Objectives The aim of this study was to use the ADKAR model of organizational change to gain an understanding of why a training program designed to equip staff with the skills to provide a Consumer Directed Care (CDC) model in nursing homes produced little change in the outcome variables, including resident quality of life. Methods We collected and analyzed various forms of site-specific data including CDC implementation plans developed by staff trained in 21 facilities, and their training facilitators' records. Results Staff trained in the principles of CDC produced well-developed, facility-specific plans to introduce a CDC model of care, yet they faced many barriers to the implementation of these plans. These barriers were spread across multiple stages of the ADKAR model and included staff turnover (including managers), lack of engagement by management, lack of or inconsistent availability of a CDC champion, and disruptions to the training program. Conclusions We identified several organizational factors contributing to the failure of the training program to produce anticipated changes. Clinical Implications Without organizational commitment and full management support, attempts to implement CDC training programs are likely to fail, leading to negative consequences for residents' autonomy and control over how they are cared for.

Objectives: This study evaluated a training program to support the delivery of consumer directed care (CDC). It was hypothesized that both interventions, compared to the control condition, would demonstrate increased levels of CDC in nursing homes, increased staff practice of CDC, and improved resident QoL. The training plus support group was expected to show greater gains, compared to the training only group. Materials and methods: In a cluster RCT design, 33 nursing homes were randomly allocated to one of three conditions: training plus support, training only, and care as usual. Outcome measures included level of CDC within each home, staff practice of CDC, and resident QoL. Results and discussion: Hypotheses for this study were partially supported. Nursing homes became more CDCoriented but with minimal changes in staff practice of CDC. Resident QoL also demonstrated limited change. The findings are discussed in terms of organizational barriers to change within nursing homes. (c) 2021 Elsevier Inc. All rights reserved.

Systematic reviews and meta-analyses are critical in health-related decision-making, and are considered the gold standard in research synthesis methods. However, with new trials being regularly published and with the development of increasingly rigorous standards of data synthesis, systematic reviews often require much expertise and long periods of time to be completed. Automation of some of the steps of evidence synthesis productions is a promising improvement in the field, capable of reducing the time and costs associated with the process.This article describes the development and main characteristics of a novel online repository of cognitive intervention studies entitled Cognitive Treatments Article Library and Evaluation (CogTale). The platform is currently in a Beta Release phase, as it is still under development. However, it already contains over 70 studies, and the CogTale team is continuously coding and uploading new studies into the repository. Key features include advanced search options, the capability to generate meta-analyses, and an up-to-date display of relevant published studies.

Objectives: To satisfy requirements for continuing professional education, workforce demand for access to large-scale continuous professional education and micro-credential-style online courses is increasing. This study examined the Knowledge Translation (KT) outcomes for a short (2 h) online course about support at night for people living with dementia (Bedtime to Breakfast), delivered at a national scale by the Dementia Training Australia (DTA). Methods: A sample of the first cohort of course completers was re-contacted after 3 months to complete a KT follow-up feedback survey (n = 161). In addition to potential practice impacts in three domains (Conceptual, Instrumental, Persuasive), respondents rated the level of Perceived Improvement in Quality of Care (PIQOC), using a positively packed global rating scale. Results: Overall, 93.8% of the respondents agreed that the course had made a difference to the support they had provided for people with dementia since the completion of the course. In addition to anticipated Conceptual impacts (e.g., change in knowledge), a range of Instrumental and Persuasive impacts were also reported, including workplace guidelines development and knowledge transfer to other staff. Tally counts for discrete KT outcomes were high (median 7/10) and explained 23% of the variance in PIQOC ratings. Conclusions: Online short courses delivered at a national scale are capable of supporting a range of translation-to-practice impacts, within the constraints of retrospective insight into personal practice change. Topics around self-assessed knowledge-to-practice and the value of positively packed rating scales for increasing variance in respondent feedback are discussed.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective To assess the effects of various built environment interventions, in the form of hospital planning and design approaches and features, on the health and wellbeing of older inpatients with cognitive impairment including dementia and delirium. Secondary objectives To assess the effects of built environment interventions on accompanying persons. These interventions consist of any design feature that supports an accompanying person as they assist or accompany the patient in the hospital. To assess the effects of built environment interventions on staff within inpatient wards who are providing care to older patients with cognitive impairment. To identify gaps in the evidence and outline topics for future research.

Objectives: The advent of Consumer-Directed Care (CDC, or individualized care) in Residential Aged Care Facilities (RACFs, or residential care) will require a paradigm shift in service delivery. This article evaluated the six-session Resident at the Centre of Care (RCC) staff training program designed to equip staff to implement a CDC model of care among residents.Method: There were two experimental conditions: RCC training program alone, RCC training program plus support, and a 'care as usual' condition. Outcome measures were resident quality of life (QoL) and resident working relationships with staff at 3-month follow-up. At Time 1, 92 residents from RACFs participated in the program. The RCC is six sessions that focus on the development of staff skills in communicating with residents, as well as the organizational change and transformational leadership that is needed for the implementation of CDC.Results: There were significant improvements in resident QoL. There was no major difference between the RCC Program plus support condition compared to the RCC Program alone condition, but both were associated with more positive changes in resident QoL than the 'care as usual' condition.Conclusion: This study demonstrates that training staff in strategies to implement CDC in RACFs can lead to an improvement in the wellbeing of many residents, and that additional support to assist staff to implement the strategies may not be required to produce such improvements. Longer term follow-up is necessary to determine if the improvements in resident QoL are sustained.

Background and Aim Irrespective of age, communication is a tool of expression and a key daily activity meeting the human need for social interaction and connection. The introduction of consumer-directed care (CDC) emphasises the importance of communication to provide consumers with the opportunity to exercise choice over the care they receive. As consumer-directed care progresses, it is hypothesised that the feasibility of shared decision-making and care planning in residential aged care will be largely determined by the communication opportunities afforded to the residents. Therefore, the aim of this study was to explore resident perceptions of the opportunities they have to communicate, including the opportunity to express their care preferences and contribute opinions about their care. Design A qualitative inductive design was adopted. Methods An individual interview format was used to gather the perspectives of 102 residents. Data were analysed using qualitative content analysis to generate themes illustrating patterns in participant views. Findings Overall, residents desired increased involvement in their care planning and increased opportunity for more meaningful communication and social opportunities. Residents described the negative impact of the communication difficulties they face on their communication and the need for support and activities to be tailored to residents' individual communication needs. Conclusions To facilitate resident participation in CDC and meet resident desire for increased social communication, further investment in resources to support resident-staff communication and accommodate residents' individual communication needs is required. Implications for Practice By highlighting communication as a stand-alone activity and a priority of residents, the findings of this study raise the profile of communication and demonstrate the need for explicit allocation of care time and specialist services to support resident-staff communication and social communication in residential aged care. Such support must be tailored to meet residents' individual communication needs and be coupled with increased staff training in providing communication support. Without facilitating resident communication and increasing the opportunity to communicate, shared decision-making and care planning in residential aged care consistent with person-centred and consumer-directed models of care will be limited.

The Australian government, partly to enable people with dementia to remain living in the community longer, subsidises day respite centre (DRC) attendance. Previous research from this group identified that, although many Australian DRCs provide quality services to people with dementia and their carers, there is room for improvement. In-depth face-to-face interviews, focused on eliciting suggestions for improving the experience of attendees with dementia, were conducted with managers of seven DRCs in Queensland and Tasmania. The dementia-friendliness of each setting was assessed via the Environmental Audit Tool (EAT). Thematic analysis of interview responses revealed three principal themes: • Importance of relationships between clients, family carers, staff, volunteers and the community—e.g. vital to communicate with client/carer about their needs and experiences. Staff and volunteers need dementia-specific training to improve communication and relationships. • Constraints for services in offering ideal support to people with dementia—primarily financial, environmental and the inability to cater for all potential clients (e.g. those with high care needs). • Future concerns—focused on funding (e.g. moving to the user pay system) and inability to provide activities desired by the incoming baby boomer generation. Although EAT scores were moderately high overall (indicating dementia friendliness), the audit revealed some concerns in specific areas and facilities, e.g. lack of comfortable or age-appropriate furniture, unsuitable decor. Centres that were not purpose-built as day centres struggled most with environmental issues, with managers indicating that solutions would require considerable monetary investment or relocation.

Improving children’s understanding of people with dementia is essential for tackling societal stigma around dementia. Kids4Dementia is a teacher-led multimedia dementia education resource for 9–12 year olds (approximately 150 minutes duration). A non-randomised, waitlist-controlled, mixed-methods design examined whether Kids4Dementia was (1) efficacious in improving students” attitudes towards people with dementia and (2) engaging and acceptable for teachers and students. Students who completed Kids4Dementia (n = 136) showed improved scores on the Kids Insight into Dementia Survey, relative to the control school (n = 67), especially students who had not heard of dementia before (Time × Group × Dementia Familiarity interaction, F(1, 191) = 5.28, p = .023, partial η2 = .027). Qualitative reports indicated that the program was acceptable and engaging for teachers and students and corroborated improvement in student empathy and behavioural intentions towards people with dementia. The findings provide preliminary evidence for the efficacy of Kids4Dementia as an engaging, stakeholder-directed, curriculum-aligned dementia education program.

BACKGROUND:Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care.METHODS:The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling.DISCUSSION:The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care.TRIAL REGISTRATION:ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/ ).

Cognition-oriented treatments (COTs), including cognitive stimulation and training, are ever more popular in the older adult population despite the ongoing debate regarding their benefits and potential to prevent cognitive and functional decline. Numerous systematic reviews on the topic have produced mixed findings and recommendations and there is a dearth of credible and unbiased resources that stakeholders can turn to for complete up-to-date evidence base. CogTale is a novel platform that aims to both accelerate the data synthesis process, and provide a range of stakeholder groups access to up to date and reliable evidence to improve decision making. A comprehensive and dynamic data extraction and coding interface, covering a wide range of design, methodology, and results of eligible trials was developed in an iterative process to form the platforms’ database. CogTale allows expert and non-experts to conduct simple and advanced trial searches. Several methodological quality scores and all relevant effect sizes are automatically computed for each trial using coded algorithms. Additional algorithms are used to pool effect estimates from selected studies, and report templates automatically generate plain language evidence reports. Pilot testing of the website's functionality is underway and CogTale's formal launch is expected in April 2018. Extraction and entry of trial data into the repository is ongoing and registered expert users are able to enter their own trial data, and we anticipate that within 12 months most of the extant literature base will be coded onto the repository. A sample of the website's automatically-generated evidence reports can be seen in Appendix 1. We expect that CogTale will represent a much needed independent and critical collaborative platform. It will serve the research, clinical, and general user communities, with the capacity to accelerate knowledge synthesis efforts and offer credible and easily accessible evidence regarding the rapidly growing field of COTs in older adults . Forest plot of meta-analysis for Depression (Post-Intervention). Table 1 presents the meta-analysis results for Depression (Post-Intervention). Based on the random-effects model, Hedges' g effect size of 0.57 (95% CI = [−0.60, 1.75]) was not significant (p = 0.170). With a Hedges' g of 0.57, 71.7% of the treatment group will be above the mean of the control group, 77.4% of the two groups will overlap, and there is a 65.7% chance that a person picked at random from the treatment group will have a higher score than a person picked at random from the control group. There was a high amount of heterogeneity (I2 = 55.6%, 95% CI = [0.0, 87.3]), which was not significant (p= 0.105). The prediction interval suggests that theres is a 95% chance that the effect size of future studies will fall between −4.99 and 6.14.

An understudied care setting for people with dementia is day respite. Government-funded day respite centres (DRC) provide opportunities for socialisation and activities to people with dementia and respite to family carers. This presentation fills a knowledge gap about what constitutes a “good day out” from three perspectives: DRC managers, DRC staff and family carers of people with dementia. Recruitment occurred via a nationally representative set of DRCs. Carers were also recruited through online newsletters and social media. From a goal of 40 DRCs, 37 participated. Managers (n=37), staff (n=28) and carers (n=43) responded to both closed- and open-ended questions on online or phone surveys. All the responding DRCs were either non-profit or government/community organisations. While the majority (87%) of managers had received dementia-specific training, only 50% of the responding staff members had. Managers named financial constraints and inadequate physical space as their biggest challenges to providing good dementia care. Individual staff members expressed a need for more dementia-specific training and activities. While carers were mostly satisfied with DRCs, they wanted more communication between staff and carers and were concerned that at times the person living with dementia did not enjoy going.

ABSTRACT Background: The vision for dementia-friendly communities is challenged by limited public awareness and stigma about dementia. The study aim was to elicit stakeholder priorities for the message content of an education program to improve dementia awareness among youth; specifically, what do children need to know about dementia? Methods: A qualitative inquiry using interviews and focus groups was used. Purposive sampling achieved maximum variation in dementia experience and participant characteristics. Focus groups with Scouts in the community aged 9–12 years old ( n = 22) used innovative techniques to explore children's attitudes towards people with dementia. Participants with personal experience of dementia were five people with early-stage dementia; 12 adult primary carers; four non-primary carers; and six grandchildren of a person with dementia. They were asked what is important for children to understand about dementia and what attitudes they may like an education program to confer. Content analysis was performed using NVivo10. Results: Strong themes to emerge were that children need to know the whole truth about dementia; that individuals with dementia are “still people,” that it is “not the fault” of the person with dementia; and that dementia is different and typically unpredictable for everyone. Discussions also indicated a need to educate children about ways to relate to a person with dementia, and to appreciate “positives” within a relationship. Conclusions: Children are our future citizens. Developing an education program for children with this message content may be fundamental to de-stigmatizing dementia and laying the foundation to dementia-friendly communities.

Objectives: Children may have a foundational role in efforts to raise community awareness about dementia. There is some qualitative work with children with a relative with dementia, but little work into the insights of children as general citizens without affected family. One issue is an absence of measurement tools; thus the study aimed to design and pilot a psychometrically sound self-report measure of dementia attitudes for children.Method: Using a multi-staged scale development process, stakeholder and expert input informed a 52-item Kids Insight into Dementia Survey (KIDS). After a pretest of KIDS with 21 Australian schoolchildren aged 10-12 years, exploratory factor analysis and reliability and validity testing were run on a revised KIDS with data from 203 similar-aged schoolchildren.Results: The KIDS was reduced from 52 to 14 items, and a three-factor solution identified: Personhood,' Stigma,' and Dementia Understanding.' A strong positive correlation with an adult measure of dementia attitudes (r = .76) and a moderate positive correlation with a child measure of attitudes towards older adults (r = .47) indicated good concurrent validity. Internal consistency of .83 indicated good reliability.Conclusion: Results support the use of KIDS as a tool to measure children's insight into dementia, and to evaluate dementia education initiatives targeting the youth.

The Research Focus section of the Australian Journal of Dementia Care aims to keep readers up to date with the fast expanding field of social, psychological and nursing research in dementia care. By this we mean every aspect of person-to-person communication, nursing and care practice and organisation, and the influence of all aspects of the environment. The aim is to provide a channel of two-way communication between researchers and practitioners, to ensure that research findings influence practice and that practitioners’ concerns are fed into the research agenda. We would like to hear from you, specifically with: notice of the publication (recent or imminent) of peer reviewed papers with practical relevance to dementia care; research reports available for interested readers; requests or offers for sharing information and experience in particular fields of interest. This section aims to provide a channel of two-way communication between researchers and practitioners in the expanding field of social, psychological and nursing research in dementia care, including all aspects of nursing and care practice, communication and the environment.

Providing information about the latest research via educational sessions to health professionals caring for people with dementia may be insufficient to drive change. This project explored self-reported impacts on practice change of adding information about knowledge translation (KT) to a national dementia education program. Six national workshop days were held. Each provided the option of participating in a Principles of KT and innovation implementation seminar in addition to a clinical topic update (sexualities and dementia, or managing behavioral and psychological symptoms of dementia). Six months postworkshop, 321 participants were invited to complete a research utilization survey. Seventy-five responded. KT seminar participants were more likely to report instrumental outcomes (e.g. changed policies, procedures) than those who did not participate in the KT seminar. Including KT information in educational sessions for health professionals may increase the likelihood of practice change in the field of dementia care and warrants further research.

Introduction:Dementia education programs are being developed for health professionals, but with limited guidance about what works in design and content to promote best practice in dementia care. Knowledge translation (KT) is a conceptual framework for putting evidence to work in health care. This narrative literature review examined the question: What does the field KT offer, conceptually and practically, for education of health professionals in dementia care? It seeks to identify the types of strategies currently used within education to facilitate effective KT for the wide range of health professionals who may be involved in the care of people with dementia, plus explore enablers and barriers to KT in this context.Methods:From 76 articles identified in academic databases and manual bibliographic searching, 22 met review criteria.Results:The literature synthesis indicated four hallmarks of successful KT-oriented dementia education for health professionals: (1) multimodal delivery, (2) tailored approaches, (3) relationship building, and (4) organizational support for change in the work setting. Participatory action frameworks were also favored, based on interactive knowledge exchange (eg, blended learning) rather than passive unidirectional approaches alone (eg, lectures).Discussion:The following six principles are proposed for educating health professionals in dementia care: (1) Match the education strategy to the KT goal and learner preferences; (2) Use integrated multimodal learning strategies and provide opportunities for multiple learning exposures plus feedback; (3) Build relationships to bridge the research-practice gap; (4) Use a simple compelling message with formats and technologies relevant to the audience; (5) Provide incentives to achieve KT goals; and (6) Plan to change the workplace, not just the individual health professional.

Background We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. Methods Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. Results Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). Conclusion Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.

Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive.

While there is considerable evidence on the impact of specific design features on problems associated with dementia, the link between the quality of the built environment and quality of life of people with dementia is largely unexplored. This study explored the environmental and personal characteristics that are associated with quality of life in people with dementia living in residential aged care. Data were obtained from 275 residents of 35 aged care homes and analysed using linear regression. The quality of the built environment was significantly associated with the quality of life of the resident measured by global self-report. Environmental ratings were not associated with proxy or detailed self-report ratings. Higher quality of life is associated with buildings that facilitate engagement with a variety of activities both inside and outside, are familiar, provide a variety of private and community spaces and the amenities and opportunities to take part in domestic activities.