1
|
Morse RM, Lang I, Rapaport P, Poppe M, Morgan-Trimmer S, Cooper C. How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program. BMC Geriatr 2024; 24:188. [PMID: 38408902 PMCID: PMC10895907 DOI: 10.1186/s12877-024-04762-3] [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: 06/28/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials. METHODS We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis. RESULTS We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients. CONCLUSION This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.
Collapse
Affiliation(s)
- Rachel M Morse
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Iain Lang
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
- UK National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (NIHR PenARC), Exeter , UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Michaela Poppe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
2
|
Cross AJ, Geethadevi GM, Magin P, Baker AL, Bonevski B, Godbee K, Ward SA, Mahal A, Versace V, Bell JS, Mc Namara K, O'Reilly SL, Thomas D, Manias E, Anstey KJ, Varnfield M, Jayasena R, Elliott RA, Lee CY, Walker C, van den Bosch D, Tullipan M, Ferreira C, George J. A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e073709. [PMID: 38114278 DOI: 10.1136/bmjopen-2023-073709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting. METHODS AND ANALYSIS General practice clinics (n≥26) across Victoria and New South Wales, Australia, will be recruited and randomised. Practice nurses will be trained to implement the HAPPI MIND intervention or a brief intervention. Patients of participating practices aged 45-65 years with ≥2 potential dementia risk factors will be identified and recruited (approximately 15 patients/clinic). Brief intervention participants receive a personalised report outlining their risk factors for dementia based on Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) scores, education booklet and referral to their general practitioner as appropriate. HAPPI MIND participants receive the brief intervention as well as six individualised dementia risk reduction sessions with a nurse trained in motivational interviewing and principles of behaviour change, a personalised risk reduction action plan and access to the purpose-built HAPPI MIND smartphone app for risk factor self-management. Follow-up data collection will occur at 12, 24 and 36 months. Primary outcome is ANU-ADRI score change at 12 months from baseline. Secondary outcomes include change in cognition, quality of life and individual risk factors of dementia. ETHICS AND DISSEMINATION Project approved by Monash University Human Research Ethics Committee (ID: 28273). Results will be disseminated in peer-reviewed journals and at healthcare conferences. If effective in reducing dementia risk, the HAPPI MIND intervention could be integrated into primary care, scaled up nationally and sustained over time. TRIAL REGISTRATION NUMBER ACTRN12621001168842.
Collapse
Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Gopisankar Mohanannair Geethadevi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda L Baker
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kali Godbee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kevin Mc Namara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
- School of Exercise and Nutrition Science, Deakin University, Melbourne, Victoria, Australia
| | - Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marlien Varnfield
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Herston, Queensland, Australia
| | - Rajiv Jayasena
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Parkville, Victoria, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
| | - Cik Y Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Walker
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Denise van den Bosch
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Mary Tullipan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine Ferreira
- North Western Melbourne Primary Health Network, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, St Kilda, Victoria, Australia
| |
Collapse
|
3
|
Jones D, Drewery R, Windle K, Humphrey S, de Paiva AF. Dementia prevention and the GP's role: a qualitative interview study. Br J Gen Pract 2023:BJGP.2023.0103. [PMID: 37549993 PMCID: PMC10428004 DOI: 10.3399/bjgp.2023.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND GPs play an increasingly important role in proactively preventing dementia. Dementia in 40% of patients could be prevented or delayed by targeting 12 modifiable risk factors throughout life. However, little is known about how GPs perceive their role in dementia prevention and the associated barriers. AIM To explore the role of GPs in dementia prevention. DESIGN AND SETTING Qualitative study among UK GPs. METHOD Semi-structured online interviews were conducted with 11 UK GPs exploring their views regarding their role in dementia prevention. Data were analysed using thematic analysis. RESULTS GPs reported that they never explicitly discuss dementia risk with patients, even when patients are presenting with risk factors, but acknowledge that dementia prevention should be part of their role. They advocate for adopting a whole team approach to primary care preventive practice, using long-term condition/medication reviews or NHS health checks as a platform to enable dementia risk communication targeting already at-risk individuals. Barriers included a lack of time and an absence of knowledge and education about the modifiable dementia risk factors, as well as a reluctance to use 'dementia' as a term within the appointment for fear of causing health anxiety. 'Brain health' was perceived as offering a more encouraging discursive tool for primary care practitioners, supporting communication and behaviour change. CONCLUSION There needs to be a whole-systems shift towards prioritising brain health and supporting primary care professionals in their preventive role. Education is key to underpinning this role in dementia prevention.
Collapse
Affiliation(s)
- Danielle Jones
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford
| | - Rachael Drewery
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford
| | - Karen Windle
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford
| | - Sara Humphrey
- GP with an extended role in older people, associate clinical director frailty/dementia and LD, Bradford District and Craven Health and Care Partnership, Bradford; medical director, Westcliffe Health Innovations, Bradford; clinical lead, Yorkshire and the Humber Clinical Network (Dementia and Older Peoples Mental Health); honorary visiting professor, Faculty of Health Studies, University of Bradford, Bradford
| | - Andreia Fonseca de Paiva
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford
| |
Collapse
|
4
|
Siette J, Dodds L, Deckers K, Köhler S, Armitage CJ. Cross-sectional survey of attitudes and beliefs towards dementia risk reduction among Australian older adults. BMC Public Health 2023; 23:1021. [PMID: 37254125 DOI: 10.1186/s12889-023-15843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Little is known about what drives older adults' motivation to change their behaviour and whether that is associated with their personal dementia risk profile. Our aims were to (i) understand what sociodemographic factors are associated with older Australians' motivation to change behaviour to reduce their dementia risk, and (ii) explore the relationship between socio-demographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk scores in older adults. METHODS A cross-sectional online postal or telephone survey was administered to community-dwelling older adults in New South Wales, Australia between January and March 2021. Measures included socioeconomic status, locality, and health status, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale and the lifestyle-based dementia risk score (LIBRA index). Multiple linear regression analyses were used to explore the associations for (i) sociodemographic factors and motivation to reduce dementia risk (MCLHB-DRR scales) and (ii) sociodemographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk (LIBRA index). RESULTS A total of 857 older adults (mean age 73.3 years, SD = 6.0, range 65-94; 70% women; 34.6% less than grade 6 education) completed the survey. Respondents reported high levels of motivation to adopt behaviour changes, agreeing on the importance of good health. Individuals who were younger were more likely to have greater motivation to modify lifestyle to reduce dementia risk and had higher perceived benefits to gain by adopting a healthy lifestyle. Dementia risk scores were moderately low (mean LIBRA index =- 2.8 [SD = 2.0], range - 5.9-3.8), indicating relatively moderate-to-good brain health. Men with low socioeconomic status and higher perceived barriers to lifestyle change had higher dementia risk scores. CONCLUSIONS Public health campaigns need to overcome motivational barriers to support reductions in dementia risk. A multifaceted and inclusive approach targeting both sociodemographic differences and impediments to brain healthy lifestyles is required to achieve genuine change. TRIAL REGISTRATION ACTRN12621000165886, Date of registration: 17/02/2021.
Collapse
Affiliation(s)
- Joyce Siette
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia.
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - Laura Dodds
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, 2145, Australia
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6200 MD, the Netherlands
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
5
|
Godbee K, Farrow M, Bindoff A, Gunn J, Lautenschlager N, Palmer V. Implementing dementia risk reduction in primary care: views of enrollees in the Preventing Dementia Massive Open Online Course. Aust J Prim Health 2021; 27:479-484. [PMID: 34818511 DOI: 10.1071/py21122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/28/2021] [Indexed: 12/28/2022]
Abstract
There is a push for greater promotion of dementia risk reduction (DRR) by primary care practitioners (PCPs). The aims of this study were to understand the views of non-medically trained Australian contributors in a Massive Open Online Course (MOOC) about dementia prevention regarding the role of PCPs in promoting DRR and to consider the implications of those views for developing implementation strategies. Discussion board posts of MOOC enrollees were analysed regarding the actions that organisations, communities and/or governments should take to help people work towards DRR. Of the 1641 eligible contributors to the discussion, 160 (10%) indicated that PCPs had a role in promoting DRR. This subset of participants particularly wanted earlier identification of risk by PCPs and a discussion about DRR. Some participants thought PCPs did not currently prioritise DRR, lacked knowledge about DRR and faced Medicare and resource restrictions to promoting DRR. We suggest that PCPs need: better publicity for their role in promoting DRR; to prioritise DRR; knowledge about DRR; and to take advantage of existing opportunities to promote DRR quickly. The findings of this study should be considered when attempting to implement DRR guidelines in primary care.
Collapse
Affiliation(s)
- Kali Godbee
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia; and Corresponding author.
| | - Maree Farrow
- Wicking Dementia Research and Education Centre, The University of Tasmania, Hobart, Tas., Australia
| | - Aidan Bindoff
- Wicking Dementia Research and Education Centre, The University of Tasmania, Hobart, Tas., Australia
| | - Jane Gunn
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Victoria Palmer
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic., Australia
| |
Collapse
|