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Steiner‐Lim GZ, Bensoussan A, Andrews‐Marney ER, Al‐Dabbas MA, Cave AE, Chiu CL, Christofides K, De Blasio FM, Dewsbury LS, Fagan NL, Fogarty JS, Hattom LC, Hohenberg MI, Jafar D, Karamacoska D, Lim CK, Liu J, Metri N, Oxenham DV, Ratajec H, Roy N, Shipton DG, Varjabedian D, Chang DH. A randomized, double-blind, placebo-controlled, parallel-group 12-week pilot phase II trial of SaiLuoTong (SLT) for cognitive function in older adults with mild cognitive impairment. Alzheimers Dement (N Y) 2023; 9:e12420. [PMID: 37830013 PMCID: PMC10565903 DOI: 10.1002/trc2.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION This study primarily aimed to evaluate the efficacy and safety of SaiLuoTong (SLT) on cognition in mild cognitive impairment (MCI). METHODS Community-dwelling people with MCI aged ≥60 years were randomly assigned to 180 mg/day SLT or placebo for 12 weeks. RESULTS Thirty-nine participants were randomized to each group (N = 78); 65 were included in the final analysis. After 12 weeks, the between-groups difference in Logical Memory delayed recall scores was 1.40 (95% confidence interval [CI]: 0.22 to 2.58; P = 0.010); Delis-Kaplan Executive Function System Trail Making Test Condition 4 switching and contrast scaled scores were 1.42 (95% CI: -0.15 to 2.99; P = 0.038) and 1.56 (95% CI: -0.09 to 3.20; P = 0.032), respectively; Rey Auditory Verbal Learning Test delayed recall was 1.37 (95% CI: -0.10 to 2.84; P = 0.034); and Functional Activities Questionnaire was 1.21 (95% CI: -0.21 to 2.63; P = 0.047; P < 0.001 after controlling for baseline scores). DISCUSSION SLT is well tolerated and may be useful in supporting aspects of memory retrieval and executive function in people with MCI. Highlights SaiLuoTong (SLT) improves delayed memory retrieval and executive function in people with mild cognitive impairment (MCI).SLT is well tolerated in people ≥ 60 years.The sample of community dwellers with MCI was well characterized and homogeneous.
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Affiliation(s)
- Genevieve Z. Steiner‐Lim
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research Institute (THRI)Western Sydney UniversityPenrithNew South WalesAustralia
| | - Alan Bensoussan
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | | | - Mahmoud A. Al‐Dabbas
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Adele E. Cave
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Christine L. Chiu
- Macquarie Medical SchoolMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Katerina Christofides
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Frances M. De Blasio
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Lauren S. Dewsbury
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Naomi L. Fagan
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Jack S. Fogarty
- Science of Learning in Education CentreNational Institute of EducationNanyang Technological UniversitySingapore
| | - Lena C. Hattom
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Mark I. Hohenberg
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Deyyan Jafar
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
- Macquarie Medical SchoolMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Diana Karamacoska
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
- Translational Health Research Institute (THRI)Western Sydney UniversityPenrithNew South WalesAustralia
| | - Chai K. Lim
- Macquarie Medical SchoolMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Jianxun Liu
- Xiyuan HospitalChina Academy of Chinese Medical SciencesBeijingPR China
| | - Najwa‐Joelle Metri
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - D. Vincent Oxenham
- Neuropsychology DepartmentRoyal North Shore HospitalSt. LeonardsNew South WalesAustralia
- School of Psychological Sciences, Faculty of Medicine, Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Holly Ratajec
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Nikita Roy
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Danielle G. Shipton
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
| | - David Varjabedian
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
- School of MedicineWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Dennis H. Chang
- NICM Health Research InstituteWestern Sydney UniversityPenrithNew South WalesAustralia
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Steiner-Lim GZ, Karamacoska D, Abramov G, Dubois S, Harley A, McDonald K, Hohenberg MI. "I'm On My Own, I Need Support": Needs Assessment of Community Aged Care Services. Int J Integr Care 2023; 23:14. [PMID: 37745199 PMCID: PMC10516138 DOI: 10.5334/ijic.7005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Well-integrated community aged care services empower and enable older people to live and thrive in the community by supporting activities of daily living. To inform integrated community aged care service planning and delivery in South Western Sydney Australia, a needs assessment with consumers (i.e., older people), their caregivers, and healthcare providers was conducted. This study details the comprehensive and inclusive needs assessment process undertaken, with a focus on translating the findings into practice to improve integrated care. Description Qualitative interviews and community forum-style focus groups engaged 160 stakeholders including GPs, older people, and aged care workers. Transcribed data were thematically coded using an inductive approach. Data were organised into four themes: 1) access to community aged care services; (2) healthcare and medical needs; (3) social concerns and needs; and (4) education and information needs. Discussion The needs assessment undertaken identified unmet needs, gaps in service provision, and recommendations for improving integrated community aged care services. Conclusion Findings are novel in the context of South Western Sydney, Australia. The study design, methods employed, and lessons learned can be adapted internationally for future needs assessments to inform policy, strategies, and integrated aged care service delivery.
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Affiliation(s)
- Genevieve Z. Steiner-Lim
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith NSW 2751, AU
| | - Diana Karamacoska
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith NSW 2751, AU
| | - Gamze Abramov
- NICM Health Research Institute, Western Sydney University, Penrith NSW 2751, AU
- School of Psychology, University of Wollongong, Wollongong NSW 2522, AU
| | - Shamieka Dubois
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith NSW 2751, AU
| | - Anne Harley
- South Western Sydney Primary Health Network, Campbelltown NSW 2560, AU
| | - Keith McDonald
- South Western Sydney Primary Health Network, Campbelltown NSW 2560, AU
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Karamacoska D, Johnson T, Harrison L, Shi K, Akrawi J, D'Souza SP, Hohenberg MI, George ES, Steiner-Lim GZ. Venous thromboembolism risk screening, training and provider awareness in Australian residential aged care facilities. Health Soc Care Community 2022; 30:e5010-e5016. [PMID: 35855618 DOI: 10.1111/hsc.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 05/23/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in the geriatric post-surgical population, and its prevention is a public health priority. The aim of this study was to assess the use of VTE risk screening and training protocols, and VTE awareness in the Australian residential aged care sector. A cross-sectional survey was conducted that was directed at facility and policy managers of community aged care facilities with ≥10 residents in two Australian states and territories. Forty-nine of 301 (16.3%) providers responded, representing 249/871 (28.6%) aged care facilities and 20,958/66,121 (31.7%) residents. VTE risk screening protocols were used by 1.2% of facilities (3/249), and 79.5% (198/249) were unaware that VTE is an issue in this population. Only 0.8% (2/249) were aware that risk screening and prophylaxis is required to prevent VTE; none were acting upon this. No facility had specific VTE risk assessment or prevention processes in place. Most residential aged care facilities surveyed do not have VTE risk screening protocols and were unaware of the risk that may be associated with this omission. These results have implications for development and implementation of national and international VTE risk screening guidelines in community care.
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Affiliation(s)
- Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Tamara Johnson
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Lize Harrison
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Kate Shi
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Joy Akrawi
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Stephanie P D'Souza
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Emma S George
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
| | - Genevieve Z Steiner-Lim
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
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Hohenberg MI, Metri NJ, Firdaus R, Simmons D, Steiner GZ. What we need as we get older: needs assessment for the development of a community geriatrics service in an Australian context. BMC Geriatr 2021; 21:597. [PMID: 34696722 PMCID: PMC8543109 DOI: 10.1186/s12877-021-02553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to inform the development of a Community Geriatrics Service (CGS) that addressed the healthcare and social needs of community dwelling older people in an Australian context. Methods Stakeholders (N = 108) took part in a ‘needs assessment’ involving 30-min semi-structured interviews with general practitioners (GPs; N = 49), and three 2-h focus groups (community engagement meetings; N = 59) with older people, informal caregivers, allied healthcare workers, and nursing home directors. Data were transcribed and thematically coded, mapped to source and weighted to the frequency that the theme was raised across sources. Results Five themes informing CGS development and delivery emerged: active health conditions (management of behavioural and psychological symptoms of dementia, falls, multimorbidity, and other relevant conditions), active social challenges (patient non-compliance, need for aged care social workers, caregiver stress, elder abuse, social isolation, and stigma), referrals (availability of specialists, communication, specialist input, and advance care directives), access (lack of transport options, and inaccessibility of local geriatrics clinics and specialists), and awareness (lack of awareness, knowledge, and resources). Conclusions The CGS will need to address access, referral processes and health system navigation, which were perceived by stakeholders as significant challenges. These findings warrant the development of a CGS with an integrated approach to aged care, pertinent for the health and social needs of the elderly.
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Affiliation(s)
- Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Rubab Firdaus
- School of Health Science, Western Sydney University, Penrith, NSW, 2751, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia.,Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, 2560, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Steiner GZ, George ES, Metri NJ, MacMillan F, Dubois S, Moyle W, Hohenberg MI, Singh K, Townsend C, Chang D, Bensoussan A, McBride KA. Use of complementary medicines and lifestyle approaches by people living with dementia: Exploring experiences, motivations and attitudes. Int J Older People Nurs 2021; 16:e12378. [PMID: 34176213 DOI: 10.1111/opn.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/26/2021] [Accepted: 03/24/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of effective treatments for chronic conditions is associated with high rates of complementary medicine (CM) use. However, little is known about CM use for dementia. AIMS AND OBJECTIVES The aim of this study was to explore the experiences, motivations, and attitudes towards CM use by people living with dementia in an Australian setting. DESIGN This study had a qualitative research design; quantitative demographic information was also collected. METHODS In-depth interviews were conducted with people living with dementia and their caregivers (N = 18). A thematic (inductive) analysis approach was taken to interpret data. RESULTS Three in four participants used CM for dementia, spending ~AUD$100/month (USD$70/month). Within three overarching themes, a range of sub-themes was identified: (1) CM knowledge and use: people living with dementia and caregivers understanding of CM, types of CM used, and CM usage patterns; (2) Self-determined reasons for use/non-use: maintain or improve quality of life, hope, management of dementia symptoms, level of awareness, willingness and evidence, perceptions on efficacy and safety of CM, experiences of conventional medicine, and holistic approach to wellness; (3) External determinants of use: information on CM, relationship influences on CM use, and experiences with General Practitioners (GPs) and CM. CONCLUSION Findings highlight that CM use is widespread and positively viewed by people living with dementia and their caregivers. Decisions regarding CM use were based on personal opinions. Findings have important implications for conversations with health professionals regarding CM use by people living with dementia to improve communication, health literacy, and reduce the risk of adverse effects through polypharmacy. IMPLICATIONS FOR PRACTICE This study showed that CM is a valued approach for dementia management by people living with dementia, their families, and healthcare providers. Future international research is required to evaluate the efficacy and safety of these approaches and promote accurate advice in nursing care.
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Affiliation(s)
- Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Emma S George
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Shamieka Dubois
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Kawaljit Singh
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate A McBride
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Zheng L, Godbee K, Steiner GZ, Daylight G, Ee C, Hill TY, Hohenberg MI, Lautenschlager NT, McDonald K, Pond D, Radford K, Anstey KJ, Peters R. Dementia risk reduction in practice: the knowledge, opinions and perspectives of Australian healthcare providers. Aust J Prim Health 2021; 27:PY20189. [PMID: 33567248 DOI: 10.1071/py20189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Lidan Zheng
- UNSW Psychology, Sydney, NSW, Australia; and Neuroscience Research Australia, Randwick, NSW, Australia; and UNSW Ageing Futures Institute, The University of New South Wales, Sydney, NSW, Australia; and Corresponding author
| | - Kali Godbee
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Vic., Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Gail Daylight
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Thi Yen Hill
- Neuroscience Research Australia, Randwick, NSW, Australia; and Department of Aged Care, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, Melbourne Medical School, University of Melbourne, Parkville, Vic., Australia; and NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Keith McDonald
- South Western Sydney PHN (SWSPHN), Sydney, NSW, Australia
| | - Dimity Pond
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Kylie Radford
- UNSW Psychology, Sydney, NSW, Australia; and Neuroscience Research Australia, Randwick, NSW, Australia; and UNSW Ageing Futures Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Kaarin J Anstey
- UNSW Psychology, Sydney, NSW, Australia; and Neuroscience Research Australia, Randwick, NSW, Australia; and UNSW Ageing Futures Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Ruth Peters
- UNSW Psychology, Sydney, NSW, Australia; and Neuroscience Research Australia, Randwick, NSW, Australia; and UNSW Ageing Futures Institute, The University of New South Wales, Sydney, NSW, Australia
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Steiner GZ, Ee C, Dubois S, MacMillan F, George ES, McBride KA, Karamacoska D, McDonald K, Harley A, Abramov G, Andrews-Marney ER, Cave AE, Hohenberg MI. "We need a one-stop-shop": co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers. BMC Geriatr 2020; 20:49. [PMID: 32046657 PMCID: PMC7014614 DOI: 10.1186/s12877-019-1410-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/30/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. METHODS Data collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos. RESULTS GPs' attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs. CONCLUSION This study demonstrates the importance of working with stakeholders to co-design models of care for people with dementia that take into account the local communities' needs. Findings pave the way for the development of a potential new "gold standard" memory clinic model of care and operationalise new national clinical guidelines.
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Affiliation(s)
- Genevieve Z. Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2751 Australia
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2751 Australia
| | - Shamieka Dubois
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - Freya MacMillan
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2751 Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751 Australia
| | - Emma S. George
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2751 Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW 2751 Australia
| | - Kate A. McBride
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW 2751 Australia
- School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Keith McDonald
- South Western Sydney Primary Health Network (SWSPHN, Campbelltown, NSW 2560 Australia
| | - Anne Harley
- South Western Sydney Primary Health Network (SWSPHN, Campbelltown, NSW 2560 Australia
| | - Gamze Abramov
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
| | | | - Adele E. Cave
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - Mark I. Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW 2751 Australia
- Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW 2560 Australia
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Chan DKY, Zhang S, Liu Y, Upton C, Kurien PE, Li R, Hohenberg MI, Hung WT. Effectiveness and analysis of factors predictive of discharge to home in a 4-year cohort in a residential transitional care unit. Aging Med (Milton) 2019; 2:162-167. [PMID: 31942530 PMCID: PMC6880721 DOI: 10.1002/agm2.12076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness and identify factors predictive of home discharge in a cohort of patients admitted to the residential Transitional Aged Care Program (r-TACP) after a stay in an acute hospital. METHODS A retrospective observational cohort study of patients admitted to a single r-TACP unit between 1 January 2014 and 31 December 2017 was carried out. Baseline patient characteristics and discharge outcomes were analyzed. RESULTS Three hundred sixty-nine patients were admitted during the study period. The discharge outcomes were as follows: 68% returned home, 17% went onto residential care, 14% were readmitted to hospital, and 1% died. Factors associated with not returning home were increased age, increased comorbidities, and lower Barthel Index on admission to the r-TACP. CONCLUSION Our r-TACP is an effective program that successfully returns the majority (67.8%) of older patients home after an acute hospital admission. Older patients with greater comorbidities and poorer baseline functional status in our program were less likely to return home.
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Affiliation(s)
| | | | - Yvonne Liu
- University of NSWBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | - Ciaran Upton
- University of NSWBankstown‐Lidcombe HospitalBankstownNSWAustralia
| | | | - Rui Li
- Beijing Geriatric HospitalBeijingChina
| | - Mark I. Hohenberg
- Western Sydney University School of MedicinePenrith South DCNSWAustralia
| | - Wai Tak Hung
- University of Technology SydneySydneyNSWAustralia
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Steiner GZ, Bensoussan A, Liu J, Hohenberg MI, Chang DH. Study protocol for a randomised, double-blind, placebo-controlled 12-week pilot phase II trial of Sailuotong (SLT) for cognitive function in older adults with mild cognitive impairment. Trials 2018; 19:522. [PMID: 30253809 PMCID: PMC6156958 DOI: 10.1186/s13063-018-2912-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Mild cognitive impairment (MCI) is a syndrome characterised by a decline in cognition but relatively intact activities of daily living. People with MCI have an increased risk of developing dementia, and MCI is often referred to as a transitional stage between healthy ageing and dementia. Currently, there are no pharmaceutical therapies approved by the US Federal Drug Administration for MCI. Randomised controlled trials on the two major classes of anti-dementia pharmaceuticals, cholinesterase inhibitors and glutamate receptor antagonists, have produced poor results in MCI cohorts. There is a need to test and evaluate new and promising treatments for MCI that target multiple aspects of the syndrome’s multi-faceted pathophysiology. The primary aim of this study is to evaluate the efficacy of 12 weeks of treatment with a standardised herbal formula, Sailuotong (SLT), compared to placebo, on cognition in older adults with MCI. Secondary aims are to assess SLT’s mechanisms of action via electroencephalography (EEG), autonomic function, brain blood flow, and inflammation, as well as its safety in this cohort. Methods/design The target cohort for this trial is community-dwelling older adults over the age of 60 years who meet the National Institute of Aging-Alzheimer’s Association working group core clinical criteria for MCI due to Alzheimer’s disease. Eighty participants will be recruited and randomly allocated via a permuted block strategy at a 1:1 ratio to either the treatment or placebo group. The co-primary cognitive outcome measures are Logical Memory Story A delayed recall (episodic memory), Letter Number Sequencing (perceptual processing speed), and both the Trail Making Test and Rey Complex Figure Test (executive function). Secondary outcome measures are EEG activity, autonomic function (via electrocardiogram, skin conductance, and peripheral pulse pressure), brain blood flow (via common carotid artery ultrasound), and serum concentrations of inflammatory cytokines. Analyses will be performed blind to group allocation. Discussion This study is a 12-week, randomised, double-blind, placebo-controlled trial. Primary and secondary outcome measures will be compared between treatment and placebo groups at baseline and endpoint. Data from this pilot study will inform a larger, more highly powered clinical trial if the findings are positive. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000371392 Registered on 10 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jianxun Liu
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Chaoyang District, Beijing, People's Republic of China
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Dennis H Chang
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Hohenberg MI, Gonski P. 32TEACH ME OR GUIDE ME? WHAT DO JUNIOR DOCTORS WANT TO LEARN ABOUT GERIATRIC MEDICINE AND HOW, DURING THEIR FIRST YEAR OF PRACTICE? Age Ageing 2017. [DOI: 10.1093/ageing/afx119.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Steiner GZ, Mathersul DC, MacMillan F, Camfield DA, Klupp NL, Seto SW, Huang Y, Hohenberg MI, Chang DH. A Systematic Review of Intervention Studies Examining Nutritional and Herbal Therapies for Mild Cognitive Impairment and Dementia Using Neuroimaging Methods: Study Characteristics and Intervention Efficacy. Evid Based Complement Alternat Med 2017; 2017:6083629. [PMID: 28303161 PMCID: PMC5337797 DOI: 10.1155/2017/6083629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022]
Abstract
Neuroimaging facilitates the assessment of complementary medicines (CMs) by providing a noninvasive insight into their mechanisms of action in the human brain. This is important for identifying the potential treatment options for target disease cohorts with complex pathophysiologies. The aim of this systematic review was to evaluate study characteristics, intervention efficacy, and the structural and functional neuroimaging methods used in research assessing nutritional and herbal medicines for mild cognitive impairment (MCI) and dementia. Six databases were searched for articles reporting on CMs, dementia, and neuroimaging methods. Data were extracted from 21/2,742 eligible full text articles and risk of bias was assessed. Nine studies examined people with Alzheimer's disease, 7 MCI, 4 vascular dementia, and 1 all-cause dementia. Ten studies tested herbal medicines, 8 vitamins and supplements, and 3 nootropics. Ten studies used electroencephalography (EEG), 5 structural magnetic resonance imaging (MRI), 2 functional MRI (fMRI), 3 cerebral blood flow (CBF), 1 single photon emission tomography (SPECT), and 1 positron emission tomography (PET). Four studies had a low risk of bias, with the majority consistently demonstrating inadequate reporting on randomisation, allocation concealment, blinding, and power calculations. A narrative synthesis approach was assumed due to heterogeneity in study methods, interventions, target cohorts, and quality. Eleven key recommendations are suggested to advance future work in this area.
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Affiliation(s)
- Genevieve Z. Steiner
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - Danielle C. Mathersul
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
- School of Medicine, Stanford University, Stanford, CA 94305, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Freya MacMillan
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - David A. Camfield
- School of Psychology and Illawarra Health & Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2252, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorne, VIC 3122, Australia
| | - Nerida L. Klupp
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - Sai W. Seto
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | - Yong Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Mark I. Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
- Department of Medicine, Campbelltown Hospital, South Western Sydney Area Health Service, Campbelltown, NSW 2560, Australia
| | - Dennis H. Chang
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
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