The role of demographic change in explaining the growth of Australia's older migrant population living with dementia, 2016–2051

Objective: To examine the demographic drivers contributing to the future growth in the population of older migrants in Australia living with dementia. Methods: Using birthplace-specific cohort-component projection models, we projected the number of older migrants living with dementia. ABS data on births, deaths, migration and birthplace were used, alongside Australian Institute of Health and Welfare (AIHW) estimates of dementia prevalence with birthplace dementia weights calculated from administrative data. Results: The number of older migrants living with dementia is projected to increase from about 134,423 in 2016 to 378,724 by 2051. Increases in populations with dementia varied considerably, from a slight decrease for those born in Southern & Eastern Europe to over 600% increases amongst the South-East Asia, Southern & Central Asia, and Sub-Saharan Africa-born populations. Conclusions: Cohort flow is the primary driver increasing the number of older migrants living with dementia. This growth is largely inevitable because the cohorts are already living in Australia as part of the migrant population, but currently at ages below 60 years. Implications for public health: High relative growth and shifting birthplace composition in the number of migrants living with dementia poses implications for culturally appropriate care, health care access and workforce needs to support migrant families, carers and their communities

Relational Solidarity and Conflicting Ethics in Dementia Care in Urban India.

OBJECTIVES: Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. METHODS: Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. RESULTS: Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent-child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. DISCUSSION: There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India

Recruitment, retention, and reporting of variables related to ethnic diversity in randomised controlled trials : An umbrella review

Peer reviewe

MOVING PICTURES: RAISING AWARENESS OF DEMENTIA IN CALD COMMUNITIES THROUGH MULTIMEDIA

Abstract Limited awareness of dementia in people from culturally and linguistically diverse (CALD) backgrounds often results in delayed diagnosis, poorer prognosis, and a higher burden of care on families and health systems. Given the rapidly ageing and multicultural populations in migrant-receiving countries such as Australia and the United States, this disparity needs to be addressed urgently. This project aimed to inform and educate people from five linguistically diverse backgrounds – Hindi, Tamil, Mandarin, Cantonese, and Arabic – about dementia. A mixed methods, multimedia design comprising video-interviews with 76 participants including carers from the five language groups and key service providers was employed. Data were gathered nationally across Australia in 2018 and thematically analysed. Data were used to co-produce 15 short films, comics, and a mobile-optimised website from which data analytics were measured. The films and comics focused on dementia detection and timely diagnosis, how to navigate the aged care system, and the importance of self-care. Analytics data is currently being collected online and via community forums. In conclusion, co-production methods in tandem with digital multimedia are fundamental to developing culturally salient interventions to address dementia disparities in CALD populations in Australia and internationally.</jats:p

Codesigning training for health providers to improve detection and response to elder abuse.

BACKGROUND AND OBJECTIVES: Screening for elder abuse can improve detection, but many health providers lack the necessary skills and confidence. To address this, training for health providers on elder abuse screening was co-designed as part of a trial aimed at improving elder abuse detection and response. RESEARCH DESIGN AND METHODS: Between March and April 2023, 7 health providers and 10 older people and family carers participated in two national Australian online codesign workshops. Using the World Café method, discussions focused on what knowledge and skills health providers needed for screening; clinical and social issues affecting screening and referral; and support older people needed throughout the process. Data were thematically analyzed. RESULTS: Participants said health providers should take a trauma-informed, person-centered approach to screening, and explain the limits of confidentiality to older people. Clinical, social, and systemic issues such as dementia, ethnic diversity, and housing availability complicated screening and referrals. To facilitate disclosure, participants said health providers needed to reflect on whether they held ageist views. There were differing opinions on the length of the training and if all health providers or only social workers should screen for abuse. DISCUSSION AND IMPLICATIONS: Participants' feedback on trauma-informed care, consent, and cognitive impairment concorded with evidence on best practice responses to elder abuse and were integrated in the training. Given operational constraints in health services, feedback from health providers about the training length and the inclusion of all health providers in screening were prioritized. The training is being evaluated in a national trial

The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial.

BACKGROUND: Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse. METHODS: This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. DISCUSSION: This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. TRIAL REGISTRATION: ANZCTR, ACTRN12623000676617p . Registered 22 June 2023

General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: Implications for patient care

© 2016 The Author(s). Background: In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). Method: A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman's correlation, and multiple ordered logistic regressions were performed. Results: Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education on road traffic crash injury management. Conclusion: This study has enhanced understanding of the knowledge skills and attitudes of GPs towards road traffic crash injury care in Australia, and has identified areas for further education and training. If delivered, this training has the potential to reduce unnecessary imaging for WAD and optimise the early referral of patients at risk of delayed recovery following a road traffic crash

Creating 'Partnership in iSupport program' to optimise family carers' impact on dementia care: a randomised controlled trial protocol

Background: The majority of people with dementia are cared for by their family members. However, family carers are often unprepared for their caring roles, receiving less education and support compared with professional carers. The consequences are their reduced mental and physical health and wellbeing, and that of care recipients. This study protocol introduces the ‘Partnership in iSupport program’ that includes five interventional components: managing transitions, managing dementia progression, psychoeducation, carer support group and feedback on services. This health services research is built on family carer and dementia care service provider partnerships. The aims of the study are to evaluate the effectiveness, cost-effectiveness and family carers’ experiences in the program. Methods: A multicentre randomised controlled trial will be conducted with family carers of people living with dementia from two tertiary hospitals and two community aged care providers across three Australian states. The estimated sample size is 185 family carers. They will be randomly assigned to either the intervention group or the usual care group. Outcomes are measurable improvements in quality of life for carers and people with dementia, caregiving self-efficacy, social support, dementia related symptoms, and health service use for carers and their care recipients. Data will be collected at three time points: baseline, 6 months and 12 months post-initiation of the intervention. Discussion: This is the first large randomised controlled trial of a complex intervention on health and social care services with carers of people living with dementia in real-world practice across hospital and community aged care settings in three Australian states to ascertain the effectiveness, cost-effectiveness and carers’ experiences of the innovative program. We expect that this study will address gaps in supporting dementia carers in health and social care systems while generating new knowledge of the mechanisms of change in the systems. Findings will strengthen proactive health management for both people living with dementia and their carers by embedding, scaling up and sustaining the ‘Partnership in iSupport program’ in the health and social care systems.Lily Xiao, Ying Yu, Julie Ratcliffe, Rachel Milte, Claudia Meyer, Michael Chapman, Langduo Chen, Shahid Ullah, Alison Kitson, Andre Queiroz De Andrade, Elizabeth Beattie, Henry Brodaty, Sue McKechnie, Lee, Fay Low, Tuan Anh Nguyen, Craig Whitehead, Bianca Brijnath, Ronald Sinclair, and Diana Vos