BackgroundPalliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.MethodsA two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions).ResultsTwo-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes.ConclusionFCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12612001164886

Providing meaningful or individualized tailored activities for people with dementia living in RACFs appears to be effective for a range of behavioral and psychological symptoms. The strongest evidence was for individualized activities/recreational interventions for a range of BPSD; preferred music for agitation, depression and anxiety; and RT for mood and cognitive functioning. Insufficient evidence precluded making recommendations regarding animal-assisted (dog) therapy and training staff to develop individual care plans using PCC or similar approaches, while there was no good quality evidence to show that Snoezelen was effective for any outcome. What remains unclear, however, is whether any of these interventions is more effective than the provision of one-to-one social interaction.

The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.

Many health and social care research studies report difficulties recruiting sufficient numbers of participants, adding to time and money expenditures and potentially jeopardizing the generalizability of findings. The current article reports the effectiveness and resource requirements of recruitment strategies used in nine dementia-related studies conducted in Australia. Articles, notices, or advertisements in targeted specialist newsletters were the most cost-effective method of recruitment. The use of service providers to aid recruitment yielded mixed results, but was lengthy in terms of research time. Online and social media were low cost but not reliably effective in terms of recruitment potential. Despite using multiple strategies to maximize recruitment, significant challenges were encountered achieving the required sample sizes; in most cases these challenges resulted in delays in the recruitment phase. Implications for researchers in the fields of dementia and general social/health research are discussed. [Res Gerontol Nurs. 2018; 11(3):119-128.].

As the population ages, the number of patients with dementia in acute care environments is projected to increase rapidly. However, many acute care nurses have undertaken little or no dementia training, potentially leading to reduced quality of care for these patients. This article details the development and delivery of a tailored education program to improve thhequality of care of patients with dementia in a large, urban hospital in Australia. Designed specifically for the existing context, environment, and knowledge levels,--the program was developed from multiple inputs including expert opinion, literature on workplace and demenitia care training, and feedback from participants. The program was delivered to acute care nurses and allied health staff within an outcome-based, microteaching model. The development and delivery tecbuniques used in this program also are discussed.

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Individualized multicomponent psychosocial interventions following residential care placement may be beneficial in improving family carers' role overload, psychological distress and guilt. Group interventions may also improve feelings of guilt and sadness. There is insufficient evidence that individualized or group interventions improve carer depression, burden or satisfaction. However, due to substantial heterogeneity between studies and methodological flaws, the grade of this evidence is very low.Further high quality RCTs that include different groups of carers are recommended. Comparative effects of individualized versus group interventions should be examined as these are likely to have cost implications.

Technologies have the capacity to be enabling or disabling for people who are living with dementia. Accessible information is required to equip people to make informed decisions about what technologies are available and how they may be utilised to support independence. This article describes the development of a web-based resource called ATdementia which was designed to provide independent information on assistive technologies for people who are living with dementia. It was designed to be accessed by people with dementia, families, supporters and professionals. The article describes the development and the early operation of ATdementia. Mention is also made of the ATguide, a self assessment tool to support decision-making in relation to technologies. ATguide was launched in 2012.