Victoria Traynor

Development and pilot testing of a decision aid for drivers with dementia

BackgroundAn increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures.MethodsA mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid.ResultsTwelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use.ConclusionsThis decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool.

Barriers to Qualitative Dementia Research The Elephant in the Room

As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the “elephant in the room” of dementia research. In this article, we describe and emphasize the need for qualitative dementia research, highlight existing barriers, and outline potential solutions. Examples of barriers are provided and theoretical underpinnings are proposed.

Improving outcomes for dementia care in acute aged care: impact of an education programme

Abstract The aim of this paper is to report on the transformation of a small local hospital offering, for the first time, anacute geriatric service. At the start of this process in 2005 it became evident that many of the staff wereinexperienced in providing care to older patients, specifically, and most obviously, in the area of dementia care.Previously, the clinical focus had been on medical and surgical care and the staff therefore needed to develop anew range of skills and knowledge. A practice development process was adopted to transform the service withthe overall aims of: • creating a workforce competent to provide safe, effective, patientcentred care for olderpatients; and • developing and implementing a staff education programme to meet the needs of the staff andpatients. This involved using a survey to gather baseline data about the level of dementia competence anddeveloping a dementia educational programme. In this paper, we present the evaluation of this dementiaeducational programme and its impact on knowledge in a new specialist aged care clinical setting.

Driving, dementia and Australian physicians: primum non nocere?

Older Australians are increasingly reliant on automobiles as their sole form of transport. As our population is ageing and the prevalence of dementia is increasing, it is anticipated that the number of drivers with dementia will rise over time. Much of the literature relating to driving and dementia focuses on safety rather than mobility. The objective of this paper is to highlight several topical ethical issues that pertain to Australian drivers with dementia. It is recommended that future research, policy and practice should centre on the crucial mobility and transport needs of our senior citizens.

An integrative review: understanding driving retirement decisions for individuals living with a dementia

AIM To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia. BACKGROUND Driving requires complex cognitive and physical skills potentially compromised due to the progressive nature of dementia. Whilst on-road assessments are considered reliable indicators of driving capacity by clinicians, drivers with dementia disagree. DESIGN Integrative literature review informed by Whittemore & Knafl (2005). DATA SOURCES Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997-2012; and incremental hand search. REVIEW METHODS Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools. RESULTS A total of 43 studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. Six themes emerged: (i) dementia may compromise the complex task of driving; (ii) defining onset and severity of dementia is problematic; (iii) symptom progression impacts on driving skills; (iv) assessment of fitness to drive remains subjective; (v) some drivers are reluctant to accept negative assessment outcomes; and (vi) the search for effective strategies to enhance acceptance of driver retirement continues. CONCLUSION This integrative literature review identified a large body of knowledge exploring the issues of driving cessation for drivers with dementia. However a challenge remains for practitioners, drivers and their family carers regarding how best to address this highly emotive issue. Findings could inform a structured approach to address this sensitive topic in a timely manner.

Person-centred care as caring for country: an indigenous australian experience

There is an emerging interest and a developing evidence base about the significance of dementia within Aboriginal and Torres Strait Islander communities1 across Australia. Poor Indigenous health status remains a fundamental issue, particularly when compared to New Zealand and North America where in the past ten years health inequities have begun to be successfully redressed. As the life expectancy of Indigenous Australians has started to increase beyond 45 years, the issue of dementia is becoming a priority health issue to address. As there is currently, on average, a 17 year gap in life years between Indigenous and non-Indigenous people, there is a need to better understand both dementia and ageing within the Indigenous context in order to provide meaningful services and care. Within a historical context, colonization has had, and continues to have, a significant impact on the health of Indigenous people. In 1997, the Human Rights and Equal Opportunity Commission released its report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, more commonly known as the Bringing Them Home report (Australian Human Rights Commission, 1997). The report examined evidence from members of the ‘stolen generations’, a term which refers to those Indigenous children forcibly removed from their families and communities as part of past government policies. The legacies of past policies continue to impact upon Indigenous Australians, many of whom continue to experience multiple disadvantages including diminished mental and physical health as they age. Disciplines Arts and Humanities | Life Sciences | Medicine and Health Sciences | Social and Behavioral Sciences Publication Details McMillan, F., Kampers, D., Traynor, V. & Dewing, J. (2010). Person-centred care as caring for country: an indigenous australian experience. Dementia: the international journal of social research and practice, 9 (2), 163-167. This journal article is available at Research Online: http://ro.uow.edu.au/hbspapers/1486The prevalence of dementia in Aboriginal communities is up to 5.2 times greater than the overall Australian population. (Alzheimer’s Australia, 2007). This is supported by research conducted in the remote Kimberley area in 2006 which found it to be 12.4% of the local population. Preliminary analyses of research undertaken by the Koori Growing Old Well Study (KGOWS) in urban and rural Aboriginal communities in NSW also found similar prevalence rates.

Is delirium being detected in emergency

To report on the use of Delirium Care Pathways to screen for and recognise delirium by Aged Care Services in Emergency Teams (ASETs) at five metropolitan hospitals in New South Wales, Australia. Knowledge of delirium and the use of Delirium Care Pathways are vital to ensure that older people presenting with delirium receive best practice care.

Is it my job? The role of RNs in the assessment and identification of delirium in hospitalized older adults: an exploratory qualitative study

Delirium is characterized by acute and fluctuating cognitive decline, which is often missed in older adults who are assumed to be experiencing age-related changes or dementia. Delirium affects up to 50% of hospitalized older adults. The aim of the current study was to (a) explore current practices of RNs in assessing and identifying delirium in hospitalized older adults and (b) inform new educational initiatives. Qualitative methods were adopted using eight semi-structured group interviews with 24 RNs. Thematic analysis revealed a dichotomy in practice where RNs described delirium assessment and identification as (a) Its Not My Job, (b) It is My Job, and (c) Its Complex. The imperative to improve delirium assessment and identification to create safer and more caring health care environments means the current findings provide important evidence to build into practice and education strategies. The current authors have developed engaging educational interventions and begun implementation at the study site to develop delirium assessment and identification capacity, which moves clinicians beyond awareness and aims at practice adherence or the consistent application of evidence-based delirium assessment. [Journal of Gerontological Nursing, 43(4), 29-37.].

Driving with dementia: Equity, obligation, and insurance

Driving is a complex task, yet some people with dementia are capable of driving safely.1–5 As driving a vehicle is a privilege and not a right,6–8 clinicians are often called upon to provide guidance regarding their patients’ ability to drive safely.1,9,10 The Australian Bureau of Statistics has predicted that by 2056, one in four Australians will be aged over 65.11 Older members of our community are increasingly dependent upon the private car as their preferred, and in some cases only viable, mode of transport.5,8 Given that the prevalence of dementia rises with age, we can expect an increased number of drivers with dementia on our roads.5 As outlined in the National Health and Medical Research Council 2013–15 Strategic Plan, Australian health ministers have designated dementia and injury prevention as national health priority areas.12 Thus, there now exists both an impetus and an opportunity to address the issue of driving and dementia on a national level. The purpose of this editorial is to consider: (1) the social impact of a loss of licence; (2) driver and health professional obligations to report conditions that can adversely affect driving; and (3) the response of motor vehicle insurers to the issue of driving with dementia.

Review of transnational nursing education programme curricula: process, findings, and recommendations

BACKGROUND The University of Wollongong (UOW) delivers two Transnational International Programmes (TNEP) in Hong Kong (HK): a 1-year undergraduate Bachelor of Nursing (Conversion) degree and a 2-year postgraduate Master of Nursing degree. A curriculum review of these programmes has been undertaken to ensure the quality of the programme remains consistently high and competitive in an international environment. AIM The aim of the Curriculum Review Project was to utilise the experience of expert academic staff to review the TNEP curricula delivered by an Australian University in Hong Kong (HK) to ensure it met contemporary needs of students, the university, and the Hong Kong Authority. METHODS The curriculum review projects followed a qualitative research methodology. Thematic analysis was undertaken utilising Braun and Clarkes six-phase method (2006), as this method facilitated an inductive semantic approach where themes are strongly linked to the data and sourced from the explicit meaning of the discourse within the interview (Braun and Clarke, 2006). RESULTS In total, there were 6 participants who were all permanent academic staff members within the School of Nursing at the UOW. The results of this project have been reported within a strengths, weaknesses, opportunity, and threats (SWOT) framework. Participants recognised the value and challenges to both individual students and the broader nursing profession in HK. Overall, there was a perception that being involved as an academic staff member in a TNEP developed both their subject knowledge and teaching skills. CONCLUSIONS This project has demonstrated that the TNEP makes an important contribution to the nursing profession in HK, while also facilitating the growth and development of academic staff at UOW.