Collaboration in ageing research and education

CHAPTER 25 Collaboration in ageing research and education



Susan Koch, Henry Brodaty, Glenn Rees, David Ames



FRAMEWORK


The importance of collaboration and research in education from an Australian perspective is discussed through the current development of dementia becoming a National Health Priority and the subsequent allocation of funds to improve education and care. The new approach has been to develop Dementia Collaborative Research Centres and Dementia Training Study Centres. Each research centre has a different focus and is formed by a collaborative effort of teams from various groups (e.g., universities, providers, clinicians and voluntary care organisations). The teaching centres are aiming to provide education to the broad population covering the whole of Australia. As these centres progress in their work, the emergent data will be used to improve practice. Already a quarterly newsletter advising progress and a website have been developed. Changes in practice take time, but the impact of the work of the centres is already being experienced. [RN, SG]



Introduction


Dementia was identified by the Australian Government in 2004 as a national health priority.


In the May 2005 Federal Budget, the Commonwealth of Australia announced $26 million over 4 years to enhance research in dementia with a focus on translational research; that is, research that can be directly applied to practice. Approximately $18 million was allocated to dementia research grants to fund individual projects for which investigators would compete based on scientific merit and applicability, and $7 million dollars over 3 years was allocated for the establishment of three Dementia Collaborative Research Centres (DCRCs).



image Dementia was identified by the Australian Government in 2004 as a national health priority.


At the same time as the DCRCs were being funded and developed, the Commonwealth of Australia also announced funding of $8.46 million over 4 years for Dementia Training Study Centres (DTSCs) to promote dementia studies in universities for health professionals. The DTSCs each designed programs encouraging dementia studies in Australian graduate and undergraduate health curricula. Four DTSCs were funded.


The model of the DCRCs and the DTSCs differs markedly from the usual ways of funding research and education. Traditionally research and education has been funded on a competitive basis with applicants submitting individual projects and being rated by independent assessors using predetermined criteria. In contrast, this model rewards collaboration rather than competition and brings researchers and educators together to consider how they can best tackle issues determined as important by the Australian Department of Health and Ageing.



The Dementia Collaborative Research Centres


Each of the four centres had a different focus and one of them, the Primary Dementia Collaborative Research Centre, was charged with added responsibilities including the coordination of the other three DCRCs, organisation of a National Research Forum and workshops, and hosting a website (www.dementia.unsw.edu.au/DCRC) for the 3 DCRCs. Applications to establish research centres were called for in February 2006 and by mid-2006 the successful applications were announced:


1. Primary Dementia Collaborative Research Centre focusing on assessment and better care outcomes awarded to the University of New South Wales, led by Professor Henry Brodaty

2. Dementia Collaborative Research Centre focusing on prevention, risk reduction and early detection awarded to Australian National University, led by Associate Professor Marc Budge

3. Dementia Collaborative Research Centre focusing on consumers, carers and social research awarded to Queensland University of Technology, led by Professor Jenny Abbey (Professor Elizabeth Beattie replaced Professor Abbey in 2008).

Each centre had a number of collaborators from other institutions around Australia. In the second half of 2006 staff were hired, facilities found, projects decided upon, and the three DCRCs were up and running.



The model


The three DCRCs can be likened to solar systems each with its own sun based at the host university with planets in orbit. The planets, or nodes as they are formally known, are the collaborating centres.



Overarching theme of the DCRCs


All three DCRCs are aiming to translate research into practice. The general schema is for each node to complete a review of literature in its area with specific attention to:


• how the lessons from previous research can be translated into practice

• summarising recommendations for clinicians and aged care workers

• noting the gaps in research and providing an agenda for future research.


image All three DCRCs are aiming to translate research into practice.


All groups are required to consider their areas in relation to special groups such as people with intellectual disability, people with young onset dementia, Aboriginal and Torres Strait Islanders, people from culturally and linguistically diverse (CALD) backgrounds, and people living in rural and remote areas.



Primary Collaborative Research Centre


The DCRC focusing on Assessment and Better Care Outcomes has members from: University of Newcastle; University of Sydney; Hornsby Ku-ring-gai Health Service; University of Technology of Sydney; University of Wollongong; Hammond Care Group; Australian Institute for Health and Welfare (AIHW); Monash University; and the Prince of Wales Hospital, Sydney. The seven areas of research emanating from the centre and its collaborators include:


1. Improving assessment and management of dementia in general practice

This work builds on a National Health and Medical Research Council (NHMRC) project grant for a randomised control trial (RCT) to determine whether training general practitioners (GPs) can improve their abilities for assessment and management and also whether this makes a difference in the quality of life, (QoL) for people diagnosed with dementia and their family carers.

2. Physical comorbidity in dementia

Examples of physical comorbidity include delirium, falls, epilepsy and oral disease. Dementia tends to overshadow other illnesses that are often overlooked, yet they can cause distress and can worsen the already compromised function of those affected.

3. Nursing retention and recruitment and nursing competencies

In response to the looming workforce crisis in nursing in general and in aged care in particular, strategies to improve working conditions for nurses and to encourage recruitment and retention of high quality staff are critical. The second part of this node addresses articulation of nursing competencies in dementia to ensure adequate training of aged care personnel.

4. Technology and design

Assistive technology has the potential to improve the capacity of people with dementia to remain independent at home longer. Better design of one’s own home and of residential care can improve QoL. A review of the literature to determine what is best practice, thus enabling families and residential care facilities to improve care, has been undertaken.

5. Transitions in care

What happens after discharge from hospital for patients with dementia? Do they go home? If so, do they receive community care? Or are they discharged into residential care? What predicts the pathway of further care for these patients? And afterwards? How many patients successfully make transition from community care to residential care? These questions can be answered by examining large databases held within the Commonwealth Department of Health and Ageing.

6. Behavioural and psychological symptoms of dementia (BPSD)

A review of psychosocial interventions for BPSD has shown that non-drug treatments can be effective in reducing symptoms such as agitation, aggression and depression.

7. Special groups and dementia

This node focuses on Indigenous people with dementia, young onset dementia (YOD), and people with dementia from CALD backgrounds. One team is researching the prevalence and causes of dementia in Indigenous populations living in urban centres (where the majority reside), and what Indigenous populations understand about dementia. The rate of dementia in Aboriginal people between 45 and 65 years of age from remote communities is several-fold greater than in the non-Indigenous population. A team is also planning an Australia-wide study of the prevalence of people with dementia with onset before the age of 65, of their needs and of the best ways to provide services for them. Even though YOD is rare compared to late-onset dementias, they number over 11 000 in Australia. These people and their families have special needs for services. Finally, people from non-English speaking backgrounds are less likely to know about what dementia is and how to access services. This is particularly true for older migrants who are likely to miss out on access to assessment and care. A survey of dementia literacy among people of Italian, Greek, Chinese and Australian descent will be undertaken in order to determine how best to overcome these barriers.


Dementia Collaborative Research Centre focusing on prevention, risk reduction and early detection


Centre members include: the Australian National University; Alzheimer’s Australia Vic; Edith Cowan University; University of Canberra; University of Melbourne; and the University of Queensland. The areas of research emanating from the centre and its collaborators include:


1. Understanding risks for dementia

This program will include identification and review of ‘established’ and new or emerging risk factors; genetic-biological markers, environment and lifestyle factors and their interaction in developing dementia will also be examined.

2. Development of diagnostic tools and algorithms for early dementia

Diagnostic tools and pathways for cognitive testing (e.g., checklists, computerised and online or self-administered tools) will be reviewed and developed. Neuro-imaging projects will include the development of the Australian Normative and Dementia Imaging Database (ANDI) whilst methodological development of dementia-related biomarkers will also be undertaken.

3. Development of risk reduction interventions

Projects under this program are aimed at translating the knowledge derived from programs A and B into health professional and public awareness, knowledge and action.

4. Modelling impacts of risk reduction on cognitive decline and dementia

Projects will develop methodology for, and model, the impact of dementia risk reduction programs.


Dementia Collaborative Research Centre focusing on carers, consumers and social research


Collaborative partners in this undertaking are: Alzheimer’s Australia; Curtin University of Technology; Griffith University; Hammond Care Group; and La Trobe University through the Australian Centre for Evidence Based Aged Care (ACEBAC). The Queensland University of Technology (QUT), through management of the centre, coordinates, undertakes, facilitates, and promotes reviews and research.


This DCRC is currently undertaking nine primary projects within five themes:


1. diagnosis, assessment and management of pain for people with dementia

2. carer and community issues

3. residential/industry models

4. quality of life, lifestyles, prevention of functional decline and acute care issues

5. palliative care and end-of-life issues.

Specific projects include:


• providing a palliative approach for people with end-stage dementia in residential aged care facilities: a systematic review and development of a palliative care case conferencing educational package

• use of medical, home-based and residential aged care by older decedents with dementia during the last 3 years of life

• review of current research activities in aged care services and the identification of priorities for support with completion and dissemination of results

• older people who receive enteral nutrition via gastrostomy tubes: a population-based study of incidence, indications and outcomes

• loneliness: the influence of activity and social engagement on loneliness and QoL of people with dementia and their carers

• investigation of the use of thickened fluids/energy supplements for people with dementia in residential aged care facilities (RACFs)

• clinical practice improvement in acute care settings — pain priority

• development of a method of assessing the implementation of person-centred care in the management of pain in all care settings

• investigating the use of a symbol for people with dementia in the community

• developing guidelines and clinical pathways for care of people in the community.

This DCRC is additionally conducting a number of centre-based projects. One main focus of the centre is to increase consumer participation in research and to take up consumer-based issues. A future planned activity for the Dementia Collaborative Research Centre for Consumers, Carers and Social Research (DCRC–CCSR) is to investigate the use of consumer-directed care, especially in relation to respite. The need for individual solutions for carers may be better met if they can have control over the finances to purchase such care. Closer liaison with industry is planned in order to assist with providing evidence-based guidelines and protocols that are practical, useful, and appropriate to the clinical setting where care for people with dementia is delivered.



The Dementia Training Study Centres


The DTSCs each designed programs encouraging dementia studies in Australian graduate and undergraduate health curricula. The overall responsibility for the coordination of the centres was allocated to the University of Wollongong. Applications to establish DTSCs were called for in February 2006 and in mid-2006 the four successful applications were announced:


1. The Eastern Australia Dementia Training and Study Centre (EADTSC) managed by University of Wollongong, led by Associate Professor Victoria Traynor

2. The South Australian & Northern Territory Dementia Training Study Centre managed by Alzheimer’s Australia South Australia

3. The Western Australia Territory Dementia Training Study Centre managed by Curtin University of Technology, led by Professor Barbara Horner

4. Victoria and Tasmania Dementia Training Study Centre managed by La Trobe University, led by Professor Rhonda Nay.

Each centre had a number of collaborators from other institutions around Australia.



image The DTSCs each designed programs encouraging dementia studies in Australian graduate and undergraduate health curricula.



The model


The four DTSCs can be likened to the model described for the DCRCs; that is, solar systems each with its own sun based at the host university with planets in orbit. The planets, or nodes as they are formally known, are the collaborating centres.



Overarching theme of the DTSCs


The four DTSCs are aiming to provide educational materials to a broad population covering the whole of Australia. This is a first for Australia and reflects the commitment the Australian Government has to education on dementia. Each centre has identified the specific population they will target, the content to be delivered, and the mode of delivery.


Like the DCRCs, this current model rewards collaboration rather than competition and brings clinicians and academics together to consider how best to provide learning materials for health care workers.



image Like the DCRCs, this current model rewards collaboration rather than competition and brings clinicians and academics together to consider how best to provide learning materials for health care workers.

Related posts:

  1. Older people in acute care
  2. Getting ageing on the agenda – lessons from Alzheimer’s Australia
  3. Supporting independent function and preventing falls
  4. Health care in a longevity regime

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Dec 10, 2016 | Posted by in NURSING | Comments Off on Collaboration in ageing research and education

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