Knowledge Network in Rural and Remote Dementia Care

Healthcare Delivery Across the Continuum for Rural and Remote Seniors with Dementia

7th Annual Summit

October 21st & 22nd, 2014

Scientifi c Poster Session

7777777Summit

2014

Tuesday October 21st, 2014Scientific Poster Program

5:00 PM – 8:30 PM at the Delta Bessbourough (Battleford Room)

Poster Presenter Authors & Poster Titles Page

Juanita Bacsu Bacsu J, Viger M, Abonyi S, Jeffery B

Rural Older Adults’ Perceptions of Cognitive Health1

Anita Bergen Nein L, Bergen A, Evjen T

Accurate assessment, effective care planning and quality improvement for better resident outcomes

2

Camille Branger Branger C, Burton R, O’Connell ME, Stewart N, Morgan D

Coping with Cognitive Impairment and Dementia: Rural caregivers’ Perspectives

3

Rachel Burton Burton R, O’Connell MERecruiting individuals diagnosed with dementia due to Alzheimer’s disease for cognitive rehabilitation: Ethical tension between the clinician and investigator roles

4

Allison Cammer Cammer A, Whiting S, Morgan D

The Intersection of Resident-Centered Care and Best Practices for Nutrition Care in Long-term Care

5

Vanina Dal Bello- Haas

Dal Bello-Haas V, Crossley M, O’Connell ME, Morgan D, Kirk A

Characteristics of Falls in Community Dwelling Older Adults with Early Memory Problems

6

Vanina Dal Bello- Haas

Dal Bello-Haas V, O’Connell ME, Morgan D

Fitness and Physical Activity Levels of Individuals Attending a Rural and Remote Memory Clinic

7

Tracy Danylyshen-Laycock

Danylyshen-Laycock T, Morgan D

Examining the Relationship Between Leadership and Sustainability of a Dementia Training Program in Long-Term Care

8

Ben Gould Gould B, Enright J, O’Connell ME, Morgan D

Reliable Change (RCI) on Repeatable Battery for the Assessmentof Neuropsychological Status (RBANS) in a Dementia Sample

9

Sarah Hambidge Hambidge S

Care farming: providing brighter futures for young and old 10

Ben Hicks Hicks, B

An exploration of commercial gaming technology as a leisure activity for older men with dementia in rural Dorset

11

Poster Presenter Authors & Poster Titles Page

Leslie Holfeld Holfeld L, Morgan D, O’Connell ME, Crossley M, Kirk A, Stewart N, Dal Bello-Haas V, McBain L, Cammer A, Minish D, Beever R, Kosteniuk J

Rural And Remote Memory Clinic – Update (March 2004 – June 2014)12

Paulette Hunter Hunter P, Hadjistavropoulos T, Thorpe L, Malloy D

The influence of individual and organizational factors on person-centred dementia care

13

Paulette Hunter and Anita Bergen

Berger J, Blevins L, Evjen T, Gelowitz K, Nein L, Nowlan D, Tiedjens A, Werle J

myPLAN 1.0: Resident Centred Care Planning In Long Term Care 14

Paulette Hunter and Anita Bergen

Hunter P, Bergen A, Berger H, Blevins L, Evjen T, Gelowitz K, Nein L, Nowlan D, Tiedjens A, Werle J

myPLAN 1.0: Evaluation Framework14

Paulette Hunter and Anita Bergen

Hunter P, Fick F

myPLAN 1.0: Staff Perceptions 15

Anthea Innes Innes A, Page S, Cutler C, Crossen-White H, Cash M, McParland P

Dementia Friendly Tourism 16

Anthea Innes Cutler C, Innes A

Tech Club: What are the benefits of a technology group on the quality of life for people with dementia living within the community?

16

Anthea Innes Cutler C, Heward M, Hambidge S, Innes A

Dementia Friendly Communities: Dorset 17

Anthea Innes Innes A, Reynolds L A musical ensemble: evaluation of a Bournemouth Symphony Orchestra /Bournemouth University Music initiative for people with dementia and their carers

17

Anthea Innes O’Malley, M

Dementia Friendly Architecture 18

Poster Presenter Authors & Poster Titles Page

Anthea Innes Cutler C, Palma P

Tales of the sea: Engaging people with dementia in maritime archaeology 18

Kathleen Kulyk Kulyk K, Stewart N, Peacock S, Morgan D, O’Connell ME, Kosteniuk J

Evaluating the Construction and Validity of a Questionnaire Assessing Healthcare Provider Perceptions of Rural Dementia Care Pathways

19

Debra Morgan Morgan D, Kosteniuk J, Crossley M, O’Connell ME, Kirk A, Stewart N, Dal Bello-Haas V, Forbes D, Innes A, McBain L, Mou H, Parrott E

Team 20 of the Canadian Consortium on Neurodegeneration in Aging (CCNA): Rural Dementia Action Research (RaDAR)

20

Darrell Mousseau**Due to time constraints the poster is not included in this booklet**

Nyarko J, Fehr K, Pennington P, Maley J, Mousseau D

A simple test for mutations in the presenilin-1 gene revealed a mutation that can protect against Alzheimer disease

Jennifer Nyarko Wei Z, Nyarko J, Pennington P, Fernyhough P, Baker G, Mousseau DPhosphorylation of the insulin receptor substrate-1 regulatesmonoamine oxidase-A in primary and immortalized neuronal,but not glial, cultures

21

Megan O’Connell O’Connell ME, Burton R, Michael J

From Research to Practice: Collaboration with the Alzheimer Society of Saskatchewan for a Telehealth Delivered Frontotemporal Dementia Caregiver Support Group

22

Posters presented as part of the 7th International Symposium: Safety & Health in Agricultural & Rural Populations:

Global Perspectives (SHARP)

Allison Cammer Cammer A, O’Connell ME, Morgan D, Whiting S

Nutrition Care Needs of Alzheimer Disease versus non-Alzheimer Disease Dementia Patients

23

Joe Enright Enright J, O’Connell ME

An Evaluation of a Reminiscence Intervention via TelehealthVideoconferencing for Caregivers of Persons with Dementia

24

Julie Kosteniuk Kosteniuk J, Morgan D, Quail J, Teare G, Kulyk K, O’Connell ME, Kirk A, Crossley M, Stewart N, Dal Bello-Haas V, McBain L, Mou H, Forbes D, Innes A, Bracken J, Parrot E

Analysis of dementia prevalence, incidence, and care gaps in Saskatchewan: A mixed methods study

25

1

R

ural

Old

er A

dults

’ Per

cept

ions

of

Cog

nitiv

e H

ealth

Juan

ita B

acsu

,123 M

arc

Vige

r,1 Syl

via

Abo

nyi,12

3 Bon

nie

Jeffe

ry,14

5 1S

aska

tche

wan

Pop

ulat

ion

Hea

lth &

Eva

luat

ion

Res

earc

h U

nit,

2Com

mun

ity H

ealth

& E

pide

mio

logy

, 3U

nive

rsity

of S

aska

tche

wan

, 4Fa

culty

of S

ocia

l Wor

k, 5

Uni

vers

ity o

f Reg

ina

Sign

ific

ance

•

In 2

010,

app

roxi

mat

ely

4.4

mill

ion

Nor

th A

mer

ican

s ha

d de

men

tia a

nd th

is

num

ber i

s pr

ojec

ted

to in

crea

se si

gnifi

cant

ly (W

orld

Hea

lth O

rgan

izat

ion,

201

2).

Exis

ting

liter

atur

e on

cog

nitiv

e he

alth

focu

ses

prim

arily

on

thre

e gr

oups

of p

eopl

e,

incl

udin

g ol

der a

dults

dia

gnos

ed w

ith d

emen

tia, f

amily

car

egiv

ers,

and

hea

lthca

re

prov

ider

s. W

ith th

e ex

cept

ion

of C

orne

r and

Bon

d (2

004)

, the

re is

a p

auci

ty o

f re

sear

ch o

n th

e pe

rcep

tions

of c

ogni

tive

heal

th a

mon

g he

alth

y ol

der a

dults

w

ithou

t im

pair

men

t, es

peci

ally

with

in ru

ral a

reas

. Sev

eral

rura

l bar

rier

s may

im

pede

ear

ly d

emen

tia d

iagn

osis

rela

ted

to la

ck o

f edu

catio

n, li

mite

d he

alth

se

rvic

es, c

ultu

ral o

bsta

cles

and

fina

ncia

l cha

lleng

es. R

esea

rch

on ru

ral s

enio

rs’

perc

eptio

ns o

f cog

nitiv

e he

alth

is im

port

ant t

o in

form

the

deve

lopm

ent o

f effe

ctiv

e pr

even

tion

and

dem

entia

aw

aren

ess

stra

tegi

es.

Obj

ectiv

es

•Th

e pu

rpos

e of

this

stu

dy w

as tw

o-fo

ld:

1)To

exa

min

e ru

ral o

lder

adu

lts’ p

erce

ptio

ns, b

elie

fs a

nd m

eani

ngs

of c

ogni

tive

heal

th in

the

cultu

ral c

onte

xt o

f rur

al S

aska

tche

wan

, Can

ada;

2)To

iden

tify

how

hea

lthy

rura

l old

er a

dults

with

out i

mpa

irm

ent

mai

ntai

n an

d su

ppor

t the

ir c

ogni

tive

heal

th.

Met

hods

•

Part

of a

larg

er H

ealth

y A

ging

in

Plac

e St

udy

at th

e Sa

skat

chew

an P

opul

atio

n H

ealth

and

Eva

luat

ion

Rese

arch

Uni

t (Je

ffery

et a

l., 2

014)

.

•U

sing

an

ethn

ogra

phic

met

hodo

logi

cal a

ppro

ach,

dat

a w

as c

olle

cted

thro

ugh

2 w

aves

of s

emi-s

truc

ture

d in

terv

iew

s with

adu

lts a

ged

60 a

nd o

ver i

n th

e ru

ral

com

mun

ities

of Y

oung

, Wat

rous

and

Man

itou

Beac

h, S

aska

tche

wan

, Can

ada.

•1s

t wav

e w

ith 4

2 pa

rtic

ipan

ts, F

ebru

ary

to M

ay,

2014

.

•2n

d w

ave

with

37

part

icip

ants

, Jul

y to

Aug

ust,

2014

. •

Part

icip

ant o

bser

vatio

n w

as c

ondu

cted

by

spen

ding

tim

e w

ith 5

old

er a

dults

to

obse

rve

day-

to-d

ay a

ctiv

ities

rela

ted

to m

emor

y an

d co

gniti

ve h

ealth

. •

Gui

ded

by la

y th

eory

(Fur

nham

, 198

8) a

nd c

ultu

ral s

chem

a th

eory

(Qui

nn, 2

005)

, th

emat

ic a

naly

sis

was

per

form

ed u

sing

the

qual

itativ

e so

ftwar

e A

tlas.

ti-7

to

iden

tify

patte

rns,

them

es a

nd re

latio

nshi

ps in

the

data

.

Fi

ndin

gs

K

ey D

omai

ns •

Inte

llect

ual h

ealt

h - d

efin

ed a

s th

e im

port

ance

of c

ompr

ehen

sion

, aw

aren

ess,

m

enta

l stim

ulat

ion

and

cont

inuo

us le

arni

ng.

Su

ppor

tive a

ctiv

ities

: rea

ding

, puz

zles

, cro

ssw

ords

, Sud

oku,

car

ds, t

rave

ling,

le

arni

ng (i

.e.,

joke

s, b

irds

, cur

rent

eve

nts)

, nee

dle

wor

k an

d w

ood

wor

k.

•So

cial

hea

lth

- dis

cuss

ed a

s be

ing

activ

e, in

volv

ed in

the

com

mun

ity a

nd

com

mun

icat

ing

with

oth

ers.

Supp

ortiv

e act

iviti

es: c

offe

e ro

w, e

vent

s, te

leph

one,

tech

nolo

gy (i

.e.,

Face

book

, Sk

ype)

, pet

s, v

olun

teer

ing

and

visi

ting

at lo

dge

and

hosp

ital.

•Em

otio

nal h

ealt

h –e

xpre

ssed

in

term

s of m

enta

l wel

l-bei

ng, b

alan

ced

lifes

tyle

an

d sp

iritu

ality

.

Supp

ortiv

e act

iviti

es: m

edita

tion,

yog

a, p

aint

ing,

pho

togr

aphy

, scr

ap-b

ooki

ng,

gard

enin

g, m

usic

, chu

rch,

sm

iling

, exe

rcis

e an

d jo

urna

ling.

•Fu

ncti

onal

hea

lth–

des

crib

ed in

rela

tion

to p

hysi

cal h

ealth

, act

iviti

es o

f dai

ly

livin

g an

d in

depe

nden

ce.

Su

ppor

tive a

ctiv

ities

: hea

lthy

eatin

g, sl

eep,

exe

rcis

e (p

ickl

e-ba

ll, w

alk,

bow

l, go

lf, c

url,

swim

, tai

chi

, dan

ce),

hear

ing

aids

, eye

gla

sses

and

wal

king

aid

s.

Con

clus

ions

•

Und

erst

andi

ng th

e pe

rcep

tions

of c

ogni

tive

heal

th a

mon

g sp

ecifi

c cu

ltura

l gro

ups

such

as

rura

l old

er a

dults

sup

port

s th

e de

velo

pmen

t of t

arge

ted

inte

rven

tions

ai

med

at a

war

enes

s, e

duca

tion

and

earl

y de

men

tia d

iagn

osis

.

Ref

eren

ces

Cor

ner,

L., &

Bon

d, J

. (20

04).

Bei

ng a

t ris

k of

dem

entia

: Fea

rs a

nd a

nxie

ties

of o

lder

adu

lts. J

ourn

al o

f Agi

ng S

tudi

es, 1

8(2)

, 143

-55.

Fu

rnha

m, A

. (19

88).

Lay

theo

ries:

Eve

ryda

y un

ders

tand

ing

of p

robl

ems

in th

e so

cial

sci

ence

s. O

xfor

d, E

ngla

nd: P

erga

mon

Pre

ss.

Jeffe

ry, B

., B

acsu

, J.,

Abo

nyi,

S.,

Nov

ik, N

., M

artz

, D.,

John

son,

S.,

& O

osm

an, S

. (20

14).

Hea

lthy

agin

g in

pla

ce: A

ctio

n pl

an s

umm

ary.

.

Avai

labl

e fro

m, h

ttp://

sphe

ru.c

a/re

sear

ch_p

roje

cts/

proj

ects

/Pro

ject

.pdf

/Hea

lthy%

20Ag

ing%

20A

ctio

n%20

Pla

n%20

2014

-201

7.pd

f.Q

uinn

, N. (

2005

). Fi

ndin

g cu

lture

in ta

lk: A

col

lect

ion

of m

etho

ds. N

ew Y

ork,

NY:

Pal

grav

e M

acm

illan

. W

orld

Hea

lth O

rgan

izat

ion.

(201

2). D

emen

tia: A

pub

lic h

ealth

prio

rity.

Ava

ilabl

e fro

m, h

ttp://

ww

w.w

ho/d

emen

tia.h

tml

Inte

llect

ual

Emot

iona

l

Soci

al

Func

tiona

l

2

3. In

form

atio

n (H

irdes

, Pos

s, C

ald

erel

li, Fr

ies,

Mor

ris, T

eare

, Jut

an A

n ev

alua

tion

of d

ata

qual

ity in

Can

ada’

s Con

tinui

ng C

are

Repo

rting

Sys

tem

, 201

3; a

nd

Prin

gle,

Orli

kow

An

Inco

nven

ient

Tru

th p

rese

ntat

ion

2012

inte

rRA

I con

fere

nce)

be

cam

e av

aila

ble

abou

t ass

essm

ent e

rrors

cau

sed

by

auto

pop

ulat

ion

(all

field

s in

the

asse

ssm

ent a

re a

utom

atic

ally

pop

ulat

ed w

ith d

ata

from

the

last

as

sess

men

t and

ass

esso

r cha

nges

the

dat

a w

here

nee

ded

). A

uto

popu

latio

n of

RA

I ass

essm

ents

in S

aska

toon

Hea

lth R

egio

n ca

used

a h

igh

erro

r rat

e in

as

sess

men

t of e

limin

atio

n pa

ttern

s in

sect

ion

H2e

4.

Use

of C

APs

for c

are

plan

ning

was

pro

gres

sing

very

slow

ly a

nd C

APs

wer

e no

t sup

porte

d in

the

pape

r-bas

ed c

are

plan

ning

tem

plat

e.

Acc

urat

e as

sess

men

t, ef

fect

ive

care

pla

nnin

g an

d qu

ality

impr

ovem

ent f

or b

ette

r res

iden

t out

com

es

Lau

reen

Nei

n, B

SN

RN

A

nita

Ber

gen

BN

, MS

c

Tar

a E

vjen

, BS

N R

N

An

accu

rate

resp

onse

to th

e as

sess

men

t of t

he

bow

el e

limin

atio

n pa

ttern

(ite

m H

2e) o

f the

RA

I-MD

S qu

arte

rly a

sses

smen

t is a

lmos

t alw

ays n

one

of th

e ab

ove.

Aut

o-po

pula

tion

of a

sses

smen

ts

auto

mat

ical

ly p

uts t

his r

espo

nse

into

an

annu

al

asse

ssm

ent w

here

it is

alm

ost a

lway

s ina

ccur

ate;

co

nseq

uent

ly, w

here

non

e of

the

abov

e is

the

resp

onse

to H

2e it

was

con

sider

ed a

n er

ror d

ue to

au

to p

opul

atio

n. A

n au

dit

of H

2e re

spon

ses o

n an

nual

ass

essm

ents

at t

hree

hom

es in

Sas

kato

on

Heal

th R

egio

n sh

owed

that

aut

o po

pula

tion

caus

ed

an a

vera

ge e

rror r

ate

of 7

5%.

Back

grou

nd

•RA

I-MD

S as

sess

men

ts a

re c

ompl

eted

qua

rterly

for 2

200

peop

le in

Sa

skat

oon

Heal

th R

egio

n

•RA

I-MD

S ou

tput

s are

use

d fo

r car

e pl

anni

ng, q

ualit

y im

prov

emen

t, st

rate

gic

plan

ning

and

fund

ing

•In

tern

al a

nd e

xter

nal R

AI-M

DS

aud

it pr

oces

s im

plem

ente

d in

200

5 •

Lean

met

hod

olog

y as

par

t of t

he S

aska

tche

wan

Hea

lth-C

are

Man

agem

ent S

yste

m in

crea

sed

the

focu

s on

heal

th in

dic

ator

s and

pu

t mor

e em

phas

is on

per

form

ance

•

Sask

atch

ewan

Min

istry

of H

ealth

impl

emen

ted

a Q

ualit

y In

dic

ator

Im

prov

emen

t ini

tiativ

e in

201

3 fo

cusin

g on

seve

n of

the

RAI-M

DS

qual

ity in

dic

ator

s and

incl

udin

g im

prov

emen

t pla

ns su

bmitt

ed to

the

Min

istry

on

a qu

arte

rly b

asis

from

eac

h ho

me

whe

re th

e ta

rget

has

no

t bee

n m

et

Ana

lysis

of c

urre

nt p

roce

sses

1. D

aily

dat

a co

llect

ion

by C

ontin

uing

Car

e A

ssist

ants

requ

ired

kn

owle

dge

of R

AI-M

DS

cod

ing

stan

dar

ds;

how

ever

a tr

aini

ng p

rogr

am

to a

pply

the

cod

ing

accu

rate

ly w

as n

ot c

onsis

tent

ly a

vaila

ble.

A

sses

sors

lack

ed c

onfid

ence

in th

e d

ata

colle

cted

. Was

the

curre

nt

met

hod

of d

ata

colle

ctio

n ne

cess

ary

for a

ccur

ate

asse

ssm

ent?

Tw

o as

sess

ors s

imul

tane

ously

ass

esse

d a

resid

ent t

o an

swer

this

ques

tion.

O

ne a

sses

sor u

sed

the

dat

a co

llect

ion

tool

s in

use,

and

the

othe

r use

d

alte

rnat

e so

urce

s of i

nfor

mat

ion

from

the

heal

th re

cord

. Tes

t res

ults

sh

owed

that

col

lect

ing

dat

a in

alte

rnat

ive

way

s had

onl

y a

smal

l to

m

oder

ate

impa

ct o

n RA

I out

puts

.

2.

RAI-M

DS

aud

its a

nd a

ctio

n pl

ans f

aile

d to

yie

ld c

onsis

tent

im

prov

emen

t in

asse

ssm

ent a

ccur

acy

over

a lo

ng p

erio

d o

f tim

e.

Inte

rnal

aud

it re

sults

var

ied

from

ext

erna

l aud

it re

sults

:

Stra

tegi

es

Obj

ectiv

e C

are

team

s will

impr

ove

resid

ent o

utco

mes

by

incr

easin

g bo

th th

e ac

cura

cy o

f RA

I-MD

S as

sess

men

ts a

nd th

e us

e of

CA

Ps fo

r car

e pl

anni

ng.

Cre

ate

and

impl

emen

t a n

ew R

AI d

ata

colle

ctio

n to

ol th

at:

•Pr

ovid

es a

ccur

ate

dat

a fo

r RA

I ass

essm

ent t

hat c

anno

t be

foun

d e

lsew

here

on

the

heal

th re

cord

•

Can

be

com

plet

ed a

ccur

atel

y w

ithou

t ad

diti

onal

trai

ning

•

Can

be

com

plet

ed in

a sh

orte

r am

ount

of t

ime

than

the

curre

nt to

ols

Repl

ace

inte

rnal

aud

it pr

oces

s with

AIS

com

pete

ncy

eval

uatio

ns:

•A

ctiv

ate/

reac

tivat

e RA

I-MD

S us

er a

ccou

nts o

nly

afte

r pas

sing

com

pete

ncy

eval

uatio

ns

•D

iver

t RA

I-MD

S au

dit

fund

ing

to p

aid

tim

e fo

r ass

esso

rs to

com

plet

e co

mpe

tenc

y ev

alua

tions

ann

ually

Impl

emen

t a c

are

plan

ning

tool

that

: •

Inte

grat

es re

siden

t pre

fere

nces

, car

e ne

eds,

goal

s, an

d o

utco

mes

•

Incl

udes

pla

nnin

g fo

r nur

sing

reha

bilit

atio

n/re

stor

ativ

e ca

re

•In

corp

orat

es C

linic

al A

sses

smen

t Pro

toco

ls (C

APs

)

Shut

off

auto

pop

ulat

ion

of R

AI-M

DS

asse

ssm

ents

in J

une

of 2

014

Ack

now

ledg

emen

ts

Con

clus

ion

Resid

ents

, car

e te

ams,

and

man

agem

ent t

eam

s at S

aska

toon

Hea

lth R

egio

n sp

ecia

l car

e ho

mes

hav

e en

thus

iast

ical

ly p

artic

ipat

ed in

the

impl

emen

tatio

n of

new

pro

cess

es a

nd to

ols,

and

pro

vid

ed fe

edba

ck fo

r the

pu

rpos

e of

eva

luat

ion.

The

y pl

ay th

e m

ost i

mpo

rtant

role

in th

e su

cces

s of t

hese

stra

tegi

es a

nd th

eir d

edic

atio

n to

im

prov

ing

the

serv

ice

prov

ided

in lo

ng te

rm c

are

hom

es is

sign

ifica

nt.

•C

hang

ing

the

dat

a co

llect

ion

proc

ess p

rom

pted

a p

ositi

ve re

spon

se fr

om st

aff a

nd m

anag

ers.

•M

anag

ers w

ere

rece

ptiv

e to

mak

ing

a d

ecisi

on a

bout

act

ivat

ing

laps

ed R

AI-M

DS

user

acc

ount

s bas

ed o

n A

IS

com

pete

ncy

eval

uatio

ns.

•Sh

uttin

g of

f aut

o po

pula

tion

of R

AI-M

DS

elic

ited

little

feed

back

. •

The

new

car

e pl

an is

fully

impl

emen

ted

in 5

0% o

f the

hom

es in

the

Regi

on, 6

% o

f the

hom

es h

ave

not y

et b

egun

im

plem

enta

tion

and

the

rem

aini

ng 4

4% a

re in

var

ious

stag

es o

f im

plem

enta

tion.

Eval

uatio

n of

Stra

tegi

es

A tw

o ye

ar e

valu

atio

n of

the

new

car

e pl

an is

cur

rent

ly u

nder

way

thro

ugh

colla

bora

tion

with

a re

sear

ch te

am fr

om th

e Un

iver

sity

of S

aska

tche

wan

led

by

Dr.

Paul

ette

Hun

ter.

Mea

sure

s of t

he e

ffect

iven

ess

of sh

uttin

g of

f aut

o po

pula

tion:

•

Rate

of a

uto

popu

latio

n er

rors

(dec

reas

e by

70%

) •

Ass

essm

ent c

ompl

etio

n ra

te (m

aint

ain)

Mea

sure

s of t

he e

ffect

iven

ess

of th

e us

e of

AIS

com

pete

ncy

eval

uatio

ns:

•

Ove

rall

RUG

s acc

urac

y (im

prov

e by

20%

in o

ne y

ear)

•A

ccur

acy

of th

e Ph

ysic

al F

unct

ioni

ng R

UG (i

mpr

ove

by 3

0% in

one

yea

r) •

Acc

urac

y of

ass

essm

ent o

f Nur

sing

Reha

bilit

atio

n/Re

stor

ativ

e ca

re (i

mpr

ove

by

30%

in o

ne y

ear)

•A

ccur

acy

of th

e as

sess

men

t of f

alls

(impr

ove

by 1

5% in

one

yea

r) •

Acc

urac

y of

ass

essm

ent o

f the

rapi

es p

rovi

ded

(im

prov

e by

20%

in o

ne y

ear

•A

sses

smen

t com

plet

ion

rate

(mai

ntai

n)

Mea

sure

s of t

he e

ffect

iven

ess

of n

ew d

ata

colle

ctio

n pr

oces

s: •

Feed

back

from

a p

ilot a

t fou

r hom

es (t

o re

vise

tool

s and

pro

cess

es)

•Pr

e an

d p

ost i

mpl

emen

tatio

n tim

e st

udy

•RU

Gs a

ccur

acy

(ove

rall a

nd sp

ecifi

c se

ctio

ns) i

n on

e ye

ar

3

Six

them

es o

f cop

ing:

• 

Soc

ial S

uppo

rt *

“I h

ave

good

frie

nds

I can

pho

ne w

hen

the

pres

sure

is

too

muc

h”

• M

akin

g tim

e fo

r Sel

f *

“Doi

ng a

n ac

tivity

that

is ju

st fo

r me”

• 

Ada

ptat

ion

thro

ugh

beha

vior

al a

nd c

ogni

tive

chan

ges

“I w

rite

in a

dia

ry o

f the

day

’s a

ctiv

ities

and

if I’

ve

reac

ted

to/o

n an

issu

e th

at a

rose

.”

“I a

m le

arni

ng to

redu

ce m

y ex

pect

atio

ns o

f mys

elf

and

my

love

d on

e”

• R

elia

nce

on fa

ith a

nd g

od

“In

the

mor

ning

I gi

ve m

ysel

f ove

r to

God

.” • 

Che

ckin

g in

“I

usu

ally

just

cal

l eve

ry d

ay o

r tw

o to

see

how

she

is

and

to re

min

d he

r of w

hat n

eeds

to b

e do

ne o

r s

ugge

stio

ns a

s to

wha

t to

have

for s

uppe

r tha

t day

.” • 

Eng

agin

g in

join

t act

ivity

with

car

e re

cipi

ent.

“I tr

y to

kee

p he

r occ

upie

d w

ith d

iffer

ent t

hing

s to

d

o.”

b

INT

RO

DU

CT

ION

Purp

ose

• Th

e pu

rpos

e of

the

curr

ent s

tudy

is to

des

crib

e ho

w

rura

l car

egiv

ers

cope

with

car

ing

for a

love

d on

e w

ith

cogn

itive

impa

irmen

t or d

emen

tia.

Rat

iona

le

• C

anad

ian

info

rmal

car

egiv

ers

prov

ide

care

with

a

year

ly e

stim

ated

val

ue o

f $26

bill

ion1

• 

Inci

denc

e of

dem

entia

exp

ecte

d to

incr

ease

250

% b

y 20

38, w

ith th

is th

e nu

mbe

r of i

nfor

mal

car

egiv

ers

will

in

crea

se2,

3

• C

areg

ivin

g in

a ru

ral c

onte

xt is

uni

que,

but

the

expe

rienc

es o

f rur

al c

areg

iver

s ha

ve n

ot b

een

wel

l st

udie

d4

Met

hod

• Th

is s

tudy

use

d qu

alita

tive

desc

riptio

n to

ana

lyze

re

spon

ses

to th

e op

en e

nded

que

stio

n : “

Wha

t he

lps

you

cope

on

a da

y- to

day

bas

is w

ith th

e de

man

ds e

xper

ienc

ed a

s a

care

give

r to

som

eone

w

ith m

emor

y di

fficu

lties

?”

• Th

is m

etho

dolo

gy a

llow

ed u

s to

take

an

expl

orat

ive

appr

oach

to th

is u

nder

stud

ied

area

and

gen

erat

e a

desc

riptio

n of

the

mos

t sal

ient

them

es b

roug

ht fo

rth

by th

e re

sear

ch p

artic

ipan

ts.

Cop

ing

with

Cog

nitiv

e Im

pairm

ent a

nd D

emen

tia:

Rur

al c

areg

iver

s’ P

ersp

ectiv

es

RE

SU

LTS

C. B

rang

er1 ,

R. B

urto

n1, M

. E. O

’Con

nell1

, N. S

tew

art2

, & D

. Mor

gan3

1

Dep

artm

ent o

f Psy

chol

ogy,

Uni

vers

ity o

f Sas

katc

hew

an, 2

Col

lege

of N

ursi

ng, U

nive

rsity

of S

aska

tche

wan

, 3C

anad

ian

Cen

tre

for H

ealth

and

Saf

ety

in A

gric

ultu

re,

Uni

vers

ity o

f Sas

katc

hew

an

• Th

is s

tudy

is b

ased

on

166

care

give

rs o

f per

sons

di

agno

sed

with

mild

cog

nitiv

e im

pairm

ent (

MC

I) or

de

men

tia, l

ivin

g in

rura

l Sas

katc

hew

an.

Tabl

e 1:

Fre

quen

cy o

f Car

egiv

er/ C

are

reci

pien

t Rel

atio

nshi

p Ta

ble

2: F

requ

ency

of C

are-

reci

pien

t Dia

gnos

is

AD

: Dem

entia

due

to A

lzhe

imer

’s D

isea

se; F

TD: F

ront

otem

pora

l Dem

entia

; LB

D: L

ewy

Bod

y D

emen

tia; D

ME

: Dem

entia

due

to m

ultip

le e

tiolo

gies

; Oth

er: O

ther

Dem

entia

s; M

CI:

Mild

co

gniti

ve im

pairm

ent

DIS

CU

SS

ION

• 

‘Soc

ial S

uppo

rt’ a

nd’ T

ime

for S

elf’

emer

ged

as m

ost

com

mon

form

s of

cop

ing.

• 

Pre

dom

inan

tly, t

he m

etho

ds o

f cop

ing

reve

aled

in th

is

stud

y re

flect

app

roac

h-ba

sed

copi

ng s

trate

gies

. Suc

h st

rate

gies

hav

e be

en s

how

n to

be

parti

cula

rly

effe

ctiv

e.

• Th

ese

data

sug

gest

thes

e ca

regi

vers

ado

pt a

dapt

ive

copi

ng s

trate

gies

to m

eet t

he d

eman

ds o

f the

ca

regi

ving

role

1 H

olla

nder

, M. J

., Li

u, G

., &

Cha

ppel

l, N

. L. (

2009

). W

ho c

ares

and

how

muc

h? T

he im

pute

d ec

onom

ic c

ontri

butio

n to

the

Can

adia

n. h

ealth

care

sys

tem

of m

iddl

e-ag

ed a

nd o

lder

unp

aid

care

give

rs p

rovi

ding

car

e to

the

elde

rly. H

ealth

care

Q

uarte

rly, 1

2(2)

, 42-

49.

2 D

upui

s, S

. L.,

Epp

, T.,

& S

mal

e, B

. J. A

. (20

04, M

arch

). C

areg

iver

s of

per

sons

with

dem

entia

: Rol

es, e

xper

ienc

es,

supp

orts

, and

cop

ing.

Lite

ratu

re re

view

pre

pare

d fo

r the

Min

istry

of H

ealth

and

Lon

g-Te

rm C

are

and

the

Ont

ario

Sen

ior's

S

ecre

taria

t as

part

of O

ntar

io's

Alz

heim

er S

trate

ty (I

nitia

tive

#6 R

esea

rch

on C

areg

iver

Nee

ds).

Wat

erlo

o, O

N: M

urra

y A

lzhe

imer

Res

earc

h an

d E

duca

tion

Pro

gram

. 111

pp.

3 S

met

anin

, P.,

Kob

ack,

P.,

Bria

nte,

C.,

Stif

f, D

., S

herm

an, G

., &

Ahm

ad, S

. (20

10).

Ris

ing

Tide

: The

impa

ct o

f Dem

entia

on

Can

adia

n S

ocie

ty 2

008

to 2

038.

Alz

heim

er S

ocie

ty. R

etrie

ved

from

ww

w.a

lzhe

imer

.ca

4 M

orga

n, D

., In

nes,

A.,

& K

oste

niuk

, J(2

011)

. Dem

entia

car

e in

rura

l and

rem

ote

setti

ngs:

A s

yste

mat

ic re

view

of f

orm

al o

r pa

id c

are.

Mat

urita

s, 6

8(1)

, 17–

33.

Fin

din

gs:

Co

pin

g T

hem

es

RR

MC

Fun

ding

and

in-k

ind

supp

ort i

s ge

nero

usly

pro

vide

d by

:

b

Man

y ca

regi

vers

repo

rted

use

of m

ore

than

one

them

e of

cop

ing,

and

the

frequ

enci

es o

f co-

occu

rrin

g th

emes

ar

e pr

esen

ted.

Ta

ble

3: F

requ

ency

of

Co-

occ

urrin

g C

opin

g Th

emes

* Mos

t com

mon

them

es: S

ocia

l Sup

port

and

Mak

ing

Tim

e fo

r Sel

f

Co-

Occ

urre

nce

of C

opin

g Fr

eque

ncy

Soc

ial S

uppo

rt/Ti

me

for S

elf

20

Soc

ial S

uppo

rt/R

estru

ctur

ing

11

Soc

ial S

uppo

rt/Ti

me

for S

elf/S

pirit

ualit

y 8

Soc

ial S

uppo

rt/S

pirit

ualit

y 8

Soc

ial S

uppo

rt/Ti

me

for S

elf/R

estru

ctur

ing

4

Soc

ial S

uppo

rt/Ti

me

for S

elf/R

estru

ctur

ing/

Join

t Act

ivity

3

Soc

ial S

uppo

rt/R

estru

ctur

ing/

Spi

ritua

lity

3

Soc

ial S

uppo

rt/C

heck

-in

3

Soc

ial S

uppo

rt/R

estru

ctur

ing/

Join

t Act

ivity

2

Soc

ial S

uppo

rt/Ti

me

for S

elf S

elf/R

estru

ctur

ing/

Spi

ritua

lity

1

Soc

ial S

uppo

rt/Jo

int A

ctiv

ity/R

estru

ctur

ing

1

Soc

ial S

uppo

rt/Jo

int A

ctiv

ity/C

heck

-in

1

Soc

ial S

uppo

rt/Ti

me

for S

elf/S

pirit

ualit

y 1

Tim

e fo

r Sel

f/Res

truct

urin

g/Jo

int A

ctiv

ity

1

Tim

e fo

r Sel

f/Spi

ritua

lity

1

Rel

atio

nshi

p to

car

e- re

cipi

ent

Wife

H

usba

nd D

augh

ter

Son

O

ther

To

tal

N

umbe

r 59

30

51

16

10

16

6

Car

e-

reci

pien

t A

D

FTD

LB

D

VD

D

ME

O

ther

M

CI

Num

ber

64

16

9 3

15

30

31

4

• W

hen

study

ing

inte

rven

tions

it is

crit

ical

to

be

awar

e of

the

pote

ntia

l for

con

flict

be

twee

n th

e cl

inic

ian

and

inve

stiga

tor

role

s reg

ardl

ess o

f whe

ther

one

ado

pts t

he

simila

rity

or th

e di

ffere

nce

posit

ion.

• In

ord

er to

max

imiz

e di

strib

utiv

e ju

stice

, m

ake

the

incl

usio

n cr

iteria

of i

nter

vent

ion

studi

es a

s bro

ad a

s pos

sible

in o

rder

to

mak

e th

e re

sear

ch tr

eatm

ent a

vaila

ble

to

as m

any

inte

reste

d in

divi

dual

s as p

ossib

le,

and

the

resu

lts a

pplic

able

to a

s man

y pe

ople

as p

ossib

le.

• Co

nsid

er n

on-tr

aditi

onal

rese

arch

de

signs

such

as m

ultip

le b

asel

ine,

sin

gle-

case

exp

erim

enta

l des

igns

.

• Co

nsist

ent w

ith ‘r

espo

nsib

le c

arin

g’,

whe

n th

e in

terv

entio

n be

ing

studi

ed

cann

ot b

e of

fere

d m

ake

refe

rrals

to

appr

opria

te re

sour

ces.

• To

avo

id c

onfli

cts o

f int

eres

t, av

oid

recr

uitin

g pa

rtici

pant

s fro

m o

ne’s

own

prac

tice

as m

uch

as p

ossib

le.

• If

this

is un

avoi

dabl

e, c

lear

ly se

para

te

the

rese

arch

con

sent

from

con

sent

to

treat

men

t as u

sual

. • 

Recr

uit p

artic

ipan

ts fro

m c

linic

-bas

ed

setti

ngs r

athe

r tha

n co

mm

unity

-bas

ed

setti

ngs i

n or

der t

o m

inim

ize

diffi

culti

es

rela

ted

to d

iagn

osis

and

incl

usio

n cr

iteria

.

• A

uniq

ue st

reng

th o

f the

Can

adia

n Co

de o

f Eth

ics i

s tha

t it p

rovi

des s

peci

fic g

uide

lines

for

actio

n w

hen

ethi

cal p

rinci

ples

are

in c

onfli

ct, a

nd a

10

step

appr

oach

to a

ddre

ssin

g et

hica

l di

lem

mas

(Can

adia

n Ps

ycho

logi

cal A

ssoc

iatio

n, 2

001)

.

Intr

oduc

tion

Rec

ruiti

ng in

divi

dual

s dia

gnos

ed w

ith d

emen

tia d

ue to

Alz

heim

er’s

dise

ase

for c

ogni

tive

reha

bilit

atio

n: E

thic

al te

nsio

n be

twee

n th

e cl

inic

ian

and

inve

stig

ator

role

s

Rac

hel L

. Bur

ton

& M

egan

E. O

’Con

nell

Dep

artm

ent o

f Psy

chol

ogy,

Uni

vers

ity o

f Sas

katc

hew

an

rach

el.b

urto

n@us

ask.

ca,

meg

an.o

conn

ell@

usas

k.ca

Eth

ical

Gui

delin

es fo

r th

e C

linic

ian

and

the

Inve

stig

ator

Ref

eren

ces a

nd A

ckno

wle

dgem

ents

App

licat

ion

of th

e C

anad

ian

Cod

e of

Eth

ics f

or P

sych

olog

ists

Sugg

estio

ns

Brod

y an

d M

iller

(200

3) h

ave

argu

ed th

at

the

goal

s of r

esea

rch

and

the

goal

s of

clin

ical

pra

ctic

e ar

e lo

gica

lly

inco

nsist

ent.

“Diff

eren

ce”

posit

ion:

Res

earc

h is

dire

cted

tow

ard

prov

idin

g ge

nera

lized

kn

owle

dge

and

clin

ical

pra

ctic

e is

dire

cted

tow

ard

prov

idin

g th

e be

st po

ssib

le c

are

to a

n in

divi

dual

(Bro

dy &

M

iller

, 200

3).

• Th

is ar

gum

ent h

as b

een

fierc

ely

criti

cize

d.

“Sim

ilari

ty”

posit

ion:

Clin

ical

in

vesti

gato

rs o

ught

to b

e bo

und

by th

e sa

me

prin

cipl

es th

at g

over

n th

erap

eutic

m

edic

ine

(Bro

dy &

Mill

er, 2

003)

.

Co

gniti

ve re

habi

litat

ion

is a

prom

ising

, no

n-ph

arm

acol

ogic

al in

terv

entio

n fo

r in

divi

dual

s dia

gnos

ed w

ith d

emen

tia d

ue

to A

lzhe

imer

’s di

seas

e (A

D) o

r mix

ed

AD

and

vas

cula

r dem

entia

(VaD

; i.e

., Cl

are

et a

l., 2

010)

. Whi

le re

crui

ting

rese

arch

par

ticip

ants

for a

stud

y se

ekin

g to

repl

icat

e an

d ex

tend

pre

viou

s wor

k in

th

is ar

ea, w

e en

coun

tere

d an

eth

ical

di

lem

ma

whe

n ou

r rol

e as

trea

ting

psyc

holo

gists

con

flict

ed w

ith o

ur ro

le a

s re

sear

cher

s. Th

e D

ilem

ma

We

strug

gled

with

how

to p

rovi

de th

e be

st po

ssib

le se

rvic

e to

all

pers

ons w

ho

atte

nded

our

inta

ke a

sses

smen

t (cl

inic

ian

role

), w

hile

adh

erin

g to

exc

lusio

n cr

iteria

in

ord

er to

max

imiz

e th

e in

tern

al v

alid

ity

of th

e stu

dy (i

nves

tigat

or ro

le).

Indi

vidu

als a

ttend

ing

the

inta

ke

asse

ssm

ent h

ad c

once

rns t

hat c

ould

be

addr

esse

d th

roug

h co

gniti

ve

reha

bilit

atio

n, b

ut th

eir e

ligib

ility

for t

he

study

was

unc

lear

. O

bjec

tives

of t

he C

urre

nt P

roje

ct:

1. 

Dra

w a

ttent

ion

to th

e et

hica

l ten

sion

betw

een

the

role

of c

linic

ian

and

the

role

of i

nves

tigat

or in

the

cont

ext o

f re

crui

ting

and

excl

udin

g in

divi

dual

s fo

r a st

udy

on c

ogni

tive

reha

bilit

atio

n fo

r ear

ly st

age A

D o

r mix

ed A

D/

VaD

. 2. 

Offe

r an

exam

ple

of e

thic

al d

ecisi

on

mak

ing

usin

g th

e Ca

nadi

an C

ode

of

Ethi

cs fo

r Psy

chol

ogist

s.

3. 

Prov

ide

sugg

estio

ns fo

r how

to b

est

man

age

the

tens

ion

betw

een

the

clin

icia

n an

d in

vesti

gato

r rol

es w

hen

recr

uitin

g an

d ex

clud

ing

indi

vidu

als

with

a d

emen

tia d

iagn

osis

for a

n in

terv

entio

n stu

dy.

Post

er P

rese

nted

at t

he 4

3rd A

nnua

l Sc

ient

ific

and

Edu

catio

nal M

eetin

g of

the

Can

adia

n A

ssoc

iatio

n on

Ger

onto

logy

R. B

urto

n’s W

ork

Supp

orte

d by

a D

octo

ral A

war

d fro

m:

How

can

the

sam

e in

divi

dual

be

gui

ded

by d

iffer

ent m

oral

ob

ligat

ions

at d

iffer

ent t

imes

? “J

ekyl

l-And

- Hyd

e ap

proa

ch”.

(Mill

er, 2

002)

Add

ition

al c

onsid

erat

ions

in d

emen

tia:

• Re

spec

t for

the

auto

nom

y of

per

sons

an

d th

e pr

otec

tion

of v

ulne

rabl

e pe

rson

s (F

isk, 2

007)

. • 

Capa

city

to c

onse

nt a

nd d

istrib

utiv

e ju

stice

. M

ost e

thic

al g

uide

lines

trea

t the

two

activ

ities

as s

imila

r. Fo

r exa

mpl

e:

Cana

da’s

Tri-C

ounc

il Po

licy

Stat

emen

t: Et

hica

l Con

duct

for R

esea

rch

Invo

lvin

g H

uman

s.

Step

2: R

elev

ant s

tand

ards

I.

Resp

ect f

or th

e di

gnity

of

pers

ons

• N

on-d

iscrim

inat

ion

• In

form

ed c

onse

nt

• Fr

eedo

m o

f con

sent

• Pr

otec

tion

of v

ulne

rabl

e pe

rson

s

II. R

espo

nsib

le c

arin

g • 

Max

imiz

e be

nefit

• M

inim

ize

harm

• Ri

sk/b

enefi

t ana

lysis

III. I

nteg

rity

in re

latio

nshi

ps

• Av

oida

nce

of c

onfli

ct o

f int

eres

t

IV. R

espo

nsib

ility

to so

ciet

y • 

Dev

elop

men

t of s

ocie

ty

Step

1: W

ho is

invo

lved

? • 

Indi

vidu

al w

ith c

ogni

tive

com

plai

nts;

fam

ily m

embe

rs;

grad

uate

stud

ent;

supe

rvisi

ng p

sych

olog

ist; i

ndiv

idua

ls w

ho st

and

to b

enefi

t fro

m th

e re

sear

ch; o

ther

rese

arch

ers.

Also

rele

vant

: Tri-

coun

cil P

olic

y St

atem

ent,

Sect

ion

5 on

in

clus

ion

in re

sear

ch.

Step

3: F

acto

rs th

at m

ight

influ

ence

the

deve

lopm

ent o

f or

choi

ce b

etw

een

cour

ses o

f act

ion

• Pe

rson

al b

iase

s: N

eed

to re

crui

t par

ticip

ants,

nee

d fo

r a

‘cle

an’ s

ampl

e.

• Pe

rson

al/p

rofe

ssio

nal s

tress

ors:

Shor

tage

of t

ime

and

reso

urce

s. • 

Self-

inte

rest:

Diss

erta

tion

rese

arch

.

Step

s 4 a

nd 5

: Alte

rnat

ive

cour

se o

f act

ion,

and

risk

s/ben

efits

of

actio

n. A

ctio

n Be

nefit

s R

isks

Incl

ude

in th

e stu

dy

Cons

isten

t with

non

-di

scrim

inat

ion.

M

axim

izes

the

pote

ntia

l be

nefit

of c

ogni

tive

reha

bilit

atio

n fo

r thi

s in

divi

dual

.

Chal

leng

ing

to in

terp

ret

data

with

out c

lear

di

agno

sis.

Oth

er se

rvic

es m

ay b

e m

ore

appr

opria

te fo

r the

fa

mily

.

Excl

ude

from

the

study

Ensu

res t

he re

sults

of

the

study

con

tribu

te to

th

e de

velo

pmen

t of

soci

ety

as m

uch

as

poss

ible

. M

ake

mor

e ap

prop

riate

re

ferra

l as g

uide

d by

re

spon

sible

car

ing.

Fam

ily d

oes n

ot re

ceiv

e a

pote

ntia

lly b

enefi

cial

in

terv

entio

n.

Step

6: C

hoic

e.

• Ch

ose

to e

xclu

de fr

om th

e stu

dy.

Step

7: A

ctio

n.

• Pr

ovid

ed o

ne se

ssio

n of

psy

choe

duca

tion

abou

t cog

nitiv

e re

habi

litat

ion,

and

info

rmat

ion

abou

t alte

rnat

e re

sour

ces i

n th

e ci

ty.

Step

8: E

valu

ate

and

follo

w-u

p.

Step

9: A

ssum

ptio

n of

resp

onsib

ility

of a

ny c

onse

quen

ces.

Step

10:

Fut

ure

prev

entio

n.

• Im

plem

ente

d m

ore

thor

ough

tele

phon

e pr

e-sc

reen

ing.

Cl

inic

-bas

ed ra

ther

than

com

mun

ity re

crui

tmen

t foc

us.

Cana

dian

Insti

tute

s of H

ealth

Res

earc

h, N

atur

al S

cien

ces a

nd E

ngin

eerin

g Re

sear

ch C

ounc

il of

Can

ada,

Soc

ial

Sci

ence

s and

Hum

aniti

es R

esea

rch

Coun

cil o

f Can

ada.

(200

5). T

ri-Co

unci

l P

olic

y St

atem

ent:

Ethi

cal

Con

duct

for R

esea

rch

Invo

lvin

g H

uman

s. O

ttaw

a, O

ntar

io: I

nter

agen

cy S

ecre

taria

t on

Rese

arch

Eth

ics.

Cana

dian

Psy

chol

ogic

al A

ssoc

iatio

n. (2

001)

. Com

pani

on M

anua

l to

the

Cana

dian

Cod

e of

Eth

ics f

or P

sych

olog

ists,

Thi

rd E

ditio

n. O

ttaw

a, O

ntar

io: C

anad

ian

Psyc

holo

gica

l Ass

ocia

tion.

Clar

e, L

., Li

nden

, D. E

. J.,

Woo

ds, R

. T.,

Whi

take

r, R.

, Eva

ns, S

. J.,

Park

inso

n, C

. H.,

… R

ugg,

M. D

. (20

10).

Goa

l- O

rient

ed C

ogni

tive

Reha

bilit

atio

n fo

r Peo

ple

With

Ear

ly-S

tage

Alz

heim

er D

iseas

e: A

Sin

gle-

Blin

d R

ando

miz

ed C

ontro

l Tria

l of C

linic

al E

ffica

cy. A

mer

ican

Jou

rnal

of G

eria

tric

Psyc

hiat

ry, 1

8, 9

28-9

39.

doi

:10.

1097

/JGP

0b01

3e31

81d5

792a

. Br

ody,

H. &

Mill

er, F

. G. (

2002

). Th

e cl

inic

ian-

inve

stiga

tor:

Una

void

able

but

man

agea

ble

tens

ion.

Ken

nedy

Insti

tute

o

f Eth

ics J

ourn

al, 1

3(4)

, 329

-346

. Fi

sk, J

. (20

07).

Ethi

cal c

onsid

erat

ions

for t

he c

ondu

ct o

f ant

idem

entia

tria

ls in

Can

ada.

The

Can

adia

n Jo

urna

l of

Neu

rolo

gica

l Sci

ence

s, 34

(1),

S32-

36.

Mill

er, P

. B. (

2002

). Av

oidi

ng a

Jeky

ll-an

d-H

yde

appr

oach

to th

e et

hics

of c

linic

al re

sear

ch a

nd p

ract

ice.

The

A

mer

ican

Jou

rnal

of B

ioet

hics

, 2(2

), 14

– 1

7.

Cont

act:

5

The

Inte

rsec

tion

of

Res

iden

t-C

ente

red

Car

e an

d Be

st P

ract

ices

for

Nut

ritio

n C

are

in L

ong

-ter

m C

are

A. Cam

mer

1,2 , S. W

hitin

g2, D

. Morgan1

1 Can

adian Ce

ntre fo

r Health

 and

 Safety in Agriculture, College of M

edicine, University

 of Saskatche

wan

, 2Co

llege of P

harm

acy an

d Nutrition, University

 of Saskatche

wan

 

Know

ledg

e Tran

slatio

n

Ackn

owledgem

ents

Back

grou

nd•

Car

e A

ides

per

form

the

maj

ori

ty o

f di

rect

res

iden

t ca

re in

long

-te

rm c

are

(LTC

) w

ith li

ttle

tra

inin

g in

nut

ritio

n•

Polic

ies

and

stan

dard

ized

car

e pr

oce

dure

s ai

m t

o e

limin

ate

gues

swo

rk b

ut c

an c

reat

e ro

utin

ized

, tas

k-ba

sed

care

focu

s re

gard

ing

nutr

itio

n ca

re•

Pers

on-

cent

ered

car

e re

spec

ts t

he r

esid

ent

as a

n in

divi

dual

with

un

ique

nee

ds a

nd t

he r

ight

to

dig

nity

, res

pect

, and

full

part

icip

atio

n in

the

ir o

wn

care

•Th

e st

ruct

ured

wo

rk e

nviro

nmen

t o

f LTC

lend

s its

elf

to s

ched

uled

an

d st

anda

rdiz

ed c

are

prac

tices

, yet

:•

Hig

hly

defin

ed L

TC p

roto

cols

oft

en o

ppo

se t

he c

entr

al t

enet

s o

f pe

rso

n-ce

nter

ed c

are

Obj

ectiv

e•

To e

xam

ine

the

inte

rsec

tion

of

pers

on-

cent

ered

car

e ph

iloso

phy

with

nut

ritio

n ca

re d

inin

g be

st p

ract

ices

in L

TC in

ord

er t

o

unde

rsta

nd w

here

nut

ritio

n po

licy

initi

ativ

es c

oul

d en

hanc

e qu

ality

o

f car

e fo

r LT

C r

esid

ents

, esp

ecia

lly t

hose

with

dem

entia

Nex

t St

eps

•C

om

pari

son

with

oth

er s

ectio

ns o

f th

e gu

idel

ines

is n

eede

d to

iden

tify

pote

ntia

l sup

port

s th

at e

nabl

e o

r di

sco

rds

that

cre

ate

a ba

rrie

r to

ach

ievi

ng p

erso

n-ce

nter

ed c

are

•C

om

pari

son

with

oth

er ju

risd

ictio

ns c

oul

d id

entif

y po

tent

ial ‘

miss

ing

piec

es’ n

ot

out

lined

with

in t

hese

•St

udy

of

the

upta

ke a

nd a

pplic

atio

n o

f th

e gu

idel

ines

, with

spe

cific

att

entio

n to

ho

w e

ach

is in

terp

rete

d an

d ap

plie

d, c

oul

d ge

nera

te u

nder

stan

ding

of g

aps

•Ex

amin

atio

n o

f the

bal

ance

bet

wee

n pe

rso

n-ce

nter

ed a

ppro

ach

and

the

func

tion

of t

he o

rgan

izat

ion

and

betw

een

pers

on-

cent

ered

app

roac

h an

d en

suri

ng a

dequ

ate

nutr

itio

nal i

ntak

e co

uld

reve

al s

yste

mic

ch

alle

nges

with

in L

TC p

ract

ice

Find

ings

•St

ruct

ured

gui

delin

es f

or

nutr

itio

n ca

re s

erve

as

an

impo

rtan

t st

artin

g po

int

for

ensu

ring

co

mpe

tent

nu

triti

on

care

, but

are

no

t co

mpr

ehen

sive

•N

on-

pres

crip

tive

styl

e o

f th

ese

guid

elin

es d

oes

no

t fo

rce

rout

iniz

ed c

are;

allo

ws

for

tailo

ring

of

inte

rnal

po

licie

s an

d pr

actic

es t

o fi

t ea

ch p

artic

ular

LT

C in

the

ir c

apac

ity a

nd s

tyle

to

ado

pt a

per

son-

cent

ered

car

e ph

iloso

phy

of

care

•A

gap

exi

sts

betw

een

polic

y an

d ‘h

ow

to’

pra

ctic

e re

com

men

datio

ns t

o a

chie

ve p

erso

n-ce

nter

ed c

are

in f

oo

d an

d nu

triti

on;

tra

inin

g ef

fort

s sh

ould

foc

us

on

ope

ratio

naliz

ing

pers

on-

cent

ered

car

e ph

iloso

phy

in e

ach

LTC

•To

ols

to

ass

ist in

impl

emen

ting

pers

on-

cent

ered

nu

triti

on

care

co

uld

help

to

tra

nsla

te s

tand

ards

an

d gu

idel

ines

into

eff

ectiv

e pr

actic

e•

Gui

delin

es a

re a

use

ful f

irst

-ste

p; e

valu

atio

n ef

fort

s m

ust

exam

ine

the

abili

ty o

f the

LTC

to

ena

ble

pers

on-

cent

ered

car

e in

eve

ryda

y pr

actic

e

Met

hods

•In

Apr

il, 2

013

Sask

atch

ewan

Hea

lth

man

date

d pr

ogr

am g

uide

lines

fo

r sp

ecia

l-car

e ho

mes

(LT

C)

•Se

ctio

n 13

.2 e

nco

mpa

ss t

he F

oo

d an

d N

utri

tion

Din

ing

Expe

rien

ce

com

pone

nts

of t

he p

rogr

am g

uide

lines

, with

a t

ota

l of 2

1 po

licy

indi

catio

ns c

ont

aine

d w

ithin

•Th

e V

IPS

fram

ewo

rk fo

r pe

rso

n-ce

nter

ed c

are

(Bro

oke

r, 20

07)

and

Rei

mer

and

Kel

ler’

s (2

009)

mo

del o

f 4 e

lem

ents

of p

erso

n-ce

nter

ed m

ealti

me

care

for

LTC

wer

e us

ed t

o c

om

pare

per

son

cent

ered

ness

with

the

nut

ritio

n gu

idel

ines

•Fo

ur e

lem

ents

of

pers

on-

cent

ered

car

e:•

Pro

vidi

ng C

hoic

es a

nd P

refe

renc

es•

Supp

ort

ing

Inde

pend

ence

•Sh

ow

ing

Res

pect

•Pr

om

otin

g So

cial

Inte

ract

ion

•Ea

ch g

uide

line

was

co

ntra

sted

with

el

emen

ts t

o d

eter

min

e th

e fit

of t

he le

gally

m

anda

ted

guid

elin

es w

ith p

erso

n-ce

nter

ed

care

phi

loso

phy

Co

mpa

riso

n o

f Gui

delin

es t

o R

eim

er a

nd

Kel

ler’

s m

ode

l of p

erso

n-ce

nter

ed c

are:

Fit

with

Bro

oke

r’s

VIP

S fr

amew

ork

:Va

lue

–st

ates

a r

esid

ent-

cent

ered

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roac

hIn

divi

dual

ized

–re

view

of

resid

ent

need

s, e

valu

atio

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rspe

ctiv

e–

not

expl

icit

with

in g

uide

line;

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ls f

or

resid

ent

resp

ect

and

dign

itySo

cial

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ibes

a s

oci

ally

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port

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envi

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6

85%

15%

Whe

re th

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lls o

ccur

red

Out

door

s

Ackn

owle

dgem

ents

: W

e th

ank

the

part

icip

ants

. Fun

ded

by th

e Sa

skat

chew

an H

ealth

Res

earc

h Fo

unda

tion

Cha

ract

eris

tics

of F

alls

in C

omm

unity

Dw

ellin

g O

lder

Adu

lts w

ith E

arly

Mem

ory

Prob

lem

s D

al B

ello

-Haa

s V1

, Cro

ssle

y M

2 , O

’Con

nell

ME2

, Mor

gan

D3 ,

Kirk

A4

1 Sch

ool o

f Reh

abili

tatio

n Sc

ienc

e, M

cMas

ter U

nive

rsity

; 2 D

epar

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t of P

sych

olog

y, 3

Can

adia

n C

entr

e fo

r Hea

lth a

nd S

afet

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Agr

icul

ture

, 4N

euro

logy

, Uni

vers

ity o

f Sas

katc

hew

an

INTR

ODU

CTIO

N

• Th

e an

nual

inci

denc

e of

falls

in p

erso

ns w

ith

m

oder

ate

to se

vere

dem

entia

has

bee

n

re

port

ed to

be

40%

to 6

0% (

Shaw

, 20

03)

• Li

mite

d nu

mbe

r of l

ongi

tudi

nal,

pros

pect

ive

stud

y ha

s exa

min

ed fa

ll-re

late

d in

jurie

s in

com

mun

ity d

wel

ling

olde

r adu

lts w

ith d

emen

tia

(A

llen

2009

) •

No

stud

ies h

ave

pros

pect

ivel

y tr

acke

d pe

ople

with

ear

ly m

emor

y pr

oble

ms

PURP

OSE

To d

escr

ibe

the

prof

ile o

f fal

l eve

nts i

n

peop

le w

ith e

arly

mem

ory

prob

lem

s.

MET

HODS

• F

ifty-

nine

Rur

al a

nd R

emot

e M

emor

y Cl

inic

pat

ient

s (Sa

skat

oon,

Sas

katc

hew

an, C

anad

a)

• A

ge =

72

± 10

yea

rs; 5

5.9%

fem

ale

•

Pro

spec

tive

stud

y ov

er si

x m

onth

s •

Pat

ient

car

egiv

ers (

PC) c

ompl

eted

a m

onth

ly

f

all d

iary

•

Res

earc

h as

sist

ant t

elep

hone

d P

C ev

ery

two

wee

ks to

incr

ease

acc

urac

y of

the

colle

cted

dat

a an

d to

inc

reas

e ad

here

nce

Trip

sSl

ips

Loss

of

bala

nce

Not

pay

ing

atte

ntio

n

20%

30%

36

.70%

13.3

0%

REAS

ON

FO

R FA

LLS

012345

Frac

ture

Head

impa

ctBr

uise

sCu

ts/s

crap

es

INJU

RIES

RES

ULT

ING

FRO

M FA

LLS

%

INCI

DEN

CE O

F FA

LLS

Tota

l fal

ls

35.6

%

Sing

le fa

lls

16.9

%

Mul

tiple

falls

18

.5%

TI

ME

OF

FALL

Af

tern

oon

or e

veni

ng

53.8

%

SAFE

TY IS

SUE

No

foot

wea

r/ba

refo

ot

41.7

%

DISC

USS

ION

• O

vera

ll fa

ll in

cide

nce

was

sim

ilar t

o w

hat h

as b

een

repo

rted

in c

omm

unity

-

dw

ellin

g ol

der a

dults

with

out c

ogni

tive

impa

irmen

ts

• A

bout

1 in

3 c

omm

unity

-dw

ellin

g ol

der a

dults

fall

(Tro

mp

2001

) •

Fal

ls in

peo

ple

with

ear

ly m

emor

y pr

oble

ms o

ccur

red

mai

nly

durin

g

po

sitio

n tr

ansi

tions

or w

hile

neg

otia

ting

stai

rs/s

teps

/cur

b •

Thi

s diff

ers t

o w

hat h

as b

een

repo

rted

in c

omm

unity

-dw

ellin

g ol

der a

dults

with

out c

ogni

tive

impa

irmen

ts –

55%

of f

alls

occ

urre

d du

ring

am

bula

tion

(Ta

lbot

200

5)

• T

he fi

ndin

gs h

ave

impl

icat

ions

for p

atie

nt a

nd c

areg

iver

trai

ning

and

safe

ty

i

n ho

me

& c

omm

unity

env

ironm

ents

to ta

rget

fall

risk

for t

hose

with

ear

ly

mem

ory

prob

lem

s

20.8

0%

33.3

0%

Posi

tion

tran

sitio

ns (b

ed, c

hair,

car

,to

ilet t

rans

fers

)

Wal

king

Clim

bing

or d

esce

ndin

g (S

tairs

,st

eps,

cur

bs)

Activ

ities

at t

ime

of fa

ll

RESU

LTS

45.8

0%

Indo

ors

7

Fitness  and  Physical  Ac0vity  Levels  of  Individuals  A7ending  a  Rural  and  Remote  Memory  Clinic    Dal  Bello-­‐Haas  V1,  Megan  E.  O'Connell2,  Debra  G.  Morgan3    

1School of Rehabilitation Science, McMaster University, Hamilton, Ontario; 2Department of Psychology, 3 Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan

INTRODUCTION    

•   There  has  been  growing  interest  in  physical  ac0vity  as  a  poten0al  disease-­‐modifying  therapeu0c  interven0on  for  people  with  demen0a.    •   Physical  ac0vity  is  defined  as  any  bodily  movement  produced  by  skeletal  muscles  that  results  in  energy  expenditure;  broadly  encompasses  exercise,  sports,  physical  ac0vi0es  done  as  part  of  daily  living,  occupa0on,  leisure,  ac0ve  transporta0on  [Caspersen  1985]  •   Physical  ac0vity    has  been  shown  to  improve  cogni0on  [Hokkanen  2008],  ac0vi0es  of  daily  living  [Arcoverde  2008],  and  func0onal  ability  and  mental  health  [Teri  2008]  in  people  with  demen0a  

OBJECTIVE    

To  examine  ‘fitness'  and  physical  ac0vity  levels  in  community  dwelling  people  with  early  stage  memory  problems  living  in  rural  and  remote  areas.  

 Physical  fitness    -­‐  ‘’[a  set  of]  measurable  health  and  skill-­‐related  a;ributes’’  that  include  cardiorespiratory  fitness,  muscular  strength  and  endurance,  body  composi?on  and  flexibility,  balance,  agility,  reac?on  ?me,  power  [Caspersen  1985]  Func?onal  fitness  -­‐    having  the  physical  capacity  to  perform    everyday  ac?vi?es  safely  and  independently  without  undue  fa?gue  

CONCLUSION    

•   Male  par0cipants  had  more  acceptable  levels  of  physical  ac0vity  ,  as  measured  by  the  PASE,  compared  to  female  par0cipants.  •   As  measured  by  SFT  components,  ‘fitness'  of  males  and  females  with  early  memory  problems  living  in  rural  and  remote  areas  were  not  op0mal.  •   People  with  early  memory  problems  may  require  educa0on  about  the  benefits  of  physical  ac0vity  and  maintaining  fitness.  

Acknowledgements:    We  thank  the  par0cipants.  This  research  was  supported    by  the  Saskatchewan  Health  Research  Founda0on  (V.  Dal  Bello-­‐Haas),    and    an  Applied  Chair  in  Health  Services  and  Policy  Research  from  the  Canadian  Ins0tutes  of  Health  Research  and  the  Saskatchewan  Health  Research  Founda0on  (D.  Morgan)  

STUDY    PARTICIPANTS  

§  Mean  age  =  72,  SD  =  10.0  §  56%  female    §  Mean  MMSE  score  =  25  (SD  =  4)    §  Mean  3MS  score  =  82  (SD  =  13)    

Senior  Fitness  Test  (Rikli  &  Jones  1999)  

METHODS  Fify-­‐nine  Rural  and  Remote  Memory  Clinic  (Saskatoon,  SK)  pa0ents  par0cipated.    Measures  completed:  §  A  baseline  demographic  ques0onnaire  §  Neuropsychological  tests    -­‐  Mini-­‐mental  Status  Exam  (MMSE),  3MS  §  Senior  Fitness  Test  (SFT)  components    -­‐    Sit-­‐to-­‐Stand,  Arm  Curls,  2-­‐minute  step  test  §  Physical  Ac0vity  Scale  for  the  Elderly  (PASE;  with  the  assistance  of  caregivers)  

RESULTS  

Neuropsychological  Screens  §  MMSE          -­‐  brief,  cogniIve  screen          -­‐  score  ranges  from  0  to  30          -­‐  score  of  24  indicates  further  tesIng                  is  required  §  3MS        -­‐  brief  screening  test  for  demenIa        -­‐  score  ranges  from  0  to  100        -­‐  score  < 79  suggests  further  tesIng  required  

Lower  Body  Strength  §  Major  factor  in  mobility  and  disability  

prevenIon  §  Correlates  with  stair-­‐climbing  ability,  walking  

speed,  fall    risk  §  #  of  full  stands  from  a    seated    posiIon  in  30  

seconds  

Upper  Body  Strength  §  Important  for  normal  daily  acIviIes,  e.g,  

household  chores,              carrying  groceries,  personal  care  §  #  of  arm-­‐curls  in  30  seconds  (5  lbs  for  females,                8  lbs  for    males)  

Aerobic  Test  §  A  (alternaIve)  measure  of  aerobic  endurance  §  Correlates  with  common  measures  of  endurance  §  Necessary  to  perform  many  daily  acIviIes  e.g.,  

walking,                shopping,  recreaIonal  acIviIes  §  #  of  Imes  individual  can  step  in  place  in  2  

minutes  

PASE  (Washburn  1993)  §  Measure  of  physical  acIvity              levels  of  older  adults  §  Household,  occupaIonal,  and    leisure  

Ime  acIvity  §  Each  acIvity  is  given  a  weight;  total  

score  is  recorded  as  the  sum  of  the  amount  of  Ime  in  each  acIvity  mulIplied  by  the  weight  of  the  acIvity.  

Males,  n  =  23  Mean  (SD)  

Females,  n  =  32  Mean  (SD)   p  

Sit-­‐to-­‐stand   10.39    (4.46)   8.94  (4.12)   .192  

Arm  curl   12.00  (4.20)   11.09  (4.51)   .414  

Step  test   62.15  (25.86)     55.13  (28.72)   .336  

PASE   112.73  (63.86)   68.45  (48.11)   .008  

Males    (n  =  23)   Females  (n  =  32)  

Norm  Range  

PercenIle  Rank  

Norm  Range  

PercenIle  Rank  

Sit-­‐to-­‐stand   6  to  23   15th   4  to  21   10th    to  15th  

Arm  curl   9  to  27   15th   6  to  24   15th  

2-­‐minute  step  test  

48  to  135   5th  to  10th   37  to  130   10th    to  15th  

PASE   102.4   n/a   89.1   n/a    

ParIcipant  Comparison  to  Age-­‐related  Norms  

Bibliography:  •  Arcoverde  C,  Deslandes  A,  Rangel  A,  Rangel  A,  Pavao  R,  Nigri  F,  et  al.  Role  of  physical  acIvity  on  the  maintenance  of  cogniIon  and  

acIviIes  of  daily  living  in  elderly  with  Alzheimer’s  disease.  Arq  Neuro-­‐Psiquiat.  2008;66:323-­‐27.  •  Caspersen  CJ,  Powell  KE,  Christenson  GM.  Physical  acIvity,  exercise,  and  physical  fitness:  definiIons  and  disIncIons  for  health-­‐

related  research.  Public  Health  Rep.  1985;100(2):126–31.  •  Hokkanen  L,  Rantala  L,  Remes  AM,  Harkonen  B,  Viramo  P,  Winblad  I.  Dance  and  movement  therapeuIc  methods  in  management  

of  demenIa:  a  randomized,  controlled  study.  J  Am  Geriatr  Soc.  2008;56:771-­‐72.  •  Rikli  RE,  Jones  JC.    Development  and  validaIon  of  a  funcIonal  fitness  test  for  community-­‐residing  older  adults.    •  J  Aging  Phys  Act.  1999;7:129-­‐61  •  Teri  L,  Logsdon  RG,  McCurry  SM:    Exercise  intervenIons  for  demenIa  and  cogniIve  impairment:  the  Seaile  Protocols.  J  Nutr  

Health  Aging.  2008;  12:391394.  •  Washburn  RA,  Smith  KW,  Jeie  AM,  Janney  CA.    The  Physical  AcIvity  Scale  for  the  Elderly  (PASE):    development  and  valuaIon.  J  

Clin  Epidemiol.  1993;46(2):153-­‐62  

8

Exam

inin

g th

e R

elat

ions

hip

Bet

wee

n Le

ader

ship

and

Su

stai

nabi

lity

of a

Dem

entia

Tra

inin

g Pr

ogra

m in

Lon

g-Te

rm C

are

Trac

y D

anyl

yshe

n-La

ycoc

k, P

h.D

. Can

dida

te, U

nive

rsity

of S

aska

tche

wan

and

Dr.

Deb

ra M

orga

n, U

nive

rsity

of

Sask

atch

ewan

Intr

oduc

tion

Obj

ectiv

es

Met

hods

R

esul

ts

Res

ults

Con

’t

Con

clus

ion

With

in h

ealth

car

e, th

ere

is a

n as

sum

ptio

n th

at o

nce

staf

f rec

eive

trai

ning

they

will

au

tom

atic

ally

impl

emen

t tho

se sk

ills i

n th

eir d

aily

pra

ctic

e. U

nfor

tuna

tely

, si

mpl

e di

ssem

inat

ion

of k

now

ledg

e is

not

ef

fect

ive

in c

reat

ing

and

sust

aini

ng

beha

viou

ral c

hang

e (N

utle

y, W

alte

r, &

D

avie

s, 20

03).

A k

ey fa

ctor

that

co

ntrib

utes

to su

stai

nabi

lity

of

educ

atio

nal p

rogr

ams i

n lo

ng-te

rm c

are

(LTC

) is t

he ro

le o

f lea

ders

hip

(Wal

lin e

t al

., 20

02).

For e

xam

ple,

stro

ng le

ader

ship

is

requ

ired

to “

cham

pion

” th

e ne

w

prog

ram

or i

nitia

tive

with

in th

e or

gani

zatio

n (E

vash

wic

k &

Ory

, 200

3). I

n lo

ng-te

rm c

are,

the

role

of l

eade

rshi

p ha

s no

t bee

n ex

amin

ed a

s ext

ensi

vely

as i

n ot

her h

ealth

car

e se

tting

s.

As

part

of a

larg

er s

tudy

of t

he G

PA

prog

ram

, the

pur

pose

of t

his

rese

arch

w

as to

exp

lore

the

role

of l

eade

rshi

p in

th

e su

stai

nabi

lity

of a

dem

entia

spe

cific

tra

inin

g pr

ogra

m fo

r sta

ff in

rura

l lon

g-te

rm c

are

hom

es.

.

• In

hom

es w

here

the

GPA

pro

gram

was

su

stai

ned,

the

lead

ersh

ip te

am

(Adm

inis

trato

r and

Dire

ctor

of C

are)

cr

eate

d a

cultu

re th

at w

as b

ased

on

the

philo

sphy

of p

erso

n-ce

ntre

d ca

re.

For

exam

ple,

the

lead

ersh

ip te

am su

ppor

ted

staf

f in

hono

ring

the

valu

es, b

elie

fs,

and

choi

ces o

f the

resi

dent

s.

• B

ehav

iour

s req

uire

d by

lead

ersh

ip

incl

uded

role

-mod

ellin

g th

e sk

ills t

hat

wer

e ta

ught

in th

e pr

ogra

m a

nd

coac

hing

staf

f who

wer

e st

rugg

ling

to

man

age

resp

onsi

ve b

ehav

iour

s. • 

Oth

er le

ader

ship

beh

avio

urs t

hat

help

ed to

sust

ain

the

GPA

pro

gram

in

clud

ed: b

eing

vis

ible

in th

e LT

C

hom

e, sp

endi

ng ti

me

in th

e LT

C h

ome

to a

sses

s/ob

serv

e an

d su

ppor

t sta

ff to

us

e th

e G

PA sk

ills,

hold

ing

staf

f ac

coun

tabl

e w

hen

they

wer

e no

t usi

ng

the

GPA

skill

s, an

d m

eetin

g re

gula

rly

with

staf

f to

revi

ew/b

rain

stor

m h

ow th

e G

PA sk

ills c

ould

hel

p th

em m

anag

e re

spon

sive

beh

avio

urs.

In h

omes

whe

re th

e G

PA p

rogr

am w

as n

ot

sust

aine

d, th

e le

ader

ship

team

: • 

Faile

d to

supp

ort t

he p

rogr

am.

It w

as

view

ed a

s “ju

st a

noth

er p

rogr

am.”

• 

Cre

ated

a c

ultu

re o

f “in

stitu

tiona

lizat

ion”

w

here

resi

dent

s did

not

hav

e ch

oice

, car

e w

as fo

rced

on

resi

dent

s, an

d ta

sks w

ere

com

plet

ed o

n st

affs

’ tim

e sc

hedu

le.

• D

isci

plin

ed st

aff w

ho w

ere

prac

ticin

g G

PA.

• A

llow

ed b

ully

ing

of st

aff w

ho w

ere

prac

ticin

g G

PA.

• Sp

oke

nega

tivel

y ab

out t

he G

PA p

rogr

am

in fr

ont o

f the

ir st

aff.

Gen

tle P

ersu

asiv

e A

ppro

ache

s Pr

ogra

m

The

over

all g

oal o

f the

GPA

pro

gram

is to

ed

ucat

e st

aff h

ow to

: • 

Use

a p

erso

n-ce

ntre

d, c

ompa

ssio

nate

ap

proa

ch w

ith in

divi

dual

s with

de

men

tia.

• R

espo

nd re

spec

tfully

, with

con

fiden

ce

and

skill

, to

resp

onsi

ve b

ehav

iour

s as

soci

ated

with

dem

entia

.

Two

com

plem

enta

ry st

udie

s wer

e co

nduc

ted

to e

xam

ine

the

rela

tions

hip

betw

een

sust

aina

bilit

y an

d le

ader

ship

in

rura

l lon

g-te

rm c

are

hom

es.

St

udy

One

(Ret

rosp

ectiv

e)

Des

ign:

cro

ss-s

ectio

nal,

retro

spec

tive

qual

itativ

e re

sear

ch d

esig

n.

Site

Sel

ectio

n: fi

ve ru

ral L

TC h

omes

in

Wes

tern

Can

ada

whe

re th

e G

PA

Prog

ram

was

impl

emen

ted

betw

een

May

an

d D

ecem

ber 2

010.

Pa

rtic

ipan

ts: t

his s

tudy

focu

sed

on th

e ex

perie

nces

of t

he A

dmin

istra

tors

, D

irect

ors o

f Car

e, M

anag

ers,

GPA

C

oach

es, N

urse

s, an

d N

ursi

ng A

ides

. D

ata

Col

lect

ion:

fou

r foc

us g

roup

s w

ith N

ursi

ng A

ides

and

14

sem

i-st

ruct

ured

int

ervi

ews w

ith

Adm

inis

trato

rs, D

irect

ors o

f Car

e,

Nur

ses,

and

GPA

Pro

gram

Coa

ches

wer

e co

mpl

eted

. St

udy

Two

(Pro

spec

tive)

D

esig

n: lo

ngitu

dina

l, m

ulti-

site

, co

mpa

rativ

e ca

se st

udy

desi

gn.

Site

Sel

ectio

n: tw

o ru

ral L

TC h

omes

w

ere

purp

osef

ully

sele

cted

to p

rovi

de

max

imum

var

iatio

n on

org

aniz

atio

nal

fact

ors t

hat m

ay in

fluen

ce su

stai

nabi

lity.

Pa

rtic

ipan

ts: a

ll st

aff w

ithin

the

two

LTC

ho

mes

wer

e el

igib

le.

Dat

a C

olle

ctio

n: i

nter

view

s wer

e co

nduc

ted

with

18

staf

f fro

m a

ll de

partm

ents

in b

oth

hom

es.

In a

dditi

on,

85 h

ours

of d

irect

ion

obse

rvat

ion

and

25

hour

s of s

hado

win

g st

aff w

ere

cond

ucte

d ov

er 1

4 m

onth

s. R

esid

ent c

harts

, inc

iden

t re

ports

, and

com

mun

icat

ion

logs

wer

e re

view

ed.

• In

ord

er fo

r the

GPA

pro

gram

to b

e su

stai

ned

in L

TC, t

he le

ader

ship

team

m

ust f

ully

supp

ort t

he p

rogr

am, m

odel

th

e G

PA sk

ills,

and

coac

h th

ose

indi

vidu

als w

ho a

re st

rugg

ling

to

chan

ge th

eir p

ract

ice.

• 

To su

ppor

t the

pro

gram

, lea

ders

mus

t pr

omot

e pe

rson

-cen

tred

care

by

crea

ting

a cu

lture

that

allo

ws f

or

resi

dent

cho

ice,

adh

eren

ce to

resi

dent

ro

utin

e, a

nd li

fe c

hoic

es.

9

à E

ach

of th

e 53

per

sons

re

ceiv

ed a

n in

terd

isci

plin

ary

di

agno

sis o

f de

men

tia

INT

RO

DU

CT

ION

Purp

ose

à E

xam

inin

g re

liabl

e ch

ange

in R

BA

NS

scor

es fo

r per

sons

w

ith d

emen

tia a

t a o

ne y

ear i

nter

val u

sing

pre

dete

rmin

ed

regr

essi

on fo

rmul

as fr

om a

nor

mat

ive

sam

ple

Bac

kgro

und

à P

ast l

itera

ture

sugg

ests

RC

I inc

orpo

rate

s rel

iabi

lity

in

calc

ulat

ion

of sm

all b

ut m

eani

ngfu

l cha

nge

in h

ealth

st

atus

ove

r tim

e1,2,

3.5

à R

CI o

ffers

mor

e in

sigh

tful c

linic

al in

terp

reta

tions

than

gr

oup-

leve

l sta

tistic

s3,5

à R

BA

NS

has l

evel

of d

iffic

ulty

app

ropr

iate

for n

orm

al

olde

r adu

lts th

roug

h in

divi

dual

s with

mod

erat

ely

seve

re

dem

entia

1,4

à D

evel

opm

ent o

f “no

rmal

” re

gres

sion

-bas

ed c

hang

e al

gorit

hms a

llow

for b

road

er a

pplic

atio

n2,5

à I

nitia

l per

form

ance

on

test

foun

d to

be

best

pre

dict

or o

f re

test

per

form

ance

2

R

elia

ble

Cha

nge

(RC

I) on

Rep

eata

ble

Bat

tery

for t

he A

sses

smen

t

of N

euro

psyc

holo

gica

l Sta

tus

(RB

AN

S) in

a D

emen

tia S

ampl

e

RE

SU

LTS

of N

euro

psyc

holo

gica

l Sta

tus

(RB

AN

S) in

a D

emen

tia S

ampl

e B

enja

min

Gou

ld1 ,

Joe

Enrig

ht1 ,

M. E

. O’C

onne

ll1, &

Deb

ra M

orga

n2

1 D

epar

tmen

t of P

sych

olog

y, U

nive

rsity

of S

aska

tche

wan

, 2C

anad

ian

Cen

tre

for H

ealth

and

Saf

ety

in A

gric

ultu

re, U

nive

rsity

of S

aska

tche

wan

à 5

3 pa

rtici

pant

s (57

% fe

mal

e) a

t the

Rur

al a

nd R

emot

e M

emor

y C

linic

who

wer

e di

agno

sed

with

dem

entia

bas

ed

on in

terv

iew

with

pat

ient

and

fam

ilies

in a

dditi

on to

: à R

ecen

t blo

od w

ork

à C

T he

ad sc

an

à N

euro

logi

cal a

sses

smen

t à N

euro

psyc

holo

gica

l ass

essm

ent

à P

hysi

cal t

hera

py a

sses

smen

t T

he sa

mpl

e on

ly in

clud

ed p

atie

nts w

ho c

ompl

eted

all

neur

opsy

chol

ogic

al v

aria

bles

at c

linic

day

and

1 y

ear

late

r

DIS

CU

SS

ION

Pers

ons w

ith d

emen

tia fr

om th

is sa

mpl

e de

mon

stra

ted

a de

clin

e be

yond

that

exp

ecte

d ba

sed

on a

cog

nitiv

ely

heal

thy

olde

r adu

lt sa

mpl

e on

all

RB

AN

S in

dice

s (M

ean)

, but

indi

vidu

al

varia

bilit

y re

gard

ing

decl

ine

vs st

abili

ty v

s im

prov

emen

t was

se

en m

ost o

ften

on th

e La

ngua

ge In

dex.

No

pers

on w

ith

dem

entia

impr

oved

on

Imm

edia

te M

emor

y.

Ass

ocia

tions

bet

wee

n pe

rson

s with

dem

entia

’s R

BA

NS

Pred

icte

d-A

ctua

l RB

AN

S sc

ores

with

dem

entia

seve

rity)

(C

linic

al D

emen

tia R

atin

g-Su

m o

f box

scor

es sc

ores

) wer

e tri

vial

or s

mal

l in

mag

nitu

de a

nd st

atis

tical

ly n

on-s

igni

fican

t.

Futu

re D

irec

tions

Ø  F

utur

e re

sear

ch w

ill a

im to

det

erm

ine

if a

rela

tions

hip

exis

ts b

etw

een

this

cog

nitiv

e ba

ttery

dem

onst

rativ

e of

m

eani

ngfu

l cha

nge

and

som

e fo

rm o

f fun

ctio

nal

asse

ssm

ent s

cale

.

1 Atti

x, D

. K.,

Sto

ry, T

. J.,

Che

lune

, G. J

., B

all,

J. D

., S

tutts

, M. L

., H

art R

. P.,

& B

arth

J. T

. (20

09).

The

pred

ictio

n of

Cha

nge:

Nor

mat

ive

neur

opsy

chol

ogic

al tr

ajec

torie

s, T

he C

linic

al N

euro

psyc

holo

gist

, 23(

1), 2

1-38

. 2 D

uff,

K.,

Sch

oenb

erg,

M. R

., P

atto

n, D

., P

auls

en, J

. S.,

Bay

less

, J. D

., M

old,

J.,

Sco

tt, J

. G.,

& A

dam

s, R

. L. (

2005

). R

egre

ssio

n-ba

sed

form

ulas

fo

r pre

dict

ing

chan

ge in

RB

AN

S s

ubte

sts

with

old

er a

dults

, Arc

hive

s of

Clin

ical

Neu

rops

ycho

logy

, 20,

281

-290

. 3 S

chm

itt, J

. S.,

& D

i Fab

io, P

. D. (

2004

). R

elia

ble

chan

ge a

nd m

inim

um im

porta

nt d

iffer

ence

(MID

) pro

porti

ons

faci

litat

ed g

roup

resp

onsi

vene

ss

com

paris

ons

usin

g in

divi

dual

thre

shol

d cr

iteria

, Jou

rnal

of C

linic

al E

pide

mio

logy

, 57,

100

8-10

18.

4 Hob

son,

V. L

., H

all,

J. R

., H

umph

reys

-Cla

rk, J

. D.,

Sch

rimsh

er, G

. W.,

& O

’Bry

ant,

S. E

. (20

10).

Iden

tifyi

ng fu

nctio

nal i

mpa

irmen

t with

sco

res

from

the

repe

atab

le b

atte

ry fo

r the

ass

essm

ent o

f neu

rops

ycho

logi

cal s

tatu

s (R

BA

NS

), In

tern

atio

nal J

ourn

al o

f Ger

iatri

c P

sych

iatry

, 25,

525

-530

. 5 D

uff,

K.,

Sch

oenb

erg,

M. R

., P

atto

n, D

., M

old,

J.,

Sco

tt, J

. G.,

& A

dam

s, R

. L. (

2004

). P

redi

ctin

g ch

ange

with

the

RB

AN

S in

a c

omm

unity

dw

ellin

g el

derly

sam

ple,

Jou

rnal

of t

he In

tern

atio

nal N

euro

psyc

holo

gica

l Soc

iety

, 10,

828

-834

.

M

in

Max

M

SD

Patie

nt a

ge a

t clin

ic d

ay

44

92

70.7

9 10

.91

Form

al E

duca

tion

4 16

11

.45

2.67

Dia

gnos

is

f A

lzhe

imer

’s d

isea

se

28

Vasc

ular

dem

entia

4

Fron

tote

mpo

ral d

emen

tia (F

TD)

FT

D, f

ront

al v

aria

nt

7

FTD

, sem

antic

var

iant

1

FT

D, p

rogr

essi

ve n

on-f

luen

t 1

Dem

entia

mul

tiple

aet

iolo

gies

6

Dem

entia

med

ical

con

ditio

n 3

Dem

entia

with

Lew

y bo

dies

3

Tota

l 53

RB

AN

S Te

st R

e-te

st M

eans

In

ital

M (S

D)

1 yr

M

(SD

) R

BA

NS-

Imm

edia

te M

emor

y 69

.15

(14.

09)

65.5

7 (1

5.91

)*

RB

AN

S- V

isuo

spat

ial/C

onst

ruct

80

.47

(16.

68)

80.5

5 (1

5.35

) R

BA

NS-

Lan

guag

e In

dex

84.9

4 (1

1.95

) 80

.02

(16.

13)*

*

RB

AN

S- A

ttent

ion

Inde

x 79

.49

(16.

04)

75.3

6 (1

5.09

)*

RB

AN

S- D

elay

ed M

emor

y 60

.09

(17.

25)

57.4

0 (1

6.82

) R

BA

NS-

Tot

al S

cale

68

.13

(10.

47)

64.9

6 (1

1.99

)*

à Pr

edet

erm

ined

regr

essi

on fo

rmul

as d

evel

oped

from

a

norm

ativ

e po

pula

tion5 w

ere

used

to d

eter

min

e pr

edic

ted

re-te

st sc

ores

for p

erso

ns w

ith d

emen

tia

à P

redi

cted

re-te

st sc

ores

on

RB

AN

S in

dexe

s wer

e co

mpa

red

to a

ctua

l re-

test

scor

es

à C

orre

latio

n be

twee

n R

BA

NS

Inde

x sc

ores

and

Clin

ical

D

emen

tia R

atin

g –

sum

of b

ox sc

ores

– se

verit

y m

easu

re

ME

TH

OD

RR

MC

Fun

ding

and

in-k

ind

supp

ort i

s ge

nero

usly

pro

vide

d by

:

RB

AN

S In

dex

Ran

ge o

f Pr

edic

ted

-A

ctua

l Sco

res

Pred

icte

d-A

ctua

l Mea

n Sc

ores

# w

here

Act

ual R

e-sc

ores

hig

her t

han

Pred

icte

d Im

m M

emor

y 2.

01 –

79.

57

35.1

1 0

Vis

uosp

atia

l -1

.77

– 75

.74

33.3

9 1

Lang

uage

-1

8.98

– 3

7.65

8.

78

12

Atte

ntio

n

-23.

72 –

50.

76

12.3

5 7

Del

Mem

ory

-17.

64 –

47.

21

15.8

7 6

RB

AN

S In

dex

C

orre

latio

n w

ith C

DR

r (

p)

RB

AN

S- Im

med

iate

Mem

ory

.129

(p >

0.0

5)

RB

AN

S- V

isuo

spat

ial/C

onst

ruct

.0

13 (p

> 0

.05)

R

BA

NS-

Lan

guag

e In

dex

.056

(p >

0.0

5)

RB

AN

S- A

ttent

ion

Inde

x .2

06 (p

> 0

.05)

R

BA

NS-

Del

ayed

Mem

ory

.094

(p >

0.0

5)

RB

AN

S- T

otal

Sca

le

.147

(p >

0.0

5)

RE

SU

LTS

Con

tact

10

11

GAME 4 BOYS

An exploration of commercial gaming technology as a leisure activity for older men

with dementia in rural Dorset

 This  project  aims  to  address  a  real  world  issue  for  Age  UK  Dorchester  and  engage  older  men  with  demen:a  in  rural  areas  of  Dorset  who  are  at  risk  of  social  exclusion  and  poor  well-­‐being.  A  technological  ini:a:ve  using  commercial  gaming  systems  (Nintendo  DS,  Wii,  MicrosoH  Kinect  and  iPads)  has  been  chosen  to  accomplish  this.  The  research  splits  into  two  empirical  phases.  The  first,  a  consulta:on  phase  to  develop  the  ini:a:ve.  The  second  (main  Doctoral  study)  is  an  explora:on  of  the  impact  of  the  technological  ini:a:ve  for  older  men  with  demen:a  in  rural  areas  of  Dorset.      

The  consulta:on  phase  was  undertaken  in  the  laLer  part  of  2013.  It  was  designed  to  explore  the  feasibility  of  engaging  older  men  with  demen:a  with  commercial  computer  game  technology.  A  user-­‐focussed  approach  was  adopted  which  enabled  the  par:cipants  to  work  as  ac:ve  collaborators  in  the  design  of  the  technological  ini:a:ve.    Four  one-­‐off  consulta:on  sessions  using  commercial  gaming  systems  were  undertaken  with  older  men  with  demen:a  in  various  rural  areas  of  Dorset.  Their  experiences  of  engaging  with  the  technology  and  par:cipa:ng  in  the  groups  were  elicited  through  discussions  with  the  men  as  well  as  observa:ons  and  reflec:ve  field-­‐notes.  The  data  ascertained  from  the  consulta:on  phase  fed  into  the  research  design  for  the  main  doctoral  study.  

 The  main  study  will  implement  three  technological  ini:a:ves  each  las:ng  eight  weeks  (one  per  week)  in  three  rural  communi:es  of  Dorset.  The  groups  will  adopt  a  Par:cipatory  Ac:on  Research  approach,  working  with  older  men  (65+)  with  demen:a  to  explore  their  experiences  of  engaging  in  the  groups  and  monitor  the  outcomes  to  their  well-­‐being.  Two  innova:ve  methods  will  be  used  to  collect  the  data;  ‘Photovoice’  and  ‘Walking  interviews.’  It  is  envisaged  that    the  research  design  will  lead  to  longer  term  beneficial  effects  for  the  well-­‐being  of  the  par:cipants.  The  technological  ini:a:ves  will  conclude  in  early  2015  and  a  final  report  alongside  guidance  documenta:on  (produced  in  collabora:on  with  the  par:cipants)  will  be  published  later  that  year.    

LEVEL  1:  PROJECT  INTRODUCTION  

LEVEL  2:  CONSULTATION  PHASE  

LEVEL  3:  MAIN  DOCTORAL  STUDY  

Ben  Hicks:  bhicks@bournemouth.ac.uk  

12

All

follo

w-u

p ap

poin

tmen

ts a

re n

ow v

ia te

lehe

alth

.

• Thi

s pr

oces

s w

as im

plem

ente

d in

Dec

embe

r 200

8 ba

sed

on re

sear

ch s

how

ing

high

pa

tient

and

fam

ily s

atis

fact

ion

with

tele

heal

th.

RU

RA

L A

ND

RE

MO

TE

ME

MO

RY

CLIN

IC –

UPD

AT

E (M

arch

2004 –

Jun

e 2014)

L. H

olfe

ld1 ,

D. M

orga

n1, M

. O’C

onne

ll2, M

. Cro

ssle

y2, A

. Kirk

3 , N

. Ste

war

t4 ,V.

Dal

Bel

lo-H

aas5

, L. M

cBai

n6, A

. Cam

mer

1 , D

. Min

ish1

, R

. Bee

ver1

, J. K

oste

niuk

1

Back

grou

nd

Fu

ll-D

ay

Coo

rdin

ate

d A

sses

smen

t

Ru

ral an

d R

emot

e M

emor

y C

lin

ic

Pati

ent

Ref

erra

ls p

er R

ura

l H

ealt

h A

uth

orit

y n

= 4

60 (Ju

ne

2014)

Sask

atc

hew

an

Tel

ehea

lth

Sit

es (2

014)

(Pre

-clin

ic A

sses

smen

ts a

nd F

ollo

w-u

ps)

Intr

oduc

tion:

•  R

ural

and

Nor

ther

n S

aska

tche

wan

hav

e a

low

pop

ulat

ion

dens

ity re

sulti

ng in

larg

e tra

vel b

urde

n fo

r med

ical

vis

its

•  Rur

al S

K is

old

er, o

n av

erag

e, th

an u

rban

and

is h

ome

to

man

y ol

der a

dults

•  Ris

k fo

r dem

entia

incr

ease

s w

ith a

ge

•  Pre

-clin

ic a

sses

smen

t of p

atie

nt a

nd c

areg

iver

s is

con

duct

ed v

ia te

lehe

alth

to

prep

are

them

for t

he o

ne-d

ay a

sses

smen

t, fa

mili

ariz

e th

em w

ith th

e cl

inic

nur

se

who

will

be

thei

r car

e lia

ison

, ord

er b

lood

wor

k or

oth

er te

sts,

and

gat

her

info

rmat

ion

to a

ssis

t with

pla

nnin

g th

e on

e-da

y as

sess

men

t • C

oord

inat

ed a

sses

smen

t tak

es p

lace

in S

aska

toon

, is

appr

oxim

atel

y 8

hour

s,

and

invo

lves

the

patie

nt a

nd th

eir i

nfor

mal

car

egiv

ers

1 Can

adia

n C

entre

for H

ealth

and

Saf

ety

in A

gric

ultu

re, U

nive

rsity

of S

aska

tche

wan

; 2D

epar

tmen

t of P

sych

olog

y, U

nive

rsity

of S

aska

tche

wan

; 3C

olle

ge o

f Med

icin

e, U

nive

rsity

of S

aska

tche

wan

; 4 C

olle

ge o

f Nur

sing

, Uni

vers

ity o

f Sas

katc

hew

an; 5

Sch

ool o

f Reh

abili

tatio

n, M

cMas

ter U

nive

rsity

; 6 F

irst N

atio

ns U

nive

rsity

of C

anad

a

Clin

ic G

oal:

•  To

deve

lop

and

eval

uate

a s

trea

mlin

ed in

tegr

ated

clin

ic fo

r pat

ient

s fro

m ru

ral

and

rem

ote

Sas

katc

hew

an fo

r dia

gnos

is a

nd m

anag

emen

t of d

emen

tia a

nd to

ev

alua

te te

lehe

alth

as

a m

eans

of d

eliv

erin

g fo

llow

-up

care

Rur

al a

nd R

emot

e M

emor

y C

linic

Pat

tern

:

Ref

erra

l by

GP

or N

P to

clin

ic v

ia

neur

olog

ist

Pre-

clin

ic

asse

ssm

ent v

ia

tele

heal

th

Follo

w-u

ps

via

tele

heal

th

(Yea

rly

follo

w-u

ps v

ia

in-p

erso

n)

8 -1

0 m

onth

w

ait-t

ime

wai

t-tim

e

Follo

w-u

ps a

s pe

r 1

mon

th

Neu

rolo

gist

and

Year

ly

Sam

e-da

y C

oord

inat

ed

Ass

essm

ent

End

of D

ay T

eam

C

onfe

renc

e, G

P in

vite

d to

pa

rtici

pate

via

te

leco

nfer

ence

Dia

gnos

is a

nd T

reat

men

t P

lan

com

mun

icat

ed to

fa

mily

Neu

rolo

gist

Neu

rops

ycho

logi

st

Psyc

hom

etris

t

Dia

gnos

tic

Imag

ing

Phys

ical

Th

erap

ist

Clin

ic N

urse

Team

C

onfe

renc

e,

Dia

gnos

is

and

Car

e Pl

anni

ng

Team

Mee

ts

with

Pat

ient

an

d Fa

mily

Com

paris

on o

f tra

vel t

ime

and

di

stan

ce s

aved

: • M

ean

dist

ance

from

hom

e to

T

eleh

ealth

= 3

2.7

km

• Mea

n di

stan

ce fr

om h

ome

to

Sas

kato

on =

267

.5 k

m

Dis

tanc

e sa

ved

by T

eleh

ealth

= 2

34.7

km

(o

ne-w

ay)

Tele

heat

h: In

201

4 th

ere

are

over

235

Te

lehe

alth

site

s cu

rren

tly o

pera

ting

in

prov

inci

al, r

egio

nal a

nd n

orth

ern

hosp

itals

in

Sask

atch

ewan

. Tel

ehea

lth c

an a

lso

link

with

ot

her s

elec

t site

s pr

ovin

cial

ly, n

atio

nally

and

in

tern

atio

nally

.

Mea

n A

ge =

70.

71 y

rs

Ran

ge A

ge =

22

- 97

yrs

Gen

der:

43%

Mal

es

58

% F

emal

es

RR

MC

Dem

ogra

ph

ics

n

= 4

61 (Ju

ne

2014)

Alz

heim

er D

isea

se -

162

Oth

er d

emen

tias:

- V

ascu

lar D

emen

tia –

10

- Dem

entia

with

Lew

y B

odie

s –

17

- Fro

ntal

Tem

pora

l – 3

4 - D

emen

tia d

ue to

Med

ical

Con

ditio

n - 5

- C

ogni

tive

Impa

irmen

t Not

Oth

erw

ise

Spe

cifie

d - 1

3

-

Dem

entia

due

to

M

ultip

le E

tiolo

gies

– 1

6 - S

ub-c

ortic

al D

emen

tia -

3 O

ther

dia

gnos

es:

- No

Cog

nitiv

e Im

pairm

ent –

81

- M

ild C

ogni

tive

Impa

irmen

t – 7

0

Clin

ical D

iagn

oses

to

Date

n

= 4

11 (Ju

ne

2014)

ww

w.c

chsa

-ccs

sma.

usas

k.ca

/rura

ldem

entia

care

Fund

ing

and

in-k

ind

supp

ort i

s ge

nero

usly

pro

vide

d by

:

Die

titia

n

Blo

odw

ork

&

ECG

38

2

32

38

87

79

29

80

4

15

5

26

25

13

The  

In'lu

ence

 of  I

ndiv

idua

l  and

 Org

aniz

atio

nal  F

acto

rs  o

n  Pe

rson

-­‐Cen

tred

 Ap

proa

ches

 to  D

emen

tia  

Care

 Pa

ule&

e  Hu

nter

,  Ph.

D.,  S

t.  Th

omas

 Mor

e  Co

llege

,  Uni

vers

ity  o

f  Sas

katc

hew

an;  T

hom

as  H

adjis

tavr

opou

los,  P

hD.,  

Uni

vers

ity  o

f  Reg

ina  

and  

Cent

re  fo

r  Agi

ng  a

nd  H

ealth

 Lilia

n  Th

orpe

,  MD,

 PhD

,  FRC

PC,  U

nive

rsity

 of  S

aska

tche

wan

;  Dav

id  M

allo

y,  F

acul

ty  o

f  Kin

esio

logy

 &  H

ealth

 Stu

dies

,  PhD

 Uni

vers

ity  o

f  Reg

ina;

 Fio

na  F

ick,

 Uni

vers

ity  o

f  Sas

katc

hew

an  

This  evalua+

on  was  fu

nded

 by  the  Saskatchew

an  Health

 Research  Foun

da+o

n.  

The  

Sask

atch

ewan

 Hea

lth  

Rese

arch

 Fou

ndat

ion  

prov

ided

 sup

port

 for  th

is  w

ork.

 

Back

grou

nd  

A  pe

rson

-­‐cen

tred

 app

roac

h  to

war

d  lo

ng-­‐t

erm

 care

 resi

dent

s  w

ith  d

emen

tia  p

rom

otes

 qua

lity  

of  li

fe  (K

itwoo

d,  1

997)

.  Mos

t  in

terv

entio

ns  to

 pro

mot

e  pe

rson

-­‐cen

tred

 resi

dent

ial  

dem

entia

 care

 (PCR

DC)  c

all  f

or  a

tten

tion  

to  th

e  at

titud

es  a

nd  

actio

ns  o

f  ind

ivid

ual  c

are  

prov

ider

s  tow

ard  

long

-­‐ter

m  ca

re  

resi

dent

s  and

 pla

ce  le

ss  e

mph

asis

 on  

orga

niza

tiona

l  con

text

s.  Th

ere  

is  li

ttle

 evi

denc

e  to

 sugg

est  w

hich

 them

e  de

serv

es  

grea

ter  a

tten

tion.

 To  

sum

mar

ize  

brie

Jly:    

• Pr

evio

us  w

ork  

sugg

ests

 that

 stru

ctur

al  e

mpo

wer

men

t  (e.

g.,  

pow

er,  i

nfor

mat

ion,

 supp

ort,  

and  

reso

urce

s)  e

xpla

ins  

appr

oxim

atel

y  ha

lf  th

e  va

rian

ce  in

 self-­‐

repo

rted

 in

divi

dual

ised

 care

 (Cas

par  &

 O’R

ourk

e,  2

008)

.  H

ypot

hesi

s:  O

rgan

isat

iona

l  cha

ract

eris

tics  i

n3lu

ence

 PC

RDC.

 • 

Seve

ral  s

tudi

es  su

gges

t  tha

t  hig

her  l

evel

s  of  e

duca

tion  

and/

or  q

ualiJ

icat

ions

 are

 ass

ocia

ted  

with

 mor

e  po

sitiv

e,  

pers

on-­‐c

entr

ed,  o

r  hop

eful

 att

itude

s  tow

ard  

long

-­‐ter

m  

care

 resi

dent

s  with

 dem

entia

 (e.g

.,  Nor

man

n,  A

splu

nd,  &

 N

orbe

rg,  1

999)

 alth

ough

 such

 Jind

ings

 are

 not

 uni

vers

al  

(e.g

.,  Mac

Dona

ld  &

 Woo

ds,  2

005)

.  Few

 stud

ies  h

ave  

exam

ined

 the  

role

 of  a

ge  a

nd  g

ende

r  in  

dete

rmin

ing  

attit

udes

 and

 ther

e  is

 a  d

eart

h  of

 evi

denc

e  ab

out  e

mpl

oyee

 fa

ctor

s  ass

ocia

ted  

with

 per

son-­‐

cent

red  

beha

viou

r.  H

ypot

hesi

s:  A

ge,  g

ende

r,  y

ears

 of  e

duca

tion,

 and

 oc

cupa

tion  

in3lu

ence

 PCR

DC.

 • 

Belie

fs  a

bout

 per

sonh

ood  

in  d

emen

tia  a

ccou

nt  fo

r  a  sm

all  

but  s

igni

Jican

t  am

ount

 of  v

aria

nce  

in  in

tend

ed  a

ppro

ache

s  to

 pai

n  m

anag

emen

t  for

 per

sons

 with

 dem

entia

 (Hun

ter  e

t  al

.,  201

3).    A

 mod

erat

e  as

soci

atio

n  be

twee

n  be

liefs

 abo

ut  

pers

onho

od  a

nd  b

elie

fs  a

bout

 the  

impo

rtan

ce  o

f  per

son-­‐

cent

red  

care

 has

 als

o  be

en  d

ocum

ente

d  (H

unte

r  et  a

l.,  

2013

).  H

ypot

hesi

s:  E

mpl

oyee

 bel

iefs

 abo

ut  p

erso

nhoo

d  in

3luen

ce  P

CRD

C.  

• Bu

rnou

t  is  a

ssoc

iate

d  w

ith  le

ss  p

ositi

ve  a

ttitu

des  a

nd  

low

er  e

mpa

thy  

tow

ard  

peop

le  w

ith  d

emen

tia  (e

.g.,  A

stro

m,  

Nils

son,

 Nor

berg

,  San

dman

,  &  W

inbl

ad,  1

991)

,  as  w

ell  a

s  a  

decr

ease

d  w

illin

g  ne

ss  to

 hel

p,  lo

w  o

ptim

ism

,  and

 neg

ativ

e  em

otio

nal  r

espo

nses

 (Tod

d  &

 Wat

ts,  2

005)

.  Hyp

othe

sis:

 Em

ploy

ee  b

urno

ut  in

3luen

ces  P

CRD

C.    

The  

purp

ose  

of  th

is  st

udy  

was

 to  in

vest

igat

e  th

e  co

ntri

butio

ns  

of  o

rgan

izat

iona

l  fac

tors

 and

 care

 pro

vide

rs’  p

erso

nal  

qual

ities

 to  se

lf-­‐re

port

ed  P

CRDC

.      

Met

hod  

Desi

gn:  

• A  

corr

elat

iona

l  des

crip

tive  

surv

ey  

  Part

icip

ants

:    • 

109  

staf

f  mem

bers

 from

 two  

larg

e  ru

ral  l

ong-­‐

term

 care

 hom

es    

• 10

%  m

ale  

and  

90%

 fem

ale;

 25%

 nur

ses,  

41%

 care

 aid

es,  a

nd  3

4%  o

ther

;  ave

rage

 age

 43  

(SD  

=  12

.71)

    M

easu

res :

 • 

The  

Pers

on-­‐D

irec

ted  

Care

 scal

e  (P

DC;  W

hite

,  New

ton-­‐

Curt

is,  &

 Lyo

ns,  2

008)

 mea

sure

d  se

lf-­‐re

port

ed  p

erso

n-­‐ce

ntre

d  ca

re  a

cros

s  the

se  su

bsca

les:

 Aut

onom

y,  P

erso

nhoo

d,  K

now

ing  

the  

Pers

on,  C

omfo

rt  C

are,

 and

 Sup

port

ing  

Rela

tions

hips

.  • 

The  

Envi

ronm

enta

l  Sup

port

 for  P

erso

n-­‐Di

rect

ed  C

are  

scal

e  (W

hite

 et  a

l.,  2

008)

 mea

sure

d  or

gani

satio

nal-­‐e

nvir

onm

enta

l  sup

port

s  for

 per

son-­‐

cent

red  

care

.  • 

The  

Pers

onho

od  in

 Dem

entia

 Que

stio

nnai

re  (H

unte

r  et  a

l.,  2

013)

 ass

esse

d  be

liefs

 abo

ut  

pers

onho

od  in

 dem

entia

.  • 

The  

Mas

lach

 Bur

nout

 Inve

ntor

y  –  

Hum

an  S

ervi

ces  S

cale

 (Mas

lach

 &  Ja

ckso

n,  1

996)

 ass

esse

d  bu

rnou

t.  • 

A  de

mog

raph

ic  fo

rm  d

ocum

ente

d  ag

e,  g

ende

r,  ye

ars  o

f  edu

catio

n,  a

nd  o

ccup

atio

n.    

  Anal

ysis

:  • 

Hie

rarc

hica

l  reg

ress

ion:

 Wor

kpla

ce  fa

ctor

s,  de

mog

raph

ic  fa

ctor

s,  be

liefs

 abo

ut  p

erso

nhoo

d,  

and  

burn

out,  

wer

e  re

gres

sed,

 in  th

at  o

rder

,  on  

each

 PDC

 subs

cale

.      

Resu

lts  

In  a

 seri

es  o

f  hie

rarc

hica

l  reg

ress

ion  

mod

els  e

xam

inin

g  Jiv

e  as

pect

s  of  P

CRDC

 (see

 Tab

les)

,  we  

foun

d  th

at  o

rgan

izat

iona

l  fac

tors

 wer

e  ro

bust

 pre

dict

ors  o

f  PCR

DC,  e

xpla

inin

g  17

 to  3

4  pe

rcen

t  of

 scor

e  va

rian

ce  o

n  th

e  PD

C  in

 eac

h  of

 the  

Jive  

mod

els,  

afte

r  con

trol

ling  

for  e

mpl

oyee

 de

mog

raph

ic  fa

ctor

s.  Pe

rson

al  v

aria

bles

 wer

e  al

so  im

port

ant  f

or  so

me  

type

s  of  P

CRDC

:  gen

der  

for  c

omfo

rt  ca

re,  b

elie

fs  a

bout

 per

sonh

ood  

for  e

mpa

thic

 resp

onse

s  to  

resi

dent

s’  di

sabi

litie

s  (i.e

.,  pe

rson

hood

 subs

cale

 of  P

DC),  

and  

burn

out  f

or  co

mfo

rt  ca

re  a

nd  su

ppor

t  for

 rela

tions

hips

.  Bel

iefs

 ab

out  p

erso

nhoo

d  an

d  bu

rnou

t  wer

e  as

sess

ed  a

s  lat

er  st

eps  i

n  th

e  re

gres

sion

 mod

els,  

mea

ning

 th

at  th

ey  re

mai

ned  

impo

rtan

t  for

 som

e  ty

pes  o

f  PCR

DC  a

fter  c

ontr

ollin

g  fo

r  oth

er  fa

ctor

s.    

 Dis

cuss

ion  

This

 stud

y  co

ntri

bute

s  to  

emer

ging

 evi

denc

e  su

gges

ting  

that

 org

aniz

atio

nal  f

acto

rs  (e

.g.,  

colla

bora

tion  

in  ca

re  a

nd  th

e  bu

ilt  a

nd  so

cial

 env

iron

men

t  of  c

are)

 are

 ver

y  im

port

ant  t

o  PC

RDC.

 PC

RDC  

is  a

 mul

ti-­‐di

men

sion

al  co

nstr

uct,  

and  

pers

onal

 var

iabl

es  in

clud

ing  

gend

er,  b

elie

fs  a

bout

 pe

rson

hood

 in  d

emen

tia,  a

nd  b

urno

ut  a

lso  

appe

ar  to

 be  

impo

rtan

t  for

 som

e  of

 its  d

imen

sion

s.  Al

thou

gh  e

ach  

of  th

ese  

obse

rvat

ions

 requ

ires

 furt

her  s

tudy

,  thi

s  res

earc

h  in

vite

s  fur

ther

 co

nsid

erat

ion  

of  o

rgan

izat

iona

l  and

 per

sona

l  fac

tors

 whe

n  de

sign

ing  

and  

impl

emen

ting  

inte

rven

tions

 to  e

nhan

ce  p

erso

n-­‐ce

ntre

d  re

side

ntia

l  dem

entia

 care

.  

Tabl

es  

 

14

myP

LAN

1.0

: Res

iden

t Cen

tred

Car

e Pl

anni

ng In

Lon

g Te

rm C

are!

Jan

Ber

ger,

BSN

RN

- L

ynda

Ble

vins

BSN

RN

- T

ara

Evje

n, B

SN R

N -

Kar

en G

elow

itz, M

SN R

N -

Laur

een

Nei

n, B

SN R

N -

Dia

ne N

owla

n, B

SN R

N -

A

licia

Tie

djen

s, B

SN R

N -

Jill

Wer

le, B

SN R

N!

!

myP

LAN

1.0

Dev

elop

men

t O

ur d

evel

opm

ent p

roce

ss in

clud

ed:

• lo

okin

g at

car

e pl

anni

ng to

ols

from

oth

er s

ourc

es

• co

nsul

ting

with

resi

dent

s, fa

mili

es, l

ong

term

car

e ho

me

staf

f an

d ot

her c

onsu

ltant

s (s

peec

h la

ngua

ge p

atho

logi

sts,

di

etiti

ans,

beh

avio

ur m

anag

emen

t spe

cial

ists

) . • 

pilo

ting

and

revi

sing

the

myP

LAN

A

s a

resu

lt, m

yPLA

N 1

.0 is

a re

side

nt-c

entre

d, in

terd

isci

plin

ary

tool

that

coo

rdin

ates

resi

dent

pre

fere

nces

, car

e ne

eds,

goa

ls,

and

outc

omes

. MyP

LAN

1.0

is o

rgan

ized

usi

ng R

AI-M

DS

2.0

as

sess

men

t sec

tions

suc

h as

bed

mob

ility

, tra

nsfe

r, pe

rson

al

hygi

ene,

cog

nitiv

e pa

ttern

s/de

cisi

on m

akin

g, c

ontin

ence

&

deal

ing

with

pai

n. A

lso,

ther

e ar

e fo

ur d

iffer

ent c

ateg

orie

s of

in

form

atio

n in

the

myP

LAN

1.0

: All

Abo

ut M

e, A

ll A

bout

My

Car

e, N

ursi

ng R

ehab

ilita

tion

and

CA

Ps.

The

se a

re d

escr

ibed

to

the

right

.

Bac

kgro

und

The

Sas

kato

on H

ealth

Reg

ion

has

over

220

0 re

side

nts

who

re

side

in 3

0 lo

ng te

rm c

are

hom

es. E

ach

resi

dent

is a

sses

sed

quar

terly

usi

ng th

e R

esid

ent A

sses

smen

t Ins

trum

ent -

Min

imum

da

ta s

et 2

.0 (R

AI-M

DS

2.0

). A

naly

sis

of th

e as

sess

men

t dat

a tri

gger

s th

e in

terR

AI C

linic

al A

sses

smen

t Pro

toco

ls (C

AP

s).

Prio

r to

the

deve

lopm

ent o

f myP

LAN

1.0

, exi

stin

g ca

re p

lans

: • 

wer

e no

t con

sist

ently

revi

ewed

and

upd

ated

by

care

team

s • 

did

not i

nclu

de m

easu

rabl

e go

als

• di

d no

t alig

n w

ith th

e ne

w R

AI-M

DS

CA

Ps

We

need

ed a

tool

that

add

ress

ed th

ese

issu

es a

nd:

• cr

eate

d a

stro

ng li

nk b

etw

een

resi

dent

s’ p

refe

renc

es a

nd

thei

r car

e pl

ans

• ca

ptur

ed c

hang

es in

resi

dent

s’ p

refe

renc

es, h

ealth

, and

car

e ov

er ti

me

• en

gage

d ca

re te

ams,

incl

udin

g th

e re

side

nt a

nd fa

mily

, to

regu

larly

revi

ew a

nd u

pdat

e th

e go

al-d

irect

ed p

lan

Nur

sing

Reh

abili

tatio

n is

us

ed b

y th

e ca

re te

am,

incl

udin

g th

e re

side

nt, w

hen

ther

e is

a g

oal t

o m

aint

ain

or

impr

ove

the

resi

dent

’s

abili

ties.

The

pla

n m

ust m

eet

RA

I-MD

S 2

.0 re

quire

men

ts fo

r nu

rsin

g re

habi

litat

ion

such

as

taki

ng a

t lea

st 1

5 m

inut

es

myP

LAN

1.0

Det

ails

Th

e A

ll A

bout

Me

cont

ains

in

form

atio

n an

d pr

efer

ence

s fro

m th

e re

side

nt. T

he A

ll A

bout

My

Car

e co

nnec

ts th

e A

ll A

bout

Me

and

othe

r hea

lth

info

rmat

ion

to s

peci

fic d

etai

ls

abou

t the

resi

dent

’s c

are.

Clin

ical

Ass

essm

ent

Prot

ocol

s ar

e tri

gger

ed

thro

ugh

anal

ysis

of

asse

ssm

ent d

ata

with

in R

AI—

MD

S 2

.0. T

he C

AP

s fa

ll in

to

four

bro

ad c

ateg

orie

s:

func

tiona

l per

form

ance

, co

gniti

ve a

nd m

enta

l hea

lth,

soci

al li

fe a

nd c

linic

al is

sues

.

each

day

. Exa

mpl

es a

re: w

alki

ng, t

rans

ferr

ing,

mov

ing

in b

ed,

eatin

g an

d ot

hers

. The

pla

n m

ust b

e re

view

ed, e

valu

ated

and

re

vise

d at

leas

t eve

ry 9

0 da

ys.

The

purp

ose

of C

AP

s fo

r the

resi

dent

is to

reso

lve

prob

lem

s,

redu

ce th

e ris

k of

dec

line

or in

crea

se th

e po

tent

ial f

or

impr

ovem

ent.

Car

e te

ams

may

dev

elop

thei

r ow

n go

als

or u

se

thos

e pr

ovid

ed o

n th

e m

yPLA

N. E

xam

ples

are

:

Nex

t ste

ps

We

rece

ived

feed

back

initi

ally

abo

ut th

e le

ngth

of t

he m

yPLA

N

1.0

and

the

pote

ntia

l tim

e to

com

plet

e it.

We

ackn

owle

dged

th

ese

conc

erns

and

put

in p

lace

a c

ompr

ehen

sive

eva

luat

ion

proc

ess.

E

valu

atio

n be

gan

in 2

013

in p

artn

ersh

ip w

ith th

e U

nive

rsity

of

Sas

katc

hew

an. T

he e

valu

atio

n w

ill id

entif

y w

heth

er th

e m

yPLA

N 1

.0:

• ha

s be

tter c

ompl

etio

n ra

tes

than

pas

t too

ls

• fa

cilit

ates

the

use

of R

AI-M

DS

2.0

dat

a to

enh

ance

resi

dent

ca

re

• le

ads

to b

ette

r res

iden

t out

com

es

• fa

cilit

ates

com

mun

icat

ion

amon

g th

e ca

re te

am, i

nclu

ding

th

e re

side

nt/fa

mily

A

ny n

eces

sary

revi

sion

s ar

e pl

anne

d fo

r 201

5. T

hese

will

be

base

d on

feed

back

and

the

eval

uatio

n fin

ding

s.

Cur

rent

sta

te

In J

une

2013

, the

myP

LAN

1.0

was

intro

duce

d in

all

long

term

ca

re h

omes

in th

e S

aska

toon

Hea

lth R

egio

n. Im

plem

enta

tion

stra

tegi

es a

re in

pla

ce, w

ith h

omes

at v

ario

us s

tage

s of

co

mpl

etio

n.

Urin

ary

Inco

ntin

ence

CA

P w

ith

poss

ible

goa

ls o

f:

• Im

prov

e bl

adde

r fun

ctio

n as

ev

iden

ced

by re

duce

d nu

mbe

r of

epi

sode

s of

inco

ntin

ence

O

R

• Pr

even

t dec

line

in b

ladd

er

func

tion

as e

vide

nced

by

mai

ntai

ned

or re

duce

d nu

mbe

r of

epi

sode

s of

inco

ntin

ence

B

ehav

iour

CA

P w

ith p

ossi

ble

goal

s of

: • 

Red

uce

daily

resp

onsi

ve

beha

vior

s as

evi

denc

ed b

y re

spon

sive

beh

avio

urs

occu

rrin

g le

ss th

an d

aily

OR

• 

Prev

ent i

ncre

ase

in re

spon

sive

be

havi

ors

as e

vide

nced

by

resp

onsi

ve b

ehav

iour

s oc

curr

ing

less

than

dai

ly O

R

• M

inim

ize

resp

onsi

ve b

ehav

iors

from

occ

urrin

g as

ev

iden

ced

by B

ehav

ior C

AP

not b

eing

trig

gere

d

myP

LAN

1.0

: Eva

luat

ion

Fram

ewor

k!Pa

ulet

te H

unte

r, Ph

.D.,

St. T

hom

as M

ore

Col

lege

, Uni

vers

ity o

f Sas

katc

hew

an !

Anita

Ber

gen,

BN

, MSc

, Sas

kato

on H

ealth

Reg

ion!

Jan

Berg

er, B

SN R

N -

Lyn

da B

levi

ns B

SN R

N -

Tar

a Ev

jen,

BSN

RN

- K

aren

Gel

owitz

, MSN

RN

– !

Laur

een

Nei

n, B

SN R

N -

Dia

ne N

owla

n, B

SN R

N -

Alic

ia T

iedj

ens,

BSN

RN

- J

ill W

erle

, BSN

RN!

!In

Jul

y, 2

013,

Sen

iors

’ Hea

lth a

nd C

ontin

uing

Car

e (S

aska

toon

Hea

lth R

egio

n) e

stab

lishe

d a

two-

year

par

tner

ship

with

a re

sear

ch g

roup

ca

lled

the

Com

mun

ity a

nd R

esea

rch

Alli

ance

for Q

ualit

y of

Life

in O

lder

Adu

lts to

eva

luat

e a

new

resi

dent

-dire

cted

car

e pl

an e

ntitl

ed

myP

LAN

1.0

. The

firs

t eva

luat

ion

phas

e, w

hich

focu

sed

on D

irect

or o

f Car

e, C

linic

al L

eade

r, ca

re p

rovi

der,

resi

dent

, and

des

igna

te

perc

eptio

ns o

f the

pla

n, w

as p

lann

ed to

ext

end

from

Jul

y 1,

201

3 to

Jun

e 30

, 201

4. T

he s

econ

d ph

ase,

whi

ch fo

cuse

d on

the

qual

ity o

f ca

re p

lann

ing

and

on re

side

nt o

utco

mes

, was

pla

nned

to e

xten

d fro

m J

uly

1, 2

014

to J

une

30, 2

015.

Evalua&on  

(Phase  1)  

Was  myPLAN  1.0  

rolled  out  

smoothly?  

Do  directors  o

f  care/clinical  

leaders  and  care  

providers  like  

myPLAN  1.0?  

Do  resid

ents  and  

designates  see  

myPLAN  1.0  as  

resid

ent  

directed?  

Is  myPLAN  1.0  

used  regularly?  

The  Saskatchew

an  Health

 Research  Foun

da5o

n  provided

 supp

ort  for  th

is  work.  

Four

pro

ject

s w

ere

incl

uded

in P

hase

1:

q U

nder

stan

ding

the

Rol

lout

Pro

cess

q U

ser R

espo

nses

to m

yPLA

N 1

.0

q R

esid

ent a

nd F

amily

Res

pons

es to

myP

LAN

1.0

q U

tilis

atio

n of

myP

LAN

Use

r Res

pons

es

Sem

i-stru

ctur

ed in

terv

iew

s w

ere

plan

ned

to a

sses

s ca

re p

rovi

ders

’ res

pons

es to

myP

LAN

1.0

. In

addi

tion,

5

stru

ctur

ed q

uest

ions

requ

iring

a L

iker

t-typ

e re

spon

se a

sses

sed

the

degr

ee to

whi

ch c

are

prov

ider

s fin

d th

e ne

w p

lan

to b

e co

ncis

e, re

leva

nt,

and

easy

to fo

llow

; bet

ter i

nteg

rate

d w

ith R

AI-M

DS

2.

0; a

nd u

sefu

l for

com

mun

icat

ion.

Und

erst

andi

ng th

e R

ollo

ut P

roce

ss

Inte

rvie

ws

wer

e pl

anne

d to

ass

ess

indi

cato

rs o

f a

smoo

th ro

llout

, inc

ludi

ng th

e ab

ility

of h

omes

to

artic

ulat

e th

e ro

llout

pro

cess

, rat

iona

le fo

r dev

iatio

ns

from

the

chos

en p

roce

ss a

nd ti

mel

ine,

ratio

nale

for

early

or l

ate

adop

tion,

and

fact

ors

influ

enci

ng th

e su

cces

s of

the

rollo

ut.

Res

iden

t and

Fam

ily R

espo

nses

In

terv

iew

s w

ere

plan

ned

to a

sses

s th

e de

gree

to

whi

ch re

side

nts

or th

eir d

esig

nate

s be

lieve

that

m

yPLA

N 1

.0 is

resi

dent

-dire

cted

.

Util

isat

ion

of m

yPLA

N 1

.0

An

expe

rimen

t inv

olvi

ng th

e re

triev

al o

f a n

ote

plac

ed

on a

n se

vera

l old

and

new

car

e pl

ans

was

pla

nned

to

asse

ss w

heth

er c

are

prov

ider

s co

nsul

t myP

LAN

1.0

m

ore

frequ

ently

than

the

prev

ious

car

e pl

an.

Thre

e pr

ojec

ts w

ere

incl

uded

in P

hase

2:

q Q

ualit

ativ

e “S

pot C

heck

” q R

etro

spec

tive

Cha

rt R

evie

w

q P

re-P

ost C

ompa

rison

of M

DS

Dat

a

Qua

litat

ive

“Spo

t Che

ck”

A se

ries

of ra

pid

“spo

t che

ck” i

nter

view

s w

as p

lann

ed

to a

sses

s ca

re p

rovi

ders

’ kno

wle

dge

abou

t res

iden

ts’

care

pla

ns. T

he g

oal o

f the

inte

rvie

ws

was

to

dete

rmin

e th

e ex

tent

to w

hich

car

e pr

ovid

ers

are

awar

e of

CA

Ps

and

Nur

sing

Reh

abili

tatio

n in

terv

entio

ns c

urre

ntly

list

ed in

the

care

pla

ns.

Cha

rt R

evie

w

A ch

art r

evie

w w

as p

lann

ed to

ass

ess

whe

ther

car

e pl

anni

ng h

as im

prov

ed in

qua

lity

sinc

e th

e im

plem

enta

tion

of m

yPLA

N 1

.0.

Pre-

Post

Com

paris

on o

f RA

I-MD

S D

ata

A co

mpa

rison

of R

AI-M

DS

out

com

es a

nd in

dica

tors

w

as p

lann

ed to

ass

ess

whe

ther

the

intro

duct

ion

of

myP

LAN

1.0

led

to a

ny o

f the

follo

win

g:

ü Q

ualit

y in

dica

tors

rela

ted

to fa

lls, m

edic

atio

ns,

pres

sure

ulc

ers,

rest

rain

ts, i

nfec

tions

, and

pai

n sh

ow im

prov

emen

t.

ü R

esid

ent o

utco

mes

(inc

ludi

ng d

epre

ssio

n, p

ain,

ac

tiviti

es o

f dai

ly li

ving

per

form

ance

, soc

ial

enga

gem

ent,

aggr

essi

on, p

ress

ure

ulce

rs, a

nd

delir

ium

) sho

w a

vera

ge im

prov

emen

t.

ü T

here

is a

n in

crea

se in

doc

umen

tatio

n of

nur

sing

re

habi

litat

ion.

Ph

ase

1

Ph

ase

2

Evalua&on  

(Phase  2)  

How  familiar  are  care  

providers  w

ith  

resid

ents’  care  plans?  

Are  comple&on  rates  

higher  than  for  

previous  care  plans?  

Does  the  new  plan  

influence  resid

ent  

outcom

es,  quality  

indicators,  and  

documenta&on  of  

nursing  rehabilita&on?  

Evalua&on  

(Phase  1)  

Was  myPLAN  1.0  

rolled  out  

smoothly?  

Do  directors  o

f  care/clinical  

leaders  and  care  

providers  like  

myPLAN  1.0?  

Do  resid

ents  and  

designates  see  

myPLAN  1.0  as  

resid

ent  

directed?  

Is  myPLAN  1.0  

used  regularly?  

Four

pro

ject

s w

ere

incl

uded

in P

hase

1:

qU

nder

stan

ding

the

Rol

lout

Pro

cess

q

Use

r Res

pons

es to

myP

LAN

1.0

q

Res

iden

t and

Fam

ily R

espo

nses

to m

yPLA

N 1

.0

qU

tilis

atio

n of

myP

LAN

Use

r Res

pons

es

Sem

i-stru

ctur

ed in

terv

iew

s w

ere

plan

ned

to a

sses

s ca

re p

rovi

ders

’ res

pons

es to

myP

LAN

1.0

. In

addi

tion,

5

stru

ctur

ed q

uest

ions

requ

iring

a L

iker

t-typ

e re

spon

se a

sses

sed

the

degr

ee to

whi

ch c

are

prov

ider

s fin

d th

e ne

w p

lan

to b

e co

ncis

e, re

leva

nt,

and

easy

to fo

llow

; bet

ter i

nteg

rate

d w

ith R

AI-M

DS

2.

0; a

nd u

sefu

l for

com

mun

icat

ion.

Und

erst

andi

ng th

e R

ollo

ut P

roce

ss

Inte

rvie

ws

wer

e pl

anne

d to

ass

ess

indi

cato

rs o

f a

smoo

th ro

llout

, inc

ludi

ng th

e ab

ility

of h

omes

to

artic

ulat

e th

e ro

llout

pro

cess

, rat

iona

le fo

r dev

iatio

ns

from

the

chos

en p

roce

ss a

nd ti

mel

ine,

ratio

nale

for

early

or l

ate

adop

tion,

and

fact

ors

influ

enci

ng th

e su

cces

s of

the

rollo

ut.

Res

iden

t and

Fam

ily R

espo

nses

In

terv

iew

s w

ere

plan

ned

to a

sses

s th

e de

gree

to

whi

ch re

side

nts

or th

eir d

esig

nate

s be

lieve

that

m

yPLA

N 1

.0 is

resi

dent

-dire

cted

.

Util

isat

ion

of m

yPLA

N 1

.0

An

expe

rimen

t inv

olvi

ng th

e re

triev

al o

f a n

ote

plac

ed

on a

n se

vera

l old

and

new

car

e pl

ans

was

pla

nned

to

asse

ss w

heth

er c

are

prov

ider

s co

nsul

t myP

LAN

1.0

m

ore

frequ

ently

than

the

prev

ious

car

e pl

an.

Ph

ase

1

Thre

e pr

ojec

ts w

ere

incl

uded

in P

hase

2:

Thre

e pr

ojec

ts w

ere

incl

uded

in P

hase

2:

qQ

ualit

ativ

e “S

pot C

heck

” q

Ret

rosp

ectiv

e C

hart

Rev

iew

q

Pre

-Pos

t Com

paris

on o

f MD

S D

ata

Pre

-Pos

t Com

paris

on o

f MD

S D

ata

Qua

litat

ive

“Spo

t Che

ck”

A se

ries

of ra

pid

“spo

t che

ck” i

nter

view

s w

as p

lann

ed

to a

sses

s ca

re p

rovi

ders

’ kno

wle

dge

abou

t res

iden

ts’

care

pla

ns. T

he g

oal o

f the

inte

rvie

ws

was

to

dete

rmin

e th

e ex

tent

to w

hich

car

e pr

ovid

ers

are

awar

e of

CA

Ps

and

Nur

sing

Reh

abili

tatio

n in

terv

entio

ns c

urre

ntly

list

ed in

the

care

pla

ns.

Cha

rt R

evie

w

A ch

art r

evie

w w

as p

lann

ed to

ass

ess

whe

ther

car

e pl

anni

ng h

as im

prov

ed in

qua

lity

sinc

e th

e im

plem

enta

tion

of m

yPLA

N 1

.0.

Pre-

Post

Com

paris

on o

f RA

I-MD

S D

ata

A co

mpa

rison

of R

AI-M

DS

out

com

es a

nd in

dica

tors

w

as p

lann

ed to

ass

ess

whe

ther

the

intro

duct

ion

of

myP

LAN

1.0

led

to a

ny o

f the

follo

win

g:

üQ

ualit

y in

dica

tors

rela

ted

to fa

lls, m

edic

atio

ns,

pres

sure

ulc

ers,

rest

rain

ts, i

nfec

tions

, and

pai

n sh

ow im

prov

emen

t.

üR

esid

ent o

utco

mes

(inc

ludi

ng d

epre

ssio

n, p

ain,

ac

tiviti

es o

f dai

ly li

ving

per

form

ance

, soc

ial

enga

gem

ent,

aggr

essi

on, p

ress

ure

ulce

rs, a

nd

delir

ium

) sho

w a

vera

ge im

prov

emen

t.

üTh

ere

is a

n in

crea

se in

doc

umen

tatio

n of

nur

sing

re

habi

litat

ion.

Ph

ase

2

Evalua&on  

(Phase  2)  

How  familiar  are  care  

providers  w

ith  

resid

ents’  care  plans?  

Are  comple&on  rates  

higher  than  for  

previous  care  plans?  

Does  the  new  plan  

influence  resid

ent  

outcom

es,  quality  

indicators,  and  

documenta&on  of  

nursing  rehabilita&on?  

15

myPLAN 1.0: Evaluation Results (Phase 1)!Paulette Hunter, Ph.D., St. Thomas More College, University of Saskatchewan !

& Fiona Fick, University of Saskatchewan!

The  Saskatchewan  Health  Research  Founda5on  provided  support  for  this  work.  

In July, 2013, Seniors’ Health and Continuing Care (Saskatoon Health Region) established a two-year partnership with a research group called the Community and Research Alliance for Quality of Life in Older Adults to evaluate a new resident-directed care plan entitled myPLAN 1.0. The first evaluation phase focused on Director of Care, Clinical Leader, care provider, resident, and designate perceptions of the plan, and extended from July 1, 2013 to June 30, 2014.

DOC/CL Perceptions DOCs/CLs indicated that the workload to roll out myPLAN 1.0 was daunting because of the time required to learn the new format and complete each plan. DOC/CLs saw myPLAN 1.0 as comprehensive and well-integrated with the RAI-MDS, but lengthy and time-consuming to complete. They noted that for most residents, some portions of the plan would not be applicable. They were concerned that staff members may become accustomed to blank sections and neglect to re-evaluate those portions of the plan.

Care Provider Perceptions Care providers saw the plan as comprehensive and well-integrated with the RAI-MDS. However, the length of the document and time needed to complete and/or review each plan was a concern. It was thought to be a good source of comprehensive information for occasional reference, but impractical for day-to-day use. Still, as Table 1 illustrates, myPLAN 1.0 was perceived as more concise, more relevant, better integrated with the RAI-MDS, and more useful for communicating about resident care than the previous care plan.

Conclusions Although many users expressed appreciation for the comprehensiveness of myPLAN 1.0 relative to the previous plan, its length was consistently flagged as a factor that may impede reference to the document, including necessary updates. An ongoing challenge will be reconciling DOC/CL and care provider support for a comprehensive care planning tool with their interest in having a day-to-day reference document that is convenient to search and update.

Methods We report here on a series of interviews with 9 Directors of Care or Clinical Leaders (DOCs/CLs), 23 care providers (RNs, LPNs, and CCAs), and 4 residents or designates1. All participants were asked open-ended questions about their experience of myPLAN 1.0. Interview transcripts were analysed using thematic content analysis. Care provider interviews contained five additional structured interview questions, in which respondents were asked to rate attributes of myPLAN 1.0 and the previous care plan on a 10 point scale ranging from 1 (not at all) to 10 (extremely). These responses were compared using a dependent measures t-test.

1Residents and designates had experienced myPlan 1.0 in the context of a recent care planning meeting in which they participated in completing the plan. Resident and designate interviews carried over into Phase 2 of the evaluation; therefore, results are not reported here.

Care Plan Consultation Experiment The first phase of the myPLAN 1.0 evaluation focused mainly on perceptions of the new plan. However, we also conducted an experiment to assess whether myPLAN 1.0 was being consulted more often than the previous plan. During the experiment, sticky notes were placed in a comparable location on at least one old and one new care plan within the same neighbourhood. The notes contained a message requesting that the care provider who found the note return it to the DOC and claim a prize. Missing data prevented a statistically reliable comparison of return times for old versus new care plans. On average, it took 18.45 days for the notes to be returned (including both old and new plans), suggesting an overall low rate of care plan consultation. This result aligns well with the information care providers gave in interviews. Encouragingly, care providers from diverse occupations (e.g., care aides, nurses, and physiotherapists) retrieved the notes.

16

DE

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NTI

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DLY

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RIN

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OW

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RIS

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ND

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NEE

DS

OF

PEO

PLE

WIT

HD

EMEN

TIA

AN

DTH

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CA

RER

S .IN

NE

S,A

., PA

GE, S

., C

UTL

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, C.,

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OS

SE

N-W

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., M

CPA

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dem

entia

and

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ren

gage

men

tw

ithto

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man

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rch

onto

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cuse

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tions

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and

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ions

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reis

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raph

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that

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ajor

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ality

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asth

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prev

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mea

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atpe

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dem

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How

ever

exis

ting

infra

stru

ctur

ean

dst

rate

gies

for

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have

larg

ely

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pend

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phic

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b.To

date

,co

mpa

rativ

ely

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rese

arch

has

exam

ined

the

impl

icat

ions

ofto

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man

dhe

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latio

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estic

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,whi

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rtant

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ortin

gth

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focu

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with

old

er p

eopl

e, p

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e w

ith d

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nd th

eir c

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Acc

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tle a

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enes

s of

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hav

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pote

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-inst

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CH

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IN T

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MM

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RE

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TLER

(PA

RT

TIM

E PH

D S

TUD

ENT)

, PR

OF.

AN

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ES

CC

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UR

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OU

TH.A

C.U

K

¢ 

With

in t

he U

K t

here

is

a pu

sh t

owar

ds a

ctiv

e an

d he

alth

y ag

eing

with

the

aim

of

enab

ling

peop

le l

ivin

g w

ith

dem

entia

to r

emai

n in

depe

nden

t and

as

a pa

rt of

thei

r so

ciet

y an

d co

mm

unity

for

as lo

ng a

s po

ssib

le. T

here

is a

huge

bod

y of

lite

ratu

re a

roun

d th

e be

nefit

s of

mai

ntai

ning

and

enh

anci

ng w

ellb

eing

and

the

impo

rtanc

e of

phy

sica

l, so

cial

and

men

tal a

ctiv

ity (

Hal

l et a

l 200

9; H

ill e

t al

2010

; Wan

g et

al 2

012;

Sw

an 2

012)

. With

app

roxi

mat

ely

two

third

s of

peo

ple

with

dem

entia

livi

ng w

ithin

the

com

mun

ity (A

lzhe

imer

’s S

ocie

ty 2

013)

ther

e is

now

a n

atio

nal d

rive

tow

ards

mai

ntai

ning

a g

ood

qual

ity o

f life

in o

lder

age

and

whe

n liv

ing

with

dem

entia

(Har

ley

et a

l 201

0).

¢ 

Lim

ited

rese

arch

has

bee

n co

nduc

ted

into

the

role

of g

amin

g te

chno

logy

in d

emen

tia c

are

and

has

negl

ecte

d th

e po

tent

ial

Qua

lity

of L

ife (

QoL

) be

nefit

s ar

isin

g fro

m t

he u

se o

f su

ch e

quip

men

t. To

dat

e, g

amin

g te

chno

logy

re

sear

ch h

as t

radi

tiona

lly l

ooke

d at

its

rol

e in

reh

abili

tatio

n fo

r pe

ople

affe

cted

by

stro

kes,

can

cer,

asth

ma

and

autis

m (

Rah

man

i and

Bor

en 2

012)

, an

d as

a p

reve

ntat

ive

mea

sure

aga

inst

cog

nitiv

e de

clin

e (W

ang

et a

l 201

2).

From

this

we

know

that

gam

ing

tech

nolo

gy, p

artic

ular

ly th

e N

inte

ndo

Wii,

has

the

pote

ntia

l to

enha

nce

and

supp

ort

heal

th c

are.

Wha

t we

don’

t kno

w is

the

pote

ntia

l whe

n us

ed in

dem

entia

car

e, e

spec

ially

its

pote

ntia

l to

enha

nce

QoL

and

to s

uppo

rt ac

tive

and

heal

thy

agei

ng.

¢ 

This

pos

ter w

ill re

port

on tw

o Te

chno

logy

Clu

b’s,

loo

king

spe

cific

ally

at Q

oL b

enef

its.

¢ 

  BA

CK

GR

OU

ND

MET

HO

DS

ww

w.b

ourn

emou

th.a

c.uk

/dem

entia

-inst

itute

Com

plet

ion

of fi

eld

wor

k an

d Q

oL in

terv

iew

s. T

he d

ata

will

then

be

them

atic

ally

an

alys

ed a

nd w

ill in

form

the

mai

n bo

dy o

f dis

cuss

ion

for t

his

thes

is.

Usi

ng t

he N

inte

ndo

Wii,

Nin

tend

o D

S,

Xbo

x K

inec

t an

d A

pple

iP

ad,

two

sets

of

Tech

nolo

gy s

essi

ons

(cal

led

the

Tech

Clu

b) w

ere

prov

ided

for

peo

ple

livin

g w

ith

dem

entia

with

in t

he B

ourn

emou

th

area

(D

orse

t). T

he a

im o

f th

e Te

ch C

lub

was

to

esta

blis

h an

d ex

plor

e th

e qu

ality

of l

ife b

enef

its o

f a te

chno

logy

gro

up fo

r peo

ple

livin

g w

ith d

emen

tia.

A

tota

l of

12

sess

ions

wer

e de

liver

ed b

etw

een

two

grou

ps o

f pe

ople

liv

ing

with

de

men

tia,

the

first

at

a lo

cal d

ay c

entre

and

the

sec

ond

at a

com

mun

ity v

enue

. The

se

ssio

ns (

each

tw

o ho

urs

long

) ai

med

to

use

all a

spec

ts (

gam

es,

apps

, so

ftwar

e) o

f ea

ch p

iece

of e

quip

men

t thr

ough

out t

he d

urat

ion

of th

e Te

ch C

lub.

Q

ualit

y of

life

int

ervi

ews

wer

e co

nduc

ted

with

the

per

son

with

dem

entia

and

a Q

oL

ques

tionn

aire

was

com

plet

ed b

y th

e pr

ofes

sion

al o

r fam

ily c

arer

prio

r to

the

star

t of t

he

sess

ions

. Thi

s Q

oL p

roce

ss w

ill b

e re

peat

ed fo

llow

ing

the

final

ses

sion

and

at a

thre

e m

onth

fol

low

up

stag

e. I

n ad

ditio

n to

QoL

dat

a, t

he s

essi

ons

used

qua

litat

ive

data

co

llect

ion

met

hods

to c

aptu

re th

e pa

rtici

pant

s th

ough

ts, c

omm

ents

, opi

nion

s, li

kes

and

disl

ikes

abo

ut th

e te

chno

logi

es a

nd th

e se

ssio

ns a

s a

who

le.

Com

plet

ion

of fi

eld

wor

k an

d Q

oL in

terv

iew

s. T

he d

ata

will

then

be

them

atic

ally

NEX

T ST

EPS

Serv

ice

eval

uatio

n fu

nded

by

Bou

rnem

outh

Bor

ough

Cou

ncil

17

D

EM

EN

TIA F

RIE

ND

LY C

OM

MU

NIT

IES: D

OR

SE

T C

UTL

ER, C

., H

EWA

RD

, M.,

HA

MB

IDG

E, S

. AN

D IN

NES

, A

The

num

ber

of p

eopl

e ag

ed 6

5 or

ove

r liv

ing

with

dem

entia

in D

orse

t, E

ngla

nd, w

ill in

crea

se fr

om 7

,796

in 2

010

to 1

1,73

4 by

20

25 (D

orse

t Hea

lth S

crut

iny

Com

mitt

ee, 2

010)

(1).

This

incr

ease

in th

e nu

mbe

r of p

eopl

e w

ho w

ill b

e liv

ing

with

dem

entia

in th

e ne

xt fe

w y

ears

has

resu

lted

in s

igni

fican

t pub

lic a

nd p

oliti

cal c

omm

itmen

t to

driv

e im

prov

emen

t and

cha

nge

for t

hose

affe

cted

by

dem

entia

(A

lzhe

imer

Soc

iety

, 20

13)(2

). W

hils

t m

any

initi

ativ

es a

re p

rogr

essi

ng u

nder

the

age

nda

of a

ge f

riend

ly c

omm

uniti

es

(WH

O 2

007)

(3),

in th

e U

K th

e P

rime

Min

iste

r lau

nche

d a

spec

ific

Dem

entia

Cha

lleng

e (D

epar

tmen

t of H

ealth

, 201

2)(4

). Th

e ai

m o

f th

e D

emen

tia C

halle

nge

is to

impr

ove

the

lives

of p

eopl

e w

ith d

emen

tia a

nd th

eir

fam

ilies

thro

ugh

thre

e ar

eas

of a

ctio

n: d

rivin

g im

prov

emen

ts i

n he

alth

and

car

e, c

reat

ing

dem

entia

frie

ndly

com

mun

ities

and

im

prov

ing

dem

entia

res

earc

h (D

epar

tmen

t of

Hea

lth, 2

012)

(4).

In r

espo

nse

to t

he P

rime

Min

iste

rs D

emen

tia C

halle

nge

and

the

natio

nal D

emen

tia F

riend

ly C

omm

unity

(D

FC)

initi

ativ

e (D

epar

tmen

t of

Hea

lth,

2012

)(4),

10 p

artn

ers

from

acr

oss

Dor

set

deve

lope

d th

e D

orse

t D

FC (

DD

FC)

proj

ect.

The

over

all

aim

of t

he D

DFC

pro

ject

was

:

‘To

crea

te d

emen

tia fr

iend

ly c

omm

uniti

es a

nd lo

cal D

emen

tia A

ctio

n A

llian

ces

invo

lvin

g lo

cal b

usin

esse

s, c

harit

ies,

in

depe

nden

t, vo

lunt

ary

and

com

mun

ity s

ervi

ces,

and

inde

pend

ent p

rovi

ders

as

wel

l as

the

stat

utor

y se

ctor

’.

Wor

k w

as u

nder

take

n in

sev

en l

ocal

ities

in

the

Dor

set

regi

on (

Bla

ndfo

rd F

orum

, C

hris

tchu

rch,

Dor

ches

ter,

Poo

le,

Sou

thbo

urne

, Wey

mou

th a

nd P

ortla

nd, a

nd W

imbo

rne

Min

ster

). Th

is e

valu

atio

n fo

cuse

s on

the

first

yea

r of

act

ivity

of t

he

Dor

set D

FC p

roje

ct b

etw

een

Mar

ch 2

013

and

Mar

ch 2

014.

The

eva

luat

ion

used

the

Alz

heim

er’s

Soc

iety

(201

3) fr

amew

ork,

whi

ch p

rovi

des

ten

area

s of

focu

s fo

r a D

FC. T

he p

rogr

ess

of e

ach

loca

lity

was

mea

sure

d ag

ains

t thi

s fra

mew

ork.

BA

CK

GR

OU

ND

MET

HO

DS

ww

w.b

ourn

emou

th.a

c.uk

/dem

entia

-inst

itute

: D

impr

ovem

ents

in

heal

th a

nd c

are,

cre

atin

g de

men

tia f

riend

ly c

omm

uniti

es a

nd i

mpr

ovin

g de

men

tia r

esea

rch

(Dep

artm

ent

of

OM

MU

NIT

IES

OR

SE

T

The

num

ber

of p

eopl

e ag

ed 6

5 or

ove

r liv

ing

with

dem

entia

in D

orse

t, E

ngla

nd, w

ill in

crea

se fr

om 7

,796

in 2

010

to 1

1,73

4 by

impr

ovem

ents

in

heal

th a

nd c

are,

cre

atin

g de

men

tia f

riend

ly c

omm

uniti

es a

nd i

mpr

ovin

g de

men

tia r

esea

rch

(Dep

artm

ent

of

In r

espo

nse

to t

he P

rime

Min

iste

rs D

emen

tia C

halle

nge

and

the

natio

nal D

emen

tia F

riend

ly C

omm

unity

(D

FC)

initi

ativ

e

impr

ovem

ents

in

heal

th a

nd c

are,

cre

atin

g de

men

tia f

riend

ly c

omm

uniti

es a

nd i

mpr

ovin

g de

men

tia r

esea

rch

(Dep

artm

ent

of im

prov

emen

ts i

n he

alth

and

car

e, c

reat

ing

dem

entia

frie

ndly

com

mun

ities

and

im

prov

ing

dem

entia

res

earc

h (D

epar

tmen

t of

In r

espo

nse

to t

he P

rime

Min

iste

rs D

emen

tia C

halle

nge

and

the

natio

nal D

emen

tia F

riend

ly C

omm

unity

(D

FC)

initi

ativ

e

impr

ovem

ents

in

heal

th a

nd c

are,

cre

atin

g de

men

tia f

riend

ly c

omm

uniti

es a

nd i

mpr

ovin

g de

men

tia r

esea

rch

(Dep

artm

ent

of

In r

espo

nse

to t

he P

rime

Min

iste

rs D

emen

tia C

halle

nge

and

the

natio

nal D

emen

tia F

riend

ly C

omm

unity

(D

FC)

initi

ativ

e

OR

SE

TO

RS

ET

C

whi

ch p

rovi

des

ten

area

s of

focu

s fo

r a D

FC. T

he p

rogr

ess

of e

ach

loca

lity

was

mea

sure

d ag

ains

t thi

s fra

mew

ork.

• E

stab

lishi

ng n

etw

orks

and

con

nect

ions

with

in a

com

mun

ity ta

kes

time

and

ultim

atel

y is

an

on-g

oing

res

pons

ibili

ty o

f eac

h lo

calit

y.

• E

very

com

mun

ity is

diff

eren

t. Le

sson

s le

arnt

and

exa

mpl

es o

f goo

d pr

actic

e fro

m e

ach

of th

e se

ven

loca

litie

s

c

ould

be

deve

lope

d an

d sh

ared

with

oth

ers

deve

lopi

ng D

FC’s

regi

onal

ly a

nd n

atio

nally

. • 

The

DD

FC p

roje

ct a

chie

vem

ent h

as b

een

to c

reat

e th

e ci

rcum

stan

ces

to e

nabl

e pr

ogre

ss to

war

ds d

evel

opin

g

t

hese

fully

in a

ll se

ven

loca

litie

s in

the

futu

re.

KEY

FIN

DIN

GS

CO

NC

LUSI

ON

1. In

volv

emen

t of p

eopl

e w

ith d

emen

tia

2. C

halle

nge

stig

ma

and

build

und

erst

andi

ng

3. A

cces

sibl

e co

mm

unity

act

iviti

es

4. A

ckno

wle

dge

pote

ntia

l

5. E

nsur

e an

ear

ly d

iagn

osis

6. P

ract

ical

sup

port

to e

nabl

e en

gage

men

t in

com

mun

ity li

fe

7. C

omm

unity

-bas

ed s

olut

ions

8. C

onsi

sten

t and

relia

ble

trav

el o

ptio

ns

9. E

asy-

to-n

avig

ate

envi

ronm

ents

10. R

espe

ctfu

l and

resp

onsi

ve b

usin

esse

s an

d se

rvic

es

• 59

9 pe

ople

atte

nded

aw

aren

ess

rais

ing

sess

ions

in D

orse

t. • 

Ste

erin

g gr

oups

hav

e be

en e

stab

lishe

d.

• C

omm

uniti

es h

ave

com

mitt

ed to

loca

l an

d na

tiona

l D

emen

tia A

ctio

n A

llian

ce’s

.

• B

usin

esse

s w

ere

posi

tive

abou

t the

D

FC in

itiat

ives

. • 

Dem

entia

aw

aren

ess

rais

ing

and

the

num

ber o

f or

gani

satio

ns jo

inin

g lo

cal D

AA’

s or

M

emor

y Aw

are

Sch

eme’

s

i

ncre

ased

ove

r tim

e.

(1) D

orse

t Hea

lth S

crut

iny

Com

mitt

ee, S

crut

iny

Rev

iew

Pan

el. 2

010.

Dem

entia

Ser

vice

s D

orse

t. D

orse

t Cou

nty

Cou

ncil.

Impr

ovin

g th

e qu

ality

of

life

for p

eopl

e in

Dor

set,

now

and

for t

he fu

ture

. (2

) Alz

heim

er’s

Soc

iety

. 201

3. ‘B

uild

ing

dem

entia

frie

ndly

com

mun

ities

: A p

riorit

y fo

r eve

ryon

e’.

(3) W

orld

Hea

lth O

rgan

isat

ion.

200

7. ‘G

loba

l age

-frie

ndly

citi

es: A

Gui

de’.

(4) D

epar

tmen

t of H

ealth

. 201

2. P

rime

Min

iste

r’s c

halle

nge

on d

emen

tia: D

eliv

erin

g m

ajor

impr

ovem

ents

in d

emen

tia c

are

and

rese

arch

by

2015

. Lon

don:

DH

Pub

licat

ions

.

Our

Obj

ectiv

es

1. T

o  iden*fy  any  impact  on  quality  of  life  fo

r  people  with

 dem

en*a  as  a

 result  

of  th

e  interven*o

n.  

2. T

o  iden*fy  any  impact  on  quality  of  life  fo

r  carers  a

s  a  re

sult  of  th

e  interven*o

n.  

3. T

o  evaluate  th

e  interven*o

n  process  for  poten*al  future  grou

ps  via  

feedback  from

 par*cipants.  

4. T

o  refin

e  the  interven*o

n  process,  if  necessary,  for  any  fu

ture  groups  b

ased  

on  th

e  evalua*ve  feedback.  

A M

usic

al E

nsem

ble

  • The  interven*o

n  consisted  of  10  weekly  music  se

ssions  facilitated  

by  mem

bers  of  the  Bou

rnem

outh  Sym

phon

y  Orchestra  (B

SO),  BU

 Music  scho

lars,  and  students  .  

• The  BU

DI  Orchestra  mem

bers  (p

eople  with

 dem

en*a  and  th

eir  

carers)  w

ere  invited  to  use  instruments  and  sing  in  order  to

 create  

an  integrated  musical  ensem

ble  with

 the  BSO  and  BU  M

usic  

students.      

• Each  se

ssion  built  upo

n  previous  weeks;  increasing  the  number  o

f  musical  pieces  a

nd  th

eir  com

plexity.  

• The  BU

DI  Orchestra  were  invited  to  sh

owcase  th

eir  talents  in  a  

performance  at  the  end  of  the  10  weeks.    

Intro

duci

ng th

e

BU

DI O

rche

stra

I  can

 hon

estly

 say

 tha

t  th

e  or

ches

tra  

has  

been

 the

 be

st  experience…

 sin

ce  [p

erso

n  w

ith  d

emen

6a]  w

as  

diag

nose

d  …

 qui

te  h

ones

tly  t

his  

was

 so  

diffe

rent

…  

and  it  do

es  li/  the  spirits

. Par*cipant

.  

“ ”

It’s  n

ot  a

bout

 kud

os…

 It’s

 abo

ut  w

hat  w

e  ca

n  achieve  

with

 thes

e  pe

ople

.  I’m

 learning

 just  as  m

uch  from

 them

 as  t

hey  

are,

 hop

eful

ly,  f

rom

 us.      

BSO  Facilitator.  ”

“

Our

Eva

luat

ion

Our  evalua*on

 has  con

sisted  of  a  variety  of  m

easures  in  order  to  gain  a  holis*

c  overview

 of  the  interven*o

n.  W

e  have  collected:  

• Weekly  ob

serva*on

s  of  each  session    

• Weekly  evalua*o

n  sheets  com

pleted  by  facilitators  a

nd  BUDI  Orchestra  mem

bers  

• Quality  of  life  ques*on

naire

s  com

pleted  by  peop

le  with

 dem

en*a  and  th

eir  carers  

pre-­‐  and  post-­‐interven*o

n.    

• Interviews  b

efore  the  interven*o

n  to  discover  musical  preferences  and  

experie

nces  so

 that  th

e  interven*o

n  could  be  tailored  to  th

e  par*cipants  

• Interviews  a

Uer  the  interven*o

n  with

 facilitators  a

nd  BUDI  orchestra  mem

bers  to

 fin

d  ou

t  what  they  thou

ght  w

orked  well,  if  they  had  any  challenges  and  if  th

ey  

have  any  th

oughts  abo

ut  how

 we  may  im

prove  the  sessions.    

For  m

ore  inform

a+on

,  please  visit:  h4

p://www.bou

rnem

outh.ac.uk

/dem

en+a

-­‐ins+tute/  

18

The

virt

ual c

are-

hom

e en

viro

nmen

t: ro

ute

lear

ning

task

s will

be

used

.

Refe

renc

es:

Braa

k, H

., Br

aak,

E. (

1991

). N

euro

path

olog

ical

stag

eing

of A

lzhei

mer

-rel

ated

cha

nges

. Ac

ta N

euro

path

olog

ica82

(4):

239–

59

Cush

man

L. A

., St

ein,

K.,

Duffy

, C. J

. (20

08) D

etec

ting

navi

gatio

nal d

efici

ts in

cog

nitiv

e ag

ing

and

Alzh

eim

er d

iseas

e us

ing

virt

ual r

ealit

y. N

euro

logy

71:

888

–895

Ec

hava

rri,

C., A

alte

n, P.

, Uyl

ings

, H. B

., Ja

cobs

, H. I

., Vi

sser

, P. J

., Gr

onen

schi

ld, E

. H.,

. . .

Burg

man

s, S

. (20

11).

Atro

phy

in th

e pa

rahi

ppoc

ampa

l gyr

us a

s an

early

bi

omar

ker o

f Alzh

eim

er's

dise

ase.

Bra

in S

truc

t Fun

ct, 2

15(3

-4),

265-

271.

doi

: 10.

1007

/s00

429-

010-

0283

-8

Looi

, J. C

., Sv

enss

on, L

., Li

ndbe

rg, O

., Za

ndbe

lt, B

. B.,

Ost

berg

, P.,

Orn

dahl

, E.,

Wah

lund

, L. O

. (20

09).

Puta

min

al v

olum

e in

fron

tote

mpo

ral l

obar

deg

ener

ation

an

d Al

zhei

mer

dise

ase:

diff

eren

tial v

olum

es in

dem

entia

subt

ypes

and

con

trol

s. A

JNR

Am J

Neur

orad

iol,

30(8

), 15

52-1

560.

doi

: 10.

3174

/ajn

r.A16

40

Peng

as, G

., Pa

tters

on, K

., Ar

nold

, R. J

., Bi

rd, C

. M.,

Burg

ess,

N.,

Nes

tor,

P. J.

(201

0) L

ost a

nd fo

und:

bes

poke

mem

ory

testi

ng fo

r Alzh

eim

er's

dise

ase

and

Sem

an-

tic D

emen

tia. J

ourn

al o

f Alzh

eim

er’s

dise

ase.

21:

p. 1

347-

1365

.

De

men

tia F

riend

ly A

rchi

tect

ure

Redu

cing

spati

al-d

isorie

ntati

on fo

r peo

ple

with

Alzh

eim

er’s

dise

ase

(AD)

.

Ove

rall

aim

: To

ide

ntify

the

env

ironm

enta

l fe

atur

es t

hat c

an a

llevi

ate

diso

rient

ation

for

peop

le w

ith A

D.

Obj

ectiv

es:

U

nder

stan

ding

how

inte

rior d

esig

n fa

cilit

ates

or i

mpe

des

orie

nta-

tion

in p

eopl

e w

ith A

D.

De

velo

ping

an

in-d

epth

und

erst

andi

ng o

f th

e sp

ecifi

c im

pair-

men

ts in

land

mar

k ba

sed

navi

gatio

n in

peo

ple

with

AD.

Cons

truc

ting

empi

rical

ly v

alid

ated

dem

entia

des

ign

guid

elin

es.

Su

perv

isors

: Jan

Wie

ner,

Anth

ea In

nes,

Mar

iela

Gae

te-R

eyes

Bour

nem

outh

Uni

vers

ity D

emen

tia In

stitu

te (B

UDI

), U

K

Ps

ycho

logy

Res

earc

h Ce

ntre

, Bou

rnem

outh

Uni

vers

ity, U

K

W

ayfin

ding

Res

earc

h Ce

ntre

, Bou

rnem

outh

Uni

vers

ity, U

K

Mar

y O

’Mal

ley

My

Appr

oach

:

Virt

ual R

ealit

y (V

R) w

ill a

llow

to

syst

emati

cally

man

ipul

ate

the

envi

ronm

ent i

.e. s

truc

tura

l lay

out a

nd la

ndm

arks

.

Man

ipul

ating

la

ndm

ark

char

acte

ristic

s w

ill

high

light

w

hich

fe

atur

es a

re m

ore

bene

ficia

l for

peo

ple

with

AD

as w

ell a

s th

e na

viga

tion

stra

tegi

es th

at h

ave

been

ado

pted

.

Nav

igati

on p

erfo

rman

ce w

ill b

e m

easu

red

by a

sses

sing

reac

tion

time,

err

or ra

te a

nd e

ye g

aze

perfo

rman

ce.

Re

sults

will

be

rela

ted

to p

sych

olog

ical

and

neu

rops

ycho

logi

cal

rese

arch

.

Bac

kgro

und:

One

of t

he e

arly

effe

cts

of A

D is

a m

arke

d di

fficu

lty t

o or

ient

an

d ‘w

ayfin

d’

arou

nd

unfa

mili

ar/r

ecen

tly

lear

ned

envi

ronm

ents

, whi

ch a

s th

e di

seas

e pr

ogre

sses

, sta

rts

to a

ffect

fa

mili

ar e

nviro

nmen

ts a

s wel

l (Cu

shm

an e

t al,

2008

).

Th

e ar

eas

first

affe

cted

in

AD a

re t

hose

ass

ocia

ted

with

na

viga

tion;

th

e hi

ppoc

ampu

s (s

patia

l m

emor

ies)

, th

e pa

rahi

ppoc

ampa

l gyr

us (

land

mar

k en

codi

ng)

and

surr

ound

ing

regi

ons.

Very

few

dem

entia

-frie

ndly

env

ironm

ent g

uide

lines

add

ress

ing

orie

ntati

on s

kills

exi

st;

thes

e ar

e oft

en b

ased

on

cust

om a

nd

prac

tice

rath

er th

an o

n em

piric

al d

ata.

It is

uncl

ear

whi

ch

navi

gatio

n st

rate

gies

an

d la

ndm

ark

char

acte

ristic

s (e

.g. p

ositi

onin

g, u

niqu

enes

s, s

alie

ncy,

stab

ility

) ar

e m

ost

impo

rtan

t in

alle

viati

ng s

patia

l di

sorie

ntati

on f

or

peop

le w

ith A

D. S

tria

tal

func

tion

has

been

sai

d to

rem

ain

rela

tivel

y in

tact

in

early

AD;

thi

s re

gion

is

impl

icat

ed i

n eg

ocen

tric

, per

son-

cent

red

navi

gatio

n.

Appl

icati

ons:

Tr

ansla

te fi

ndin

gs fr

om t

he e

mpi

rical

exp

erim

ents

into

dem

entia

fr

iend

ly d

esig

n gu

idel

ines

.

Use

the

find

ings

fro

m t

he V

R ex

perim

ents

in

real

car

e-ho

me

setti

ngs.

Pot

entia

l im

prov

emen

ts c

ould

the

n be

map

ped

onto

ot

her s

pace

s e.g

. sho

ps a

nd le

isure

cen

tres

.

Such

app

licati

ons w

ould

furt

her w

ell-b

eing

and

inde

pend

ence

for

peop

le w

ith A

D.

mar

y.om

alle

y@bo

urne

mou

th.a

c.uk

•Th

e se

ssio

ns e

nabl

ed

peop

le to

ask

que

stio

ns

and

lear

n

•Pe

rson

al in

tere

sts,

hobb

ies

and

expe

rienc

es

wer

e pr

ompt

ed b

y th

e se

ssio

ns a

nd w

ere

expl

ored

and

dis

cuss

ed

•Pr

ovid

ing

info

rmat

ion

dire

ctly

abo

ut th

e re

gion

al

loca

lity

was

of i

nter

est a

s it

had

rele

vanc

e to

man

y of

th

e pa

rtici

pant

s w

hich

m

ade

cont

ribut

ing

to d

iscu

ssio

ns

ea

sier

the

parti

cipa

nts

whi

ch

the

parti

cipa

nts

whi

ch

the

parti

cipa

nts

whi

ch

the

parti

cipa

nts

whi

ch

mad

e co

ntrib

utin

g

m

ade

cont

ribut

ing

mad

e co

ntrib

utin

g

m

ade

cont

ribut

ing

to d

iscu

ssio

ns

to

dis

cuss

ions

to d

iscu

ssio

ns

the

parti

cipa

nts

whi

ch

mad

e co

ntrib

utin

g

to

dis

cuss

ions

to d

iscu

ssio

ns

to

dis

cuss

ions

the

parti

cipa

nts

whi

ch

mad

e co

ntrib

utin

g

m

ade

cont

ribut

ing

to d

iscu

ssio

ns

to

dis

cuss

ions

to d

iscu

ssio

ns

the

parti

cipa

nts

whi

ch

mad

e co

ntrib

utin

g

m

ade

cont

ribut

ing

to d

iscu

ssio

ns

to

dis

cuss

ions

to d

iscu

ssio

ns

to

dis

cuss

ions

mad

e co

ntrib

utin

g

m

ade

cont

ribut

ing

•

Com

plet

ion

and

enga

gem

ent i

n th

e ac

tiviti

es p

rovi

ded

a se

nse

of a

chie

vem

ent

•Pr

ogre

ssio

n of

build

ing

co

nfid

ence

was

ach

ieve

d th

roug

hout

the

sess

ions

•C

once

ntra

tion

was

pr

omot

ed d

urin

g th

e se

ssio

ns. I

t gav

e pa

rtici

pant

s tim

e to

thin

k ab

out t

he a

ctiv

ity a

nd

expl

ore

at th

eir o

wn

pace

ex

plor

e at

thei

r ow

n

ex

plor

e at

thei

r ow

n

ex

plor

e at

thei

r ow

n

ex

plor

e at

thei

r ow

n

•Th

ere

was

a g

ener

al

exci

tem

entt

o ta

ke p

art

•Th

e se

ssio

ns e

nabl

ed

rem

inis

cenc

e an

d th

e sh

arin

g of

sto

ries

•Th

e se

ssio

ns w

ere

sugg

este

d to

be

in

terg

ener

atio

nal a

s th

ey

can

be re

plic

ated

with

gr

andc

hild

ren

•Th

ere

was

an

eage

rnes

s to

ta

ke p

art

•Se

ssio

ns p

rovi

ded

stim

ulat

ion

•A

good

atm

osph

ere

was

in

tegr

al to

the

succ

ess

of

the

sess

ions

as

a ‘fu

n’

elem

ent w

as p

rom

oted

•Su

ppor

t ena

bled

and

en

cour

aged

par

ticip

atio

n w

ithou

t fea

r of ‘

doin

g so

met

hing

wro

ng’

•En

cour

agem

ent p

rom

pted

pa

rtici

pant

s to

par

ticip

ate

and

‘hav

e a

go’

Enco

urag

emen

t pro

mpt

ed

parti

cipa

nts

to p

artic

ipat

e pa

rtici

pant

s to

par

ticip

ate

parti

cipa

nts

to p

artic

ipat

e pa

rtici

pant

s to

par

ticip

ate

parti

cipa

nts

to p

artic

ipat

e

TALE

S FR

OM

TH

E SE

AEN

GA

GIN

G P

EOPL

E W

ITH

DEM

ENTI

A IN

MA

RIT

IME

AR

CH

AEO

LOG

Y C

UTL

ER,C

(BU

DI)

AN

DPA

LMA,

P (A

PSC

)

M

ariti

me

arch

aeol

ogy

is a

vita

lpa

rtof

the

UK’

sna

tiona

lhe

ritag

eth

atpe

ople

with

dem

entia

are

ofte

nex

clud

edfro

mac

cess

ing.

The

Tale

sFr

omth

eSe

apr

ojec

tthe

refo

rede

liver

ed a

ser

ies

ofin

tera

ctiv

e,ed

ucat

iona

land

stim

ulat

ing

mar

itim

ear

chae

olog

ical

sess

ions

for

peop

lew

ithde

men

tia. T

heai

mof

the

sess

ions

was

topr

ovid

ean

oppo

rtuni

tyfo

rac

cess

and

lear

ning

arou

ndth

ehi

stor

y,di

scov

ery

and

reco

very

ofth

eU

K’s

mar

itim

ear

chae

olog

ical

herit

age.

Thi

spo

ster

repo

rtson

a

pilo

tst

udy

that

has

eval

uate

dth

eab

ove

initi

ativ

ean

ddi

scus

ses

how

toen

gage

peop

lew

ithde

men

tiaw

ithno

n-co

nven

tiona

ltop

ics

such

as m

ariti

me

arch

aeol

ogy.

Thi

sno

veli

nter

vent

ion

isan

inno

vativ

ede

mon

stra

tion

ofth

ew

ays

inw

hich

peop

lew

ithde

men

tiaca

nbe

stim

ulat

edan

den

gage

din

cultu

rean

dhi

stor

yin

a w

ayth

atis

mea

ning

fult

oth

eir

loca

lity.

Iti

sho

ped

that

the

findi

ngs

will

prov

ide

insp

iratio

nto

othe

rsto

try‘n

ew’a

ctiv

ities

that

are

stim

ulat

ing.

The

aim

ofth

epr

ojec

tw

asto

eval

uate

the

impa

ctof

inte

ract

ive

mar

itim

ear

chae

olog

ical

sess

ions

(as

anac

tivity

)w

ithpe

ople

with

dem

entia

livin

gw

ithin

the

com

mun

ity. S

essi

ons

wer

ede

liver

edto

87in

divi

dual

sw

ithde

men

tiain

five

Dor

set

com

mun

ityda

yce

ntre

sov

er a

con

secu

tive

thre

ew

eek

perio

d. T

hese

ssio

nsw

ere

eval

uate

dus

ing

qual

itativ

em

etho

dsw

hich

incl

uded

ethn

ogra

phic

field

note

s,en

dof

sess

ion

disc

ussi

ons

and

eval

uatio

nfo

rms.

The

sess

ions

repl

icat

edar

chae

olog

ical

proc

esse

sw

hich

are

follo

wed

byfie

ldar

chae

olog

ists

and

incl

uded

activ

ities

such

as:

•Rec

onst

ruct

ing

arte

fact

s(p

uttin

gex

cava

ted

arte

fact

sba

ckto

thei

rorig

inal

stat

e)•P

roce

ssin

gof

arte

fact

s(c

olle

ctin

gan

dor

derin

gar

tefa

cts

foun

dfro

mth

eex

cava

tion)

•Con

duct

ing

a m

ariti

me

arch

aeol

ogic

alex

cava

tion

•Pho

togr

aphi

ngar

tefa

cts

insi

tu

•Inte

ract

ing

with

arch

aeol

ogic

alar

tefa

cts

(fore

xam

ple

potte

ryan

dw

ood)

BA

CK

GR

OU

ND

MET

HO

DS

Man

y pa

rtici

pant

s en

joye

d th

e m

ariti

me

arch

aeol

ogic

al s

essi

ons

and

foun

d th

ese

inte

rest

ing.

The

impo

rtanc

e of

the

sess

ions

was

that

they

al

low

ed th

e pa

rtici

pant

s to

be

apar

t of:

•So

cial

inte

ract

ion

•St

imul

atio

n•

Rem

inis

cenc

e•

Enga

gem

ent i

n a

‘diff

eren

t act

ivity

’•

Lear

ning

abo

ut a

n in

tere

stin

g to

pic

ww

w.b

ourn

emou

th.a

c.u

k/d

emen

tia-

inst

itu

te

RES

ULT

S

CO

NC

LUSI

ON

Anal

ysis

of t

he s

essi

ons

indi

cate

d fo

ur re

curr

ent

them

es:

Acc

ess

to in

form

atio

nA

cces

s to

lear

ning

Acc

ess

to a

ctiv

ities

Acc

ess

to s

uppo

rt

ww

w.b

ourn

emou

th.a

c.u

k/a

pp

lied

-sci

ence

s

Th

e Sc

hoo

l of

A

pp

lied

Sci

ence

s (A

pSc

i)

19

Eva

luat

ing

the

Con

stru

ctio

n an

d V

alid

ity o

f a Q

uest

ionn

aire

A

sses

sing

Hea

lthca

re P

rovi

der

Per

cept

ions

of R

ural

Dem

entia

C

are

Pat

hway

s

The  

purp

ose  

of  th

e  pr

opos

ed  re

sear

ch  st

udy  

is  to

 pre

test

 a  n

ewly

 dev

elop

ed  q

ues6

onna

ire  

asse

ssin

g  he

alth

care

 pro

vide

r  per

cep6

ons  o

f  cu

rren

t  rur

al  d

emen

6a  c

are  

path

way

s  and

 pr

ac6c

es.  T

he  q

ues6

onna

ire  w

ill  b

e  us

ed  in

 a  

larg

er  st

udy  

aim

ed  a

t  dev

elop

ing  

effec

6ve  

and  

sust

aina

ble  

rura

l  prim

ary  

heal

th  c

are  

mod

els  a

nd  w

ill    b

e  co

nduc

ted  

by  th

e  Ru

ral  

Dem

en6a

 Ac6

on  R

esea

rch  

(RaD

AR)  t

eam

 

Kath

leen

 Kul

yk,  B

SN;  N

orm

a  St

ewar

t,  Ph

D,  R

N;  S

helle

y  Pe

acoc

k,  P

hD,  R

N;  D

ebra

 Mor

gan,

 PhD

,  RN

;  M

egan

 O’C

onne

ll,  P

hD,  R

D  Ps

ych;

 Julie

 Kos

teni

uk,  P

hD.  

Dem

en6a

 has

 a  d

evas

ta6n

g  im

pact

 on  

indi

vidu

als  a

nd  fa

mili

es.  P

roje

c6on

s  of  

incr

ease

d  pr

eval

ence

 of  d

emen

6a  

(Alzh

eim

er’s

 Dise

ase  

Inte

rna6

onal

,  200

9)  w

ill  

plac

e  gr

eate

r  dem

ands

 on  

heal

th  c

are  

syst

ems  i

n  th

e    fu

ture

.  Alth

ough

 bes

t  pr

ac6c

es  in

 prim

ary  

heal

th  c

are  

for  d

emen

6a  

have

 bee

n  id

en6fi

ed  (A

min

zade

h  et

 al.,

 20

12),  

liVle

 is  k

now

n  ab

out  h

ow  to

 op

era6

onal

ize  th

ese  

prac

6ces

 in  ru

ral  s

eWng

s  

The  

obje

c6ve

s  of  t

he  st

udy  

will

 be  

to:    

(1)  e

xam

ine  

the  

cons

truc

6on  

of  th

e  qu

es6o

nnai

re  (f

easib

ility

 and

 acc

epta

bilit

y),    

(2)  p

rovi

de  e

vide

nce  

to  su

ppor

t  val

idity

 of  t

he  

ques

6onn

aire

 and

,    (3

)  pro

vide

 reco

mm

enda

6ons

 for  t

he  re

finem

ent  

of  th

e  qu

es6o

nnai

re  

      A  pu

rpos

ive  

sam

ple  

of  tw

elve

 par

6cip

ants

 (in

clud

ing  

fam

ily  p

hysic

ian,

 nur

se  p

rac6

6one

r,  ho

me  

care

 nur

se  a

nd  o

ccup

a6on

al  th

erap

ist)  w

ill  

be  d

raw

n  fr

om    r

ural

 Sas

katc

hew

an  p

rimar

y  he

alth

 car

e  te

ams  a

nd  w

ill  c

ompl

ete  

the  

ques

6onn

aire

 via

 a  te

leph

one-­‐

base

d  in

terv

iew

.    Re

com

men

da6o

ns  fo

r  que

s6on

naire

 refin

emen

t  w

ill  b

e  pr

ovid

ed  to

 the  

RaDA

R  te

am  b

ased

 on  

data

 resu

lts  

Alzh

eim

er’s

 Dise

ase  

Inte

rna6

onal

.  (20

09).  World  Alzh

eimer  Report.  

hVp:

//w

ww

.alz.

co.u

k/re

sear

ch/fi

les/

Wor

ldAl

zhei

mer

Repo

rt.p

df    

Amin

zade

h,  F

.,  M

olna

r,  F.

,  Dal

ziel,  

W.B

.,  M

ound

e,  C

.,  &

 Ayo

Ve,

 D.  (

2012

).  A  

scop

ing  

inte

rpre

6ve  

revi

ew  o

f  lite

ratu

re  o

n  pe

rspe

c6ve

s  and

 pra

c6ce

s  of  p

rimar

y  ca

re  p

hysic

ians

 vis-­‐

à-­‐vi

s  dia

gnos

is  an

d    m

anag

emen

t  of  c

omm

unity

 livi

ng  o

lder

 per

sons

 with

 dem

en6a

.  Can

adian  Ge

riatrics  Jou

rnal,  15(

3),  1

-­‐13  

.  doi

:  10.

5770

/cgj

.15.

42  

(RaD

AR)  t

eam

:  hV

p://

ww

w.c

chsa

-­‐ccs

sma.

usas

k.ca

/rur

alde

men

6aca

re/  

 

20

CCN

A Te

am 2

0

CCN

A Te

am 2

0

Team

20

of th

e Ca

nadi

an C

onso

rtiu

m o

n N

euro

dege

nera

tion

in A

ging

(CCN

A):

Rur

al D

emen

tia A

ctio

n R

esea

rch

(RaDAR

) 1 D

. Mor

gan

, 1 J. K

oste

niuk

, 1 M. C

ross

ley,

1 M.E

. O’C

onne

ll, 1 A

. Kirk

, 1 N. S

tew

art,

2 V. D

al B

ello

-Haa

s, 3 D

. For

bes,

4 A. I

nnes

, 5 L. M

cBai

n, 1 H

. Mou

, 6 E. P

arro

tt

1 Uni

vers

ity o

f Sas

katc

hew

an, 2

McM

aste

r Uni

vers

ity,

3 Uni

vers

ity o

f Al

bert

a, 4 B

ourn

emou

th U

nive

rsity

, 5 F

irst N

atio

ns U

nive

rsity

of C

anad

a, ,

6 Fam

ily c

areg

iver

Back

grou

nd

Rura

l and

rem

ote

indi

vidu

als

with

mild

cog

nitiv

e im

pairm

ent (

MCI

) and

dem

entia

are

a h

ighl

y vu

lner

able

po

pula

tion

that

face

s ch

alle

nges

acc

essi

ng n

eces

sary

se

rvic

es. S

aska

tche

wan

’s g

eogr

aphy

and

spa

rse

popu

latio

n co

ntrib

ute

to th

e ch

alle

nges

in ru

ral h

ealth

se

rvic

e de

liver

y. Th

e Ru

ral a

nd R

emot

e M

emor

y Cl

inic

(RRM

C)*

is

loca

ted

in th

e ci

ty o

f Sas

kato

on, S

aska

tche

wan

and

se

rves

rura

l and

rem

ote

indi

vidu

als

livin

g in

depe

nden

tly in

com

mun

ities

that

are

mor

e th

an 1

00

km fr

om S

aska

toon

or R

egin

a (th

e tw

o ce

nsus

m

etro

polit

an a

reas

in th

e pr

ovin

ce o

f Sas

katc

hew

an):

• Pa

tient

s an

d fa

mili

es a

re re

ferr

ed to

the

fam

ily-

cent

red

inte

rpro

fess

iona

l RRM

C by

thei

r prim

ary

care

hea

lth p

rovi

der

• Pa

tient

s, a

ccom

pani

ed b

y a

care

give

r, re

ceiv

e a

prec

linic

tele

heal

th-fa

cilit

ated

ass

essm

ent b

y a

neur

opsy

chol

ogis

t and

nur

se

• Fo

ur to

six

wee

ks la

ter,

patie

nts

and

care

give

r(s)

atte

nd a

1-d

ay in

-per

son

clin

ic e

valu

atio

n th

at

invo

lves

the

full

clin

ical

team

of a

neu

rolo

gist

, ph

ysic

al th

erap

ist,

diet

itian

, and

neu

rops

ycho

logy

te

am.

• At

the

end

of th

e 1-

day

eval

uatio

n, p

atie

nts

and

care

give

rs re

ceiv

e in

form

atio

n re

gard

ing

the

prob

able

dia

gnos

is, r

ecom

men

datio

ns fo

r m

anag

emen

t, an

d se

rvic

e re

ferr

als

as a

ppro

pria

te.

* Rur

al D

emen

tia C

are

web

site

: ht

tp:/

/ww

w.cc

hsa-

ccss

ma.

usas

k.ca

/rur

alde

men

tiaca

re/

The

RaDA

R (R

ural

Dem

entia

Act

ion

Rese

arch

) Tea

m*

• An

inte

rdis

cipl

inar

y gr

oup

of re

sear

cher

s fro

m th

ree

Cana

dian

pro

vinc

es a

nd th

e UK

. Sin

ce 2

011,

the

team

has

bee

n de

velo

ping

a c

omm

unity

-bas

ed

part

icip

ator

y re

sear

ch p

rogr

am a

imed

at i

mpr

ovin

g pr

imar

y he

alth

car

e (P

HC) f

or p

eopl

e w

ith d

emen

tia

i n ru

ral a

nd re

mot

e se

tting

s in

resp

onse

to a

cal

l for

Co

mm

unity

-Bas

ed P

rimar

y H

ealth

Car

e Te

am G

rant

s by

CIH

R (C

anad

ian

Inst

itute

s of

Hea

lth R

esea

rch)

. *R

ural

Dem

entia

Act

ion

Rese

arch

web

site

: ht

tp:/

/ww

w.cc

hsa-

ccss

ma.

usas

k.ca

/rur

alde

men

tiaca

re/

rada

r.htm

l IN

FORM

ATIO

N

Dr.

Deb

ra M

orga

n. C

anad

ian

Cent

re fo

r Hea

lth &

Saf

ety

in

Agric

ultu

re, U

nive

rsity

of S

aska

tche

wan

: de

bra.

mor

gan@

usas

k.ca

or 3

06-9

66-7

905

" AC

KNOW

LED

GEM

ENTS"

Invi

tatio

n to

Join

CCN

A In

itial

sta

ges

– su

bmitt

ing

a CB

PHC

Team

Gra

nt

Octo

ber,

2011

Pla

nnin

g Se

ssio

n* to

dev

elop

a C

BPHC

Tea

m

R ese

arch

Pro

gram

• 

The

purp

ose

of th

is p

lann

ing

sess

ion

was

to b

ring

toge

ther

re

sear

cher

s (1

5) a

nd D

ecis

ion

Mak

ers

(53)

to id

entif

y im

port

ant

issu

es in

prim

ary

heal

thca

re (P

HC) a

nd in

nova

tive

serv

ice

deliv

ery

mod

els

for p

eopl

e w

ith d

emen

tia a

nd th

eir c

areg

iver

s liv

ing

in

rura

l/re

mot

e ar

eas.

Pla

nn

ing

fo

r th

e R

isin

g T

ide

:

Ne

w M

od

els

of

Ru

ral

Pri

ma

ry H

ea

lth

ca

re

for

Pe

rso

ns

wit

h D

em

en

tia

Co

mm

un

ity-B

ased

Pri

mary

Healt

hcare

Team

Gra

nt

Pla

nn

ing

Sessio

n,

Octo

ber

17,

2011

RE

PO

RT

TE

AM

ME

MB

ER

S

De

bra

Mo

rga

n

Ju

lie K

oste

niu

k

Ma

rga

ret

Cro

ssle

y

An

dre

w K

irk

Me

ga

n O

’Co

nn

ell

No

rma

Ste

wa

rt

Do

roth

y F

orb

es

Va

nin

a D

al B

ello

-Ha

as

An

the

a I

nn

es

Jo

hn

Ke

ad

y

Srid

ha

r V

aith

esw

ara

n

Ala

n M

urd

och

Com

mun

ity-B

ased

Prim

ary

Hea

lthca

re T

eam

Gra

nt P

lann

ing

Ses

sion

, Oct

ober

17,

201

1 P

lann

ing

for t

he R

isin

g Ti

de: N

ew M

odel

s of

Rur

al P

rimar

y H

ealth

care

for P

erso

ns w

ith D

emen

tia

12

4. P

REP

AR

ATO

RY

MA

TER

IAL

Prio

r to

the

Oct

ober

17th

Pla

nnin

g Se

ssio

n, w

e m

aile

d a

bind

er o

f mee

ting

docu

men

ts b

y po

st to

ea

ch p

artic

ipan

t. Th

e bi

nder

incl

uded

: •

a w

elco

me

lette

r fro

m th

e pr

inci

pal i

nves

tigat

or (D

r. M

orga

n)

• C

IHR

ann

ounc

emen

t of t

he C

BPH

C T

eam

Gra

nt c

ompe

titio

n •

our t

eam

’s C

IHR

Pla

nnin

g G

rant

app

licat

ion

to h

ost t

he O

ctob

er 1

7th P

lann

ing

Sess

ion

• Pl

anni

ng S

essi

on o

bjec

tives

, par

ticip

ant c

onta

ct in

form

atio

n, p

rese

ntat

ions

, and

con

sent

fo

rms t

o pa

rtici

pate

in re

sear

ch

• 6

key

jour

nal p

ublic

atio

ns o

n de

men

tia c

are

rese

arch

•

two

orig

inal

rese

arch

repo

rts w

ritte

n by

our

team

as b

ackg

roun

d m

ater

ial f

or th

e Pl

anni

ng

Sess

ion

5.

INVI

TED

PA

RTI

CIP

AN

TS

W

e m

aile

d in

vita

tions

to th

e Pl

anni

ng S

essi

on b

y po

st to

mem

bers

of a

num

ber o

f sta

keho

lder

gr

oups

. Fi

rst,

we

invi

ted

all f

amily

phy

sici

ans

prac

ticin

g in

Sas

katc

hew

an o

utsi

de o

f Sas

kato

on

and

Reg

ina

(N=4

02) (

30).

We

also

em

aile

d in

vita

tions

to a

ll he

alth

regi

on d

irect

ors o

f pr

imar

y he

alth

care

, chr

onic

dis

ease

man

agem

ent,

long

-term

car

e, a

nd H

ome

Car

e, u

sing

a c

urre

nt

list p

rovi

ded

by a

Sas

katc

hew

an H

ealth

staf

f m

embe

r. A

s wel

l, th

e Sa

skat

chew

an R

egis

tere

d N

urse

s Ass

ocia

tion

(SR

NA

) em

aile

d an

in

vita

tion

on o

ur b

ehal

f to

all 1

22 S

aska

tche

wan

R

N(N

P)s o

n th

eir l

ists

erve

(31)

. Sel

ecte

d pa

st

parti

cipa

nts o

f the

Ann

ual K

now

ledg

e N

etw

ork

in R

ural

and

Rem

ote

Dem

entia

Car

e Su

mm

it w

ere

also

invi

ted,

incl

udin

g fa

mily

car

egiv

ers o

f R

ural

and

Rem

ote

Mem

ory

Clin

ic p

atie

nts.

Afte

r the

invi

tatio

ns w

ere

sent

, add

ition

al

stak

ehol

ders

lear

ned

of th

e Pl

anni

ng S

essi

on a

nd

cont

acte

d ou

r Tea

m to

regi

ster

for t

he P

lann

ing

Sess

ion.

App

endi

x A

list

s the

par

ticip

ants

of t

he

Oct

ober

17th

Pla

nnin

g Se

ssio

n.

*Ful

l Rep

ort o

f Pla

nnin

g Se

ssio

n (1

09 p

ages

) ava

ilabl

e on

line!

http

://w

ww.

cchs

a-cc

ssm

a.us

ask.

ca/r

ural

dem

entia

care

/rad

ar.h

tml

!

Reco

mm

enda

tions

from

Oct

ober

, 201

1 Pl

anni

ng S

essi

on

1. D

evel

op d

emen

tia c

are

coor

dina

tors

to p

rovi

de c

ase

man

agem

ent

and

syst

em n

avig

atio

n 2. O

ffer e

duca

tion

& tr

aini

ng to

PH

C pr

ovid

ers

3. E

stab

lish

guid

elin

es to

impr

ove

early

det

ectio

n &

dia

gnos

is

4. In

trodu

ce s

tand

ardi

zed

care

pat

hway

s fo

r PH

C pr

ovid

ers

5. S

uppo

rt a

pro

vinc

ial a

nd n

atio

nal s

trate

gy fo

r dem

entia

, tha

t re

cogn

izes

dem

entia

as

a ch

roni

c di

seas

e

Octo

ber 2

012

CBPH

C Te

am G

rant

su

bmitt

ed to

CIH

R

April

201

3 N

otifi

catio

n of

CIH

R re

view

: CBP

HC

Team

gr

ant n

ot fu

nded

May

201

3 In

vita

tion

to p

artic

ipat

e in

th

e Ca

nadi

an C

onso

rtiu

m

on N

euro

dege

nera

tion

in

Agin

g (C

CNA)

June

201

3

RaDA

R Te

am a

nd m

embe

rs

of th

e In

tern

atio

nal

Indi

geno

us D

emen

tia

Rese

rch

Net

wor

k fo

rm

CCN

A Te

am 2

0

April

201

4 CI

HR

esta

blis

hes

CCN

A

The

Cana

dian

Con

sort

ium

of N

euro

dege

nera

tion

in A

ging

br

ings

toge

ther

340

rese

arch

ers

acro

ss 2

0 re

sear

ch te

ams,

or

gani

zed

into

thre

e Th

emes

(pre

vent

ion,

trea

tmen

t, ca

re).

“The

vis

ion

of th

e CC

NA

is to

brin

g to

geth

er th

e be

st o

f Ca

nadi

an re

sear

ch in

the

field

of n

euro

dege

rnat

ive

dise

ases

affe

ctin

g co

gniti

on in

a c

olla

bora

tive

and

syne

rgis

tic s

pace

to w

ork

on b

old,

inno

vativ

e an

d tr

ansf

orm

ativ

e re

sear

ch th

at w

ill u

ltim

atel

y im

pact

the

qual

ity o

f life

and

qua

lity

of s

ervi

ces

for t

hose

hav

ing

to

live

with

dem

entia

and

thei

r car

ers”

(CIH

R, 2

014)

CCN

A Te

am 2

0

July

29,

201

3 (U

nive

rsity

of S

aska

tche

wan

)

Team

20

Lead

s:

• Ru

ral:

Deb

ra M

orga

n (U

nive

rsity

of S

aska

tche

wan

) • 

I ndi

geno

us:

Kris

ten

Jack

lin (N

orth

ern

Onta

rio S

choo

l of

Med

icin

e), C

arrie

Bou

rass

a (F

irst N

atio

ns U

nive

rsity

of C

anad

a)

Team

20

Rura

l Res

earc

h Pr

ojec

ts:

W

orki

ng in

itial

ly w

ith 1

hea

lth re

gion

in S

aska

tche

wan

: 1. Rural  PHC

 Dem

en0a

 Care  Mod

el  Dev

elop

men

t   -­‐    lon

gitudinal  m

ix-­‐

metho

d  mul0p

le  case  study  to  iden0fy  gaps  in  dem

en0a  care  

pathways,  assist  PHC

 team

s  to  adapt  P

HC  dem

en0a  care  prac0ces  to

 rural  se<

ngs  (using  PD

SA  cycles),  and  evaluate  the  adapted  

interven0o

ns  and  facilitators/barriers  of  successful  adapta0on

 2. Stand

ardized  Ca

re  Pathw

ays  a

nd  Too

ls  (R

aDAR

 Too

lkit)  -­‐  iden0fy  

and  adapt  e

vidence-­‐based  clinical  su

pport  too

ls  to  ru

ral  PHC

 se<ngs;  

evaluate  th

e  effi

cacy  of  the  adapted  to

ols  for  im

proving  the  quality  of  

care  provided  to  individuals  w

ith  dem

en0a  

3. Cap

acity

-­‐building/Men

torin

g  of  PHC

 Provide

rs  -­‐  deliver  tailored    

e-­‐learning  mod

els  a

nd  case-­‐based  specialist-­‐to-­‐PHC

 support  u

sing  

web-­‐based  to

ols  for  sp

ecialist  con

sulta0o

n  and  peer  learning,  

evaluate  th

e  eff

ec0veness  a

nd  acceptability  of  e-­‐learning  mod

els,  and  

determ

ine  the  impact  of  specialist-­‐to-­‐PH

C  support  o

n  diagno

sis  and  

specialist  referral.    

RaDA

R an

d SK

Hea

lth Q

ualit

y Co

unci

l will

pro

vide

the

first

-eve

r pr

ovin

cial

-leve

l evi

denc

e-ba

sed

anal

ysis

(Tea

m 2

0 ba

selin

e da

ta):

1) a

sy

nthe

sis

of b

est p

ract

ices

from

inte

rnat

iona

l dem

entia

stra

tegi

es; 2

) an

envi

ronm

enta

l sca

n/in

vent

ory

of a

vaila

ble

dem

entia

ser

vice

s an

d th

eir P

HC

attri

bute

s, b

y SK

hea

lth re

gion

; and

3) a

link

ed a

naly

sis

of 1

0 SK

dat

abas

es

(200

1-20

13) t

o es

timat

e th

e pr

eval

ence

and

inci

denc

e of

dem

entia

am

ong

adul

ts 4

5 ye

ars

of a

ge a

nd o

lder

.

21

22

Solu

tion

Ø  In

nova

tive

use

of te

lehe

alth

vid

eoco

nfer

enci

ng to

co

nnec

t 10

care

give

rs fr

om 6

regi

ons

of th

e pr

ovin

ce

Ø  O

nce

mon

thly

gro

up 1½

hr m

eetin

g fo

r spo

uses

Ø  E

mot

ion

proc

essi

ng fo

cus

of g

roup

rath

er th

an

psyc

ho-e

duca

tion

From

Res

earc

h to

Pra

ctic

e: C

olla

bora

tion

with

the

Alz

heim

er S

ocie

ty o

f Sas

katc

hew

an

for a

Tel

ehea

lth D

eliv

ered

Fro

ntot

empo

ral D

emen

tia C

areg

iver

Sup

port

Gro

up

•  We

ackn

owle

dge

our

care

give

r pa

rtne

rs w

ithou

t w

hom

w

e w

ould

not

hav

e be

en a

ble

to d

o th

is w

ork

•  We

wou

ld li

ke t

o ac

know

ledg

e ou

r w

onde

rful

sup

port

fr

om T

eleh

ealth

Sas

katc

hew

an

Meg

an E

. O’C

onne

ll,1 R

ache

l Bur

ton1

& J

oann

e M

icha

el2

1 D

epar

tmen

t of P

sych

olog

y, U

nive

rsity

of S

aska

tche

wan

, 2Pr

ogra

m S

ervi

ces

Man

ager

, Alz

heim

er S

ocie

ty o

f Sas

katc

hew

an

Pre

sent

ed a

t the

43r

d Ann

ual S

cien

tific

and

Edu

catio

nal M

eetin

g of

the

Can

adia

n A

ssoc

iatio

n on

Ger

onto

logy

, Nia

gara

Fal

ls, O

N

RE

FER

EN

CE

S

1 de

Vugt

, M

., Rie

dijk

, S.

R.,

Aalte

n, P

., Ti

bben

, A.

, va

n Sw

iete

n, J

. C.

, &

Ver

hey,

F. R. J.

(20

06).

Im

pact

of

beha

viou

ral p

robl

ems

on s

pous

al c

areg

iver

s: A

co

mpa

rison

bet

wee

n Al

zhei

mer

’s d

isea

se a

nd

fron

tote

mpo

ral d

emen

tia. D

emen

tia a

nd G

eria

tric

Co

gniti

ve D

isor

ders

, 22,

35-

41.

2 Die

hl, J.

, M

ayer

, T.

, Fo

rstl,

H.,

& K

urz,

A. (2

003)

. A

supp

ort

grou

p fo

r ca

regi

vers

of

patie

nts

with

fr

onto

tem

pora

l dem

entia

. D

emen

tia, 2

, 151

-61.

3 v

an S

wie

ten,

J. C

. & R

osso

, S. M

. (20

06).

Rev

iew

: E

pide

mio

logy

of f

ront

otem

pora

l dem

entia

. Adv

ance

s in

C

linic

al N

euro

scie

nce

and

Reh

abili

tatio

n, 6

(1),

9-10

.

Uni

que

colla

bora

tion

– cl

inic

al re

sear

cher

s co

-fa

cilit

atin

g w

ith A

lzhe

imer

Soc

iety

of S

K s

taff

to

incr

ease

cap

acity

for t

eleh

ealth

del

iver

y of

a

spec

ializ

ed in

terv

entio

n fo

r spo

uses

of p

erso

ns

diag

nose

d w

ith F

TD

Ø  c

olla

bora

tion

for 1

st n

ew g

roup

beg

an F

ebru

ary

2012

Ø  d

isco

vere

d co

mpl

emen

tary

ski

lls th

at e

nhan

ce

the

supp

ort g

roup

inte

rven

tion

Ø ad

ditio

nal c

apac

ity b

uild

ing

and

a 2n

d gro

up

bega

n Ja

nuar

y 20

13

R

esea

rche

r co-

faci

litat

ion

diss

emin

ated

to c

omm

unity

-ba

sed

staf

f lea

rnin

g ab

out F

TD a

nd it

s un

ique

ch

alle

nges

for s

pous

es; a

lthou

gh in

itial

ly d

efer

ring

to

the

rese

arch

ers,

com

mun

ity-b

ased

faci

litat

ors

are

now

ab

le to

resp

ond

to F

TD s

peci

fic q

uest

ions

and

val

idat

e sp

ecifi

c be

havi

ors

as ty

pica

l in

this

type

of d

emen

tia.

C

o-fa

cilit

atio

n of

rese

arch

ers

and

com

mun

ity-b

ased

st

aff l

ed to

dis

sem

inat

ion

of h

ow to

del

iver

a s

uppo

rt gr

oup

virtu

ally

via

tele

heal

th v

ersu

s in

-per

son;

lear

ning

in

clud

ed a

wkw

ardn

ess

of m

aint

aini

ng e

qual

eye

con

tact

fo

r gro

up m

embe

rs a

ttend

ing

in p

erso

n an

d th

ose

who

at

tend

by

vide

ocon

fere

ncin

g.

Hig

h ne

ed fo

r car

egiv

er in

terv

entio

ns s

peci

fic to

at

ypic

al n

on-A

lzhe

imer

dem

entia

s su

ch a

s fr

onto

tem

pora

l dem

entia

(FTD

) or o

ther

ear

ly-o

nset

de

men

tias

Ø  S

pous

al c

areg

iver

s of

per

sons

dia

gnos

ed w

ith

atyp

ical

dem

entia

s (e

.g.,

FTD

) exp

erie

nce

mor

e ps

ycho

logi

cal d

istre

ss th

an s

pous

es o

f per

sons

di

agno

sed

with

Alz

heim

er d

isea

se1

Ø  F

ew s

peci

fic in

terv

entio

ns h

ave

been

dev

elop

ed

to a

ddre

ss th

eir n

eeds

2

Rat

iona

le fo

r Spe

cial

ized

Gro

up In

terv

entio

n Ø  S

pous

al c

arer

s of

indi

vidu

als

diag

nose

d w

ith a

typi

cal

dem

entia

s ca

n ob

tain

bot

h pr

actic

al in

form

atio

n an

d su

ppor

t fro

m o

ther

s w

ho a

re e

xper

ienc

ing

sim

ilar

troub

ling

beha

viou

rs in

thei

r spo

use2

Prob

lem

– L

arge

Geo

grap

hic

Dis

tanc

es

Ø  In

rura

l and

rem

ote

regi

ons

it is

diff

icul

t to

find

man

y ca

rers

of i

ndiv

idua

ls d

iagn

osed

with

thes

e ra

re

dem

entia

s (p

reva

lenc

e es

timat

es o

f 15

per 1

00,0

003

age

of o

nset

50-

60 y

ears

mos

t com

mon

, but

but

rang

e 21

to 8

5 ye

ars

old1

) – c

anno

t con

nect

in-p

erso

n

Eval

uatio

n of

Effe

ctiv

enes

s R

esea

rch

at th

e R

ural

and

Rem

ote

Mem

ory

Clin

ic, U

nive

rsity

of

Sas

katc

hew

an s

ugge

sts

that

the

tele

heal

th

vide

ocon

fere

nced

sup

port

grou

p w

as h

elpf

ul fo

r spo

usal

ca

regi

vers

of p

erso

ns d

iagn

osed

with

FTD

O

’Con

nell,

M. E

., C

ross

ley,

M.,

Cam

mer

, A.,

Mor

gan,

D.,

Alli

ngha

m, W

., C

heav

ins,

B.,

Dal

ziel

, D.,

Lem

ire, M

., M

itche

ll,

S.,

& M

orga

n, E

. (20

14).

Dem

entia

: The

Inte

rnat

iona

l Jo

urna

l of S

ocia

l Res

earc

h an

d Pr

actic

e, 1

3(3)

, 382

-95.

D

OI:

10.1

177/

1471

3012

1247

4143

.

Alz

heim

er d

isea

se is

the

mos

t com

mon

form

of

dem

entia

Ø  F

irst i

mpa

cts

the

part

of th

e br

ain

resp

onsi

ble

for

form

ing

new

mem

orie

s, b

ut p

erso

nalit

y re

mai

ns th

e sa

me

– at

leas

t ear

ly o

n Fr

onto

tem

pora

l dem

entia

s Ø  Im

pact

s ci

rcui

ts o

f the

bra

in re

spon

sibl

e fo

r pe

rson

ality

and

lang

uage

4 v

aria

nts

(firs

t 3 m

ost c

omm

only

reco

gniz

ed)

1. 

Beh

avio

ural

or f

ront

al v

aria

nt –

per

sona

lity

chan

ges

2. 

Sem

antic

dem

entia

– lo

ss o

f und

erst

andi

ng o

f la

ngua

ge

3. 

Non

-flue

nt v

aria

nt –

loss

of a

bilit

y to

com

mun

icat

e la

ngua

ge

4. 

Logo

peni

c va

riant

– e

rror

s in

spe

akin

g/re

peat

ing

Sust

aina

bilit

y of

Res

earc

h In

itiat

ive

Dep

ende

nt o

n C

omm

unity

-Bas

ed P

artn

ersh

ip B

uild

ing

Ø Al

zhei

mer

Soc

iety

of S

K w

ere

aske

d by

car

egiv

er

advo

cate

s to

fill

this

nee

d

Ø Al

zhei

mer

Soc

iety

agr

eed

only

if re

sear

cher

s co

-fa

cilit

ated

to b

uild

cap

acity

for F

TD s

peci

fic k

now

ledg

e

Ø Fi

rst L

ink

to fi

nd c

areg

iver

s fro

m a

cros

s th

e pr

ovin

ce

Co

nta

ct

23

• • •• • • •

• • •

• • •• •

24

An

Eval

uatio

n of

a R

emin

isce

nce

Inte

rven

tion

via

Tele

heal

th

Vide

ocon

fere

ncin

g fo

r Car

egiv

ers

of P

erso

ns w

ith D

emen

tia !

Joe

Enrig

ht &

Meg

an E

. O’C

onne

ll - D

epartm

ent  of  Psychology,  University  of  Saskatchewan!

!

• Informal  caregivers  of  persons  with  dem

en5a  

o6en  experience  significant  difficul5es  or  

“caregiver  burden”,  which  has  been  linked  to  

the  quality  of  the  caregiver  and  care-­‐recipient  

rela5onship1.  The  nega5ve  effects  of  caring  on  

physical  and  mental  health  have  a  considerable  

and  grow

ing  impact  on  the  econom

y  and  

society1.    

  • Reminiscence  Therapy  (RT)  is  the  facilitated  

recall  of  shared  posi5ve  mem

ories,  and  may  

improve  the  quality  of  the  rela5onship  and  

mi5gate  caregiver  difficul5es

2,3 .  

  • In  rural  and  remote  communi5es  there  is  a  

high  propor5on  of  older-­‐adults  and  limited  

access  to  health  services

4 .  This  makes  efficient  

delivery  of  dem

en5a-­‐care  related  services  a  

challenge.    

• Videoconferencing  over  the  Telehealth  

Saskatchewan  network  offers  a  secure  medium  

for  the  delivery  of  service  to  rural  and  remote  

areas,  aimed  at  improving  access  to  services  

hindered  by  geography5.  Though  prom

ising,  

the  poten5al  of  this  m

edium  for  the  delivery  of  

psychosocial  interven5ons  for  caregivers  is  

rela5vely  untested

6 .    

BA

CK

GR

OU

ND!

Acknow

ledgem

ents!

!! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

! Objec&v

es:  

• The  first  objec5ve  is  to  inves5gate  the  benefits  

of  a  RT  ac5vity  for  informal  caregivers  of  

persons  w

ith  dem

en5a  

• A  second  objec5ve  is  to  assess  the  efficacy  of  

the  RT  interven5on  delivered  via  

videoconferencing.  

Metho

d:  

• Sixty-­‐four  informal  caregivers  w

ill  be  recruited  

from

 the  University  of  Saskatchewan  Rural  and  

Remote  Mem

ory  Clinic  and  random

ly  assigned  

to  1  of  four  condi5ons:  in-­‐person  RT  /  in-­‐person  

control,  Telehealth  RT  /  Telehealth  control.  

• The  RT  interven5on  will  be  based  on  an  

empirically  supported  autobiographical  mem

ory  

ac5vity

7 .     • Rela5onship  quality,  caregiver  burden,  and  

other  outcome  measures  w

ill  be  administered  

at  pre,  post,  and  follow-­‐up."

Hypo

theses:  

• It  is  expected  that  caregivers  in  the  RT  groups  

will  dem

onstrate  an  increase  in  perceived  

quality  of  their  rela5onship  with  the  care-­‐

recipient  and  a  decrease  in  perceived  burden  

of  caring  

• It  is  also  an5cipated  that  there  will  not  be  a  

significant  difference  in  outcomes  between  the  

in-­‐person  versus  Telehealth  delivery  

condi5ons.    

  Project  R

elevan

ce:  

• This  project  w

ill  provide  evidence  of  RT  effi

cacy  

for  improving  caregiver/care-­‐recipient  

rela5onships  and  reducing  the  perceived  

burden  and  strain  of  caring  for  persons  with  

demen5a.  Further,  it  w

ill  inform  the  use  of  

videoconferencing  technology  in  the  

developm

ent  of  accessible  services  for  those  

with  limited  access,  especially  in  rural  and  

remote  areas.  

MET

HO

D!

HYP

OTH

ESES

& R

ELEV

AN

CE!

References  

1.Alzheimer  Society  of  Canada.  (2010).  Rising  Tide:  The  Im

pact  of  D

emenAa  on  Canadian  Society.  Toronto:  Author  2

.  Woods,  B.,  et  al.  (2005).  

Reminiscence  therapy  for  people  with  dem

en5a  (review).Cochrane  Da

tabase  SystemaAc  Review

,  2005,  (2);    3.  W

oods,  R.T.,  et  al.  (2009).  Rem

iniscence  

groups  for  people  with  dem

en5a  and  their  fam

ily  carers:  pragm

a5c  eight-­‐centre  random

ised  trial  of  joint  reminiscence  and  maintenance  versus  usual  

treatment:  a  protocol.  Trials  2009,  (10),64  4.  Morgan,  D.,et  al.  (2002).  Rural  families  caring  for  a  rela5ve  with  dem

en5a:Barriers  to  use  of  formal  services.  

Social  Science  &  Medicine,  55(7),  51-­‐64    5.  M

organ,  D.  G.,  Crossley,  M.,  Kirk,  A.,  McBain,  L.,  Stewart,  N.  J.,  D’Arcy,  C.,  ...  &  Basran,  J.  (2011).  Evalua5on  of  

telehealth  for  preclinic  assessment  and  follow-­‐up  in  an  interprofessional  rural  and  remote  mem

ory  clinic.  Journal  of  Applied  Gerontology,  30(3),  304-­‐331.  

6.  O’Connell,  M.  E.,  Crossley,  M.,  Cammer,  A.,  Morgan,  D.,  Allingham

,  W.,  Cheavins,  B.,  Dalziel,  D.,  Lemire,  M

.,  Mitchell,  S.,  &  Morgan,  E.  (in  press).  

Developm

ent  and  evalua5on  of  a  telehealth  videoconferenced  support  group  for  rural  spouses  of  individuals  diagnosed  with  atypical  early-­‐  onset  

demen5as.  Dem

enAa:  TheInternaAonal  Journal  of  Social  Research  and  PracAce.  7.  Alea,  N.,  &  Bluck,  S.  (2007).  I'll  keep  you  in  mind:  The  in5m

acy  func5on  

of  autobiographical  m

emory.  Applied  Cogni5ve  Psychology,  21(8),  1091-­‐1111.  

This  research  is  funded  by  TVN,  which  is  supported  by  the  Government  of  

Canada  through  the  Networks  of  Centres  of  Excellence  (NCD)  program

.      ™  Trademark  of  TVN  (Technology  Evalua5on  in  the  Elderly  Network).  Used  

with  permission.    

Your

reco

mm

enda

tions

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mm

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olicy,  

research

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wledg

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chan

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hese  re

commen

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e  ev

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ce  presented

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 adu

lts*  are  diag

nosed  or  otherwise

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en)a

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 dem

en)a

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ed  45  ye

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over).  Th

ese  reco

mmen

da)o

ns  add

ress  th

e  ch

alleng

es  ra

ised  in  th

is  repo

rt:  tha

t  our  

prov

incial  hea

lth  care  system

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erdiag

noses  d

emen

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s  evide

nt  in

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ll  ne

w  cases  each  ye

ar  being

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t  adm

ission  to  LTC

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erserves  in

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als  

with

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en)a

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ilies  –  cha

lleng

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ify  ove

r  the

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ars  a

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popu

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n  ag

es  if  w

e  do

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elop

 long

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.       Po

licy  

    1.  D

evel

op  a

 pro

vinc

ial  d

emen

)a  st

rate

gy  th

at  is  based

 on  the  follo

wing  principles:  

Is  dev

elop

ed  in

 collabo

ra)o

n  with

 families  of  ind

ividua

ls  with

 dem

en)a

,  exp

erts  in

 dem

en)a

 an

d  de

men

)a  care,  hea

lth  care  professio

nals,  hea

lth  re

gion

 represen

ta)v

es,  a

nd  th

e  Alzh

eimer  Soc

iety  of  S

aska

tche

wan

.  Fo

cuses  o

n  be

st  prac)

ces  in  de

men

)a  care,  as  p

ut  fo

rth  in  na)

onal  dem

en)a

 plans

 from

 othe

r  cou

ntrie

s:  exp

anding

 dem

en)a

 research

,  qua

lity  im

prov

emen

t  in  care  se

rvices,  raisin

g  pu

blic  awaren

ess,  early  diagn

osis,  fa

mily

 supp

ort,  an

d  staff

 training

.  Bu

ilds  o

n  reco

mmen

da)o

ns  from

 the  Alzh

eimer  Soc

iety  of  C

anad

a  Risin

g  Tide

 reco

mmen

da)o

ns  

    Incr

ease

 acc

ess  t

o  he

alth

 and

 com

mun

ity  se

rvices

 for  i

ndiv

idua

ls  li

ving

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ral  c

omm

uni)

es  

by  in

crea

sing  inve

stmen

ts  in

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idize

d  an

d  free

 tran

sporta)o

n  for  o

lder  adu

lts  living

 outsid

e  of  Saska

toon

 and

 Reg

ina  (spe

cialist

 services)  a

nd  sm

aller  u

rban

 cen

tres.  

    Ensu

re  th

at  fa

mily

 car

egiv

ers  a

re  a

dequ

atel

y  su

ppor

ted  by

 increa

sing  inve

stmen

ts  to

 im

prov

e  the  av

ailability  an

d  freq

uenc

y  of  hom

e-­‐ba

sed  an

d  co

mmun

ity-­‐based

 resp

ite  care,  

includ

ing  ev

ening,  w

eeke

nd,  a

nd  emerge

ncy  care.  

    Includ

e  de

men

)a  in

 the  

Chro

nic  Di

seas

e  M

anag

emen

t  Qua

lity  Im

prov

emen

t  Pro

gram

,  thereb

y  establish

ing  a  pa

)ent  re

gistry  and

 dec

ision

 supp

ort  too

ls  (stand

ardized  care)  for  

health  care  professio

nals  sim

ilar  t

o  othe

r  chron

ic  con

di)o

ns  (e

.g.,  diab

etes,  h

ealth

 dise

ase).  

        Rese

arch

      Tr

ack  qu

ality

 indi

cato

rs  o

f  dem

en)a

 car

e  pr

ovin

cial

ly  a

nd  b

y  he

alth

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on,  to  en

sure  th

at  

individu

als  a

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rly  assessed,  diagn

osed

,  and

 man

aged

 with

in  th

e  he

alth  care  system

.  Th

e  follo

wing  principles  provide

 guida

nce:  

Qua

lity  indicators  sh

ould  be  de

velope

d  in  partnersh

ip  betwee

n  ex

perts  in  de

men

)a,  h

ealth

 care  professiona

ls,  hea

lth  re

gion

 represen

ta)v

es  (e

.g.,  Po

pula)o

n  an

d  Pu

blic  Hea

lth,  P

rimary  

Health  Care,  Acu

te  Care,  Hom

e  Ca

re,  a

nd  Lon

g-­‐term

 Care),  e

Health,  a

nd  Hea

lth  Qua

lity  

Coun

cil.  

Qua

lity  indicators  sh

ould  be  repo

rted

 ann

ually

,  with

 improv

emen

ts  and

 dec

lines  noted

,  and

 he

alth  re

gion

s’  com

men

ts  on  fin

ding

s  inc

lude

d.  

    Incr

ease

 inve

stm

ent  i

n  th

e  Firs

t  Lin

k  re

ferral

 pro

gram

 pro

vide

d  by

 the  

Alzh

eim

er  Soc

iety

 of  

Sask

atch

ewan

,  to  en

sure  th

at  link

s  are  m

ade  be

twee

n  individu

als  w

ith  dem

en)a

,  the

ir  families,  loc

al  hea

lth  se

rvices,  a

nd  Alzh

eimer  Soc

iety  program

s.  Add

i)on

al  st

aff  sh

ould  be  

hired  in  hea

lth  re

gion

s  tha

t  currently  hav

e  the  First  L

ink  prog

ram  in

 ope

ra)o

n  (Saska

toon

,  Re

gina

 Qu’Ap

pelle

,  Cyp

ress,  P

rairie  North,  P

rince

 Albert  P

arklan

d,  Sun

 Cou

ntry)  a

nd  

expa

nded

 to  th

ose  he

alth  re

gion

s  with

out  F

irst  L

ink  (Cyp

ress,  F

ive  Hills,  H

eartland

,  Kelsey  

Trail,  Su

nrise

,  and

 the  Northern  he

alth  re

gion

s).  

        Know

ledg

e  Tr

ansla)

on  a

nd  E

xcha

nge  

    Partne

r  with

 tele

vision

 and

 new

spap

er  m

edia

 to  ra

ise  

publ

ic  a

war

enes

s  of  risk  re

duc)

on,  

warning

 sign

s,  and

 the  im

portan

ce  of  )

mely  diag

nosis

,  e.g.,  co

ntrib

ute  a  regu

lar  t

wice-­‐

mon

thly  colum

n  to  th

e  Sa

skatoo

n  Star  Pho

enix  and

 Reg

ina  Le

ader  Pos

t  and

 con

tribute  

regu

lar  items  t

o  Sa

skatoo

n  an

d  Re

gina

 new

s  program

s.  

    Esta

blish  

the  

partne

rshi

ps  re

quire

d  to

 est

ablis

h  an

d  m

aint

ain  

con)

nuin

g  ed

uca)

on  

prog

ram

s  for  hea

lth  care  professio

nals  to  im

prov

e  skills  in  assessmen

t,  diag

nosis

,  and

 man

agem

ent.  Pa

rtne

rs  m

ay  in

clud

e  ex

perts  in  de

men

)a  and

 dem

en)a

 care,  Unive

rsity

 of  

Saskatch

ewan

,  Teleh

ealth

 Saska

tche

wan

,  Saska

tche

wan

 Med

ical  Assoc

ia)o

n,  nursin

g  asso

cia)

ons,  Alzh

eimer  Soc

iety  of  S

aska

tche

wan

,  hea

lth  re

gion

 represen

ta)v

es,  a

nd  others.  

    Incr

ease

 aw

aren

ess  o

f  ear

ly  o

nset

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en)a

 (you

nger

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 65  

year

s)  amon

g  the  pu

blic  as  

well  a

s  hea

lth  care  professio

nals.  Estab

lish  services  th

at  are  designe

d  for  a

dults

 with

 early  

onset  d

emen

)a,  w

ho  m

ay  hav

e  un

ique

 nee

ds  (e

.g.,  in  th

e  workforce

,  with

 children).  

       

 Dra%  

reco

mm

enda

)ons

 for  a

c)on

 are  offe

red  be

low  in

 the  area

s  of  p

olicy,  

research

,  and

 kno

wledg

e  tran

sla)o

n  an

d  ex

chan

ge.  T

hese  re

commen

da)o

ns  re

cogn

ize  th

e  ev

iden

ce  presented

 in  th

is  repo

rt  th

at  each  ye

ar,  3

,217

 adu

lts*  are  diag

nosed  or  otherwise

 iden

)fied

 with

 dem

en)a

 and

 13,  012

 are  currently  living

 with

 dem

en)a

 (*ag

ed  45  ye

ars  a

nd  

over).  Th

ese  reco

mmen

da)o

ns  add

ress  th

e  ch

alleng

es  ra

ised  in  th

is  repo

rt:  tha

t  our  

prov

incial  hea

lth  care  system

 currently  und

erdiag

noses  d

emen

)a  (a

s  evide

nt  in

 28%

 of  a

ll  ne

w  cases  each  ye

ar  being

 iden

)fied

 first  a

t  adm

ission  to  LTC

)  and

 und

erserves  in

dividu

als  

with

 dem

en)a

 and

 their  fam

ilies  –  cha

lleng

es  th

at  w

ill  in

tens

ify  ove

r  the

 com

ing  ye

ars  a

s  our  

popu

la)o

n  ag

es  if  w

e  do

 not  dev

elop

 long

-­‐term  plans

.       Po

licy  

    1.  D

evel

op  a

 pro

vinc

ial  d

emen

)a  st

rate

gy  th

at  is  based

 on  the  follo

wing  principles:  

Is  dev

elop

ed  in

 collabo

ra)o

n  with

 families  of  ind

ividua

ls  with

 dem

en)a

,  exp

erts  in

 dem

en)a

 an

d  de

men

)a  care,  hea

lth  care  professio

nals,  hea

lth  re

gion

 represen

ta)v

es,  a

nd  th

e  Alzh

eimer  Soc

iety  of  S

aska

tche

wan

.  Fo

cuses  o

n  be

st  prac)

ces  in  de

men

)a  care,  as  p

ut  fo

rth  in  na)

onal  dem

en)a

 plans

 from

 othe

r  cou

ntrie

s:  exp

anding

 dem

en)a

 research

,  qua

lity  im

prov

emen

t  in  care  se

rvices,  raisin

g  pu

blic  awaren

ess,  early  diagn

osis,  fa

mily

 supp

ort,  an

d  staff

 training

.  Bu

ilds  o

n  reco

mmen

da)o

ns  from

 the  Alzh

eimer  Soc

iety  of  C

anad

a  Risin

g  Tide

 reco

mmen

da)o

ns  

    Incr

ease

 acc

ess  t

o  he

alth

 and

 com

mun

ity  se

rvices

 for  i

ndiv

idua

ls  li

ving

 in  ru

ral  c

omm

uni)

es  

by  in

crea

sing  inve

stmen

ts  in

 subs

idize

d  an

d  free

 tran

sporta)o

n  for  o

lder  adu

lts  living

 outsid

e  of  Saska

toon

 and

 Reg

ina  (spe

cialist

 services)  a

nd  sm

aller  u

rban

 cen

tres.  

    Ensu

re  th

at  fa

mily

 car

egiv

ers  a

re  a

dequ

atel

y  su

ppor

ted  by

 increa

sing  inve

stmen

ts  to

 im

prov

e  the  av

ailability  an

d  freq

uenc

y  of  hom

e-­‐ba

sed  an

d  co

mmun

ity-­‐based

 resp

ite  care,  

includ

ing  ev

ening,  w

eeke

nd,  a

nd  emerge

ncy  care.  

    Includ

e  de

men

)a  in

 the  

Chro

nic  Di

seas

e  M

anag

emen

t  Qua

lity  Im

prov

emen

t  Pro

gram

,  thereb

y  establish

ing  a  pa

)ent  re

gistry  and

 dec

ision

 supp

ort  too

ls  (stand

ardized  care)  for  

health  care  professio

nals  sim

ilar  t

o  othe

r  chron

ic  con

di)o

ns  (e

.g.,  diab

etes,  h

ealth

 dise

ase).  

        Rese

arch

      Tr

ack  qu

ality

 indi

cato

rs  o

f  dem

en)a

 car

e  pr

ovin

cial

ly  a

nd  b

y  he

alth

 regi

on,  to  en

sure  th

at  

individu

als  a

re  prope

rly  assessed,  diagn

osed

,  and

 man

aged

 with

in  th

e  he

alth  care  system

.  Th

e  follo

wing  principles  provide

 guida

nce:  

Qua

lity  indicators  sh

ould  be  de

velope

d  in  partnersh

ip  betwee

n  ex

perts  in  de

men

)a,  h

ealth

 care  professiona

ls,  hea

lth  re

gion

 represen

ta)v

es  (e

.g.,  Po

pula)o

n  an

d  Pu

blic  Hea

lth,  P

rimary  

Health  Care,  Acu

te  Care,  Hom

e  Ca

re,  a

nd  Lon

g-­‐term

 Care),  e

Health,  a

nd  Hea

lth  Qua

lity  

Coun

cil.  

Qua

lity  indicators  sh

ould  be  repo

rted

 ann

ually

,  with

 improv

emen

ts  and

 dec

lines  noted

,  and

 he

alth  re

gion

s’  com

men

ts  on  fin

ding

s  inc

lude

d.  

    Incr

ease

 inve

stm

ent  i

n  th

e  Firs

t  Lin

k  re

ferral

 pro

gram

 pro

vide

d  by

 the  

Alzh

eim

er  Soc

iety

 of  

Sask

atch

ewan

,  to  en

sure  th

at  link

s  are  m

ade  be

twee

n  individu

als  w

ith  dem

en)a

,  the

ir  families,  loc

al  hea

lth  se

rvices,  a

nd  Alzh

eimer  Soc

iety  program

s.  Add

i)on

al  st

aff  sh

ould  be  

hired  in  hea

lth  re

gion

s  tha

t  currently  hav

e  the  First  L

ink  prog

ram  in

 ope

ra)o

n  (Saska

toon

,  Re

gina

 Qu’Ap

pelle

,  Cyp

ress,  P

rairie  North,  P

rince

 Albert  P

arklan

d,  Sun

 Cou

ntry)  a

nd  

expa

nded

 to  th

ose  he

alth  re

gion

s  with

out  F

irst  L

ink  (Cyp

ress,  F

ive  Hills,  H

eartland

,  Kelsey  

Trail,  Su

nrise

,  and

 the  Northern  he

alth  re

gion

s).  

        Know

ledg

e  Tr

ansla)

on  a

nd  E

xcha

nge  

    Partne

r  with

 tele

vision

 and

 new

spap

er  m

edia

 to  ra

ise  

publ

ic  a

war

enes

s  of  risk  re

duc)

on,  

warning

 sign

s,  and

 the  im

portan

ce  of  )

mely  diag

nosis

,  e.g.,  co

ntrib

ute  a  regu

lar  t

wice-­‐

mon

thly  colum

n  to  th

e  Sa

skatoo

n  Star  Pho

enix  and

 Reg

ina  Le

ader  Pos

t  and

 con

tribute  

regu

lar  items  t

o  Sa

skatoo

n  an

d  Re

gina

 new

s  program

s.  

    Esta

blish  

the  

partne

rshi

ps  re

quire

d  to

 est

ablis

h  an

d  m

aint

ain  

con)

nuin

g  ed

uca)

on  

prog

ram

s  for  hea

lth  care  professio

nals  to  im

prov

e  skills  in  assessmen

t,  diag

nosis

,  and

 man

agem

ent.  Pa

rtne

rs  m

ay  in

clud

e  ex

perts  in  de

men

)a  and

 dem

en)a

 care,  Unive

rsity

 of  

Saskatch

ewan

,  Teleh

ealth

 Saska

tche

wan

,  Saska

tche

wan

 Med

ical  Assoc

ia)o

n,  nursin

g  asso

cia)

ons,  Alzh

eimer  Soc

iety  of  S

aska

tche

wan

,  hea

lth  re

gion

 represen

ta)v

es,  a

nd  others.  

    Incr

ease

 aw

aren

ess  o

f  ear

ly  o

nset

 dem

en)a

 (you

nger

 than

 65  

year

s)  amon

g  the  pu

blic  as  

well  a

s  hea

lth  care  professio

nals.  Estab

lish  services  th

at  are  designe

d  for  a

dults

 with

 early  

onset  d

emen

)a,  w

ho  m

ay  hav

e  un

ique

 nee

ds  (e

.g.,  in  th

e  workforce

,  with

 children).  

       

RaDA

R’s

reco

mm

enda

tions

  Th

ese

reco

mm

enda

tions

add

ress

the

chal

leng

es ra

ised

in th

is m

ixed-

met

hods

stu

dy: t

hat o

ur p

rovi

ncia

l hea

lth c

are

syst

em c

urre

ntly

und

erdi

agno

ses

dem

entia

and

und

erse

rves

indi

vidu

als

with

dem

entia

and

thei

r fam

ilies

–

chal

leng

es th

at w

ill in

tens

ify o

ver t

he c

omin

g ye

ars

as o

ur p

opul

atio

n ag

es if

we

do n

ot d

evel

op lo

ng-te

rm p

lans

.   Po

licy

  1. R

evis

it an

d up

date

the

Prov

inci

al S

trat

egy

for A

lzhe

imer

Dis

ease

and

Rel

ated

Dem

entia

s in

Sas

katc

hew

an,

r ele

ased

in 2

004

• 

colla

bora

te w

ith in

divi

dual

s w

ith d

emen

tia a

nd fa

mili

es, e

xper

ts in

dem

entia

and

dem

entia

car

e, h

ealth

car

e pr

ofes

sion

als,

hea

lth re

gion

repr

esen

tativ

es, t

he A

lzhe

imer

Soc

iety

of S

aska

tche

wan

, and

oth

er p

artn

ers

• fo

cus

on b

est p

ract

ices

in d

emen

tia c

are,

as

put f

orth

in n

atio

nal d

emen

tia p

lans

from

oth

er c

ount

ries:

ex

pand

ing

dem

entia

rese

arch

, qua

lity

impr

ovem

ent i

n ca

re s

ervi

ces,

rais

ing

publ

ic a

war

enes

s, e

arly

di

agno

sis,

fam

ily s

uppo

rt, a

nd s

taff

train

ing.

• 

buils

on

reco

mm

enda

tions

put

fort

h in

the

Alzh

eim

er S

ocie

ty o

f Can

ada

Risi

ng T

ide

Repo

rt

  2 . I

mpr

ove

acce

ss to

a ti

mel

y di

agno

sis

by id

entif

ying

and

add

ress

ing

pote

ntia

l bar

riers

to a

dia

gnos

is, i

nclu

ding

pa

tient

and

car

egiv

er fa

ctor

s (e

.g.,

lack

of s

ympt

om a

war

enes

s), h

ealth

car

e pr

ofes

sion

al fa

ctor

s (e

.g.,

diag

nost

ic u

ncer

tain

ty),

and

heal

th s

yste

m fa

ctor

s (la

ck o

f acc

ess

to s

tand

ardi

zed

care

pat

hway

s, d

emen

tia-

spec

ific

cont

inui

ng e

duca

tion,

and

mul

tidis

cipl

inar

y te

am a

sses

smen

t).

3 . I

ncre

ase

acce

ss to

hea

lth a

nd c

omm

unity

ser

vice

s fo

r ind

ivid

uals

livi

ng in

rura

l com

mun

ities

by:

• 

incr

easi

ng in

vest

men

ts in

sub

sidi

zed

and

free

trans

port

atio

n fo

r old

er a

dults

livi

ng o

utsi

de o

f Sas

kato

on a

nd

Regi

na (s

peci

alis

t ser

vice

s) a

nd o

utsi

de o

f com

mun

ities

with

the

desi

red

serv

ices

• 

incr

easi

ng th

e ca

paci

ty o

f loc

al re

sour

ces,

in o

rder

to re

duce

the

need

for t

rave

l and

inst

itutio

naliz

atio

n ea

rlier

than

nec

essa

ry a

mon

g ol

der a

dults

(e.g

., pr

imar

y he

alth

car

e, h

ome

care

, and

oth

er s

uppo

rt s

ervi

ces)

4. E

nsur

e th

at fa

mily

car

egiv

ers

are

adeq

uate

ly s

uppo

rted

by

incr

easi

ng in

vest

men

ts to

impr

ove

the

avai

labi

lity

and

frequ

ency

of h

ome-

base

d an

d co

mm

unity

-bas

ed re

spite

car

e, in

clud

ing

even

ing,

wee

kend

, and

em

erge

ncy

care

. 5. I

nclu

de d

emen

tia in

the

prov

inci

al C

hron

ic D

isea

se M

anag

emen

t Qua

lity

Impr

ovem

ent P

rogr

am, t

here

by

esta

blis

hing

a p

atie

nt re

gist

ry a

nd d

ecis

ion

supp

ort t

ools

(sta

ndar

dize

d ca

re) f

or h

ealth

car

e pr

ofes

sion

als

sim

ilar t

o ot

her c

hron

ic c

ondi

tions

(e.g

., di

abet

es, h

ealth

dis

ease

).   Re

sear

ch

  6 . T

rack

qua

lity

indi

cato

rs o

f dem

entia

car

e pr

ovin

cial

ly a

nd b

y he

alth

regi

on, t

o en

sure

that

indi

vidu

als

are

prop

erly

ass

esse

d, d

iagn

osed

, and

man

aged

with

in th

e he

alth

car

e sy

stem

. The

follo

win

g pr

inci

ples

pro

vide

gu

idan

ce:

• qu

ality

indi

cato

rs s

houl

d be

dev

elop

ed in

par

tner

ship

with

exp

erts

in d

emen

tia, h

ealth

car

e pr

ofes

sion

als,

he

alth

regi

on re

pres

enta

tives

(e.g

., Po

pula

tion

and

Publ

ic H

ealth

, Prim

ary

Hea

lth C

are,

Acu

te C

are,

Hom

e Ca

re, a

nd L

ong-

term

Car

e), e

Hea

lth, a

nd H

ealth

Qua

lity

Coun

cil.

• qu

ality

indi

cato

rs s

houl

d be

repo

rted

ann

ually

, with

impr

ovem

ents

and

dec

lines

not

ed, a

nd h

ealth

regi

ons’

co

mm

ents

on

findi

ngs

incl

uded

.   7. I

ncre

ase

inve

stm

ent i

n th

e Fi

rst L

ink

refe

rral

pro

gram

pro

vide

d by

the

Alzh

eim

er S

ocie

ty o

f Sas

katc

hew

an, t

o en

sure

that

link

s ar

e m

ade

amon

g in

divi

dual

s w

ith d

emen

tia, t

heir

fam

ilies

, loc

al h

ealth

ser

vice

s, a

nd

Alzh

eim

er S

ocie

ty p

rogr

ams.

Add

ition

al s

taff

shou

ld b

e hi

red

in h

ealth

regi

ons

that

cur

rent

ly h

ave

the

Firs

t Lin

k pr

ogra

m in

ope

ratio

n (S

aska

toon

, Reg

ina

Qu’A

ppel

le, C

ypre

ss, P

rairi

e N

orth

, Prin

ce A

lber

t Par

klan

d, S

un

Coun

try)

and

exp

ande

d to

thos

e he

alth

regi

ons

with

out F

irst L

ink

(Cyp

ress

, Fiv

e H

ills,

Hea

rtla

nd, K

else

y Tr

ail,

Sunr

ise,

and

the

Nor

ther

n he

alth

regi

ons)

.     Kn

owle

dge

Tran

slat

ion

and

Exch

ange

  8 . P

artn

er w

ith te

levi

sion

and

new

spap

er m

edia

to ra

ise

publ

ic a

war

enes

s of

risk

redu

ctio

n, w

arni

ng s

igns

, and

the

impo

rtan

ce o

f tim

ely

diag

nosi

s, e

.g.,

cont

ribut

e a

regu

lar t

wic

e-m

onth

ly c

olum

n to

the

Sask

atoo

n St

ar P

hoen

ix

and

Regi

na L

eade

r Pos

t and

con

tribu

te re

gula

r ite

ms

to S

aska

toon

and

Reg

ina

new

s pr

ogra

ms.

9. E

stab

lish

and

mai

ntai

n co

ntin

uing

edu

catio

n pr

ogra

ms

for h

ealth

car

e pr

ofes

sion

als

to im

prov

e sk

ills

in

asse

ssm

ent,

diag

nosi

s, a

nd m

anag

emen

t. Pa

rtne

rs m

ay in

clud

e ex

pert

s in

dem

entia

and

dem

entia

car

e,

Univ

ersi

ty o

f Sas

katc

hew

an, T

eleh

ealth

Sas

katc

hew

an, S

aska

tche

wan

Med

ical

Ass

ocia

tion,

nur

sing

as

soci

atio

ns, A

lzhe

imer

Soc

iety

of S

aska

tche

wan

, hea

lth re

gion

repr

esen

tativ

es, a

nd o

ther

s.

10. In

crea

se a

war

enes

s of

ear

ly o

nset

dem

entia

(you

nger

than

65

year

s) a

mon

g th

e pu

blic

as

wel

l as

heal

th c

are

prof

essi

onal

s. E

stab

lish

serv

ices

that

are

des

igne

d fo

r adu

lts w

ith e

arly

ons

et d

emen

tia, w

ho m

ay h

ave

uniq

ue

need

s (e

.g.,

in th

e w

orkf

orce

, with

chi

ldre

n).

Anal

ysis

of d

emen

tia p

reva

lenc

e, in

cide

nce,

and

car

e ga

ps in

Sas

katc

hew

an:

A m

ixed

met

hods

stu

dy

Anal

ysis

of d

emen

tia p

reva

lenc

e, in

cide

nce,

and

car

e ga

ps in

Sas

katc

hew

an:

J. Ko

sten

iuk1

D. M

orga

n1 , J.

Qua

il2 , G

. Tea

re2 ,

K. K

ulyk

1 , M

. O’C

onne

ll1 , A

. Kirk

1 , M

. Cro

ssle

y1 , N

. Ste

war

t1 , V

. Dal

Bel

lo-H

aas3 ,

L. M

cBai

n4 , H

. Mou

1 , D

. For

bes5 ,

A.

Inne

s6 , J.

Bra

cken

7 , E

. Par

rot8

1 Uni

vers

ity o

f Sas

katc

hew

an 2 S

K H

ealth

Qua

lity

Coun

cil

3 McM

aste

r Uni

vers

ity 4 F

irst N

atio

ns U

nive

rsity

of C

anad

a 5 U

nive

rsity

of

Albe

rta

6 Bou

rnem

outh

Uni

vers

ity 7 A

lzhe

imer

Soc

iety

of S

aska

tche

wan

8 Fam

ily c

areg

iver

Back

grou

nd

Wor

ldw

ide,

it is

est

imat

ed

that

ther

e is

one

new

(inc

iden

t) ca

se o

f dem

entia

eve

ry 4

se

cond

s, o

r 7.7

mill

ion

inci

dent

ca

ses

each

yea

r (W

HO

and

ADI

2012

). Th

e m

ost r

ecen

t est

imat

es

show

that

44

mill

ion

peop

le n

ow

live

with

dem

entia

(pre

vale

nce)

, pr

ojec

ted

to in

crea

se to

135

m

illio

n by

205

0 (P

rince

et a

l. 20

13a)

. T

o da

te, l

ittle

rese

arch

has

be

en c

arrie

d ou

t to

exam

ine

the

scop

e of

dem

entia

and

dem

entia

ca

re a

cros

s th

e pr

ovin

ce o

f Sa

skat

chew

an. E

pide

mio

logi

cal

data

that

is a

s cu

rren

t as

poss

ible

, and

that

com

bine

s bo

th

com

mun

ity-b

ased

and

long

-term

da

ta, c

an in

form

pol

icy

deci

sion

s th

at a

ffect

indi

vidu

als

with

de

men

tia a

nd th

eir f

amili

es li

ving

in

eve

ry c

orne

r of t

he p

rovi

nce.

 

S tud

y ob

ject

ives

In

par

tner

ship

with

the

Sask

atch

ewan

Hea

lth Q

ualit

y C o

unci

l, th

is s

tudy

invo

lves

a

com

paris

on o

f act

ual t

o be

st

prac

tices

in d

emen

tia c

are,

with

th

ree

com

pone

nts:

1) A

r evi

ew o

f bes

t pra

ctic

es

acro

ss th

e ca

re c

ontin

uum

of

heal

th a

nd s

ocia

l ser

vice

s fo

r in

divi

dual

s w

ith d

emen

tia a

nd

thei

r fam

ilies

2) A

n a n

alys

is o

f adm

inis

trativ

e h e

alth

dat

a to

det

erm

ine

the

12-m

onth

inci

denc

e an

d pr

eval

ence

of d

emen

tia a

mon

g in

divi

dual

s ag

ed 4

5 an

d ol

der

in th

e pr

ovin

ce o

f Sa

skat

chew

an b

y da

taba

se o

f id

entif

icat

ion,

dem

ogra

phic

ch

arac

teris

tics

(age

gro

up, s

ex,

and

rura

l/ur

ban

resi

denc

e),

and

heal

th re

gion

3) A

n e n

viro

nmen

tal s

can

of

dem

entia

-rela

ted

serv

ices

and

re

sour

ces

acro

ss th

e co

ntin

uum

of c

are,

spe

cific

ally

se

rvic

e av

aila

bilit

y an

d pr

imar

y he

alth

car

e or

ient

atio

n of

suc

h se

rvic

es, p

rovi

ncia

lly a

nd b

y he

alth

regi

on

Stud

y se

tting

• 

The

prov

inci

al h

ealth

sys

tem

ha

s a

regi

onal

mod

el o

f go

vern

ance

(see

map

bel

ow),

with

eac

h of

the

13 h

ealth

re

gion

s re

spon

sibl

e fo

r pr

ovid

ing

basi

c he

alth

ser

vice

s to

thei

r pop

ulat

ion.

Adm

inis

trativ

e D

ata

Anal

ysis

! S tud

y ob

ject

ives

• 

To d

eter

min

e th

e 12

-mon

th in

cide

nce

and

prev

alen

ce o

f dem

entia

am

ong

indi

vidu

als

aged

45

and

olde

r* in

the

prov

ince

of S

aska

tche

wan

by

data

base

of i

dent

ifica

tion,

dem

ogra

phic

ch

arac

teris

tics

(age

gro

up, s

ex, a

nd r u

ral/

urba

n**

resi

denc

e), a

nd h

ealth

regi

on.

* Ag

e cu

t-off

of 4

5 ye

ars

was

use

d to

iden

tify

the

inci

denc

e an

d pr

eval

ence

of ‘

early

ons

et d

emen

tia’ (

i.e.,

dem

entia

in in

divi

dual

s yo

unge

r tha

n ag

e 65

yea

rs).

**

Bas

ed o

n po

stal

cod

e, re

side

nts

of c

ensu

s m

etro

polit

an a

reas

(100

,000

or o

ver,

with

a c

ore

popu

latio

n of

50,

000

or o

ver)

and

cens

us a

gglo

mer

atio

ns (c

ore

popu

latio

n of

10,

000

or o

ver)

wer

e co

nsid

ered

urb

an, a

nd w

ere

othe

rwis

e co

nsid

ered

rura

l.

Dat

a so

urce

s • 

10 p

rovi

ncia

l-lev

el d

atab

ases

link

ed b

y a

uniq

ue p

erso

nal h

ealth

ser

vice

s nu

mbe

r ass

igne

d to

in

divi

dual

s el

igib

le fo

r hea

lth in

sura

nce

bene

fits.

The

dat

abas

es w

ere

acce

ssed

, lin

ked,

and

an

alys

ed b

y re

sear

cher

s at

the

SK H

ealth

Qua

lity

Coun

cil.

C ase

def

initi

on

• Th

e co

hort

incl

uded

indi

vidu

als

aged

45

year

s an

d ol

der a

t the

ir fir

st-e

ver r

ecor

ded

iden

tific

atio

n of

dem

entia

* (i.

e., i

ndex

dat

e) b

etw

een

April

1, 2

001

and

Mar

ch 3

1, 2

013

in o

ne

of 4

adm

inis

trativ

e he

alth

dat

abas

es (H

ospi

tal D

isch

arge

Abs

tract

s, P

hysi

cian

Ser

vice

Cla

ims,

Pr

escr

iptio

n D

rug,

and

RAI

-MD

S, i.

e., L

ong-

term

Car

e). I

ncid

ence

and

pre

vale

nce

for t

he

2012

-201

3 pe

riod

only

wer

e ca

lcul

ated

for t

he p

rese

nt a

naly

sis.

• 

C ase

def

initi

on a

lgor

ithm

: > 1

phy

sici

an v

isits

or >

1 h

ospi

taliz

atio

ns o

r > 1

pre

scrip

tions

for a

ch

olin

este

rase

inhi

bito

r or [

a RA

I-MD

S CP

S sc

ore

of >

2 a

nd/o

r (a

dise

ase

cate

gory

of

Alzh

eim

er’s

dis

ease

or d

emen

tia o

ther

than

Alz

heim

er’s

dis

ease

)]

Hos

pita

l Dis

char

ge A

bstr

acts

(ICD

-10-

CA c

odes

: F00

, F01

, F02

, F03

, F04

, F05

.1, F

06.8

, F06

.9, F

09, F

10.6

, F10

.7, F

18.6

, F18

.7, F

19.6

, F1

9.7,

G30

, G31

.0, G

31.1

, G91

, R54

); Ph

ysic

ian

Serv

ices

Cla

ims

(ICD

-9-C

M c

odes

: 290

, 294

, 331

, 797

); Pr

escr

iptio

n D

rug

(Aric

ept

DIN

s: 0

2232

043,

022

3204

4; E

xelo

n D

INs:

022

4211

5-02

2421

18, 0

2245

240;

Rem

inyl

DIN

s: 0

2244

298-

0224

4300

, 022

6671

7,

0226

6725

, 022

6673

3); L

ong-

term

Car

e, i.

e., R

AI-M

DS

(Cog

nitiv

e Pe

rform

ance

Sca

le (C

PS) s

core

of 2

and

ove

r, in

dica

ting

mild

to v

ery

seve

re im

pairm

ent)

[Mor

ris e

t al.

1994

] and

/or a

dis

ease

cat

egor

y of

Alz

heim

er’s

dis

ease

or d

emen

tia o

ther

than

Alz

heim

er’s

dis

ease

).

K E

Y FI

ND

ING

S In

cide

nce

(201

2/20

13)

• 3,

270

inci

dent

(new

) cas

es o

f dem

entia

wer

e id

entif

ied

amon

g ad

ults

45

year

s an

d ol

der i

n Sa

skat

chew

an d

urin

g th

e 20

12/1

3 12

-mon

th p

erio

d [7

.28

per 1

,000

pop

ulat

ion

at ri

sk (P

AR)]

• 1,

887

inci

dent

cas

es a

mon

g fe

mal

es (8

.25

per 1

,000

PAR

) vs.

1,3

83 a

mon

g m

ales

(6.2

8 pe

r 1,

000

PAR)

[p<0

.05]

• 

Adul

ts a

ged

45 to

64

cont

ribut

ed 8

% o

f inc

iden

t cas

es, a

ged

65 to

84

cont

ribut

ed 4

1%, a

nd

aged

85

and

olde

r acc

ount

ed fo

r 51%

• 

Unad

just

ed in

cide

nce

rate

incr

ease

d 15

2 tim

es b

etw

een

the

grou

p ag

ed 4

5 to

54

and

thos

e ag

ed 8

5 ye

ars

and

olde

r (0.

46 v

s. 6

9.73

per

1,0

00 P

AR)

• Th

e gr

eate

st p

ropo

rtio

n w

as fi

rst i

dent

ified

in L

TC (3

4.98

%, 1

,144

/3,2

70),

follo

wed

by

a di

agno

sis

in p

hysi

cian

ser

vice

s cl

aim

s (2

9.94

%),

in h

ospi

tal (

28.5

3%),

and

by a

cho

lines

tera

se

inhi

bito

r pre

scrip

tion

(6.5

4%)

• Of

inci

dent

cas

es th

at w

ere

first

iden

tifie

d in

long

-term

car

e, 7

9.72

% (9

12/1

,144

) wer

e id

entif

ied

at th

e po

int o

f adm

issi

on [t

here

fore

27.

89%

of a

ll in

cide

nt c

ases

(912

/1,1

44) w

ere

first

iden

tifie

d w

ith d

emen

tia a

t the

poi

nt o

f adm

issi

on to

LTC

] • 

Amon

g ag

ed 8

5 ye

ars

and

olde

r, th

e un

adju

sted

inci

denc

e ra

te w

as 1

4% h

ighe

r am

ong

rura

l th

an u

rban

[p<0

.05]

• 

Inci

denc

e (a

nd p

opul

atio

n at

risk

) was

hig

hest

in S

aska

toon

Hea

lth R

egio

n (8

80 n

ew c

ases

) an

d lo

wes

t in

the

Nor

ther

n H

ealth

Reg

ions

(32

new

cas

es)

• Th

e ag

e- a

nd s

ex-a

djus

ted

inci

denc

e ra

tes

wer

e hi

ghes

t in

Sun

Coun

try

Hea

lth R

egio

n (8

.77

per

1,00

0 PA

R) a

nd H

eart

land

Hea

lth R

egio

n (8

.63

per 1

,000

PAR

) vs.

the

adju

sted

rate

for a

ll he

alth

regi

ons

com

bine

d (7

.51

per 1

,000

PAR

) [p<

0.05

] • 

The

age-

and

sex

-adj

uste

d in

cide

nce

rate

s w

ere

low

est i

n Pr

ince

Alb

ert P

arkl

and

(6.5

9 pe

r 1,

000

PAR)

and

the

Nor

ther

n H

ealth

Reg

ions

(6.6

6 pe

r 1,0

00 P

AR) v

s. th

e ad

just

ed ra

te fo

r all

heal

th re

gion

s co

mbi

ned

(7.5

1 pe

r 1,0

00 P

AR) [

p<0.

05]"

" P rev

alen

ce (2

012/

2013

) • 

13,0

12 p

reva

lent

(exi

stin

g) c

ases

wer

e id

entif

ied

amon

g ad

ults

45

year

s an

d ol

der i

n Sa

skat

chew

an d

urin

g th

e 20

12/1

3 12

-mon

th p

erio

d [ra

te o

f 28.

16 p

er 1

,000

pop

ulat

ion

at ri

sk

( PAR

)] • 

8,09

9 pr

eval

ent c

ases

am

ong

fem

ales

(34.

19 p

er 1

,000

PAR

) vs.

4,9

13 a

mon

g m

ales

(21,

92

per 1

,000

PAR

) [p<

0.05

] • 

Adul

ts a

ged

45 to

64

acco

unte

d fo

r 8%

of p

reva

lent

cas

es, a

ged

65 to

84

acco

unte

d fo

r 39%

, an

d th

ose

85 y

ears

and

old

er c

ontri

bute

d 53

%

• Un

adju

sted

pre

vale

nce

rate

was

160

tim

es h

ighe

r am

ong

adul

ts a

ged

85 a

nd o

lder

than

am

ong

thos

e 45

to 5

4 ye

ars

of a

ge (2

21.3

0 vs

. 1.3

8 pe

r 1,0

00 P

AR)

• Th

e gr

eate

st p

ropo

rtio

n w

as fi

rst i

dent

ified

by

a di

agno

sis

in p

hysi

cian

ser

vice

s cl

aim

s (4

0.16

%),

follo

wed

by

a di

agno

sis

in L

TC (2

4.72

%, 3

,217

/13,

012)

, in

hosp

ital (

23.8

4%),

and

by a

ch

olin

este

rase

inhi

bito

r pre

scrip

tion

(11.

28%

) • 

Of p

reva

lent

cas

es th

at w

ere

first

iden

tifie

d in

long

-term

car

e, 6

8.89

% (2

,216

/3,2

17) w

ere

iden

tifie

d at

the

poin

t of a

dmis

sion

to L

TC [t

here

fore

, 17.

03%

of a

ll pr

eval

ent c

ases

(2

,216

/13,

012)

wer

e fir

st id

entif

ied

with

dem

entia

at t

he p

oint

of a

dmis

sion

to lo

ng-te

rm c

are]

• 

Amon

g th

ose

youn

ger t

han

85, t

he u

nadj

uste

d pr

eval

ence

rate

s w

ere

high

er a

mon

g ur

ban

than

ru

ral r

esid

ents

[p<0

.05]

; am

ong

thos

e ag

ed 8

5 ye

ars

and

olde

r, th

e un

adju

sted

pre

vale

nce

rate

w

as h

ighe

r am

ong

rura

l tha

n ur

ban

[p<0

.05]

. Am

ong

all a

ge g

roup

s co

mbi

ned,

the

unad

just

ed

prev

alen

ce ra

te w

as 6

% h

ighe

r am

ong

urba

n th

an ru

ral [

p<0.

05]

• Pr

eval

ence

(and

pop

ulat

ion

at ri

sk) w

as h

ighe

st in

Sas

kato

on H

ealth

Reg

ion

(3,2

86 c

ases

) and

Re

gina

Qu’

Appe

lle H

ealth

Reg

ion

(3,0

41 c

ases

). Pr

eval

ence

(and

pop

ulat

ion

at ri

sk) w

as lo

wes

t in

the

Nor

ther

n H

ealth

Reg

ions

(126

cas

es)

• Th

e ag

e- a

nd s

ex-a

djus

ted

prev

alen

ce ra

te w

as h

ighe

st in

Prin

ce A

lber

t Par

klan

d H

ealth

Reg

ion

(31.

91 p

er 1

,000

PAR

) and

Sun

Cou

ntry

Hea

lth R

egio

n (3

0.55

per

1,0

00 P

AR) [

not s

igni

fican

tly

high

er (p

<0.0

5) th

an a

ll he

alth

regi

ons

com

bine

d (2

8.16

per

1,0

00 P

AR)].

Tw

o ad

ditio

nal h

ealth

re

gion

s ha

d ad

just

ed p

reva

lenc

e ra

tes

that

wer

e si

gnifi

cant

ly h

ighe

r (p<

0.05

) tha

n al

l hea

lth

regi

ons

com

bine

d: S

unris

e at

29.

40 a

nd R

egin

a Qu

’App

elle

at 2

8.75

per

1,0

00 P

AR.

• Th

e ag

e- a

nd s

ex-a

djus

ted

prev

alen

ce ra

te w

as lo

wes

t in

the

Nor

ther

n H

ealth

Reg

ions

(25.

87

per 1

,000

PAR

) [no

t sig

nific

antly

low

er (p

<0.0

5) th

an a

ll he

alth

regi

ons

com

bine

d (2

8.16

per

1,

000

PAR)

]. Th

e ad

just

ed p

reva

lenc

e ra

te in

the

Sask

atoo

n H

ealth

Reg

ion

(26.

45 p

er 1

,000

PA

R) w

as s

igni

fican

tly lo

wer

than

the

adju

sted

rate

for a

ll he

alth

regi

ons

com

bine

d [p

<0.0

5].

" "

Best

Pra

ctic

e Re

view

R e

sear

ch Q

uest

ions

• 

Wha

t are

the

curr

ent i

nter

natio

nal

best

pra

ctic

es in

dem

entia

car

e in

na

tiona

l pla

ns?

• W

hat b

est p

ract

ice

them

es a

re

repr

esen

ted

acro

ss a

ll na

tiona

l pl

ans?

  Se

arch

stra

tegy

A to

tal o

f tw

elve

nat

iona

l pla

ns

wer

e id

entif

ied

from

the

Alzh

eim

er

Dis

ease

Inte

rnat

iona

l web

site

.   In

clus

ion

crite

ria

A

nat

iona

l pla

n w

as c

onsi

dere

d fo

r if

it m

et a

ll of

the

follo

win

g cr

iteria

: • 

A na

tiona

l dem

entia

pla

n lis

ted

on

the

“Gov

ernm

ent A

lzhe

imer

Pla

ns”

page

on

the

Alzh

eim

er’s

Dis

ease

In

tern

atio

nal w

ebpa

ge: h

ttp:/

/w

ww.

alz.

co.u

k/al

zhei

mer

-pla

ns

• N

ot a

sub

-nat

iona

l Alz

heim

er p

lan

nor a

non

-gov

ernm

enta

l dem

entia

st

rate

gy

• Av

aila

ble

in E

nglis

h • 

Publ

ishe

d af

ter J

anua

ry 1

200

0 • 

Publ

ical

ly a

vaila

ble

onlin

e D

ata

char

ting

and

extra

ctio

n

One

revi

ewer

ext

ract

ed th

e da

ta

from

eac

h na

tiona

l pla

n (K

K).

Com

mon

them

es in

bes

t pra

ctic

es

wer

e id

entif

ied

acro

ss th

e pl

ans.

KEY

FIN

DIN

GS

Nin

e na

tiona

l dem

entia

pla

ns w

ere

incl

uded

in th

e re

view

: Aus

tralia

, En

glan

d, F

inla

nd, F

ranc

e, N

orw

ay,

Scot

land

, Nor

ther

n Ire

land

, Uni

ted

Stat

es, a

nd W

ales

. S i

x be

st p

ract

ice

them

es w

ere

i den

tifie

d:

1) E

xpan

ding

Dem

entia

R e

sear

ch**

** in

volv

es a

n in

crea

sed

emph

asis

on

grow

ing

the

dem

entia

rese

arch

fiel

d.

2) Q

ualit

y Im

prov

emen

t in

Care

Se

rvic

es**

** e

ncom

pass

es

impr

oved

acc

ess,

ava

ilabi

lity,

and

coor

dina

tion

of c

urre

nt a

nd

futu

re s

ervi

ces

thro

ugho

ut th

e di

seas

e st

ages

alo

ng th

e co

ntin

uum

of c

are.

3 ) R

aisi

ng P

ublic

Aw

aren

ess*

**

incl

udes

reco

mm

enda

tions

to

assi

st w

ith th

e re

cogn

ition

of

sym

ptom

s an

d re

duct

ion

of

stig

ma.

4 ) E

arly

Dia

gnos

is a

nd

Trea

tmen

t**

emph

asiz

es

diss

emin

atin

g in

form

atio

n to

th

e pu

blic

and

hea

lth c

are

prof

essi

onal

s, to

impr

ove

early

di

agno

sis

and

enco

urag

e he

lp

seek

ing

in e

arly

sta

ge.

5) S

taff

Trai

ning

** in

volv

es

incr

easi

ng re

sour

ces

to im

prov

e aw

aren

ess,

kno

wle

dge,

and

tr

aini

ng a

mon

g he

alth

car

e pr

ofes

sion

als

resp

onsi

ble

for

prov

idin

g ca

re to

indi

vidu

als

with

dem

entia

. 6 ) F

amily

Sup

port

* em

phas

izes

th

e ne

ed to

impr

ove

the

avai

labi

lity

and

appr

opria

tene

ss

of c

omm

unity

sup

port

and

re

spite

opt

ions

to c

areg

iver

s an

d fa

mili

es o

f ind

ivid

uals

with

de

men

tia.

****

Sup

port

ed b

y al

l 9 c

ount

ries

**

* S

uppo

rted

by

8 co

untri

es

**

Sup

port

ed b

y 6

coun

tries

*

Supp

orte

d by

5 c

ount

ries

Envi

ronm

enta

l Sca

n

Stud

y ob

ject

ives

To

det

erm

ine,

with

in e

ach

of th

e 13

hea

lth re

gion

s of

Sas

katc

hew

an a

nd fo

r the

pro

vinc

e as

a w

hole

: • 

the

avai

labi

lity

of d

emen

tia-re

late

d se

rvic

es a

nd re

sour

ces

acro

ss th

e co

ntin

uum

of c

are,

and

• 

the

orie

ntat

ion

of d

emen

tia-re

late

d se

rvic

es to

war

d ke

y di

men

sion

s of

prim

ary

heal

th c

are

Sam

ple

and

data

col

lect

ion

• D

ata

colle

ctio

n be

twee

n Ju

ne a

nd D

ecem

ber,

2013

• 

Stud

y po

pula

tion

cons

iste

d of

all

Hom

e Ca

re A

sses

sors

(Clie

nt C

are

Coor

dina

tors

, Cas

e M

anag

ers,

or T

eam

M

anag

ers)

ser

ving

Sas

k.

• A s

sess

ors

serv

ing

the

citie

s of

Sas

kato

on o

r Reg

ina

wer

e co

nsid

ered

‘urb

an’ a

nd A

sses

sors

ser

ving

out

side

of

S ask

atoo

n an

d Re

gina

wer

e co

nsid

ered

‘rur

al’

En

viro

nmen

tal S

can

inst

rum

ent

• Av

aila

bilit

y of

dem

entia

-rela

ted

serv

ices

: Res

pond

ents

indi

cate

d th

e av

aila

bilit

y of

43

serv

ices

in th

e m

ajor

ity

of c

omm

uniti

es fo

r whi

ch th

ey w

ere

prim

arily

resp

onsi

ble

(‘eve

ryda

y’, ‘

a fe

w ti

mes

a w

eek’

, ‘on

ce a

wee

k’,

‘onc

e a

mon

th’,

‘less

ofte

n th

an o

nce

a m

onth

’, an

d ‘n

ot a

vaila

ble’

) • 

P rim

ary

Hea

lth C

are

Orie

ntat

ion

of d

emen

tia-re

late

d se

rvic

es: S

ix 5

-item

sca

les,

eac

h ite

m ra

ted

on a

5-p

oint

sc

ale

from

‘no,

not

at a

ll’ (1

) to

‘yes

, to

a ve

ry g

reat

ext

ent’

(5);

high

er s

core

s in

dica

ted

grea

ter o

rient

atio

n of

de

men

tia-re

late

d se

rvic

es to

key

dim

ensi

ons

of p

rimar

y he

alth

car

e.

Resp

onse

by

heal

th re

gion

• 

Only

the

resu

lts fo

r hea

lth re

gion

s w

ith 4

+ su

rvey

resp

onde

nts

surv

ey w

ere

incl

uded

(the

exc

eptio

n w

as

Atha

basc

a H

ealth

Aut

horit

y, w

hich

had

1 re

spon

dent

and

was

gro

uped

with

Kee

wat

in Y

atth

e in

to th

e ‘N

orth

ern

Hea

lth R

egio

ns’)

• Re

spon

se ra

te o

f 45.

6% (8

2 of

180

): 68

rura

l and

14

urba

n (a

ll ur

ban

resp

onde

nts

wer

e fro

m R

egin

a Qu

’App

elle

Hea

lth R

egio

n)

K EY

FIN

DIN

GS

A vai

labi

lity

of D

emen

tia-re

late

d Se

rvic

es

• H

ealth

Pro

mot

ion

Prog

ram

s re

late

d to

dem

entia

car

e w

ere

repo

rted

to b

e w

idel

y un

avai

labl

e ac

cord

ing

to

mor

e th

an h

alf o

f res

pond

ents

. • 

Prim

ary

Hea

lth C

are

serv

ices

rela

ted

to d

emen

tia c

are

that

wer

e av

aila

ble

at le

ast w

eekl

y ac

cord

ing

to m

ore

than

hal

f of r

espo

nden

ts, r

ank

orde

red,

incl

uded

bas

ic s

ervi

ces

– ph

arm

acis

ts, f

amily

phy

sici

ans,

phy

sica

l th

erap

ists

, and

occ

upat

iona

l the

rapi

sts.

How

ever

, Nur

se P

ract

ition

ers

and

mul

tidis

cipl

inar

y te

am a

sses

smen

t w

ere

unav

aila

ble

in n

early

hal

f of t

he c

omm

uniti

es s

erve

d by

resp

onde

nts.

• 

Post

-dia

gnos

is S

uppo

rt s

ervi

ces

mos

t ava

ilabl

e w

eekl

y in

clud

ed th

e br

oad

heal

th s

ervi

ces

of p

allia

tive

care

, ad

ult d

ay p

rogr

ams,

cas

e m

anag

emen

t, an

d vo

lunt

eer s

ervi

ces/

visi

tors

. Mor

e th

an h

alf o

f res

pond

ents

re

port

ed th

at o

ther

pos

t-dia

gnos

tic s

uppo

rt w

as n

ot a

vaila

ble

in th

eir c

omm

uniti

es (p

rivat

e ca

regi

ving

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regi

ver s

uppo

rt g

roup

s, a

nd c

ouns

ellin

g fo

r dia

gnos

ed in

divi

dual

s)

• H

ome

Care

ser

vice

s w

ere

wid

ely

avai

labl

e w

eekl

y (p

erso

nal c

are

serv

ices

, mea

ls o

n w

heel

s an

d m

eal

prep

arat

ion,

pla

nned

resp

ite, a

nd in

-hom

e re

spite

). H

ome

care

ser

vice

s th

at w

ere

unav

aila

ble

acco

rdin

g to

th

e m

ajor

ity o

f res

pond

ents

incl

uded

nig

ht re

spite

, wee

kend

resp

ite, a

nd tr

ansp

orta

tion

to h

ealth

car

e.

• Lo

ng-te

rm C

are

coun

selli

ng fo

r ind

ivid

uals

with

dem

entia

and

car

egiv

ers

was

repo

rted

to b

e w

idel

y un

avai

labl

e. L

ong-

term

car

e ho

usin

g av

aila

ble

in m

ost c

omm

uniti

es in

clud

ed s

enio

rs h

ousi

ng, s

peci

al c

are

hom

es, a

nd p

erso

nal c

are

hom

es. L

ong-

term

car

e ho

usin

g th

at w

as m

ore

likel

y to

be

unav

aila

ble

incl

uded

as

sist

ed li

ving

opt

ions

and

spe

cial

car

e un

its.

Prim

ary

Hea

lth C

are

Orie

ntat

ion

of D

emen

tia-re

late

d Se

rvic

es

Conc

lusi

ons

• 

Whe

n co

mpa

red

to R

isin

g Ti

de

proj

ectio

ns fo

r Sas

k (S

met

anin

et a

l.,

2009

), ou

r fin

ding

s su

gges

t tha

t onl

y 79

% o

f inc

iden

t cas

es

(3,2

70/4

,154

) and

71%

of

prev

alen

t cas

es (1

3,01

2/18

,332

) w

ere

diag

nose

d or

oth

erw

ise

iden

tifie

d; i.

e., a

n es

timat

ed 2

1%

of in

cide

nt c

ases

and

29%

of

prev

alen

t cas

es w

ere

not

diag

nose

d or

oth

erw

ise

iden

tifie

d.

• Th

is s

tudy

hig

hlig

hts

sign

ifica

nt

gaps

bet

wee

n be

st p

ract

ices

in

dem

entia

car

e (B

est P

ract

ice

Revi

ew) a

nd a

ctua

l pra

ctic

es

(Env

ironm

enta

l Sca

n):

R e

fere

nces

Pr

ince

M, B

ryce

R, A

lban

ese

E, W

imo

A, R

ibei

ro W

, Fer

ri C

. The

glo

bal

prev

alen

ce o

f dem

entia

: a s

yste

mat

ic re

view

and

met

aana

lysi

s.

Alzh

eim

er’s

and

Dem

entia

201

3;9:

63-7

5. "

Sask

atch

ewan

Bur

eau

of S

tatis

tics.

Sas

katc

hew

an P

opul

atio

n by

5 Y

ear

Age

Gro

ups,

200

3 to

201

3. 2

014.

[http

://w

ww.

stat

s.go

v.sk.

ca/p

op/]"

Smet

anin

P, K

obak

P, B

riant

e C

, Stif

f D, S

harm

an G

, Ahm

ad S

. Ris

ing

Tide

: Th

e Im

pact

of D

emen

tia in

Sas

katc

hew

an 2

008

to 2

038.

200

9.

Ris

kAna

lytic

a an

d Al

zhei

mer

Soc

iety

of S

aska

tche

wan

, Can

ada."

Wor

ld H

ealth

Org

aniz

atio

n an

d Al

zhei

mer

’s D

isea

se In

tern

atio

nal.

Dem

entia

: A P

ublic

Hea

lth P

riorit

y. 2

012.

[http

://w

ww.

who

.int/

men

tal_

heal

th/p

ublic

atio

ns/d

emen

tia_r

epor

t_20

12/e

n/]"

" *Rur

al D

emen

tia A

ctio

n Re

sear

ch

web

site

: ht

tp:/

/ww

w.cc

hsa-

ccss

ma.

usas

k.ca

/ru

rald

emen

tiaca

re/r

adar

.htm

l

INQU

IRIE

S:

Dr.

Deb

ra M

orga

n. C

anad

ian

Cent

re fo

r H

ealth

& S

afet

y in

Agr

icul

ture

, Uni

vers

ity o

f Sa

skat

chew

an:

debr

a.m

orga

n@us

ask.

ca o

r 30

6-96

6-79

05

ACKN

OWLE

DG

EMEN

TS  

• In

form

atio

n an

d Ed

ucat

ion.

Com

mun

ity-le

vel

dem

entia

-rela

ted

info

rmat

ion

and

educ

atio

n w

ere

perc

eive

d as

inad

equa

te, r

angi

ng fr

om

stro

ngly

neg

ativ

e (p

ublic

edu

catio

n to

redu

ce

stig

ma)

to s

omew

hat p

ositi

ve (d

emen

tia

awar

enes

s am

ong

loca

l hea

lth c

are

prof

essi

onal

). • 

Acce

ssib

ility

. Res

pond

ents

hel

d ov

eral

l so

mew

hat n

egat

ive

perc

eptio

ns, p

artic

ular

ly

rega

rdin

g th

e in

fluen

ce o

f geo

grap

hic

loca

tion

on

acce

ssib

ility

and

ava

ilabi

lity

of s

ubsi

dize

d/fre

e tra

nspo

rtat

ion

serv

ices

. • 

Popu

latio

n Or

ient

atio

n (c

omm

unity

fit).

Re

spon

dent

s he

ld s

omew

hat n

egat

ive

view

s ov

eral

l, sp

ecifi

cally

on

leve

l of c

areg

iver

sup

port

an

d le

vel o

f prim

ary

heal

th c

are

serv

ices

. • 

Coor

dina

ted

Care

. Per

cept

ions

wer

e ne

utra

l on

the

seam

less

ness

of t

rans

ition

from

com

mun

ity

to lo

ng-te

rm c

are

as w

ell a

s ea

se o

f acc

ess

to

patie

nt h

ealth

his

tory

, and

som

ewha

t pos

itive

on

coor

dina

tion

of p

atie

nt c

are

and

serv

ice

deliv

ery.

• 

Com

preh

ensi

vene

ss o

f Car

e. O

f the

6

dim

ensi

ons

cons

ider

ed, C

ompr

ehen

sive

ness

of

Care

fare

d th

e m

ost f

avor

ably

with

som

ewha

t po

sitiv

e vi

ews

over

all.

Perc

eptio

ns ra

nged

from

ne

utra

l reg

ardi

ng ti

mel

y re

ferr

al to

app

ropr

iate

se

rvic

es to

som

ewha

t pos

itive

with

resp

ect t

o on

e or

mor

e he

alth

car

e pr

ofes

sion

al b

eing

abl

e to

pro

vide

on-

goin

g m

anag

emen

t.

• Qu

ality

of C

are.

Thi

s di

men

sion

was

vie

wed

ne

utra

lly o

vera

ll, ra

ngin

g fro

m s

omew

hat

nega

tive

(tim

ely

diag

nosi

s) to

som

ewha

t pos

itive

(e

ffect

iven

ess

of s

cree

ning

tool

s).

• Ac

cord

ing

to a

sin

gle

sum

mar

y ite

m, t

he a

mou

nt

of s

uppo

rtiv

e re

sour

ces

and

serv

ices

ava

ilabl

e in

th

e co

mm

unity

was

som

ewha

t ina

dequ

ate

over

all.

Do

you

have

re

com

men

datio

ns

f or a

ctio

n on

de

men

tia?

Plea

se s

hare

Best  

Prac*ce  

(Best  

Prac*ce  

Review

)  

 Ac

tual  Prac*ce  

(Enviro

nmen

tal  Scan)  

Expanding  

Demen-a  

Research  

Not  examined  

Quality  

Improvem

ent  in  Care  

Services  

Across  Sask:  Low

 accessibility  to

 dem

en-a-­‐

related  services,  poo

r  fit  

between  community  

needs  a

nd  se

rvices,  and  

room

 for  improvem

ent  in  

coordinated  care  

Raising  

Public  

Awareness  

Inadequate  dem

en-a-­‐

related  info  and  

educa-on

 

Early  

Diagno

sis  

and  

Treatm

ent  

Room

 for  improvem

ent  

in  -mely  diagno

sis  and  

use  of  standardize

d  diagno

s-c  crite

ria  and  

care  pathw

ays  

Staff

 Training  

Demen-a-­‐specific  

con-

nuing  educa-on

 for  

health  care  professio

nals  

is  currently  inadequate  

Family  

Support  

Num

erou

s  services  n

eed  

to  be  off

ered  more  

frequently:  post-­‐

diagno

s-c  care  

(cou

nselling,  su

pport  

grou

ps,  private  

caregiving),  ho

me  care  

(transpo

rta-on

,  respite)  

and  long-­‐term  care  

(cou

nselling,  assisted  

living,  sp

ecial  care  units)  

The

Prov

ince

of

Sask

atch

ewan

(C

anad

a) c

over

s 65

1,00

0 km

2 an

d ha

s a

popu

latio

n of

ov

er 1

.08

mill

ion

(SK

Bure

au o

f Sta

tistic

s,

2014

)

Prov

ince

of S

aska

tche

wan

Attrib

ute

N Me

an

(max

. 25)

SD

(rang

e) Inf

ormati

on an

d Edu

catio

n 81

13

.0 3.9

(6-23

) Ad

equa

te aw

arene

ss ab

out ‘w

hat to

do’ o

r ‘whe

re to

go’

81

2.7

1.1 (1

-5)

Adeq

uate

inform

ation

for c

aregiv

ers

81

2.4

1.1 (1

-4)

Adeq

uate

aware

ness

of de

menti

a amo

ng he

alth c

are pr

ofessi

onals

in th

e com

munit

y 81

3.5

1.2

(1-5)

Adeq

uate

deme

ntia-s

pecifi

c con

tinuin

g edu

catio

n for

healt

h care

profe

ssion

als

81

2.5

1.1 (1

-5)

Adeq

uate

public

educ

ation

to re

duce

stigm

a of d

emen

tia

81

1.8

0.8 (1

-4)

Acce

ssibili

ty 80

12

.4 3.8

(5-22

) Ap

propri

ate fre

quen

cy of

servi

ces

81

2.4

1.1 (1

-5)

Appro

priate

wait t

ime f

or se

rvice

s 80

2.7

1.3

(1-5)

Av

ailable

public

trans

porta

tion t

o serv

ices (

for ol

der a

dults)

81

3.1

1.5

(1-5)

Av

ailable

subs

idized

/free t

ransp

ortati

on to

servi

ces (

for ol

der

ad

ults)

81

1.9

1.3 (1

-5)

Equa

lly ac

cessi

ble se

rvice

s, reg

ardles

s of g

eogra

phic l

ocati

on

80

2.2

1.2 (1

-5)

Popu

lation

Orie

ntatio

n 81

11

.9 3.8

(5-21

) Ap

propri

ate le

vel o

f PHC

servi

ces

81

2.2

1.0 (1

-5)

Appro

priate

leve

l of H

ome C

are se

rvice

s 81

2.7

1.2

(1-5)

Ap

propri

ate nu

mber

of LT

C bed

s 81

2.3

1.3

(1-5)

Ap

propri

ate te

lehea

lth se

rvice

s 81

2.7

1.1

(1-5)

Ap

propri

ate le

vel o

f sup

port f

or ca

regive

rs 81

2.0

0.9

(1-4)

Co

-ordin

ated C

are

81

15.6

3.6 (8

-24)

Servi

ce de

livery

by di

fferen

t hea

lth ca

re pro

fessio

nals i

n the

comm

unity

is co-o

rdina

ted

81

3.3

1.1 (1

-5)

All he

alth c

are pr

ofessi

onals

in th

e com

munit

y hav

e eas

y acce

ss

to pa

tient

healt

h histo

ry 81

2.8

1.3

(1-5)

Healt

h care

profe

ssion

als co

-ordin

ate we

ll with

each

othe

r to

m

anag

e [pa

tient

care

(with

in an

d outs

ide co

mmun

ity)

81

3.4

1.0 (1

-5)

Healt

h care

profe

ssion

als co

-ordin

ate we

ll with

comm

unity

agen

cies t

o man

age p

atien

t care

(with

in an

d outs

ide co

mmun

ity)

81

3.3

1.0 (1

-5)

Seam

less t

ransiti

on fro

m co

mmun

ity to

LTC

81

2.8

1.2 (1

-5)

Comp

rehen

siven

ess o

f Care

81

17

.1 3.9

(7-25

) On

e or m

ore he

alth c

are pr

ofessi

onal

is able

to di

agno

se

81

3.3

1.4 (1

-5)

One o

r more

healt

h care

profe

ssion

al is a

ble to

prov

ide on

-going

man

agem

ent

81

3.8

0.9 (2

-5)

There

is tim

ely re

ferral

to ap

propri

ate he

alth a

nd so

cial se

rvice

s 81

3.0

1.0

(1-5)

Mu

ltidisc

iplina

ry ca

re is a

vailab

le

81

3.6

1.1 (1

-5)

Healt

h care

profe

ssion

als co

nside

r dem

entia

a ch

ronic d

iseas

e 81

3.4

1.1

(1-5)

Qu

ality o

f care

81

14

.3 3.2

(8-21

) Tim

ely di

agno

sis oc

curs

81

2.5

0.9

(1-5)

He

alth c

are pr

ofessi

onals

use s

tanda

rdize

d diag

nostic

crite

ria

81

3.1

1.0 (1

-5)

Curre

nt scr

eenin

g too

ls are

effec

tive

81

3.3

0.9 (1

-5)

Care

and m

anag

emen

t are

guide

d by s

tanda

rdize

d care

pathw

ays

81

2.4

1.0 (1

-5)

Healt

h care

profe

ssion

als ad

equa

tely m

onito

r safe

ty of

indiv

iduals

with

deme

ntia l

iving a

t hom

e 81

2.9

1.1

(1-5)

Adeq

uate

amou

nt of

supp

ortive

reso

urces

and s

ervice

s 80

2.4

1.1

(1-4)

!Ite

m s

tatis

tics

of P

rimar

y H

ealth

Car

e Or

ient

atio

n of

Dem

entia

-rela

ted

Serv

ices

, Sa

skat

chew

an (N

= 8

3)

This

stu

dy w

as c

ondu

cted

, in

part,

with

dat

a pr

ovid

ed b

y th

e Sa

skat

chew

an M

inis

try o

f Hea

lth to

the

Hea

lth

Qua

lity

Cou

ncil.

The

inte

rpre

tatio

ns a

nd c

oncl

usio

ns

here

in d

o no

t nec

essa

rily

repr

esen

t tho

se o

f the

Sa

skat

chew

an M

inis

try o

f Hea

lth o

r Gov

ernm

ent o

f Sa

skat

chew

an.  

regi

ons

resp

onsi

ble

for

prov

idin

g ba

sic

heal

th s

ervi

ces

to th

eir p

opul

atio

n.

the

publ

ic a

nd h

ealth

car

e pr

ofes

sion

als,

to im

prov

e ea

rly

diag

nosi

s an

d en

cour

age

help

se

ekin

g in

ear

ly s

tage

.5)

Staf

fTin

crea

sing

reso

urce

s to

impr

ove

awar

enes

s, k

now

ledg

e, a

nd

trai

ning

am

ong

heal

th c

are

prof

essi

onal

s re

spon

sibl

e fo

r pr

ovid

ing

care

to in

divi

dual

s w

ith d

emen

tia.

6)Fa

mily

the

need

to im

prov

e th

e av

aila

bilit

y an

d ap

prop

riate

ness

of

com

mun

ity s

uppo

rt a

nd

resp

ite o

ptio

ns to

car

egiv

ers

and

fam

ilies

of i

ndiv

idua

ls w

ith

dem

entia

. **

** S

uppo

rted

by

all 9

cou

ntrie

s

***

Sup

port

ed b

y 8

coun

tries

**

S

uppo

rted

by

6 co

untri

es

*

Su

ppor

ted

by 5

cou

ntrie

s

The

Prov

ince

of

Sask

atch

ewan

(C

anad

a) c

over

s 65

1,00

0 km

2

and

has

a po

pula

tion

of

over

1.0

8 m

illio

n (S

K Bu

reau

of S

tatis

tics,

20

14)

Prov

ince

of S

aska

tche

wan

For additional information contact:Debra Morgan, PhD, RNProfessorCIHR-SHRF Applied Chair in Health Services and Policy ResearchCollege of Medicine Chair, Rural Health DeliveryCanadian Centre for Health & Safety in Agriculture (CCHSA)University of Saskatchewan104 Clinic Pl, PO Box 23Saskatoon, SK S7N 2Z4

Telephone: (306) 966-7905Facsimilie: (306) 966-8799Email: debra.morgan@usask.cahttp://cchsa-ccssma.usask.ca