A Randomised Clinical Trial Of Cognitive Activity For Older Adults With Mild Cognitive Impairment
Funder
National Health and Medical Research Council
Funding Amount
$490,127.00
Summary
Australia’s population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state potentially predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable ri ....Australia’s population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state potentially predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable risk factors. In older adults, frequent participation in mentally stimulating leisure activities has been associated with stronger cognitive (abilities such as memory) performances and reduced risk of dementia. Further, the rate of cognitive and functional decline can be influenced by cognitive intervention strategies, though few randomised control studies have explored these findings with individuals who have a diagnosis of MCI. The primary focus of this research is to determine whether a structured program of cognitive activity (CA) can delay progression of cognitive decline amongst older adults with MCI. 160 older adults will be randomised (by chance, like the flip of a coin) to either a 10 week CA intervention with a focus on cognitive training and rehabilitation techniques or a 10 week control educational intervention providing information on aging and retirement. Their cognitive performance, quality of life and functional level will be monitored during follow-up. The proposed study will improve the understanding of possible modifying factors of cognition and highlight the potential of intervention in an older age population. The obtained results will have implications for policy recommendations regarding health care resources and facilitate changes in the approach and management of individuals with MCI.Read moreRead less
Greek & Italian Residents With Dementia In Aged Care: Language Use, Psychiatric Medication,quaity Of Life & Satisfaction
Funder
National Health and Medical Research Council
Funding Amount
$194,543.00
Summary
Australia has a growing older migrant population and rates of dementia in residential care are high. Communication difficulties for older persons with limited English language proficiency and dementia provide a particular challenge in terms of meeting care needs effectively in residential settings. The current project will compare older Greek and Italian background persons with dementia who are residing in either mainstream or ethno-specific residential care facilities in Melbourne. The study wi ....Australia has a growing older migrant population and rates of dementia in residential care are high. Communication difficulties for older persons with limited English language proficiency and dementia provide a particular challenge in terms of meeting care needs effectively in residential settings. The current project will compare older Greek and Italian background persons with dementia who are residing in either mainstream or ethno-specific residential care facilities in Melbourne. The study will extend our pilot research, which focused on language use, and will also measure a number of factors that may influence the rate of communication, including prescribed psychiatric medication, language proficiency, cognitive impairment and behavioural-psychiatric symptoms. Additionally, the project will compare factors that may differ between the facility types, to provide further understanding of services offered. Furthermore, measures of satisfaction with the facility and quality of life will be included to provide an indication of the clinical significance of residing in a mainstream or ethno-specific aged care facility. The expected outcome of the study is to provide additional data in a very under researched and increasingly important field, to inform policy and practice, with the aim of improving the quality of life for older persons from diverse backgrounds in residential care.Read moreRead less
The Effect Of Music On Agitated Behaviours In Older People With Dementia: A Randomised Control Trial
Funder
National Health and Medical Research Council
Funding Amount
$153,634.00
Summary
This study uses a cost effective non-pharmacological intervention, that being music therapy to improve quality of life (QOL) in people with dementia. Dementia results in a decline in mood and cognitive functioning and the emergence of behaviour problems that include aggressive acts, agitation, and sleep-wake and rest-activity pattern disturbance. Aggressive behaviour is a common burden for caregivers in residential and family care. The subsequent stress that aggression places on caregivers can l ....This study uses a cost effective non-pharmacological intervention, that being music therapy to improve quality of life (QOL) in people with dementia. Dementia results in a decline in mood and cognitive functioning and the emergence of behaviour problems that include aggressive acts, agitation, and sleep-wake and rest-activity pattern disturbance. Aggressive behaviour is a common burden for caregivers in residential and family care. The subsequent stress that aggression places on caregivers can lead to staff and family burn out, an increase in restraint use, and decreased quality of care. Research suggests that disruptive behaviours are recognised as a predictor in staff resignation and carer stress, both of which add significantly to the current costs of aged care. This project therefore has the potential to benefit both people living with dementia and their carers. The positive outcomes of music on people of all ages and health status have been established in various clinical settings. Recent research suggests that music therapy may be useful in the management of disruptive behaviours in people with dementia. Music therapy for people with dementia has the potential to improve their quality of life (QOL) through an improvement in depression, and a reduction in aggression and agitation. This study will investigate the effect of a live music program (where participants use their voices and instruments to perform and create music) on agitated behaviours in older people with dementia. It will provide evidence contributing to better understandings about music therapy and its contribution to QOL and disruptive behaviours in people with dementia that can be transferred to other settings such as the community and home based care of people with dementia.Read moreRead less
A Computer Model Of Service Delivery For Behavioural And Psychological Symptoms Of Dementia: A Tool For Policy Makers An
Funder
National Health and Medical Research Council
Funding Amount
$400,108.00
Summary
Behavioural and psychological symptoms of dementia (BPSD) affect approximate 90% of persons with dementia. BPSD include depression, aggression and psychosis and have negative effects on persons with dementia and carers. Management of BPSD is costly. This project will update and enhance our theoretical model of service delivery for BPSD by turning it into a computer-based model to assist health managers and policy makers. This model will incorporate the projected increase in prevalence of dementi ....Behavioural and psychological symptoms of dementia (BPSD) affect approximate 90% of persons with dementia. BPSD include depression, aggression and psychosis and have negative effects on persons with dementia and carers. Management of BPSD is costly. This project will update and enhance our theoretical model of service delivery for BPSD by turning it into a computer-based model to assist health managers and policy makers. This model will incorporate the projected increase in prevalence of dementia and project associated costs of care into the future. It will also incorporate information about interventions for BPSD, and how they may affect prevalence and cost in the future.Read moreRead less
Does Vitamin D Supplementation Reduce Cognitive Decline?
Funder
National Health and Medical Research Council
Funding Amount
$646,601.00
Summary
Australia's population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable risk factors. ....Australia's population is ageing rapidly and so is the frequency of age-related disorders. Dementia is one of the most frequent mental health disorders of older people and one of the leading causes of years of life lost due to disability in Australia. Mild Cognitive Impairment (MCI) in old age is considered an important clinical state predictive of future cognitive decline. There is increasing evidence that the onset of dementia can be delayed with targeting potentially modifiable risk factors. Vitamin D is important for healthy bones and muscle function, but is now also discussed as being important for healthy brain function. The purpose of this randomised placebo-controlled clinical trial is to investigate whether supplementation with vitamin D for 18 months in older adults with MCI who have low vitamin D levels, can help to reduce cognitive decline. 110 older adults with MCI will be randomised (by chance, like the flip of a coin) to either active treatment or placebo. Their cognition (such as memory) performance, quality of life and functional level will be compared at 6, 12, and 18 months. If our hypothesis is confirmed, vitamin D supplementation might prove to be a simple, effective and inexpensive way of delaying cognitive decline in people at risk for dementia. This could lead to the reconsideration of current sun exposure policies in Australia and the more widespread use of food fortification and supplementation.Read moreRead less
The number of Australians with dementia is increasing and so therefore is the frequency of people with dementia presenting to general practice. There is a recent evidence based clinical practice guideline to inform the diagnosis and management of people with dementia and the support of their carers. Many of the recommendations from this guideline are relevant to Australian general practitioners. Strategies to implement guidelines into practice are needed in all areas of health care, but changing ....The number of Australians with dementia is increasing and so therefore is the frequency of people with dementia presenting to general practice. There is a recent evidence based clinical practice guideline to inform the diagnosis and management of people with dementia and the support of their carers. Many of the recommendations from this guideline are relevant to Australian general practitioners. Strategies to implement guidelines into practice are needed in all areas of health care, but changing clinical practice is complex and a body of research developing methods of identifying barriers to specific practice changes is emerging. This project aims to support GPs in improving the general practice based care of people with dementia, and so improve their quality of life. In addition we aim to contribute to the body of knowledge about how to bring about practice change and implement a clinical practice guideline. We plan to design a strategy for implementing this new guideline into practice, working with GPs to change their practice where needed. We will test the effect of this strategy on the care of people with dementia, on their quality of life and on that of their carers.Read moreRead less
Identification And Quantification Of Risk Of Falls In Cognitively Impaired Older Adults
Funder
National Health and Medical Research Council
Funding Amount
$530,741.00
Summary
This study represents the first systematic approach to understanding the complex interaction of factors that contribute to risk of falling in cognitively impaired older people. The results will provide much needed information on how to intervene to prevent falls and fractures in this high risk population. In the last decade, 25 randomised controlled trials have been published which show it is possible to prevent falls in older people. However, a major disappointing outcome of research in this fi ....This study represents the first systematic approach to understanding the complex interaction of factors that contribute to risk of falling in cognitively impaired older people. The results will provide much needed information on how to intervene to prevent falls and fractures in this high risk population. In the last decade, 25 randomised controlled trials have been published which show it is possible to prevent falls in older people. However, a major disappointing outcome of research in this field is that trials that have included or specifically focused on older people with cognitive impairment have been unsuccessful in preventing falls. Cognitive impairment has long been known to be a major risk factor for falls and fractures but little research has been undertaken to understand the underlying mechanisms as to why this is the case. It is likely that previous falls prevention trials involving people with cognitive impairment were unsuccessful because they did not directly assess mechanisms for falls in this group and simply translated intervention strategies from studies undertaken in cognitively intact older people. This study aims to develop our understanding of the important factors that contribute to risk of falling in older people with cognitive impairment and dementia. Participants will be recruited from a number of sources including hospitals, out-patient clinics, retirement villages, hostels etc. Whilst some participants will be able to consent to take part, all participants must have a nominated person responsible. Consenting participants will undergo a series of assessments, the majority of which can be undertaken in their own home. These will include medical and medication history, measures of gait and balance and tests assessing performance of different regions of the brain. An MRI scan will allow us to determine whether risk of falling relates to any specific pathology in different parts of the brain. We anticipate that we will be able to identify which risk factors and underlying mechanisms are most strongly associated with falling in cognitively impaired older people. We then hope to use the information to design targeted and tailored intervention strategies to reduce falls and fractures in this high risk population.Read moreRead less
Validation Of A Competency Assessment Method For Persons With Dementia
Funder
National Health and Medical Research Council
Funding Amount
$580,451.00
Summary
Deciding what if any aspects of their financial affairs a person with dementia or suspected dementia can responsibly manage is a difficult process for health and legal professionals as well as for guardianship boards and tribunals. This process is often stressful for the older person, and families can find deciding when to “take over” stressful. Also, having family members manage the older person’s assets may result in family conflict. There is a small amount of overseas research examining this ....Deciding what if any aspects of their financial affairs a person with dementia or suspected dementia can responsibly manage is a difficult process for health and legal professionals as well as for guardianship boards and tribunals. This process is often stressful for the older person, and families can find deciding when to “take over” stressful. Also, having family members manage the older person’s assets may result in family conflict. There is a small amount of overseas research examining this issue. However, no comprehensive and validated method exists internationally or in Australia to determine competency in this context. We will test a methodology for assessing the capacity of individuals to manage their own financial affairs where dementia is an issue. This method involves the use of a number of reliable and well-validated instruments measuring the older person’s mental state, anxiety levels, depression, and social vulnerability combined with an interview exploring the personal circumstances of the older adult in relation to their financial affairs. We will work with the Office of the Adult Guardian in Queensland to recruit participants and to verify both the utility and usability of our methodology with stakeholders (e.g. solicitors, the Office of the Adult Guardian). A comparison will be made between the results obtained in approximately 200 financial competency cases with the competency opinions independently arrived at by the Office of the Adult Guardian in Queensland. As a result of this research, we will be able to ascertain the viability and utility of this assessment method, improve the method as per the data gathered, and ultimately seek future funding to trial the methods across multiple jurisdictions (e.g. other states) and contexts (e.g. various cultural contexts).Read moreRead less