Background As Australia's ethnically diverse population ages, dementia prevalence is rising. Professional interpreter support is essential to ensure equitable access to accurate dementia diagnosis and care. To address this need, a nationally specialised online, self-paced training on dementia and cognitive assessments was developed for interpreters. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this article reports on the training's implementation. Specifically, it explores the training's reach, barriers and facilitators to adoption, perceived effectiveness in improving interpreter-mediated assessments, and potential for long-term maintenance. Methods Between 24 November 2023 and 12 December 2024, the online self-paced training was rolled out to interpreters nationally across Australia. Implementation was supported by industry study partners, including interpreter agencies, advocacy organisations, a technology partner, and the national accreditor for interpreters. A mixed-methods evaluation was undertaken. Quantitative monitoring captured the training's reach, uptake, and successful completion. In parallel, qualitative interviews were conducted with 24 interpreters who completed the training, 6 managers from interpreter agencies, and 16 clinicians who worked with interpreters to undertake cognitive assessments. Quantitative data were descriptively analyzed, and qualitative data were analyzed using the framework method. Results Eight hundred sixty-five interpreters, representing 14.5% of Australia's active interpreter workforce, completed the training. Interpreters and agency managers reported that the training improved interpreter practice and confidence. In contrast, clinicians were unaware of the training. Barriers to uptake included time constraints, technical issues and limited computer literacy, and the perceived difficulty of the content for some participants. Key facilitators included ease of access (being online and no cost), incentive of professional development points, a straightforward final assessment, and administrative support. The training has now been made freely and permanently available on the national accreditation authority's website. Conclusions This world-first study demonstrates a scalable approach to delivering interpreter training for dementia assessments, with the potential to enhance the accuracy and timeliness of diagnosis for ethnically and linguistically diverse people living with dementia.

Existing literature has identified inequalities in incidence and health outcomes between urban and rural populations with Alzheimer's disease (AD), however, potential disparities in the diagnostic process are poorly understood. We aimed to investigate differences in the diagnostic pathway – including the completion of key diagnostic investigations and diagnostic wait times – among individuals with all-cause mild cognitive impairment (MCI) or dementia due to AD residing in rural and urban Australia. We conducted a cross-sectional study using data from the Australia Dementia Network (ADNeT) Registry. Patients diagnosed with all-cause MCI or AD dementia between registry commencement (March 2020) and December 2023 were included. Participants were categorised into three geographic groups – Major Cities (urban), Inner Regional, Outer Regional (both rural) – based on patient postcode (or clinic postcode if unavailable). Logistic and quantile regression models were used to investigate associations between rural/urban residence and the clinical diagnostic pathway. We identified 3,648 patients, 1,455(39.88%) with all-cause MCI and 2,193(60.12%) with dementia due to AD. Participants in inner regional areas were more likely (odds ratio [OR]=1.55; 95% confidence interval [CI]=1.14,2.13; p  = 0.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in both inner regional (OR=0.37; 95% CI=0.28,0.48; p  <0.001) and outer regional (OR=0.32; 95% CI=0.21,0.48; p  <0.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median)=12.92; 95% CI=5.15,20.69; p  = 0.001; Outer regional: Beta (median)=27.50; 95% CI=18.80,36.20; p  <0.001). However, median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median)=-46.83; 95% CI=-52.35,-41.32; p  <0.001; Outer regional: Beta (median)=-44.42; 95% CI=-50.35,-38.49; p  <0.001). Findings suggest disparities in access to advanced diagnostic investigations and timely initial appointments across rural Australia. These inequalities may preclude access to timely post-diagnostic services and exacerbate existing barriers to access novel disease modifying therapies which often require advanced diagnostic investigations such as functional neuroimaging.

Importance With increasing dementia prevalence due to population aging, interpreters are needed to facilitate timely dementia diagnosis by supporting the complex verbal and nonverbal interplay between clinicians and patients during cognitive assessments. However, to our knowledge, no randomized clinical trials have previously evaluated interventions to improve interpreter communication during cognitive assessments for dementia. Objective To assess whether online training codesigned by interpreters, clinicians, and multilingual family carers improves the quality of interpreter communication during cognitive assessments for dementia. Design, Setting, and Participants The Improving Interpreting for Dementia Assessments (MINDSET) study was a single-blind, parallel-group randomized clinical trial including certified interpreters and certified provisional interpreters of Arabic, Cantonese, Greek, Italian, Mandarin, or Vietnamese with at least 6 months' experience. The trial was community based and conducted online across Australia between June 26, 2022, and April 2, 2023, with follow-up at 3 and 6 months after baseline. Intervention Participants were randomized 1:1 to receive interpreter training during the study or, if assigned to the waiting list control, after their 6-month assessment. Main Outcomes and Measures The primary outcome was change in the quality of interpreted communication, as measured by a weighted score comprising 5 domains: (1) knowledge of dementia, (2) cross-cultural communication, (3) briefings and debriefings, (4) interpreting skills for cognitive assessments, and (5) ethical principles relevant during a cognitive assessment. Mixed-effects generalized linear regression was conducted with random effects accounting for repeated measures from participating interpreters. Secondary analyses were conducted for differences in individual interpreting domains. A secondary per-protocol analysis included only participants who completed at least 70% of the training in the intervention group. Results At baseline, there were 126 participants (106 [84.1%] women); mean (SD) age was 44.13 (12.71) years, mean years of interpreting experience was 8.57 (8.48) years, and 106 of 120 (88.3%) lived in an urban area. A total of 22 (17.5%) were Arabic interpreters; 14 (11.1%), Cantonese; 6 (4.8%), Greek; 14 (11.1%), Italian; 64 (50.8%), Mandarin; and 6 (4.8%), Vietnamese. The primary outcome of communication quality in the main analysis did not significantly improve in the intervention group compared with controls (mean score difference, 2.10; 95% CI, -0.43 to 4.62; P = .10). Per-protocol findings showed a significant intervention effect (mean score difference, 2.73; 95% CI, 0.14-5.31; P = .04), suggesting that the MINDSET-trained interpreters benefited in the primary outcome when they completed at least 70% of the training. Of the 5 domains, a significant intervention effect was shown in only domain 1 (knowledge of dementia) in the main analysis (mean score difference, 1.15; 95% CI, 0.54-1.77; P < .001) and per-protocol analysis (1.03; 95% CI, 0.27-1.79; P = .008) at 3 months. Conclusions and Relevance In this randomized clinical trial, results of the primary, intention-to-treat analysis showed that interpreters' overall interpreting communication quality did not improve in the intervention group compared with controls, but in the secondary, per-protocol analysis, it was improved when at least 70% of the training was completed. These findings suggest that an online training intervention can improve interpreters' communication quality during cognitive assessments for dementia if at least 70% of training is completed. Trial Registration ANZCTR Identifier: ACTRN12621001281886

BACKGROUND:Existing literature has identified inequalities in incidence and health outcomes between urban and rural populations with Alzheimer's disease (AD), however, potential disparities in the diagnostic process are poorly understood. We aimed to investigate differences in the diagnostic pathway - including the completion of key diagnostic investigations and diagnostic wait times - among individuals with all-cause mild cognitive impairment (MCI) or dementia due to AD residing in rural and urban Australia. METHOD:We conducted a cross-sectional study using data from the Australia Dementia Network (ADNeT) Registry. Patients diagnosed with all-cause MCI or AD dementia between registry commencement (March 2020) and December 2023 were included. Participants were categorised into three geographic groups - Major Cities (urban), Inner Regional, Outer Regional (both rural) - based on patient postcode (or clinic postcode if unavailable). Logistic and quantile regression models were used to investigate associations between rural/urban residence and the clinical diagnostic pathway. RESULT:We identified 3,648 patients, 1,455(39.88%) with all-cause MCI and 2,193(60.12%) with dementia due to AD. Participants in inner regional areas were more likely (odds ratio [OR]=1.55; 95% confidence interval [CI]=1.14,2.13; p = 0.006) to have had more basic diagnostic investigations completed (including core blood tests, cognitive assessments, functional assessments, structural neuroimaging) compared to those in major cities. However, participants in both inner regional (OR=0.37; 95% CI=0.28,0.48; p <0.001) and outer regional (OR=0.32; 95% CI=0.21,0.48; p <0.001) areas were less likely to have functional neuroimaging completed. Median wait times for an initial appointment following referral to a memory clinic were up to 28 days longer for rural compared to urban participants (Inner regional: Beta (median)=12.92; 95% CI=5.15,20.69; p = 0.001; Outer regional: Beta (median)=27.50; 95% CI=18.80,36.20; p <0.001). However, median wait times from initial appointment to diagnosis were up to 47 days shorter in rural compared to urban residents (Inner regional: Beta (median)=-46.83; 95% CI=-52.35,-41.32; p <0.001; Outer regional: Beta (median)=-44.42; 95% CI=-50.35,-38.49; p <0.001). CONCLUSION:Findings suggest disparities in access to advanced diagnostic investigations and timely initial appointments across rural Australia. These inequalities may preclude access to timely post-diagnostic services and exacerbate existing barriers to access novel disease modifying therapies which often require advanced diagnostic investigations such as functional neuroimaging.

The Improving Interpreting for Dementia Assessments (MINDSET) study aimed to upskill interpreters through an online co-designed course in dementia and cognitive assessments. A single-blinded randomized controlled digital trial conducted between June 2022 and November 2023. Interpreters were randomized to training or waitlist control conditions with 3- and 6-month follow-up. The primary outcome was a composite Z- score comprising dementia and cross-cultural knowledge, translation and ethical knowledge, and observed interpreting skills. Preliminary analyses were conducted using a mixed ANOVA with assessment period as the within-subjects factor and intervention group as the between-subjects factor, controlling for age. 126 interpreters (M age = 44.13 years ( SD = 12.71) completed baseline (22 Arabic, 14 Cantonese, 6 Greek, 14 Italian, 64 Mandarin, 6 Vietnamese), 3m follow-up (n = 100) and 6m follow-up (n = 101). For the primary outcome, there were no significant main effects for assessment period F (2, 178) = 0.21, p = .814 nor intervention group F (1, 89) = 0.31, p = .548, and no significant interaction between intervention group and assessment period, F (2, 178) = 0.64, p = .526. Secondary outcomes revealed significant main effects for dementia knowledge (DKAS) for the assessment period, F (2, 98) = 8.80, p <.001, and intervention group F (1, 99) = 4.59, p = .035, with significantly higher scores at the 3- (mean difference = 1.308, SE = .31, p <.001, 95% CI .692, 1.924) and 6-month follow-up (mean difference = .814, SE = .31, p = .010, 95% CI .203, 1.425); and significantly higher scores in the intervention compared to control (mean difference = .842, SE = .393, p =  .035, 95% CI .062, 1.621). A significant interaction between assessment period and intervention group F (2, 98) = 3.33, p = .040 indicated that the increase in scores at the 3- and 6-month periods were greater for the intervention group. This is the first time a dementia training resource for interpreters has been trialled. Preliminary analyses revealed an improvement in interpreter’s dementia knowledge.

OBJECTIVE:Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings. METHODS:Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised. FINDINGS:Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (n = 28, 54%), accessibility (n = 11, 21%), resources (n = 9, 17%), and hospital readmissions (n = 4, 8%). Most QIs were outcome (n = 25, 48%) or process (n = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas. CONCLUSIONS:Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare.

Importance With increasing dementia prevalence due to population aging, interpreters are needed to facilitate timely dementia diagnosis by supporting the complex verbal and nonverbal interplay between clinicians and patients during cognitive assessments. However, to our knowledge, no randomized clinical trials have previously evaluated interventions to improve interpreter communication during cognitive assessments for dementia. Objective To assess whether online training codesigned by interpreters, clinicians, and multilingual family carers improves the quality of interpreter communication during cognitive assessments for dementia. Design, Setting, and Participants The Improving Interpreting for Dementia Assessments (MINDSET) study was a single-blind, parallel-group randomized clinical trial including certified interpreters and certified provisional interpreters of Arabic, Cantonese, Greek, Italian, Mandarin, or Vietnamese with at least 6 months’ experience. The trial was community based and conducted online across Australia between June 26, 2022, and April 2, 2023, with follow-up at 3 and 6 months after baseline. Intervention Participants were randomized 1:1 to receive interpreter training during the study or, if assigned to the waiting list control, after their 6-month assessment. Main Outcomes and Measures The primary outcome was change in the quality of interpreted communication, as measured by a weighted score comprising 5 domains: (1) knowledge of dementia, (2) cross-cultural communication, (3) briefings and debriefings, (4) interpreting skills for cognitive assessments, and (5) ethical principles relevant during a cognitive assessment. Mixed-effects generalized linear regression was conducted with random effects accounting for repeated measures from participating interpreters. Secondary analyses were conducted for differences in individual interpreting domains. A secondary per-protocol analysis included only participants who completed at least 70% of the training in the intervention group. Results At baseline, there were 126 participants (106 [84.1%] women); mean (SD) age was 44.13 (12.71) years, mean years of interpreting experience was 8.57 (8.48) years, and 106 of 120 (88.3%) lived in an urban area. A total of 22 (17.5%) were Arabic interpreters; 14 (11.1%), Cantonese; 6 (4.8%), Greek; 14 (11.1%), Italian; 64 (50.8%), Mandarin; and 6 (4.8%), Vietnamese. The primary outcome of communication quality in the main analysis did not significantly improve in the intervention group compared with controls (mean score difference, 2.10; 95% CI, −0.43 to 4.62; P = .10). Per-protocol findings showed a significant intervention effect (mean score difference, 2.73; 95% CI, 0.14-5.31; P = .04), suggesting that the MINDSET-trained interpreters benefited in the primary outcome when they completed at least 70% of the training. Of the 5 domains, a significant intervention effect was shown in only domain 1 (knowledge of dementia) in the main analysis (mean score difference, 1.15; 95% CI, 0.54-1.77; P < .001) and per-protocol analysis (1.03; 95% CI, 0.27-1.79; P = .008) at 3 months. Conclusions and Relevance In this randomized clinical trial, results of the primary, intention-to-treat analysis showed that interpreters’ overall interpreting communication quality did not improve in the intervention group compared with controls, but in the secondary, per-protocol analysis, it was improved when at least 70% of the training was completed. These findings suggest that an online training intervention can improve interpreters’ communication quality during cognitive assessments for dementia if at least 70% of training is completed. Trial Registration ANZCTR Identifier: ACTRN12621001281886

Real-world data on the uptake, effectiveness and safety of new diagnostics and disease-modifying (DMT) treatments for Alzheimer’s Disease (AD) are imperative. This can be achieved through patient registries. A major challenge is how to embed registry data capture into routine clinical practice. To optimize coverage and maintain data contribution over time, registry participation needs to create maximal benefits, yet impose minimal burdens, on clinical sites. In the experience of the Australian Dementia Network (ADNeT) Registry, it has been the unique insights that clinicians obtain into their own diagnostic practices that has incentivised ongoing participation. The ADNeT Registry collects data primarily to measure the quality of diagnosis and clinical care provided to people with either mild cognitive impairment or dementia and was pragmatically designed to be utilized in multiple diagnostic settings and by different clinical craft groups. Clinicians enter a brief minimum dataset, based upon routine clinical data, at the time of diagnosis. These data are augmented by the ADNeT Registry’s collection of patients and/or carer-reported experience and outcome measures and will be further augmented by planned linkage with administrative datasets. By January 2024, the ADNeT Registry had collected data on over 4000 participants, from 66 sites, had issued 4 benchmarked site reports, and published 2 annual reports. Of this cohort, 75% of people with dementia had an AD subtype. At the national level, considerable variation exists in diagnostic time intervals, and in the use of functional neuroimaging and biomarkers. At the individual site level, clinicians report regularly comparing their individual data against Registry benchmarked data to review, and if some cases, improve, their diagnostic approaches. The Registry’s explicit focus on supporting clinicians is further enhanced by broader achievements of ADNeT, including the publication of memory clinic guidelines, streamlined processes for accessing clinical trials, and appropriate use recommendations for DMTs. Collectively, ADNeT and the ADNeT Registry provides a strong foundation for additional data capture on DMT prescription, safety, and outcome measures, with a design that helps ensure that collected data are truly reflective of the “real-world”.

The Australian Dementia Network (ADNeT) is a collaboration of dementia researchers and clinicians established in 2018. It includes a clinical quality registry that reports on diagnosis and early management of people with dementia or Mild Cognitive Impairment (MCI) across public, private, metropolitan and rural settings. Australia is multicultural and the registry collects information regarding cultural and linguistic diversity (CALD). The aim of this study was to determine if CALD status was associated with time to dementia diagnosis. ADNeT registry data from March 2020 – Sept 2023 were analysed. Primary endpoint was time to diagnosis for three groups based on CALD status and preferred spoken language: non-CALD; English-speaking CALD; and non-English-speaking CALD. Descriptive statistics, univariate and multivariate regression analysis were undertaken for five outcome measures: (1) time from referral to diagnosis (2) time from referral to first appointment, (3) time from first appointment to diagnosis (4) age at referral, and (5) diagnostic outcome (dementia vs MCI). Of 3,634 participants, 2,817 (78%) were non-CALD; 451 (12%) were English-speaking CALD and 366 (10%) were non-English speaking CALD. Overall median times were 131 days from referral to diagnosis, 75 days from referral to first appointment, and 28 days from first appointment to diagnosis. Both English and non-English-speaking CALD background were associated with longer time from referral to diagnosis (154/158 days vs 123 days for non-CALD), and longer time from first appointment to diagnosis (46/70 days vs 18 days) (p<0.001), remaining significant after adjusting for demographic/health factors. There was no association between CALD and time from referral to first appointment. Non-English-speaking CALD background was also associated with older age at referral (80 years vs 78/77 years) and a higher likelihood of dementia diagnosis (75% vs 63/65%), although these differences disappeared after adjustment. This large national study shows that cultural and linguistic diversity is associated with delayed diagnosis of dementia, with further research required regarding underlying causes. This has important implications for equity of care as it may preclude people from CALD backgrounds accessing novel disease modifying treatments. People from CALD backgrounds may specifically benefit from dementia diagnostic biomarkers to facilitate earlier diagnosis.

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.

OBJECTIVES:This study investigated the predictors of poor mental health outcomes among family carers of residents after transitioning into residential aged care. METHODS:Using a cross-sectional design, five groups of variables were evaluated as predictors: caregiver demographics; caregiving load; resident-related variables; loneliness and visiting frequency; and the impact of the COVID-19 context. A total of 309 primary family contacts of all residents of two residential aged care organisations in the state of Victoria (Australia) participated in the study (response rate 19%). The K-10 and the Burden Scale for Family Caregivers were used to measure the primary outcomes. We compared psychological distress and burden outcomes between carers whose relative was admitted within the last 12 months, or longer than 12 months ago. RESULTS:Time since admission (<12 months or >12 months) did not affect the level of psychological distress (t (238) = -.08, p = .94) or subjective burden (t (245) = -.89, p = .38). Being a woman, a spouse, speaking a language other than English at home, being less satisfied with the support offered by the facility, not feeling supported in the decision to admit their relative, being lonely and providing higher levels of care preadmission were predictors of poor mental health outcomes. CONCLUSIONS:Older women with low-English proficiency who were primary carers and are socially isolated, are more likely to experience poor mental health outcomes and need additional support. These findings may inform the development of screening tools and tailored interventions to support this population during and after the transition process.

OBJECTIVE:Sub-optimal care of people living with dementia has serious consequences for older populations. The 2021 Australian Royal Commission noted that a large proportion of older adults in aged care live with dementia, yet there are limitations in the knowledge and understanding of staff who care for them. In the pursuit of educating pharmacists, physicians, allied health care professionals, researchers, academics, people living with dementia and their carers, and the public, who are facing the challenges of dementia management, the 'Best Practice in Dementia Health Care' conference was held on November 10, 2022 at Western Health (Sunshine Hospital, Melbourne, Australia). METHODS:Sixteen experts presented on the current practice and challenges associated with delivering best practice dementia health care to older Australians, often highlighting how medication-related challenges impacted on their area of practice. RESULTS:Presenters highlighted the importance of individualised medication management plans, considerations of culture and Indigenous communities, the role of technology, and the impact of exercise and the physical environment on care of people living with dementia. Key clinical practice messages from each expert presenter fit into four main topics: 'navigating complexities of medication management'; 'enhancing wellbeing'; 'supportive settings and environments'; and 'programs and services improving care'. CONCLUSIONS:Pharmacists are crucial members of allied health care teams. They have the necessary medication and comorbidity expertise to review medication regimens, liaise with all health care providers, and provide holistic, pharmacological and non-pharmacological patient education. Towards providing best practice dementia health care, pharmacists can contribute in several ways, such as providing health practitioner education to increase understanding about medications and how they can impact on allied health practice, to ensure that medications are prescribed appropriately and safely. Further, pharmacists can make available resources to ensure people living with dementia receive culturally safe and appropriate care, while advocating for greater understanding of the history and experiences of people living with dementia to ensure care aligns with their day-to-day routines. Finally, pharmacists can provide peer-support to other health care professionals and care staff to ensure optimal management of behavioural and psychological symptoms of dementia. The information and insights shared at the conference can serve as a valuable resource for pharmacists and other health care professionals and researchers working to improve the lives of those living with dementia.

There is a growing demand for interpreter-mediated cognitive assessments for dementia. However, most interpreters lack specialist knowledge of dementia and cognitive assessment tools. This can negatively affect the way instructions and responses are conveyed between clinicians and patients, undermining clinicians' ability to accurately assess for cognitive impairment. This article reports on the co-design of an online dementia training package, MINDSET, which aims to address this gap. Two iterative online co-design workshops were conducted in October and November 2021, using a World Café approach. Sixteen clinicians, interpreters, and multilingual family carers of a person with dementia participated. Based on these workshops, training and assessment materials were developed and tested with 12 interpreters from April to June 2022. The training package comprises online modules: 1) Knowledge of Dementia and Australia's Aged Care System, 2) Briefings and Introductions, 3) Interpreting Skills, 4) Interpreting Ethics, and 5) Cross-cultural Communication. The codesign process highlighted divergent perspectives between clinicians and interpreters on an interpreter's role during a cognitive assessment, but it also facilitated negotiation and consensus building, which enriched the training content. The training is now developed and will be evaluated in a randomized control trial and subsequent implementation study.

OBJECTIVES:Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. 'One-stop' cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one-stop State-wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas.METHODS:A novel single-visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross-sectional evaluation was undertaken using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry.RESULTS:Over the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas.EFFECTIVENESS:98.5% (128/130) received a same-day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients.IMPLEMENTATION:Nearly all 'ideal' diagnostic clinical practices were met and >90% of surveyed patients reported 'good/very good' clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days).CONCLUSIONS:This 'one-stop' model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.

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.

In 2018, the Australian Dementia Network (ADNeT) was established to bring together Australia's leading dementia researchers, people with living experience and clinicians to transform research and clinical care in the field. To address dementia diagnosis, treatment, and care, ADNeT has established three core initiatives: the Clinical Quality Registry (CQR), Memory Clinics, and Screening for Trials. Collectively, the initiatives have developed an integrated clinical and research community, driving practice excellence in this field, leading to novel innovations in diagnostics, clinical care, professional development, quality and harmonization of healthcare, clinical trials, and translation of research into practice. Australia now has a national Registry for Mild Cognitive Impairment and dementia with 55 participating clinical sites, an extensive map of memory clinic services, national Memory and Cognition Clinic Guidelines and specialized screening for trials sites in five states. This paper provides an overview of ADNeT's achievements to date and future directions. With the increase in dementia cases expected over coming decades, and with recent advances in plasma biomarkers and amyloid lowering therapies, the nationally coordinated initiatives and partnerships ADNeT has established are critical for increased national prevention efforts, co-ordinated implementation of emerging treatments for Alzheimer's disease, innovation of early and accurate diagnosis, driving continuous improvements in clinical care and patient outcome and access to post-diagnostic support and clinical trials. For a heterogenous disorder such as dementia, which is now the second leading cause of death in Australia following cardiovascular disease, the case for adequate investment into research and development has grown even more compelling.

OBJECTIVES:This study investigated attitudes towards dementia among Chinese immigrants aged 50 years and over living in Australia and compares these attitudes with those of individuals living in mainland China. It aimed to better understand what older Chinese adults think about dementia and to inform the development of tailored dementia-related services for this group of people. DESIGN:A qualitative design involving individual interviews was employed in this study. PARTICIPANTS:Forty-six participants were recruited: 21 in Melbourne and 25 in Beijing. All interviewees were born in mainland China, were community-dwelling, and did not have a dementia diagnosis. MEASUREMENTS:The tripartite model of attitudes was used to guide the semi-structured interview design and report the results. Thematic qualitative analysis was employed. RESULTS:In both groups, most participants held negative feelings, stigmatized views and negative stereotypes of dementia. However, most participants expressed a willingness to help individuals living with dementia. Regarding dementia care, nearly all participants preferred home care but thought formal care would become the mainstream form of care in the future. Fewer Melbourne participants expressed concerns regarding developing dementia, were interested in dementia, or perceived a need for dementia-related educational activities. Melbourne participants also reported more avoidant responses to dementia or individuals living with dementia. CONCLUSION:This study carefully compares attitudes towards dementia between older Chinese immigrants in Melbourne and older Chinese adults in Beijing. Similarities and differences were observed between these two groups. Dementia-related service providers should consider the sociocultural changes and migration-related barriers experienced by Chinese immigrants.