CJCADR Public Dementia Forum part 2: treatment and care

The public dementia forum on February 19 provided an overview not only of the research being conducted at QBI (see part 1 here), but also of efforts to deal with the treatment and ongoing care of dementia patients. With dementia cases in Queensland expected to quadruple by 2050 and the significant economic and societal costs associated with the disease, these talks provided insight into current and future practices that should be adopted to best manage the developing situation.

Following on from the science-laden talks of the morning, Professor Gerard Byrne, Director of the Older Persons Mental Health Service at the Royal Brisbane and Women's Hospital, spoke further about clinical trials of dementia treatments, including some of the immunotherapeutic approaches discussed by Professor Götz. However Professor Byrne also mentioned studies into the importance of exercise in staving off cognitive decline, as well as epidemiological work showing that early education and high levels of cognitive activity during middle age were predictive of low dementia rates. Although current pharmacological approaches are not particularly effective, Professor Byrne noted that clinicians can still help guard against dementia by promoting healthy living, with cardiovascular health a significant risk factor for dementias.

The idea of structuring environments to assist in dementia care ran throughout the forum. Dr Kana Appadurai, Clinical Director of Geriatric & Rehabilitation Medicine at RBWH, spoke about the steps hospitals should be taking to enhance dementia care. In addition to specialised staff education and training in dementia care, which are currently largely absent, Dr Appadurai highlighted the importance of easily navigable environments in minimising confusion in patients, for example by providing coloured doors for toilet entrances. The difficulties in establishing a dementia-optimal environment was not glossed over, with Dr Appadurai acknowledging that such undertakings need to have buy-in from hospital management and at every level below that, including even at the hospital planning stage as architectural plans are agreed upon.

Professor Elizabeth Beattie of QUT and Director of the Dementia Collaborative Research Centre also spoke of dementia care, but from the point of view of aged care facilities rather than hospitals. Emphasised once again were the need for a well-designed, easily navigable facility with prominent signage, as well as the desire to allow access of friends and family members to their loved ones. Other significant issues raised included providing proper training amongst carers and sufficient staffing at all times, particularly on weekends.

Associate Professor Eddy Strivens Co-Clinical Chair of the Statewide Dementia Clinical Network (SDCN) of Queensland Health, spoke about the role of SDCN. It was established in 2007 with an open membership to all clinicians with an active interest in improving the care of people with dementia. Consumers are also members of SDCN and it covers the whole state and the whole care spectrum. They have twice yearly forums bringing together clinicians to present research, breakthroughs and to network with colleagues. Topics covered have included driving with dementia, dementia in acute care, young onset dementia and transitions in care. There will be opportunity for researchers to present at future SDCN forums. The SDCN is pursuing partnerships with CJCADR as well as Queensland Dementia Training and Study Centre, DBMAS and Alzheimer’s Australia Queensland. Key priority areas for the SDCN are: dementia awareness; risk factor reduction; timely and skilled assessment and diagnosis; person centred post diagnosis support and services and end of life / palliative care issues.

In the final talk, Graham Kraak from the Queensland Department of Health highlighted some of the steps State and Federal Governments are taking to address dementia, including the allocation of $130m for various initiatives to assist in aged care. This money will be directed towards enhancing awareness, minimising risk, promoting research, and providing care and support to patients at various stages, from post-diagnosis to end of life and palliative care. The overriding theme in this final presentation was that aged care is clearly suboptimal, that governments are aware of this, and that some initial steps are being taken to address the problem. But there’s a way to go yet.