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Sluggett JK, Caughey GE, Air T, Cations M, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services. Int J Geriatr Psychiatry 2024; 39:e6089. [PMID: 38676658 DOI: 10.1002/gps.6089] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES Dementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non-drug interventions fail, and to regularly review use. Population-level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC. METHODS Retrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011-12 to 2015-16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function. RESULTS Between 2011-12 and 2015-16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2-11.1) to 10.1% (95% CI 9.6-10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95-0.98)), and in PRAC residents from 24.5% (95% CI 24.2-24.7) to 21.8% (95% CI 21.5-22.0, aIRR 0.97 (95% CI 0.96-0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108-958) and 555 (IQR 197-1239) days, respectively. CONCLUSIONS While small decreases in antipsychotic use >90 days were observed between 2011-12 and 2015-16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Thapaliya K, Caughey GE, Crotty M, Williams H, Wesselingh SL, Roder D, Cornell V, Harvey G, Sluggett JK, Gill TK, Cations M, Khadka J, Kellie A, Inacio MC. Primary, allied health, selected specialists, and mental health service utilisation by home care recipients in Australia before and after accessing the care, 2017-2019. Aging Clin Exp Res 2024; 36:83. [PMID: 38551712 PMCID: PMC10980604 DOI: 10.1007/s40520-024-02731-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES To examine changes in primary, allied health, selected specialists, and mental health service utilisation by older people in the year before and after accessing home care package (HCP) services. METHODS A retrospective cohort study using the Registry of Senior Australians Historical National Cohort (≥ 65 years old), including individuals accessing HCP services between 2017 and 2019 (N = 109,558), was conducted. The utilisation of general practice (GP) attendances, health assessments, chronic disease management plans, allied health services, geriatric, pain, palliative, and mental health services, subsidised by the Australian Government Medicare Benefits Schedule, was assessed in the 12 months before and after HCP access, stratified by HCP level (1-2 vs. 3-4, i.e., lower vs. higher care needs). Relative changes in service utilisation 12 months before and after HCP access were estimated using adjusted risk ratios (aRR) from Generalised Estimating Equation Poisson models. RESULTS Utilisation of health assessments (7-10.2%), chronic disease management plans (19.7-28.2%), and geriatric, pain, palliative, and mental health services (all ≤ 2.5%) remained low, before and after HCP access. Compared to 12 months prior to HCP access, 12 months after, GP after-hours attendances increased (HCP 1-2 from 6.95 to 7.5%, aRR = 1.07, 95% CI 1.03-1.11; HCP 3-4 from 7.76 to 9.32%, aRR = 1.20, 95%CI 1.13-1.28) and allied health services decreased (HCP 1-2 from 34.8 to 30.7%, aRR = 0.88, 95%CI 0.87-0.90; HCP levels 3-4 from 30.5 to 24.3%, aRR = 0.80, 95%CI 0.77-0.82). CONCLUSIONS Most MBS subsidised preventive, management and specialist services are underutilised by older people, both before and after HCP access and small changes are observed after they access HCP.
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Affiliation(s)
- Kailash Thapaliya
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gillian E Caughey
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David Roder
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Victoria Cornell
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Gillian Harvey
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Janet K Sluggett
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Tiffany K Gill
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
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Cations M, Atee M, Morris T, Whiting D. Neuropsychiatric symptoms of dementia in those with and without a recorded history of psychological trauma: A comparative study from an Australian dementia support service. Int J Geriatr Psychiatry 2024; 39:e6054. [PMID: 38185811 PMCID: PMC10952246 DOI: 10.1002/gps.6054] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/30/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To compare the number and severity of neuropsychiatric symptoms (NPS) and associated caregiver distress between those with and without a noted history of psychological trauma among those referred to a specialised national dementia NPS support service. METHODS This was a 5-year retrospective observational study of records from the Dementia Support Australia NPS support service. NPS were reported by formal or informal caregivers at service entry using the Neuropsychiatric Inventory Nursing Home version or Questionnaire version. A history of psychological trauma was recorded in the person's social or medical history and/or endorsed as a contributor to NPS by a trained dementia consultant after a comprehensive clinical review. Regression was used to examine the impact of a recorded history of psychological trauma on NPS severity and associated caregiver distress, controlling for age and sex. RESULTS Among 41,876 eligible referrals with dementia, 6% (n = 2529) had some reference in their records to a history of psychological trauma. Referrals with a recorded history of psychological trauma were rated with a higher rate of both NPS severity (mean = 12.0) and associated caregiver distress (mean = 16.5) at service entry than those without a recorded history of psychological trauma (means = 10.7 and 14.5, respectively). A recorded history of psychological trauma was associated with higher odds of psychotic symptoms, agitation/aggression, irritability, disinhibition, affective symptoms and night-time behaviours. CONCLUSIONS Traumatic stress symptoms may represent a neglected target for intervention to reduce the impact of NPS in people with dementia.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Mustafa Atee
- The Dementia CentreHammondCareOsborne ParkWestern AustraliaAustralia
- Faculty of Health SciencesCurtin Medical SchoolCurtin UniversityBentleyWestern AustraliaAustralia
- Faculty of Medicine and HealthSydney Pharmacy SchoolThe University of SydneySydneyNew South WalesAustralia
- Centre for Research in Aged CareSchool of Nursing and MidwiferyEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | - Thomas Morris
- The Dementia CentreHammondCareSt LeonardsNew South WalesAustralia
- Faculty of Medicine and HealthSydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Daniel Whiting
- The Dementia CentreHammondCareSt LeonardsNew South WalesAustralia
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Cations M, Lang C, Draper B, Caughey GE, Evans K, Wesselingh S, Crotty M, Whitehead C, Inacio MC. Death by suicide among aged care recipients in Australia 2008-2017. Int Psychogeriatr 2023; 35:724-735. [PMID: 36803904 DOI: 10.1017/s104161022300008x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. DESIGN Population-based, retrospective exploratory study. SETTING AND PARTICIPANTS Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. MEASUREMENTS Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. RESULTS Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. CONCLUSIONS Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- College of Education, Psychology and Social Work, Flinders University, AdelaideSA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, SydneyAustralia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
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Cook JM, Cations M, Simiola V, Ellis AE, Bellamy C, Martino S. Comparisons Between Young, Middle-Aged, and Older Adult Sexual and Gender Minority Male Sexual Assault Survivors. Am J Geriatr Psychiatry 2023; 31:833-843. [PMID: 37217371 DOI: 10.1016/j.jagp.2023.04.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors. DESIGN Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial. SETTING SGM males 18 years or older, residing in the U.S. or Canada, were recruited online. PARTICIPANTS This study included younger (aged 18-39; n = 1,435), middle-aged (aged 40-59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault. MEASUREMENTS Participants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement. RESULTS Older SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group. CONCLUSION While there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources.
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Affiliation(s)
- Joan M Cook
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT.
| | - Monica Cations
- College of Education (MC), Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Vanessa Simiola
- Kaiser Permanente (VS), Center for Integrated Health Care Research, Honolulu, HI
| | - Amy E Ellis
- Nova Southeastern University (AEE), Trauma Resolution & Integration Program, Fort Lauderdale, FL
| | - Chyrell Bellamy
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT
| | - Steve Martino
- Department of Psychiatry (JMC, CB, SM), Yale School of Medicine, New Haven, CT; VA Connecticut Healthcare System, Psychology Service (SM), West Haven, CT
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Cations M. The critical role of clinical champions: Commentary on "Establishing and sustaining high quality services for people with young onset dementia: The perspective of senior service providers and commissioners". Int Psychogeriatr 2023:1-7. [PMID: 37767712 DOI: 10.1017/s1041610223000832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, AdelaideAustralia
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Cations M. A devastating loss: driving cessation due to young onset dementia. Age Ageing 2023; 52:afad174. [PMID: 37725970 DOI: 10.1093/ageing/afad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Sturt Road Bedford Park, Adelaide 5042, Australia
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Inacio MC, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Wesselingh SL, Kellie A, Roder D, Lewis A, Harvey G, Sluggett JK, Cations M, Gill TK, Khadka J, Caughey GE. Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017. Australas J Ageing 2023; 42:564-576. [PMID: 37070244 PMCID: PMC10947441 DOI: 10.1111/ajag.13199] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. METHODS Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). RESULTS In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. CONCLUSIONS The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.
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Affiliation(s)
- Maria C. Inacio
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Luke Collier
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Tracy Air
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Kailash Thapaliya
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Maria Crotty
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | | | - Steve L. Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI)AdelaideSouth AustraliaAustralia
| | - Andrew Kellie
- East Adelaide HealthcareNewtonSouth AustraliaAustralia
| | - David Roder
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Adrienne Lewis
- SA Health Dental ServiceAdelaideSouth AustraliaAustralia
| | - Gillian Harvey
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Janet K. Sluggett
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash UniversityParkvilleVictoriaAustralia
| | - Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tiffany K. Gill
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Gillian E. Caughey
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Cations M, Cook JM, Fischer I, Pietrzak RH. Exacerbated PTSD symptoms among older U.S. military veterans during the COVID-19 pandemic: Results from the national health and resilience in veterans study. J Psychiatr Res 2023; 163:386-390. [PMID: 37269773 PMCID: PMC10227439 DOI: 10.1016/j.jpsychires.2023.05.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
Research has demonstrated that the impact of the coronavirus 2019 (COVID-19) pandemic on the mental health of United States (U.S.) veterans was less negative than originally anticipated. However, U.S. veterans are susceptible to exacerbation of post-traumatic stress disorder (PTSD) symptomology in late life. The aims of this study were to examine the extent to which older U.S. veterans experienced an exacerbation of PTSD symptoms during the COVID-19 pandemic, and to identify pre- and peri-pandemic factors that conferred risk for symptom exacerbation. Participants were U.S. military veterans aged 60 and older who completed three waves of the 2019-2022 National Health and Resilience in Veterans Study (NHRVS) (n=1858). PTSD symptoms were measured at all waves using the PTSD Checklist for DSM-5, and a latent growth mixture model was conducted to compute latent slopes of change of PTSD symptoms over the 3-year period. 159 (8.3%) participants experienced a worsening of PTSD symptomology over the pandemic period. Factors related to PTSD exacerbation were incident trauma exposure between Waves 1 and 2, more medical conditions with onset prior to the pandemic, and peri-pandemic social restriction stress. Number of incident traumas moderated the relationship between both number of pre-pandemic medical conditions and pre-pandemic social connectedness, and exacerbated PTSD symptoms. These results suggest that the pandemic did not confer additional risk for PTSD exacerbation than would be expected over a 3-year period for older veterans. Those who experience incident trauma exposure should be monitored for symptom exacerbation.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
| | - Joan M Cook
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Ian Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care. Med J Aust 2023. [PMID: 37270204 DOI: 10.5694/mja2.51995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Samantha M Loi
- University of Melbourne, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
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Huo Y, Couzner L, Windsor T, Laver K, Dissanayaka NN, Cations M. Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review. Implement Sci Commun 2023; 4:49. [PMID: 37147695 PMCID: PMC10161455 DOI: 10.1186/s43058-023-00428-0] [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: 10/24/2022] [Accepted: 04/05/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Healthcare services can be re-traumatising for trauma survivors where they trigger memories of past distressing events and exert limits to a survivor's sense of autonomy, choice, and control. The benefits of receiving trauma-informed healthcare are well established; however, factors that promote or impede the implementation of trauma-informed care are not yet well characterised and understood. The aim of this review was to systematically identify and synthesise evidence regarding factors that promote or reduce the implementation of TIC in healthcare settings. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2.0 guidelines. Scopus, MEDLINE, Proquest, PsycINFO and grey literature were searched for original research or evaluations published between January 2000 and April 2021 reporting barriers and/or facilitating factors for the implementation of trauma-informed care in a healthcare setting. Two reviewers independently assessed the quality of each included study using the Mixed Methods Appraisal Tool (MMAT) Checklist. RESULTS Twenty-seven studies were included, 22 of which were published in the USA. Implementation occurred in a range of health settings, predominantly mental health services. The barriers and facilitators of implementing trauma-informed care were categorised as follows: intervention characteristics (perceived relevance of trauma-informed care to the health setting and target population), influences external to the organisation (e.g. interagency collaboration or the actions of other agencies) and influences within the organisation in which implementation occurred (e.g. leadership engagement, financial and staffing resources and policy and procedure changes that promote flexibility in protocols). Other factors related to the implementation processes (e.g. flexible and accessible training, service user feedback and the collection and review of initiative outcomes) and finally the characteristics of individuals within the service or system such as a resistance to change. CONCLUSIONS This review identifies key factors that should be targeted to promote trauma-informed care implementation. Continued research will be helpful for characterising what trauma-informed care looks like when it is delivered well, and providing validated frameworks to promote organisational uptake for the benefit of trauma survivors. REGISTRATION The protocol for this review was registered on the PROSPERO database (CRD42021242891).
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Affiliation(s)
- Yan Huo
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Leah Couzner
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Tim Windsor
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Department of Neurology, Royal Brisbane and Woman's Hospital, Brisbane, QLD, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.
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12
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Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care: a narrative review. Med J Aust 2023; 218:182-189. [PMID: 36807325 PMCID: PMC10952480 DOI: 10.5694/mja2.51849] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
Young-onset dementia comprises a heterogeneous range of dementias, with onset at less than 65 years of age. These include primary dementias such as Alzheimer disease, frontotemporal and vascular dementias; genetic/familial dementias; metabolic disorders; and secondary dementias such as those that result from alcohol use disorder, traumatic brain injury, and infections. The presentation of young-onset dementia is varied and may include cognitive, psychiatric and neurological symptoms. Diagnostic delay is common, with a frequent diagnostic conundrum being, "Is this young-onset dementia or is this psychiatric?". For assessment and accurate diagnosis, a thorough screen is recommended, such as collateral history and investigations such as neuroimaging, lumbar puncture, neuropsychology, and genetic testing. The management of young-onset dementia needs to be age-appropriate and multidisciplinary, with timely access to services and consideration of the family (including children).
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Affiliation(s)
- Samantha M Loi
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
| | | | - Dennis Velakoulis
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
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13
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Bartholomaeus JD, Collier LR, Lang C, Cations M, Kellie AR, Inacio MC, Caughey GE. Trends in mental health service utilisation by Australia's older population. Australas J Ageing 2023; 42:159-164. [PMID: 35912507 PMCID: PMC10947389 DOI: 10.1111/ajag.13118] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the incidence, trends, and differences between age groups and sex in Medicare Benefits Schedule (MBS)-subsidised mental health service utilisation by older Australians over the past 10 years. METHODS A cross-sectional cohort study between 1 July 2009 and 30 June 2019 was conducted using publicly available MBS data for older individuals aged ≥65 years. Age- and sex-standardised yearly incidence rates of psychological therapy (MBS M06), GP mental health treatments (MBS A20), focussed psychological strategy (MBS M07), and psychiatric attendances (MBS A08) and incidence rate ratios (IRR) estimated using Poisson regression were calculated. RESULTS Overall, the rate of utilisation of primary care mental health services by the older population increased over the study period, with psychological therapy claims increasing the greatest from 14.4/1000 older persons in 2009/10 to 38.5/1000 in 2018/19 (IRR 1.11, 95% CI 1.09-1.13), followed by GP mental health treatments increasing from 43.7/1000 (95% CI 43.4-43.9) in 2009/10 to 81.0/1000 (95% CI 80.7-81.3) in 2018/19 (IRR 1.07/year, 95% CI 1.06-1.09). Females aged 65-74 years had the highest use of GP mental health treatments at 123.8/1000 compared to 63.6/1000 in males in 2018/2019. CONCLUSIONS While utilisation of mental health services by the older population in Australia has increased over the study period, it is important that policymakers and service providers continue to support access and use of these services, which may facilitate well-being and quality of life in the older population.
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Affiliation(s)
- Jonathan D. Bartholomaeus
- The Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- School of PsychologyUniversity of AdelaideSouth AustraliaAustralia
| | - Luke R. Collier
- The Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Catherine Lang
- The Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityBedford ParkSouth AustraliaAustralia
| | | | - Maria C. Inacio
- The Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Gillian E. Caughey
- The Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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14
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Cations M, Cook JM, Nichter B, Esterlis I, Pietrzak RH. Subjective cognitive difficulties and posttraumatic stress disorder interact to increase suicide risk among middle-aged and older US military veterans. Int Psychogeriatr 2023:1-9. [PMID: 36756753 DOI: 10.1017/s1041610222001053] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To examine the role of subjective cognitive difficulties (SCD), posttraumatic stress disorder (PTSD), and their interaction in predicting suicidal ideation and current suicidal intent in middle-aged and older United States (US) military veterans. DESIGN Population-based cross-sectional study. SETTING AND PARTICIPANTS Data were analyzed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3602 US veterans aged 50 years and older (mean age = 69.0). MEASUREMENTS Questionnaires including the Medical Outcomes Study Cognitive Functioning Scale (SCD), PTSD Checklist for DSM-5 (PTSD), Patient Health Questionnaire-9 (suicidal ideation in the previous two weeks), and the Suicide Behaviors Questionnaire-Revised (current suicidal intent). RESULTS A total of 154 (4.4%) veterans screened positive for current PTSD, 239 (6.7%) reported past two-week suicidal ideation, and 37 (1.0%) reported current suicidal intent. The probability of suicidal ideation among veterans with both SCD and PTSD was more than six times higher than that observed in the full sample (44.5% vs. 6.7%) and more than 2.5 times higher than that observed in veterans with SCD and no PTSD (44.5% vs. 17.5%). Veterans with both subjective memory and concentration difficulties were more likely to report suicidal intent, though the interaction between SCD and PTSD was not significantly associated with suicidal intent. CONCLUSION Middle-aged and older U.S. veterans with subjective cognitive impairment and PTSD report higher rates of suicidal ideation than those with SCD alone. Interventions targeting SCD and PTSD may mitigate suicide risk among middle-aged and older veterans.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Joan M Cook
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
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Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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16
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Cations M, Dwyer J. Response to "The Enduring Association of a First Pregnancy Abortion With Subsequent Pregnancy Outcomes: A Longitudinal Cohort Study". Health Serv Res Manag Epidemiol 2023; 10:23333928231171122. [PMID: 37181435 PMCID: PMC10170587 DOI: 10.1177/23333928231171122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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17
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Sluggett JK, Air T, Cations M, Caughey GE, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. Clinical Quality Indicators for Monitoring Hospitalizations Among Older People with Dementia Accessing Aged Care Services. J Alzheimers Dis 2023; 96:1747-1758. [PMID: 38007661 DOI: 10.3233/jad-230730] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer's disease and other forms of dementia. OBJECTIVE To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia accessing aged care services and determine 1) annual trends in CQI incidence between 2011-2012 and 2015-2016, 2) associated factors, and 3) geographic and facility variation in CQI incidence. METHODS This retrospective repeated cross-sectional study included non-Indigenous individuals aged 65-105 years who lived with dementia between July 2008-June 2016, were assessed for government-funded aged care services, and resided in New South Wales or Victoria (n = 180,675). Poisson or negative binomial regression models estimated trends in annual CQI incidence and associated factors. Funnel plots examined CQI variation. RESULTS Between 2011-2012 and 2015-2016, CQI incidence increased for falls (11.0% to 13.9%, adjusted incidence rate ratio (aIRR) 1.05 (95% CI 1.01-1.06)) and delirium (4.7% to 6.7%, aIRR 1.09 (95% CI 1.07-1.10)), decreased for unplanned hospitalizations (28.7% to 27.9%, aIRR 0.99 (95% CI 0.98-0.99)) and remained steady for fracture (6.2% to 6.5%, aIRR 1.01 (95% CI 0.99-1.01)) and pressure injuries (0.5% to 0.4%, aIRR 0.99 (95% CI 0.96-1.02)). Being male, older, having more comorbidities and living in a major city were associated with higher CQI incidence. Considerable geographical and facility variation was observed for unplanned hospitalizations and delirium CQIs. CONCLUSIONS The CQI results highlighted considerable morbidity. The CQIs tested should be considered for application in clinical quality registries to monitor dementia care quality.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Day S, Couzner L, Laver KE, Withall A, Draper B, Cations M. Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia. Health Soc Care Community 2022; 30:e6135-e6144. [PMID: 36177663 DOI: 10.1111/hsc.14051] [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: 03/09/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.
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Affiliation(s)
- Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
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Cations M, Wilton-Harding B, Laver KE, Brodaty H, Low LF, Collins N, Lie D, McKellar D, Macfarlane S, Draper B. Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review. Aust N Z J Psychiatry 2022; 57:811-833. [PMID: 36317325 DOI: 10.1177/00048674221134510] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. METHODS A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. RESULTS From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. CONCLUSIONS AND IMPLICATIONS The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Bethany Wilton-Harding
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Noel Collins
- Great Southern Mental Health Service, Albany, WA, Australia.,West Australian Country Health Service, Albany, WA, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - David Lie
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.,Office of the Chief Psychiatrist, SA Health, Adelaide, SA, Australia
| | - Steve Macfarlane
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Brian Draper
- Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
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de la Perrelle L, Klinge N, Windsor T, Low LF, Laver K, Cations M. Characterising trauma-informed aged care: An appreciative inquiry approach. Int J Geriatr Psychiatry 2022; 37. [PMID: 36017588 DOI: 10.1002/gps.5802] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE While Trauma-informed care (TIC) has the potential to improve the quality of aged and dementia care, the challenge remains in translating the principles of TIC into practice. This study aimed to characterise what trauma-informed aged care looks like in practice, by learning from an aged care service acknowledged as delivering trauma-informed aged care effectively. METHOD We conducted an appreciative inquiry study within a residential aged care service catering for veterans and others with trauma histories. Observation of care behaviours, interviews with staff and residents, and organisational policy mapping were used to identify elements that maximised care safety and accessibility for trauma survivors. Data were analysed and triangulated using a framework analysis approach. RESULTS The aged care provider embedded the principles of TIC into its staff training (i) to promote understanding of how trauma may affect experiences in care, and (ii) to adapt care when appropriate to promote safety. The service promoted a calm atmosphere where residents could make choices and felt safe. Uniforms and signage provided consistency, clarity, and transparency for residents. Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff. CONCLUSION Trauma-informed practice was facilitated through organisational policy, a dignified environment, and thoughtful staff behaviour creating safety, choice, and control for residents.
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Affiliation(s)
- Lenore de la Perrelle
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Nathan Klinge
- RSL Care SA, Myrtle Bank, South Australia, Australia
| | - Tim Windsor
- College of Education, Psychology and Social Work, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Chirico I, Giebel C, Lion K, Mackowiak M, Chattat R, Cations M, Gabbay M, Moyle W, Pappadà A, Rymaszewska J, Senczyszyn A, Szczesniak D, Tetlow H, Trypka E, Valente M, Ottoboni G. Use of technology by people with dementia and informal carers during COVID-19: A cross-country comparison. Int J Geriatr Psychiatry 2022; 37. [PMID: 36005276 DOI: 10.1002/gps.5801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Considering the adverse outcomes of COVID-19, it is essential to provide adequate support and care for people with dementia and informal carers. Technology can reduce the distress associated with social distancing rules and the decreased access to in-person services. This study aimed to explore the use of technology and its perceived effects across different settings and countries. METHODS The sample was composed of 127 informal carers and 15 people with dementia from the UK, Italy, Australia and Poland. Semi-structured interviews explored participants' experiences of using technology and their perceived effects. Transcripts were analysed by researchers in each country using an inductive approach. RESULTS Three overarching themes were developed: (1) Technology kept us alive during COVID-19; (2) Remote care was anything but easy; (3) Perceived technology limitations. Many similarities emerged between countries supporting the role of technology for being socially engaged, having a routine, and staying active. However, the benefits of technology for health and psychosocial care were more limited. Across countries, barriers to the access and use of technology included lack of digital literacy, dementia severity, and lack of appropriate digital environments. Help and supervision from carers were also necessary and sometimes perceived as an additional burden. CONCLUSIONS Technology can effectively reduce the shrinking world that may be amplified by the pandemic, thus preserving people with dementia's social skills and maintaining family connections. However, for more extensive and well-adapted use of technology in dementia care, actions should be taken to overcome the barriers to the access and use of technology by older and vulnerable people globally.
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Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | - Katarzyna Lion
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Maria Mackowiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | | | | | | | - Dorota Szczesniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Elzbieta Trypka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Marco Valente
- Department of Psychology, University of Bologna, Bologna, Italy
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22
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Lion KM, Moyle W, Cations M, Day S, Pu L, Murfield J, Gabbay M, Giebel C. How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study. J Fam Nurs 2022; 28:205-218. [PMID: 35674356 DOI: 10.1177/10748407221101638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore how formal social support changed after implementation of the COVID-19 public health measures and how these restrictions affected people living with dementia and their informal carers in Australia. Sixteen informal carers and two people living with dementia were interviewed between August and November 2020. Participants were asked about their experiences of the pandemic and the impact that the restrictions had on their lives and care. Thematic analysis identified four overarching themes describing (a) prepandemic limitations of the aged care system, (b) the aged care system's response to the COVID-19 restrictions, (c) changes affecting informal carers, and (d) the challenges faced by people living with dementia. The findings highlighted the challenges faced by the Australian aged care system before the pandemic and the additional burden placed on informal carers who supported people living with dementia across residential and home settings during the pandemic.
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Affiliation(s)
| | - Wendy Moyle
- Griffith University, Brisbane, Queensland, Australia
| | - Monica Cations
- Flinders University, Adelaide, South Australia, Australia
| | - Sally Day
- Flinders University, Adelaide, South Australia, Australia
| | - Lihui Pu
- Griffith University, Brisbane, Queensland, Australia
| | - Jenny Murfield
- Griffith University, Brisbane, Queensland, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Mark Gabbay
- University of Liverpool, Liverpool, UK
- National Institute of Health Research Applied Research Collaboration North West Coast, Liverpool, UK
| | - Clarissa Giebel
- University of Liverpool, Liverpool, UK
- National Institute of Health Research Applied Research Collaboration North West Coast, Liverpool, UK
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23
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Couzner L, Spence N, Fausto K, Huo Y, Vale L, Elkins S, Saltis J, Cations M. Delivering Trauma-Informed Care in a Hospital Ward for Older Adults With Dementia: An Illustrative Case Series. Front Rehabilit Sci 2022; 3:934099. [PMID: 36188945 PMCID: PMC9397751 DOI: 10.3389/fresc.2022.934099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
IntroductionUp to 70% of older adults have experienced a psychologically traumatic event in their life. Traumatic events can have lifelong effects on functioning and emotion regulation and can affect behavior and experiences in care settings. Common healthcare practices and environments can be re-traumatizing for trauma survivors. These features may trigger behavior change (e.g., aggression and agitation) particularly after the onset of dementia. However, very little research exists to understand how the effects of traumatic events manifest in aged care settings. Trauma-informed care is a framework in which the potential impact of trauma is acknowledged, and practices and procedures are adapted to maximize feelings of control and safety for the patient. Trauma-informed care is an innovative approach with little published evidence in acute geriatric settings.MethodsWe present a series of cases to demonstrate how psychological trauma can affect the experience of inpatient care for older people. The cases detail the patients' relevant background, triggers and behaviors followed by the steps taken by staff to support the patient and respond to their trauma-related needs. These cases describe how the principles of trauma-informed care can be applied to recognize when past psychologically traumatic events are impacting the older adult in hospital. The outcomes of these interventions are reported on in terms of their impact on challenging behavior, patient experiences and satisfaction with care, and/or staff confidence and skill.FindingsA range of past events negatively impacted the patients during their time in hospital, including childhood abuse, military service, and domestic violence. Staff implemented strategies to accommodate trauma-related needs while providing care that improved safety and reduced patient distress. Principles of trauma-informed care were applied where able, including providing choices and enabling autonomy. However, organizational and environmental features of inpatient wards continued to pose risks for re-traumatisation.ConclusionsTrauma-informed care is an under-utilized yet potentially beneficial approach to care for older adults in the hospital setting. The cases detailed here demonstrated that the impact of psychological trauma requires an individualized response from staff which when effectively implemented can promote staff and patient safety, reduce the risk of re-traumatisation, and minimize adverse events.
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Affiliation(s)
- Leah Couzner
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Natalie Spence
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Karina Fausto
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Yan Huo
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Lynn Vale
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Samantha Elkins
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Johanna Saltis
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
- *Correspondence: Monica Cations
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Rahja M, Air T, Ahern S, Ward SA, Caughey GE, Sluggett JK, Cations M, Lin X, Wallis K, Crotty M, Inacio M. Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation. J Alzheimers Dis 2022; 88:1511-1522. [DOI: 10.3233/jad-220336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Methods: Retrospective cohort study (2011–2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and PRAC facility variation. Results: CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02–1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10–1.14). GP mental health treatment plans increased from 1.30 to 2.1/1000 person-days (aIRR = 1.13, 95% CI 1.12–1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03–1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and facility variation was observed (0–92%). Conclusion: Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.
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Affiliation(s)
- Miia Rahja
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Stephanie A. Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Gillian E. Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Janet K. Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, Australia
| | - Xiaoping Lin
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Kasey Wallis
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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25
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Cations M, Collier LR, Caughey G, Bartholomaeus J, Lang C, Crotty M, Harvey G, Wesselingh S, Corlis M, Inacio MC. Government-subsidised mental health services are underused in Australian residential aged care facilities. AUST HEALTH REV 2022; 46:432-441. [PMID: 35772928 DOI: 10.1071/ah22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities.MethodsA retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services.ResultsThe use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services.ConclusionsLess than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Luke R Collier
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jonathan Bartholomaeus
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Steven Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Megan Corlis
- Aged Care and Research, Australian Nursing and Midwifery Foundation, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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26
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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. J Interpers 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] [What about the content of this article? (0)] [Affiliation(s)] [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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27
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Abstract
OBJECTIVE Post-diagnosis service delivery for young-onset dementia (with onset prior to 65 years) recently moved to the disability system in an attempt to address systemic barriers to best practice in aged care. The objective of this study was to examine experiences and satisfaction with disability services so far among people with young-onset dementia and their care partners and identify strategies for service and system improvement. METHODS The 151 participating Australians living with young-onset dementia or providing informal care to a person with young-onset dementia were recruited via social media, advocacy bodies and specialist medical clinics. A cross-sectional online survey asked participants to provide a timeline of their interactions with the disability system so far and rate their satisfaction with the disability system, aged care and disability services. RESULTS Participants reported a mean age at symptom onset of 55 years. In all, 53% were diagnosed with Alzheimer's disease and 25% were diagnosed with frontotemporal dementia. Sixty percent had received an approved plan from the National Disability Insurance Scheme, although 3% were rejected. More than 27% waited longer than 6 months to receive their plan, and half waited at least a month post-approval to access services. Less than 30% agreed that the National Disability Insurance Scheme understands dementia, and fewer than half felt that the process of accessing National Disability Insurance Scheme funding is easy and fast enough. Nonetheless, respondents remained overwhelmingly in favour of young-onset dementia services remaining in the disability system rather than in aged care. CONCLUSIONS While people with young-onset dementia and their care partners strongly agree with their inclusion in the National Disability Insurance Scheme, a relatively low level of experience with dementia in the disability workforce and a lack of integration with the healthcare and aged care systems continue to create important barriers for accessing the services they need.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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28
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Giebel C, Lion K, Mackowiak M, Chattat R, Kumar PNS, Cations M, Gabbay M, Moyle W, Ottoboni G, Rymaszewska J, Senczyszyn A, Szczesniak D, Tetlow H, Trypka E, Valente M, Chirico I. A qualitative 5-country comparison of the perceived impacts of COVID-19 on people living with dementia and unpaid carers. BMC Geriatr 2022; 22:116. [PMID: 35148712 PMCID: PMC8840054 DOI: 10.1186/s12877-022-02821-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/24/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. Methods Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. Results Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. Conclusions The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02821-1.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK. .,NIHR ARC NWC, Liverpool, UK.
| | - Katarzyna Lion
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Maria Mackowiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | | | | | - Dorota Szczesniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Elzbieta Trypka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Marco Valente
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Ilaria Chirico
- Department of Psychology, University of Bologna, Bologna, Italy
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Couzner L, Day S, Draper B, Withall A, Laver KE, Eccleston C, Elliott KE, McInerney F, Cations M. What do health professionals need to know about young onset dementia? An international Delphi consensus study. BMC Health Serv Res 2022; 22:14. [PMID: 34974838 PMCID: PMC8722147 DOI: 10.1186/s12913-021-07411-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/21/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background People with young onset dementia (YOD) have unique needs and experiences, requiring care and support that is timely, appropriate and accessible. This relies on health professionals possessing sufficient knowledge about YOD. This study aims to establish a consensus among YOD experts about the information that is essential for health professionals to know about YOD. Methods An international Delphi study was conducted using an online survey platform with a panel of experts (n = 19) on YOD. In round 1 the panel individually responded to open-ended questions about key facts that are essential for health professionals to understand about YOD. In rounds 2 and 3, the panel individually rated the collated responses in terms of their importance in addition to selected items from the Dementia Knowledge Assessment Scale. The consensus level reached for each statement was calculated using the median, interquartile range and percentage of panel members who rated the statement at the highest level of importance. Results The panel of experts were mostly current or retired clinicians (57%, n = 16). Their roles included neurologist, psychiatrist and neuropsychiatrist, psychologist, neuropsychologist and geropsychologist, physician, social worker and nurse practitioner. The remaining respondents had backgrounds in academia, advocacy, or other areas such as law, administration, homecare or were unemployed. The panel reached a high to very high consensus on 42 (72%) statements that they considered to be important for health professionals to know when providing care and services to people with YOD and their support persons. Importantly the panel agreed that health professionals should be aware that people with YOD require age-appropriate care programs and accommodation options that take a whole-family approach. In terms of identifying YOD, the panel agreed that it was important for health professionals to know that YOD is aetiologically diverse, distinct from a mental illness, and has a combination of genetic and non-genetic contributing factors. The panel highlighted the importance of health professionals understanding the need for specialised, multidisciplinary services both in terms of diagnosing YOD and in providing ongoing support. The panel also agreed that health professionals be aware of the importance of psychosocial support and non-pharmacological interventions to manage neuropsychiatric symptoms. Conclusions The expert panel identified information that they deem essential for health professionals to know about YOD. There was agreement across all thematic categories, indicating the importance of broad professional knowledge related to YOD identification, diagnosis, treatment, and ongoing care. The findings of this study are not only applicable to the delivery of support and care services for people with YOD and their support persons, but also to inform the design of educational resources for health professionals who are not experts in YOD.
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Affiliation(s)
- Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
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30
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Day S, Roberts S, Launder NH, Goh AMY, Draper B, Bahar-Fuchs A, Loi SM, Laver K, Withall A, Cations M. Age of Symptom Onset and Longitudinal Course of Sporadic Alzheimer's Disease, Frontotemporal Dementia, and Vascular Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 85:1819-1833. [PMID: 34958038 DOI: 10.3233/jad-215360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding how the age of dementia symptom onset affects the longitudinal course of dementia can assist with prognosis and care planning. OBJECTIVE To synthesize evidence regarding the relationship of age of symptom onset with the longitudinal course of sporadic Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). METHODS We searched Medline, CINAHL, Embase, PsycINFO, PubMed, and Scopus for longitudinal studies that examined the impact of sporadic AD, VaD, or FTD symptom onset age on measures of cognition, function, or behavioral symptoms. Studies that examined age at diagnosis only were excluded. Quantitative meta-analysis was conducted where studies reported sufficient data for pooling. RESULTS Thirty studies met all inclusion criteria (people with AD (n = 26), FTD (n = 4)) though no studies examined VaD. Earlier onset of AD was associated with more rapid annual cognitive decline (estimate = -0.07; 95% CI -0.14 to 0.00; p = 0.045). Most studies that stratified their sample reported that younger AD onset (usually < 65 years) was associated with more rapid cognitive decline. Other evidence was inconclusive. CONCLUSION Younger people with AD appear to have a poorer prognosis in terms of faster cognitive decline than older people with AD. More research is required to determine the impact of symptom onset age in VaD and FTD, and on functional decline in all dementias.
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Affiliation(s)
- Sally Day
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Stefanie Roberts
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Nathalie H Launder
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Anita M Y Goh
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, New South Wales, Australia
| | - Alex Bahar-Fuchs
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville VIC, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, New South Wales, Australia.,Ageing Futures Institute, UNSW Sydney, New South Wales, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
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Windsor TD, Abbott MJ, Cations M, Howard AJ, Wilton-Harding B. Subjective perceptions of age-related gains buffer negative associations of perceived age-related losses with health, well-being, and engagement. International Journal of Behavioral Development 2021. [DOI: 10.1177/01650254211039025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People reflect on their own aging, and this subjective awareness has an influence on developmental outcomes. Scholars have recently operationalized subjective aging in terms of awareness of age-related change (AARC), which captures awareness of both gains and losses. We examined associations of AARC-gains and AARC-losses with physical functioning, subjective well-being, and engagement with life (enjoyable activities and sense of purpose). Importantly, we extended previous research by not only assessing main effects of gains and losses but also testing their interaction. We hypothesized that awareness of losses would be more weakly negatively associated with health and well-being among those who possessed higher awareness of gains. A total of 399 older participants aged 65 to 91 (235 women and 164 men) were recruited via Prime Panels crowd-sourcing platform to complete an online questionnaire. Greater AARC-losses was associated with poorer health, lower subjective well-being, and lower sense of purpose. AARC-gains was associated with better outcomes in general, and moderated associations of AARC-losses with physical functioning, subjective well-being, and sense of purpose (but not engagement in leisure activities). Consistent with predictions, moderation effects showed that negative associations of AARC-losses with the outcomes were weaker among those who reported higher AARC-gains. Results provided some support for a role of AARC-gains in buffering negative effects of AARC-losses on developmental outcomes.
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Cations M, Laver K, Couzner L, Flatman S, Bierer P, Ames C, Huo Y, Whitehead C. Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol. BMC Geriatr 2021; 21:492. [PMID: 34507553 PMCID: PMC8434725 DOI: 10.1186/s12877-021-02441-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/01/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
Background Geriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings. Methods Four wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy. Discussion Trauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, SA, Adelaide, Australia. .,South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Leah Couzner
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, SA, Adelaide, Australia
| | - Stephen Flatman
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Petra Bierer
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Catherine Ames
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Yan Huo
- College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, SA, Adelaide, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
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Cations M, Keage HAD, Laver KE, Byles J, Loxton D. Impact of Historical Intimate Partner Violence on Wellbeing and Risk for Elder Abuse in Older Women. Am J Geriatr Psychiatry 2021; 29:930-940. [PMID: 33431284 DOI: 10.1016/j.jagp.2020.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the psychological impacts and risk for elder abuse associated with historical intimate partner violence (IPV) in older women. DESIGN Prospective cohort study SETTING: All Australian states and territories. PARTICIPANTS A total of 12,259 women aged 70-75 years at baseline participating in the Australian Longitudinal Study of Women's Health. MEASUREMENTS Women were asked at baseline whether they had ever been in a violent relationship with a partner, and completed a comprehensive survey about their physical and psychological health every 3 years (15 years follow-up) including the Short Form-36 Mental Health subscale (SF-MH) and Vulnerability to Abuse Screening Scale (VASS). Linear mixed effects modelling with maximum likelihood estimation assessed the impact of IPV over time on the SF-MH and VASS. Risk for incident depression and experiencing physical or sexual violence over follow-up was examined using logistic regression models. RESULTS The 782 (6.4%) women who reported historical IPV recorded significantly poorer psychological wellbeing at all timepoints compared to those who did not report historical IPV, and were at higher risk for incident depression over follow up (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI]:1.11-1.67). There was no significant relationship between historical IPV and self-reported exposure to physical or sexual violence in late life (aOR = 0.87, 95%CI: 0.53-1.43), but women who reported historical IPV recorded higher rates of vulnerability to abuse on the VASS. DISCUSSION Women who have experienced a violent relationship continue to experience negative effects into older age, highlighting the importance of clinical monitoring and ongoing support for survivors as they age.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology (MC), Flinders University, South Australia, Australia; Justice and Society (MC, HADK), The University of South Australia, South Australia, Australia.
| | - Hannah A D Keage
- Justice and Society (MC, HADK), The University of South Australia, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health (KEL), Flinders University, South Australia, Australia
| | - Julie Byles
- Faculty of Health and Medicine (JB), The University of Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine (JB), The University of Newcastle, New South Wales, Australia
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Cations M, Loi SM, Draper B, Swaffer K, Velakoulis D, Goh AM. A call to action for the improved identification, diagnosis, treatment and care of people with young onset dementia. Aust N Z J Psychiatry 2021; 55:837-840. [PMID: 34382425 DOI: 10.1177/00048674211037542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian Draper
- Faculty of Medicine School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Kate Swaffer
- Faculty of Science, Medicine, and Health School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Anita My Goh
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,National Ageing Research Institute, Melbourne, VIC, Australia
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Jorissen RN, Inacio MC, Cations M, Lang C, Caughey GE, Crotty M. Effect of Dementia on Outcomes After Surgically Treated Hip Fracture in Older Adults. J Arthroplasty 2021; 36:3181-3186.e4. [PMID: 34059366 DOI: 10.1016/j.arth.2021.04.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip fractures are associated with increased mortality and functional limitations. However, the effect that dementia has on these outcomes in individuals in aged care settings after fracture is not well established. This study examined the association of dementia with post-hip fracture mortality, permanent residential aged care entry, transition care use, and change in activities of daily living (ADL) needs. METHODS A retrospective cohort study using data from the Registry of Senior Australians (2003-2015) was conducted. Individuals with a hip fracture while receiving aged care services were included. Associations of dementia with mortality, risks of transition and permanent care use, and ADL needs progression were estimated using multivariable Cox, Fine-Gray, and logistic regression methods, respectively. RESULTS Of 4771 individuals evaluated, 76% were women, the median age was 86 years (IQR 82-90), and 71% already lived in permanent residential aged care at the time of fracture. Within two years of their hip fracture, 50.4% (95% CI 48.9%-51.8%) of individuals died, 16.2% (95% CI 14.2%-18.2%) entered a transition care program, 59.1% (95% CI 56.5%-61.7%) entered permanent residential aged care, and 32% had greater ADL needs. Dementia was associated with higher risk of two-year mortality (HR = 1.19, 95% CI 1.09-1.30), 90-day entry into permanent care (sHR = 1.96, 95% CI 1.60-2.38), and increased likelihood of ADL limitations (OR = 1.36, 95% CI 1.00-1.85). Minor differences were seen in transition care use by dementia status. CONCLUSION Dementia is a strong risk factor for mortality after hip fractures in individuals in aged care settings and associated with a high risk of entry into permanent care. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Flinders Medical Centre, Australia
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Clemson L, Laver K, Rahja M, Culph J, Scanlan JN, Day S, Comans T, Jeon YH, Low LF, Crotty M, Kurrle S, Cations M, Piersol CV, Gitlin LN. Implementing a Reablement Intervention, "Care of People With Dementia in Their Environments (COPE)": A Hybrid Implementation-Effectiveness Study. Gerontologist 2021. [PMID: 32803248 DOI: 10.1093/geront/gnaa105/5893197] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services. RESEARCH DESIGN AND METHODS An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre-post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation. RESULTS Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre-post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002). DISCUSSION AND IMPLICATIONS This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families.
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Affiliation(s)
- Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia.,Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Culph
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Justin N Scanlan
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Sally Day
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sue Kurrle
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cathy V Piersol
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
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Jogie P, Rahja M, van den Berg M, Cations M, Brown S, Laver K. Goal setting for people with mild cognitive impairment or dementia in rehabilitation: A scoping review. Aust Occup Ther J 2021; 68:563-592. [PMID: 34346077 DOI: 10.1111/1440-1630.12758] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes. METHODS Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively. RESULTS Twenty-seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial. CONCLUSION Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia.
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Affiliation(s)
- Praneeta Jogie
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Kingston Centre, Monash Health, Melbourne, Victoria, Australia
| | - Miia Rahja
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Maayken van den Berg
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Sarah Brown
- Department of Occupational Therapy, Monash Health, Melbourne, Victoria, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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de la Perrelle L, Cations M, Barbery G, Radisic G, Kaambwa B, Crotty M, Fitzgerald JA, Kurrle S, Cameron I, Whitehead C, Thompson J, Laver K. How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation. BMJ Open Qual 2021; 10:bmjoq-2020-001147. [PMID: 33990392 PMCID: PMC8127967 DOI: 10.1136/bmjoq-2020-001147] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246.
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Affiliation(s)
- Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Gaery Barbery
- Health Services Management School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Janna Anneke Fitzgerald
- Business Strategy and Innovation, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Susan Kurrle
- Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Jane Thompson
- NNIDR Consumer Involvement Reference Group, NHMRC CDPC, Hornsby, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
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Browne-Yung K, O'Neil D, Walker R, Corlis M, Smyth A, Putsey P, Laver KE, Fernandez E, Cations M. Perspectives of professionals on the safety and accessibility of aged care for Care Leavers and Forgotten Australians. Australas J Ageing 2021; 41:42-49. [PMID: 33960580 DOI: 10.1111/ajag.12948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/08/2020] [Revised: 10/29/2020] [Accepted: 02/24/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Little is known about how prepared the aged care system is to meet the specific needs of Care Leavers and Forgotten Australians. We explored service provider and advocate perspectives about the barriers and facilitators for appropriate and safe care for this group. METHODS Three focus groups with sixteen professional stakeholders examined the ways aged care support is accessible and inaccessible for Forgotten Australians. RESULTS Participants noted structural and organisational features that act as barriers to best practice aged care. It was perceived that funding models and processes provide insufficient opportunity to develop trust with professionals and access tailored care. Once engaged with aged care services, the sector lacks the psychological literacy required to tailor care to manage the complex needs and preferences of Forgotten Australians. CONCLUSION Systemic and organisational change that promotes increased flexibility, trauma-informed care and non-residential housing options will improve the safety and accessibility of aged care for Forgotten Australians.
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Affiliation(s)
- Kathryn Browne-Yung
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Diana O'Neil
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Helping Hand Aged Care, North Adelaide, SA, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, SA, Australia
| | | | | | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Browne-Yung K, O'Neil D, Walker R, Smyth A, Putsey P, Corlis M, Laver KE, Fernandez E, Cations M. 'I'd rather die in the middle of a street': Perceptions and expectations of aged care among Forgotten Australians. Australas J Ageing 2020; 40:168-176. [PMID: 33336557 DOI: 10.1111/ajag.12851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/04/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To explore perceptions and expectations regarding aged care among older Forgotten Australians, informing better ways of delivering safe and inclusive care for this group. METHODS In-depth interviews were undertaken with sixteen Forgotten Australians to understand their perspectives, hopes and perceived barriers to receiving appropriate aged care. Qualitative data were analysed using Ritchie and Spencer's framework approach. RESULTS Participants were highly averse to receiving aged care in residential settings, particularly where delivered by religious organisations. Limited perceived opportunities to develop trust and maintain control and independence while managing re-traumatising situations shaped Forgotten Australians negative perceptions of the aged care system. Participants also spoke of how their lifelong marginalisation could limit their access to choice and quality in aged care. CONCLUSION The aged care industry could provide safe and inclusive care by adopting a person-centred and trauma-informed model that recognises and addresses the specific needs and challenges of Forgotten Australians.
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Affiliation(s)
- Kathryn Browne-Yung
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Diana O'Neil
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Helping Hand Aged Care, North Adelaide, SA, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | | | | | - Megan Corlis
- Helping Hand Aged Care, North Adelaide, SA, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Laver KE, Crotty M, Low LF, Clemson L, Whitehead C, McLoughlin J, Swaffer K, Cations M. Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes. BMC Geriatr 2020; 20:531. [PMID: 33297973 PMCID: PMC7727118 DOI: 10.1186/s12877-020-01940-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/26/2020] [Accepted: 11/30/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND People with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families. METHODS Interviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs. RESULTS Interviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable. CONCLUSIONS People with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.
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Affiliation(s)
- Kate E Laver
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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44
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Laver K, Cations M, de la Perrelle L, Radisic G. Agents of change: Establishment of quality improvement collaboratives to improve the quality of dementia care in Australia. Alzheimers Dement 2020. [DOI: 10.1002/alz.044661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate Laver
- Flinders University Adelaide SA Australia
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45
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Giebel C, Cations M, Draper B, Komuravelli A. Ethnic disparities in the uptake of anti‐dementia medication in young and late onset dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.036176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Clarissa Giebel
- University of Liverpool Liverpool United Kingdom
- NIHR ARC NWC Liverpool United Kingdom
| | - Monica Cations
- South Australian Health and Medical Research Institute Adelaide Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney Australia
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46
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Cations M, Lang C, Crotty M, Wesselingh S, Whitehead C, Inacio MC. Factors associated with success in transition care services among older people in Australia. BMC Geriatr 2020; 20:496. [PMID: 33228558 PMCID: PMC7686713 DOI: 10.1186/s12877-020-01914-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/16/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Australian Transition Care Program (TCP) is a national intermediate care service aiming to optimise functional independence and delay entry to permanent care for older people leaving hospital. The aim of this study was to describe the outcomes of TCP and identify demographic and clinical factors associated with TCP 'success', to assist with clinical judgements about suitable candidates for the program. METHOD We conducted a descriptive cohort study of all older Australians accessing TCP for the first time between 2007 and 2015. Logistic regression models assessed demographic and clinical factors associated with change in performance on a modified Barthel Index from TCP entry to discharge and on discharge to community. Fine-Gray regression models estimated factors associated with transition to permanent care within 6 months of TCP discharge, with death as a competing event. RESULTS Functional independence improved from entry to discharge for 46,712 (38.4%) of 124,301 TCP users. Improvement was more common with younger age, less frailty, shorter hospital stay prior to TCP, and among women, those without a carer, living outside a major city, and without dementia. People who received TCP in a residential setting were far less likely to record improved functional impairment and more likely to be discharged to permanent care than those in a community setting. Discharge to community was more common with younger age and among women and those without dementia. Nearly 12% of community TCP and 63% of residential TCP users had transitioned to permanent care 6 months after discharge. Entry to permanent care was more common with older age, higher levels of frailty, and among those with dementia. CONCLUSIONS More than half of TCP users are discharged to home and remain at home after 6 months. However, residential-based TCP may have limited efficacy. Age, frailty, carer status, and dementia are key factors to consider when assessing program suitability. Future studies comparing users to a suitably matched control group will be very helpful for confirming whether the TCP program is meeting its aims.
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Affiliation(s)
- Monica Cations
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia.
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Catherine Lang
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Steven Wesselingh
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Maria C Inacio
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA, 5001, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Cations M, May N, Crotty M, Low LF, Clemson L, Whitehead C, McLoughlin J, Swaffer K, Laver KE. Health Professional Perspectives on Rehabilitation for People With Dementia. Gerontologist 2020; 60:503-512. [PMID: 30759218 DOI: 10.1093/geront/gnz007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia. RESEARCH DESIGN AND METHODS Sixteen health professionals from a variety of settings and professional backgrounds were purposively sampled using maximum variation sampling. Semi-structured interviews were conducted to explore attitudes toward the care of people with dementia and beliefs about the feasibility and value of multidisciplinary rehabilitation in this population. Thematic analysis was used to identify themes. RESULTS Participating clinicians acknowledged problems with existing dementia care pathways in Australia but rarely conceptualized rehabilitation as relevant to this pathway. Analyses yielded two main and related themes: (i) difficulty defining worthwhile outcomes of a rehabilitation program for people with dementia and (ii) perceived barriers to participation in this population. Clinicians felt that achievable outcomes for people with dementia were not sufficiently worthwhile for investment. DISCUSSION AND IMPLICATIONS Broader acceptance of multidisciplinary rehabilitation as relevant to dementia care will require a reframing of practice that both educates emerging health professionals regarding the outcomes that may be achievable for people with dementia and persuades staff to appreciate that the investment is worthwhile.
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Natalie May
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, New South Wales
| | - Lindy Clemson
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales.,Faculty of Health Sciences, The University of Sydney, New South Wales.,ARC Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Kate Swaffer
- University of Wollongong, New South Wales, Australia.,Dementia Alliance International, Ankeny, Iowa
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, South Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, New South Wales
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48
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Laver K, Cations M, Radisic G, de la Perrelle L, Woodman R, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, Crotty M. Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study. Implement Sci Commun 2020; 1:80. [PMID: 32984846 PMCID: PMC7513321 DOI: 10.1186/s43058-020-00073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations. METHODS Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence. RESULTS A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08-1.87; p = 0.012). CONCLUSION Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting. TRIAL REGISTRATION ACTRN12618000268246.
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Affiliation(s)
- Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Janna Anneke Fitzgerald
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D. Cameron
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Jane Thompson
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Hayes
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
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49
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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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50
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Clemson L, Laver K, Rahja M, Culph J, Scanlan JN, Day S, Comans T, Jeon YH, Low LF, Crotty M, Kurrle S, Cations M, Piersol CV, Gitlin LN. Implementing a Reablement Intervention, “Care of People With Dementia in Their Environments (COPE)”: A Hybrid Implementation-Effectiveness Study. The Gerontologist 2020; 61:965-976. [DOI: 10.1093/geront/gnaa105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background and Objectives
The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services.
Research Design and Methods
An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre–post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation.
Results
Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre–post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002).
Discussion and Implications
This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families.
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Affiliation(s)
- Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
- Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Culph
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Justin N Scanlan
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Sally Day
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sue Kurrle
- Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cathy V Piersol
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
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