Deploying Robot-Led Activities for People With Dementia at Aged Care Facilities: A Feasibility Study

OBJECTIVES

To explore the feasibility of deploying robot-led activities for people with dementia living in aged care facilities.

DESIGN

Embedded mixed-methods design.

SETTING AND PARTICIPANTS

Eleven residents (≥65 years) with mild to moderate cognitive impairment were recruited from 2 aged care facilities in Brisbane, Australia.

METHODS

We implemented a novel control logic, "Adam Program," for a human-like robot to provide proactive robot activities for people with dementia. Participants individually participated in a nonfacilitated robot intervention thrice a week for 5 weeks from November to December 2022. We video-recorded each intervention session and quantified participants' visual, behavioral, and verbal engagement. A semi-structured interview was conducted at the end of the 5-week intervention. The treatment fidelity strategies and finances were reported and evaluated. The Bowen feasibility framework guided data analysis into 6 focus areas: acceptability, demand, implementation, efficacy, integration, and practicality.

RESULTS

Based on participants' perceptions, findings demonstrated adequate acceptability and demand for robot-led activities. Findings reported a high level of visual engagement (98.54%) and an increased trend of behavior engagement over 5 weeks. Participants independently communicated with Adam, with most (97.02%) verbal engagements free of human facilitation. The treatment fidelity strategies regarding the activity delivery, intervention received, and intervention skills are provided alongside the equipment expenses, revealing the feasibility of integrating robot-led activities for people with dementia in aged care facilities.

CONCLUSIONS AND IMPLICATIONS

Using human-like robots to independently lead interactive activities for people with dementia at aged care facilities is feasible and acceptable. Although robot-led activities require further improvement, this study explored a practical-driven solution that provided guidelines for developing and implementing robot-led activities in aged care settings. Future studies could replicate similar robot-led activities for further investigation and evaluation. Strategies for multilevel determinants of Adam's implementation based on a context assessment are recommended for future research.

A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study

AIM

The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings.

DESIGN

A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility.

METHODS

Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators.

RESULTS

Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members.

CONCLUSION

Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months.

IMPACT

This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting.

REPORTING METHOD

The authors have adhered to the EQUATOR STROBE Statement.

PATIENT OR PUBLIC CONTRIBUTION

A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

Factors related to nurses' beliefs regarding pain assessment in people living with dementia

AIM

To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia.

DESIGN

A descriptive cross-sectional survey was conducted between July 2022 and April 2023.

METHODS

An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia.

RESULTS

RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge).

CONCLUSION

The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes.

IMPACT

Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia.

REPORTING METHOD

This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

PATIENT OR PUBLIC CONTRIBUTION

RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

Associations between facial expressions and observational pain in residents with dementia and chronic pain

AIM

To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia.

DESIGN

This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021.

METHODS

Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model.

RESULTS

A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified.

CONCLUSION

Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real-time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision-making in clinical practice.

IMPACT

Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence-based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations.

REPORTING METHOD

The study adheres to the CONSORT reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).

Exploring Australian dietitians' experiences and preparedness for working in residential aged care facilities

BACKGROUND

Dietitians are increasingly working in residential aged care facilities (RACF). As such, supporting the RACF dietetic workforce is imperative. This qualitative study explored dietitians' experiences and preparedness for working in RACFs.

METHODS

A qualitative descriptive approach from a non-singular reality relational position was used. Recruitment occurred through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. The interviews included a semi-structured approach. Data were analysed using constant comparison and reflexive thematic analysis.

RESULTS

Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of career experience participated in an interview. Interviews ranged from 25 to 68 min (mean duration, 41 min). Five themes and 14 subthemes were identified. Themes were: (1) joining the aged care workforce was not initially considered a career option, (2) difficulty sustaining satisfaction working in aged care, (3) navigating practical challenges working with residents while prioritising quality care, (4) poor acknowledgement of the dietitian role by staff and (5) grappling with a moral desire to improve the aged care sector.

CONCLUSION

Dietitians face many challenges in fulfilling their role in RACFs, including RACF staff's poor understanding of dietitians' scope and a lack of procedural support for their daily activities. Dietitians report that genuine improvements in their job satisfaction and experiences of older adults require structural reform within the government, beyond their locus of control.

The Role of Self-Compassion, Dispositional Mindfulness, and Emotion Regulation in the Psychological Health of Family Carers of Older Adults

OBJECTIVES

This study explored the role of compassion and dispositional mindfulness in the psychological health of family carers of older adults and tested for potential mediating effects of emotion regulation difficulties and adaptive coping strategies.

METHODS

A sample of 141 family carers of adults aged 65 years or older with chronic conditions completed a cross-sectional survey between July - December 2019. The survey included self-report scales that measured: self-compassion, compassion for others, compassion from others, dispositional mindfulness, depression, anxiety, stress, emotion- and problem-focused coping strategies, and difficulties in emotion regulation.

RESULTS

Path analyses found that increased self-compassion and increased dispositional mindfulness was associated with lower psychological distress, and that this was mediated by reduced difficulties in emotion regulation. The model had excellent fit, explaining 64.8% of the variance in psychological distress, and 52.2% of the variance in emotion regulation difficulties.

CONCLUSIONS

Self-compassion and dispositional mindfulness may help buffer the psychological distress of family carers of older adults, and adaptive emotion regulation is an important mechanism of change in these relationships.

CLINICAL IMPLICATIONS

Interventions that aim to cultivate self-compassion and mindfulness could be clinically useful in reducing psychological distress within populations of family carers of older adults by promoting adaptive emotion regulation.

Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study

BACKGROUND

Pain is a common problem but often undiagnosed and untreated in people with dementia.

AIMS

This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia.

DESIGN

A qualitative study.

SETTINGS/PARTICIPANTS

Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility.

METHOD

Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis.

RESULTS

Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care.

CONCLUSIONS

Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.

Social Support for Physical Activity Over 9 Years in Adults Aged 60-65 Years at Baseline

Physical activity is a leading determinant of health and well-being in older adults; however, participation is low. Social support can significantly influence physical activity uptake and maintenance; however, most research is cross-sectional and does not differentiate among types of support. The current study assessed four types of social support for physical activity reported over 9 years by adults aged 60-65 at baseline (n = 1,984). Data were collected using a mail survey at four time points. Data were analyzed using linear mixed models. The most common type of support was emotional, with 25% of participants reporting this often/very often. Total support for activity declined by 16% across the 9 years (p < .001). Companionship had the greatest decline among types (17%-18%, p < .001). More work is needed to understand the factors contributing to the decline in support and how to enable access to support for physical activity in older adults.

Frequency of Physical Activity Done with a Companion: Changes Over Seven Years in Adults Aged 60+ Living in an Australian Capital City

Objectives:This study examined how often adults 60+ years were physically active with a partner, close family, friends, and neighbors, over 7 years. Methods: Data from 2062 adults living in an Australian capital city were collected using a mail survey at four time points and analyzed using multinomial logistic regression. Results: A partner was the most frequent companion at all time points. From baseline to 7 years, the greatest decline was activity with family 1-4x/month (.79 [.64-.98]) and ≥5x/month (.54 [.36-.80]). There were also decreases in activity 1-4x/month with a partner (OR = .75, [.62-.92]), friends (.55 [.44-.68]), and neighbors (.79 [.64-.98]). Physical activity with friends or neighbors ≥5x/month did not decline. Discussion: Findings extend understanding of physical activity and activity companions among older adults. More research is needed to understand factors contributing to changes in activity done with companions.

Development and validity of a mentally-passive and mentally-active sedentary time questionnaire in nursing college students

Objective

This study aimed to develop and validate a questionnaire to evaluate nursing college students' mentally-passive and mentally-active sedentary time (M-PAST) in China.

Methods

An initial M-PAST questionnaire with mentally-passive and mentally-active sedentary behaviors was developed with content validity undertaken through a consensus panel and pilot test where a convenience sample of six nursing students was recruited to assess the relevance, comprehensiveness, and comprehensibility of the refined questionnaire after expert panelists' responses. A cross-sectional online survey using a self-reported questionnaire was distributed to nursing students by email and then conducted using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity of the M-PAST questionnaire and factor structures. Finally, the criterion validity was examined by exploring the associations between the M-PAST and the IPAQ sitting time, psychological distress, and insomnia.

Results

Eight items regarding learning and leisure were included in the final version of the M-PAST questionnaire. A group of 650 nursing college students in China completed the study. Principal component analysis revealed two factors (i.e., mentally-passive and mentally-active sedentary behaviors), which explained 41.98% of the variance contributing to the questionnaire. The CFA reached the adaptive standard. Cronbach's α ranged from 0.730 to 0.742. The correlations between M-PAST and IPAQ total sitting time were significant (p < 0.01, r = 0.125-0.396). Mentally-passive sedentary time was associated with psychological distress and insomnia (p < 0.01, r = 0.078-0.163), while no significant associations were found in mentally-active sedentary behaviors.

Conclusion and implications for practice

The M-PAST questionnaire appears to be a reliable and valid tool that reported both mentally-passive and mentally-active sedentary behaviors in nursing college students in China. However, future studies may need to further examine its validity among international nursing college students. This study further confirmed that mentally-passive sedentary behavior was positively associated with psychological distress and insomnia. Effective strategies are needed to reduce nursing college students' mentally-passive sedentary time to improve their health and wellbeing in China.

Australian dietitians' confidence in their knowledge and skills working with older adults in aged care: A national survey

AIM

This study aimed to describe dietitians' confidence in their knowledge and skills working with older adults in residential aged care facilities or home care services.

METHODS

A novel, quantitative online survey was distributed to aged care dietitians. Activities, knowledge, and skills areas outlined by the Dietitians Australia 'Older Persons and Aged Care Dietitian Role Statement' were included in the 23-item survey. Likert scales captured participant responses. Median responses (n, %) are presented. Associations between participants' confidence in their knowledge and skills and years of experience working in aged care were explored using Pearson's chi-squared tests.

RESULTS

Dietitians completed the survey (N = 125; age: 40 ± 13 years [mean ± SD]; 97.6% female). Dietitians reported they "always" worked collaboratively (n = 65%, 52%) and 'often' prescribed supplements (n = 52%, 41.6%) and utilised a food-first approach (n = 36%, 28.8%). Dietitians 'sometimes' conducted malnutrition screening (n = 28%, 22.4%), audits (n = 36%, 28.8%), nutrition education (n = 53%, 42.4%) and quality improvement activities (n = 28%, 22.4%). Dietitians 'rarely' utilised food service/standards (n = 38%, 30.4%) and nutrition/hydration procedures (n = 35%, 28.0%). Dietitians with ≥6 years of experience were more confident than dietitians with 0-5 years in providing support programs (p = 0.003), utilising healthcare policies (p = 0.013), interpreting quality assessment (p = 0.014) and communication skills (p = 0.047). Dietitians felt 'completely' or 'fairly' confident in all knowledge and skill areas, except for government and community support programs (n = 38%, 30.4%) rated 'somewhat' confident.

CONCLUSION

Aged care dietitians are confident in most aspects of their role but have opportunities to be better supported. Developing the confidence of higher-level systems and communication in early career dietitians is warranted.

Effects of recorded maternal voice on anthropometric parameters and heart rate in premature infants: A pilot randomised controlled trial

PURPOSE

To explore the benefits of a recorded maternal voice intervention on weight, recumbent length, head circumference, and heart rate of preterm infants in the neonatal intensive care unit.

METHODS

A pilot randomised controlled trial was conducted in this study. Preterm infants in the neonatal intensive care unit (N = 109) were recruited and randomly assigned to an intervention or control group. Both groups received routine nursing care, while preterm infants in the intervention group received a recorded maternal voice program of 20 min, twice daily for 21 days. Preterm infants' daily weight, recumbent length, head circumference, and heart rate were collected during the 21-day intervention. Participants' heart rate in the intervention group was also recorded once a day pre-during-after the recorded maternal voice program.

RESULTS

Preterm infants in the intervention group showed a significant increase in weight (-75.94, 95% CI -108.04, -43.85, P < 0.001), recumbent length (-0.54, 95% CI -0.76, -0.32, P < 0.001), and head circumference (-0.37, 95%CI -0.56, -0.18, P < 0.001) compared with the control group. Preterm infants in the intervention group also showed significant changes in heart rate pre-during-after the recorded maternal voice program. However, no significant differences were found in the heart rate scores between the two groups.

DISCUSSION

The changes in heart rate pre-during-after the intervention may help explain participants' more significant increase in weight, recumbent length, and head circumference.

PRACTICE IMPLICATIONS

The recorded maternal voice intervention could be incorporated into clinical practice to promote growth and development in preterm infants in the neonatal intensive care unit.

STUDY REGISTRATION

Australian New Zealand Clinical Trials Register, https://www.anzctr.org.au/; (registration number: ACTRN12622000019707).

Technology in aged care: a qualitative survey of academic, research, and technology industry professionals

AIMS AND OBJECTIVES

The study's aim was two-fold: (1) to explore the experiences and perceptions of industry, academic, and research professionals concerning technologies used within aged care; and (2) to identify needs-led priorities for the future development and application of technologies within aged care.

BACKGROUND

Global population ageing requires a recalibration of aged care policies, systems, and services to promote and support healthy ageing. It is expected that technology will play an important role in this regard. This study qualitatively assessed the landscape of technology use in aged care from the perspective of industry, academic, and research professionals.

DESIGN

A purposefully designed cross-sectional survey collecting experiences, perspectives, and barriers about technology through open responses.

METHODS

Using convenience sampling, thirty-five participants completed an online survey between April and October 2020. A descriptive qualitative content analysis approach was used to analyse the written responses. Reporting of findings followed the EQUATOR's Standards for Reporting Qualitative Research checklist.

RESULTS

Four themes were identified that characterised the use of technologies within aged care: (1) User Perceptions and Attitudes: wariness and reluctance to technology; (2) Systemic Issues within Aged Care: Under-resourced with opportunities for innovation; (3) Technology-Related Barriers: Equity, costs, privacy, integration, and interoperability and (4) Research Priorities: Co-design and integration of technology.

CONCLUSIONS

The existing technology does not meet the needs of older people, aged care personnel and the system in general, which prevents its successful implementation and uptake.

Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review

BACKGROUND

Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia.

AIM

This review explores the influence of culture on nurses... pain observations experienced by people living with dementia.

SETTINGS

Studies were included regardless of the setting (e.g., acute medical care, long-term care, community).

DESIGN

An integrative review.

PARTICIPANTS/SUBJECTS

PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search.

METHODS

Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

RESULTS

Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation.

CONCLUSIONS

There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.

The Relationship between Social Support for Physical Activity and Physical Activity across Nine Years in Adults Aged 60-65 Years at Baseline

Physical activity is consistently recognized as a key component of healthy aging. The current study aimed to investigate the prospective association between social support specific for physical activity (SSPA) and physical activity across nine years among adults aged 60-65 years at baseline (n = 1984). An observational longitudinal design was used, with mail surveys administered to a population-based sample across four waves. SSPA was measured using a score ranging from 5-25, and physical activity was assessed as time spent in walking, or engaging in moderate and vigorous activity, during the previous week. Data were analyzed using linear mixed-effects models. The results demonstrated a positive significant relationship between SSPA and physical activity, accounting for sociodemographic and health variables. Each unit of increase in SSPA was associated with 11 extra minutes of physical activity per week (p < 0.001). There was a significant interaction between SSPA and wave at the final timepoint, such that the relationship was weaker (p = 0.017). The results highlight the value of even small increases in SSPA. SSPA could be targeted to promote physical activity among older adults, but may be more impactful in young-old adults. More research is needed to understand impactful sources of SSPA, underlying mechanisms between SSPA and physical activity, and potential moderation by age.

Barriers and enablers to embedding fundamental nursing care for older patients-Implications of a mixed methods study for nursing leadership

AIMS

To understand the enablers and barriers for delivering fundamental care to hospitalized older patients.

DESIGN

Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results.

METHODS

Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations.

RESULTS

There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs.

CONCLUSION

The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions.

IMPACT

Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.

Family Involvement in Pain Management for People Living With Dementia: An Integrative Review

This review aimed to synthesize current evidence on family involvement in pain management for people living with dementia from the perceptions of family carers and health care professionals. An integrative review was conducted using CINAHL, Embase, PubMed, PsycINFO and Cochrane Library electronic databases. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by thematic analysis. Twelve studies were included and four themes were identified: (1) The roles and responsibilities of family carers; (2) Enablers and barriers for pain identification; (3) Strategies and concerns for pain management; and (4) Lack of staff education and communication with health care providers. Family carers play an important role in pain assessment and management for people living with dementia, but they cannot be actively involved in this process due to a lack of communication with health care providers. An integrated approach that includes education and communication with family carers and health care providers is needed.

Examining dietitians' knowledge, skills and attitudes regarding working with older adults in residential aged care facilities and home care services: An integrative review

BACKGROUND

The Australian 2021 Royal Commission identified that the dietetic workforce needs to grow in size and capacity to support nutrition care in older adults. However, little is known about dietitians' knowledge, skills and attitudes (KSA) regarding working with older adults in residential aged care facilities (RACFs) or their homes. This review describes dietitians' KSA regarding older adults in RACFs and home care services.

METHODS

A systematic literature search was conducted in August 2021 to identify studies examining any aspect of dietitians or student dietitians' KSA working in RACFs and home care services. No restrictions were applied to methodological design, language, location or publication year. Studies were assessed for quality using the Johanna Briggs Institute Quality Appraisal Tools. Study findings were analysed thematically using meta-synthesis.

RESULTS

All 17 studies that met the inclusion criteria explored dietitians' attitudes towards their role, three studies examined perceived knowledge, although no studies objectively explored dietitians' skill levels. Five themes were developed inductively: (1) recognising their contribution as dietitians; (2) lacking clarity about the boundaries of their role; (3) all team members have a role to play in nutrition care; (4) assumptions and biases about working with older people; and (5) needing to build capacity in the workforce.

DISCUSSION

Dietitians have mixed attitudes about working in RACFs and home care services. Future directions include evaluating dietitians' role in RACFs, reviewing education and training and practical opportunities for student dietitians, and assessing the impact of more dietitian support on an older person's dietary intake and nutrition.

The Impact of Engagement with the PARO Therapeutic Robot on the Psychological Benefits of Older Adults with Dementia

OBJECTIVES

This study aimed to examine the effect of 8-weeks of a 60-minute PARO intervention to reduce depressive symptoms and loneliness in older adults with dementia and investigated changes in their emotional or behavioral expressions and level of engagement with the PARO robot.

METHODS

This was a quasi-experimental study with a repeated measures design. The outcome measures were evaluated at four time-points: before the intervention, week 4, immediately after the intervention, and one month after the PARO intervention.

RESULTS

Fifty-two participants were recruited. The age of the participants ranged from 65 to 96 years, with a mean age of 81.81 years (SD = 8.54) in the PARO group and 79.08 years (SD = 7.71) in the control group. Using a mixed between-within subjects' analysis of variance, the results showed that there were significant interaction effects between the groups and time-periods for depression (p < .000), loneliness (p < .000), and engagement (p < .000).

CONCLUSIONS

The PARO intervention alleviated depression and loneliness for older adults. Furthermore, the process of engagement with PARO may play an important role in the PARO effects.

CLINICAL IMPLICATIONS

A tailored PARO intervention of at least 4 weeks could engender positive psychological benefits for older adults.

Use of technology by people with dementia and informal carers during COVID-19: A cross-country comparison

OBJECTIVES

Considering the adverse outcomes of COVID-19, it is essential to provide adequate support and care for people with dementia and informal carers. Technology can reduce the distress associated with social distancing rules and the decreased access to in-person services. This study aimed to explore the use of technology and its perceived effects across different settings and countries.

METHODS

The sample was composed of 127 informal carers and 15 people with dementia from the UK, Italy, Australia and Poland. Semi-structured interviews explored participants' experiences of using technology and their perceived effects. Transcripts were analysed by researchers in each country using an inductive approach.

RESULTS

Three overarching themes were developed: (1) Technology kept us alive during COVID-19; (2) Remote care was anything but easy; (3) Perceived technology limitations. Many similarities emerged between countries supporting the role of technology for being socially engaged, having a routine, and staying active. However, the benefits of technology for health and psychosocial care were more limited. Across countries, barriers to the access and use of technology included lack of digital literacy, dementia severity, and lack of appropriate digital environments. Help and supervision from carers were also necessary and sometimes perceived as an additional burden.

CONCLUSIONS

Technology can effectively reduce the shrinking world that may be amplified by the pandemic, thus preserving people with dementia's social skills and maintaining family connections. However, for more extensive and well-adapted use of technology in dementia care, actions should be taken to overcome the barriers to the access and use of technology by older and vulnerable people globally.

Consumer and Provider Perspectives on Technologies Used Within Aged Care: An Australian Qualitative Needs Assessment Survey

We undertook a qualitative assessment of aged care technology needs from the perspective of consumers and providers using a cross-sectional survey that assumed a largely open-response format. We recruited a convenience sample of individuals aged 18 years or older, lived in Australia, and self-identified as either an older adult (n = 133), an informal caregiver of an older adult (n = 27), and/or clinician, healthcare practitioner, and aged care provider (n = 148). Survey responses were analyzed using a descriptive qualitative content analysis approach to interpret meaning from written survey responses. We identified seven themes reporting that technologies used in aged care do not appear to be meeting end-user needs. Supporting the Technology Acceptance Model, consumers and providers perceive usefulness of the technology and its actual ease of use as drivers of acceptance toward gerontechnology. Ten recommendations are proposed to support technology use and the quality of aged care.

How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study

The aim of this study was to explore how formal social support changed after implementation of the COVID-19 public health measures and how these restrictions affected people living with dementia and their informal carers in Australia. Sixteen informal carers and two people living with dementia were interviewed between August and November 2020. Participants were asked about their experiences of the pandemic and the impact that the restrictions had on their lives and care. Thematic analysis identified four overarching themes describing (a) prepandemic limitations of the aged care system, (b) the aged care system's response to the COVID-19 restrictions, (c) changes affecting informal carers, and (d) the challenges faced by people living with dementia. The findings highlighted the challenges faced by the Australian aged care system before the pandemic and the additional burden placed on informal carers who supported people living with dementia across residential and home settings during the pandemic.

Family carers' expectations regarding dementia care services and support in China: A qualitative study

INTRODUCTION

In China, approximately 85% of people with dementia are cared for by family carers. However, limited research has been conducted to examine family carers' expectations regarding what they perceive is required for optimal care. Therefore, this study aimed to explore family carers' expectations regarding dementia care support and services in China.

METHODS

A qualitative study employing semi-structured interviews, with data collected from three public tertiary hospitals where the primary family carers of people with dementia (N = 21) were recruited from May to December 2019. Purposive maximum variation sampling was used to recruit participants. Data was interpreted both inductively and deductively using thematic analysis.

FINDINGS

Four themes were identified. The family carers reported minimal support regarding dementia care, and they held little hope of receiving support. However, most carers expressed their limited expectations, such as financial support from the government and respite care services from the community. Carers believed that care was their duty, and some of them were unwilling to move their relative with dementia into a nursing home.

CONCLUSION

Health and the three-tier long-term care systems in China are inadequately prepared for the challenges of dementia care, suggesting the need to develop health and social services and improve support for family carers to enable improved care for people with dementia.

Therapeutic use of the humanoid robot, Telenoid, with older adults: A critical interpretive synthesis review

This review sought to critically evaluate the use of the teleoperated humanoid robotic communications device, Telenoid, for therapeutic purposes with older adults, and identify and highlight key considerations for future research and clinical practice within gerontechnology. A critical interpretive synthesis was conducted, with nine electronic databases and online sources searched using the keyword "Telenoid." Studies were included in the review if they were: written in English; reported primary research; employed a qualitative, quantitative, or mixed-method design; and described or measured effects, experiences, or perceptions of using Telenoid for therapeutic purposes with older adults. Critical engagement with the studies identified key themes, as well as opportunities to advance future research. Ten studies involving Telenoid were identified, with eight focused on older adults living with dementia. Study findings centered around two themes: effects (including positive effects and negative reactions), and challenges and considerations (including technical issues, operator training, acceptability, and dosage). Although several issues currently challenge the use of Telenoid, available studies show some therapeutic potential of using Telenoid with older adults, including those living with dementia, particularly for communication and mood. Higher-quality studies are required to advance understanding, and considerations for the field are outlined to aid development.

A qualitative 5-country comparison of the perceived impacts of COVID-19 on people living with dementia and unpaid carers

Background

Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries.

Methods

Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis.

Results

Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings.

Conclusions

The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02821-1.

Planning and designing a self-compassion intervention for family carers of people living with dementia: a person-based and co-design approach

Background

This article describes the research activities undertaken to plan and design a self-compassion intervention for family carers of people living with dementia using a person-based and co-design approach. In providing this example, our aim is two-fold: to highlight the value of using qualitative research and co-design processes within intervention development; and to showcase systematic reporting of an intervention’s early planning and design stages.

Methods

A person-based and co-design approach informed the planning and design of the self-compassion intervention. In Stage 1, qualitative interviews were undertaken with 14 family carers of people living with dementia and 14 professional stakeholders. In Stage 2, intervention guiding principles were developed, psychological theory was incorporated, and six family carers of people living with dementia were engaged as co-designers.

Results

Knowledge generated during intervention planning identified that the intervention should be situated within the concept of compassion more broadly; address misperceptions, fears, blocks, and resistances to self-compassion; and target feelings of shame, guilt, and self-criticism. Subsequent intervention design activities determined that the needs of family carers of people living with dementia were best met by tailoring an existing intervention, namely group-based Compassion-Focused Therapy.

Conclusions

Our systematic approach highlights the value of incorporating in-depth qualitative research and co-design within the intervention development process to prioritise the perspectives and lived experiences of family carers of people living with dementia. The planning and design process outlined provides insight that is applicable to the development of our intervention and complex health interventions within gerontology and beyond.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02754-9.

Alzheimer's disease research progress in Australia: The Alzheimer's Association International Conference Satellite Symposium in Sydney

The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.

Baduanjin Exercise for Adults Aged 65 Years and Older: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

This study performed a systematic review and meta-analysis to evaluate the health effects of Baduanjin exercise on adults aged 65 years and older. Chinese and English databases were electronically searched using search terms related to the PICO model from inception through June 2021. The study quality assessment and meta-analysis were conducted using the PEDro scale and RevMan 5.4 software. Eleven included Chinese studies, published between 2015 and 2021, recruited participants from the mainland of China. The aggregated results showed significant benefits of Baduanjin on physical function, walking ability, balance, and anxiety. A long-term Baduanjin intervention could also improve quality of life and reduce falls and pain. Baduanjin appears to have the potential to improve the health of older adults, but conclusions are limited due to the lack of rigorous and robust studies within and outside of mainland China. Larger, well-designed RCTs are needed to confirm these findings.

The Impact of a Dementia-Friendly Garden Design on People With Dementia in a Residential Aged Care Facility: A Case Study

BACKGROUND

There is a paucity of evidence on the efficacy of garden design based on dementia-friendly environment (DFE) characteristics on the level of agitation, apathy, and engagement of people with dementia in residential aged care facilities (RACFs).

OBJECTIVE

To investigate the effect of a garden improved according to DFE characteristics on agitation, apathy, and engagement of people with dementia in one RACF.

METHODS

A case study design with a mixed-method approach was used.

RESULTS

There was no significant improvement in the level of participants' agitation following visits to the improved garden, χ²(2) = 5.167, p = .076. A high level of engagement was found in participants during the intervention (Week 1-1, p < .01; Week 1-2, p < .01; Week 2, p < .01; Week 3, p < .05; and Week 4, p < .05) when compared to before intervention (Week 0). A higher level of apathy was found in participants at Week 0 when compared to during the intervention (Week 1-1, p < .05; Week 1-2, p < .01; Week 2, p < .05; Week 3, p < .01; and Week 4, p < .01). Five themes emerged from participant interviews: the presence of sensory-provoking elements in the garden, meaningful engagement in the garden, accessibility of the garden, garden impacts, and garden experiences that demonstrated the effectiveness of the garden.

CONCLUSIONS

The garden promoted engagement and decreased apathy of people with dementia living in the RACF with the researcher's partial facilitation of the intervention sessions. The qualitative findings indicated the effectiveness of the garden in reducing agitation.

Feasibility study protocol of the PainChek app to assess the efficacy of a social robot intervention for people with dementia

AIM

This study aims to test the feasibility of the PainChek app to assess pain for people with dementia living in residential aged care facilities (RACFs). It will also identify the optimal dosage and efficacy of a social robot (personal assistant robot [PARO]) intervention on chronic pain for people with dementia.

DESIGN

This is a feasibility randomized controlled trial with three groups.

METHODS

Forty-five residents living with dementia and chronic pain will be recruited from one RACF. The intervention consists of an individual 15-min non-facilitated session with a PARO robot twice a day (Group 1), a PARO robot once a day (Group 2), or a Plush-Toy (non-robotic PARO) once a day (Group 3) from Monday to Friday for 4 weeks. Participants will be followed at 4 and 8 weeks after baseline assessments. The primary outcome will be the feasibility of using the PainChek app to measure changes in pain levels before and after each session. Secondary outcomes include staff-rated pain levels, neuropsychiatric symptoms, quality of life and changes in psychotropic and analgesic medication use. Participants, staff and family perceptions of using PARO and the PainChek app will be collected after the 4-week intervention.

DISCUSSION

This study will test the use of the PainChek app and PARO to improve pain management for people with dementia. Results from this study will help determine its usefulness, feasibility and acceptability for pain management in people with dementia living in RACFs.

IMPACT

As pain is a significant problem for people with dementia, this project will generate evidence on the use of the PainChek to measure the efficacy of a social robot intervention that has the potential to improve the quality of pain care in people with dementia.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820) date registered 30/06/2021.

Physical Activity Participation and Psychological Wellbeing in University Office Workers in China and Australia: An Online Survey

Background and purpose: Physical inactivity and prolonged sitting have associations with adverse health. University office workers are at a high risk of psychological and pain issues. This study aimed to explore the differences in sitting time, levels of physical activity participation, stress, depression, anxiety, and pain among university office workers in China and Australia. Methods: Online surveys were distributed to university office workers over 55 years at two universities in China and Australia, respectively. Results: A total of 185 participants completed the online survey (119 in China and 66 in Australia). Significant differences were found in sitting time during workdays between the two countries (p < 0.05) with a longer sitting time in the Australian respondents (7.5 h/day) than those in China (4.6 h/day). Additionally, there were also significant differences in terms of levels of depression and pain symptoms within the two countries (p < 0.05). The Australian respondents reported high levels of depression and pain (M = 7.38, SD = 5.86 and M = 3.65, SD = 2.21, respectively) than those in China (M = 5.71, SD = 4.87 and M = 1.89, SD = 1.89, respectively). The gender, education level, and sitting time of participants were found to be associated with pain scores (p < 0.05). A significant association between marital status and pain scores was found among the Australian respondents (p < 0.05). Conclusions: Future studies with a larger population are needed to validate the results and to further explore the association between physical activity participation and psychological wellbeing among university office workers.

The perceptions of informal carers of older people with dementia about the role of their pharmacists

OBJECTIVES

As medication experts, pharmacists can play a significant role in helping people living with dementia and their informal carers make the best use of medications. However, little is known about this population's needs and expectations of their pharmacists. The objective of this study was to report informal carers' perceptions about the role of their pharmacists.

METHODS

In a previous study, informal carers were interviewed to explore factors influencing medication adherence in older people living with dementia. The interview transcripts from the previous study were analysed thematically using an inductive approach to explore carers' perceptions about the role of community pharmacists in helping carers and people living with dementia use medications as prescribed.

KEY FINDINGS

The interviews of 20 informal carers were analysed. Carers were primarily females (85%), married (60%), completed university (60%) and unemployed (70%). The majority of care recipients had comorbidities (75%), and the number of medications ranged from 1 to 20. Three significant roles emerged: (1) provision of medication information, (2) advising on medication organisation and (3) conducting medication reviews.

CONCLUSIONS

Informal carers face several challenges in administering the medications to older people living with dementia. Pharmacists are expected to play a more active role in helping people living with dementia, and their carers make safe and effective use of medications.

Use of complementary medicines and lifestyle approaches by people living with dementia: Exploring experiences, motivations and attitudes

BACKGROUND

Lack of effective treatments for chronic conditions is associated with high rates of complementary medicine (CM) use. However, little is known about CM use for dementia.

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences, motivations, and attitudes towards CM use by people living with dementia in an Australian setting.

DESIGN

This study had a qualitative research design; quantitative demographic information was also collected.

METHODS

In-depth interviews were conducted with people living with dementia and their caregivers (N = 18). A thematic (inductive) analysis approach was taken to interpret data.

RESULTS

Three in four participants used CM for dementia, spending ~AUD$100/month (USD$70/month). Within three overarching themes, a range of sub-themes was identified: (1) CM knowledge and use: people living with dementia and caregivers understanding of CM, types of CM used, and CM usage patterns; (2) Self-determined reasons for use/non-use: maintain or improve quality of life, hope, management of dementia symptoms, level of awareness, willingness and evidence, perceptions on efficacy and safety of CM, experiences of conventional medicine, and holistic approach to wellness; (3) External determinants of use: information on CM, relationship influences on CM use, and experiences with General Practitioners (GPs) and CM.

CONCLUSION

Findings highlight that CM use is widespread and positively viewed by people living with dementia and their caregivers. Decisions regarding CM use were based on personal opinions. Findings have important implications for conversations with health professionals regarding CM use by people living with dementia to improve communication, health literacy, and reduce the risk of adverse effects through polypharmacy.

IMPLICATIONS FOR PRACTICE

This study showed that CM is a valued approach for dementia management by people living with dementia, their families, and healthcare providers. Future international research is required to evaluate the efficacy and safety of these approaches and promote accurate advice in nursing care.

Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial

INTRODUCTION

There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers' health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers' health-related quality of life (HRQOL) after care recipients' hospital discharge.

METHODS AND ANALYSIS

A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient's discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30-45 min telephone support sessions over 6 months. The primary outcome is caregivers' HRQOL measured using the Assessment of Quality of Life-eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements.

ETHICS AND DISSEMINATION

Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

ACTRN12620000060943.

Health Professionals' Recommendations for a Dementia Plan for China

There is no specific national dementia plan concerning people with dementia in China. The purpose of this study was to explore health professionals' recommendations for a dementia plan for China to meet the needs of people with dementia. Semi-structured interviews were conducted with 24 doctors and nurses using purposive maximum variation sampling. Data were interpreted inductively using thematic analysis. Four themes were identified. Themes on policy recommendations emphasized a need to support people with dementia and those who care for them, including the development of community daycare centers, specialized dementia care units in hospitals, and specialized nursing homes. Improvement in dementia care in China is needed, including services across all care settings. Programs to train and support family caregivers and help health professionals to detect, diagnose and treat dementia are crucial. Further support for the families of people with dementia is required.

Experiences of compassion among family carers of older adults: Qualitative content analysis of survey free-text comments

OBJECTIVES

To provide qualitative insight into the experiences of compassion (to self, to others and from others) among family carers of older adults by exploring the written responses provided within a cross-sectional survey that asked about carers' levels of compassion, mindfulness, emotion regulation, coping strategies and psychological health.

METHODS

Family carers of adults aged ≥65 years from around the world completed the survey between July and December 2019. To provide carers with an opportunity to describe experiences in their own words and expand on issues beyond the limits of closed-response items, the survey included eight free-text boxes. These appeared after each self-report measure and at the end of the survey. From a total of 127 carers providing 504 written responses, inductive qualitative content analysis identified and evaluated 245 comments from 105 family carers' that were about their experiences of compassion (to self, to others and from others).

RESULTS

Some family carers perceived a lack of compassion, both for themselves and from others, and several barriers to carers' openness to receiving compassion were identified. Factors influencing carers' compassion to others in general included how carers were feeling themselves, the person it was directed towards and the situation. Within the caregiving relationship specifically, this included care recipients' level of need and behaviour.

CONCLUSIONS

Findings provide qualitative understanding about family carers' realities of compassion (to self, to others and from others) within their role and highlight the applicability and warranted focus of compassion-based approaches within family caregiving research and practice.

Development of the 'Intimacy and Sexuality Expression Preference' tool for residential aged care

OBJECTIVES

To outline development of the Intimacy and Sexuality Expression Preference (ISEP) tool that elicits preferences for the expression of intimacy and sexuality of older people, living with and without dementia, in residential aged care.

METHODS

Using two rounds of the Delphi technique involving 14 panelists, tool items were evaluated for importance, usefulness, relevancy and clarity on a 5-point Likert scale.

RESULTS

All tool items achieved a mean score of ≥3.4 across the four areas of evaluation with an overall average tool-level content validity index of 0.89. Instructions were deemed appropriate (M=4.6; SD=0.8), easy to understand and simple to follow (M=4.6; SD=0.6).

DISCUSSION

The ISEP tool can improve care and support older people's expression of intimacy and sexuality from a person-centered approach. Further research into the use of the tool in 'real' residential aged care settings is required to establish external validity prior to implementation.

Portable EEG monitoring for older adults with dementia and chronic pain - A feasibility study

Given the reduced ability of people with dementia to self-report pain, this study examined the feasibility of using a portable electroencephalography (EEG) headband (MUSE 2) as a pain measurement tool for long-term care residents with dementia. Ten minutes of resting-state EEG was acquired by MUSE 2 from people with dementia experiencing ongoing pain (n = 3) and without current pain (n = 1) over three days. The MUSE 2 was acceptable and feasible for use in people with dementia while challenges regarding software, data collection and analysis in using this device are reported. Compared to the resident not experiencing pain, EEG signals of residents with ongoing pain showed different EEG patterns, and this could be a potential biomarker to support pain measurement in people with dementia. Further research with larger sample size is warranted to verify study results.

Hospital healthcare professionals' knowledge of dementia and attitudes towards dementia care: A cross-sectional study

AIMS AND OBJECTIVES

To explore hospital healthcare professionals' knowledge and attitudes towards dementia care in China.

BACKGROUND

Hospital healthcare professionals deliver most diagnosis and treatment for people with dementia in China. Literature shows that healthcare professionals' knowledge and attitudes are of great importance in providing optimum dementia care. However, there is limited research of healthcare professionals' dementia knowledge and attitudes within hospital contexts in China.

DESIGN

A cross-sectional survey was conducted between April and December 2019.

METHODS

A self-report questionnaire composed of demographics and knowledge and attitude scales related to dementia was used for doctors and registered nurses working in settings where people with dementia are cared for in eleven public tertiary hospitals in Hebei Province, China. The STROBE checklist was adhered to in this study.

RESULTS

In total, 603 healthcare professionals completed the study. The majority of respondents were registered nurses (71.3%). The overall mean knowledge score was 20.7 (SD = 2.9) out of a maximum possible score of 30. The overall mean score for attitudes was 91.3 (SD = 15.9) out of a maximum possible score of 140. Standard multiple linear regression analysis revealed that the highest level of education, the experience of searching for dementia-related information and willingness to receive dementia training or education were significant predictors of knowledge scores. The department, the experience of working with people with dementia, length of dementia care, interest in dementia care and training type were significant predictors of attitude scores.

CONCLUSIONS

Deficits in the knowledge of dementia and a low level of positive attitude were identified among the healthcare professionals who work in hospital settings where people with dementia are cared for in China.

RELEVANCE TO CLINICAL PRACTICE

Education and training in dementia care should be integrated into undergraduate nursing and medical programmes and provided for healthcare professionals after commencing employment.

Self-Compassion, Health Outcomes, and Family Carers of Older Adults: An Integrative Review

OBJECTIVES

This review sought to synthesize published evidence about the role of self-compassion on health outcomes for family carers of older adults, to describe the current state of knowledge.

METHOD

Using an integrative review method that permitted any research design, eight databases were searched. Extensive searching of gray literature sources was also undertaken. Studies included in the review underwent processes of methodological quality assessment (Mixed Methods Appraisal Tool - Version 2011), data extraction, analysis, and syntheses.

RESULTS

Four studies were included: two randomized controlled trials, a descriptive cross-sectional survey, and a qualitative study. There was preliminary evidence to show the potential of self-compassion to help family carers cope and reduce levels of burden. However, efficacy of self-compassion interventions to improve family carer health outcomes could not be determined.

CONCLUSIONS

Self-compassion in family carers of older adults is a new and emerging research area, and there is very little published evidence about how self-compassion might be developed to improve health outcomes for family carers.

CLINICAL IMPLICATIONS

To inform clinical understanding within this population, future quality research is needed, particularly regarding proof-of-concept, moderating effects of carer and care recipient factors, reliability of self-compassion measures, and the development and testing of self-compassion based interventions.

The effect of a social robot intervention on sleep and motor activity of people living with dementia and chronic pain: A pilot randomized controlled trial

OBJECTIVE

To investigate the effect of a social robot intervention on sleep and motor activity in nursing home residents living with dementia and chronic pain.

METHOD

A pilot randomized controlled trial was conducted with 41 residents from three Australian nursing homes. People living with dementia and chronic pain were randomized into either a 30-minute daily social robot (PARO) condition or a usual care condition for six weeks. Sleep and motor activity were assessed by actigraphy at four-time points: week 0 at baseline, week one, week six, and after the intervention. Data were reduced into daytime (8:00am - 7:59pm) and night-time (8:00pm - 7:59am) summaries. Change scores for each time point compared with baseline were computed for data analysis and the generalized estimating equation model with imbalanced baseline values added as covariates were performed.

RESULTS

At week one, residents in the PARO group had a greater increase in the night sleep period (1.81, 95 % CI: 0.22-3.84, p = 0.030, Cohen's d = 0.570). At week six, residents in the PARO group showed a greater increase in daytime wakefulness (1.91, 95 % CI: 0.09-3.73, p = 0.042, Cohen's d = 0.655) and a greater reduction in daytime sleep (-1.35, 95 % CI: -2.65 to -0.05, p = 0.040, Cohen's d = 0.664). No significant results were found for motor activity.

CONCLUSION

PARO could improve sleep patterns for nursing home residents living with dementia and chronic pain, but the effect of PARO on motor activity needs further research. Australian New Zealand Clinical Trials Registry (ACTRN12618000082202).

The Use of Modified Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy Program for Family Caregivers of People Living with Dementia: A Feasibility Study

PURPOSE

The aim of this study was to investigate the feasibility and preliminary efficacy of a modified mindfulness-based stress reduction (MBSR) program and mindfulness-based cognitive therapy (MBCT) program for reducing the stress, depressive symptoms, and subjective burden of family caregivers of people with dementia (PWD).

METHODS

A prospective, parallel-group, randomized controlled trial design was adopted. Fifty-seven participants were recruited from the community and randomized into either the modified MBSR group (n = 27) or modified MBCT group (n = 26), receiving seven face-to-face intervention sessions for more than 16 weeks. Various psychological outcomes were measured at baseline (T0), immediately after intervention (T1), and at the 3-month follow-up (T2).

RESULTS

Both interventions were found to be feasible in view of the high attendance (more than 70.0%) and low attrition (3.8%) rates. The mixed analysis of variance (ANOVA) results showed positive within-group effects on perceived stress (p = .030, Cohen's d = 0.54), depressive symptoms (p = .002, Cohen's d = 0.77), and subjective caregiver burden (p < .001, Cohen's d = 1.12) in both interventions across the time points, whereas the modified MBCT had a larger effect on stress reduction, compared with the modified MBSR (p = .019).

CONCLUSION

Both the modified MBSR and MBCT are acceptable to family caregivers of PWD. Their preliminary effects were improvements in stress, depressive symptoms, and subjective burden. The modified MBCT may be more suitable for caregivers of PWD than the MBSR. A future clinical trial is needed to confirm their effectiveness in improving the psychological well-being of caregivers of PWD.

Physical Activity, Health-Related Quality of Life, and Stress among the Chinese Adult Population during the COVID-19 Pandemic

The COVID-19 pandemic poses a threat to global public health due to home confinement policies impacting on physical activity engagement and overall health. This study aimed to explore physical activity participation, health-related quality of life (HRQoL), and levels of perceived stress among Chinese adults during the COVID-19 pandemic. An online survey was conducted between 25 February and 15 March 2020. A total of 645 surveys were completed. Participants reported increased sedentary time from pre-COVID-19 period to the COVID-19 pandemic period (p < 0.05). Over 80% of the sample engaged in either low or moderate intensity physical activity. Participants' average physical component summary score (PCS) and mental component summary score (MCS) for HRQoL were 75.3 (SD = 16.6) and 66.6 (SD = 19.3), respectively. More than half of participants (53.0%) reported moderate levels of stress. Significant correlations between physical activity participation, HRQoL, and levels of perceived stress were observed (p < 0.05). Prolonged sitting time was also found to have a negative effect on HRQoL (p < 0.05). During such periods of home confinement, public health strategies aimed at educating Chinese adults to enhance home-based physical activity may be necessary to maintain health on a population level.

Restraint use in residents with dementia living in residential aged care facilities: A scoping review

AIMS AND OBJECTIVES

To provide an overview of restraint use in residents with dementia in the context of residential aged care facilities.

BACKGROUND

Restraints are commonly used in people with dementia living in residential aged care facilities to manage behaviours and reduce injuries, but the concept of restraint use in people with dementia remains ambiguous, and current practices to reduce restraint use in long-term care residents with dementia remain unclear.

DESIGN

A scoping review using the methodological frameworks of Arskey and O'Malley and colleagues.

METHODS

Nine databases (CINAHL, MEDLINE, EMBASE, PubMed, Scopus, Web of Science, OVID, Cochrane Central Register of Controlled Trials and ProQuest) were searched from 2005 to 20 May 2019. Articles were included if they were written in English, peer-reviewed and used any research method that described restraint use in residents with dementia living in residential care settings. The PRISMA-ScR checklist was used.

RESULTS

From 1,585 articles, 23 met the inclusion criteria. There is a lack of a clear definition of restraint use, and the prevalence of restraint use varied from 30.7% to 64.8% depending on the different operational concepts. People with dementia were at a higher risk for restraint use, and the decision-making process for restraint use was largely ignored in the literature. The effect of staff educational interventions to reduce restraint use was inconsistent due to varying delivery duration and content.

CONCLUSIONS

The prevalence of restraint use in people with dementia living in residential care settings remains high alongside the absence of a clear definition of restraint use. More research about the decision-making process involved in using restraint and development of effective interventions are needed.

RELEVANCE TO CLINICAL PRACTICE

Better education about the decision-making regarding staff, conditions of residents and organisations for restraint use is needed to improve the care for people with dementia living in care settings.