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18 results

Care of the Person with Dementia
  • Interprofessional Practice and Education
  • Dawn Forman, Dimity Pond
  • Published online:
    06 August 2018
    Print publication:
    15 September 2015
  • Care of the Person with Dementia responds to the urgent need for health practitioners to take an innovative approach to the challenge of dementia. The first Australian text of its kind, it combines evidence-based resources with interprofessional education and practice, exploring the ethical, social and environmental repercussions of dementia to provide a comprehensive overview of dementia care in an Australian context. The text is structured around a model of interprofessional education and practice (IPE) tailored to dementia care. This model incorporates the context of care, an important element missing from other recognised models of IPE. Throughout the book, principles of IPE are explained within the context of dementia, drawing on exemplars from a body of current, well-researched and evaluated dementia practice. Written by experienced academics, and providing national and international perspectives, this is a unique and crucial resource to develop collaborative skills and professional knowledge in the management of dementia.

  • Quality assessment of systematic reviews of vitamin D, cognition and dementia

  • Fariba Aghajafari, Dimity Pond, Nigel Catzikiris, Ian Cameron
  • Journal:
    BJPsych Open / Volume 4 / Issue 4 / July 2018
    Published online by Cambridge University Press:
    09 July 2018, pp. 238-249
    • Article
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  • Background

    There is conflicting evidence regarding the association of vitamin D with cognition performance and dementia.

    Aims

    We aimed to summarise the evidence on the association of vitamin D with cognitive performance, dementia and Alzheimer disease through a qualitative assessment of available systematic reviews and meta-analyses.

    Method

    We conducted an overview of the systematic reviews of all study types with or without meta-analyses on vitamin D and either Alzheimer disease, dementia or cognitive performance up to June 2017.

    Results

    Eleven systematic reviews were identified, nine of which were meta-analyses with substantial heterogeneity, differing statistical methods, variable methodological quality and quality of data abstraction. A Measurement Tool to Assess Systematic Reviews checklist scores ranged from 4 to 10 out of 11, with seven reviews of ‘moderate’ and four of ‘high’ methodological quality. Out of six meta-analyses on the association between low serum concentration of 25-hydroxyvitamin D and risk of dementia, five showed a positive association. Results of meta-analyses on the association between low serum concentration of 25-hydroxyvitamin D and memory function tests showed conflicting results.

    Conclusions

    This systematic evaluation of available systematic reviews provided a clearer understanding of the potential link between low serum vitamin D concentrations and dementia. This evaluation also showed that the quality of the available evidence is not optimal because of both the low methodological quality of the reviews and low quality of the original studies. Interpretation of these systematic reviews should therefore be made with care.

    Declaration of interest

    None.

  • The role of primary care in identification and ongoing management of dementia: a time of transition

  • Constance Dimity Pond
  • Journal:
    International Psychogeriatrics / Volume 29 / Issue 9 / September 2017
    Published online by Cambridge University Press:
    13 July 2017, pp. 1409-1411

  • In this edition of International Psychogeriatrics, Pertrazzuoli et al. (2017) address attitudes to dementia by primary care physicians (PCPs) across a range of European countries. The article focusses on diagnosis, screening instruments and drug treatment, and finds a wide range of approaches to the PCPs’ role in referral for diagnosis and medication prescription. The findings include that PCPs who are allowed to prescribe dementia drugs, engage in higher levels of diagnostic work up, despite all the barriers to identification ably summarized in the paper. Perhaps, this heterogeneity is not random: it may be that roles and responsibilities for PCPs in relation to dementia are in transition.

  • A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study

  • Tim Luckett, Lynnette Chenoweth, Jane Phillips, Deborah Brooks, Janet Cook, Geoffrey Mitchell, Dimity Pond, Patricia M. Davidson, Elizabeth Beattie, Georgina Luscombe, Stephen Goodall, Thomas Fischer, Meera Agar
  • Journal:
    International Psychogeriatrics / Volume 29 / Issue 10 / October 2017
    Published online by Cambridge University Press:
    27 June 2017, pp. 1713-1722
  • Background:

    Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.

    Method:

    Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.

    Results:

    Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.

    Conclusion:

    The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.

  • 5 - Leadership in interprofessional dementia care

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 81-92

  • Summary

    Learning outcomes

  • Outline why interprofessional leadership is required.

  • Describe the leadership skills required to facilitate interprofessional practice.

  • Discuss the development of interprofessional leadership within the interprofessional practice context.

    • Key terms

  • capabilities

  • dementia

  • leadership

    • Leadership

    Some are born to leadership; some achieve leadership; others have leadership thrust upon them.

    Marie’s letter to Malvolio in Shakespeare’s Twelfth Night

    Introduction

    Historically health service provision has worked on a hierarchical system of leadership in which the doctor has been seen to be the lead both legally and ultimately in practice for any decisions about a patient’s care. However, practice is starting to change. In 2000, in Canada, the legislation changed to ensure that any health professional could be nominated as leader and is then legally responsible for the care of the individual.

    Why has this move away from doctors always being legally responsible happened? In many situations the doctor is not always present or reachable, for example, in remote, rural locations and some community settings. As Australia has an increasingly ageing population, there are not enough doctors and other health care professionals to service their needs. This has led to the realisation that new health care models and ways of working need to be developed.

  • Introduction to dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 1-10

  • Summary

    Learning outcomes

  • Describe what dementia is in broad descriptive medical terms.

  • Describe the impact of dementia on the Australian population in terms of disability burden.

  • Identify some of the key challenges for individuals and their families and carers throughout the course of the disease.

  • Reflect on the impact of culture and membership of different special needs groups on the experience of dementia.

  • Outline how interprofessional ways of working are needed in the care of people with dementia.

    • Key terms

  • aged care services

  • autonomy

  • communication

  • culture

  • dementia

  • interprofessional

  • neurocognitive disorder (NCD)

  • respect

    • Introduction

    Dementia is a life limiting condition. The needs of people living with dementia are at the forefront of the minds of people concerned with receiving, resourcing, managing, providing and evaluating services for older people. In particular, there is an urgent need for health care teams and service providers to respond in innovative ways (Productivity Commission, 2011) to address the ‘mismatch of professional competencies to patient and population priorities’ and the chronic shortfall in health workforces (Frenk et al., 2010 ; Health Workforce Australia, 2012).

    As people live longer, the shape of society has changed and is continuing to change; creating both benefits and challenges that humanity has not met before. One of these challenges is the increased prevalence of dementia (Productivity Commission, 2011). Dementia embodies our greatest fears: a living death; cognitive decline; lost abilities; increasing dependence; loss of the person as others know them. While acknowledging that a person with dementia and their families require complex care and support over an extended period of years, perhaps there are lessons to be learned by society about what it means to be human and the real priorities of living and dying.

  • Conclusion

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 171-182

  • Summary

    Learning outcomes

  • Discuss ways in which the interprofessional approach might assist individuals with dementia and carers at each stage of the dementia journey.

  • Discuss ways in which individuals with dementia and their carers can contribute to the work of the team at each stage of the journey.

  • Consider how a big team, consisting of a range of professionals with various roles, might work together, particularly in the middle stages where the person living with dementia is requiring maximum support in the home.

  • Discuss the issues relating to leadership in team care and how the team might resolve these issues in different clinical settings.

    • Key terms

  • dementia

  • evidence-based practice (EBP)

  • leadership

    • Introduction

    Many of the key messages from this book are about how health professionals should work together in the care of people living with dementia. To summarise some of the key points, we will follow Mary as she travels along a dementia journey, and explore some of the many ways in which professionals can work together to help her on that journey.

    Early signs of dementia

    Mary, aged 76, lives alone. Her husband died shortly after he retired some 10 years ago and the couple had no children. Mary used to work in an office, but has lost touch with most of her former workmates now. Her one companion is a much loved dog named Freddie, although there is also a niece who visits from time to time. She has been a patient of her GP for over 10 years. She books a regular monthly appointment for a blood pressure check, repeats of her eight medications when necessary and a bit of a chat. She has quite stable diabetes, for which she is taking oral medication, and every three months she has this reviewed under a chronic disease management plan. She has never brought along her niece to these appointments.

  • 2 - The journey of dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 37-48

  • Summary

    Learning outcomes

  • Discuss the course of the disease from health to illness to death.

  • Discuss the importance of acknowledging the social, emotional and spiritual aspects of a person living with dementia.

  • Discuss the significance of the person’s life lived before the onset of dementia.

  • Consider the impact of the journey of dementia on family and friends.

    • Key terms

  • Alzheimer’s disease

  • dementia

  • neurocognitive disorder (NCD)

  • personality

    • Introduction

    The journey of dementia can be described as follows:

  • something is not right;

  • diagnosis;

  • course;

  • transitions;

  • end of life;

  • life stories;

  • the family experience.

    • Mace and Rabins (1981) made four connected statements about dementia:

  • there is damage to the brain;

  • the person is still there;

  • the family is also affected;

  • there are things we can do.

    • This chapter will expand on the first three statements and allude to the last.

    As health or care professionals, we should always remember that people have lived 60 or 70 years before the onset of dementia – it does not define them. Each of us comes in and out of people’s lives in just this small portion. Really we might be a bit important but in the totality we are just a small-bit player.

  • Predictors of agreement between general practitioner detection of dementia and the revised Cambridge Cognitive Assessment (CAMCOG-R)

  • C. Dimity Pond, Karen E. Mate, Jill Phillips, Nigel P. Stocks, Parker J. Magin, Natasha Weaver, Henry Brodaty
  • Journal:
    International Psychogeriatrics / Volume 25 / Issue 10 / October 2013
    Published online by Cambridge University Press:
    26 June 2013, pp. 1639-1647
  • Background:

    Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia.

    Methods:

    This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively.

    Results:

    GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p < 0.001) score, female gender (p = 0.005), and larger practice size (p < 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p < 0.001) were more likely to result in a false-positive diagnosis of dementia.

    Conclusions:

    Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.

  • How to Help Depressed Older People Living in Residential Care: A Multifaceted Shared-Care Intervention for Late-Life Depression

  • Robert H. Llewellyn-Jones, Karen A. Baikie, Sally Castell, Carol L. Andrews, Anne Baikie, C. Dimity Pond, Simon M. Willcock, John Snowdon, Chris C. Tennant
  • Journal:
    International Psychogeriatrics / Volume 13 / Issue 4 / December 2001
    Published online by Cambridge University Press:
    10 January 2005, pp. 477-492

  • Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.