcome cognitive and organisational barriers to adherence during and between consultations. Occupational therapists primarily focussed on functional assessment rather than on delivering evidence-based interventions. Clinicians also found it difficult to identify and address the array of needs reported by informal carers, especially when the person with dementia is present during the consultation. Though these results are reported by a selected sample, they emphasise the need for innovative knowledge translation strategies to facilitate widespread quality improvement in post-diagnosis dementia care. Trial registration Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 (ACTRN12618000268246)
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia. .,Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, NSW, Australia.
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, NSW, Australia
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