ABSTRACT
Like other countries, aged care homes in Australia have been significantly affected by the COVID‐19 pandemic. To ensure the safety of residents and staff, lockdown, and social restrictions (e.g., limited or no visits from family) have been introduced across Australia. These measures caused tremendous emotional, psychological, and physical burdens on residents, particularly those living with dementia. In response to the pandemic, the Australian Government has funded the Aged Care COVID‐19 Grief and Trauma support package for older people receiving aged care, their families, and aged care staff. Part of this package is the Dementia Engagement Modelling Program (DEMP), a free national support program developed by Dementia Support Australia, HammondCare to help staff support residents whose wellbeing have been affected by COVID‐19 with tailored engagement strategies. The program represents a first line multimodal support for people living with dementia in residential aged care who may have experienced withdrawal, frustration, or fear and at a greater risk of developing behaviors and psychological symptoms of dementia (BPSD), such as apathy, anxiety, and depression. Through a multidisciplinary team of dedicated consultants, the program delivers best practice, person‐centered engagement strategies to support staff, providing meaningful engagement, comfort, and reassurance to residents living with dementia. DEMP consultants work collaboratively and closely with lifestyle and care staff to develop tailored activities and provide appropriate resources (e.g., brokerage items such as music therapy) for engagement. DEMP will also provide support and coaching to staff for the individual or small groups to ensure that both staff and residents gain the full benefit from the program. The eligibility criteria for DEMP support include aged care homes that: 1) experienced an outbreak of COVID‐19 or those subject to a precautionary lockdown, and/or 2) sought engagement plans and strategies for residents living with dementia, or those at risk of developing BPSD due to COVID‐19 restrictions. This descriptive study will discuss the DEMP's model of care, eligibility criteria, activities, and outcomes and provide case examples that can guide meaningful engagement for other aged care residents living in other countries during COVID‐19.
ABSTRACT
Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has a significant impact on the quality of life of aged care residents living with dementia (RLWD). Lockdown measures necessary to protect RLWD and caring staff from COVID-19 have resulted in increased social isolation, loneliness, and behaviors and psychological symptoms of dementia (BPSD). In response, the Australian Government funded a pilot program, the Dementia Engagement Modelling Program (DEMP) as part of the Aged Care COVID-19 Grief and Trauma support package for RLWD, their families and aged care staff. Operated by the Dementia Centre of HammondCare, the DEMP provides first-line multimodal external support for RLWD at a greater risk of developing BPSD due to COVID-19 restrictions. This study aims to describe the DEMP and evaluate its feasibility and outcomes for Australian RLWD. METHODS: A team of 10 trained DEMP consultants was involved in delivering a consultancy service that modelled best practice and person-centred activities of engagement to support staff in providing residents with meaningful purpose, comfort, and reassurance. Consultants also provided coaching and development opportunities for staff to enhance their knowledge regarding communication and engagement. Outcome measures included the regular administration of the Engagement in Preferred ActivitieS Scale (EPASS; ≥4-9 moderate-to-high engagement). A phone evaluation survey for supported residential aged care homes (RACHs) was conducted to determine the feasibility of DEMP. RESULTS: A total of 60 residents (86.0 ± 7.8 y; 68% female) across 10 RACHs from three Australian states (VIC, NSW, QLD) was supported by DEMP between May and July 2021. More than half of the residents had Alzheimer's disease (n = 24, 40%) and vascular dementia (n = 7, 12%). Completed EPASS assessments (n = 389) demonstrated that the vast majority (64%-72%) of residents scored moderate-to-high engagement. All supported RACHs highly recommended the DEMP to other colleagues and rated the program highly for implementation feasibility including the recommended engagement activities/brokered items. CONCLUSIONS: The DEMP is a novel, feasible and effective dementia-specific engagement modelling program for Australian RLWD in the era of COVID-19 pandemic.
ABSTRACT
BACKGROUND: Globally, Coronavirus disease 2019 (COVID-19) caused a significant disruption to the physical and mental well-being of all individuals, including those living with dementia. Social restrictions and lockdown measures due to COVID-19 have worsened the feelings of loneliness and behaviours and psychological symptoms of dementia (BPSD). National BPSD support programs in Australia are offered by Dementia Support Australia (DSA) through the Dementia Behavior Management Advisory Service (DBMAS) and the Severe Behavior Response Teams (SBRT). This study aims to investigate the impact of COVID-19 on BPSD severity and related caregiver distress among referrals to DSA programs. METHODS: A retrospective comparative analysis was conducted on the intake data of referrals to DSA between two periods: Pre-COVID-19 Period (January 2018-Decmeber 2019) and COVID-19 Period (January 2020-July 2021). Referrals were compared on demographic characteristics (e.g., age), and BPSD severity (i.e., neuropsychiatric symptoms such as agitation) and caregiver distress as measured by the Neuropsychiatric Inventory (NPI). NPI scores were compared on a month-to-month basis between the specified periods. RESULTS: Across the two periods, there were a total of 23,180 referrals eligible for the analysis. While no differences were noted in age, sex, or dementia subtype, there were elevated levels of NPI severity and caregiver distress scores during COVID-19 Period compared to the Pre-COVID-19 Period. The month-to-month trends of these differences (Figure 1, Figure 2) reflect the timing of outbreaks across Australia. Specifically, there were no significant differences at the start of 2020 prior to the declaration of the pandemic, with an initial rise in NPI severity and distress through April after initial measures were implemented nationally in March 2020. These levels of severity and distress continued to rise through the remainder of 2020, alongside outbreaks in specific regions within Australia, such as Victoria (June-October), and New South Wales (December/January). NPI severity and caregiver distress then began to return to Pre-COVID levels from February-May before elevating again with the outbreak of the Delta variant in Australia. CONCLUSIONS: COVID-19 has a significant impact on the severity levels of BPSD and related caregiver distress.