New resources for the healthcare professional

Working with carers training package
This training package is for workers to gain a broader awareness of carers, their needs, and strategies for supporting them. The training package includes 5 sections; Carers in society; Why support carers?; Who are carers?; The caring experience, and; How to support carers.



Planning for palliative dementia care : a resource kit

The resource kit for ACH Group staff provides valuable support and resources for staff to assist in supporting choices for people with dementia and their families.

Exercise & physical activity : your everyday guide

Exercise & physical activity : your everyday guide from the National Institute on Aging

Regular physical activity over long periods of time can produce long-term health benefits. That’s why health experts say that older adults should be active every day to maintain their health. In addition, regular exercise and physical activity can reduce the risk of developing some diseases and disabilities that develop as people grow older. In some cases, exercise is an effective treatment for many chronic conditions. For example, studies show that people with arthritis, heart disease, or diabetes benefit from regular exercise. Exercise also helps people with high blood pressure, balance problems, or difficulty walking. One of the great things about physical activity is that there are so many ways to be active. For example, you can be active in short spurts throughout the day, or you can set aside specific times of the day on specific days of the week to exercise. Many physical activities — such as brisk walking, raking leaves, or taking the stairs whenever you can — are free or low cost and do not require special equipment

New resources for carers of people with dementia

Driving and progressive dementia

The purpose of the series of educational sessions called Driving and Progressive Dementia is to describe briefly issues of driving safety especially as driver skills change in people who have declines in memory and thinking functions. There are three sessions. Session one: Safe driving focuses on the importance of the driver who may be undergoing general health changes and ways to stay safe when operating a motor vehicle. Session two: Safe driving and mild cognitive impairment focuses on the driving issues related to the person who is having some mild short-term memory problems and perhaps some very early signs of occasional difficulty in other thinking functions, but appears to be functioning normally on a daily basis. Session three: Safe driving and Alzheimer’s disease or a related dementia (memory disorder) focuses on the driving issues related to the person who is dealing with a diagnosis of Alzheimer’s disease or a related progressive memory disorder.

Volume 1: Managing the difficulties of mealtime : Volume 2: Overview of Alzheimer's disease ...

looks at: Appetite, digestion and hydration; Pain, medication, & medical conditions; Cognitive changes; Behavior: wandering, pacing and restlessness; Behavior: aggression, depression and apathy; Social, cultural and environmental factors.

School days and early days : growing up in Australia mid 1920s to late 1930s

Includes:
Around our school; Bands & marching & music!; Bath night; Battle of the sexes; Billycarts; Birds & bees; Boarding; Collecting; Comics & annuals; Country teaching; Discipline; Empire Day; Friendship --Fun in the water; Games; Getting around; Grandparents; Guides & scouts; Health; Holidays; Home help; Home-based teaching; Institutional care; Keeping up appearances; Maiden aunts; Making models; Matinee memories; May Day; New chums; On state & the ‘Big Top’; Organised sport; Picnics; Reading; Secular v denominational?; Serial listeners; Showtime!; Silent stars; Sporting heroes; Sunday stories; Swaggies & the ‘Susso’; Uniforms; Wattle Day;

• Suggestions for building on your kit

2007 Progress report on Alzheimer's disease: discovery and hope
A variety of scientific disciplines must collaborate if we are to understand the genetic and environmental influences, including lifestyle and health factors, that may increase or decrease an individual’s risk of developing cognitive decline, amnestic mild cognitive impairment, or AD

Australian Ageing Agenda - July August 2009

Dementia care gap
In just 2 decades there will not be enough cares to support people with dementia, according to new research conducted by Alzheimer’s Australia and Access Economics…see full report www.alzheimers.org.au p.9

Community care feeling the squeeze
As demographic pressure tightens on the thinly spread resources in community aged care, the nature of those services is going to have to adapt…Data from NATSEM 2004
Between 2001 and 2031 the number of carers over 65 will grow by 91000 or 110%
The number of older people with a severe or profound disabilities is projected to grow from 539000 in 2001 to 1390000 in 2031 and increase of about 160%
In 2031 it is expected that there will be on 35 primary carers for every 100 older people requiring care currently the ration is 57:100 page 25

When quality hits home
as the community aged care sector continues to mature the complicated and controversial issue of quality and reporting for home care deepens…the standards:
the draft common standards are based on existing HACC standards and were endorsed by the Community and Aged Care Officials (CACO) 2008, the standards cover:
Efficient and effective management
Access to Services
Information and Consultation
Coordinated, planned and reliable service delivery
Privacy, dignity, confidentiality and access to personal information
Complaints
Advocacy …p. 27

Where to next? Consumer control in OZ
Global attention has turned to consumer directed care to offer more choice to clients and as a cost effective way of expanding community based care- we look at what the future of consumer directed care will look like in Australia…p. 32

Making connections - report on an innovative program that helps re-connect carers and family members with the community…p. 34

Dementia Supplement
the Dancing Way - the agitation which is often expressed by people with dementia can be stressful and debilitating for both the individual and the carers. A small trial of an alternative form of dance therapy by Alzheimer’s Australia WA has produced encouraging results… p. 36
Enabling care
Three of Australia’s leading dementia academics are collaborating on a project which will measure the benefits of person centred care and change of practice…p. 37

Randwick revisited: Montefiore masterpiece continues to impress
in 2006 AAA brought readers a story about a visionary not-for-profit provider that was transforming traditional models of residential care aged care through its brand new flagship facility in Sydney’s east. Montefiore employs what it calls the ‘neighborhood’ model of care and it works by:
Dividing large areas into smaller, more home like units - known as neighborhoods
Assisting residents with orientation (using visual prompts and signage, memory boxes and other cues
Ensuring team leaders within each neighborhood understand the care needs of the residents and coordinate the care teams maximizing care outcomes
Tailoring the skills of the care team to suit the residents
Neighborhoods supporting the streaming of residents into areas with other residents who have similar or complimentary care needs
Helping to facilitate team work, build staff morale and encourage pride and friendly competition between neighborhoods… p. 39

Law
Exercising restraint
looks at the legal complexities surrounding the use of restraints for people with cognitive impairments…restraints must be used as a last resort and when used, must be at the minimum amount to restraint to manage the situation…p. 44

Clinical Governance
Beyond box-ticking- as we learn the language and adopt the systems of clinical governance in aged care we need to ensure strong connections between bureaucracy and the bedside…looks at the processes and outcomes…p. 48

Technology
Mission implementation
looks at the people side of implementing technology solutions in aged care…’ask dumb questions’ conduct an analysis of the outcomes and requirements that the new system will be expected to deliver; ‘debates are good’ and ‘two-way training’ …p. 5

Continence
H.E.L.P for IAD - despite the devastating effect it can have, there is little hard evidence concerning how best to avoid and treat incontinence associated with dermatitis - article explores the ‘best’ advice that is currently available…p. 54

Alzheimer's & Dementia: The Journal of the Alzheimer's Association

May 2009 No. 3, p199

• The pattern of cognitive symptoms predicts time to dementia onset,
  Few studies have examined whether cognitive symptom patterns differ by age and length of time before dementia onset. Our objective was to investigate whether different patterns of cognitive symptoms at ages 70, 75, and 79 years predict short-term (≤5 years) and long-term (>5 years) dementia onset.
  Conclusion: A global pattern of low cognitive performance predicts short-term but not long-term onset of dementia, whereas isolated low memory performance predicts dementia only in the long-term. Our findings also suggest that preclinical symptoms of dementia might differ by age
  pages 199-206

• Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: The ARIC MRI Study, Atherosclerosis Risk in Communities Study Brain MRI Study
  Background
  Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited.
  Objective
  We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age.
  Conclusions
  The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE ɛ4 genotype independently contribute to cognitive decline in late middle age and early elderly years....pages 207-214

• Early identification and treatment of Alzheimer's disease: Social and fiscal outcomes
  Background: Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long-term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare-funded caregiver support programs.
  A Monte Carlo cost-benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government.
  Conclusions: These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound.
  pages 215-226

• Prevalence rates for dementia and Alzheimer's disease in African Americans: 1992 versus 2001
  Background
  This study compares age-specific and overall prevalence rates for dementia and Alzheimer's disease (AD) in two nonoverlapping, population-based cohorts of elderly African Americans in Indianapolis in 2001 and 1992.
  Conclusions
  We found no differences in the prevalence rates of dementia and AD between 1992 and 2001, despite significant differences in medical history and medical treatment within these population-based cohorts of African American elderly.
  pages 227-233

• 2009 Alzheimer's disease facts and figures Alzheimer's Association
  Alzheimer's disease (AD) is the sixth leading cause of all deaths in the United States, and the fifth leading cause of death in Americans aged 65 and older. Whereas other major causes of death have been on the decrease, deaths attributable to AD have been rising dramatically. Between 2000 and 2006, heart-disease deaths decreased nearly 12%, stroke deaths decreased 18%, and prostate cancer-related deaths decreased 14%, whereas deaths attributable to AD increased 47%. An estimated 5.3 million Americans have AD; the approximately 200,000 persons under age 65 years with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050, this time is expected to decrease to every 33 seconds. Over the coming decades, the “baby-boom” population is projected to add 10 million people to these numbers…This report provides information meant to increase an understanding of the public-health impact of AD, including incidence and prevalence, mortality, lifetime risks, costs, and impact on family caregivers. This report also sets the stage for a better understanding of the relationship between MCI and AD. pages 234-270

• Concordance rates for cognitive impairment among older African American twins
  Background
  There is significant attention to the growing elderly African American population and estimating who and how many within this population will be affected by cognitive impairment.
  Conclusions
  The study findings indicate that cognitive impairment is highly heritable, suggesting that genetics may play a relatively large role in the development of cognitive impairment in African American twins. pages 276-279

• Commentary on Low and Anstey: Cross-cultural findings and insights
  Current work focuses investigating dementia literacy in population samples of Australian residents from Italian, greek and Mainland Chinese backgrounds…. pages 280-281

• Early detection
  The Alzheimer’s Association has kicked off its Know the 10 Signs: Early Detection Matters campaign, a multi-faceted national education effort to increase awareness of the 10 warning signs of Alzheimer's and the benefits of early detection and early diagnosis. Early detection, diagnosis and intervention are vital because they provide individuals the best opportunities for treatment, support and planning for their future. page 285

Working with Aboriginal people and communities : a practice resource

• Working with Aboriginal people and communities : a practice resource

This resource will help us become more culturally aware and responsive to the needs of Aboriginal people and communities. Working with Aboriginal people and communities provides important information to improve our knowledge and understanding of the diverse cultural dynamics that exist within Aboriginal families and communities. It suggests some engagement and communication strategies that will improve the way we work with and relate to Aboriginal people.

Also see our reading lists

- Indigenous Health Issues

- Indigenous dementia resources

Journal of Dementia Care - May/June 2009 Vol 17, No 3

May/June 2009 Vol 17, No 3

• Creative activities
  Magic across the generations
  Two innovative Magic Me projects that bring young and older people together in care homes
  Magic me projects -
  Are fun, creative and educational with a positive lasting impact on participants
  Raise awareness about the needs of older people and help combat isolation
  Brings people from diverse sections of the community together
  Addresses prejudices about ageing, young people and cultural differences
  Involve participants in planning and developing activities p. 22

• Diagnosis and support
  Out of the shadows: attending to its message
  Article spells out important messages from people with dementia and their carers on coping with dementia and diagnosis, drawn from research conducted last year by the Mental Health Foundation for the Alzheimer’s Society …”a key role practitioners culd usefully perform would be to learn about the coping mechanisms and strategies described in this and other research, and share them with people with dementia and their cares… ‘ p. 26

• Design
  ‘They’ve thought of everything’
  Reports on a visit to The Lodge: a new care home in Lancashire with a reputation for attention to detail in its design… p. 28

• Design
  Auditing design for dementia
  This article explains how and why Stirling University’s Dementia Services Development Centre have developed a new audit tool for evaluating design in dementia care environments
  p. 31

• Care practice
  Measuring well-being when it matters most
  Article explains how profiling one resident’s well-being prompted staff to try a fresh approach to her care in the final days of her life…p. 32

• Research
  Ambitious study of complex interventions
  The findings of the Centre for Aged Dementia Care Resident Study (CADRES) and reflects on the research, its background and implications… main results were;
  Levels of agitation increased in ‘usual care’ homes
  Levels of agitation had decreased in person centred care homes
  Levels of agitation did decrease significantly in DCM homes over time but levels of agitation were significantly lower at follow up than the usual care homes
  The proportion of residents experiencing falls decreased significantly in the DCM homes at follow up…p.37

• Medicines and people with dementia
  5. Antipsychotics: what are the facts?
  Article attempts to clarify some best practice principles - looks at when to use, how they act, side effects, using antipsychotics wisely… p.10

• Memory clinic networks: helping professionals thrive
  We explain what has been involved in getting the West Midlands memory clinic network up and running…p 11

• Just Checking: lessons three years on
  Looks at lessons from the first years of using the Just Checking monitoring system:
  People living with early to moderate dementia are generally managing better than expected in their own homes
  Observations of how a person is using the space in their own home throughout a 24 hour period is surprisingly powerful information
  Older people are often more active than expected when they are alone in their own home
  Wandering or leaving home unsafely is over reported
  Sharing the activity data with family cares helps collaboration, reassures families and brings confidence in the care package……p.12

• Accept people as they are
  Looks at concerns about the emphasis on positive emotions in dementia care…p.15

• Valuing the contribution of people with dementia
  Looks at how we can ensure that the contribution of people with dementia is valued in a way that promotes, rather than discourages, their participation…p.16

• Hearing the voice of those who work in dementia care
  Person-centred principles must be applied to staff working in dementia care, article describes Dementia Care Matters’ Nurturing approach…p. 18

• Environments that help, not hinder
  We describe a project that has worked hard to improve a continuing care ward by displaying a range of art works…p. 21
  

Interested in staying power and other interesting topics

Staying power : tips and tools to keep you on your feet

The key to healthy ageing is to adopt a positive, confident attitude and to stay connected to your community. It is essential to keep your independence, especially as you approach that stage of life when you can fall more easily. Staying power: tips and tools for keeping you on your feet gives practical and inspirational advice on how to prevent falls in your life. Through a combination of exercise and a healthy, active approach, you can beat what seem like inevitable outcomes of getting older.



The anti-anxiety workbook : proven strategies to overcome worry, phobias, panic, and obsessions

Recent breakthroughs in the study and treatment of anxiety are empowering countless people to find relief from chronic fears, worrying, phobias, and obsessions. This inviting workbook shows how.



A special place : caring for a parent with Alzheimer's - the journey

Susan's insightful sayings are included throughout the book. Susan's father, Merv, was a gentle man with a great big heart and even bigger hugs. This book spans their final four and a half years together. Beginning her career as storyteller and puppeteer in 1978, Susan is a great believer in partaking of substantial doses of the arts for healing and peace.




Understanding dementia : multilingual : English captions

English captions includes descriptive subtitles for the hearing impaired.Multilingual edition: English, English captions, Arabic, Cantonese, Croatian, Greek, Italian, Khmer, Macedonian, Mandarin, Polish, Serbian, Spanish, Vietnamese

Books for the healthcare professional

• Paid care in Australia : politics, profits, practices
• Effective communication : a workbook for social care workers
• The end-of-life namaste care program for people with dementia
• A palliative care approach to dementia
• Art is communication : art, art therapy and art activities

see our reading lists on Art Therapy, Communication or Palliative care

Journal of Gerontological Nursing

Vol. 35 No. 6 June 2009

Guest Editorial The Future of Health Care: Balancing Patient Care with (Reasonable) Profit excerpt During my 26 years of practicing nursing, I have frequently been baffled and frustrated by (and at odds with) administrators who seemed to lack compassion for others and make self-serving decisions that were detrimental to patients. As a clinician, I understood that administrators had to deal with nonclinical responsibilities such as budgets and staffing, but it often seemed as if they had forgotten that our ultimate goal was patient care. p. 3

Feature Articles
Positive and Negative Neuroplasticity: Implications for Age-Related Cognitive Declines Cognitive complaints and declines increase with age, which can interfere with everyday functioning and quality of life for older adults. With the increasing number of older adults, the need to promote successful cognitive aging will grow. Nurses, as health educators, will be increasingly called on to provide patients with information on how to avoid cognitive problems and accentuate cognitive abilities. This article provides some of the basic principles and ways of facilitating successful cognitive aging, such as positive and negative neuroplasticity and cognitive reserve, that can be incorporated into nursing education. 1.Neuroplasticity refers to the brain’s ability to change in response to environmental stimuli 2 Novel experiences promote positive Neuroplasticity as observed by the increase in connections between neurons 3 Methods of building up Neuroplasticity include mental stimulation and intellectual pursuits, exercise, proper nutrition, proper sleep hygiene and cognitive remediation. p. 11

Promoting Evidence-Based Dysphagia Assessment and Management by Nurses The Ottawa Model of Research Use guided the Hospital Elder Life Program nursing staff at a community hospital in promoting dysphagia assessment and management. The effect of an educational program and educational outreach on nurses’ knowledge retention and nurse-initiated speech language pathology (SLP) referrals were assessed. The sample consisted of 122 nurses. Repeated measures analysis of variance demonstrated significant differences among the pretest and posttests immediately after and at 2 and 6 months later (F[3,70] = 10.126, p 28

Incidence and Duration of Urinary Catheters in Hospitalized Older Adults: Before and After Implementing a Geriatric Protocol This study examined the incidence and duration of urinary catheters in acute care older adults before and after the implementation of a protocol developed to make clinicians aware of the appropriate use of catheters and the parameters for catheter removal. A total of 187 patients (99 pre-intervention, 88 post-intervention) age 65 and older admitted to a community hospital were assessed for the insertion of an indwelling urinary catheter using retrospective record review. A significant reduction was found in the incidence of indwelling urinary catheters in the post-intervention sample (from 33% to 15.3%, p = 0.006). There was a 20.4% reduction in the mean duration of urinary catheterization (from 4.9 days to 3.9 days). The catheter device-days were significantly reduced. p. 35

Enhancing Relationships in Long-Term Care Through Story Sharing Relationships

Between staff and residents in long-term care (LTC) are foundational to quality of life and high standards of care. Although nurse aides (NAs) provide more than 80% of personal care to nursing home residents, little research has focused on the NA-resident relationship or how NAs come to know and connect with their residents. This interpretive phenomenological study explored how a Story Sharing intervention initiates and enhances this relationship. Following the Story Sharing intervention, 84 volunteer NAs and 54 residents in six nursing homes were interviewed over a 6-month period. Analysis of these interviews revealed 9 patterns and 25 themes that describe how NAs and residents interact every day, along with innovative NA best practices. One theme, exemplifying a best practice, Restoring the Reciprocity of Care, is given. The findings have been incorporated into an extended Story Sharing Program for all LTC staff. p. 43

see Reading list on Risk reduction
* The brain that changes itself : stories of personal triumph from the frontiers of brain science Norman Doidge (2008)
*Can Alzheimer's Disease be prevented? National Institutes of Health (U.S.)
*It's never too late to change your mind : the latest medical thinking on what you can do to avoid dementia / Dr Michael J. Valenzuela