Morag E. Taylor

Background: Promoting physical activity among people living with dementia is critical to maximise physical, cognitive and social benefits; yet the lack of knowledge, skills and confidence among health professionals, informal care partners and people with dementia deters participation. As the initial phase of a larger feasibility study, co-design was employed to develop a new model of community care, ‘Changing the Focus’, to facilitate the physical activity participation of older people living with mild dementia. Methods: Co-design methodology was utilised with nine stakeholders (with experience in referring to or providing physical activity programs and/or contributing to policy and program planning) over three workshops plus individual interviews with four care partners of people with dementia. Insights were gathered on the physical activity for people with mild dementia, referral pathways were explored and ‘personas’ were developed and refined. Materials and resources to support exercise providers and referrers to work effectively with people with mild dementia were finalised. Results: Three ‘personas’ emerged from the co-design sessions, aligned with stages of behaviour change: (1) hesitant to engage; (2) preparing to engage; and (3) actively engaged. Referral pathway discussions identified challenges related to limited resources, limited knowledge, access constraints and individual factors. Opportunities were classified as using champions, streamlining processes, recognising triggers for disengagement, influencing beliefs and attitudes, and means of communication. Conclusion: This study captured the views of physical activity referrers and providers and informal care partners in an inclusive and iterative manner. The use of co-design ensured a robust approach to facilitating participation in formal and informal physical activity options for people living with mild dementia. This study has provided the necessary framework from which to develop and test training and resources for the next stage of intervention (a feasibility trial) to improve physical activity participation for people with dementia.

StandingTall uses eHealth to deliver evidence-based balance and functional strength exercises. Clinical trials have demonstrated improved balance, reduced falls and fall-related injuries and high adherence. This study aimed to evaluate the implementation of StandingTall into health services in Australia and the UK. Two hundred and forty-six participants (Australia, n = 184; UK, n = 62) were recruited and encouraged to use StandingTall for 2 h/week for 6-months. A mixed-methods process evaluation assessed uptake and acceptability of StandingTall. Adherence, measured as % of prescribed dose completed, was the primary outcome. The study, conducted October 2019 to September 2021 in Australia and November 2020 to April 2022 in the UK, was affected by COVID-19. Participants’ mean age was 73 ± 7 years, and 196 (81%) were female. Of 129 implementation partners (e.g. private practice clinicians, community exercise providers, community service agencies) approached, 34% (n = 44) agreed to be implementation partners. Of 41 implementation partners who referred participants, 15 (37%) referred ≥5. Participant uptake was 42% (198/469) with mean adherence over 6 months being 41 ± 39% of the prescribed dose (i.e. 39 ± 41 min/week) of exercise. At 6 months, 120 (76%) participants indicated they liked using StandingTall, 89 (56%) reported their balance improved (moderately to a great deal better) and 125 (80%) rated StandingTall as good to excellent. For ongoing sustainability, health service managers highlighted the need for additional resources. StandingTall faced challenges in uptake, adoption and sustainability due to COVID-19 and a lack of ongoing funding. Adherence levels were lower than the effectiveness trial, but were higher than other exercise studies. Acceptance was high, indicating promise for future implementation, provided sufficient resources and support are made available. Australian and New Zealand Clinical Trials Registry ACTRN12619001329156.

Objectives: The purpose of this assessor‐blinded, randomised controlled trial was to determine the effect of computerised cognitive training (CT) on executive function, processing speed and working memory in 61 people with mild‐to‐moderate dementia.Methods: The primary outcomes were forward Digit Span and Trail Making Tests (TMT) at the completion of the 6‐month intervention. Secondary outcomes included cognitive and physical performance, rate of falls, participant and caregiver's quality of life and usability and adherence to the CT program. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000364370).Results: Intervention group (n = 31) participants averaged 81 min of CT per week, and system usability scores were acceptable (participants: 68.8 ± 22.1; caregivers: 79.4 ± 23.5). There were no statistically significant differences in cognitive or physical performance outcomes between the intervention and control groups at 6‐ or 12‐months (between‐group differences [95% CI] for primary outcomes at 6‐months: Forward Digit Span −0.3 [−0.8, 0.3]; TMT‐A 2.7 s [−14.1, 19.5]; TMT‐B −17.1 s [−79.3, 45.2]). At the 12‐month follow‐up reassessment, the intervention group reported significantly more depressive symptoms and had lower caregiver‐rated participant quality of life and higher caregiver quality of life compared to control.Conclusions: This study showed no benefit of the CT program on working memory, processing speed and executive function. Future studies are required to better understand how CT can be used to improve cognitive and physical functioning in older people with mild–moderate dementia.

Objective The aim of this study was to examine temporal trends (2016-2020) in hip fracture care in Australian and New Zealand (ANZ) hospitals that started providing patient-level data to the ANZ Hip Fracture Registry (ANZHFR) on/before 1 January 2016 (early contributors). Methods Retrospective cohort study of early contributor hospitals (n = 24) to the ANZHFR. The study cohort included patients aged >= 50 years admitted with a low trauma hip fracture between 1 January 2016 and 31 December 2020 (n = 26,937). Annual performance against 11 quality indicators and 30- and 365-day mortality were examined. Results Compared to 2016/2017, year-on-year improvements were demonstrated for preoperative cognitive assessment (2020: OR 3.57, 95% confidence interval [95% CI] 3.29-3.87) and nerve block use prior to surgery (2020: OR 4.62, 95% CI 4.17-5.11). Less consistent improvements over time from 2016/2017 were demonstrated for emergency department (ED) stay of <4 h (2017; 2020), pain assessment <= 30 min of ED presentation (2020), surgery <= 48 h (2020) and bone protection medication prescribed on discharge (2017-2020; 2020 OR 2.22, 95% CI 2.03-2.42). The odds of sustaining a hospital-acquired pressure injury increased in 2019-2020 compared to 2016. The odds of receiving an orthogeriatric model of care and being offered the opportunity to mobilise on Day 1 following surgery fluctuated. There was a reduction in 365-day mortality in 2020 compared to 2016 (OR 0.86, 95% CI 0.74-0.98), whereas 30-day mortality did not change. Conclusions Several quality indicators improved over time in early contributor hospitals. Indicators that did not improve may be targets for future care improvement activities, including considering incentivised hip fracture care, which has previously been shown to improve care/outcomes. COVID-19 and reporting practices may have impacted the study findings.