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Keast S, Broatch JR, Chung S, Dixon R, Dongol R, Emerson L, Hayes A, Iuliano S, Levinger I, Lin X, McKnight E, Moore K, Nagano H, Parker AG, Said CM, Sales M, Thomas R, White C, Zanker J, Gilmartin-Thomas J. Best practice in dementia health care: Key clinical practice pointers from a national conference and innovative opportunities for pharmacy practice. Res Social Adm Pharm 2024:S1551-7411(24)00230-4. [PMID: 39122588 DOI: 10.1016/j.sapharm.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Sub-optimal care of people living with dementia has serious consequences for older populations. The 2021 Australian Royal Commission noted that a large proportion of older adults in aged care live with dementia, yet there are limitations in the knowledge and understanding of staff who care for them. In the pursuit of educating pharmacists, physicians, allied health care professionals, researchers, academics, people living with dementia and their carers, and the public, who are facing the challenges of dementia management, the 'Best Practice in Dementia Health Care' conference was held on November 10, 2022 at Western Health (Sunshine Hospital, Melbourne, Australia). METHODS Sixteen experts presented on the current practice and challenges associated with delivering best practice dementia health care to older Australians, often highlighting how medication-related challenges impacted on their area of practice. RESULTS Presenters highlighted the importance of individualised medication management plans, considerations of culture and Indigenous communities, the role of technology, and the impact of exercise and the physical environment on care of people living with dementia. Key clinical practice messages from each expert presenter fit into four main topics: 'navigating complexities of medication management'; 'enhancing wellbeing'; 'supportive settings and environments'; and 'programs and services improving care'. CONCLUSIONS Pharmacists are crucial members of allied health care teams. They have the necessary medication and comorbidity expertise to review medication regimens, liaise with all health care providers, and provide holistic, pharmacological and non-pharmacological patient education. Towards providing best practice dementia health care, pharmacists can contribute in several ways, such as providing health practitioner education to increase understanding about medications and how they can impact on allied health practice, to ensure that medications are prescribed appropriately and safely. Further, pharmacists can make available resources to ensure people living with dementia receive culturally safe and appropriate care, while advocating for greater understanding of the history and experiences of people living with dementia to ensure care aligns with their day-to-day routines. Finally, pharmacists can provide peer-support to other health care professionals and care staff to ensure optimal management of behavioural and psychological symptoms of dementia. The information and insights shared at the conference can serve as a valuable resource for pharmacists and other health care professionals and researchers working to improve the lives of those living with dementia.
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Affiliation(s)
- Sam Keast
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - James R Broatch
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | | | | | - Roshna Dongol
- Doutta Galla Aged Care Services, Melbourne, Australia.
| | - Leanne Emerson
- Dementia Australia, Melbourne, Australia; Audiology Australia, Victoria, Australia.
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia; Department of Medicine, Western Health (University of Melbourne), Melbourne, Australia.
| | | | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | | | - Kirsten Moore
- National Ageing Research Institute, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital (University of Melbourne), Parkville, Victoria, Australia.
| | - Hanatsu Nagano
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Catherine M Said
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Myrla Sales
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia.
| | - Rees Thomas
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | | | - Jesse Zanker
- Western Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital (University of Melbourne), Parkville, Victoria, Australia.
| | - Julia Gilmartin-Thomas
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Western Health, Melbourne, Australia; Department of Medicine, Western Health (University of Melbourne), Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia; Allied Health Department, Alfred Health, Victoria, Australia.
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Scott S, Raynor A, Dare J, Grieve J, Costello L. Improving the Transition of Older Adults into Residential Aged Care: A Scoping Review. Clin Gerontol 2023:1-14. [PMID: 37929882 DOI: 10.1080/07317115.2023.2274042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The transition into residential aged care (RAC) is often associated with loss, grief, isolation and loneliness. This scoping review aimed to identify quantitative research which focused on reducing the negative effects associated with transition, thereby improving the transition experience. METHODS A scoping review, which concentrated on quantitative research, was conducted. MEDLINE, CINAHL andPSYCHINFO databases were searched using the initial search terms "olderadults", "residential aged care" and "transition". RESULTS From the 457 original citations identified, four met the inclusion criteria. The interventions used a range of professionals and clinicians, diverse content, and a mixture of outcomes. The content of the more successful studies were underpinned by mental wellness themes and helped to reduce depressive symptoms among new residents. CONCLUSIONS Our review provides a summary of interventions aimed at improving the transition experience for older adults moving into RAC and highlights gaps in the literature. This review is limited by the paucity of quantitative research in this area. Further research is required to address the negative psychosocial effects associated with transition into RAC. CLINICAL IMPLICATIONS Assessing which of the transition phases an individual is in can help individualize interventions to reduce negative symptoms relating to transition.
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Affiliation(s)
- Stacey Scott
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia
| | - Annette Raynor
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia
| | - Julie Dare
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia
| | - Jennifer Grieve
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia
| | - Leesa Costello
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia
- Nutrition & Health Innovation Research Institute
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Rahja M, Nguyen KH, Post D, Parfitt G, Corlis M, Comans T. Some gain for a small investment: An economic evaluation of an exercise program for people living in residential aged care. Australas J Ageing 2020; 40:e116-e124. [PMID: 33135260 DOI: 10.1111/ajag.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a 12-week Exercise Physiology (EP) program for people living in a residential aged care facility. METHODS A within-study pre- and postintervention design to calculate incremental cost-effectiveness ratios per quality-adjusted life years gained. A health service provider perspective was used. RESULTS Fifty-nine participants enrolled in a 12-week program. The program cost was A$514.30 per resident. At a willingness-to-pay threshold of A$64 000, the likelihood of being cost-effective of the program is approximately 60%, due to a small increase in participants' quality of life, as reported by care staff. The model showed great variance, depending on who rated the participants' quality of life outcomes. CONCLUSION It is uncertain that a 12-week EP program is cost-effective based on the evidence of the current trial. However, it appears that a low-cost program can produce small improvements for residents in care facilities.
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Affiliation(s)
- Miia Rahja
- Department of Rehabilitation, Aged and Palliative Care, Flinders Health & Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Dannielle Post
- School of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Gaynor Parfitt
- School of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Megan Corlis
- Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Parfitt G, Post D, Penington A, Davison K, Corlis M. Evaluation of an implementation project: The exercise physiology in aged care program. Geriatr Gerontol Int 2020; 20:595-601. [DOI: 10.1111/ggi.13923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) University of South Australia Allied Health and Human Performance Adelaide South Australia Australia
- NHMRC Cognitive Decline Partnership Centre University of Sydney Sydney New South Wales Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) University of South Australia Allied Health and Human Performance Adelaide South Australia Australia
- NHMRC Cognitive Decline Partnership Centre University of Sydney Sydney New South Wales Australia
| | - Alison Penington
- Helping Hand Organisation North Adelaide South Australia Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) University of South Australia Allied Health and Human Performance Adelaide South Australia Australia
- NHMRC Cognitive Decline Partnership Centre University of Sydney Sydney New South Wales Australia
| | - Megan Corlis
- Helping Hand Organisation North Adelaide South Australia Australia
- NHMRC Cognitive Decline Partnership Centre University of Sydney Sydney New South Wales Australia
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Parfitt G, Post D, Penington A, Davison K, Corlis M. Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols. SAGE Open Med 2020; 8:2050312120910359. [PMID: 32166030 PMCID: PMC7052450 DOI: 10.1177/2050312120910359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Regular physical activity for older adults as they age is important for
maintaining not only physical function but also independence and self-worth.
To be able to monitor changes in physical function, appropriate validated
measures are required. Reliability of measures such as the timed-up-and-go,
five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second
sit-to-stand, and four-metre walk has been demonstrated; however, the
appropriateness of such measures in a population of adults living with
dementia, who may be unable to follow instructions or have diminished
physical capacity, is not as well quantified. This study sought to test
modified standard protocols for these measures. Methods: Modification to the standard protocols of the timed-up-and-go,
five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second
sit-to-stand, and four-metre walk was trialled. This occurred through
modification of procedural components of the assessment, such as encouraging
participants to use their hands to raise themselves from a seated position,
or the incorporation of staged verbal cueing, demonstration, or physical
guidance where required. The test–retest reliability of the modified
protocols was assessed using Pearson’s correlation, and performance
variances were assessed using the %coefficient of variation. Intraclass
correlations were included for comparisons to previous research and to
examine measurement consistency within three trials. Results: At least 64% of the population were able to complete all measures. Good
test–retest reliability was indicated for the modified measures
(timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip
strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93;
and the four-metre walk = 0.83), and the %coefficient of variation
(7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to
good. Conclusion: This article describes the methodology of the modified assessments, presents
the test–retest statistics, and reports how modification of the current
protocols for common measures of physical function enabled more older adults
living with dementia in a residential aged care facility to participate in
assessments, with high reliability demonstrated for the measures.
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Affiliation(s)
- Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia.,Helping Hand Organisation, North Adelaide, SA, Australia
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It’s Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care. J Aging Phys Act 2020; 28:104-113. [DOI: 10.1123/japa.2019-0088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/12/2019] [Accepted: 05/30/2019] [Indexed: 11/18/2022]
Abstract
Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants’ physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.
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