Effects of physical activity on depressive symptoms in older caregivers: The IMPACCT randomized controlled trial.

OBJECTIVES: Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care-recipients. The aim of this single-blind randomized controlled trial was to investigate the effect of a 6-month tailored PA program on depressive symptoms in older caregivers. METHOD: Caregivers were included if they had scores of ≥5 on the 15-item geriatric depression scale (GDS-15). Care-recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago-Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. RESULTS: Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social-control, and usual-care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS-15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini-mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social-control (p < 0.02) and usual-care groups (p < 0.02). CONCLUSIONS: A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment.

Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI).

In Australia there is an absence of an elder abuse screening instrument that is widely accepted and that has been designed with, and for, end-users. This study aimed to develop an effective and acceptable elder abuse screening instrument by engaging with frontline professionals through a co-design process. To date, co-design methodologies are recommended to ensure successful adoption and implementation of complex interventions by end-users, but the scholarship is limited on the specific steps to achieve this as well as the pragmatics of such work. Addressing this lacunae, results demonstrate how qualitative methods align with a co-design approach; underscore the importance of multidisciplinary perspectives; showcase how to streamline complex processes into routine practice; and accentuate the importance of good design. These are valuable insights necessary to develop inter-professional and community-based solutions to the challenge of elder abuse.

Co-producing research with people impacted by dementia and service providers: issues and challenges.

BACKGROUND/OBJECTIVE: Co-production is a collaborative method that can make the research process more egalitarian by ensuring researchers work in partnership with key stakeholders in both the design and delivery of research projects and outcomes. A departure from more traditional ways of conducting research, co-production requires the researcher to reflect on their role in the co-production partnership. However, academic research projects are often constrained by parameters set by funding bodies, ethics committees and the researchers themselves. This raises questions about whether some of the key tenets of co-production, including equally shared power, control and responsibility, can be achieved in a meaningful way. This paper presents some of the issues and challenges faced by researchers in achieving shared power when utilising co-production methodology in academic settings. Type of program or service: The application of co-production within an academic research project is illustrated by a case study involving co-production with family carers, people living with dementia and service providers to develop dementia-specific training for home care workers. RESULTS: There were unavoidable external constraints on sharing power and decision making within some elements of this project. Project parameters, including the research topic, timelines and funds available, were set by the funding body. Similarly, the study objectives and methods involving participants were required to be predetermined for ethical review. Power was redistributed by shifting the power dynamic in various ways within the internal project environment. Researchers developed strong relationships and built trust with key stakeholders, maintained consistent communication, negotiated conflict, ensured each stakeholder voice was heard and supported people living with dementia to be involved safely and comfortably. LESSONS LEARNT: Funding body requirements, ethical governance and researcher responsibilities can limit power sharing and decision making when using co-production in academic contexts. Although the researcher or research organisation may hold ultimate responsibility for the overall management and delivery of the project, power can still be ceded and redistributed at many points within the project.

START-online: acceptability and feasibility of an online intervention for carers of people living with dementia.

BACKGROUND: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). METHOD: A mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia. RESULTS: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers' qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring. CONCLUSION: START-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services.

Co-designing a dementia-specific education and training program for home care workers: The 'Promoting Independence Through Quality Dementia Care at Home' project.

Undertaking co-design with the end users of services has rapidly evolved as the best-practice approach to program design, development and implementation. Increased interest in using participatory co-design in dementia care has drawn attention to the need for evidence-informed methods for facilitating the meaningful involvement of people with dementia and their family carers in co-design activities. The aim of this paper is to describe the co-design framework used in the co-design of a dementia specialist training program for home care workers. The Promoting Independence Through quality dementia Care at Home program is a successful example of co-design methodology used across multiple project stages and with various stakeholder groups, including people living with dementia, family carers, home care workers, managers and researchers. Co-design methods were tailored to each stage, purpose, and stakeholder group, and to facilitate the involvement of people living with dementia. Findings provide unique insights into optimising input from co-design partners, including people living with dementia; the methodology, conditions and requirements for participants to co-design and implement ideas; and perspectives on the enablers and challenges of using co-design in this population. In this paper, we present a comprehensive approach for involving people living with dementia as active and equal contributors in inclusive and meaningful participatory co-design.

"Build Rapport, Otherwise No Screening Tools in the World Are Going to Help": Frontline Service Providers' Views on Current Screening Tools for Elder Abuse.

BACKGROUND AND OBJECTIVES: Without an effective screening tool, accompanied by clear guidelines of what to do when elder abuse is suspected, health workers may face challenges when asking questions about elder abuse. This study aimed to find the most effective and acceptable existing elder abuse screening tool and to create guidelines for using the tool. RESEARCH DESIGN AND METHODS: A rapid review of the literature identified existing validated elder abuse screening tools. Then, 5 tools (Vulnerability to Abuse Screening Scale [VASS], Elder Abuse Suspicion Index [EASI], Elder Assessment Instrument [EAI], Caregiver Abuse Screen [CASE], and Brief Abuse Screen for the Elderly [BASE]), selected based on their internal rigor, were presented to health professionals to assess the tools' relevance to their practice. Three focus groups were held with 23 health professionals in Victoria, Australia, in 2017. Data were thematically analyzed. RESULTS: None of the tools were deemed suitable by participants for use in their practice. Criticisms of the tools included: using outdated terminology, asking binary questions, asking multiple questions at once, failure to consider the older person's cognitive status, failure to consider how culture mediates elder abuse, and failure to outline a referral pathway to those administering the tool. Participants emphasized that the screening tool must promote trust and rapport between the assessor and the older person to solicit a story on this sensitive subject. DISCUSSION AND IMPLICATIONS: A successful elder abuse screening tool must be concise, easy to use, account for the older person's health and social vulnerabilities, and outline a referral pathway if elder abuse is suspected.

An update on dementia training programmes in home and community care.

PURPOSE OF REVIEW: Many people living with dementia (PLWD) wish to continue living at home. The quality of home care services directly influences their ability to stay at home, their quality of life, and can promote independence for PLWD, and reduce burden for the family carer. For high-quality, effective, person-centred community-based dementia care, a knowledgeable and empathetic workforce is crucial. This article presents an up-to-date review and summary of the literature investigating dementia training programmes for community home care professionals and care workers, referred to collectively as home care workers (HCWs). RECENT FINDINGS: We reviewed the literature between October 2016 and April 2018 on dementia training for HCWs. We found a significant lack of evidence-based, codesigned specialist dementia training programmes for HCWs that address the needs of all stakeholders in home care, and which formally measure outcomes. SUMMARY: In order to enable PLWD to maintain living at home in the community, dementia-friendly and knowledgeable HCWs are needed. This review highlights the need for more research into the design and evaluation of evidence-based dementia specialist training programmes for community care.

What do older Australians want?

OBJECTIVE: The objective of this study was to report older Australians' views about what they want from aged care reforms expressed in submissions to the Productivity Commission's 'Inquiry into Caring for Older Australians' and the 'Conversations on Ageing' (Conversations). METHOD: Consumer responses to the 'Inquiry into Caring for Older Australians' (n = 59) and findings from the Conversations (n = 31) conducted by the Honourable MarkButler with the Council on the Ageing were summarised. RESULTS: Older people wanted to be included as full citizens in community life with their contributions acknowledged, including as carers. They wanted high quality, accessible and respectful services that supported their independence and over which they had control. They wanted fair and transparent funding arrangements and care that caters for diversity in Australia's older people. They wanted reform to be soon and to have bipartisan support. CONCLUSION: This paper provides consumer perspectives to inform aged care policy, practice and research in Australia.