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Partnership Centre: Dealing with Cognitive and Related Functional Decline in Older People

On 9 April 2013 the Minister for Mental Health and Ageing, Mark Butler, launched the first Partnership Centre on the theme of ‘Dealing with Cognitive and Related Functional Decline in Older People’. View the Media Release about this launch here.

Over five years the Centre will be jointly governed and supported to the value of $25 million by NHMRC and its partners: HammondCare (NSW), Helping Hand Aged Care (SA), Brightwater Care Group (WA) and Alzheimer’s Australia.

This Partnership Centre’s Chief Investigator, Associate Professor Susan Kurrle of Hornsby Ku-ring-gai Hospital, will lead an Investigator Team in improving the management and treatment of people with cognitive decline, building the capacity of the aged care sector, and strengthening the support systems for carers of older people with cognitive and related functional decline.

The Theme: ‘Dealing with Cognitive and Related Functional Decline in Older People’

Forty years from now in 2050 the scale of cognitive decline and its functional sequelae will dwarf almost all other social issues facing Australia. Instead of today’s 400,000 over the age of 85 there will be 1.8 million. There will be 3.5 million Australians – nearly ten percent of the population – in need of aged services, with dementia and other forms of cognitive decline representing the lion’s share of that need. Spending on aged care will consume nearly 2% of GDP but instead of the current five workers per person over 65 generating wealth there will only be 2.7.1

While physical ailments among the elderly tend to receive the lion’s share of attention it is the burden created by cognitive decline that is the hidden time-bomb. While some of this burden falls upon formal systems of caring and state forms of support, most lands on the shoulders of spouses, peers, volunteers, charities and the like. In the most optimistic outcome we will uncover a cure and/or effective preventive strategies for the various dementias that afflict the elderly (and, tragically, some of the young). However, even with this optimistic outcome there will be many who still suffer from the inevitable decline of cognitive capacity and related functional abilities that comes with age. The focus of this Partnership Centre is, therefore, on how to better apply our existing knowledge and how to create new knowledge that will directly improve our support to those elderly suffering from cognitive decline, their carers (formal and informal) and the various agencies delivering services for them.

Major Activities

  • Activity 1: Understanding the real cost of long-term care models for older people with cognitive decline

For this activity, researchers will develop a theoretical ‘efficient price’ for residential aged care in Australia which will then be tested and modelled in real services and among a selected cohort of residents (450) with cognitive decline.

  • Activity 2: Implementing the Confused Hospitalised Older Persons Study (CHOPS) model to improve outcomes for people with cognitive decline

The 12-month CHOPS pilot in NSW was successful in improving care for people with cognitive decline in hospitals, particularly in relation to delirium. This activity will expand the program, firstly in NSW and then in WA and SA.

  • Activity 3: The key worker role for people with dementia and their carers

This activity will evaluate current models of key workers for people with dementia in Australia and conduct a systematic review of international evidence. The findings will then be used to develop recommendations to inform policy and practice around the implementation of key worker models.

  • Activity 4: Prototyping alternative respite models for older people with cognitive decline and their carers

This activity will test two alternative respite models for people with cognitive decline that have already been developed based on a comprehensive literature review and through a service co-creation process.

  • Activity 5: Systematic review and scoping study for the implementation of a national approach to dementia specific advance care planning

This activity will review existing literature to identify and evaluate existing models (processes, documentation, and implementation/evaluation strategies) for advance care planning for people with dementia in multiple aged care/health settings. A composite national approach will then be developed and disseminated throughout Australia.

  • Activity 6: The policies and practices of financial institutions around substitute decision making

This pilot activity in NSW will identify common problems with substitute decision making instruments for people with cognitive decline. Based on these findings, an education package will be developed for banks and credit unions, while financial literacy packs for older people will be updated. If successful, the intervention will be expanded throughout Australia.

  • Activity 7: The effects of regulation on aged care services for people with cognitive decline

This activity will review the effects on care (both positive and negative) of three particular areas of regulation (identified through a survey of aged care leaders). Alternative regulatory models will then be developed and tested to make recommendations for evidence-based regulations that promote high-quality care.

  • Activity 8: Living with dementia in the community: assessing the risks

This activity will simplify and adapt an existing framework from the UK for assessing the physical and psychosocial risks for people with dementia who live in the community. The new tool will then be evaluated from the perspective of people living with dementia, their carers and various professionals who work with them. Following the evaluation and any necessary changes, the tool will be promoted and disseminated nationally.

  • Activity 9: Evaluating the outcomes of interprofessional education programs in residential aged care

This activity will evaluate existing models for interprofessional student (including medicine, pharmacy, physiotherapy, occupational therapy, nursing and speech therapy) placement programs in residential aged care that have been developed by centre partners. The project will measure how these programs affect hospital admissions for older people with cognitive decline.

  • Activity 10: Improving quality of residential dementia care and promoting change by supporting and caring for staff

This activity will review current literature to examine the relationship between staff variables (such as attitude, wellbeing, skills, knowledge, personality and dementia literacy) and quality of care/resident wellbeing. It will then develop two interpretive reviews: one explaining how good support for staff leads to better care; and the other developing methods and interventions for improving support for care staff in residential aged care.

  • Activity 11: Optimising the quality use of medicines for people with cognitive and related functional decline

This activity will synthesise existing research and literature to and determine which quality use of medicines tool(s) would benefit older people with cognitive decline. The identified tools will then be trialled in hospital and aged care settings in three states.

  • Activity 12: Focus on the implementation of the universal use of Vitamin D supplements in Australian RACFs

This activity will implement a Vitamin D medication regime (which has been introduced as policy in New Zealand) in 15 randomised facilities to measure the effect it has on falls (related functional decline) among people with dementia. This activity will also measure adherence to the ‘policy’ to, serving as a case study of the effect of introducing new policies/regulations in residential care.

  • Activity 13: Review international dementia guidelines and synthesise to develop national Australian guidelines

This activity will establish new national clinical guidelines for dementia in Australia, based on a review of international dementia guidelines and state health service plans for dementia. The guidelines will follow the NHMRC Standards for Clinical Practice Guidelines and will include an implementation plan and a training package. The guidelines will focus on primary care, early diagnosis and acute hospital care.

  • Activity 14: Development and implementation of a consensus guide on dementia in primary care

This activity will update the 2003 Australian guidelines on dementia in primary care, based on a review of international guidelines and current literature. Following the update, a series of forums will be held with GPs, primary care nurses and consumers (and their carers) at six primary care clinics throughout Australia to obtain feedback on how to translate the guidelines into a user-friendly decision aid. The guidelines and associated tools will then be disseminated at 6-10 target sites which will help develop broader implementation principles.

1 Data from: Productivity Commission 2011, Caring for Older Australians, Report No. 53, Final Inquiry Report, Canberra

Page reviewed: 13 June, 2013