The ‘Anxiety and Depression in Dementia Research Network (ADDResearch)’ was formulated in collaboration with Dr Nadeeka Dissanayaka at the University of Queensland in 2020.

Aims of SiG and research network:

1. To foster research into improving quality of life for people living with dementia
2. To encourage research implementation
3. To encourage collaboration in research and implementation between people living with dementia, families and care partners, service providers, government and policy makers and researchers
4. To provide a forum for discussion that is inclusive of people living with dementia, families and care partners

Please email c.burley@unsw.edu.au to find out more information and if you are interested in joining either the Changed Behaviours SiG and/ or ADDResearch.

* Please see article published in the International Journal of Geriatric Psychiatry, Language paradigms when behaviour changes with dementia: #BanBPSD (Cunningham et al. 2019). For more information about preferences on terminology, please consult the Dementia Language Guidelines produced by Dementia Australia.

‘The DCRC will be ceasing operations Dec 2nd  2021. However, the SiG and ADDResearch Network will be relocated to another dementia organisation and future events will be organised. Details will be provided when confirmed. Please email c.burley@unsw.edu.au or n.dissanayaka@uq.edu.au (for ADDResearch) if you would like to be kept informed and are not already a member of the group.’

Upcoming events:

Past Events

Resources

Please click on hyperlinks below to access special interest group resources.

Previous events:

DCRC Symposia, Nov 2020, Online
BPSD Workshop, Nov 2019, Sydney: Sustaining Desirable Practice Change Workshop Slides
BPSD Roundtable Discussion, June 2019, ADF 2019, Hobart

The post Changed Behaviours Special Interest Group (SiG) appeared first on DCRC.

We are reviewing literature investigating the neurobiological underpinnings for disinhibited behaviours. We are also reviewing pharmacological and nonpharmacological management approaches published between 2002 and 2020. Biological factors integrated with psychological, social and environmental factors help to explain disinhibited behaviours. We have developed a conceptual model that incorporates all associated factors and are developing case study examples to show how the model may assist in understanding these behaviours and determining the most appropriate treatment.

This project was accepted for a verbal presentation at the Dementia Australia Forum (ADF) 2020 (postponed).

The post Biopsychosocial mechanisms of disinhibited behaviours in dementia and a systematic review of management approaches appeared first on DCRC.

We are systematically reviewing the literature to consider statistical and clinical meaningfulness of nonpharmacological (i.e. psychosocial) approaches that reduce symptoms of depression in people living with dementia. We are also looking at differences between residential care and community settings, and sustained effects at long-term follow-up.

This project was presented at the Alzheimer’s Association International Conference (AAIC) Satellite Symposium, Sydney 2019.

The post Nonpharmacological approaches for depression in dementia appeared first on DCRC.

No study has addressed the views and concerns of people living with dementia about what they think should happen if they experience changed behaviours. This information could be used to educate families and carers, inform clinical guidance, and improve care practice. This qualitative study is using an integrated approach to investigate the views of people with dementia, their families or care partners and professionals in separate interviews, on care and appropriate use of language to describe the behaviours. We will also explore potential differences between women’s and men’s experiences. In response to the COVID-19 pandemic, we will also be asking participants about how their social and professional support activities and general health have been affected.

This project was accepted for a poster presentation at the Dementia Australia Forum (ADF) 2020 (postponed).

If you are someone living with a diagnosis of dementia and are interested in taking part please email c.burley@unsw.edu.au.

The post The views and concerns of people living dementia, families/care partners and healthcare workers appeared first on DCRC.

Behaviours and psychological symptoms are a key driver of the rapidly escalating social and economic costs of dementia globally. This project poses the question: Do the economic benefits of non–pharmacological approaches in preventing and managing BPSD outweigh the costs?

This work has been presented at the Dementia Australia Forum (ADF) 2019 and the Alzheimer’s Association International Conference (AAIC) 2020. The research was published in International Psychogeriatrics, 2020.

The post Cost-effectiveness of evidence-based approaches for reducing behaviours and symptoms associated with dementia appeared first on DCRC.

People with dementia and their carers have a number of additional challenges when confronted with an emergency situation, including the limited capacity of the person with dementia to understand and cope with the sudden changes occasioned by emergencies. During these events, people with dementia have special needs, including improved identification (e.g. photos, identification bracelet if the person gets lost), prevention of wandering, the use appropriate communication skills (e.g. to help them remaining calm), and preparation of medical records in case nursing and medical care is required.

The predicted large increase in the number of people with dementia in the coming decades coupled with the increasing frequency of natural disasters, mean it is timely that consideration be given to better understand the specific needs of people with dementia who live in the community and their carers during disasters and emergencies. In response to these important issues, this project aims to develop a disaster preparedness tool – the CaRed-Guide- that takes into account the challenge that Australian carers of people with dementia living in the community face when a natural disaster strikes.

This project consists of three interconnected phases. The aim of the first phase is to be aware of relevant literature and practices related to disaster management of carers of people with dementia living in the community. Relevant literature and the research team’s skills and knowledge will be converted into a draft CaRed-Guide. In the second phase the draft guide will be further refined, customised and agreed on by an expert advisory group that includes carers of people with dementia living in the community and emergency services workers.

A structured communication method will be used to gather expert opinions about the drafted guide. In the end, a final CaRed-guide for carers of people with dementia living in the community will be established. The aim of the third phase is to create a clear implementation plan. The plan will include strategies for successful implementation of the guide in Australian communities. For example, how to best reach the end users of the guide and encourage its utilisation.

Findings from this research will be available to support carers of people with dementia living in the community to prepare for potential natural disasters. It will facilitate their capacity to prepare a family emergency plan that addresses the special needs of carers of people with dementia and those depending on them in the event of a natural disaster.

Project lead by Dr Linda Schnitker.
Other researchers: Prof Vivienne Tippett (QUT), Prof Gerry Fitzgerald (QUT) & Prof Lisa Brown (USA);
Development team: Deborah Brooks, Sara Baniahmadi

The post Preparing carers of people with dementia living in the community for natural disasters: developing a guide for carers – The Carer Ready Guide (CaRed-Guide) appeared first on DCRC.

Cognitive bias modification (CBM) is a novel, simple and safe intervention that targets negative biases associated with depression and anxiety. In the proposed trial this will be done through two approaches. The first exposes participants to a set of two emotionally discrepant faces displayed on a computer screen followed by a circle or square placed in the position that one of the faces occupied. The participant is then required to indicate if they see a circle or square through a response box. In active CBM the shape will always be placed over the neutral/happy face and in the control intervention the shape will occur equally over the neutral/happy and sad/angry face. The second technique involves being shown an ambiguous stem word followed by two words below. One of these words is related to this word in a negative or positive/neutral manner and the other is unrelated to it. The person is asked to indicate if the related word (negative or positive/neutral) is on the left or the right of the screen by pushing the corresponding button on the response box.

Active CBM will always use positive or neutral words while the control intervention will involve an equal mix of positive/neutral and negative words. CBM uses implicit memory (i.e. memory not accessible to conscious thought processes) systems, which are spared until late in the course of the illness. CBM is effective at reducing depressive symptoms in adults without cognitive impairment and our early data indicate that this is a feasible and, most likely, efficacious treatment for people with depression in AD but this needs to be tested in a properly designed, randomised controlled trial.

The proposed trial aims to determine if CBM is effective in alleviating depressive symptoms in people with AD and their carers. We additionally aim to explore if CBM results in improved quality of life and reduced carer burden. We will test this through a novel trial design that will enrol patients and their primary carers and randomly expose both to active or control CBM (patients and carers may receive either type of treatment). Participants will undergo 16 treatments in total over 6 months and be carefully monitored for evidence of depression over this time. We all also collect demographic, lifestyle (e.g. alcohol use, physical exercise) and clinical data and monitor quality of life/carer burden. CBM for this trial will be delivered at the respective research centres in Perth and Melbourne to ensure that our findings are valid and methodologically rigorous. If CBM is proven to be effective, we will then aim to make this intervention freely available via the internet. This would allow those with AD and their carers to access CBM in the comfort of their own home when it suits them.

This is a highly innovative and carefully designed trial that brings together an accomplished team of investigators with expertise in ageing research, depression, dementia, CBM, randomised trials and in translation of research findings into clinical practice. This study will produce definitive high quality evidence for the benefits of CBM in improving the quality of life of people with AD and those who care for them and facilitate the translation of this evidence into an important and growing clinical population.

Successful DCRC grant recipient 2016

Other team members:
T/L: Dr Andrew Ford, University of Western Australia
Prof Osvaldo Almeida, University of Western Australia
Prof Colin MacLeod, University of Western Australia
Prof Leon Flicker, University of Western Australia
Dr Chrisos Plakiotis, Monash University

The post Depression in people with dementia and their carers appeared first on DCRC.

The aim of the Project is to develop and pilot test a protocol which promotes collaboration and positive relationships between family and direct care staff for the purpose of improving the quality of residential care services. It will use amixed-method, 5 stage pre-post-evaluation design over 12 months.

The Research Questions which are guiding the Project:

Will a protocol developed during the pilot study to promote collaboration and positive relationships between family and direct care staff:

1. improve family carer and direct care staff relationships?
2. improve the quality of residential care services for recently transitioned aged care residents?

The post Collaboration between family members and direct care staff in quality improvement of residential care services appeared first on DCRC.

Older people with dementia are at increased risk of developing delirium, an acute confusional state, when in ED. Delirium is common (~10%) in older ED patients and is positively linked to negative patient health results (e.g. death) and increased healthcare costs. Besides risk factors as being older, having cognitive impairment (a sign of dementia), and being acutely sick (wherefore presenting to ED), the ED environment itself and ED processes can trigger delirium. For example the ED environment, which is often hectic and noisy, has limited orientation cues (e.g. no daylight, clocks, poor signage), uncomfortable trolleys, limited strategies relevant to the care of older people with dementia, and staff with poor geriatric knowledge.

Some ED processes, such as (long) waiting times, treatment with multiple and incorrect medications, poor recognition of cognitive impairment, can also contribute to delirium. In the literature, delirium has been described as an avoidable syndrome, and it appears that a number of those ED processes, ED structures, and patient-specific delirium risk factors are modifiable.

There is a lack of evidence on what the best intervention strategies are to prevent delirium in older patients with dementia in ED. Based on the research team’s experience and what consumers tell us, older people with dementia may benefit from multiple changes in current ED processes (e.g. having protocols relevant to pain assessment, nutrition, bladder catheter use, and cognitive screening) and structures (e.g. having orientation cues and engagement activities, geriatric streaming, policies relevant to geriatric emergency care). In the acute care setting, multi-component delirium prevention interventions have been proven effective.

Consequently, multiple strategies targeting those adjustable ED processes, structures and patient-specific delirium risk factors can be developed in the form of a multi-component intervention that suits the ED setting and this vulnerable ED population. This project aims to develop a useable multi-component delirium prevention intervention relevant for older people with dementia presenting to EDs in the form of clear protocols, guidelines and manuals. This new intervention, the Delirium Action Response in ED (DARe-ED) intervention, will be developed in order to improve care and health outcomes of acutely sick people with dementia visiting EDs who are at risk of delirium.

The development of the DARe-ED intervention for older ED patients with dementia will be realised by:

1. approaching the literature and translating evidence and the research team’s experience into a draft multi-component delirium prevention intervention, and
2. consulting an expert panel using a structured communication method. An international panel of experts consisting of consumers (i.e. people with dementia and/or their carers) and skilled workers in the field of geriatric emergency medicine and nursing, dementia care, and research will be consulted to assist in establishing the DARe-ED intervention. A defined implementation plan outlining the relevant steps to successfully apply the DARe- ED intervention into Australian ED settings will be constructed.

Ultimately, this project will optimise clinical care for acutely sick people with dementia in ED environments, in which delirium may be easily triggered, by translating evidence into a practical intervention, which is likely to benefit older ED patients and Australian health care. In addition, this proposed research project has the potential to inform further research. For example, a study to test the cause-effect relation between this new intervention and older ED patients’ health results and health care costs.

Successful Grant Recipient 2016

Team members:

A/Prof Glenn Arendts, The University of Western Australia;
A/Prof Christopher Carpenter, Washington University;
A/Prof Dina Lagiudice, The University of Melbourne;
A/Prof Gideon Caplan, University of New South Wales;
Prof Elizabeth Beattie, Queensland University of Technology.

The post Building delirium care for people with dementia into the emergency department (ED): Systematic development of the Delirium Action Response in ED (DARe-ED) intervention appeared first on DCRC.

Currently there are no pharmacotherapies that can prevent the onset of dementia, although lifestyle interventions, such as engagement in physical activity, hold promise. To yield large-scale, sustainable effects on behaviours that benefit brain and cognitive health (e.g., socializing, physical activity), interventions need to involve urban planning, transportation, residential age care, and health sectors and aim to create community environments that support and promote such behaviours in entire populations.

Although there is evidence that walkable neighbourhoods (typified by a large number of services, interconnected street networks and higher residential density) promote physical activity and socialising in older adults, no studies have systematically examined whether and how aspects of walkable neighbourhoods may affect brain and cognitive health. We propose to use open-source objective data to quantify the neighbourhood characteristics of 1,112 older residents (60+ years) of Melbourne and Perth from the Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing, the largest prospective study in Australia to examine factors predicting Alzheimer’s Disease.

By combining information from the AIBL study with information on objectively-assessed characteristics of the residential neighbourhoods of AIBL participants, we will examine whether neighbourhood characteristics such as residential density, access to parks, access to public transport, and the presence of various amenities in the neighbourhood, are related to the level and changes in cognitive function and relevant biological factors (e.g., brain volume).

We will also examine the extent to which these relationships are explained by engagement in physical activity, and whether they vary in people that vary in genetic risk of dementia. In partnership with the Planning Institute Australia and Victorian Department of Health and Human Services, this evidence will contribute to informing urban planning and aged care policy and practice that could have sustainable, population-wide effects on the prevention and delay of dementia.

DCRC Grant Recipient 2016

Other team members:

The post Understanding how the neighbourhood environment influences brain and cognitive health in older adults appeared first on DCRC.