Knowledge Network in Rural and Remote Dementia Care
Healthcare Delivery Across the Continuum for Rural and Remote Seniors with Dementia
7th Annual Summit
October 21st & 22nd, 2014
Scientifi c Poster Session
7777777Summit
2014
Tuesday October 21st, 2014Scientific Poster Program
5:00 PM – 8:30 PM at the Delta Bessbourough (Battleford Room)
Poster Presenter Authors & Poster Titles Page
Juanita Bacsu Bacsu J, Viger M, Abonyi S, Jeffery B
Rural Older Adults’ Perceptions of Cognitive Health1
Anita Bergen Nein L, Bergen A, Evjen T
Accurate assessment, effective care planning and quality improvement for better resident outcomes
2
Camille Branger Branger C, Burton R, O’Connell ME, Stewart N, Morgan D
Coping with Cognitive Impairment and Dementia: Rural caregivers’ Perspectives
3
Rachel Burton Burton R, O’Connell MERecruiting individuals diagnosed with dementia due to Alzheimer’s disease for cognitive rehabilitation: Ethical tension between the clinician and investigator roles
4
Allison Cammer Cammer A, Whiting S, Morgan D
The Intersection of Resident-Centered Care and Best Practices for Nutrition Care in Long-term Care
5
Vanina Dal Bello- Haas
Dal Bello-Haas V, Crossley M, O’Connell ME, Morgan D, Kirk A
Characteristics of Falls in Community Dwelling Older Adults with Early Memory Problems
6
Vanina Dal Bello- Haas
Dal Bello-Haas V, O’Connell ME, Morgan D
Fitness and Physical Activity Levels of Individuals Attending a Rural and Remote Memory Clinic
7
Tracy Danylyshen-Laycock
Danylyshen-Laycock T, Morgan D
Examining the Relationship Between Leadership and Sustainability of a Dementia Training Program in Long-Term Care
8
Ben Gould Gould B, Enright J, O’Connell ME, Morgan D
Reliable Change (RCI) on Repeatable Battery for the Assessmentof Neuropsychological Status (RBANS) in a Dementia Sample
9
Sarah Hambidge Hambidge S
Care farming: providing brighter futures for young and old 10
Ben Hicks Hicks, B
An exploration of commercial gaming technology as a leisure activity for older men with dementia in rural Dorset
11
Poster Presenter Authors & Poster Titles Page
Leslie Holfeld Holfeld L, Morgan D, O’Connell ME, Crossley M, Kirk A, Stewart N, Dal Bello-Haas V, McBain L, Cammer A, Minish D, Beever R, Kosteniuk J
Rural And Remote Memory Clinic – Update (March 2004 – June 2014)12
Paulette Hunter Hunter P, Hadjistavropoulos T, Thorpe L, Malloy D
The influence of individual and organizational factors on person-centred dementia care
13
Paulette Hunter and Anita Bergen
Berger J, Blevins L, Evjen T, Gelowitz K, Nein L, Nowlan D, Tiedjens A, Werle J
myPLAN 1.0: Resident Centred Care Planning In Long Term Care 14
Paulette Hunter and Anita Bergen
Hunter P, Bergen A, Berger H, Blevins L, Evjen T, Gelowitz K, Nein L, Nowlan D, Tiedjens A, Werle J
myPLAN 1.0: Evaluation Framework14
Paulette Hunter and Anita Bergen
Hunter P, Fick F
myPLAN 1.0: Staff Perceptions 15
Anthea Innes Innes A, Page S, Cutler C, Crossen-White H, Cash M, McParland P
Dementia Friendly Tourism 16
Anthea Innes Cutler C, Innes A
Tech Club: What are the benefits of a technology group on the quality of life for people with dementia living within the community?
16
Anthea Innes Cutler C, Heward M, Hambidge S, Innes A
Dementia Friendly Communities: Dorset 17
Anthea Innes Innes A, Reynolds L A musical ensemble: evaluation of a Bournemouth Symphony Orchestra /Bournemouth University Music initiative for people with dementia and their carers
17
Anthea Innes O’Malley, M
Dementia Friendly Architecture 18
Poster Presenter Authors & Poster Titles Page
Anthea Innes Cutler C, Palma P
Tales of the sea: Engaging people with dementia in maritime archaeology 18
Kathleen Kulyk Kulyk K, Stewart N, Peacock S, Morgan D, O’Connell ME, Kosteniuk J
Evaluating the Construction and Validity of a Questionnaire Assessing Healthcare Provider Perceptions of Rural Dementia Care Pathways
19
Debra Morgan Morgan D, Kosteniuk J, Crossley M, O’Connell ME, Kirk A, Stewart N, Dal Bello-Haas V, Forbes D, Innes A, McBain L, Mou H, Parrott E
Team 20 of the Canadian Consortium on Neurodegeneration in Aging (CCNA): Rural Dementia Action Research (RaDAR)
20
Darrell Mousseau**Due to time constraints the poster is not included in this booklet**
Nyarko J, Fehr K, Pennington P, Maley J, Mousseau D
A simple test for mutations in the presenilin-1 gene revealed a mutation that can protect against Alzheimer disease
Jennifer Nyarko Wei Z, Nyarko J, Pennington P, Fernyhough P, Baker G, Mousseau DPhosphorylation of the insulin receptor substrate-1 regulatesmonoamine oxidase-A in primary and immortalized neuronal,but not glial, cultures
21
Megan O’Connell O’Connell ME, Burton R, Michael J
From Research to Practice: Collaboration with the Alzheimer Society of Saskatchewan for a Telehealth Delivered Frontotemporal Dementia Caregiver Support Group
22
Posters presented as part of the 7th International Symposium: Safety & Health in Agricultural & Rural Populations:
Global Perspectives (SHARP)
Allison Cammer Cammer A, O’Connell ME, Morgan D, Whiting S
Nutrition Care Needs of Alzheimer Disease versus non-Alzheimer Disease Dementia Patients
23
Joe Enright Enright J, O’Connell ME
An Evaluation of a Reminiscence Intervention via TelehealthVideoconferencing for Caregivers of Persons with Dementia
24
Julie Kosteniuk Kosteniuk J, Morgan D, Quail J, Teare G, Kulyk K, O’Connell ME, Kirk A, Crossley M, Stewart N, Dal Bello-Haas V, McBain L, Mou H, Forbes D, Innes A, Bracken J, Parrot E
Analysis of dementia prevalence, incidence, and care gaps in Saskatchewan: A mixed methods study
25
1
R
ural
Old
er A
dults
’ Per
cept
ions
of
Cog
nitiv
e H
ealth
Juan
ita B
acsu
,123 M
arc
Vige
r,1 Syl
via
Abo
nyi,12
3 Bon
nie
Jeffe
ry,14
5 1S
aska
tche
wan
Pop
ulat
ion
Hea
lth &
Eva
luat
ion
Res
earc
h U
nit,
2Com
mun
ity H
ealth
& E
pide
mio
logy
, 3U
nive
rsity
of S
aska
tche
wan
, 4Fa
culty
of S
ocia
l Wor
k, 5
Uni
vers
ity o
f Reg
ina
Sign
ific
ance
•
In 2
010,
app
roxi
mat
ely
4.4
mill
ion
Nor
th A
mer
ican
s ha
d de
men
tia a
nd th
is
num
ber i
s pr
ojec
ted
to in
crea
se si
gnifi
cant
ly (W
orld
Hea
lth O
rgan
izat
ion,
201
2).
Exis
ting
liter
atur
e on
cog
nitiv
e he
alth
focu
ses
prim
arily
on
thre
e gr
oups
of p
eopl
e,
incl
udin
g ol
der a
dults
dia
gnos
ed w
ith d
emen
tia, f
amily
car
egiv
ers,
and
hea
lthca
re
prov
ider
s. W
ith th
e ex
cept
ion
of C
orne
r and
Bon
d (2
004)
, the
re is
a p
auci
ty o
f re
sear
ch o
n th
e pe
rcep
tions
of c
ogni
tive
heal
th a
mon
g he
alth
y ol
der a
dults
w
ithou
t im
pair
men
t, es
peci
ally
with
in ru
ral a
reas
. Sev
eral
rura
l bar
rier
s may
im
pede
ear
ly d
emen
tia d
iagn
osis
rela
ted
to la
ck o
f edu
catio
n, li
mite
d he
alth
se
rvic
es, c
ultu
ral o
bsta
cles
and
fina
ncia
l cha
lleng
es. R
esea
rch
on ru
ral s
enio
rs’
perc
eptio
ns o
f cog
nitiv
e he
alth
is im
port
ant t
o in
form
the
deve
lopm
ent o
f effe
ctiv
e pr
even
tion
and
dem
entia
aw
aren
ess
stra
tegi
es.
Obj
ectiv
es
•Th
e pu
rpos
e of
this
stu
dy w
as tw
o-fo
ld:
1)To
exa
min
e ru
ral o
lder
adu
lts’ p
erce
ptio
ns, b
elie
fs a
nd m
eani
ngs
of c
ogni
tive
heal
th in
the
cultu
ral c
onte
xt o
f rur
al S
aska
tche
wan
, Can
ada;
2)To
iden
tify
how
hea
lthy
rura
l old
er a
dults
with
out i
mpa
irm
ent
mai
ntai
n an
d su
ppor
t the
ir c
ogni
tive
heal
th.
Met
hods
•
Part
of a
larg
er H
ealth
y A
ging
in
Plac
e St
udy
at th
e Sa
skat
chew
an P
opul
atio
n H
ealth
and
Eva
luat
ion
Rese
arch
Uni
t (Je
ffery
et a
l., 2
014)
.
•U
sing
an
ethn
ogra
phic
met
hodo
logi
cal a
ppro
ach,
dat
a w
as c
olle
cted
thro
ugh
2 w
aves
of s
emi-s
truc
ture
d in
terv
iew
s with
adu
lts a
ged
60 a
nd o
ver i
n th
e ru
ral
com
mun
ities
of Y
oung
, Wat
rous
and
Man
itou
Beac
h, S
aska
tche
wan
, Can
ada.
•1s
t wav
e w
ith 4
2 pa
rtic
ipan
ts, F
ebru
ary
to M
ay,
2014
.
•2n
d w
ave
with
37
part
icip
ants
, Jul
y to
Aug
ust,
2014
. •
Part
icip
ant o
bser
vatio
n w
as c
ondu
cted
by
spen
ding
tim
e w
ith 5
old
er a
dults
to
obse
rve
day-
to-d
ay a
ctiv
ities
rela
ted
to m
emor
y an
d co
gniti
ve h
ealth
. •
Gui
ded
by la
y th
eory
(Fur
nham
, 198
8) a
nd c
ultu
ral s
chem
a th
eory
(Qui
nn, 2
005)
, th
emat
ic a
naly
sis
was
per
form
ed u
sing
the
qual
itativ
e so
ftwar
e A
tlas.
ti-7
to
iden
tify
patte
rns,
them
es a
nd re
latio
nshi
ps in
the
data
.
Fi
ndin
gs
K
ey D
omai
ns •
Inte
llect
ual h
ealt
h - d
efin
ed a
s th
e im
port
ance
of c
ompr
ehen
sion
, aw
aren
ess,
m
enta
l stim
ulat
ion
and
cont
inuo
us le
arni
ng.
Su
ppor
tive a
ctiv
ities
: rea
ding
, puz
zles
, cro
ssw
ords
, Sud
oku,
car
ds, t
rave
ling,
le
arni
ng (i
.e.,
joke
s, b
irds
, cur
rent
eve
nts)
, nee
dle
wor
k an
d w
ood
wor
k.
•So
cial
hea
lth
- dis
cuss
ed a
s be
ing
activ
e, in
volv
ed in
the
com
mun
ity a
nd
com
mun
icat
ing
with
oth
ers.
Supp
ortiv
e act
iviti
es: c
offe
e ro
w, e
vent
s, te
leph
one,
tech
nolo
gy (i
.e.,
Face
book
, Sk
ype)
, pet
s, v
olun
teer
ing
and
visi
ting
at lo
dge
and
hosp
ital.
•Em
otio
nal h
ealt
h –e
xpre
ssed
in
term
s of m
enta
l wel
l-bei
ng, b
alan
ced
lifes
tyle
an
d sp
iritu
ality
.
Supp
ortiv
e act
iviti
es: m
edita
tion,
yog
a, p
aint
ing,
pho
togr
aphy
, scr
ap-b
ooki
ng,
gard
enin
g, m
usic
, chu
rch,
sm
iling
, exe
rcis
e an
d jo
urna
ling.
•Fu
ncti
onal
hea
lth–
des
crib
ed in
rela
tion
to p
hysi
cal h
ealth
, act
iviti
es o
f dai
ly
livin
g an
d in
depe
nden
ce.
Su
ppor
tive a
ctiv
ities
: hea
lthy
eatin
g, sl
eep,
exe
rcis
e (p
ickl
e-ba
ll, w
alk,
bow
l, go
lf, c
url,
swim
, tai
chi
, dan
ce),
hear
ing
aids
, eye
gla
sses
and
wal
king
aid
s.
Con
clus
ions
•
Und
erst
andi
ng th
e pe
rcep
tions
of c
ogni
tive
heal
th a
mon
g sp
ecifi
c cu
ltura
l gro
ups
such
as
rura
l old
er a
dults
sup
port
s th
e de
velo
pmen
t of t
arge
ted
inte
rven
tions
ai
med
at a
war
enes
s, e
duca
tion
and
earl
y de
men
tia d
iagn
osis
.
Ref
eren
ces
Cor
ner,
L., &
Bon
d, J
. (20
04).
Bei
ng a
t ris
k of
dem
entia
: Fea
rs a
nd a
nxie
ties
of o
lder
adu
lts. J
ourn
al o
f Agi
ng S
tudi
es, 1
8(2)
, 143
-55.
Fu
rnha
m, A
. (19
88).
Lay
theo
ries:
Eve
ryda
y un
ders
tand
ing
of p
robl
ems
in th
e so
cial
sci
ence
s. O
xfor
d, E
ngla
nd: P
erga
mon
Pre
ss.
Jeffe
ry, B
., B
acsu
, J.,
Abo
nyi,
S.,
Nov
ik, N
., M
artz
, D.,
John
son,
S.,
& O
osm
an, S
. (20
14).
Hea
lthy
agin
g in
pla
ce: A
ctio
n pl
an s
umm
ary.
.
Avai
labl
e fro
m, h
ttp://
sphe
ru.c
a/re
sear
ch_p
roje
cts/
proj
ects
/Pro
ject
/Hea
lthy%
20Ag
ing%
20A
ctio
n%20
Pla
n%20
2014
-201
7.pd
f.Q
uinn
, N. (
2005
). Fi
ndin
g cu
lture
in ta
lk: A
col
lect
ion
of m
etho
ds. N
ew Y
ork,
NY:
Pal
grav
e M
acm
illan
. W
orld
Hea
lth O
rgan
izat
ion.
(201
2). D
emen
tia: A
pub
lic h
ealth
prio
rity.
Ava
ilabl
e fro
m, h
ttp://
ww
w.w
ho/d
emen
tia.h
tml
Inte
llect
ual
Emot
iona
l
Soci
al
Func
tiona
l
2
3. In
form
atio
n (H
irdes
, Pos
s, C
ald
erel
li, Fr
ies,
Mor
ris, T
eare
, Jut
an A
n ev
alua
tion
of d
ata
qual
ity in
Can
ada’
s Con
tinui
ng C
are
Repo
rting
Sys
tem
, 201
3; a
nd
Prin
gle,
Orli
kow
An
Inco
nven
ient
Tru
th p
rese
ntat
ion
2012
inte
rRA
I con
fere
nce)
be
cam
e av
aila
ble
abou
t ass
essm
ent e
rrors
cau
sed
by
auto
pop
ulat
ion
(all
field
s in
the
asse
ssm
ent a
re a
utom
atic
ally
pop
ulat
ed w
ith d
ata
from
the
last
as
sess
men
t and
ass
esso
r cha
nges
the
dat
a w
here
nee
ded
). A
uto
popu
latio
n of
RA
I ass
essm
ents
in S
aska
toon
Hea
lth R
egio
n ca
used
a h
igh
erro
r rat
e in
as
sess
men
t of e
limin
atio
n pa
ttern
s in
sect
ion
H2e
4.
Use
of C
APs
for c
are
plan
ning
was
pro
gres
sing
very
slow
ly a
nd C
APs
wer
e no
t sup
porte
d in
the
pape
r-bas
ed c
are
plan
ning
tem
plat
e.
Acc
urat
e as
sess
men
t, ef
fect
ive
care
pla
nnin
g an
d qu
ality
impr
ovem
ent f
or b
ette
r res
iden
t out
com
es
Lau
reen
Nei
n, B
SN
RN
A
nita
Ber
gen
BN
, MS
c
Tar
a E
vjen
, BS
N R
N
An
accu
rate
resp
onse
to th
e as
sess
men
t of t
he
bow
el e
limin
atio
n pa
ttern
(ite
m H
2e) o
f the
RA
I-MD
S qu
arte
rly a
sses
smen
t is a
lmos
t alw
ays n
one
of th
e ab
ove.
Aut
o-po
pula
tion
of a
sses
smen
ts
auto
mat
ical
ly p
uts t
his r
espo
nse
into
an
annu
al
asse
ssm
ent w
here
it is
alm
ost a
lway
s ina
ccur
ate;
co
nseq
uent
ly, w
here
non
e of
the
abov
e is
the
resp
onse
to H
2e it
was
con
sider
ed a
n er
ror d
ue to
au
to p
opul
atio
n. A
n au
dit
of H
2e re
spon
ses o
n an
nual
ass
essm
ents
at t
hree
hom
es in
Sas
kato
on
Heal
th R
egio
n sh
owed
that
aut
o po
pula
tion
caus
ed
an a
vera
ge e
rror r
ate
of 7
5%.
Back
grou
nd
•RA
I-MD
S as
sess
men
ts a
re c
ompl
eted
qua
rterly
for 2
200
peop
le in
Sa
skat
oon
Heal
th R
egio
n
•RA
I-MD
S ou
tput
s are
use
d fo
r car
e pl
anni
ng, q
ualit
y im
prov
emen
t, st
rate
gic
plan
ning
and
fund
ing
•In
tern
al a
nd e
xter
nal R
AI-M
DS
aud
it pr
oces
s im
plem
ente
d in
200
5 •
Lean
met
hod
olog
y as
par
t of t
he S
aska
tche
wan
Hea
lth-C
are
Man
agem
ent S
yste
m in
crea
sed
the
focu
s on
heal
th in
dic
ator
s and
pu
t mor
e em
phas
is on
per
form
ance
•
Sask
atch
ewan
Min
istry
of H
ealth
impl
emen
ted
a Q
ualit
y In
dic
ator
Im
prov
emen
t ini
tiativ
e in
201
3 fo
cusin
g on
seve
n of
the
RAI-M
DS
qual
ity in
dic
ator
s and
incl
udin
g im
prov
emen
t pla
ns su
bmitt
ed to
the
Min
istry
on
a qu
arte
rly b
asis
from
eac
h ho
me
whe
re th
e ta
rget
has
no
t bee
n m
et
Ana
lysis
of c
urre
nt p
roce
sses
1. D
aily
dat
a co
llect
ion
by C
ontin
uing
Car
e A
ssist
ants
requ
ired
kn
owle
dge
of R
AI-M
DS
cod
ing
stan
dar
ds;
how
ever
a tr
aini
ng p
rogr
am
to a
pply
the
cod
ing
accu
rate
ly w
as n
ot c
onsis
tent
ly a
vaila
ble.
A
sses
sors
lack
ed c
onfid
ence
in th
e d
ata
colle
cted
. Was
the
curre
nt
met
hod
of d
ata
colle
ctio
n ne
cess
ary
for a
ccur
ate
asse
ssm
ent?
Tw
o as
sess
ors s
imul
tane
ously
ass
esse
d a
resid
ent t
o an
swer
this
ques
tion.
O
ne a
sses
sor u
sed
the
dat
a co
llect
ion
tool
s in
use,
and
the
othe
r use
d
alte
rnat
e so
urce
s of i
nfor
mat
ion
from
the
heal
th re
cord
. Tes
t res
ults
sh
owed
that
col
lect
ing
dat
a in
alte
rnat
ive
way
s had
onl
y a
smal
l to
m
oder
ate
impa
ct o
n RA
I out
puts
.
2.
RAI-M
DS
aud
its a
nd a
ctio
n pl
ans f
aile
d to
yie
ld c
onsis
tent
im
prov
emen
t in
asse
ssm
ent a
ccur
acy
over
a lo
ng p
erio
d o
f tim
e.
Inte
rnal
aud
it re
sults
var
ied
from
ext
erna
l aud
it re
sults
:
Stra
tegi
es
Obj
ectiv
e C
are
team
s will
impr
ove
resid
ent o
utco
mes
by
incr
easin
g bo
th th
e ac
cura
cy o
f RA
I-MD
S as
sess
men
ts a
nd th
e us
e of
CA
Ps fo
r car
e pl
anni
ng.
Cre
ate
and
impl
emen
t a n
ew R
AI d
ata
colle
ctio
n to
ol th
at:
•Pr
ovid
es a
ccur
ate
dat
a fo
r RA
I ass
essm
ent t
hat c
anno
t be
foun
d e
lsew
here
on
the
heal
th re
cord
•
Can
be
com
plet
ed a
ccur
atel
y w
ithou
t ad
diti
onal
trai
ning
•
Can
be
com
plet
ed in
a sh
orte
r am
ount
of t
ime
than
the
curre
nt to
ols
Repl
ace
inte
rnal
aud
it pr
oces
s with
AIS
com
pete
ncy
eval
uatio
ns:
•A
ctiv
ate/
reac
tivat
e RA
I-MD
S us
er a
ccou
nts o
nly
afte
r pas
sing
com
pete
ncy
eval
uatio
ns
•D
iver
t RA
I-MD
S au
dit
fund
ing
to p
aid
tim
e fo
r ass
esso
rs to
com
plet
e co
mpe
tenc
y ev
alua
tions
ann
ually
Impl
emen
t a c
are
plan
ning
tool
that
: •
Inte
grat
es re
siden
t pre
fere
nces
, car
e ne
eds,
goal
s, an
d o
utco
mes
•
Incl
udes
pla
nnin
g fo
r nur
sing
reha
bilit
atio
n/re
stor
ativ
e ca
re
•In
corp
orat
es C
linic
al A
sses
smen
t Pro
toco
ls (C
APs
)
Shut
off
auto
pop
ulat
ion
of R
AI-M
DS
asse
ssm
ents
in J
une
of 2
014
Ack
now
ledg
emen
ts
Con
clus
ion
Resid
ents
, car
e te
ams,
and
man
agem
ent t
eam
s at S
aska
toon
Hea
lth R
egio
n sp
ecia
l car
e ho
mes
hav
e en
thus
iast
ical
ly p
artic
ipat
ed in
the
impl
emen
tatio
n of
new
pro
cess
es a
nd to
ols,
and
pro
vid
ed fe
edba
ck fo
r the
pu
rpos
e of
eva
luat
ion.
The
y pl
ay th
e m
ost i
mpo
rtant
role
in th
e su
cces
s of t
hese
stra
tegi
es a
nd th
eir d
edic
atio
n to
im
prov
ing
the
serv
ice
prov
ided
in lo
ng te
rm c
are
hom
es is
sign
ifica
nt.
•C
hang
ing
the
dat
a co
llect
ion
proc
ess p
rom
pted
a p
ositi
ve re
spon
se fr
om st
aff a
nd m
anag
ers.
•M
anag
ers w
ere
rece
ptiv
e to
mak
ing
a d
ecisi
on a
bout
act
ivat
ing
laps
ed R
AI-M
DS
user
acc
ount
s bas
ed o
n A
IS
com
pete
ncy
eval
uatio
ns.
•Sh
uttin
g of
f aut
o po
pula
tion
of R
AI-M
DS
elic
ited
little
feed
back
. •
The
new
car
e pl
an is
fully
impl
emen
ted
in 5
0% o
f the
hom
es in
the
Regi
on, 6
% o
f the
hom
es h
ave
not y
et b
egun
im
plem
enta
tion
and
the
rem
aini
ng 4
4% a
re in
var
ious
stag
es o
f im
plem
enta
tion.
Eval
uatio
n of
Stra
tegi
es
A tw
o ye
ar e
valu
atio
n of
the
new
car
e pl
an is
cur
rent
ly u
nder
way
thro
ugh
colla
bora
tion
with
a re
sear
ch te
am fr
om th
e Un
iver
sity
of S
aska
tche
wan
led
by
Dr.
Paul
ette
Hun
ter.
Mea
sure
s of t
he e
ffect
iven
ess
of sh
uttin
g of
f aut
o po
pula
tion:
•
Rate
of a
uto
popu
latio
n er
rors
(dec
reas
e by
70%
) •
Ass
essm
ent c
ompl
etio
n ra
te (m
aint
ain)
Mea
sure
s of t
he e
ffect
iven
ess
of th
e us
e of
AIS
com
pete
ncy
eval
uatio
ns:
•
Ove
rall
RUG
s acc
urac
y (im
prov
e by
20%
in o
ne y
ear)
•A
ccur
acy
of th
e Ph
ysic
al F
unct
ioni
ng R
UG (i
mpr
ove
by 3
0% in
one
yea
r) •
Acc
urac
y of
ass
essm
ent o
f Nur
sing
Reha
bilit
atio
n/Re
stor
ativ
e ca
re (i
mpr
ove
by
30%
in o
ne y
ear)
•A
ccur
acy
of th
e as
sess
men
t of f
alls
(impr
ove
by 1
5% in
one
yea
r) •
Acc
urac
y of
ass
essm
ent o
f the
rapi
es p
rovi
ded
(im
prov
e by
20%
in o
ne y
ear
•A
sses
smen
t com
plet
ion
rate
(mai
ntai
n)
Mea
sure
s of t
he e
ffect
iven
ess
of n
ew d
ata
colle
ctio
n pr
oces
s: •
Feed
back
from
a p
ilot a
t fou
r hom
es (t
o re
vise
tool
s and
pro
cess
es)
•Pr
e an
d p
ost i
mpl
emen
tatio
n tim
e st
udy
•RU
Gs a
ccur
acy
(ove
rall a
nd sp
ecifi
c se
ctio
ns) i
n on
e ye
ar
3
Six
them
es o
f cop
ing:
•
Soc
ial S
uppo
rt *
“I h
ave
good
frie
nds
I can
pho
ne w
hen
the
pres
sure
is
too
muc
h”
• M
akin
g tim
e fo
r Sel
f *
“Doi
ng a
n ac
tivity
that
is ju
st fo
r me”
•
Ada
ptat
ion
thro
ugh
beha
vior
al a
nd c
ogni
tive
chan
ges
“I w
rite
in a
dia
ry o
f the
day
’s a
ctiv
ities
and
if I’
ve
reac
ted
to/o
n an
issu
e th
at a
rose
.”
“I a
m le
arni
ng to
redu
ce m
y ex
pect
atio
ns o
f mys
elf
and
my
love
d on
e”
• R
elia
nce
on fa
ith a
nd g
od
“In
the
mor
ning
I gi
ve m
ysel
f ove
r to
God
.” •
Che
ckin
g in
“I
usu
ally
just
cal
l eve
ry d
ay o
r tw
o to
see
how
she
is
and
to re
min
d he
r of w
hat n
eeds
to b
e do
ne o
r s
ugge
stio
ns a
s to
wha
t to
have
for s
uppe
r tha
t day
.” •
Eng
agin
g in
join
t act
ivity
with
car
e re
cipi
ent.
“I tr
y to
kee
p he
r occ
upie
d w
ith d
iffer
ent t
hing
s to
d
o.”
b
INT
RO
DU
CT
ION
Purp
ose
• Th
e pu
rpos
e of
the
curr
ent s
tudy
is to
des
crib
e ho
w
rura
l car
egiv
ers
cope
with
car
ing
for a
love
d on
e w
ith
cogn
itive
impa
irmen
t or d
emen
tia.
Rat
iona
le
• C
anad
ian
info
rmal
car
egiv
ers
prov
ide
care
with
a
year
ly e
stim
ated
val
ue o
f $26
bill
ion1
•
Inci
denc
e of
dem
entia
exp
ecte
d to
incr
ease
250
% b
y 20
38, w
ith th
is th
e nu
mbe
r of i
nfor
mal
car
egiv
ers
will
in
crea
se2,
3
• C
areg
ivin
g in
a ru
ral c
onte
xt is
uni
que,
but
the
expe
rienc
es o
f rur
al c
areg
iver
s ha
ve n
ot b
een
wel
l st
udie
d4
Met
hod
• Th
is s
tudy
use
d qu
alita
tive
desc
riptio
n to
ana
lyze
re
spon
ses
to th
e op
en e
nded
que
stio
n : “
Wha
t he
lps
you
cope
on
a da
y- to
day
bas
is w
ith th
e de
man
ds e
xper
ienc
ed a
s a
care
give
r to
som
eone
w
ith m
emor
y di
fficu
lties
?”
• Th
is m
etho
dolo
gy a
llow
ed u
s to
take
an
expl
orat
ive
appr
oach
to th
is u
nder
stud
ied
area
and
gen
erat
e a
desc
riptio
n of
the
mos
t sal
ient
them
es b
roug
ht fo
rth
by th
e re
sear
ch p
artic
ipan
ts.
Cop
ing
with
Cog
nitiv
e Im
pairm
ent a
nd D
emen
tia:
Rur
al c
areg
iver
s’ P
ersp
ectiv
es
RE
SU
LTS
C. B
rang
er1 ,
R. B
urto
n1, M
. E. O
’Con
nell1
, N. S
tew
art2
, & D
. Mor
gan3
1
Dep
artm
ent o
f Psy
chol
ogy,
Uni
vers
ity o
f Sas
katc
hew
an, 2
Col
lege
of N
ursi
ng, U
nive
rsity
of S
aska
tche
wan
, 3C
anad
ian
Cen
tre
for H
ealth
and
Saf
ety
in A
gric
ultu
re,
Uni
vers
ity o
f Sas
katc
hew
an
• Th
is s
tudy
is b
ased
on
166
care
give
rs o
f per
sons
di
agno
sed
with
mild
cog
nitiv
e im
pairm
ent (
MC
I) or
de
men
tia, l
ivin
g in
rura
l Sas
katc
hew
an.
Tabl
e 1:
Fre
quen
cy o
f Car
egiv
er/ C
are
reci
pien
t Rel
atio
nshi
p Ta
ble
2: F
requ
ency
of C
are-
reci
pien
t Dia
gnos
is
AD
: Dem
entia
due
to A
lzhe
imer
’s D
isea
se; F
TD: F
ront
otem
pora
l Dem
entia
; LB
D: L
ewy
Bod
y D
emen
tia; D
ME
: Dem
entia
due
to m
ultip
le e
tiolo
gies
; Oth
er: O
ther
Dem
entia
s; M
CI:
Mild
co
gniti
ve im
pairm
ent
DIS
CU
SS
ION
•
‘Soc
ial S
uppo
rt’ a
nd’ T
ime
for S
elf’
emer
ged
as m
ost
com
mon
form
s of
cop
ing.
•
Pre
dom
inan
tly, t
he m
etho
ds o
f cop
ing
reve
aled
in th
is
stud
y re
flect
app
roac
h-ba
sed
copi
ng s
trate
gies
. Suc
h st
rate
gies
hav
e be
en s
how
n to
be
parti
cula
rly
effe
ctiv
e.
• Th
ese
data
sug
gest
thes
e ca
regi
vers
ado
pt a
dapt
ive
copi
ng s
trate
gies
to m
eet t
he d
eman
ds o
f the
ca
regi
ving
role
1 H
olla
nder
, M. J
., Li
u, G
., &
Cha
ppel
l, N
. L. (
2009
). W
ho c
ares
and
how
muc
h? T
he im
pute
d ec
onom
ic c
ontri
butio
n to
the
Can
adia
n. h
ealth
care
sys
tem
of m
iddl
e-ag
ed a
nd o
lder
unp
aid
care
give
rs p
rovi
ding
car
e to
the
elde
rly. H
ealth
care
Q
uarte
rly, 1
2(2)
, 42-
49.
2 D
upui
s, S
. L.,
Epp
, T.,
& S
mal
e, B
. J. A
. (20
04, M
arch
). C
areg
iver
s of
per
sons
with
dem
entia
: Rol
es, e
xper
ienc
es,
supp
orts
, and
cop
ing.
Lite
ratu
re re
view
pre
pare
d fo
r the
Min
istry
of H
ealth
and
Lon
g-Te
rm C
are
and
the
Ont
ario
Sen
ior's
S
ecre
taria
t as
part
of O
ntar
io's
Alz
heim
er S
trate
ty (I
nitia
tive
#6 R
esea
rch
on C
areg
iver
Nee
ds).
Wat
erlo
o, O
N: M
urra
y A
lzhe
imer
Res
earc
h an
d E
duca
tion
Pro
gram
. 111
pp.
3 S
met
anin
, P.,
Kob
ack,
P.,
Bria
nte,
C.,
Stif
f, D
., S
herm
an, G
., &
Ahm
ad, S
. (20
10).
Ris
ing
Tide
: The
impa
ct o
f Dem
entia
on
Can
adia
n S
ocie
ty 2
008
to 2
038.
Alz
heim
er S
ocie
ty. R
etrie
ved
from
ww
w.a
lzhe
imer
.ca
4 M
orga
n, D
., In
nes,
A.,
& K
oste
niuk
, J(2
011)
. Dem
entia
car
e in
rura
l and
rem
ote
setti
ngs:
A s
yste
mat
ic re
view
of f
orm
al o
r pa
id c
are.
Mat
urita
s, 6
8(1)
, 17–
33.
Fin
din
gs:
Co
pin
g T
hem
es
RR
MC
Fun
ding
and
in-k
ind
supp
ort i
s ge
nero
usly
pro
vide
d by
:
b
Man
y ca
regi
vers
repo
rted
use
of m
ore
than
one
them
e of
cop
ing,
and
the
frequ
enci
es o
f co-
occu
rrin
g th
emes
ar
e pr
esen
ted.
Ta
ble
3: F
requ
ency
of
Co-
occ
urrin
g C
opin
g Th
emes
* Mos
t com
mon
them
es: S
ocia
l Sup
port
and
Mak
ing
Tim
e fo
r Sel
f
Co-
Occ
urre
nce
of C
opin
g Fr
eque
ncy
Soc
ial S
uppo
rt/Ti
me
for S
elf
20
Soc
ial S
uppo
rt/R
estru
ctur
ing
11
Soc
ial S
uppo
rt/Ti
me
for S
elf/S
pirit
ualit
y 8
Soc
ial S
uppo
rt/S
pirit
ualit
y 8
Soc
ial S
uppo
rt/Ti
me
for S
elf/R
estru
ctur
ing
4
Soc
ial S
uppo
rt/Ti
me
for S
elf/R
estru
ctur
ing/
Join
t Act
ivity
3
Soc
ial S
uppo
rt/R
estru
ctur
ing/
Spi
ritua
lity
3
Soc
ial S
uppo
rt/C
heck
-in
3
Soc
ial S
uppo
rt/R
estru
ctur
ing/
Join
t Act
ivity
2
Soc
ial S
uppo
rt/Ti
me
for S
elf S
elf/R
estru
ctur
ing/
Spi
ritua
lity
1
Soc
ial S
uppo
rt/Jo
int A
ctiv
ity/R
estru
ctur
ing
1
Soc
ial S
uppo
rt/Jo
int A
ctiv
ity/C
heck
-in
1
Soc
ial S
uppo
rt/Ti
me
for S
elf/S
pirit
ualit
y 1
Tim
e fo
r Sel
f/Res
truct
urin
g/Jo
int A
ctiv
ity
1
Tim
e fo
r Sel
f/Spi
ritua
lity
1
Rel
atio
nshi
p to
car
e- re
cipi
ent
Wife
H
usba
nd D
augh
ter
Son
O
ther
To
tal
N
umbe
r 59
30
51
16
10
16
6
Car
e-
reci
pien
t A
D
FTD
LB
D
VD
D
ME
O
ther
M
CI
Num
ber
64
16
9 3
15
30
31
4
• W
hen
study
ing
inte
rven
tions
it is
crit
ical
to
be
awar
e of
the
pote
ntia
l for
con
flict
be
twee
n th
e cl
inic
ian
and
inve
stiga
tor
role
s reg
ardl
ess o
f whe
ther
one
ado
pts t
he
simila
rity
or th
e di
ffere
nce
posit
ion.
• In
ord
er to
max
imiz
e di
strib
utiv
e ju
stice
, m
ake
the
incl
usio
n cr
iteria
of i
nter
vent
ion
studi
es a
s bro
ad a
s pos
sible
in o
rder
to
mak
e th
e re
sear
ch tr
eatm
ent a
vaila
ble
to
as m
any
inte
reste
d in
divi
dual
s as p
ossib
le,
and
the
resu
lts a
pplic
able
to a
s man
y pe
ople
as p
ossib
le.
• Co
nsid
er n
on-tr
aditi
onal
rese
arch
de
signs
such
as m
ultip
le b
asel
ine,
sin
gle-
case
exp
erim
enta
l des
igns
.
• Co
nsist
ent w
ith ‘r
espo
nsib
le c
arin
g’,
whe
n th
e in
terv
entio
n be
ing
studi
ed
cann
ot b
e of
fere
d m
ake
refe
rrals
to
appr
opria
te re
sour
ces.
• To
avo
id c
onfli
cts o
f int
eres
t, av
oid
recr
uitin
g pa
rtici
pant
s fro
m o
ne’s
own
prac
tice
as m
uch
as p
ossib
le.
• If
this
is un
avoi
dabl
e, c
lear
ly se
para
te
the
rese
arch
con
sent
from
con
sent
to
treat
men
t as u
sual
. •
Recr
uit p
artic
ipan
ts fro
m c
linic
-bas
ed
setti
ngs r
athe
r tha
n co
mm
unity
-bas
ed
setti
ngs i
n or
der t
o m
inim
ize
diffi
culti
es
rela
ted
to d
iagn
osis
and
incl
usio
n cr
iteria
.
• A
uniq
ue st
reng
th o
f the
Can
adia
n Co
de o
f Eth
ics i
s tha
t it p
rovi
des s
peci
fic g
uide
lines
for
actio
n w
hen
ethi
cal p
rinci
ples
are
in c
onfli
ct, a
nd a
10
step
appr
oach
to a
ddre
ssin
g et
hica
l di
lem
mas
(Can
adia
n Ps
ycho
logi
cal A
ssoc
iatio
n, 2
001)
.
Intr
oduc
tion
Rec
ruiti
ng in
divi
dual
s dia
gnos
ed w
ith d
emen
tia d
ue to
Alz
heim
er’s
dise
ase
for c
ogni
tive
reha
bilit
atio
n: E
thic
al te
nsio
n be
twee
n th
e cl
inic
ian
and
inve
stig
ator
role
s
Rac
hel L
. Bur
ton
& M
egan
E. O
’Con
nell
Dep
artm
ent o
f Psy
chol
ogy,
Uni
vers
ity o
f Sas
katc
hew
an
rach
el.b
urto
n@us
ask.
ca,
meg
an.o
conn
ell@
usas
k.ca
Eth
ical
Gui
delin
es fo
r th
e C
linic
ian
and
the
Inve
stig
ator
Ref
eren
ces a
nd A
ckno
wle
dgem
ents
App
licat
ion
of th
e C
anad
ian
Cod
e of
Eth
ics f
or P
sych
olog
ists
Sugg
estio
ns
Brod
y an
d M
iller
(200
3) h
ave
argu
ed th
at
the
goal
s of r
esea
rch
and
the
goal
s of
clin
ical
pra
ctic
e ar
e lo
gica
lly
inco
nsist
ent.
“Diff
eren
ce”
posit
ion:
Res
earc
h is
dire
cted
tow
ard
prov
idin
g ge
nera
lized
kn
owle
dge
and
clin
ical
pra
ctic
e is
dire
cted
tow
ard
prov
idin
g th
e be
st po
ssib
le c
are
to a
n in
divi
dual
(Bro
dy &
M
iller
, 200
3).
• Th
is ar
gum
ent h
as b
een
fierc
ely
criti
cize
d.
“Sim
ilari
ty”
posit
ion:
Clin
ical
in
vesti
gato
rs o
ught
to b
e bo
und
by th
e sa
me
prin
cipl
es th
at g
over
n th
erap
eutic
m
edic
ine
(Bro
dy &
Mill
er, 2
003)
.
Co
gniti
ve re
habi
litat
ion
is a
prom
ising
, no
n-ph
arm
acol
ogic
al in
terv
entio
n fo
r in
divi
dual
s dia
gnos
ed w
ith d
emen
tia d
ue
to A
lzhe
imer
’s di
seas
e (A
D) o
r mix
ed
AD
and
vas
cula
r dem
entia
(VaD
; i.e
., Cl
are
et a
l., 2
010)
. Whi
le re
crui
ting
rese
arch
par
ticip
ants
for a
stud
y se
ekin
g to
repl
icat
e an
d ex
tend
pre
viou
s wor
k in
th
is ar
ea, w
e en
coun
tere
d an
eth
ical
di
lem
ma
whe
n ou
r rol
e as
trea
ting
psyc
holo
gists
con
flict
ed w
ith o
ur ro
le a
s re
sear
cher
s. Th
e D
ilem
ma
We
strug
gled
with
how
to p
rovi
de th
e be
st po
ssib
le se
rvic
e to
all
pers
ons w
ho
atte
nded
our
inta
ke a
sses
smen
t (cl
inic
ian
role
), w
hile
adh
erin
g to
exc
lusio
n cr
iteria
in
ord
er to
max
imiz
e th
e in
tern
al v
alid
ity
of th
e stu
dy (i
nves
tigat
or ro
le).
Indi
vidu
als a
ttend
ing
the
inta
ke
asse
ssm
ent h
ad c
once
rns t
hat c
ould
be
addr
esse
d th
roug
h co
gniti
ve
reha
bilit
atio
n, b
ut th
eir e
ligib
ility
for t
he
study
was
unc
lear
. O
bjec
tives
of t
he C
urre
nt P
roje
ct:
1.
Dra
w a
ttent
ion
to th
e et
hica
l ten
sion
betw
een
the
role
of c
linic
ian
and
the
role
of i
nves
tigat
or in
the
cont
ext o
f re
crui
ting
and
excl
udin
g in
divi
dual
s fo
r a st
udy
on c
ogni
tive
reha
bilit
atio
n fo
r ear
ly st
age A
D o
r mix
ed A
D/
VaD
. 2.
Offe
r an
exam
ple
of e
thic
al d
ecisi
on
mak
ing
usin
g th
e Ca
nadi
an C
ode
of
Ethi
cs fo
r Psy
chol
ogist
s.
3.
Prov
ide
sugg
estio
ns fo
r how
to b
est
man
age
the
tens
ion
betw
een
the
clin
icia
n an
d in
vesti
gato
r rol
es w
hen
recr
uitin
g an
d ex
clud
ing
indi
vidu
als
with
a d
emen
tia d
iagn
osis
for a
n in
terv
entio
n stu
dy.
Post
er P
rese
nted
at t
he 4
3rd A
nnua
l Sc
ient
ific
and
Edu
catio
nal M
eetin
g of
the
Can
adia
n A
ssoc
iatio
n on
Ger
onto
logy
R. B
urto
n’s W
ork
Supp
orte
d by
a D
octo
ral A
war
d fro
m:
How
can
the
sam
e in
divi
dual
be
gui
ded
by d
iffer
ent m
oral
ob
ligat
ions
at d
iffer
ent t
imes
? “J
ekyl
l-And
- Hyd
e ap
proa
ch”.
(Mill
er, 2
002)
Add
ition
al c
onsid
erat
ions
in d
emen
tia:
• Re
spec
t for
the
auto
nom
y of
per
sons
an
d th
e pr
otec
tion
of v
ulne
rabl
e pe
rson
s (F
isk, 2
007)
. •
Capa
city
to c
onse
nt a
nd d
istrib
utiv
e ju
stice
. M
ost e
thic
al g
uide
lines
trea
t the
two
activ
ities
as s
imila
r. Fo
r exa
mpl
e:
Cana
da’s
Tri-C
ounc
il Po
licy
Stat
emen
t: Et
hica
l Con
duct
for R
esea
rch
Invo
lvin
g H
uman
s.
Step
2: R
elev
ant s
tand
ards
I.
Resp
ect f
or th
e di
gnity
of
pers
ons
• N
on-d
iscrim
inat
ion
• In
form
ed c
onse
nt
• Fr
eedo
m o
f con
sent
• Pr
otec
tion
of v
ulne
rabl
e pe
rson
s
II. R
espo
nsib
le c
arin
g •
Max
imiz
e be
nefit
• M
inim
ize
harm
• Ri
sk/b
enefi
t ana
lysis
III. I
nteg
rity
in re
latio
nshi
ps
• Av
oida
nce
of c
onfli
ct o
f int
eres
t
IV. R
espo
nsib
ility
to so
ciet
y •
Dev
elop
men
t of s
ocie
ty
Step
1: W
ho is
invo
lved
? •
Indi
vidu
al w
ith c
ogni
tive
com
plai
nts;
fam
ily m
embe
rs;
grad
uate
stud
ent;
supe
rvisi
ng p
sych
olog
ist; i
ndiv
idua
ls w
ho st
and
to b
enefi
t fro
m th
e re
sear
ch; o
ther
rese
arch
ers.
Also
rele
vant
: Tri-
coun
cil P
olic
y St
atem
ent,
Sect
ion
5 on
in
clus
ion
in re
sear
ch.
Step
3: F
acto
rs th
at m
ight
influ
ence
the
deve
lopm
ent o
f or
choi
ce b
etw
een
cour
ses o
f act
ion
• Pe
rson
al b
iase
s: N
eed
to re
crui
t par
ticip
ants,
nee
d fo
r a
‘cle
an’ s
ampl
e.
• Pe
rson
al/p
rofe
ssio
nal s
tress
ors:
Shor
tage
of t
ime
and
reso
urce
s. •
Self-
inte
rest:
Diss
erta
tion
rese
arch
.
Step
s 4 a
nd 5
: Alte
rnat
ive
cour
se o
f act
ion,
and
risk
s/ben
efits
of
actio
n. A
ctio
n Be
nefit
s R
isks
Incl
ude
in th
e stu
dy
Cons
isten
t with
non
-di
scrim
inat
ion.
M
axim
izes
the
pote
ntia
l be
nefit
of c
ogni
tive
reha
bilit
atio
n fo
r thi
s in
divi
dual
.
Chal
leng
ing
to in
terp
ret
data
with
out c
lear
di
agno
sis.
Oth
er se
rvic
es m
ay b
e m
ore
appr
opria
te fo
r the
fa
mily
.
Excl
ude
from
the
study
Ensu
res t
he re
sults
of
the
study
con
tribu
te to
th
e de
velo
pmen
t of
soci
ety
as m
uch
as
poss
ible
. M
ake
mor
e ap
prop
riate
re
ferra
l as g
uide
d by
re
spon
sible
car
ing.
Fam
ily d
oes n
ot re
ceiv
e a
pote
ntia
lly b
enefi
cial
in
terv
entio
n.
Step
6: C
hoic
e.
• Ch
ose
to e
xclu
de fr
om th
e stu
dy.
Step
7: A
ctio
n.
• Pr
ovid
ed o
ne se
ssio
n of
psy
choe
duca
tion
abou
t cog
nitiv
e re
habi
litat
ion,
and
info
rmat
ion
abou
t alte
rnat
e re
sour
ces i
n th
e ci
ty.
Step
8: E
valu
ate
and
follo
w-u
p.
Step
9: A
ssum
ptio
n of
resp
onsib
ility
of a
ny c
onse
quen
ces.
Step
10:
Fut
ure
prev
entio
n.
• Im
plem
ente
d m
ore
thor
ough
tele
phon
e pr
e-sc
reen
ing.
Cl
inic
-bas
ed ra
ther
than
com
mun
ity re
crui
tmen
t foc
us.
Cana
dian
Insti
tute
s of H
ealth
Res
earc
h, N
atur
al S
cien
ces a
nd E
ngin
eerin
g Re
sear
ch C
ounc
il of
Can
ada,
Soc
ial
Sci
ence
s and
Hum
aniti
es R
esea
rch
Coun
cil o
f Can
ada.
(200
5). T
ri-Co
unci
l P
olic
y St
atem
ent:
Ethi
cal
Con
duct
for R
esea
rch
Invo
lvin
g H
uman
s. O
ttaw
a, O
ntar
io: I
nter
agen
cy S
ecre
taria
t on
Rese
arch
Eth
ics.
Cana
dian
Psy
chol
ogic
al A
ssoc
iatio
n. (2
001)
. Com
pani
on M
anua
l to
the
Cana
dian
Cod
e of
Eth
ics f
or P
sych
olog
ists,
Thi
rd E
ditio
n. O
ttaw
a, O
ntar
io: C
anad
ian
Psyc
holo
gica
l Ass
ocia
tion.
Clar
e, L
., Li
nden
, D. E
. J.,
Woo
ds, R
. T.,
Whi
take
r, R.
, Eva
ns, S
. J.,
Park
inso
n, C
. H.,
… R
ugg,
M. D
. (20
10).
Goa
l- O
rient
ed C
ogni
tive
Reha
bilit
atio
n fo
r Peo
ple
With
Ear
ly-S
tage
Alz
heim
er D
iseas
e: A
Sin
gle-
Blin
d R
ando
miz
ed C
ontro
l Tria
l of C
linic
al E
ffica
cy. A
mer
ican
Jou
rnal
of G
eria
tric
Psyc
hiat
ry, 1
8, 9
28-9
39.
doi
:10.
1097
/JGP
0b01
3e31
81d5
792a
. Br
ody,
H. &
Mill
er, F
. G. (
2002
). Th
e cl
inic
ian-
inve
stiga
tor:
Una
void
able
but
man
agea
ble
tens
ion.
Ken
nedy
Insti
tute
o
f Eth
ics J
ourn
al, 1
3(4)
, 329
-346
. Fi
sk, J
. (20
07).
Ethi
cal c
onsid
erat
ions
for t
he c
ondu
ct o
f ant
idem
entia
tria
ls in
Can
ada.
The
Can
adia
n Jo
urna
l of
Neu
rolo
gica
l Sci
ence
s, 34
(1),
S32-
36.
Mill
er, P
. B. (
2002
). Av
oidi
ng a
Jeky
ll-an
d-H
yde
appr
oach
to th
e et
hics
of c
linic
al re
sear
ch a
nd p
ract
ice.
The
A
mer
ican
Jou
rnal
of B
ioet
hics
, 2(2
), 14
– 1
7.
Cont
act:
5
The
Inte
rsec
tion
of
Res
iden
t-C
ente
red
Car
e an
d Be
st P
ract
ices
for
Nut
ritio
n C
are
in L
ong
-ter
m C
are
A. Cam
mer
1,2 , S. W
hitin
g2, D
. Morgan1
1 Can
adian Ce
ntre fo
r Health
and
Safety in Agriculture, College of M
edicine, University
of Saskatche
wan
, 2Co
llege of P
harm
acy an
d Nutrition, University
of Saskatche
wan
Know
ledg
e Tran
slatio
n
Ackn
owledgem
ents
Back
grou
nd•
Car
e A
ides
per
form
the
maj
ori
ty o
f di
rect
res
iden
t ca
re in
long
-te
rm c
are
(LTC
) w
ith li
ttle
tra
inin
g in
nut
ritio
n•
Polic
ies
and
stan
dard
ized
car
e pr
oce
dure
s ai
m t
o e
limin
ate
gues
swo
rk b
ut c
an c
reat
e ro
utin
ized
, tas
k-ba
sed
care
focu
s re
gard
ing
nutr
itio
n ca
re•
Pers
on-
cent
ered
car
e re
spec
ts t
he r
esid
ent
as a
n in
divi
dual
with
un
ique
nee
ds a
nd t
he r
ight
to
dig
nity
, res
pect
, and
full
part
icip
atio
n in
the
ir o
wn
care
•Th
e st
ruct
ured
wo
rk e
nviro
nmen
t o
f LTC
lend
s its
elf
to s
ched
uled
an
d st
anda
rdiz
ed c
are
prac
tices
, yet
:•
Hig
hly
defin
ed L
TC p
roto
cols
oft
en o
ppo
se t
he c
entr
al t
enet
s o
f pe
rso
n-ce
nter
ed c
are
Obj
ectiv
e•
To e
xam
ine
the
inte
rsec
tion
of
pers
on-
cent
ered
car
e ph
iloso
phy
with
nut
ritio
n ca
re d
inin
g be
st p
ract
ices
in L
TC in
ord
er t
o
unde
rsta
nd w
here
nut
ritio
n po
licy
initi
ativ
es c
oul
d en
hanc
e qu
ality
o
f car
e fo
r LT
C r
esid
ents
, esp
ecia
lly t
hose
with
dem
entia
Nex
t St
eps
•C
om
pari
son
with
oth
er s
ectio
ns o
f th
e gu
idel
ines
is n
eede
d to
iden
tify
pote
ntia
l sup
port
s th
at e
nabl
e o
r di
sco
rds
that
cre
ate
a ba
rrie
r to
ach
ievi
ng p
erso
n-ce
nter
ed c
are
•C
om
pari
son
with
oth
er ju
risd
ictio
ns c
oul
d id
entif
y po
tent
ial ‘
miss
ing
piec
es’ n
ot
out
lined
with
in t
hese
•St
udy
of
the
upta
ke a
nd a
pplic
atio
n o
f th
e gu
idel
ines
, with
spe
cific
att
entio
n to
ho
w e
ach
is in
terp
rete
d an
d ap
plie
d, c
oul
d ge
nera
te u
nder
stan
ding
of g
aps
•Ex
amin
atio
n o
f the
bal
ance
bet
wee
n pe
rso
n-ce
nter
ed a
ppro
ach
and
the
func
tion
of t
he o
rgan
izat
ion
and
betw
een
pers
on-
cent
ered
app
roac
h an
d en
suri
ng a
dequ
ate
nutr
itio
nal i
ntak
e co
uld
reve
al s
yste
mic
ch
alle
nges
with
in L
TC p
ract
ice
Find
ings
•St
ruct
ured
gui
delin
es f
or
nutr
itio
n ca
re s
erve
as
an
impo
rtan
t st
artin
g po
int
for
ensu
ring
co
mpe
tent
nu
triti
on
care
, but
are
no
t co
mpr
ehen
sive
•N
on-
pres
crip
tive
styl
e o
f th
ese
guid
elin
es d
oes
no
t fo
rce
rout
iniz
ed c
are;
allo
ws
for
tailo
ring
of
inte
rnal
po
licie
s an
d pr
actic
es t
o fi
t ea
ch p
artic
ular
LT
C in
the
ir c
apac
ity a
nd s
tyle
to
ado
pt a
per
son-
cent
ered
car
e ph
iloso
phy
of
care
•A
gap
exi
sts
betw
een
polic
y an
d ‘h
ow
to’
pra
ctic
e re
com
men
datio
ns t
o a
chie
ve p
erso
n-ce
nter
ed c
are
in f
oo
d an
d nu
triti
on;
tra
inin
g ef
fort
s sh
ould
foc
us
on
ope
ratio
naliz
ing
pers
on-
cent
ered
car
e ph
iloso
phy
in e
ach
LTC
•To
ols
to
ass
ist in
impl
emen
ting
pers
on-
cent
ered
nu
triti
on
care
co
uld
help
to
tra
nsla
te s
tand
ards
an
d gu
idel
ines
into
eff
ectiv
e pr
actic
e•
Gui
delin
es a
re a
use
ful f
irst
-ste
p; e
valu
atio
n ef
fort
s m
ust
exam
ine
the
abili
ty o
f the
LTC
to
ena
ble
pers
on-
cent
ered
car
e in
eve
ryda
y pr
actic
e
Met
hods
•In
Apr
il, 2
013
Sask
atch
ewan
Hea
lth
man
date
d pr
ogr
am g
uide
lines
fo
r sp
ecia
l-car
e ho
mes
(LT
C)
•Se
ctio
n 13
.2 e
nco
mpa
ss t
he F
oo
d an
d N
utri
tion
Din
ing
Expe
rien
ce
com
pone
nts
of t
he p
rogr
am g
uide
lines
, with
a t
ota
l of 2
1 po
licy
indi
catio
ns c
ont
aine
d w
ithin
•Th
e V
IPS
fram
ewo
rk fo
r pe
rso
n-ce
nter
ed c
are
(Bro
oke
r, 20
07)
and
Rei
mer
and
Kel
ler’
s (2
009)
mo
del o
f 4 e
lem
ents
of p
erso
n-ce
nter
ed m
ealti
me
care
for
LTC
wer
e us
ed t
o c
om
pare
per
son
cent
ered
ness
with
the
nut
ritio
n gu
idel
ines
•Fo
ur e
lem
ents
of
pers
on-
cent
ered
car
e:•
Pro
vidi
ng C
hoic
es a
nd P
refe
renc
es•
Supp
ort
ing
Inde
pend
ence
•Sh
ow
ing
Res
pect
•Pr
om
otin
g So
cial
Inte
ract
ion
•Ea
ch g
uide
line
was
co
ntra
sted
with
el
emen
ts t
o d
eter
min
e th
e fit
of t
he le
gally
m
anda
ted
guid
elin
es w
ith p
erso
n-ce
nter
ed
care
phi
loso
phy
Co
mpa
riso
n o
f Gui
delin
es t
o R
eim
er a
nd
Kel
ler’
s m
ode
l of p
erso
n-ce
nter
ed c
are:
Fit
with
Bro
oke
r’s
VIP
S fr
amew
ork
:Va
lue
–st
ates
a r
esid
ent-
cent
ered
app
roac
hIn
divi
dual
ized
–re
view
of
resid
ent
need
s, e
valu
atio
nPe
rspe
ctiv
e–
not
expl
icit
with
in g
uide
line;
cal
ls f
or
resid
ent
resp
ect
and
dign
itySo
cial
–pr
escr
ibes
a s
oci
ally
sup
port
ive
envi
ronm
ent
6
85%
15%
Whe
re th
e fa
lls o
ccur
red
Out
door
s
Ackn
owle
dgem
ents
: W
e th
ank
the
part
icip
ants
. Fun
ded
by th
e Sa
skat
chew
an H
ealth
Res
earc
h Fo
unda
tion
Cha
ract
eris
tics
of F
alls
in C
omm
unity
Dw
ellin
g O
lder
Adu
lts w
ith E
arly
Mem
ory
Prob
lem
s D
al B
ello
-Haa
s V1
, Cro
ssle
y M
2 , O
’Con
nell
ME2
, Mor
gan
D3 ,
Kirk
A4
1 Sch
ool o
f Reh
abili
tatio
n Sc
ienc
e, M
cMas
ter U
nive
rsity
; 2 D
epar
tmen
t of P
sych
olog
y, 3
Can
adia
n C
entr
e fo
r Hea
lth a
nd S
afet
y in
Agr
icul
ture
, 4N
euro
logy
, Uni
vers
ity o
f Sas
katc
hew
an
INTR
ODU
CTIO
N
• Th
e an
nual
inci
denc
e of
falls
in p
erso
ns w
ith
m
oder
ate
to se
vere
dem
entia
has
bee
n
re
port
ed to
be
40%
to 6
0% (
Shaw
, 20
03)
• Li
mite
d nu
mbe
r of l
ongi
tudi
nal,
pros
pect
ive
stud
y ha
s exa
min
ed fa
ll-re
late
d in
jurie
s in
com
mun
ity d
wel
ling
olde
r adu
lts w
ith d
emen
tia
(A
llen
2009
) •
No
stud
ies h
ave
pros
pect
ivel
y tr
acke
d pe
ople
with
ear
ly m
emor
y pr
oble
ms
PURP
OSE
To d
escr
ibe
the
prof
ile o
f fal
l eve
nts i
n
peop
le w
ith e
arly
mem
ory
prob
lem
s.
MET
HODS
• F
ifty-
nine
Rur
al a
nd R
emot
e M
emor
y Cl
inic
pat
ient
s (Sa
skat
oon,
Sas
katc
hew
an, C
anad
a)
• A
ge =
72
± 10
yea
rs; 5
5.9%
fem
ale
•
Pro
spec
tive
stud
y ov
er si
x m
onth
s •
Pat
ient
car
egiv
ers (
PC) c
ompl
eted
a m
onth
ly
f
all d
iary
•
Res
earc
h as
sist
ant t
elep
hone
d P
C ev
ery
two
wee
ks to
incr
ease
acc
urac
y of
the
colle
cted
dat
a an
d to
inc
reas
e ad
here
nce
Trip
sSl
ips
Loss
of
bala
nce
Not
pay
ing
atte
ntio
n
20%
30%
36
.70%
13.3
0%
REAS
ON
FO
R FA
LLS
012345
Frac
ture
Head
impa
ctBr
uise
sCu
ts/s
crap
es
INJU
RIES
RES
ULT
ING
FRO
M FA
LLS
%
INCI
DEN
CE O
F FA
LLS
Tota
l fal
ls
35.6
%
Sing
le fa
lls
16.9
%
Mul
tiple
falls
18
.5%
TI
ME
OF
FALL
Af
tern
oon
or e
veni
ng
53.8
%
SAFE
TY IS
SUE
No
foot
wea
r/ba
refo
ot
41.7
%
DISC
USS
ION
• O
vera
ll fa
ll in
cide
nce
was
sim
ilar t
o w
hat h
as b
een
repo
rted
in c
omm
unity
-
dw
ellin
g ol
der a
dults
with
out c
ogni
tive
impa
irmen
ts
• A
bout
1 in
3 c
omm
unity
-dw
ellin
g ol
der a
dults
fall
(Tro
mp
2001
) •
Fal
ls in
peo
ple
with
ear
ly m
emor
y pr
oble
ms o
ccur
red
mai
nly
durin
g
po
sitio
n tr
ansi
tions
or w
hile
neg
otia
ting
stai
rs/s
teps
/cur
b •
Thi
s diff
ers t
o w
hat h
as b
een
repo
rted
in c
omm
unity
-dw
ellin
g ol
der a
dults
with
out c
ogni
tive
impa
irmen
ts –
55%
of f
alls
occ
urre
d du
ring
am
bula
tion
(Ta
lbot
200
5)
• T
he fi
ndin
gs h
ave
impl
icat
ions
for p
atie
nt a
nd c
areg
iver
trai
ning
and
safe
ty
i
n ho
me
& c
omm
unity
env
ironm
ents
to ta
rget
fall
risk
for t
hose
with
ear
ly
mem
ory
prob
lem
s
20.8
0%
33.3
0%
Posi
tion
tran
sitio
ns (b
ed, c
hair,
car
,to
ilet t
rans
fers
)
Wal
king
Clim
bing
or d
esce
ndin
g (S
tairs
,st
eps,
cur
bs)
Activ
ities
at t
ime
of fa
ll
RESU
LTS
45.8
0%
Indo
ors
7
Fitness and Physical Ac0vity Levels of Individuals A7ending a Rural and Remote Memory Clinic Dal Bello-‐Haas V1, Megan E. O'Connell2, Debra G. Morgan3
1School of Rehabilitation Science, McMaster University, Hamilton, Ontario; 2Department of Psychology, 3 Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan
INTRODUCTION
• There has been growing interest in physical ac0vity as a poten0al disease-‐modifying therapeu0c interven0on for people with demen0a. • Physical ac0vity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure; broadly encompasses exercise, sports, physical ac0vi0es done as part of daily living, occupa0on, leisure, ac0ve transporta0on [Caspersen 1985] • Physical ac0vity has been shown to improve cogni0on [Hokkanen 2008], ac0vi0es of daily living [Arcoverde 2008], and func0onal ability and mental health [Teri 2008] in people with demen0a
OBJECTIVE
To examine ‘fitness' and physical ac0vity levels in community dwelling people with early stage memory problems living in rural and remote areas.
Physical fitness -‐ ‘’[a set of] measurable health and skill-‐related a;ributes’’ that include cardiorespiratory fitness, muscular strength and endurance, body composi?on and flexibility, balance, agility, reac?on ?me, power [Caspersen 1985] Func?onal fitness -‐ having the physical capacity to perform everyday ac?vi?es safely and independently without undue fa?gue
CONCLUSION
• Male par0cipants had more acceptable levels of physical ac0vity , as measured by the PASE, compared to female par0cipants. • As measured by SFT components, ‘fitness' of males and females with early memory problems living in rural and remote areas were not op0mal. • People with early memory problems may require educa0on about the benefits of physical ac0vity and maintaining fitness.
Acknowledgements: We thank the par0cipants. This research was supported by the Saskatchewan Health Research Founda0on (V. Dal Bello-‐Haas), and an Applied Chair in Health Services and Policy Research from the Canadian Ins0tutes of Health Research and the Saskatchewan Health Research Founda0on (D. Morgan)
STUDY PARTICIPANTS
§ Mean age = 72, SD = 10.0 § 56% female § Mean MMSE score = 25 (SD = 4) § Mean 3MS score = 82 (SD = 13)
Senior Fitness Test (Rikli & Jones 1999)
METHODS Fify-‐nine Rural and Remote Memory Clinic (Saskatoon, SK) pa0ents par0cipated. Measures completed: § A baseline demographic ques0onnaire § Neuropsychological tests -‐ Mini-‐mental Status Exam (MMSE), 3MS § Senior Fitness Test (SFT) components -‐ Sit-‐to-‐Stand, Arm Curls, 2-‐minute step test § Physical Ac0vity Scale for the Elderly (PASE; with the assistance of caregivers)
RESULTS
Neuropsychological Screens § MMSE -‐ brief, cogniIve screen -‐ score ranges from 0 to 30 -‐ score of 24 indicates further tesIng is required § 3MS -‐ brief screening test for demenIa -‐ score ranges from 0 to 100 -‐ score < 79 suggests further tesIng required
Lower Body Strength § Major factor in mobility and disability
prevenIon § Correlates with stair-‐climbing ability, walking
speed, fall risk § # of full stands from a seated posiIon in 30
seconds
Upper Body Strength § Important for normal daily acIviIes, e.g,
household chores, carrying groceries, personal care § # of arm-‐curls in 30 seconds (5 lbs for females, 8 lbs for males)
Aerobic Test § A (alternaIve) measure of aerobic endurance § Correlates with common measures of endurance § Necessary to perform many daily acIviIes e.g.,
walking, shopping, recreaIonal acIviIes § # of Imes individual can step in place in 2
minutes
PASE (Washburn 1993) § Measure of physical acIvity levels of older adults § Household, occupaIonal, and leisure
Ime acIvity § Each acIvity is given a weight; total
score is recorded as the sum of the amount of Ime in each acIvity mulIplied by the weight of the acIvity.
Males, n = 23 Mean (SD)
Females, n = 32 Mean (SD) p
Sit-‐to-‐stand 10.39 (4.46) 8.94 (4.12) .192
Arm curl 12.00 (4.20) 11.09 (4.51) .414
Step test 62.15 (25.86) 55.13 (28.72) .336
PASE 112.73 (63.86) 68.45 (48.11) .008
Males (n = 23) Females (n = 32)
Norm Range
PercenIle Rank
Norm Range
PercenIle Rank
Sit-‐to-‐stand 6 to 23 15th 4 to 21 10th to 15th
Arm curl 9 to 27 15th 6 to 24 15th
2-‐minute step test
48 to 135 5th to 10th 37 to 130 10th to 15th
PASE 102.4 n/a 89.1 n/a
ParIcipant Comparison to Age-‐related Norms
Bibliography: • Arcoverde C, Deslandes A, Rangel A, Rangel A, Pavao R, Nigri F, et al. Role of physical acIvity on the maintenance of cogniIon and
acIviIes of daily living in elderly with Alzheimer’s disease. Arq Neuro-‐Psiquiat. 2008;66:323-‐27. • Caspersen CJ, Powell KE, Christenson GM. Physical acIvity, exercise, and physical fitness: definiIons and disIncIons for health-‐
related research. Public Health Rep. 1985;100(2):126–31. • Hokkanen L, Rantala L, Remes AM, Harkonen B, Viramo P, Winblad I. Dance and movement therapeuIc methods in management
of demenIa: a randomized, controlled study. J Am Geriatr Soc. 2008;56:771-‐72. • Rikli RE, Jones JC. Development and validaIon of a funcIonal fitness test for community-‐residing older adults. • J Aging Phys Act. 1999;7:129-‐61 • Teri L, Logsdon RG, McCurry SM: Exercise intervenIons for demenIa and cogniIve impairment: the Seaile Protocols. J Nutr
Health Aging. 2008; 12:391394. • Washburn RA, Smith KW, Jeie AM, Janney CA. The Physical AcIvity Scale for the Elderly (PASE): development and valuaIon. J
Clin Epidemiol. 1993;46(2):153-‐62
8
Exam
inin
g th
e R
elat
ions
hip
Bet
wee
n Le
ader
ship
and
Su
stai
nabi
lity
of a
Dem
entia
Tra
inin
g Pr
ogra
m in
Lon
g-Te
rm C
are
Trac
y D
anyl
yshe
n-La
ycoc
k, P
h.D
. Can
dida
te, U
nive
rsity
of S
aska
tche
wan
and
Dr.
Deb
ra M
orga
n, U
nive
rsity
of
Sask
atch
ewan
Intr
oduc
tion
Obj
ectiv
es
Met
hods
R
esul
ts
Res
ults
Con
’t
Con
clus
ion
With
in h
ealth
car
e, th
ere
is a
n as
sum
ptio
n th
at o
nce
staf
f rec
eive
trai
ning
they
will
au
tom
atic
ally
impl
emen
t tho
se sk
ills i
n th
eir d
aily
pra
ctic
e. U
nfor
tuna
tely
, si
mpl
e di
ssem
inat
ion
of k
now
ledg
e is
not
ef
fect
ive
in c
reat
ing
and
sust
aini
ng
beha
viou
ral c
hang
e (N
utle
y, W
alte
r, &
D
avie
s, 20
03).
A k
ey fa
ctor
that
co
ntrib
utes
to su
stai
nabi
lity
of
educ
atio
nal p
rogr
ams i
n lo
ng-te
rm c
are
(LTC
) is t
he ro
le o
f lea
ders
hip
(Wal
lin e
t al
., 20
02).
For e
xam
ple,
stro
ng le
ader
ship
is
requ
ired
to “
cham
pion
” th
e ne
w
prog
ram
or i
nitia
tive
with
in th
e or
gani
zatio
n (E
vash
wic
k &
Ory
, 200
3). I
n lo
ng-te
rm c
are,
the
role
of l
eade
rshi
p ha
s no
t bee
n ex
amin
ed a
s ext
ensi
vely
as i
n ot
her h
ealth
car
e se
tting
s.
As
part
of a
larg
er s
tudy
of t
he G
PA
prog
ram
, the
pur
pose
of t
his
rese
arch
w
as to
exp
lore
the
role
of l
eade
rshi
p in
th
e su
stai
nabi
lity
of a
dem
entia
spe
cific
tra
inin
g pr
ogra
m fo
r sta
ff in
rura
l lon
g-te
rm c
are
hom
es.
.
• In
hom
es w
here
the
GPA
pro
gram
was
su
stai
ned,
the
lead
ersh
ip te
am
(Adm
inis
trato
r and
Dire
ctor
of C
are)
cr
eate
d a
cultu
re th
at w
as b
ased
on
the
philo
sphy
of p
erso
n-ce
ntre
d ca
re.
For
exam
ple,
the
lead
ersh
ip te
am su
ppor
ted
staf
f in
hono
ring
the
valu
es, b
elie
fs,
and
choi
ces o
f the
resi
dent
s.
• B
ehav
iour
s req
uire
d by
lead
ersh
ip
incl
uded
role
-mod
ellin
g th
e sk
ills t
hat
wer
e ta
ught
in th
e pr
ogra
m a
nd
coac
hing
staf
f who
wer
e st
rugg
ling
to
man
age
resp
onsi
ve b
ehav
iour
s. •
Oth
er le
ader
ship
beh
avio
urs t
hat
help
ed to
sust
ain
the
GPA
pro
gram
in
clud
ed: b
eing
vis
ible
in th
e LT
C
hom
e, sp
endi
ng ti
me
in th
e LT
C h
ome
to a
sses
s/ob
serv
e an
d su
ppor
t sta
ff to
us
e th
e G
PA sk
ills,
hold
ing
staf
f ac
coun
tabl
e w
hen
they
wer
e no
t usi
ng
the
GPA
skill
s, an
d m
eetin
g re
gula
rly
with
staf
f to
revi
ew/b
rain
stor
m h
ow th
e G
PA sk
ills c
ould
hel
p th
em m
anag
e re
spon
sive
beh
avio
urs.
In h
omes
whe
re th
e G
PA p
rogr
am w
as n
ot
sust
aine
d, th
e le
ader
ship
team
: •
Faile
d to
supp
ort t
he p
rogr
am.
It w
as
view
ed a
s “ju
st a
noth
er p
rogr
am.”
•
Cre
ated
a c
ultu
re o
f “in
stitu
tiona
lizat
ion”
w
here
resi
dent
s did
not
hav
e ch
oice
, car
e w
as fo
rced
on
resi
dent
s, an
d ta
sks w
ere
com
plet
ed o
n st
affs
’ tim
e sc
hedu
le.
• D
isci
plin
ed st
aff w
ho w
ere
prac
ticin
g G
PA.
• A
llow
ed b
ully
ing
of st
aff w
ho w
ere
prac
ticin
g G
PA.
• Sp
oke
nega
tivel
y ab
out t
he G
PA p
rogr
am
in fr
ont o
f the
ir st
aff.
Gen
tle P
ersu
asiv
e A
ppro
ache
s Pr
ogra
m
The
over
all g
oal o
f the
GPA
pro
gram
is to
ed
ucat
e st
aff h
ow to
: •
Use
a p
erso
n-ce
ntre
d, c
ompa
ssio
nate
ap
proa
ch w
ith in
divi
dual
s with
de
men
tia.
• R
espo
nd re
spec
tfully
, with
con
fiden
ce
and
skill
, to
resp
onsi
ve b
ehav
iour
s as
soci
ated
with
dem
entia
.
Two
com
plem
enta
ry st
udie
s wer
e co
nduc
ted
to e
xam
ine
the
rela
tions
hip
betw
een
sust
aina
bilit
y an
d le
ader
ship
in
rura
l lon
g-te
rm c
are
hom
es.
St
udy
One
(Ret
rosp
ectiv
e)
Des
ign:
cro
ss-s
ectio
nal,
retro
spec
tive
qual
itativ
e re
sear
ch d
esig
n.
Site
Sel
ectio
n: fi
ve ru
ral L
TC h
omes
in
Wes
tern
Can
ada
whe
re th
e G
PA
Prog
ram
was
impl
emen
ted
betw
een
May
an
d D
ecem
ber 2
010.
Pa
rtic
ipan
ts: t
his s
tudy
focu
sed
on th
e ex
perie
nces
of t
he A
dmin
istra
tors
, D
irect
ors o
f Car
e, M
anag
ers,
GPA
C
oach
es, N
urse
s, an
d N
ursi
ng A
ides
. D
ata
Col
lect
ion:
fou
r foc
us g
roup
s w
ith N
ursi
ng A
ides
and
14
sem
i-st
ruct
ured
int
ervi
ews w
ith
Adm
inis
trato
rs, D
irect
ors o
f Car
e,
Nur
ses,
and
GPA
Pro
gram
Coa
ches
wer
e co
mpl
eted
. St
udy
Two
(Pro
spec
tive)
D
esig
n: lo
ngitu
dina
l, m
ulti-
site
, co
mpa
rativ
e ca
se st
udy
desi
gn.
Site
Sel
ectio
n: tw
o ru
ral L
TC h
omes
w
ere
purp
osef
ully
sele
cted
to p
rovi
de
max
imum
var
iatio
n on
org
aniz
atio
nal
fact
ors t
hat m
ay in
fluen
ce su
stai
nabi
lity.
Pa
rtic
ipan
ts: a
ll st
aff w
ithin
the
two
LTC
ho
mes
wer
e el
igib
le.
Dat
a C
olle
ctio
n: i
nter
view
s wer
e co
nduc
ted
with
18
staf
f fro
m a
ll de
partm
ents
in b
oth
hom
es.
In a
dditi
on,
85 h
ours
of d
irect
ion
obse
rvat
ion
and
25
hour
s of s
hado
win
g st
aff w
ere
cond
ucte
d ov
er 1
4 m
onth
s. R
esid
ent c
harts
, inc
iden
t re
ports
, and
com
mun
icat
ion
logs
wer
e re
view
ed.
• In
ord
er fo
r the
GPA
pro
gram
to b
e su
stai
ned
in L
TC, t
he le
ader
ship
team
m
ust f
ully
supp
ort t
he p
rogr
am, m
odel
th
e G
PA sk
ills,
and
coac
h th
ose
indi
vidu
als w
ho a
re st
rugg
ling
to
chan
ge th
eir p
ract
ice.
•
To su
ppor
t the
pro
gram
, lea
ders
mus
t pr
omot
e pe
rson
-cen
tred
care
by
crea
ting
a cu
lture
that
allo
ws f
or
resi
dent
cho
ice,
adh
eren
ce to
resi
dent
ro
utin
e, a
nd li
fe c
hoic
es.
9
à E
ach
of th
e 53
per
sons
re
ceiv
ed a
n in
terd
isci
plin
ary
di
agno
sis o
f de
men
tia
INT
RO
DU
CT
ION
Purp
ose
à E
xam
inin
g re
liabl
e ch
ange
in R
BA
NS
scor
es fo
r per
sons
w
ith d
emen
tia a
t a o
ne y
ear i
nter
val u
sing
pre
dete
rmin
ed
regr
essi
on fo
rmul
as fr
om a
nor
mat
ive
sam
ple
Bac
kgro
und
à P
ast l
itera
ture
sugg
ests
RC
I inc
orpo
rate
s rel
iabi
lity
in
calc
ulat
ion
of sm
all b
ut m
eani
ngfu
l cha
nge
in h
ealth
st
atus
ove
r tim
e1,2,
3.5
à R
CI o
ffers
mor
e in
sigh
tful c
linic
al in
terp
reta
tions
than
gr
oup-
leve
l sta
tistic
s3,5
à R
BA
NS
has l
evel
of d
iffic
ulty
app
ropr
iate
for n
orm
al
olde
r adu
lts th
roug
h in
divi
dual
s with
mod
erat
ely
seve
re
dem
entia
1,4
à D
evel
opm
ent o
f “no
rmal
” re
gres
sion
-bas
ed c
hang
e al
gorit
hms a
llow
for b
road
er a
pplic
atio
n2,5
à I
nitia
l per
form
ance
on
test
foun
d to
be
best
pre
dict
or o
f re
test
per
form
ance
2
R
elia
ble
Cha
nge
(RC
I) on
Rep
eata
ble
Bat
tery
for t
he A
sses
smen
t
of N
euro
psyc
holo
gica
l Sta
tus
(RB
AN
S) in
a D
emen
tia S
ampl
e
RE
SU
LTS
of N
euro
psyc
holo
gica
l Sta
tus
(RB
AN
S) in
a D
emen
tia S
ampl
e B
enja
min
Gou
ld1 ,
Joe
Enrig
ht1 ,
M. E
. O’C
onne
ll1, &
Deb
ra M
orga
n2
1 D
epar
tmen
t of P
sych
olog
y, U
nive
rsity
of S
aska
tche
wan
, 2C
anad
ian
Cen
tre
for H
ealth
and
Saf
ety
in A
gric
ultu
re, U
nive
rsity
of S
aska
tche
wan
à 5
3 pa
rtici
pant
s (57
% fe
mal
e) a
t the
Rur
al a
nd R
emot
e M
emor
y C
linic
who
wer
e di
agno
sed
with
dem
entia
bas
ed
on in
terv
iew
with
pat
ient
and
fam
ilies
in a
dditi
on to
: à R
ecen
t blo
od w
ork
à C
T he
ad sc
an
à N
euro
logi
cal a
sses
smen
t à N
euro
psyc
holo
gica
l ass
essm
ent
à P
hysi
cal t
hera
py a
sses
smen
t T
he sa
mpl
e on
ly in
clud
ed p
atie
nts w
ho c
ompl
eted
all
neur
opsy
chol
ogic
al v
aria
bles
at c
linic
day
and
1 y
ear
late
r
DIS
CU
SS
ION
Pers
ons w
ith d
emen
tia fr
om th
is sa
mpl
e de
mon
stra
ted
a de
clin
e be
yond
that
exp
ecte
d ba
sed
on a
cog
nitiv
ely
heal
thy
olde
r adu
lt sa
mpl
e on
all
RB
AN
S in
dice
s (M
ean)
, but
indi
vidu
al
varia
bilit
y re
gard
ing
decl
ine
vs st
abili
ty v
s im
prov
emen
t was
se
en m
ost o
ften
on th
e La
ngua
ge In
dex.
No
pers
on w
ith
dem
entia
impr
oved
on
Imm
edia
te M
emor
y.
Ass
ocia
tions
bet
wee
n pe
rson
s with
dem
entia
’s R
BA
NS
Pred
icte
d-A
ctua
l RB
AN
S sc
ores
with
dem
entia
seve
rity)
(C
linic
al D
emen
tia R
atin
g-Su
m o
f box
scor
es sc
ores
) wer
e tri
vial
or s
mal
l in
mag
nitu
de a
nd st
atis
tical
ly n
on-s
igni
fican
t.
Futu
re D
irec
tions
Ø F
utur
e re
sear
ch w
ill a
im to
det
erm
ine
if a
rela
tions
hip
exis
ts b
etw
een
this
cog
nitiv
e ba
ttery
dem
onst
rativ
e of
m
eani
ngfu
l cha
nge
and
som
e fo
rm o
f fun
ctio
nal
asse
ssm
ent s
cale
.
1 Atti
x, D
. K.,
Sto
ry, T
. J.,
Che
lune
, G. J
., B
all,
J. D
., S
tutts
, M. L
., H
art R
. P.,
& B
arth
J. T
. (20
09).
The
pred
ictio
n of
Cha
nge:
Nor
mat
ive
neur
opsy
chol
ogic
al tr
ajec
torie
s, T
he C
linic
al N
euro
psyc
holo
gist
, 23(
1), 2
1-38
. 2 D
uff,
K.,
Sch
oenb
erg,
M. R
., P
atto
n, D
., P
auls
en, J
. S.,
Bay
less
, J. D
., M
old,
J.,
Sco
tt, J
. G.,
& A
dam
s, R
. L. (
2005
). R
egre
ssio
n-ba
sed
form
ulas
fo
r pre
dict
ing
chan
ge in
RB
AN
S s
ubte
sts
with
old
er a
dults
, Arc
hive
s of
Clin
ical
Neu
rops
ycho
logy
, 20,
281
-290
. 3 S
chm
itt, J
. S.,
& D
i Fab
io, P
. D. (
2004
). R
elia
ble
chan
ge a
nd m
inim
um im
porta
nt d
iffer
ence
(MID
) pro
porti
ons
faci
litat
ed g
roup
resp
onsi
vene
ss
com
paris
ons
usin
g in
divi
dual
thre
shol
d cr
iteria
, Jou
rnal
of C
linic
al E
pide
mio
logy
, 57,
100
8-10
18.
4 Hob
son,
V. L
., H
all,
J. R
., H
umph
reys
-Cla
rk, J
. D.,
Sch
rimsh
er, G
. W.,
& O
’Bry
ant,
S. E
. (20
10).
Iden
tifyi
ng fu
nctio
nal i
mpa
irmen
t with
sco
res
from
the
repe
atab
le b
atte
ry fo
r the
ass
essm
ent o
f neu
rops
ycho
logi
cal s
tatu
s (R
BA
NS
), In
tern
atio
nal J
ourn
al o
f Ger
iatri
c P
sych
iatry
, 25,
525
-530
. 5 D
uff,
K.,
Sch
oenb
erg,
M. R
., P
atto
n, D
., M
old,
J.,
Sco
tt, J
. G.,
& A
dam
s, R
. L. (
2004
). P
redi
ctin
g ch
ange
with
the
RB
AN
S in
a c
omm
unity
dw
ellin
g el
derly
sam
ple,
Jou
rnal
of t
he In
tern
atio
nal N
euro
psyc
holo
gica
l Soc
iety
, 10,
828
-834
.
M
in
Max
M
SD
Patie
nt a
ge a
t clin
ic d
ay
44
92
70.7
9 10
.91
Form
al E
duca
tion
4 16
11
.45
2.67
Dia
gnos
is
f A
lzhe
imer
’s d
isea
se
28
Vasc
ular
dem
entia
4
Fron
tote
mpo
ral d
emen
tia (F
TD)
FT
D, f
ront
al v
aria
nt
7
FTD
, sem
antic
var
iant
1
FT
D, p
rogr
essi
ve n
on-f
luen
t 1
Dem
entia
mul
tiple
aet
iolo
gies
6
Dem
entia
med
ical
con
ditio
n 3
Dem
entia
with
Lew
y bo
dies
3
Tota
l 53
RB
AN
S Te
st R
e-te
st M
eans
In
ital
M (S
D)
1 yr
M
(SD
) R
BA
NS-
Imm
edia
te M
emor
y 69
.15
(14.
09)
65.5
7 (1
5.91
)*
RB
AN
S- V
isuo
spat
ial/C
onst
ruct
80
.47
(16.
68)
80.5
5 (1
5.35
) R
BA
NS-
Lan
guag
e In
dex
84.9
4 (1
1.95
) 80
.02
(16.
13)*
*
RB
AN
S- A
ttent
ion
Inde
x 79
.49
(16.
04)
75.3
6 (1
5.09
)*
RB
AN
S- D
elay
ed M
emor
y 60
.09
(17.
25)
57.4
0 (1
6.82
) R
BA
NS-
Tot
al S
cale
68
.13
(10.
47)
64.9
6 (1
1.99
)*
à Pr
edet
erm
ined
regr
essi
on fo
rmul
as d
evel
oped
from
a
norm
ativ
e po
pula
tion5 w
ere
used
to d
eter
min
e pr
edic
ted
re-te
st sc
ores
for p
erso
ns w
ith d
emen
tia
à P
redi
cted
re-te
st sc
ores
on
RB
AN
S in
dexe
s wer
e co
mpa
red
to a
ctua
l re-
test
scor
es
à C
orre
latio
n be
twee
n R
BA
NS
Inde
x sc
ores
and
Clin
ical
D
emen
tia R
atin
g –
sum
of b
ox sc
ores
– se
verit
y m
easu
re
ME
TH
OD
RR
MC
Fun
ding
and
in-k
ind
supp
ort i
s ge
nero
usly
pro
vide
d by
:
RB
AN
S In
dex
Ran
ge o
f Pr
edic
ted
-A
ctua
l Sco
res
Pred
icte
d-A
ctua
l Mea
n Sc
ores
# w
here
Act
ual R
e-sc
ores
hig
her t
han
Pred
icte
d Im
m M
emor
y 2.
01 –
79.
57
35.1
1 0
Vis
uosp
atia
l -1
.77
– 75
.74
33.3
9 1
Lang
uage
-1
8.98
– 3
7.65
8.
78
12
Atte
ntio
n
-23.
72 –
50.
76
12.3
5 7
Del
Mem
ory
-17.
64 –
47.
21
15.8
7 6
RB
AN
S In
dex
C
orre
latio
n w
ith C
DR
r (
p)
RB
AN
S- Im
med
iate
Mem
ory
.129
(p >
0.0
5)
RB
AN
S- V
isuo
spat
ial/C
onst
ruct
.0
13 (p
> 0
.05)
R
BA
NS-
Lan
guag
e In
dex
.056
(p >
0.0
5)
RB
AN
S- A
ttent
ion
Inde
x .2
06 (p
> 0
.05)
R
BA
NS-
Del
ayed
Mem
ory
.094
(p >
0.0
5)
RB
AN
S- T
otal
Sca
le
.147
(p >
0.0
5)
RE
SU
LTS
Con
tact
10
11
GAME 4 BOYS
An exploration of commercial gaming technology as a leisure activity for older men
with dementia in rural Dorset
This project aims to address a real world issue for Age UK Dorchester and engage older men with demen:a in rural areas of Dorset who are at risk of social exclusion and poor well-‐being. A technological ini:a:ve using commercial gaming systems (Nintendo DS, Wii, MicrosoH Kinect and iPads) has been chosen to accomplish this. The research splits into two empirical phases. The first, a consulta:on phase to develop the ini:a:ve. The second (main Doctoral study) is an explora:on of the impact of the technological ini:a:ve for older men with demen:a in rural areas of Dorset.
The consulta:on phase was undertaken in the laLer part of 2013. It was designed to explore the feasibility of engaging older men with demen:a with commercial computer game technology. A user-‐focussed approach was adopted which enabled the par:cipants to work as ac:ve collaborators in the design of the technological ini:a:ve. Four one-‐off consulta:on sessions using commercial gaming systems were undertaken with older men with demen:a in various rural areas of Dorset. Their experiences of engaging with the technology and par:cipa:ng in the groups were elicited through discussions with the men as well as observa:ons and reflec:ve field-‐notes. The data ascertained from the consulta:on phase fed into the research design for the main doctoral study.
The main study will implement three technological ini:a:ves each las:ng eight weeks (one per week) in three rural communi:es of Dorset. The groups will adopt a Par:cipatory Ac:on Research approach, working with older men (65+) with demen:a to explore their experiences of engaging in the groups and monitor the outcomes to their well-‐being. Two innova:ve methods will be used to collect the data; ‘Photovoice’ and ‘Walking interviews.’ It is envisaged that the research design will lead to longer term beneficial effects for the well-‐being of the par:cipants. The technological ini:a:ves will conclude in early 2015 and a final report alongside guidance documenta:on (produced in collabora:on with the par:cipants) will be published later that year.
LEVEL 1: PROJECT INTRODUCTION
LEVEL 2: CONSULTATION PHASE
LEVEL 3: MAIN DOCTORAL STUDY
Ben Hicks: [email protected]
12
All
follo
w-u
p ap
poin
tmen
ts a
re n
ow v
ia te
lehe
alth
.
• Thi
s pr
oces
s w
as im
plem
ente
d in
Dec
embe
r 200
8 ba
sed
on re
sear
ch s
how
ing
high
pa
tient
and
fam
ily s
atis
fact
ion
with
tele
heal
th.
RU
RA
L A
ND
RE
MO
TE
ME
MO
RY
CLIN
IC –
UPD
AT
E (M
arch
2004 –
Jun
e 2014)
L. H
olfe
ld1 ,
D. M
orga
n1, M
. O’C
onne
ll2, M
. Cro
ssle
y2, A
. Kirk
3 , N
. Ste
war
t4 ,V.
Dal
Bel
lo-H
aas5
, L. M
cBai
n6, A
. Cam
mer
1 , D
. Min
ish1
, R
. Bee
ver1
, J. K
oste
niuk
1
Back
grou
nd
Fu
ll-D
ay
Coo
rdin
ate
d A
sses
smen
t
Ru
ral an
d R
emot
e M
emor
y C
lin
ic
Pati
ent
Ref
erra
ls p
er R
ura
l H
ealt
h A
uth
orit
y n
= 4
60 (Ju
ne
2014)
Sask
atc
hew
an
Tel
ehea
lth
Sit
es (2
014)
(Pre
-clin
ic A
sses
smen
ts a
nd F
ollo
w-u
ps)
Intr
oduc
tion:
• R
ural
and
Nor
ther
n S
aska
tche
wan
hav
e a
low
pop
ulat
ion
dens
ity re
sulti
ng in
larg
e tra
vel b
urde
n fo
r med
ical
vis
its
• Rur
al S
K is
old
er, o
n av
erag
e, th
an u
rban
and
is h
ome
to
man
y ol
der a
dults
• Ris
k fo
r dem
entia
incr
ease
s w
ith a
ge
• Pre
-clin
ic a
sses
smen
t of p
atie
nt a
nd c
areg
iver
s is
con
duct
ed v
ia te
lehe
alth
to
prep
are
them
for t
he o
ne-d
ay a
sses
smen
t, fa
mili
ariz
e th
em w
ith th
e cl
inic
nur
se
who
will
be
thei
r car
e lia
ison
, ord
er b
lood
wor
k or
oth
er te
sts,
and
gat
her
info
rmat
ion
to a
ssis
t with
pla
nnin
g th
e on
e-da
y as
sess
men
t • C
oord
inat
ed a
sses
smen
t tak
es p
lace
in S
aska
toon
, is
appr
oxim
atel
y 8
hour
s,
and
invo
lves
the
patie
nt a
nd th
eir i
nfor
mal
car
egiv
ers
1 Can
adia
n C
entre
for H
ealth
and
Saf
ety
in A
gric
ultu
re, U
nive
rsity
of S
aska
tche
wan
; 2D
epar
tmen
t of P
sych
olog
y, U
nive
rsity
of S
aska
tche
wan
; 3C
olle
ge o
f Med
icin
e, U
nive
rsity
of S
aska
tche
wan
; 4 C
olle
ge o
f Nur
sing
, Uni
vers
ity o
f Sas
katc
hew
an; 5
Sch
ool o
f Reh
abili
tatio
n, M
cMas
ter U
nive
rsity
; 6 F
irst N
atio
ns U
nive
rsity
of C
anad
a
Clin
ic G
oal:
• To
deve
lop
and
eval
uate
a s
trea
mlin
ed in
tegr
ated
clin
ic fo
r pat
ient
s fro
m ru
ral
and
rem
ote
Sas
katc
hew
an fo
r dia
gnos
is a
nd m
anag
emen
t of d
emen
tia a
nd to
ev
alua
te te
lehe
alth
as
a m
eans
of d
eliv
erin
g fo
llow
-up
care
Rur
al a
nd R
emot
e M
emor
y C
linic
Pat
tern
:
Ref
erra
l by
GP
or N
P to
clin
ic v
ia
neur
olog
ist
Pre-
clin
ic
asse
ssm
ent v
ia
tele
heal
th
Follo
w-u
ps
via
tele
heal
th
(Yea
rly
follo
w-u
ps v
ia
in-p
erso
n)
8 -1
0 m
onth
w
ait-t
ime
wai
t-tim
e
Follo
w-u
ps a
s pe
r 1
mon
th
Neu
rolo
gist
and
Year
ly
Sam
e-da
y C
oord
inat
ed
Ass
essm
ent
End
of D
ay T
eam
C
onfe
renc
e, G
P in
vite
d to
pa
rtici
pate
via
te
leco
nfer
ence
Dia
gnos
is a
nd T
reat
men
t P
lan
com
mun
icat
ed to
fa
mily
Neu
rolo
gist
Neu
rops
ycho
logi
st
Psyc
hom
etris
t
Dia
gnos
tic
Imag
ing
Phys
ical
Th
erap
ist
Clin
ic N
urse
Team
C
onfe
renc
e,
Dia
gnos
is
and
Car
e Pl
anni
ng
Team
Mee
ts
with
Pat
ient
an
d Fa
mily
Com
paris
on o
f tra
vel t
ime
and
di
stan
ce s
aved
: • M
ean
dist
ance
from
hom
e to
T
eleh
ealth
= 3
2.7
km
• Mea
n di
stan
ce fr
om h
ome
to
Sas
kato
on =
267
.5 k
m
Dis
tanc
e sa
ved
by T
eleh
ealth
= 2
34.7
km
(o
ne-w
ay)
Tele
heat
h: In
201
4 th
ere
are
over
235
Te
lehe
alth
site
s cu
rren
tly o
pera
ting
in
prov
inci
al, r
egio
nal a
nd n
orth
ern
hosp
itals
in
Sask
atch
ewan
. Tel
ehea
lth c
an a
lso
link
with
ot
her s
elec
t site
s pr
ovin
cial
ly, n
atio
nally
and
in
tern
atio
nally
.
Mea
n A
ge =
70.
71 y
rs
Ran
ge A
ge =
22
- 97
yrs
Gen
der:
43%
Mal
es
58
% F
emal
es
RR
MC
Dem
ogra
ph
ics
n
= 4
61 (Ju
ne
2014)
Alz
heim
er D
isea
se -
162
Oth
er d
emen
tias:
- V
ascu
lar D
emen
tia –
10
- Dem
entia
with
Lew
y B
odie
s –
17
- Fro
ntal
Tem
pora
l – 3
4 - D
emen
tia d
ue to
Med
ical
Con
ditio
n - 5
- C
ogni
tive
Impa
irmen
t Not
Oth
erw
ise
Spe
cifie
d - 1
3
-
Dem
entia
due
to
M
ultip
le E
tiolo
gies
– 1
6 - S
ub-c
ortic
al D
emen
tia -
3 O
ther
dia
gnos
es:
- No
Cog
nitiv
e Im
pairm
ent –
81
- M
ild C
ogni
tive
Impa
irmen
t – 7
0
Clin
ical D
iagn
oses
to
Date
n
= 4
11 (Ju
ne
2014)
ww
w.c
chsa
-ccs
sma.
usas
k.ca
/rura
ldem
entia
care
Fund
ing
and
in-k
ind
supp
ort i
s ge
nero
usly
pro
vide
d by
:
Die
titia
n
Blo
odw
ork
&
ECG
38
2
32
38
87
79
29
80
4
15
5
26
25
13
The
In'lu
ence
of I
ndiv
idua
l and
Org
aniz
atio
nal F
acto
rs o
n Pe
rson
-‐Cen
tred
Ap
proa
ches
to D
emen
tia
Care
Pa
ule&
e Hu
nter
, Ph.
D., S
t. Th
omas
Mor
e Co
llege
, Uni
vers
ity o
f Sas
katc
hew
an; T
hom
as H
adjis
tavr
opou
los, P
hD.,
Uni
vers
ity o
f Reg
ina
and
Cent
re fo
r Agi
ng a
nd H
ealth
Lilia
n Th
orpe
, MD,
PhD
, FRC
PC, U
nive
rsity
of S
aska
tche
wan
; Dav
id M
allo
y, F
acul
ty o
f Kin
esio
logy
& H
ealth
Stu
dies
, PhD
Uni
vers
ity o
f Reg
ina;
Fio
na F
ick,
Uni
vers
ity o
f Sas
katc
hew
an
This evalua+
on was fu
nded
by the Saskatchew
an Health
Research Foun
da+o
n.
The
Sask
atch
ewan
Hea
lth
Rese
arch
Fou
ndat
ion
prov
ided
sup
port
for th
is w
ork.
Back
grou
nd
A pe
rson
-‐cen
tred
app
roac
h to
war
d lo
ng-‐t
erm
care
resi
dent
s w
ith d
emen
tia p
rom
otes
qua
lity
of li
fe (K
itwoo
d, 1
997)
. Mos
t in
terv
entio
ns to
pro
mot
e pe
rson
-‐cen
tred
resi
dent
ial
dem
entia
care
(PCR
DC) c
all f
or a
tten
tion
to th
e at
titud
es a
nd
actio
ns o
f ind
ivid
ual c
are
prov
ider
s tow
ard
long
-‐ter
m ca
re
resi
dent
s and
pla
ce le
ss e
mph
asis
on
orga
niza
tiona
l con
text
s. Th
ere
is li
ttle
evi
denc
e to
sugg
est w
hich
them
e de
serv
es
grea
ter a
tten
tion.
To
sum
mar
ize
brie
Jly:
• Pr
evio
us w
ork
sugg
ests
that
stru
ctur
al e
mpo
wer
men
t (e.
g.,
pow
er, i
nfor
mat
ion,
supp
ort,
and
reso
urce
s) e
xpla
ins
appr
oxim
atel
y ha
lf th
e va
rian
ce in
self-‐
repo
rted
in
divi
dual
ised
care
(Cas
par &
O’R
ourk
e, 2
008)
. H
ypot
hesi
s: O
rgan
isat
iona
l cha
ract
eris
tics i
n3lu
ence
PC
RDC.
•
Seve
ral s
tudi
es su
gges
t tha
t hig
her l
evel
s of e
duca
tion
and/
or q
ualiJ
icat
ions
are
ass
ocia
ted
with
mor
e po
sitiv
e,
pers
on-‐c
entr
ed, o
r hop
eful
att
itude
s tow
ard
long
-‐ter
m
care
resi
dent
s with
dem
entia
(e.g
., Nor
man
n, A
splu
nd, &
N
orbe
rg, 1
999)
alth
ough
such
Jind
ings
are
not
uni
vers
al
(e.g
., Mac
Dona
ld &
Woo
ds, 2
005)
. Few
stud
ies h
ave
exam
ined
the
role
of a
ge a
nd g
ende
r in
dete
rmin
ing
attit
udes
and
ther
e is
a d
eart
h of
evi
denc
e ab
out e
mpl
oyee
fa
ctor
s ass
ocia
ted
with
per
son-‐
cent
red
beha
viou
r. H
ypot
hesi
s: A
ge, g
ende
r, y
ears
of e
duca
tion,
and
oc
cupa
tion
in3lu
ence
PCR
DC.
•
Belie
fs a
bout
per
sonh
ood
in d
emen
tia a
ccou
nt fo
r a sm
all
but s
igni
Jican
t am
ount
of v
aria
nce
in in
tend
ed a
ppro
ache
s to
pai
n m
anag
emen
t for
per
sons
with
dem
entia
(Hun
ter e
t al
., 201
3). A
mod
erat
e as
soci
atio
n be
twee
n be
liefs
abo
ut
pers
onho
od a
nd b
elie
fs a
bout
the
impo
rtan
ce o
f per
son-‐
cent
red
care
has
als
o be
en d
ocum
ente
d (H
unte
r et a
l.,
2013
). H
ypot
hesi
s: E
mpl
oyee
bel
iefs
abo
ut p
erso
nhoo
d in
3luen
ce P
CRD
C.
• Bu
rnou
t is a
ssoc
iate
d w
ith le
ss p
ositi
ve a
ttitu
des a
nd
low
er e
mpa
thy
tow
ard
peop
le w
ith d
emen
tia (e
.g., A
stro
m,
Nils
son,
Nor
berg
, San
dman
, & W
inbl
ad, 1
991)
, as w
ell a
s a
decr
ease
d w
illin
g ne
ss to
hel
p, lo
w o
ptim
ism
, and
neg
ativ
e em
otio
nal r
espo
nses
(Tod
d &
Wat
ts, 2
005)
. Hyp
othe
sis:
Em
ploy
ee b
urno
ut in
3luen
ces P
CRD
C.
The
purp
ose
of th
is st
udy
was
to in
vest
igat
e th
e co
ntri
butio
ns
of o
rgan
izat
iona
l fac
tors
and
care
pro
vide
rs’ p
erso
nal
qual
ities
to se
lf-‐re
port
ed P
CRDC
.
Met
hod
Desi
gn:
• A
corr
elat
iona
l des
crip
tive
surv
ey
Part
icip
ants
: •
109
staf
f mem
bers
from
two
larg
e ru
ral l
ong-‐
term
care
hom
es
• 10
% m
ale
and
90%
fem
ale;
25%
nur
ses,
41%
care
aid
es, a
nd 3
4% o
ther
; ave
rage
age
43
(SD
= 12
.71)
M
easu
res :
•
The
Pers
on-‐D
irec
ted
Care
scal
e (P
DC; W
hite
, New
ton-‐
Curt
is, &
Lyo
ns, 2
008)
mea
sure
d se
lf-‐re
port
ed p
erso
n-‐ce
ntre
d ca
re a
cros
s the
se su
bsca
les:
Aut
onom
y, P
erso
nhoo
d, K
now
ing
the
Pers
on, C
omfo
rt C
are,
and
Sup
port
ing
Rela
tions
hips
. •
The
Envi
ronm
enta
l Sup
port
for P
erso
n-‐Di
rect
ed C
are
scal
e (W
hite
et a
l., 2
008)
mea
sure
d or
gani
satio
nal-‐e
nvir
onm
enta
l sup
port
s for
per
son-‐
cent
red
care
. •
The
Pers
onho
od in
Dem
entia
Que
stio
nnai
re (H
unte
r et a
l., 2
013)
ass
esse
d be
liefs
abo
ut
pers
onho
od in
dem
entia
. •
The
Mas
lach
Bur
nout
Inve
ntor
y –
Hum
an S
ervi
ces S
cale
(Mas
lach
& Ja
ckso
n, 1
996)
ass
esse
d bu
rnou
t. •
A de
mog
raph
ic fo
rm d
ocum
ente
d ag
e, g
ende
r, ye
ars o
f edu
catio
n, a
nd o
ccup
atio
n.
Anal
ysis
: •
Hie
rarc
hica
l reg
ress
ion:
Wor
kpla
ce fa
ctor
s, de
mog
raph
ic fa
ctor
s, be
liefs
abo
ut p
erso
nhoo
d,
and
burn
out,
wer
e re
gres
sed,
in th
at o
rder
, on
each
PDC
subs
cale
.
Resu
lts
In a
seri
es o
f hie
rarc
hica
l reg
ress
ion
mod
els e
xam
inin
g Jiv
e as
pect
s of P
CRDC
(see
Tab
les)
, we
foun
d th
at o
rgan
izat
iona
l fac
tors
wer
e ro
bust
pre
dict
ors o
f PCR
DC, e
xpla
inin
g 17
to 3
4 pe
rcen
t of
scor
e va
rian
ce o
n th
e PD
C in
eac
h of
the
Jive
mod
els,
afte
r con
trol
ling
for e
mpl
oyee
de
mog
raph
ic fa
ctor
s. Pe
rson
al v
aria
bles
wer
e al
so im
port
ant f
or so
me
type
s of P
CRDC
: gen
der
for c
omfo
rt ca
re, b
elie
fs a
bout
per
sonh
ood
for e
mpa
thic
resp
onse
s to
resi
dent
s’ di
sabi
litie
s (i.e
., pe
rson
hood
subs
cale
of P
DC),
and
burn
out f
or co
mfo
rt ca
re a
nd su
ppor
t for
rela
tions
hips
. Bel
iefs
ab
out p
erso
nhoo
d an
d bu
rnou
t wer
e as
sess
ed a
s lat
er st
eps i
n th
e re
gres
sion
mod
els,
mea
ning
th
at th
ey re
mai
ned
impo
rtan
t for
som
e ty
pes o
f PCR
DC a
fter c
ontr
ollin
g fo
r oth
er fa
ctor
s.
Dis
cuss
ion
This
stud
y co
ntri
bute
s to
emer
ging
evi
denc
e su
gges
ting
that
org
aniz
atio
nal f
acto
rs (e
.g.,
colla
bora
tion
in ca
re a
nd th
e bu
ilt a
nd so
cial
env
iron
men
t of c
are)
are
ver
y im
port
ant t
o PC
RDC.
PC
RDC
is a
mul
ti-‐di
men
sion
al co
nstr
uct,
and
pers
onal
var
iabl
es in
clud
ing
gend
er, b
elie
fs a
bout
pe
rson
hood
in d
emen
tia, a
nd b
urno
ut a
lso
appe
ar to
be
impo
rtan
t for
som
e of
its d
imen
sion
s. Al
thou
gh e
ach
of th
ese
obse
rvat
ions
requ
ires
furt
her s
tudy
, thi
s res
earc
h in
vite
s fur
ther
co
nsid
erat
ion
of o
rgan
izat
iona
l and
per
sona
l fac
tors
whe
n de
sign
ing
and
impl
emen
ting
inte
rven
tions
to e
nhan
ce p
erso
n-‐ce
ntre
d re
side
ntia
l dem
entia
care
.
Tabl
es
14
myP
LAN
1.0
: Res
iden
t Cen
tred
Car
e Pl
anni
ng In
Lon
g Te
rm C
are!
Jan
Ber
ger,
BSN
RN
- L
ynda
Ble
vins
BSN
RN
- T
ara
Evje
n, B
SN R
N -
Kar
en G
elow
itz, M
SN R
N -
Laur
een
Nei
n, B
SN R
N -
Dia
ne N
owla
n, B
SN R
N -
A
licia
Tie
djen
s, B
SN R
N -
Jill
Wer
le, B
SN R
N!
!
myP
LAN
1.0
Dev
elop
men
t O
ur d
evel
opm
ent p
roce
ss in
clud
ed:
• lo
okin
g at
car
e pl
anni
ng to
ols
from
oth
er s
ourc
es
• co
nsul
ting
with
resi
dent
s, fa
mili
es, l
ong
term
car
e ho
me
staf
f an
d ot
her c
onsu
ltant
s (s
peec
h la
ngua
ge p
atho
logi
sts,
di
etiti
ans,
beh
avio
ur m
anag
emen
t spe
cial
ists
) . •
pilo
ting
and
revi
sing
the
myP
LAN
A
s a
resu
lt, m
yPLA
N 1
.0 is
a re
side
nt-c
entre
d, in
terd
isci
plin
ary
tool
that
coo
rdin
ates
resi
dent
pre
fere
nces
, car
e ne
eds,
goa
ls,
and
outc
omes
. MyP
LAN
1.0
is o
rgan
ized
usi
ng R
AI-M
DS
2.0
as
sess
men
t sec
tions
suc
h as
bed
mob
ility
, tra
nsfe
r, pe
rson
al
hygi
ene,
cog
nitiv
e pa
ttern
s/de
cisi
on m
akin
g, c
ontin
ence
&
deal
ing
with
pai
n. A
lso,
ther
e ar
e fo
ur d
iffer
ent c
ateg
orie
s of
in
form
atio
n in
the
myP
LAN
1.0
: All
Abo
ut M
e, A
ll A
bout
My
Car
e, N
ursi
ng R
ehab
ilita
tion
and
CA
Ps.
The
se a
re d
escr
ibed
to
the
right
.
Bac
kgro
und
The
Sas
kato
on H
ealth
Reg
ion
has
over
220
0 re
side
nts
who
re
side
in 3
0 lo
ng te
rm c
are
hom
es. E
ach
resi
dent
is a
sses
sed
quar
terly
usi
ng th
e R
esid
ent A
sses
smen
t Ins
trum
ent -
Min
imum
da
ta s
et 2
.0 (R
AI-M
DS
2.0
). A
naly
sis
of th
e as
sess
men
t dat
a tri
gger
s th
e in
terR
AI C
linic
al A
sses
smen
t Pro
toco
ls (C
AP
s).
Prio
r to
the
deve
lopm
ent o
f myP
LAN
1.0
, exi
stin
g ca
re p
lans
: •
wer
e no
t con
sist
ently
revi
ewed
and
upd
ated
by
care
team
s •
did
not i
nclu
de m
easu
rabl
e go
als
• di
d no
t alig
n w
ith th
e ne
w R
AI-M
DS
CA
Ps
We
need
ed a
tool
that
add
ress
ed th
ese
issu
es a
nd:
• cr
eate
d a
stro
ng li
nk b
etw
een
resi
dent
s’ p
refe
renc
es a
nd
thei
r car
e pl
ans
• ca
ptur
ed c
hang
es in
resi
dent
s’ p
refe
renc
es, h
ealth
, and
car
e ov
er ti
me
• en
gage
d ca
re te
ams,
incl
udin
g th
e re
side
nt a
nd fa
mily
, to
regu
larly
revi
ew a
nd u
pdat
e th
e go
al-d
irect
ed p
lan
Nur
sing
Reh
abili
tatio
n is
us
ed b
y th
e ca
re te
am,
incl
udin
g th
e re
side
nt, w
hen
ther
e is
a g
oal t
o m
aint
ain
or
impr
ove
the
resi
dent
’s
abili
ties.
The
pla
n m
ust m
eet
RA
I-MD
S 2
.0 re
quire
men
ts fo
r nu
rsin
g re
habi
litat
ion
such
as
taki
ng a
t lea
st 1
5 m
inut
es
myP
LAN
1.0
Det
ails
Th
e A
ll A
bout
Me
cont
ains
in
form
atio
n an
d pr
efer
ence
s fro
m th
e re
side
nt. T
he A
ll A
bout
My
Car
e co
nnec
ts th
e A
ll A
bout
Me
and
othe
r hea
lth
info
rmat
ion
to s
peci
fic d
etai
ls
abou
t the
resi
dent
’s c
are.
Clin
ical
Ass
essm
ent
Prot
ocol
s ar
e tri
gger
ed
thro
ugh
anal
ysis
of
asse
ssm
ent d
ata
with
in R
AI—
MD
S 2
.0. T
he C
AP
s fa
ll in
to
four
bro
ad c
ateg
orie
s:
func
tiona
l per
form
ance
, co
gniti
ve a
nd m
enta
l hea
lth,
soci
al li
fe a
nd c
linic
al is
sues
.
each
day
. Exa
mpl
es a
re: w
alki
ng, t
rans
ferr
ing,
mov
ing
in b
ed,
eatin
g an
d ot
hers
. The
pla
n m
ust b
e re
view
ed, e
valu
ated
and
re
vise
d at
leas
t eve
ry 9
0 da
ys.
The
purp
ose
of C
AP
s fo
r the
resi
dent
is to
reso
lve
prob
lem
s,
redu
ce th
e ris
k of
dec
line
or in
crea
se th
e po
tent
ial f
or
impr
ovem
ent.
Car
e te
ams
may
dev
elop
thei
r ow
n go
als
or u
se
thos
e pr
ovid
ed o
n th
e m
yPLA
N. E
xam
ples
are
:
Nex
t ste
ps
We
rece
ived
feed
back
initi
ally
abo
ut th
e le
ngth
of t
he m
yPLA
N
1.0
and
the
pote
ntia
l tim
e to
com
plet
e it.
We
ackn
owle
dged
th
ese
conc
erns
and
put
in p
lace
a c
ompr
ehen
sive
eva
luat
ion
proc
ess.
E
valu
atio
n be
gan
in 2
013
in p
artn
ersh
ip w
ith th
e U
nive
rsity
of
Sas
katc
hew
an. T
he e
valu
atio
n w
ill id
entif
y w
heth
er th
e m
yPLA
N 1
.0:
• ha
s be
tter c
ompl
etio
n ra
tes
than
pas
t too
ls
• fa
cilit
ates
the
use
of R
AI-M
DS
2.0
dat
a to
enh
ance
resi
dent
ca
re
• le
ads
to b
ette
r res
iden
t out
com
es
• fa
cilit
ates
com
mun
icat
ion
amon
g th
e ca
re te
am, i
nclu
ding
th
e re
side
nt/fa
mily
A
ny n
eces
sary
revi
sion
s ar
e pl
anne
d fo
r 201
5. T
hese
will
be
base
d on
feed
back
and
the
eval
uatio
n fin
ding
s.
Cur
rent
sta
te
In J
une
2013
, the
myP
LAN
1.0
was
intro
duce
d in
all
long
term
ca
re h
omes
in th
e S
aska
toon
Hea
lth R
egio
n. Im
plem
enta
tion
stra
tegi
es a
re in
pla
ce, w
ith h
omes
at v
ario
us s
tage
s of
co
mpl
etio
n.
Urin
ary
Inco
ntin
ence
CA
P w
ith
poss
ible
goa
ls o
f:
• Im
prov
e bl
adde
r fun
ctio
n as
ev
iden
ced
by re
duce
d nu
mbe
r of
epi
sode
s of
inco
ntin
ence
O
R
• Pr
even
t dec
line
in b
ladd
er
func
tion
as e
vide
nced
by
mai
ntai
ned
or re
duce
d nu
mbe
r of
epi
sode
s of
inco
ntin
ence
B
ehav
iour
CA
P w
ith p
ossi
ble
goal
s of
: •
Red
uce
daily
resp
onsi
ve
beha
vior
s as
evi
denc
ed b
y re
spon
sive
beh
avio
urs
occu
rrin
g le
ss th
an d
aily
OR
•
Prev
ent i
ncre
ase
in re
spon
sive
be
havi
ors
as e
vide
nced
by
resp
onsi
ve b
ehav
iour
s oc
curr
ing
less
than
dai
ly O
R
• M
inim
ize
resp
onsi
ve b
ehav
iors
from
occ
urrin
g as
ev
iden
ced
by B
ehav
ior C
AP
not b
eing
trig
gere
d
myP
LAN
1.0
: Eva
luat
ion
Fram
ewor
k!Pa
ulet
te H
unte
r, Ph
.D.,
St. T
hom
as M
ore
Col
lege
, Uni
vers
ity o
f Sas
katc
hew
an !
Anita
Ber
gen,
BN
, MSc
, Sas
kato
on H
ealth
Reg
ion!
Jan
Berg
er, B
SN R
N -
Lyn
da B
levi
ns B
SN R
N -
Tar
a Ev
jen,
BSN
RN
- K
aren
Gel
owitz
, MSN
RN
– !
Laur
een
Nei
n, B
SN R
N -
Dia
ne N
owla
n, B
SN R
N -
Alic
ia T
iedj
ens,
BSN
RN
- J
ill W
erle
, BSN
RN!
!In
Jul
y, 2
013,
Sen
iors
’ Hea
lth a
nd C
ontin
uing
Car
e (S
aska
toon
Hea
lth R
egio
n) e
stab
lishe
d a
two-
year
par
tner
ship
with
a re
sear
ch g
roup
ca
lled
the
Com
mun
ity a
nd R
esea
rch
Alli
ance
for Q
ualit
y of
Life
in O
lder
Adu
lts to
eva
luat
e a
new
resi
dent
-dire
cted
car
e pl
an e
ntitl
ed
myP
LAN
1.0
. The
firs
t eva
luat
ion
phas
e, w
hich
focu
sed
on D
irect
or o
f Car
e, C
linic
al L
eade
r, ca
re p
rovi
der,
resi
dent
, and
des
igna
te
perc
eptio
ns o
f the
pla
n, w
as p
lann
ed to
ext
end
from
Jul
y 1,
201
3 to
Jun
e 30
, 201
4. T
he s
econ
d ph
ase,
whi
ch fo
cuse
d on
the
qual
ity o
f ca
re p
lann
ing
and
on re
side
nt o
utco
mes
, was
pla
nned
to e
xten
d fro
m J
uly
1, 2
014
to J
une
30, 2
015.
Evalua&on
(Phase 1)
Was myPLAN 1.0
rolled out
smoothly?
Do directors o
f care/clinical
leaders and care
providers like
myPLAN 1.0?
Do resid
ents and
designates see
myPLAN 1.0 as
resid
ent
directed?
Is myPLAN 1.0
used regularly?
The Saskatchew
an Health
Research Foun
da5o
n provided
supp
ort for th
is work.
Four
pro
ject
s w
ere
incl
uded
in P
hase
1:
q U
nder
stan
ding
the
Rol
lout
Pro
cess
q U
ser R
espo
nses
to m
yPLA
N 1
.0
q R
esid
ent a
nd F
amily
Res
pons
es to
myP
LAN
1.0
q U
tilis
atio
n of
myP
LAN
Use
r Res
pons
es
Sem
i-stru
ctur
ed in
terv
iew
s w
ere
plan
ned
to a
sses
s ca
re p
rovi
ders
’ res
pons
es to
myP
LAN
1.0
. In
addi
tion,
5
stru
ctur
ed q
uest
ions
requ
iring
a L
iker
t-typ
e re
spon
se a
sses
sed
the
degr
ee to
whi
ch c
are
prov
ider
s fin
d th
e ne
w p
lan
to b
e co
ncis
e, re
leva
nt,
and
easy
to fo
llow
; bet
ter i
nteg
rate
d w
ith R
AI-M
DS
2.
0; a
nd u
sefu
l for
com
mun
icat
ion.
Und
erst
andi
ng th
e R
ollo
ut P
roce
ss
Inte
rvie
ws
wer
e pl
anne
d to
ass
ess
indi
cato
rs o
f a
smoo
th ro
llout
, inc
ludi
ng th
e ab
ility
of h
omes
to
artic
ulat
e th
e ro
llout
pro
cess
, rat
iona
le fo
r dev
iatio
ns
from
the
chos
en p
roce
ss a
nd ti
mel
ine,
ratio
nale
for
early
or l
ate
adop
tion,
and
fact
ors
influ
enci
ng th
e su
cces
s of
the
rollo
ut.
Res
iden
t and
Fam
ily R
espo
nses
In
terv
iew
s w
ere
plan
ned
to a
sses
s th
e de
gree
to
whi
ch re
side
nts
or th
eir d
esig
nate
s be
lieve
that
m
yPLA
N 1
.0 is
resi
dent
-dire
cted
.
Util
isat
ion
of m
yPLA
N 1
.0
An
expe
rimen
t inv
olvi
ng th
e re
triev
al o
f a n
ote
plac
ed
on a
n se
vera
l old
and
new
car
e pl
ans
was
pla
nned
to
asse
ss w
heth
er c
are
prov
ider
s co
nsul
t myP
LAN
1.0
m
ore
frequ
ently
than
the
prev
ious
car
e pl
an.
Thre
e pr
ojec
ts w
ere
incl
uded
in P
hase
2:
q Q
ualit
ativ
e “S
pot C
heck
” q R
etro
spec
tive
Cha
rt R
evie
w
q P
re-P
ost C
ompa
rison
of M
DS
Dat
a
Qua
litat
ive
“Spo
t Che
ck”
A se
ries
of ra
pid
“spo
t che
ck” i
nter
view
s w
as p
lann
ed
to a
sses
s ca
re p
rovi
ders
’ kno
wle
dge
abou
t res
iden
ts’
care
pla
ns. T
he g
oal o
f the
inte
rvie
ws
was
to
dete
rmin
e th
e ex
tent
to w
hich
car
e pr
ovid
ers
are
awar
e of
CA
Ps
and
Nur
sing
Reh
abili
tatio
n in
terv
entio
ns c
urre
ntly
list
ed in
the
care
pla
ns.
Cha
rt R
evie
w
A ch
art r
evie
w w
as p
lann
ed to
ass
ess
whe
ther
car
e pl
anni
ng h
as im
prov
ed in
qua
lity
sinc
e th
e im
plem
enta
tion
of m
yPLA
N 1
.0.
Pre-
Post
Com
paris
on o
f RA
I-MD
S D
ata
A co
mpa
rison
of R
AI-M
DS
out
com
es a
nd in
dica
tors
w
as p
lann
ed to
ass
ess
whe
ther
the
intro
duct
ion
of
myP
LAN
1.0
led
to a
ny o
f the
follo
win
g:
ü Q
ualit
y in
dica
tors
rela
ted
to fa
lls, m
edic
atio
ns,
pres
sure
ulc
ers,
rest
rain
ts, i
nfec
tions
, and
pai
n sh
ow im
prov
emen
t.
ü R
esid
ent o
utco
mes
(inc
ludi
ng d
epre
ssio
n, p
ain,
ac
tiviti
es o
f dai
ly li
ving
per
form
ance
, soc
ial
enga
gem
ent,
aggr
essi
on, p
ress
ure
ulce
rs, a
nd
delir
ium
) sho
w a
vera
ge im
prov
emen
t.
ü T
here
is a
n in
crea
se in
doc
umen
tatio
n of
nur
sing
re
habi
litat
ion.
Ph
ase
1
Ph
ase
2
Evalua&on
(Phase 2)
How familiar are care
providers w
ith
resid
ents’ care plans?
Are comple&on rates
higher than for
previous care plans?
Does the new plan
influence resid
ent
outcom
es, quality
indicators, and
documenta&on of
nursing rehabilita&on?
Evalua&on
(Phase 1)
Was myPLAN 1.0
rolled out
smoothly?
Do directors o
f care/clinical
leaders and care
providers like
myPLAN 1.0?
Do resid
ents and
designates see
myPLAN 1.0 as
resid
ent
directed?
Is myPLAN 1.0
used regularly?
Four
pro
ject
s w
ere
incl
uded
in P
hase
1:
qU
nder
stan
ding
the
Rol
lout
Pro
cess
q
Use
r Res
pons
es to
myP
LAN
1.0
q
Res
iden
t and
Fam
ily R
espo
nses
to m
yPLA
N 1
.0
qU
tilis
atio
n of
myP
LAN
Use
r Res
pons
es
Sem
i-stru
ctur
ed in
terv
iew
s w
ere
plan
ned
to a
sses
s ca
re p
rovi
ders
’ res
pons
es to
myP
LAN
1.0
. In
addi
tion,
5
stru
ctur
ed q
uest
ions
requ
iring
a L
iker
t-typ
e re
spon
se a
sses
sed
the
degr
ee to
whi
ch c
are
prov
ider
s fin
d th
e ne
w p
lan
to b
e co
ncis
e, re
leva
nt,
and
easy
to fo
llow
; bet
ter i
nteg
rate
d w
ith R
AI-M
DS
2.
0; a
nd u
sefu
l for
com
mun
icat
ion.
Und
erst
andi
ng th
e R
ollo
ut P
roce
ss
Inte
rvie
ws
wer
e pl
anne
d to
ass
ess
indi
cato
rs o
f a
smoo
th ro
llout
, inc
ludi
ng th
e ab
ility
of h
omes
to
artic
ulat
e th
e ro
llout
pro
cess
, rat
iona
le fo
r dev
iatio
ns
from
the
chos
en p
roce
ss a
nd ti
mel
ine,
ratio
nale
for
early
or l
ate
adop
tion,
and
fact
ors
influ
enci
ng th
e su
cces
s of
the
rollo
ut.
Res
iden
t and
Fam
ily R
espo
nses
In
terv
iew
s w
ere
plan
ned
to a
sses
s th
e de
gree
to
whi
ch re
side
nts
or th
eir d
esig
nate
s be
lieve
that
m
yPLA
N 1
.0 is
resi
dent
-dire
cted
.
Util
isat
ion
of m
yPLA
N 1
.0
An
expe
rimen
t inv
olvi
ng th
e re
triev
al o
f a n
ote
plac
ed
on a
n se
vera
l old
and
new
car
e pl
ans
was
pla
nned
to
asse
ss w
heth
er c
are
prov
ider
s co
nsul
t myP
LAN
1.0
m
ore
frequ
ently
than
the
prev
ious
car
e pl
an.
Ph
ase
1
Thre
e pr
ojec
ts w
ere
incl
uded
in P
hase
2:
Thre
e pr
ojec
ts w
ere
incl
uded
in P
hase
2:
ualit
ativ
e “S
pot C
heck
” q
Ret
rosp
ectiv
e C
hart
Rev
iew
q
Pre
-Pos
t Com
paris
on o
f MD
S D
ata
Pre
-Pos
t Com
paris
on o
f MD
S D
ata
Qua
litat
ive
“Spo
t Che
ck”
A se
ries
of ra
pid
“spo
t che
ck” i
nter
view
s w
as p
lann
ed
to a
sses
s ca
re p
rovi
ders
’ kno
wle
dge
abou
t res
iden
ts’
care
pla
ns. T
he g
oal o
f the
inte
rvie
ws
was
to
dete
rmin
e th
e ex
tent
to w
hich
car
e pr
ovid
ers
are
awar
e of
CA
Ps
and
Nur
sing
Reh
abili
tatio
n in
terv
entio
ns c
urre
ntly
list
ed in
the
care
pla
ns.
Cha
rt R
evie
w
A ch
art r
evie
w w
as p
lann
ed to
ass
ess
whe
ther
car
e pl
anni
ng h
as im
prov
ed in
qua
lity
sinc
e th
e im
plem
enta
tion
of m
yPLA
N 1
.0.
Pre-
Post
Com
paris
on o
f RA
I-MD
S D
ata
A co
mpa
rison
of R
AI-M
DS
out
com
es a
nd in
dica
tors
w
as p
lann
ed to
ass
ess
whe
ther
the
intro
duct
ion
of
myP
LAN
1.0
led
to a
ny o
f the
follo
win
g:
üQ
ualit
y in
dica
tors
rela
ted
to fa
lls, m
edic
atio
ns,
pres
sure
ulc
ers,
rest
rain
ts, i
nfec
tions
, and
pai
n sh
ow im
prov
emen
t.
üR
esid
ent o
utco
mes
(inc
ludi
ng d
epre
ssio
n, p
ain,
ac
tiviti
es o
f dai
ly li
ving
per
form
ance
, soc
ial
enga
gem
ent,
aggr
essi
on, p
ress
ure
ulce
rs, a
nd
delir
ium
) sho
w a
vera
ge im
prov
emen
t.
üTh
ere
is a
n in
crea
se in
doc
umen
tatio
n of
nur
sing
re
habi
litat
ion.
Ph
ase
2
Evalua&on
(Phase 2)
How familiar are care
providers w
ith
resid
ents’ care plans?
Are comple&on rates
higher than for
previous care plans?
Does the new plan
influence resid
ent
outcom
es, quality
indicators, and
documenta&on of
nursing rehabilita&on?
15
myPLAN 1.0: Evaluation Results (Phase 1)!Paulette Hunter, Ph.D., St. Thomas More College, University of Saskatchewan !
& Fiona Fick, University of Saskatchewan!
The Saskatchewan Health Research Founda5on provided support for this work.
In July, 2013, Seniors’ Health and Continuing Care (Saskatoon Health Region) established a two-year partnership with a research group called the Community and Research Alliance for Quality of Life in Older Adults to evaluate a new resident-directed care plan entitled myPLAN 1.0. The first evaluation phase focused on Director of Care, Clinical Leader, care provider, resident, and designate perceptions of the plan, and extended from July 1, 2013 to June 30, 2014.
DOC/CL Perceptions DOCs/CLs indicated that the workload to roll out myPLAN 1.0 was daunting because of the time required to learn the new format and complete each plan. DOC/CLs saw myPLAN 1.0 as comprehensive and well-integrated with the RAI-MDS, but lengthy and time-consuming to complete. They noted that for most residents, some portions of the plan would not be applicable. They were concerned that staff members may become accustomed to blank sections and neglect to re-evaluate those portions of the plan.
Care Provider Perceptions Care providers saw the plan as comprehensive and well-integrated with the RAI-MDS. However, the length of the document and time needed to complete and/or review each plan was a concern. It was thought to be a good source of comprehensive information for occasional reference, but impractical for day-to-day use. Still, as Table 1 illustrates, myPLAN 1.0 was perceived as more concise, more relevant, better integrated with the RAI-MDS, and more useful for communicating about resident care than the previous care plan.
Conclusions Although many users expressed appreciation for the comprehensiveness of myPLAN 1.0 relative to the previous plan, its length was consistently flagged as a factor that may impede reference to the document, including necessary updates. An ongoing challenge will be reconciling DOC/CL and care provider support for a comprehensive care planning tool with their interest in having a day-to-day reference document that is convenient to search and update.
Methods We report here on a series of interviews with 9 Directors of Care or Clinical Leaders (DOCs/CLs), 23 care providers (RNs, LPNs, and CCAs), and 4 residents or designates1. All participants were asked open-ended questions about their experience of myPLAN 1.0. Interview transcripts were analysed using thematic content analysis. Care provider interviews contained five additional structured interview questions, in which respondents were asked to rate attributes of myPLAN 1.0 and the previous care plan on a 10 point scale ranging from 1 (not at all) to 10 (extremely). These responses were compared using a dependent measures t-test.
1Residents and designates had experienced myPlan 1.0 in the context of a recent care planning meeting in which they participated in completing the plan. Resident and designate interviews carried over into Phase 2 of the evaluation; therefore, results are not reported here.
Care Plan Consultation Experiment The first phase of the myPLAN 1.0 evaluation focused mainly on perceptions of the new plan. However, we also conducted an experiment to assess whether myPLAN 1.0 was being consulted more often than the previous plan. During the experiment, sticky notes were placed in a comparable location on at least one old and one new care plan within the same neighbourhood. The notes contained a message requesting that the care provider who found the note return it to the DOC and claim a prize. Missing data prevented a statistically reliable comparison of return times for old versus new care plans. On average, it took 18.45 days for the notes to be returned (including both old and new plans), suggesting an overall low rate of care plan consultation. This result aligns well with the information care providers gave in interviews. Encouragingly, care providers from diverse occupations (e.g., care aides, nurses, and physiotherapists) retrieved the notes.
16
DE
ME
NTI
AFR
IEN
DLY
TOU
RIS
MEX
PLO
RIN
GH
OW
THE
TOU
RIS
MA
ND
LEIS
UR
EIN
DU
STR
YC
AN
RES
PON
DTO
THE
NEE
DS
OF
PEO
PLE
WIT
HD
EMEN
TIA
AN
DTH
EIR
CA
RER
S .IN
NE
S,A
., PA
GE, S
., C
UTL
ER
, C.,
CR
OS
SE
N-W
HIT
E, H
., C
AS
H, M
., M
CPA
RLA
ND
, PB
UD
I, B
OU
RN
EM
OU
THU
NIV
ER
SIT
Y
Th
ere
islit
tlere
sear
chex
plor
ing
the
conn
ectio
nbe
twee
nth
eex
perie
nce
ofpe
ople
with
dem
entia
and
thei
ren
gage
men
tw
ithto
uris
man
dle
isur
e.R
esea
rch
onto
uris
man
dhe
alth
has
tradi
tiona
llyfo
cuse
don
trave
lmed
icin
ean
dth
eco
nnec
tions
betw
een
tour
ism
and
med
ical
issu
esfa
ced
bytra
velle
rsin
dest
inat
ions
.The
reis
agr
owin
gbo
dyof
know
ledg
eem
ergi
ngfro
mhu
man
geog
raph
yan
dpu
blic
heal
thth
atar
gues
that
tour
ism
can
beus
edas
am
ajor
tool
forp
ositi
veen
hanc
emen
toft
hequ
ality
oflif
ew
ithsu
chgr
oups
asth
eel
derly
.The
prev
alen
ceof
dem
entia
amon
gol
derp
eopl
ean
dth
ecu
rren
tem
phas
ison
build
ing
dem
entia
frien
dly
com
mun
ities
mea
nsth
atpe
ople
with
dem
entia
mus
tbe
cons
ider
edin
prov
isio
nof
tour
ism
and
leis
ure.
How
ever
exis
ting
infra
stru
ctur
ean
dst
rate
gies
for
tour
ism
have
larg
ely
over
look
edth
eim
pend
ing
dem
ogra
phic
time
bom
b.To
date
,co
mpa
rativ
ely
little
rese
arch
has
exam
ined
the
impl
icat
ions
ofto
uris
man
dhe
alth
rese
arch
inre
latio
nto
dom
estic
tour
ism
,whi
chis
argu
ably
four
tosi
xtim
esm
ore
impo
rtant
invo
lum
eth
anin
tern
atio
nalt
ouris
mfo
rman
yco
untri
es.T
his
high
light
sth
ega
pin
know
ledg
eab
outt
hero
leto
uris
mca
npl
ayin
supp
ortin
gth
ew
ell-b
eing
ofpe
ople
with
dem
entia
and
thei
rcar
ers.
Five
focu
s gr
oups
with
old
er p
eopl
e, p
eopl
e w
ith d
emen
tia, a
nd th
eir c
arer
s w
ithin
the
Dor
set r
egio
n.
BA
CK
GR
OU
ND
MET
HO
DS
Emer
ging
The
mes
from
Pre
limin
ary
Ana
lysi
s:
Tran
spor
t
Inad
equa
te/ p
oorly
sig
npos
ted
toile
t fa
cilit
ies
Inac
cess
ible
ven
ues
Mob
ility
Fear
/Anx
iety
of g
ettin
g lo
st
Neg
ativ
e at
titud
es
Cos
t
Bar
riers
Enab
lers
Goo
d Lo
catio
n
Attr
actio
n fa
cilit
ies
Out
door
env
ironm
ent
Fam
iliar
ity
Pos
itive
atti
tude
s
Affo
rdab
ility
Acc
ess
to to
uris
m a
nd le
isur
e fo
r pe
ople
with
dem
entia
and
thei
r car
ers
:
•Lei
sure
and
tour
ism
is u
nder
use
d by
peo
ple
with
dem
entia
and
thei
r car
ers.
•Car
ers
fear
the
rece
ptio
n fr
om o
ther
leis
ure
user
s an
d a
lack
of u
nder
stan
ding
from
sta
ff w
orki
ng in
the
indu
stry
.•T
ouris
m a
nd le
isur
e pr
ovid
ers
have
ver
y lit
tle a
war
enes
s of
dem
entia
. •T
ouris
m p
rovi
ders
hav
e ye
t to
embr
ace
the
pote
ntia
l of t
arge
ting
thei
r ‘pr
oduc
t/ser
vice
’ to
thos
e w
ith
dem
entia
des
pite
legi
slat
ion
prom
otin
g ‘to
uris
m fo
r all’
.
PREL
IMIN
ARY
CO
NC
LUSI
ON
S
ww
w.bo
urne
mou
th.a
c.uk
/dem
entia
-inst
itute
TE
CH
CLU
B
WH
AT A
RE
THE
BEN
EFIT
S O
F A
TEC
HN
OLO
GY
GR
OU
P O
N T
HE
QU
ALI
TY O
F LI
FE F
OR
PEO
PLE
WIT
H D
EMEN
TIA
LIV
ING
W
ITH
IN T
HE
CO
MM
UN
ITY?
CLA
RE
CU
TLER
(PA
RT
TIM
E PH
D S
TUD
ENT)
, PR
OF.
AN
THEA
INN
ES
CC
UTL
ER@
BO
UR
NEM
OU
TH.A
C.U
K
¢
With
in t
he U
K t
here
is
a pu
sh t
owar
ds a
ctiv
e an
d he
alth
y ag
eing
with
the
aim
of
enab
ling
peop
le l
ivin
g w
ith
dem
entia
to r
emai
n in
depe
nden
t and
as
a pa
rt of
thei
r so
ciet
y an
d co
mm
unity
for
as lo
ng a
s po
ssib
le. T
here
is a
huge
bod
y of
lite
ratu
re a
roun
d th
e be
nefit
s of
mai
ntai
ning
and
enh
anci
ng w
ellb
eing
and
the
impo
rtanc
e of
phy
sica
l, so
cial
and
men
tal a
ctiv
ity (
Hal
l et a
l 200
9; H
ill e
t al
2010
; Wan
g et
al 2
012;
Sw
an 2
012)
. With
app
roxi
mat
ely
two
third
s of
peo
ple
with
dem
entia
livi
ng w
ithin
the
com
mun
ity (A
lzhe
imer
’s S
ocie
ty 2
013)
ther
e is
now
a n
atio
nal d
rive
tow
ards
mai
ntai
ning
a g
ood
qual
ity o
f life
in o
lder
age
and
whe
n liv
ing
with
dem
entia
(Har
ley
et a
l 201
0).
¢
Lim
ited
rese
arch
has
bee
n co
nduc
ted
into
the
role
of g
amin
g te
chno
logy
in d
emen
tia c
are
and
has
negl
ecte
d th
e po
tent
ial
Qua
lity
of L
ife (
QoL
) be
nefit
s ar
isin
g fro
m t
he u
se o
f su
ch e
quip
men
t. To
dat
e, g
amin
g te
chno
logy
re
sear
ch h
as t
radi
tiona
lly l
ooke
d at
its
rol
e in
reh
abili
tatio
n fo
r pe
ople
affe
cted
by
stro
kes,
can
cer,
asth
ma
and
autis
m (
Rah
man
i and
Bor
en 2
012)
, an
d as
a p
reve
ntat
ive
mea
sure
aga
inst
cog
nitiv
e de
clin
e (W
ang
et a
l 201
2).
From
this
we
know
that
gam
ing
tech
nolo
gy, p
artic
ular
ly th
e N
inte
ndo
Wii,
has
the
pote
ntia
l to
enha
nce
and
supp
ort
heal
th c
are.
Wha
t we
don’
t kno
w is
the
pote
ntia
l whe
n us
ed in
dem
entia
car
e, e
spec
ially
its
pote
ntia
l to
enha
nce
QoL
and
to s
uppo
rt ac
tive
and
heal
thy
agei
ng.
¢
This
pos
ter w
ill re
port
on tw
o Te
chno
logy
Clu
b’s,
loo
king
spe
cific
ally
at Q
oL b
enef
its.
¢
BA
CK
GR
OU
ND
MET
HO
DS
ww
w.b
ourn
emou
th.a
c.uk
/dem
entia
-inst
itute
Com
plet
ion
of fi
eld
wor
k an
d Q
oL in
terv
iew
s. T
he d
ata
will
then
be
them
atic
ally
an
alys
ed a
nd w
ill in
form
the
mai
n bo
dy o
f dis
cuss
ion
for t
his
thes
is.
Usi
ng t
he N
inte
ndo
Wii,
Nin
tend
o D
S,
Xbo
x K
inec
t an
d A
pple
iP
ad,
two
sets
of
Tech
nolo
gy s
essi
ons
(cal
led
the
Tech
Clu
b) w
ere
prov
ided
for
peo
ple
livin
g w
ith
dem
entia
with
in t
he B
ourn
emou
th
area
(D
orse
t). T
he a
im o
f th
e Te
ch C
lub
was
to
esta
blis
h an
d ex
plor
e th
e qu
ality
of l
ife b
enef
its o
f a te
chno
logy
gro
up fo
r peo
ple
livin
g w
ith d
emen
tia.
A
tota
l of
12
sess
ions
wer
e de
liver
ed b
etw
een
two
grou
ps o
f pe
ople
liv
ing
with
de
men
tia,
the
first
at
a lo
cal d
ay c
entre
and
the
sec
ond
at a
com
mun
ity v
enue
. The
se
ssio
ns (
each
tw
o ho
urs
long
) ai
med
to
use
all a
spec
ts (
gam
es,
apps
, so
ftwar
e) o
f ea
ch p
iece
of e
quip
men
t thr
ough
out t
he d
urat
ion
of th
e Te
ch C
lub.
Q
ualit
y of
life
int
ervi
ews
wer
e co
nduc
ted
with
the
per
son
with
dem
entia
and
a Q
oL
ques
tionn
aire
was
com
plet
ed b
y th
e pr
ofes
sion
al o
r fam
ily c
arer
prio
r to
the
star
t of t
he
sess
ions
. Thi
s Q
oL p
roce
ss w
ill b
e re
peat
ed fo
llow
ing
the
final
ses
sion
and
at a
thre
e m
onth
fol
low
up
stag
e. I
n ad
ditio
n to
QoL
dat
a, t
he s
essi
ons
used
qua
litat
ive
data
co
llect
ion
met
hods
to c
aptu
re th
e pa
rtici
pant
s th
ough
ts, c
omm
ents
, opi
nion
s, li
kes
and
disl
ikes
abo
ut th
e te
chno
logi
es a
nd th
e se
ssio
ns a
s a
who
le.
Com
plet
ion
of fi
eld
wor
k an
d Q
oL in
terv
iew
s. T
he d
ata
will
then
be
them
atic
ally
NEX
T ST
EPS
Serv
ice
eval
uatio
n fu
nded
by
Bou
rnem
outh
Bor
ough
Cou
ncil
17
D
EM
EN
TIA F
RIE
ND
LY C
OM
MU
NIT
IES: D
OR
SE
T C
UTL
ER, C
., H
EWA
RD
, M.,
HA
MB
IDG
E, S
. AN
D IN
NES
, A
The
num
ber
of p
eopl
e ag
ed 6
5 or
ove
r liv
ing
with
dem
entia
in D
orse
t, E
ngla
nd, w
ill in
crea
se fr
om 7
,796
in 2
010
to 1
1,73
4 by
20
25 (D
orse
t Hea
lth S
crut
iny
Com
mitt
ee, 2
010)
(1).
This
incr
ease
in th
e nu
mbe
r of p
eopl
e w
ho w
ill b
e liv
ing
with
dem
entia
in th
e ne
xt fe
w y
ears
has
resu
lted
in s
igni
fican
t pub
lic a
nd p
oliti
cal c
omm
itmen
t to
driv
e im
prov
emen
t and
cha
nge
for t
hose
affe
cted
by
dem
entia
(A
lzhe
imer
Soc
iety
, 20
13)(2
). W
hils
t m
any
initi
ativ
es a
re p
rogr
essi
ng u
nder
the
age
nda
of a
ge f
riend
ly c
omm
uniti
es
(WH
O 2
007)
(3),
in th
e U
K th
e P
rime
Min
iste
r lau
nche
d a
spec
ific
Dem
entia
Cha
lleng
e (D
epar
tmen
t of H
ealth
, 201
2)(4
). Th
e ai
m o
f th
e D
emen
tia C
halle
nge
is to
impr
ove
the
lives
of p
eopl
e w
ith d
emen
tia a
nd th
eir
fam
ilies
thro
ugh
thre
e ar
eas
of a
ctio
n: d
rivin
g im
prov
emen
ts i
n he
alth
and
car
e, c
reat
ing
dem
entia
frie
ndly
com
mun
ities
and
im
prov
ing
dem
entia
res
earc
h (D
epar
tmen
t of
Hea
lth, 2
012)
(4).
In r
espo
nse
to t
he P
rime
Min
iste
rs D
emen
tia C
halle
nge
and
the
natio
nal D
emen
tia F
riend
ly C
omm
unity
(D
FC)
initi
ativ
e (D
epar
tmen
t of
Hea
lth,
2012
)(4),
10 p
artn
ers
from
acr
oss
Dor
set
deve
lope
d th
e D
orse
t D
FC (
DD
FC)
proj
ect.
The
over
all
aim
of t
he D
DFC
pro
ject
was
:
‘To
crea
te d
emen
tia fr
iend
ly c
omm
uniti
es a
nd lo
cal D
emen
tia A
ctio
n A
llian
ces
invo
lvin
g lo
cal b
usin
esse
s, c
harit
ies,
in
depe
nden
t, vo
lunt
ary
and
com
mun
ity s
ervi
ces,
and
inde
pend
ent p
rovi
ders
as
wel
l as
the
stat
utor
y se
ctor
’.
Wor
k w
as u
nder
take
n in
sev
en l
ocal
ities
in
the
Dor
set
regi
on (
Bla
ndfo
rd F
orum
, C
hris
tchu
rch,
Dor
ches
ter,
Poo
le,
Sou
thbo
urne
, Wey
mou
th a
nd P
ortla
nd, a
nd W
imbo
rne
Min
ster
). Th
is e
valu
atio
n fo
cuse
s on
the
first
yea
r of
act
ivity
of t
he
Dor
set D
FC p
roje
ct b
etw
een
Mar
ch 2
013
and
Mar
ch 2
014.
The
eva
luat
ion
used
the
Alz
heim
er’s
Soc
iety
(201
3) fr
amew
ork,
whi
ch p
rovi
des
ten
area
s of
focu
s fo
r a D
FC. T
he p
rogr
ess
of e
ach
loca
lity
was
mea
sure
d ag
ains
t thi
s fra
mew
ork.
BA
CK
GR
OU
ND
MET
HO
DS
ww
w.b
ourn
emou
th.a
c.uk
/dem
entia
-inst
itute
: D
impr
ovem
ents
in
heal
th a
nd c
are,
cre
atin
g de
men
tia f
riend
ly c
omm
uniti
es a
nd i
mpr
ovin
g de
men
tia r
esea
rch
(Dep
artm
ent
of
OM
MU
NIT
IES
OR
SE
T
The
num
ber
of p
eopl
e ag
ed 6
5 or
ove
r liv
ing
with
dem
entia
in D
orse
t, E
ngla
nd, w
ill in
crea
se fr
om 7
,796
in 2
010
to 1
1,73
4 by
impr
ovem
ents
in
heal
th a
nd c
are,
cre
atin
g de
men
tia f
riend
ly c
omm
uniti
es a
nd i
mpr
ovin
g de
men
tia r
esea
rch
(Dep
artm
ent
of
In r
espo
nse
to t
he P
rime
Min
iste
rs D
emen
tia C
halle
nge
and
the
natio
nal D
emen
tia F
riend
ly C
omm
unity
(D
FC)
initi
ativ
e
impr
ovem
ents
in
heal
th a
nd c
are,
cre
atin
g de
men
tia f
riend
ly c
omm
uniti
es a
nd i
mpr
ovin
g de
men
tia r
esea
rch
(Dep
artm
ent
of im
prov
emen
ts i
n he
alth
and
car
e, c
reat
ing
dem
entia
frie
ndly
com
mun
ities
and
im
prov
ing
dem
entia
res
earc
h (D
epar
tmen
t of
In r
espo
nse
to t
he P
rime
Min
iste
rs D
emen
tia C
halle
nge
and
the
natio
nal D
emen
tia F
riend
ly C
omm
unity
(D
FC)
initi
ativ
e
impr
ovem
ents
in
heal
th a
nd c
are,
cre
atin
g de
men
tia f
riend
ly c
omm
uniti
es a
nd i
mpr
ovin
g de
men
tia r
esea
rch
(Dep
artm
ent
of
In r
espo
nse
to t
he P
rime
Min
iste
rs D
emen
tia C
halle
nge
and
the
natio
nal D
emen
tia F
riend
ly C
omm
unity
(D
FC)
initi
ativ
e
OR
SE
TO
RS
ET
C
whi
ch p
rovi
des
ten
area
s of
focu
s fo
r a D
FC. T
he p
rogr
ess
of e
ach
loca
lity
was
mea
sure
d ag
ains
t thi
s fra
mew
ork.
• E
stab
lishi
ng n
etw
orks
and
con
nect
ions
with
in a
com
mun
ity ta
kes
time
and
ultim
atel
y is
an
on-g
oing
res
pons
ibili
ty o
f eac
h lo
calit
y.
• E
very
com
mun
ity is
diff
eren
t. Le
sson
s le
arnt
and
exa
mpl
es o
f goo
d pr
actic
e fro
m e
ach
of th
e se
ven
loca
litie
s
c
ould
be
deve
lope
d an
d sh
ared
with
oth
ers
deve
lopi
ng D
FC’s
regi
onal
ly a
nd n
atio
nally
. •
The
DD
FC p
roje
ct a
chie
vem
ent h
as b
een
to c
reat
e th
e ci
rcum
stan
ces
to e
nabl
e pr
ogre
ss to
war
ds d
evel
opin
g
t
hese
fully
in a
ll se
ven
loca
litie
s in
the
futu
re.
KEY
FIN
DIN
GS
CO
NC
LUSI
ON
1. In
volv
emen
t of p
eopl
e w
ith d
emen
tia
2. C
halle
nge
stig
ma
and
build
und
erst
andi
ng
3. A
cces
sibl
e co
mm
unity
act
iviti
es
4. A
ckno
wle
dge
pote
ntia
l
5. E
nsur
e an
ear
ly d
iagn
osis
6. P
ract
ical
sup
port
to e
nabl
e en
gage
men
t in
com
mun
ity li
fe
7. C
omm
unity
-bas
ed s
olut
ions
8. C
onsi
sten
t and
relia
ble
trav
el o
ptio
ns
9. E
asy-
to-n
avig
ate
envi
ronm
ents
10. R
espe
ctfu
l and
resp
onsi
ve b
usin
esse
s an
d se
rvic
es
• 59
9 pe
ople
atte
nded
aw
aren
ess
rais
ing
sess
ions
in D
orse
t. •
Ste
erin
g gr
oups
hav
e be
en e
stab
lishe
d.
• C
omm
uniti
es h
ave
com
mitt
ed to
loca
l an
d na
tiona
l D
emen
tia A
ctio
n A
llian
ce’s
.
• B
usin
esse
s w
ere
posi
tive
abou
t the
D
FC in
itiat
ives
. •
Dem
entia
aw
aren
ess
rais
ing
and
the
num
ber o
f or
gani
satio
ns jo
inin
g lo
cal D
AA’
s or
M
emor
y Aw
are
Sch
eme’
s
i
ncre
ased
ove
r tim
e.
(1) D
orse
t Hea
lth S
crut
iny
Com
mitt
ee, S
crut
iny
Rev
iew
Pan
el. 2
010.
Dem
entia
Ser
vice
s D
orse
t. D
orse
t Cou
nty
Cou
ncil.
Impr
ovin
g th
e qu
ality
of
life
for p
eopl
e in
Dor
set,
now
and
for t
he fu
ture
. (2
) Alz
heim
er’s
Soc
iety
. 201
3. ‘B
uild
ing
dem
entia
frie
ndly
com
mun
ities
: A p
riorit
y fo
r eve
ryon
e’.
(3) W
orld
Hea
lth O
rgan
isat
ion.
200
7. ‘G
loba
l age
-frie
ndly
citi
es: A
Gui
de’.
(4) D
epar
tmen
t of H
ealth
. 201
2. P
rime
Min
iste
r’s c
halle
nge
on d
emen
tia: D
eliv
erin
g m
ajor
impr
ovem
ents
in d
emen
tia c
are
and
rese
arch
by
2015
. Lon
don:
DH
Pub
licat
ions
.
Our
Obj
ectiv
es
1. T
o iden*fy any impact on quality of life fo
r people with
dem
en*a as a
result
of th
e interven*o
n.
2. T
o iden*fy any impact on quality of life fo
r carers a
s a re
sult of th
e interven*o
n.
3. T
o evaluate th
e interven*o
n process for poten*al future grou
ps via
feedback from
par*cipants.
4. T
o refin
e the interven*o
n process, if necessary, for any fu
ture groups b
ased
on th
e evalua*ve feedback.
A M
usic
al E
nsem
ble
• The interven*o
n consisted of 10 weekly music se
ssions facilitated
by mem
bers of the Bou
rnem
outh Sym
phon
y Orchestra (B
SO), BU
Music scho
lars, and students .
• The BU
DI Orchestra mem
bers (p
eople with
dem
en*a and th
eir
carers) w
ere invited to use instruments and sing in order to
create
an integrated musical ensem
ble with
the BSO and BU M
usic
students.
• Each se
ssion built upo
n previous weeks; increasing the number o
f musical pieces a
nd th
eir com
plexity.
• The BU
DI Orchestra were invited to sh
owcase th
eir talents in a
performance at the end of the 10 weeks.
Intro
duci
ng th
e
BU
DI O
rche
stra
I can
hon
estly
say
tha
t th
e or
ches
tra
has
been
the
be
st experience…
sin
ce [p
erso
n w
ith d
emen
6a] w
as
diag
nose
d …
qui
te h
ones
tly t
his
was
so
diffe
rent
…
and it do
es li/ the spirits
. Par*cipant
.
“ ”
It’s n
ot a
bout
kud
os…
It’s
abo
ut w
hat w
e ca
n achieve
with
thes
e pe
ople
. I’m
learning
just as m
uch from
them
as t
hey
are,
hop
eful
ly, f
rom
us.
BSO Facilitator. ”
“
Our
Eva
luat
ion
Our evalua*on
has con
sisted of a variety of m
easures in order to gain a holis*
c overview
of the interven*o
n. W
e have collected:
• Weekly ob
serva*on
s of each session
• Weekly evalua*o
n sheets com
pleted by facilitators a
nd BUDI Orchestra mem
bers
• Quality of life ques*on
naire
s com
pleted by peop
le with
dem
en*a and th
eir carers
pre-‐ and post-‐interven*o
n.
• Interviews b
efore the interven*o
n to discover musical preferences and
experie
nces so
that th
e interven*o
n could be tailored to th
e par*cipants
• Interviews a
Uer the interven*o
n with
facilitators a
nd BUDI orchestra mem
bers to
fin
d ou
t what they thou
ght w
orked well, if they had any challenges and if th
ey
have any th
oughts abo
ut how
we may im
prove the sessions.
For m
ore inform
a+on
, please visit: h4
p://www.bou
rnem
outh.ac.uk
/dem
en+a
-‐ins+tute/
18
The
virt
ual c
are-
hom
e en
viro
nmen
t: ro
ute
lear
ning
task
s will
be
used
.
Refe
renc
es:
Braa
k, H
., Br
aak,
E. (
1991
). N
euro
path
olog
ical
stag
eing
of A
lzhei
mer
-rel
ated
cha
nges
. Ac
ta N
euro
path
olog
ica82
(4):
239–
59
Cush
man
L. A
., St
ein,
K.,
Duffy
, C. J
. (20
08) D
etec
ting
navi
gatio
nal d
efici
ts in
cog
nitiv
e ag
ing
and
Alzh
eim
er d
iseas
e us
ing
virt
ual r
ealit
y. N
euro
logy
71:
888
–895
Ec
hava
rri,
C., A
alte
n, P.
, Uyl
ings
, H. B
., Ja
cobs
, H. I
., Vi
sser
, P. J
., Gr
onen
schi
ld, E
. H.,
. . .
Burg
man
s, S
. (20
11).
Atro
phy
in th
e pa
rahi
ppoc
ampa
l gyr
us a
s an
early
bi
omar
ker o
f Alzh
eim
er's
dise
ase.
Bra
in S
truc
t Fun
ct, 2
15(3
-4),
265-
271.
doi
: 10.
1007
/s00
429-
010-
0283
-8
Looi
, J. C
., Sv
enss
on, L
., Li
ndbe
rg, O
., Za
ndbe
lt, B
. B.,
Ost
berg
, P.,
Orn
dahl
, E.,
Wah
lund
, L. O
. (20
09).
Puta
min
al v
olum
e in
fron
tote
mpo
ral l
obar
deg
ener
ation
an
d Al
zhei
mer
dise
ase:
diff
eren
tial v
olum
es in
dem
entia
subt
ypes
and
con
trol
s. A
JNR
Am J
Neur
orad
iol,
30(8
), 15
52-1
560.
doi
: 10.
3174
/ajn
r.A16
40
Peng
as, G
., Pa
tters
on, K
., Ar
nold
, R. J
., Bi
rd, C
. M.,
Burg
ess,
N.,
Nes
tor,
P. J.
(201
0) L
ost a
nd fo
und:
bes
poke
mem
ory
testi
ng fo
r Alzh
eim
er's
dise
ase
and
Sem
an-
tic D
emen
tia. J
ourn
al o
f Alzh
eim
er’s
dise
ase.
21:
p. 1
347-
1365
.
De
men
tia F
riend
ly A
rchi
tect
ure
Redu
cing
spati
al-d
isorie
ntati
on fo
r peo
ple
with
Alzh
eim
er’s
dise
ase
(AD)
.
Ove
rall
aim
: To
ide
ntify
the
env
ironm
enta
l fe
atur
es t
hat c
an a
llevi
ate
diso
rient
ation
for
peop
le w
ith A
D.
Obj
ectiv
es:
U
nder
stan
ding
how
inte
rior d
esig
n fa
cilit
ates
or i
mpe
des
orie
nta-
tion
in p
eopl
e w
ith A
D.
De
velo
ping
an
in-d
epth
und
erst
andi
ng o
f th
e sp
ecifi
c im
pair-
men
ts in
land
mar
k ba
sed
navi
gatio
n in
peo
ple
with
AD.
Cons
truc
ting
empi
rical
ly v
alid
ated
dem
entia
des
ign
guid
elin
es.
Su
perv
isors
: Jan
Wie
ner,
Anth
ea In
nes,
Mar
iela
Gae
te-R
eyes
Bour
nem
outh
Uni
vers
ity D
emen
tia In
stitu
te (B
UDI
), U
K
Ps
ycho
logy
Res
earc
h Ce
ntre
, Bou
rnem
outh
Uni
vers
ity, U
K
W
ayfin
ding
Res
earc
h Ce
ntre
, Bou
rnem
outh
Uni
vers
ity, U
K
Mar
y O
’Mal
ley
My
Appr
oach
:
Virt
ual R
ealit
y (V
R) w
ill a
llow
to
syst
emati
cally
man
ipul
ate
the
envi
ronm
ent i
.e. s
truc
tura
l lay
out a
nd la
ndm
arks
.
Man
ipul
ating
la
ndm
ark
char
acte
ristic
s w
ill
high
light
w
hich
fe
atur
es a
re m
ore
bene
ficia
l for
peo
ple
with
AD
as w
ell a
s th
e na
viga
tion
stra
tegi
es th
at h
ave
been
ado
pted
.
Nav
igati
on p
erfo
rman
ce w
ill b
e m
easu
red
by a
sses
sing
reac
tion
time,
err
or ra
te a
nd e
ye g
aze
perfo
rman
ce.
Re
sults
will
be
rela
ted
to p
sych
olog
ical
and
neu
rops
ycho
logi
cal
rese
arch
.
Bac
kgro
und:
One
of t
he e
arly
effe
cts
of A
D is
a m
arke
d di
fficu
lty t
o or
ient
an
d ‘w
ayfin
d’
arou
nd
unfa
mili
ar/r
ecen
tly
lear
ned
envi
ronm
ents
, whi
ch a
s th
e di
seas
e pr
ogre
sses
, sta
rts
to a
ffect
fa
mili
ar e
nviro
nmen
ts a
s wel
l (Cu
shm
an e
t al,
2008
).
Th
e ar
eas
first
affe
cted
in
AD a
re t
hose
ass
ocia
ted
with
na
viga
tion;
th
e hi
ppoc
ampu
s (s
patia
l m
emor
ies)
, th
e pa
rahi
ppoc
ampa
l gyr
us (
land
mar
k en
codi
ng)
and
surr
ound
ing
regi
ons.
Very
few
dem
entia
-frie
ndly
env
ironm
ent g
uide
lines
add
ress
ing
orie
ntati
on s
kills
exi
st;
thes
e ar
e oft
en b
ased
on
cust
om a
nd
prac
tice
rath
er th
an o
n em
piric
al d
ata.
It is
uncl
ear
whi
ch
navi
gatio
n st
rate
gies
an
d la
ndm
ark
char
acte
ristic
s (e
.g. p
ositi
onin
g, u
niqu
enes
s, s
alie
ncy,
stab
ility
) ar
e m
ost
impo
rtan
t in
alle
viati
ng s
patia
l di
sorie
ntati
on f
or
peop
le w
ith A
D. S
tria
tal
func
tion
has
been
sai
d to
rem
ain
rela
tivel
y in
tact
in
early
AD;
thi
s re
gion
is
impl
icat
ed i
n eg
ocen
tric
, per
son-
cent
red
navi
gatio
n.
Appl
icati
ons:
Tr
ansla
te fi
ndin
gs fr
om t
he e
mpi
rical
exp
erim
ents
into
dem
entia
fr
iend
ly d
esig
n gu
idel
ines
.
Use
the
find
ings
fro
m t
he V
R ex
perim
ents
in
real
car
e-ho
me
setti
ngs.
Pot
entia
l im
prov
emen
ts c
ould
the
n be
map
ped
onto
ot
her s
pace
s e.g
. sho
ps a
nd le
isure
cen
tres
.
Such
app
licati
ons w
ould
furt
her w
ell-b
eing
and
inde
pend
ence
for
peop
le w
ith A
D.
mar
y.om
alle
y@bo
urne
mou
th.a
c.uk
•Th
e se
ssio
ns e
nabl
ed
peop
le to
ask
que
stio
ns
and
lear
n
•Pe
rson
al in
tere
sts,
hobb
ies
and
expe
rienc
es
wer
e pr
ompt
ed b
y th
e se
ssio
ns a
nd w
ere
expl
ored
and
dis
cuss
ed
•Pr
ovid
ing
info
rmat
ion
dire
ctly
abo
ut th
e re
gion
al
loca
lity
was
of i
nter
est a
s it
had
rele
vanc
e to
man
y of
th
e pa
rtici
pant
s w
hich
m
ade
cont
ribut
ing
to d
iscu
ssio
ns
ea
sier
the
parti
cipa
nts
whi
ch
the
parti
cipa
nts
whi
ch
the
parti
cipa
nts
whi
ch
the
parti
cipa
nts
whi
ch
mad
e co
ntrib
utin
g
m
ade
cont
ribut
ing
mad
e co
ntrib
utin
g
m
ade
cont
ribut
ing
to d
iscu
ssio
ns
to
dis
cuss
ions
to d
iscu
ssio
ns
the
parti
cipa
nts
whi
ch
mad
e co
ntrib
utin
g
to
dis
cuss
ions
to d
iscu
ssio
ns
to
dis
cuss
ions
the
parti
cipa
nts
whi
ch
mad
e co
ntrib
utin
g
m
ade
cont
ribut
ing
to d
iscu
ssio
ns
to
dis
cuss
ions
to d
iscu
ssio
ns
the
parti
cipa
nts
whi
ch
mad
e co
ntrib
utin
g
m
ade
cont
ribut
ing
to d
iscu
ssio
ns
to
dis
cuss
ions
to d
iscu
ssio
ns
to
dis
cuss
ions
mad
e co
ntrib
utin
g
m
ade
cont
ribut
ing
•
Com
plet
ion
and
enga
gem
ent i
n th
e ac
tiviti
es p
rovi
ded
a se
nse
of a
chie
vem
ent
•Pr
ogre
ssio
n of
build
ing
co
nfid
ence
was
ach
ieve
d th
roug
hout
the
sess
ions
•C
once
ntra
tion
was
pr
omot
ed d
urin
g th
e se
ssio
ns. I
t gav
e pa
rtici
pant
s tim
e to
thin
k ab
out t
he a
ctiv
ity a
nd
expl
ore
at th
eir o
wn
pace
ex
plor
e at
thei
r ow
n
ex
plor
e at
thei
r ow
n
ex
plor
e at
thei
r ow
n
ex
plor
e at
thei
r ow
n
•Th
ere
was
a g
ener
al
exci
tem
entt
o ta
ke p
art
•Th
e se
ssio
ns e
nabl
ed
rem
inis
cenc
e an
d th
e sh
arin
g of
sto
ries
•Th
e se
ssio
ns w
ere
sugg
este
d to
be
in
terg
ener
atio
nal a
s th
ey
can
be re
plic
ated
with
gr
andc
hild
ren
•Th
ere
was
an
eage
rnes
s to
ta
ke p
art
•Se
ssio
ns p
rovi
ded
stim
ulat
ion
•A
good
atm
osph
ere
was
in
tegr
al to
the
succ
ess
of
the
sess
ions
as
a ‘fu
n’
elem
ent w
as p
rom
oted
•Su
ppor
t ena
bled
and
en
cour
aged
par
ticip
atio
n w
ithou
t fea
r of ‘
doin
g so
met
hing
wro
ng’
•En
cour
agem
ent p
rom
pted
pa
rtici
pant
s to
par
ticip
ate
and
‘hav
e a
go’
Enco
urag
emen
t pro
mpt
ed
parti
cipa
nts
to p
artic
ipat
e pa
rtici
pant
s to
par
ticip
ate
parti
cipa
nts
to p
artic
ipat
e pa
rtici
pant
s to
par
ticip
ate
parti
cipa
nts
to p
artic
ipat
e
TALE
S FR
OM
TH
E SE
AEN
GA
GIN
G P
EOPL
E W
ITH
DEM
ENTI
A IN
MA
RIT
IME
AR
CH
AEO
LOG
Y C
UTL
ER,C
(BU
DI)
AN
DPA
LMA,
P (A
PSC
)
M
ariti
me
arch
aeol
ogy
is a
vita
lpa
rtof
the
UK’
sna
tiona
lhe
ritag
eth
atpe
ople
with
dem
entia
are
ofte
nex
clud
edfro
mac
cess
ing.
The
Tale
sFr
omth
eSe
apr
ojec
tthe
refo
rede
liver
ed a
ser
ies
ofin
tera
ctiv
e,ed
ucat
iona
land
stim
ulat
ing
mar
itim
ear
chae
olog
ical
sess
ions
for
peop
lew
ithde
men
tia. T
heai
mof
the
sess
ions
was
topr
ovid
ean
oppo
rtuni
tyfo
rac
cess
and
lear
ning
arou
ndth
ehi
stor
y,di
scov
ery
and
reco
very
ofth
eU
K’s
mar
itim
ear
chae
olog
ical
herit
age.
Thi
spo
ster
repo
rtson
a
pilo
tst
udy
that
has
eval
uate
dth
eab
ove
initi
ativ
ean
ddi
scus
ses
how
toen
gage
peop
lew
ithde
men
tiaw
ithno
n-co
nven
tiona
ltop
ics
such
as m
ariti
me
arch
aeol
ogy.
Thi
sno
veli
nter
vent
ion
isan
inno
vativ
ede
mon
stra
tion
ofth
ew
ays
inw
hich
peop
lew
ithde
men
tiaca
nbe
stim
ulat
edan
den
gage
din
cultu
rean
dhi
stor
yin
a w
ayth
atis
mea
ning
fult
oth
eir
loca
lity.
Iti
sho
ped
that
the
findi
ngs
will
prov
ide
insp
iratio
nto
othe
rsto
try‘n
ew’a
ctiv
ities
that
are
stim
ulat
ing.
The
aim
ofth
epr
ojec
tw
asto
eval
uate
the
impa
ctof
inte
ract
ive
mar
itim
ear
chae
olog
ical
sess
ions
(as
anac
tivity
)w
ithpe
ople
with
dem
entia
livin
gw
ithin
the
com
mun
ity. S
essi
ons
wer
ede
liver
edto
87in
divi
dual
sw
ithde
men
tiain
five
Dor
set
com
mun
ityda
yce
ntre
sov
er a
con
secu
tive
thre
ew
eek
perio
d. T
hese
ssio
nsw
ere
eval
uate
dus
ing
qual
itativ
em
etho
dsw
hich
incl
uded
ethn
ogra
phic
field
note
s,en
dof
sess
ion
disc
ussi
ons
and
eval
uatio
nfo
rms.
The
sess
ions
repl
icat
edar
chae
olog
ical
proc
esse
sw
hich
are
follo
wed
byfie
ldar
chae
olog
ists
and
incl
uded
activ
ities
such
as:
•Rec
onst
ruct
ing
arte
fact
s(p
uttin
gex
cava
ted
arte
fact
sba
ckto
thei
rorig
inal
stat
e)•P
roce
ssin
gof
arte
fact
s(c
olle
ctin
gan
dor
derin
gar
tefa
cts
foun
dfro
mth
eex
cava
tion)
•Con
duct
ing
a m
ariti
me
arch
aeol
ogic
alex
cava
tion
•Pho
togr
aphi
ngar
tefa
cts
insi
tu
•Inte
ract
ing
with
arch
aeol
ogic
alar
tefa
cts
(fore
xam
ple
potte
ryan
dw
ood)
BA
CK
GR
OU
ND
MET
HO
DS
Man
y pa
rtici
pant
s en
joye
d th
e m
ariti
me
arch
aeol
ogic
al s
essi
ons
and
foun
d th
ese
inte
rest
ing.
The
impo
rtanc
e of
the
sess
ions
was
that
they
al
low
ed th
e pa
rtici
pant
s to
be
apar
t of:
•So
cial
inte
ract
ion
•St
imul
atio
n•
Rem
inis
cenc
e•
Enga
gem
ent i
n a
‘diff
eren
t act
ivity
’•
Lear
ning
abo
ut a
n in
tere
stin
g to
pic
ww
w.b
ourn
emou
th.a
c.u
k/d
emen
tia-
inst
itu
te
RES
ULT
S
CO
NC
LUSI
ON
Anal
ysis
of t
he s
essi
ons
indi
cate
d fo
ur re
curr
ent
them
es:
Acc
ess
to in
form
atio
nA
cces
s to
lear
ning
Acc
ess
to a
ctiv
ities
Acc
ess
to s
uppo
rt
ww
w.b
ourn
emou
th.a
c.u
k/a
pp
lied
-sci
ence
s
Th
e Sc
hoo
l of
A
pp
lied
Sci
ence
s (A
pSc
i)
19
Eva
luat
ing
the
Con
stru
ctio
n an
d V
alid
ity o
f a Q
uest
ionn
aire
A
sses
sing
Hea
lthca
re P
rovi
der
Per
cept
ions
of R
ural
Dem
entia
C
are
Pat
hway
s
The
purp
ose
of th
e pr
opos
ed re
sear
ch st
udy
is to
pre
test
a n
ewly
dev
elop
ed q
ues6
onna
ire
asse
ssin
g he
alth
care
pro
vide
r per
cep6
ons o
f cu
rren
t rur
al d
emen
6a c
are
path
way
s and
pr
ac6c
es. T
he q
ues6
onna
ire w
ill b
e us
ed in
a
larg
er st
udy
aim
ed a
t dev
elop
ing
effec
6ve
and
sust
aina
ble
rura
l prim
ary
heal
th c
are
mod
els a
nd w
ill b
e co
nduc
ted
by th
e Ru
ral
Dem
en6a
Ac6
on R
esea
rch
(RaD
AR) t
eam
Kath
leen
Kul
yk, B
SN; N
orm
a St
ewar
t, Ph
D, R
N; S
helle
y Pe
acoc
k, P
hD, R
N; D
ebra
Mor
gan,
PhD
, RN
; M
egan
O’C
onne
ll, P
hD, R
D Ps
ych;
Julie
Kos
teni
uk, P
hD.
Dem
en6a
has
a d
evas
ta6n
g im
pact
on
indi
vidu
als a
nd fa
mili
es. P
roje
c6on
s of
incr
ease
d pr
eval
ence
of d
emen
6a
(Alzh
eim
er’s
Dise
ase
Inte
rna6
onal
, 200
9) w
ill
plac
e gr
eate
r dem
ands
on
heal
th c
are
syst
ems i
n th
e fu
ture
. Alth
ough
bes
t pr
ac6c
es in
prim
ary
heal
th c
are
for d
emen
6a
have
bee
n id
en6fi
ed (A
min
zade
h et
al.,
20
12),
liVle
is k
now
n ab
out h
ow to
op
era6
onal
ize th
ese
prac
6ces
in ru
ral s
eWng
s
The
obje
c6ve
s of t
he st
udy
will
be
to:
(1) e
xam
ine
the
cons
truc
6on
of th
e qu
es6o
nnai
re (f
easib
ility
and
acc
epta
bilit
y),
(2) p
rovi
de e
vide
nce
to su
ppor
t val
idity
of t
he
ques
6onn
aire
and
, (3
) pro
vide
reco
mm
enda
6ons
for t
he re
finem
ent
of th
e qu
es6o
nnai
re
A pu
rpos
ive
sam
ple
of tw
elve
par
6cip
ants
(in
clud
ing
fam
ily p
hysic
ian,
nur
se p
rac6
6one
r, ho
me
care
nur
se a
nd o
ccup
a6on
al th
erap
ist) w
ill
be d
raw
n fr
om r
ural
Sas
katc
hew
an p
rimar
y he
alth
car
e te
ams a
nd w
ill c
ompl
ete
the
ques
6onn
aire
via
a te
leph
one-‐
base
d in
terv
iew
. Re
com
men
da6o
ns fo
r que
s6on
naire
refin
emen
t w
ill b
e pr
ovid
ed to
the
RaDA
R te
am b
ased
on
data
resu
lts
Alzh
eim
er’s
Dise
ase
Inte
rna6
onal
. (20
09). World Alzh
eimer Report.
hVp:
//w
ww
.alz.
co.u
k/re
sear
ch/fi
les/
Wor
ldAl
zhei
mer
Repo
rt.p
df
Amin
zade
h, F
., M
olna
r, F.
, Dal
ziel,
W.B
., M
ound
e, C
., &
Ayo
Ve,
D. (
2012
). A
scop
ing
inte
rpre
6ve
revi
ew o
f lite
ratu
re o
n pe
rspe
c6ve
s and
pra
c6ce
s of p
rimar
y ca
re p
hysic
ians
vis-‐
à-‐vi
s dia
gnos
is an
d m
anag
emen
t of c
omm
unity
livi
ng o
lder
per
sons
with
dem
en6a
. Can
adian Ge
riatrics Jou
rnal, 15(
3), 1
-‐13
. doi
: 10.
5770
/cgj
.15.
42
(RaD
AR) t
eam
: hV
p://
ww
w.c
chsa
-‐ccs
sma.
usas
k.ca
/rur
alde
men
6aca
re/
20
CCN
A Te
am 2
0
CCN
A Te
am 2
0
Team
20
of th
e Ca
nadi
an C
onso
rtiu
m o
n N
euro
dege
nera
tion
in A
ging
(CCN
A):
Rur
al D
emen
tia A
ctio
n R
esea
rch
(RaDAR
) 1 D
. Mor
gan
, 1 J. K
oste
niuk
, 1 M. C
ross
ley,
1 M.E
. O’C
onne
ll, 1 A
. Kirk
, 1 N. S
tew
art,
2 V. D
al B
ello
-Haa
s, 3 D
. For
bes,
4 A. I
nnes
, 5 L. M
cBai
n, 1 H
. Mou
, 6 E. P
arro
tt
1 Uni
vers
ity o
f Sas
katc
hew
an, 2
McM
aste
r Uni
vers
ity,
3 Uni
vers
ity o
f Al
bert
a, 4 B
ourn
emou
th U
nive
rsity
, 5 F
irst N
atio
ns U
nive
rsity
of C
anad
a, ,
6 Fam
ily c
areg
iver
Back
grou
nd
Rura
l and
rem
ote
indi
vidu
als
with
mild
cog
nitiv
e im
pairm
ent (
MCI
) and
dem
entia
are
a h
ighl
y vu
lner
able
po
pula
tion
that
face
s ch
alle
nges
acc
essi
ng n
eces
sary
se
rvic
es. S
aska
tche
wan
’s g
eogr
aphy
and
spa
rse
popu
latio
n co
ntrib
ute
to th
e ch
alle
nges
in ru
ral h
ealth
se
rvic
e de
liver
y. Th
e Ru
ral a
nd R
emot
e M
emor
y Cl
inic
(RRM
C)*
is
loca
ted
in th
e ci
ty o
f Sas
kato
on, S
aska
tche
wan
and
se
rves
rura
l and
rem
ote
indi
vidu
als
livin
g in
depe
nden
tly in
com
mun
ities
that
are
mor
e th
an 1
00
km fr
om S
aska
toon
or R
egin
a (th
e tw
o ce
nsus
m
etro
polit
an a
reas
in th
e pr
ovin
ce o
f Sas
katc
hew
an):
• Pa
tient
s an
d fa
mili
es a
re re
ferr
ed to
the
fam
ily-
cent
red
inte
rpro
fess
iona
l RRM
C by
thei
r prim
ary
care
hea
lth p
rovi
der
• Pa
tient
s, a
ccom
pani
ed b
y a
care
give
r, re
ceiv
e a
prec
linic
tele
heal
th-fa
cilit
ated
ass
essm
ent b
y a
neur
opsy
chol
ogis
t and
nur
se
• Fo
ur to
six
wee
ks la
ter,
patie
nts
and
care
give
r(s)
atte
nd a
1-d
ay in
-per
son
clin
ic e
valu
atio
n th
at
invo
lves
the
full
clin
ical
team
of a
neu
rolo
gist
, ph
ysic
al th
erap
ist,
diet
itian
, and
neu
rops
ycho
logy
te
am.
• At
the
end
of th
e 1-
day
eval
uatio
n, p
atie
nts
and
care
give
rs re
ceiv
e in
form
atio
n re
gard
ing
the
prob
able
dia
gnos
is, r
ecom
men
datio
ns fo
r m
anag
emen
t, an
d se
rvic
e re
ferr
als
as a
ppro
pria
te.
* Rur
al D
emen
tia C
are
web
site
: ht
tp:/
/ww
w.cc
hsa-
ccss
ma.
usas
k.ca
/rur
alde
men
tiaca
re/
The
RaDA
R (R
ural
Dem
entia
Act
ion
Rese
arch
) Tea
m*
• An
inte
rdis
cipl
inar
y gr
oup
of re
sear
cher
s fro
m th
ree
Cana
dian
pro
vinc
es a
nd th
e UK
. Sin
ce 2
011,
the
team
has
bee
n de
velo
ping
a c
omm
unity
-bas
ed
part
icip
ator
y re
sear
ch p
rogr
am a
imed
at i
mpr
ovin
g pr
imar
y he
alth
car
e (P
HC) f
or p
eopl
e w
ith d
emen
tia
i n ru
ral a
nd re
mot
e se
tting
s in
resp
onse
to a
cal
l for
Co
mm
unity
-Bas
ed P
rimar
y H
ealth
Car
e Te
am G
rant
s by
CIH
R (C
anad
ian
Inst
itute
s of
Hea
lth R
esea
rch)
. *R
ural
Dem
entia
Act
ion
Rese
arch
web
site
: ht
tp:/
/ww
w.cc
hsa-
ccss
ma.
usas
k.ca
/rur
alde
men
tiaca
re/
rada
r.htm
l IN
FORM
ATIO
N
Dr.
Deb
ra M
orga
n. C
anad
ian
Cent
re fo
r Hea
lth &
Saf
ety
in
Agric
ultu
re, U
nive
rsity
of S
aska
tche
wan
: de
bra.
mor
gan@
usas
k.ca
or 3
06-9
66-7
905
" AC
KNOW
LED
GEM
ENTS"
Invi
tatio
n to
Join
CCN
A In
itial
sta
ges
– su
bmitt
ing
a CB
PHC
Team
Gra
nt
Octo
ber,
2011
Pla
nnin
g Se
ssio
n* to
dev
elop
a C
BPHC
Tea
m
R ese
arch
Pro
gram
•
The
purp
ose
of th
is p
lann
ing
sess
ion
was
to b
ring
toge
ther
re
sear
cher
s (1
5) a
nd D
ecis
ion
Mak
ers
(53)
to id
entif
y im
port
ant
issu
es in
prim
ary
heal
thca
re (P
HC) a
nd in
nova
tive
serv
ice
deliv
ery
mod
els
for p
eopl
e w
ith d
emen
tia a
nd th
eir c
areg
iver
s liv
ing
in
rura
l/re
mot
e ar
eas.
Pla
nn
ing
fo
r th
e R
isin
g T
ide
:
Ne
w M
od
els
of
Ru
ral
Pri
ma
ry H
ea
lth
ca
re
for
Pe
rso
ns
wit
h D
em
en
tia
Co
mm
un
ity-B
ased
Pri
mary
Healt
hcare
Team
Gra
nt
Pla
nn
ing
Sessio
n,
Octo
ber
17,
2011
RE
PO
RT
TE
AM
ME
MB
ER
S
De
bra
Mo
rga
n
Ju
lie K
oste
niu
k
Ma
rga
ret
Cro
ssle
y
An
dre
w K
irk
Me
ga
n O
’Co
nn
ell
No
rma
Ste
wa
rt
Do
roth
y F
orb
es
Va
nin
a D
al B
ello
-Ha
as
An
the
a I
nn
es
Jo
hn
Ke
ad
y
Srid
ha
r V
aith
esw
ara
n
Ala
n M
urd
och
Com
mun
ity-B
ased
Prim
ary
Hea
lthca
re T
eam
Gra
nt P
lann
ing
Ses
sion
, Oct
ober
17,
201
1 P
lann
ing
for t
he R
isin
g Ti
de: N
ew M
odel
s of
Rur
al P
rimar
y H
ealth
care
for P
erso
ns w
ith D
emen
tia
12
4. P
REP
AR
ATO
RY
MA
TER
IAL
Prio
r to
the
Oct
ober
17th
Pla
nnin
g Se
ssio
n, w
e m
aile
d a
bind
er o
f mee
ting
docu
men
ts b
y po
st to
ea
ch p
artic
ipan
t. Th
e bi
nder
incl
uded
: •
a w
elco
me
lette
r fro
m th
e pr
inci
pal i
nves
tigat
or (D
r. M
orga
n)
• C
IHR
ann
ounc
emen
t of t
he C
BPH
C T
eam
Gra
nt c
ompe
titio
n •
our t
eam
’s C
IHR
Pla
nnin
g G
rant
app
licat
ion
to h
ost t
he O
ctob
er 1
7th P
lann
ing
Sess
ion
• Pl
anni
ng S
essi
on o
bjec
tives
, par
ticip
ant c
onta
ct in
form
atio
n, p
rese
ntat
ions
, and
con
sent
fo
rms t
o pa
rtici
pate
in re
sear
ch
• 6
key
jour
nal p
ublic
atio
ns o
n de
men
tia c
are
rese
arch
•
two
orig
inal
rese
arch
repo
rts w
ritte
n by
our
team
as b
ackg
roun
d m
ater
ial f
or th
e Pl
anni
ng
Sess
ion
5.
INVI
TED
PA
RTI
CIP
AN
TS
W
e m
aile
d in
vita
tions
to th
e Pl
anni
ng S
essi
on b
y po
st to
mem
bers
of a
num
ber o
f sta
keho
lder
gr
oups
. Fi
rst,
we
invi
ted
all f
amily
phy
sici
ans
prac
ticin
g in
Sas
katc
hew
an o
utsi
de o
f Sas
kato
on
and
Reg
ina
(N=4
02) (
30).
We
also
em
aile
d in
vita
tions
to a
ll he
alth
regi
on d
irect
ors o
f pr
imar
y he
alth
care
, chr
onic
dis
ease
man
agem
ent,
long
-term
car
e, a
nd H
ome
Car
e, u
sing
a c
urre
nt
list p
rovi
ded
by a
Sas
katc
hew
an H
ealth
staf
f m
embe
r. A
s wel
l, th
e Sa
skat
chew
an R
egis
tere
d N
urse
s Ass
ocia
tion
(SR
NA
) em
aile
d an
in
vita
tion
on o
ur b
ehal
f to
all 1
22 S
aska
tche
wan
R
N(N
P)s o
n th
eir l
ists
erve
(31)
. Sel
ecte
d pa
st
parti
cipa
nts o
f the
Ann
ual K
now
ledg
e N
etw
ork
in R
ural
and
Rem
ote
Dem
entia
Car
e Su
mm
it w
ere
also
invi
ted,
incl
udin
g fa
mily
car
egiv
ers o
f R
ural
and
Rem
ote
Mem
ory
Clin
ic p
atie
nts.
Afte
r the
invi
tatio
ns w
ere
sent
, add
ition
al
stak
ehol
ders
lear
ned
of th
e Pl
anni
ng S
essi
on a
nd
cont
acte
d ou
r Tea
m to
regi
ster
for t
he P
lann
ing
Sess
ion.
App
endi
x A
list
s the
par
ticip
ants
of t
he
Oct
ober
17th
Pla
nnin
g Se
ssio
n.
*Ful
l Rep
ort o
f Pla
nnin
g Se
ssio
n (1
09 p
ages
) ava
ilabl
e on
line!
http
://w
ww.
cchs
a-cc
ssm
a.us
ask.
ca/r
ural
dem
entia
care
/rad
ar.h
tml
!
Reco
mm
enda
tions
from
Oct
ober
, 201
1 Pl
anni
ng S
essi
on
1. D
evel
op d
emen
tia c
are
coor
dina
tors
to p
rovi
de c
ase
man
agem
ent
and
syst
em n
avig
atio
n 2. O
ffer e
duca
tion
& tr
aini
ng to
PH
C pr
ovid
ers
3. E
stab
lish
guid
elin
es to
impr
ove
early
det
ectio
n &
dia
gnos
is
4. In
trodu
ce s
tand
ardi
zed
care
pat
hway
s fo
r PH
C pr
ovid
ers
5. S
uppo
rt a
pro
vinc
ial a
nd n
atio
nal s
trate
gy fo
r dem
entia
, tha
t re
cogn
izes
dem
entia
as
a ch
roni
c di
seas
e
Octo
ber 2
012
CBPH
C Te
am G
rant
su
bmitt
ed to
CIH
R
April
201
3 N
otifi
catio
n of
CIH
R re
view
: CBP
HC
Team
gr
ant n
ot fu
nded
May
201
3 In
vita
tion
to p
artic
ipat
e in
th
e Ca
nadi
an C
onso
rtiu
m
on N
euro
dege
nera
tion
in
Agin
g (C
CNA)
June
201
3
RaDA
R Te
am a
nd m
embe
rs
of th
e In
tern
atio
nal
Indi
geno
us D
emen
tia
Rese
rch
Net
wor
k fo
rm
CCN
A Te
am 2
0
April
201
4 CI
HR
esta
blis
hes
CCN
A
The
Cana
dian
Con
sort
ium
of N
euro
dege
nera
tion
in A
ging
br
ings
toge
ther
340
rese
arch
ers
acro
ss 2
0 re
sear
ch te
ams,
or
gani
zed
into
thre
e Th
emes
(pre
vent
ion,
trea
tmen
t, ca
re).
“The
vis
ion
of th
e CC
NA
is to
brin
g to
geth
er th
e be
st o
f Ca
nadi
an re
sear
ch in
the
field
of n
euro
dege
rnat
ive
dise
ases
affe
ctin
g co
gniti
on in
a c
olla
bora
tive
and
syne
rgis
tic s
pace
to w
ork
on b
old,
inno
vativ
e an
d tr
ansf
orm
ativ
e re
sear
ch th
at w
ill u
ltim
atel
y im
pact
the
qual
ity o
f life
and
qua
lity
of s
ervi
ces
for t
hose
hav
ing
to
live
with
dem
entia
and
thei
r car
ers”
(CIH
R, 2
014)
CCN
A Te
am 2
0
July
29,
201
3 (U
nive
rsity
of S
aska
tche
wan
)
Team
20
Lead
s:
• Ru
ral:
Deb
ra M
orga
n (U
nive
rsity
of S
aska
tche
wan
) •
I ndi
geno
us:
Kris
ten
Jack
lin (N
orth
ern
Onta
rio S
choo
l of
Med
icin
e), C
arrie
Bou
rass
a (F
irst N
atio
ns U
nive
rsity
of C
anad
a)
Team
20
Rura
l Res
earc
h Pr
ojec
ts:
W
orki
ng in
itial
ly w
ith 1
hea
lth re
gion
in S
aska
tche
wan
: 1. Rural PHC
Dem
en0a
Care Mod
el Dev
elop
men
t -‐ lon
gitudinal m
ix-‐
metho
d mul0p
le case study to iden0fy gaps in dem
en0a care
pathways, assist PHC
team
s to adapt P
HC dem
en0a care prac0ces to
rural se<
ngs (using PD
SA cycles), and evaluate the adapted
interven0o
ns and facilitators/barriers of successful adapta0on
2. Stand
ardized Ca
re Pathw
ays a
nd Too
ls (R
aDAR
Too
lkit) -‐ iden0fy
and adapt e
vidence-‐based clinical su
pport too
ls to ru
ral PHC
se<ngs;
evaluate th
e effi
cacy of the adapted to
ols for im
proving the quality of
care provided to individuals w
ith dem
en0a
3. Cap
acity
-‐building/Men
torin
g of PHC
Provide
rs -‐ deliver tailored
e-‐learning mod
els a
nd case-‐based specialist-‐to-‐PHC
support u
sing
web-‐based to
ols for sp
ecialist con
sulta0o
n and peer learning,
evaluate th
e eff
ec0veness a
nd acceptability of e-‐learning mod
els, and
determ
ine the impact of specialist-‐to-‐PH
C support o
n diagno
sis and
specialist referral.
RaDA
R an
d SK
Hea
lth Q
ualit
y Co
unci
l will
pro
vide
the
first
-eve
r pr
ovin
cial
-leve
l evi
denc
e-ba
sed
anal
ysis
(Tea
m 2
0 ba
selin
e da
ta):
1) a
sy
nthe
sis
of b
est p
ract
ices
from
inte
rnat
iona
l dem
entia
stra
tegi
es; 2
) an
envi
ronm
enta
l sca
n/in
vent
ory
of a
vaila
ble
dem
entia
ser
vice
s an
d th
eir P
HC
attri
bute
s, b
y SK
hea
lth re
gion
; and
3) a
link
ed a
naly
sis
of 1
0 SK
dat
abas
es
(200
1-20
13) t
o es
timat
e th
e pr
eval
ence
and
inci
denc
e of
dem
entia
am
ong
adul
ts 4
5 ye
ars
of a
ge a
nd o
lder
.
21
22
Solu
tion
Ø In
nova
tive
use
of te
lehe
alth
vid
eoco
nfer
enci
ng to
co
nnec
t 10
care
give
rs fr
om 6
regi
ons
of th
e pr
ovin
ce
Ø O
nce
mon
thly
gro
up 1½
hr m
eetin
g fo
r spo
uses
Ø E
mot
ion
proc
essi
ng fo
cus
of g
roup
rath
er th
an
psyc
ho-e
duca
tion
From
Res
earc
h to
Pra
ctic
e: C
olla
bora
tion
with
the
Alz
heim
er S
ocie
ty o
f Sas
katc
hew
an
for a
Tel
ehea
lth D
eliv
ered
Fro
ntot
empo
ral D
emen
tia C
areg
iver
Sup
port
Gro
up
• We
ackn
owle
dge
our
care
give
r pa
rtne
rs w
ithou
t w
hom
w
e w
ould
not
hav
e be
en a
ble
to d
o th
is w
ork
• We
wou
ld li
ke t
o ac
know
ledg
e ou
r w
onde
rful
sup
port
fr
om T
eleh
ealth
Sas
katc
hew
an
Meg
an E
. O’C
onne
ll,1 R
ache
l Bur
ton1
& J
oann
e M
icha
el2
1 D
epar
tmen
t of P
sych
olog
y, U
nive
rsity
of S
aska
tche
wan
, 2Pr
ogra
m S
ervi
ces
Man
ager
, Alz
heim
er S
ocie
ty o
f Sas
katc
hew
an
Pre
sent
ed a
t the
43r
d Ann
ual S
cien
tific
and
Edu
catio
nal M
eetin
g of
the
Can
adia
n A
ssoc
iatio
n on
Ger
onto
logy
, Nia
gara
Fal
ls, O
N
RE
FER
EN
CE
S
1 de
Vugt
, M
., Rie
dijk
, S.
R.,
Aalte
n, P
., Ti
bben
, A.
, va
n Sw
iete
n, J
. C.
, &
Ver
hey,
F. R. J.
(20
06).
Im
pact
of
beha
viou
ral p
robl
ems
on s
pous
al c
areg
iver
s: A
co
mpa
rison
bet
wee
n Al
zhei
mer
’s d
isea
se a
nd
fron
tote
mpo
ral d
emen
tia. D
emen
tia a
nd G
eria
tric
Co
gniti
ve D
isor
ders
, 22,
35-
41.
2 Die
hl, J.
, M
ayer
, T.
, Fo
rstl,
H.,
& K
urz,
A. (2
003)
. A
supp
ort
grou
p fo
r ca
regi
vers
of
patie
nts
with
fr
onto
tem
pora
l dem
entia
. D
emen
tia, 2
, 151
-61.
3 v
an S
wie
ten,
J. C
. & R
osso
, S. M
. (20
06).
Rev
iew
: E
pide
mio
logy
of f
ront
otem
pora
l dem
entia
. Adv
ance
s in
C
linic
al N
euro
scie
nce
and
Reh
abili
tatio
n, 6
(1),
9-10
.
Uni
que
colla
bora
tion
– cl
inic
al re
sear
cher
s co
-fa
cilit
atin
g w
ith A
lzhe
imer
Soc
iety
of S
K s
taff
to
incr
ease
cap
acity
for t
eleh
ealth
del
iver
y of
a
spec
ializ
ed in
terv
entio
n fo
r spo
uses
of p
erso
ns
diag
nose
d w
ith F
TD
Ø c
olla
bora
tion
for 1
st n
ew g
roup
beg
an F
ebru
ary
2012
Ø d
isco
vere
d co
mpl
emen
tary
ski
lls th
at e
nhan
ce
the
supp
ort g
roup
inte
rven
tion
Ø ad
ditio
nal c
apac
ity b
uild
ing
and
a 2n
d gro
up
bega
n Ja
nuar
y 20
13
R
esea
rche
r co-
faci
litat
ion
diss
emin
ated
to c
omm
unity
-ba
sed
staf
f lea
rnin
g ab
out F
TD a
nd it
s un
ique
ch
alle
nges
for s
pous
es; a
lthou
gh in
itial
ly d
efer
ring
to
the
rese
arch
ers,
com
mun
ity-b
ased
faci
litat
ors
are
now
ab
le to
resp
ond
to F
TD s
peci
fic q
uest
ions
and
val
idat
e sp
ecifi
c be
havi
ors
as ty
pica
l in
this
type
of d
emen
tia.
C
o-fa
cilit
atio
n of
rese
arch
ers
and
com
mun
ity-b
ased
st
aff l
ed to
dis
sem
inat
ion
of h
ow to
del
iver
a s
uppo
rt gr
oup
virtu
ally
via
tele
heal
th v
ersu
s in
-per
son;
lear
ning
in
clud
ed a
wkw
ardn
ess
of m
aint
aini
ng e
qual
eye
con
tact
fo
r gro
up m
embe
rs a
ttend
ing
in p
erso
n an
d th
ose
who
at
tend
by
vide
ocon
fere
ncin
g.
Hig
h ne
ed fo
r car
egiv
er in
terv
entio
ns s
peci
fic to
at
ypic
al n
on-A
lzhe
imer
dem
entia
s su
ch a
s fr
onto
tem
pora
l dem
entia
(FTD
) or o
ther
ear
ly-o
nset
de
men
tias
Ø S
pous
al c
areg
iver
s of
per
sons
dia
gnos
ed w
ith
atyp
ical
dem
entia
s (e
.g.,
FTD
) exp
erie
nce
mor
e ps
ycho
logi
cal d
istre
ss th
an s
pous
es o
f per
sons
di
agno
sed
with
Alz
heim
er d
isea
se1
Ø F
ew s
peci
fic in
terv
entio
ns h
ave
been
dev
elop
ed
to a
ddre
ss th
eir n
eeds
2
Rat
iona
le fo
r Spe
cial
ized
Gro
up In
terv
entio
n Ø S
pous
al c
arer
s of
indi
vidu
als
diag
nose
d w
ith a
typi
cal
dem
entia
s ca
n ob
tain
bot
h pr
actic
al in
form
atio
n an
d su
ppor
t fro
m o
ther
s w
ho a
re e
xper
ienc
ing
sim
ilar
troub
ling
beha
viou
rs in
thei
r spo
use2
Prob
lem
– L
arge
Geo
grap
hic
Dis
tanc
es
Ø In
rura
l and
rem
ote
regi
ons
it is
diff
icul
t to
find
man
y ca
rers
of i
ndiv
idua
ls d
iagn
osed
with
thes
e ra
re
dem
entia
s (p
reva
lenc
e es
timat
es o
f 15
per 1
00,0
003
age
of o
nset
50-
60 y
ears
mos
t com
mon
, but
but
rang
e 21
to 8
5 ye
ars
old1
) – c
anno
t con
nect
in-p
erso
n
Eval
uatio
n of
Effe
ctiv
enes
s R
esea
rch
at th
e R
ural
and
Rem
ote
Mem
ory
Clin
ic, U
nive
rsity
of
Sas
katc
hew
an s
ugge
sts
that
the
tele
heal
th
vide
ocon
fere
nced
sup
port
grou
p w
as h
elpf
ul fo
r spo
usal
ca
regi
vers
of p
erso
ns d
iagn
osed
with
FTD
O
’Con
nell,
M. E
., C
ross
ley,
M.,
Cam
mer
, A.,
Mor
gan,
D.,
Alli
ngha
m, W
., C
heav
ins,
B.,
Dal
ziel
, D.,
Lem
ire, M
., M
itche
ll,
S.,
& M
orga
n, E
. (20
14).
Dem
entia
: The
Inte
rnat
iona
l Jo
urna
l of S
ocia
l Res
earc
h an
d Pr
actic
e, 1
3(3)
, 382
-95.
D
OI:
10.1
177/
1471
3012
1247
4143
.
Alz
heim
er d
isea
se is
the
mos
t com
mon
form
of
dem
entia
Ø F
irst i
mpa
cts
the
part
of th
e br
ain
resp
onsi
ble
for
form
ing
new
mem
orie
s, b
ut p
erso
nalit
y re
mai
ns th
e sa
me
– at
leas
t ear
ly o
n Fr
onto
tem
pora
l dem
entia
s Ø Im
pact
s ci
rcui
ts o
f the
bra
in re
spon
sibl
e fo
r pe
rson
ality
and
lang
uage
4 v
aria
nts
(firs
t 3 m
ost c
omm
only
reco
gniz
ed)
1.
Beh
avio
ural
or f
ront
al v
aria
nt –
per
sona
lity
chan
ges
2.
Sem
antic
dem
entia
– lo
ss o
f und
erst
andi
ng o
f la
ngua
ge
3.
Non
-flue
nt v
aria
nt –
loss
of a
bilit
y to
com
mun
icat
e la
ngua
ge
4.
Logo
peni
c va
riant
– e
rror
s in
spe
akin
g/re
peat
ing
Sust
aina
bilit
y of
Res
earc
h In
itiat
ive
Dep
ende
nt o
n C
omm
unity
-Bas
ed P
artn
ersh
ip B
uild
ing
Ø Al
zhei
mer
Soc
iety
of S
K w
ere
aske
d by
car
egiv
er
advo
cate
s to
fill
this
nee
d
Ø Al
zhei
mer
Soc
iety
agr
eed
only
if re
sear
cher
s co
-fa
cilit
ated
to b
uild
cap
acity
for F
TD s
peci
fic k
now
ledg
e
Ø Fi
rst L
ink
to fi
nd c
areg
iver
s fro
m a
cros
s th
e pr
ovin
ce
Co
nta
ct
23
• • •• • • •
• • •
• • •• •
24
An
Eval
uatio
n of
a R
emin
isce
nce
Inte
rven
tion
via
Tele
heal
th
Vide
ocon
fere
ncin
g fo
r Car
egiv
ers
of P
erso
ns w
ith D
emen
tia !
Joe
Enrig
ht &
Meg
an E
. O’C
onne
ll - D
epartm
ent of Psychology, University of Saskatchewan!
!
• Informal caregivers of persons with dem
en5a
o6en experience significant difficul5es or
“caregiver burden”, which has been linked to
the quality of the caregiver and care-‐recipient
rela5onship1. The nega5ve effects of caring on
physical and mental health have a considerable
and grow
ing impact on the econom
y and
society1.
• Reminiscence Therapy (RT) is the facilitated
recall of shared posi5ve mem
ories, and may
improve the quality of the rela5onship and
mi5gate caregiver difficul5es
2,3 .
• In rural and remote communi5es there is a
high propor5on of older-‐adults and limited
access to health services
4 . This makes efficient
delivery of dem
en5a-‐care related services a
challenge.
• Videoconferencing over the Telehealth
Saskatchewan network offers a secure medium
for the delivery of service to rural and remote
areas, aimed at improving access to services
hindered by geography5. Though prom
ising,
the poten5al of this m
edium for the delivery of
psychosocial interven5ons for caregivers is
rela5vely untested
6 .
BA
CK
GR
OU
ND!
Acknow
ledgem
ents!
!! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
! Objec&v
es:
• The first objec5ve is to inves5gate the benefits
of a RT ac5vity for informal caregivers of
persons w
ith dem
en5a
• A second objec5ve is to assess the efficacy of
the RT interven5on delivered via
videoconferencing.
Metho
d:
• Sixty-‐four informal caregivers w
ill be recruited
from
the University of Saskatchewan Rural and
Remote Mem
ory Clinic and random
ly assigned
to 1 of four condi5ons: in-‐person RT / in-‐person
control, Telehealth RT / Telehealth control.
• The RT interven5on will be based on an
empirically supported autobiographical mem
ory
ac5vity
7 . • Rela5onship quality, caregiver burden, and
other outcome measures w
ill be administered
at pre, post, and follow-‐up."
Hypo
theses:
• It is expected that caregivers in the RT groups
will dem
onstrate an increase in perceived
quality of their rela5onship with the care-‐
recipient and a decrease in perceived burden
of caring
• It is also an5cipated that there will not be a
significant difference in outcomes between the
in-‐person versus Telehealth delivery
condi5ons.
Project R
elevan
ce:
• This project w
ill provide evidence of RT effi
cacy
for improving caregiver/care-‐recipient
rela5onships and reducing the perceived
burden and strain of caring for persons with
demen5a. Further, it w
ill inform the use of
videoconferencing technology in the
developm
ent of accessible services for those
with limited access, especially in rural and
remote areas.
MET
HO
D!
HYP
OTH
ESES
& R
ELEV
AN
CE!
References
1.Alzheimer Society of Canada. (2010). Rising Tide: The Im
pact of D
emenAa on Canadian Society. Toronto: Author 2
. Woods, B., et al. (2005).
Reminiscence therapy for people with dem
en5a (review).Cochrane Da
tabase SystemaAc Review
, 2005, (2); 3. W
oods, R.T., et al. (2009). Rem
iniscence
groups for people with dem
en5a and their fam
ily carers: pragm
a5c eight-‐centre random
ised trial of joint reminiscence and maintenance versus usual
treatment: a protocol. Trials 2009, (10),64 4. Morgan, D.,et al. (2002). Rural families caring for a rela5ve with dem
en5a:Barriers to use of formal services.
Social Science & Medicine, 55(7), 51-‐64 5. M
organ, D. G., Crossley, M., Kirk, A., McBain, L., Stewart, N. J., D’Arcy, C., ... & Basran, J. (2011). Evalua5on of
telehealth for preclinic assessment and follow-‐up in an interprofessional rural and remote mem
ory clinic. Journal of Applied Gerontology, 30(3), 304-‐331.
6. O’Connell, M. E., Crossley, M., Cammer, A., Morgan, D., Allingham
, W., Cheavins, B., Dalziel, D., Lemire, M
., Mitchell, S., & Morgan, E. (in press).
Developm
ent and evalua5on of a telehealth videoconferenced support group for rural spouses of individuals diagnosed with atypical early-‐ onset
demen5as. Dem
enAa: TheInternaAonal Journal of Social Research and PracAce. 7. Alea, N., & Bluck, S. (2007). I'll keep you in mind: The in5m
acy func5on
of autobiographical m
emory. Applied Cogni5ve Psychology, 21(8), 1091-‐1111.
This research is funded by TVN, which is supported by the Government of
Canada through the Networks of Centres of Excellence (NCD) program
. ™ Trademark of TVN (Technology Evalua5on in the Elderly Network). Used
with permission.
Your
reco
mm
enda
tions
Dra%
reco
mm
enda
)ons
for a
c)on
are offe
red be
low in
the area
s of p
olicy,
research
, and
kno
wledg
e tran
sla)o
n an
d ex
chan
ge. T
hese re
commen
da)o
ns re
cogn
ize th
e ev
iden
ce presented
in th
is repo
rt th
at each ye
ar, 3
,217
adu
lts* are diag
nosed or otherwise
iden
)fied
with
dem
en)a
and
13, 012
are currently living
with
dem
en)a
(*ag
ed 45 ye
ars a
nd
over). Th
ese reco
mmen
da)o
ns add
ress th
e ch
alleng
es ra
ised in th
is repo
rt: tha
t our
prov
incial hea
lth care system
currently und
erdiag
noses d
emen
)a (a
s evide
nt in
28%
of a
ll ne
w cases each ye
ar being
iden
)fied
first a
t adm
ission to LTC
) and
und
erserves in
dividu
als
with
dem
en)a
and
their fam
ilies – cha
lleng
es th
at w
ill in
tens
ify ove
r the
com
ing ye
ars a
s our
popu
la)o
n ag
es if w
e do
not dev
elop
long
-‐term plans
. Po
licy
1. D
evel
op a
pro
vinc
ial d
emen
)a st
rate
gy th
at is based
on the follo
wing principles:
Is dev
elop
ed in
collabo
ra)o
n with
families of ind
ividua
ls with
dem
en)a
, exp
erts in
dem
en)a
an
d de
men
)a care, hea
lth care professio
nals, hea
lth re
gion
represen
ta)v
es, a
nd th
e Alzh
eimer Soc
iety of S
aska
tche
wan
. Fo
cuses o
n be
st prac)
ces in de
men
)a care, as p
ut fo
rth in na)
onal dem
en)a
plans
from
othe
r cou
ntrie
s: exp
anding
dem
en)a
research
, qua
lity im
prov
emen
t in care se
rvices, raisin
g pu
blic awaren
ess, early diagn
osis, fa
mily
supp
ort, an
d staff
training
. Bu
ilds o
n reco
mmen
da)o
ns from
the Alzh
eimer Soc
iety of C
anad
a Risin
g Tide
reco
mmen
da)o
ns
Incr
ease
acc
ess t
o he
alth
and
com
mun
ity se
rvices
for i
ndiv
idua
ls li
ving
in ru
ral c
omm
uni)
es
by in
crea
sing inve
stmen
ts in
subs
idize
d an
d free
tran
sporta)o
n for o
lder adu
lts living
outsid
e of Saska
toon
and
Reg
ina (spe
cialist
services) a
nd sm
aller u
rban
cen
tres.
Ensu
re th
at fa
mily
car
egiv
ers a
re a
dequ
atel
y su
ppor
ted by
increa
sing inve
stmen
ts to
im
prov
e the av
ailability an
d freq
uenc
y of hom
e-‐ba
sed an
d co
mmun
ity-‐based
resp
ite care,
includ
ing ev
ening, w
eeke
nd, a
nd emerge
ncy care.
Includ
e de
men
)a in
the
Chro
nic Di
seas
e M
anag
emen
t Qua
lity Im
prov
emen
t Pro
gram
, thereb
y establish
ing a pa
)ent re
gistry and
dec
ision
supp
ort too
ls (stand
ardized care) for
health care professio
nals sim
ilar t
o othe
r chron
ic con
di)o
ns (e
.g., diab
etes, h
ealth
dise
ase).
Rese
arch
Tr
ack qu
ality
indi
cato
rs o
f dem
en)a
car
e pr
ovin
cial
ly a
nd b
y he
alth
regi
on, to en
sure th
at
individu
als a
re prope
rly assessed, diagn
osed
, and
man
aged
with
in th
e he
alth care system
. Th
e follo
wing principles provide
guida
nce:
Qua
lity indicators sh
ould be de
velope
d in partnersh
ip betwee
n ex
perts in de
men
)a, h
ealth
care professiona
ls, hea
lth re
gion
represen
ta)v
es (e
.g., Po
pula)o
n an
d Pu
blic Hea
lth, P
rimary
Health Care, Acu
te Care, Hom
e Ca
re, a
nd Lon
g-‐term
Care), e
Health, a
nd Hea
lth Qua
lity
Coun
cil.
Qua
lity indicators sh
ould be repo
rted
ann
ually
, with
improv
emen
ts and
dec
lines noted
, and
he
alth re
gion
s’ com
men
ts on fin
ding
s inc
lude
d.
Incr
ease
inve
stm
ent i
n th
e Firs
t Lin
k re
ferral
pro
gram
pro
vide
d by
the
Alzh
eim
er Soc
iety
of
Sask
atch
ewan
, to en
sure th
at link
s are m
ade be
twee
n individu
als w
ith dem
en)a
, the
ir families, loc
al hea
lth se
rvices, a
nd Alzh
eimer Soc
iety program
s. Add
i)on
al st
aff sh
ould be
hired in hea
lth re
gion
s tha
t currently hav
e the First L
ink prog
ram in
ope
ra)o
n (Saska
toon
, Re
gina
Qu’Ap
pelle
, Cyp
ress, P
rairie North, P
rince
Albert P
arklan
d, Sun
Cou
ntry) a
nd
expa
nded
to th
ose he
alth re
gion
s with
out F
irst L
ink (Cyp
ress, F
ive Hills, H
eartland
, Kelsey
Trail, Su
nrise
, and
the Northern he
alth re
gion
s).
Know
ledg
e Tr
ansla)
on a
nd E
xcha
nge
Partne
r with
tele
vision
and
new
spap
er m
edia
to ra
ise
publ
ic a
war
enes
s of risk re
duc)
on,
warning
sign
s, and
the im
portan
ce of )
mely diag
nosis
, e.g., co
ntrib
ute a regu
lar t
wice-‐
mon
thly colum
n to th
e Sa
skatoo
n Star Pho
enix and
Reg
ina Le
ader Pos
t and
con
tribute
regu
lar items t
o Sa
skatoo
n an
d Re
gina
new
s program
s.
Esta
blish
the
partne
rshi
ps re
quire
d to
est
ablis
h an
d m
aint
ain
con)
nuin
g ed
uca)
on
prog
ram
s for hea
lth care professio
nals to im
prov
e skills in assessmen
t, diag
nosis
, and
man
agem
ent. Pa
rtne
rs m
ay in
clud
e ex
perts in de
men
)a and
dem
en)a
care, Unive
rsity
of
Saskatch
ewan
, Teleh
ealth
Saska
tche
wan
, Saska
tche
wan
Med
ical Assoc
ia)o
n, nursin
g asso
cia)
ons, Alzh
eimer Soc
iety of S
aska
tche
wan
, hea
lth re
gion
represen
ta)v
es, a
nd others.
Incr
ease
aw
aren
ess o
f ear
ly o
nset
dem
en)a
(you
nger
than
65
year
s) amon
g the pu
blic as
well a
s hea
lth care professio
nals. Estab
lish services th
at are designe
d for a
dults
with
early
onset d
emen
)a, w
ho m
ay hav
e un
ique
nee
ds (e
.g., in th
e workforce
, with
children).
Dra%
reco
mm
enda
)ons
for a
c)on
are offe
red be
low in
the area
s of p
olicy,
research
, and
kno
wledg
e tran
sla)o
n an
d ex
chan
ge. T
hese re
commen
da)o
ns re
cogn
ize th
e ev
iden
ce presented
in th
is repo
rt th
at each ye
ar, 3
,217
adu
lts* are diag
nosed or otherwise
iden
)fied
with
dem
en)a
and
13, 012
are currently living
with
dem
en)a
(*ag
ed 45 ye
ars a
nd
over). Th
ese reco
mmen
da)o
ns add
ress th
e ch
alleng
es ra
ised in th
is repo
rt: tha
t our
prov
incial hea
lth care system
currently und
erdiag
noses d
emen
)a (a
s evide
nt in
28%
of a
ll ne
w cases each ye
ar being
iden
)fied
first a
t adm
ission to LTC
) and
und
erserves in
dividu
als
with
dem
en)a
and
their fam
ilies – cha
lleng
es th
at w
ill in
tens
ify ove
r the
com
ing ye
ars a
s our
popu
la)o
n ag
es if w
e do
not dev
elop
long
-‐term plans
. Po
licy
1. D
evel
op a
pro
vinc
ial d
emen
)a st
rate
gy th
at is based
on the follo
wing principles:
Is dev
elop
ed in
collabo
ra)o
n with
families of ind
ividua
ls with
dem
en)a
, exp
erts in
dem
en)a
an
d de
men
)a care, hea
lth care professio
nals, hea
lth re
gion
represen
ta)v
es, a
nd th
e Alzh
eimer Soc
iety of S
aska
tche
wan
. Fo
cuses o
n be
st prac)
ces in de
men
)a care, as p
ut fo
rth in na)
onal dem
en)a
plans
from
othe
r cou
ntrie
s: exp
anding
dem
en)a
research
, qua
lity im
prov
emen
t in care se
rvices, raisin
g pu
blic awaren
ess, early diagn
osis, fa
mily
supp
ort, an
d staff
training
. Bu
ilds o
n reco
mmen
da)o
ns from
the Alzh
eimer Soc
iety of C
anad
a Risin
g Tide
reco
mmen
da)o
ns
Incr
ease
acc
ess t
o he
alth
and
com
mun
ity se
rvices
for i
ndiv
idua
ls li
ving
in ru
ral c
omm
uni)
es
by in
crea
sing inve
stmen
ts in
subs
idize
d an
d free
tran
sporta)o
n for o
lder adu
lts living
outsid
e of Saska
toon
and
Reg
ina (spe
cialist
services) a
nd sm
aller u
rban
cen
tres.
Ensu
re th
at fa
mily
car
egiv
ers a
re a
dequ
atel
y su
ppor
ted by
increa
sing inve
stmen
ts to
im
prov
e the av
ailability an
d freq
uenc
y of hom
e-‐ba
sed an
d co
mmun
ity-‐based
resp
ite care,
includ
ing ev
ening, w
eeke
nd, a
nd emerge
ncy care.
Includ
e de
men
)a in
the
Chro
nic Di
seas
e M
anag
emen
t Qua
lity Im
prov
emen
t Pro
gram
, thereb
y establish
ing a pa
)ent re
gistry and
dec
ision
supp
ort too
ls (stand
ardized care) for
health care professio
nals sim
ilar t
o othe
r chron
ic con
di)o
ns (e
.g., diab
etes, h
ealth
dise
ase).
Rese
arch
Tr
ack qu
ality
indi
cato
rs o
f dem
en)a
car
e pr
ovin
cial
ly a
nd b
y he
alth
regi
on, to en
sure th
at
individu
als a
re prope
rly assessed, diagn
osed
, and
man
aged
with
in th
e he
alth care system
. Th
e follo
wing principles provide
guida
nce:
Qua
lity indicators sh
ould be de
velope
d in partnersh
ip betwee
n ex
perts in de
men
)a, h
ealth
care professiona
ls, hea
lth re
gion
represen
ta)v
es (e
.g., Po
pula)o
n an
d Pu
blic Hea
lth, P
rimary
Health Care, Acu
te Care, Hom
e Ca
re, a
nd Lon
g-‐term
Care), e
Health, a
nd Hea
lth Qua
lity
Coun
cil.
Qua
lity indicators sh
ould be repo
rted
ann
ually
, with
improv
emen
ts and
dec
lines noted
, and
he
alth re
gion
s’ com
men
ts on fin
ding
s inc
lude
d.
Incr
ease
inve
stm
ent i
n th
e Firs
t Lin
k re
ferral
pro
gram
pro
vide
d by
the
Alzh
eim
er Soc
iety
of
Sask
atch
ewan
, to en
sure th
at link
s are m
ade be
twee
n individu
als w
ith dem
en)a
, the
ir families, loc
al hea
lth se
rvices, a
nd Alzh
eimer Soc
iety program
s. Add
i)on
al st
aff sh
ould be
hired in hea
lth re
gion
s tha
t currently hav
e the First L
ink prog
ram in
ope
ra)o
n (Saska
toon
, Re
gina
Qu’Ap
pelle
, Cyp
ress, P
rairie North, P
rince
Albert P
arklan
d, Sun
Cou
ntry) a
nd
expa
nded
to th
ose he
alth re
gion
s with
out F
irst L
ink (Cyp
ress, F
ive Hills, H
eartland
, Kelsey
Trail, Su
nrise
, and
the Northern he
alth re
gion
s).
Know
ledg
e Tr
ansla)
on a
nd E
xcha
nge
Partne
r with
tele
vision
and
new
spap
er m
edia
to ra
ise
publ
ic a
war
enes
s of risk re
duc)
on,
warning
sign
s, and
the im
portan
ce of )
mely diag
nosis
, e.g., co
ntrib
ute a regu
lar t
wice-‐
mon
thly colum
n to th
e Sa
skatoo
n Star Pho
enix and
Reg
ina Le
ader Pos
t and
con
tribute
regu
lar items t
o Sa
skatoo
n an
d Re
gina
new
s program
s.
Esta
blish
the
partne
rshi
ps re
quire
d to
est
ablis
h an
d m
aint
ain
con)
nuin
g ed
uca)
on
prog
ram
s for hea
lth care professio
nals to im
prov
e skills in assessmen
t, diag
nosis
, and
man
agem
ent. Pa
rtne
rs m
ay in
clud
e ex
perts in de
men
)a and
dem
en)a
care, Unive
rsity
of
Saskatch
ewan
, Teleh
ealth
Saska
tche
wan
, Saska
tche
wan
Med
ical Assoc
ia)o
n, nursin
g asso
cia)
ons, Alzh
eimer Soc
iety of S
aska
tche
wan
, hea
lth re
gion
represen
ta)v
es, a
nd others.
Incr
ease
aw
aren
ess o
f ear
ly o
nset
dem
en)a
(you
nger
than
65
year
s) amon
g the pu
blic as
well a
s hea
lth care professio
nals. Estab
lish services th
at are designe
d for a
dults
with
early
onset d
emen
)a, w
ho m
ay hav
e un
ique
nee
ds (e
.g., in th
e workforce
, with
children).
RaDA
R’s
reco
mm
enda
tions
Th
ese
reco
mm
enda
tions
add
ress
the
chal
leng
es ra
ised
in th
is m
ixed-
met
hods
stu
dy: t
hat o
ur p
rovi
ncia
l hea
lth c
are
syst
em c
urre
ntly
und
erdi
agno
ses
dem
entia
and
und
erse
rves
indi
vidu
als
with
dem
entia
and
thei
r fam
ilies
–
chal
leng
es th
at w
ill in
tens
ify o
ver t
he c
omin
g ye
ars
as o
ur p
opul
atio
n ag
es if
we
do n
ot d
evel
op lo
ng-te
rm p
lans
. Po
licy
1. R
evis
it an
d up
date
the
Prov
inci
al S
trat
egy
for A
lzhe
imer
Dis
ease
and
Rel
ated
Dem
entia
s in
Sas
katc
hew
an,
r ele
ased
in 2
004
•
colla
bora
te w
ith in
divi
dual
s w
ith d
emen
tia a
nd fa
mili
es, e
xper
ts in
dem
entia
and
dem
entia
car
e, h
ealth
car
e pr
ofes
sion
als,
hea
lth re
gion
repr
esen
tativ
es, t
he A
lzhe
imer
Soc
iety
of S
aska
tche
wan
, and
oth
er p
artn
ers
• fo
cus
on b
est p
ract
ices
in d
emen
tia c
are,
as
put f
orth
in n
atio
nal d
emen
tia p
lans
from
oth
er c
ount
ries:
ex
pand
ing
dem
entia
rese
arch
, qua
lity
impr
ovem
ent i
n ca
re s
ervi
ces,
rais
ing
publ
ic a
war
enes
s, e
arly
di
agno
sis,
fam
ily s
uppo
rt, a
nd s
taff
train
ing.
•
buils
on
reco
mm
enda
tions
put
fort
h in
the
Alzh
eim
er S
ocie
ty o
f Can
ada
Risi
ng T
ide
Repo
rt
2 . I
mpr
ove
acce
ss to
a ti
mel
y di
agno
sis
by id
entif
ying
and
add
ress
ing
pote
ntia
l bar
riers
to a
dia
gnos
is, i
nclu
ding
pa
tient
and
car
egiv
er fa
ctor
s (e
.g.,
lack
of s
ympt
om a
war
enes
s), h
ealth
car
e pr
ofes
sion
al fa
ctor
s (e
.g.,
diag
nost
ic u
ncer
tain
ty),
and
heal
th s
yste
m fa
ctor
s (la
ck o
f acc
ess
to s
tand
ardi
zed
care
pat
hway
s, d
emen
tia-
spec
ific
cont
inui
ng e
duca
tion,
and
mul
tidis
cipl
inar
y te
am a
sses
smen
t).
3 . I
ncre
ase
acce
ss to
hea
lth a
nd c
omm
unity
ser
vice
s fo
r ind
ivid
uals
livi
ng in
rura
l com
mun
ities
by:
•
incr
easi
ng in
vest
men
ts in
sub
sidi
zed
and
free
trans
port
atio
n fo
r old
er a
dults
livi
ng o
utsi
de o
f Sas
kato
on a
nd
Regi
na (s
peci
alis
t ser
vice
s) a
nd o
utsi
de o
f com
mun
ities
with
the
desi
red
serv
ices
•
incr
easi
ng th
e ca
paci
ty o
f loc
al re
sour
ces,
in o
rder
to re
duce
the
need
for t
rave
l and
inst
itutio
naliz
atio
n ea
rlier
than
nec
essa
ry a
mon
g ol
der a
dults
(e.g
., pr
imar
y he
alth
car
e, h
ome
care
, and
oth
er s
uppo
rt s
ervi
ces)
4. E
nsur
e th
at fa
mily
car
egiv
ers
are
adeq
uate
ly s
uppo
rted
by
incr
easi
ng in
vest
men
ts to
impr
ove
the
avai
labi
lity
and
frequ
ency
of h
ome-
base
d an
d co
mm
unity
-bas
ed re
spite
car
e, in
clud
ing
even
ing,
wee
kend
, and
em
erge
ncy
care
. 5. I
nclu
de d
emen
tia in
the
prov
inci
al C
hron
ic D
isea
se M
anag
emen
t Qua
lity
Impr
ovem
ent P
rogr
am, t
here
by
esta
blis
hing
a p
atie
nt re
gist
ry a
nd d
ecis
ion
supp
ort t
ools
(sta
ndar
dize
d ca
re) f
or h
ealth
car
e pr
ofes
sion
als
sim
ilar t
o ot
her c
hron
ic c
ondi
tions
(e.g
., di
abet
es, h
ealth
dis
ease
). Re
sear
ch
6 . T
rack
qua
lity
indi
cato
rs o
f dem
entia
car
e pr
ovin
cial
ly a
nd b
y he
alth
regi
on, t
o en
sure
that
indi
vidu
als
are
prop
erly
ass
esse
d, d
iagn
osed
, and
man
aged
with
in th
e he
alth
car
e sy
stem
. The
follo
win
g pr
inci
ples
pro
vide
gu
idan
ce:
• qu
ality
indi
cato
rs s
houl
d be
dev
elop
ed in
par
tner
ship
with
exp
erts
in d
emen
tia, h
ealth
car
e pr
ofes
sion
als,
he
alth
regi
on re
pres
enta
tives
(e.g
., Po
pula
tion
and
Publ
ic H
ealth
, Prim
ary
Hea
lth C
are,
Acu
te C
are,
Hom
e Ca
re, a
nd L
ong-
term
Car
e), e
Hea
lth, a
nd H
ealth
Qua
lity
Coun
cil.
• qu
ality
indi
cato
rs s
houl
d be
repo
rted
ann
ually
, with
impr
ovem
ents
and
dec
lines
not
ed, a
nd h
ealth
regi
ons’
co
mm
ents
on
findi
ngs
incl
uded
. 7. I
ncre
ase
inve
stm
ent i
n th
e Fi
rst L
ink
refe
rral
pro
gram
pro
vide
d by
the
Alzh
eim
er S
ocie
ty o
f Sas
katc
hew
an, t
o en
sure
that
link
s ar
e m
ade
amon
g in
divi
dual
s w
ith d
emen
tia, t
heir
fam
ilies
, loc
al h
ealth
ser
vice
s, a
nd
Alzh
eim
er S
ocie
ty p
rogr
ams.
Add
ition
al s
taff
shou
ld b
e hi
red
in h
ealth
regi
ons
that
cur
rent
ly h
ave
the
Firs
t Lin
k pr
ogra
m in
ope
ratio
n (S
aska
toon
, Reg
ina
Qu’A
ppel
le, C
ypre
ss, P
rairi
e N
orth
, Prin
ce A
lber
t Par
klan
d, S
un
Coun
try)
and
exp
ande
d to
thos
e he
alth
regi
ons
with
out F
irst L
ink
(Cyp
ress
, Fiv
e H
ills,
Hea
rtla
nd, K
else
y Tr
ail,
Sunr
ise,
and
the
Nor
ther
n he
alth
regi
ons)
. Kn
owle
dge
Tran
slat
ion
and
Exch
ange
8 . P
artn
er w
ith te
levi
sion
and
new
spap
er m
edia
to ra
ise
publ
ic a
war
enes
s of
risk
redu
ctio
n, w
arni
ng s
igns
, and
the
impo
rtan
ce o
f tim
ely
diag
nosi
s, e
.g.,
cont
ribut
e a
regu
lar t
wic
e-m
onth
ly c
olum
n to
the
Sask
atoo
n St
ar P
hoen
ix
and
Regi
na L
eade
r Pos
t and
con
tribu
te re
gula
r ite
ms
to S
aska
toon
and
Reg
ina
new
s pr
ogra
ms.
9. E
stab
lish
and
mai
ntai
n co
ntin
uing
edu
catio
n pr
ogra
ms
for h
ealth
car
e pr
ofes
sion
als
to im
prov
e sk
ills
in
asse
ssm
ent,
diag
nosi
s, a
nd m
anag
emen
t. Pa
rtne
rs m
ay in
clud
e ex
pert
s in
dem
entia
and
dem
entia
car
e,
Univ
ersi
ty o
f Sas
katc
hew
an, T
eleh
ealth
Sas
katc
hew
an, S
aska
tche
wan
Med
ical
Ass
ocia
tion,
nur
sing
as
soci
atio
ns, A
lzhe
imer
Soc
iety
of S
aska
tche
wan
, hea
lth re
gion
repr
esen
tativ
es, a
nd o
ther
s.
10. In
crea
se a
war
enes
s of
ear
ly o
nset
dem
entia
(you
nger
than
65
year
s) a
mon
g th
e pu
blic
as
wel
l as
heal
th c
are
prof
essi
onal
s. E
stab
lish
serv
ices
that
are
des
igne
d fo
r adu
lts w
ith e
arly
ons
et d
emen
tia, w
ho m
ay h
ave
uniq
ue
need
s (e
.g.,
in th
e w
orkf
orce
, with
chi
ldre
n).
Anal
ysis
of d
emen
tia p
reva
lenc
e, in
cide
nce,
and
car
e ga
ps in
Sas
katc
hew
an:
A m
ixed
met
hods
stu
dy
Anal
ysis
of d
emen
tia p
reva
lenc
e, in
cide
nce,
and
car
e ga
ps in
Sas
katc
hew
an:
J. Ko
sten
iuk1
D. M
orga
n1 , J.
Qua
il2 , G
. Tea
re2 ,
K. K
ulyk
1 , M
. O’C
onne
ll1 , A
. Kirk
1 , M
. Cro
ssle
y1 , N
. Ste
war
t1 , V
. Dal
Bel
lo-H
aas3 ,
L. M
cBai
n4 , H
. Mou
1 , D
. For
bes5 ,
A.
Inne
s6 , J.
Bra
cken
7 , E
. Par
rot8
1 Uni
vers
ity o
f Sas
katc
hew
an 2 S
K H
ealth
Qua
lity
Coun
cil
3 McM
aste
r Uni
vers
ity 4 F
irst N
atio
ns U
nive
rsity
of C
anad
a 5 U
nive
rsity
of
Albe
rta
6 Bou
rnem
outh
Uni
vers
ity 7 A
lzhe
imer
Soc
iety
of S
aska
tche
wan
8 Fam
ily c
areg
iver
Back
grou
nd
Wor
ldw
ide,
it is
est
imat
ed
that
ther
e is
one
new
(inc
iden
t) ca
se o
f dem
entia
eve
ry 4
se
cond
s, o
r 7.7
mill
ion
inci
dent
ca
ses
each
yea
r (W
HO
and
ADI
2012
). Th
e m
ost r
ecen
t est
imat
es
show
that
44
mill
ion
peop
le n
ow
live
with
dem
entia
(pre
vale
nce)
, pr
ojec
ted
to in
crea
se to
135
m
illio
n by
205
0 (P
rince
et a
l. 20
13a)
. T
o da
te, l
ittle
rese
arch
has
be
en c
arrie
d ou
t to
exam
ine
the
scop
e of
dem
entia
and
dem
entia
ca
re a
cros
s th
e pr
ovin
ce o
f Sa
skat
chew
an. E
pide
mio
logi
cal
data
that
is a
s cu
rren
t as
poss
ible
, and
that
com
bine
s bo
th
com
mun
ity-b
ased
and
long
-term
da
ta, c
an in
form
pol
icy
deci
sion
s th
at a
ffect
indi
vidu
als
with
de
men
tia a
nd th
eir f
amili
es li
ving
in
eve
ry c
orne
r of t
he p
rovi
nce.
S tud
y ob
ject
ives
In
par
tner
ship
with
the
Sask
atch
ewan
Hea
lth Q
ualit
y C o
unci
l, th
is s
tudy
invo
lves
a
com
paris
on o
f act
ual t
o be
st
prac
tices
in d
emen
tia c
are,
with
th
ree
com
pone
nts:
1) A
r evi
ew o
f bes
t pra
ctic
es
acro
ss th
e ca
re c
ontin
uum
of
heal
th a
nd s
ocia
l ser
vice
s fo
r in
divi
dual
s w
ith d
emen
tia a
nd
thei
r fam
ilies
2) A
n a n
alys
is o
f adm
inis
trativ
e h e
alth
dat
a to
det
erm
ine
the
12-m
onth
inci
denc
e an
d pr
eval
ence
of d
emen
tia a
mon
g in
divi
dual
s ag
ed 4
5 an
d ol
der
in th
e pr
ovin
ce o
f Sa
skat
chew
an b
y da
taba
se o
f id
entif
icat
ion,
dem
ogra
phic
ch
arac
teris
tics
(age
gro
up, s
ex,
and
rura
l/ur
ban
resi
denc
e),
and
heal
th re
gion
3) A
n e n
viro
nmen
tal s
can
of
dem
entia
-rela
ted
serv
ices
and
re
sour
ces
acro
ss th
e co
ntin
uum
of c
are,
spe
cific
ally
se
rvic
e av
aila
bilit
y an
d pr
imar
y he
alth
car
e or
ient
atio
n of
suc
h se
rvic
es, p
rovi
ncia
lly a
nd b
y he
alth
regi
on
Stud
y se
tting
•
The
prov
inci
al h
ealth
sys
tem
ha
s a
regi
onal
mod
el o
f go
vern
ance
(see
map
bel
ow),
with
eac
h of
the
13 h
ealth
re
gion
s re
spon
sibl
e fo
r pr
ovid
ing
basi
c he
alth
ser
vice
s to
thei
r pop
ulat
ion.
Adm
inis
trativ
e D
ata
Anal
ysis
! S tud
y ob
ject
ives
•
To d
eter
min
e th
e 12
-mon
th in
cide
nce
and
prev
alen
ce o
f dem
entia
am
ong
indi
vidu
als
aged
45
and
olde
r* in
the
prov
ince
of S
aska
tche
wan
by
data
base
of i
dent
ifica
tion,
dem
ogra
phic
ch
arac
teris
tics
(age
gro
up, s
ex, a
nd r u
ral/
urba
n**
resi
denc
e), a
nd h
ealth
regi
on.
* Ag
e cu
t-off
of 4
5 ye
ars
was
use
d to
iden
tify
the
inci
denc
e an
d pr
eval
ence
of ‘
early
ons
et d
emen
tia’ (
i.e.,
dem
entia
in in
divi
dual
s yo
unge
r tha
n ag
e 65
yea
rs).
**
Bas
ed o
n po
stal
cod
e, re
side
nts
of c
ensu
s m
etro
polit
an a
reas
(100
,000
or o
ver,
with
a c
ore
popu
latio
n of
50,
000
or o
ver)
and
cens
us a
gglo
mer
atio
ns (c
ore
popu
latio
n of
10,
000
or o
ver)
wer
e co
nsid
ered
urb
an, a
nd w
ere
othe
rwis
e co
nsid
ered
rura
l.
Dat
a so
urce
s •
10 p
rovi
ncia
l-lev
el d
atab
ases
link
ed b
y a
uniq
ue p
erso
nal h
ealth
ser
vice
s nu
mbe
r ass
igne
d to
in
divi
dual
s el
igib
le fo
r hea
lth in
sura
nce
bene
fits.
The
dat
abas
es w
ere
acce
ssed
, lin
ked,
and
an
alys
ed b
y re
sear
cher
s at
the
SK H
ealth
Qua
lity
Coun
cil.
C ase
def
initi
on
• Th
e co
hort
incl
uded
indi
vidu
als
aged
45
year
s an
d ol
der a
t the
ir fir
st-e
ver r
ecor
ded
iden
tific
atio
n of
dem
entia
* (i.
e., i
ndex
dat
e) b
etw
een
April
1, 2
001
and
Mar
ch 3
1, 2
013
in o
ne
of 4
adm
inis
trativ
e he
alth
dat
abas
es (H
ospi
tal D
isch
arge
Abs
tract
s, P
hysi
cian
Ser
vice
Cla
ims,
Pr
escr
iptio
n D
rug,
and
RAI
-MD
S, i.
e., L
ong-
term
Car
e). I
ncid
ence
and
pre
vale
nce
for t
he
2012
-201
3 pe
riod
only
wer
e ca
lcul
ated
for t
he p
rese
nt a
naly
sis.
•
C ase
def
initi
on a
lgor
ithm
: > 1
phy
sici
an v
isits
or >
1 h
ospi
taliz
atio
ns o
r > 1
pre
scrip
tions
for a
ch
olin
este
rase
inhi
bito
r or [
a RA
I-MD
S CP
S sc
ore
of >
2 a
nd/o
r (a
dise
ase
cate
gory
of
Alzh
eim
er’s
dis
ease
or d
emen
tia o
ther
than
Alz
heim
er’s
dis
ease
)]
Hos
pita
l Dis
char
ge A
bstr
acts
(ICD
-10-
CA c
odes
: F00
, F01
, F02
, F03
, F04
, F05
.1, F
06.8
, F06
.9, F
09, F
10.6
, F10
.7, F
18.6
, F18
.7, F
19.6
, F1
9.7,
G30
, G31
.0, G
31.1
, G91
, R54
); Ph
ysic
ian
Serv
ices
Cla
ims
(ICD
-9-C
M c
odes
: 290
, 294
, 331
, 797
); Pr
escr
iptio
n D
rug
(Aric
ept
DIN
s: 0
2232
043,
022
3204
4; E
xelo
n D
INs:
022
4211
5-02
2421
18, 0
2245
240;
Rem
inyl
DIN
s: 0
2244
298-
0224
4300
, 022
6671
7,
0226
6725
, 022
6673
3); L
ong-
term
Car
e, i.
e., R
AI-M
DS
(Cog
nitiv
e Pe
rform
ance
Sca
le (C
PS) s
core
of 2
and
ove
r, in
dica
ting
mild
to v
ery
seve
re im
pairm
ent)
[Mor
ris e
t al.
1994
] and
/or a
dis
ease
cat
egor
y of
Alz
heim
er’s
dis
ease
or d
emen
tia o
ther
than
Alz
heim
er’s
dis
ease
).
K E
Y FI
ND
ING
S In
cide
nce
(201
2/20
13)
• 3,
270
inci
dent
(new
) cas
es o
f dem
entia
wer
e id
entif
ied
amon
g ad
ults
45
year
s an
d ol
der i
n Sa
skat
chew
an d
urin
g th
e 20
12/1
3 12
-mon
th p
erio
d [7
.28
per 1
,000
pop
ulat
ion
at ri
sk (P
AR)]
• 1,
887
inci
dent
cas
es a
mon
g fe
mal
es (8
.25
per 1
,000
PAR
) vs.
1,3
83 a
mon
g m
ales
(6.2
8 pe
r 1,
000
PAR)
[p<0
.05]
•
Adul
ts a
ged
45 to
64
cont
ribut
ed 8
% o
f inc
iden
t cas
es, a
ged
65 to
84
cont
ribut
ed 4
1%, a
nd
aged
85
and
olde
r acc
ount
ed fo
r 51%
•
Unad
just
ed in
cide
nce
rate
incr
ease
d 15
2 tim
es b
etw
een
the
grou
p ag
ed 4
5 to
54
and
thos
e ag
ed 8
5 ye
ars
and
olde
r (0.
46 v
s. 6
9.73
per
1,0
00 P
AR)
• Th
e gr
eate
st p
ropo
rtio
n w
as fi
rst i
dent
ified
in L
TC (3
4.98
%, 1
,144
/3,2
70),
follo
wed
by
a di
agno
sis
in p
hysi
cian
ser
vice
s cl
aim
s (2
9.94
%),
in h
ospi
tal (
28.5
3%),
and
by a
cho
lines
tera
se
inhi
bito
r pre
scrip
tion
(6.5
4%)
• Of
inci
dent
cas
es th
at w
ere
first
iden
tifie
d in
long
-term
car
e, 7
9.72
% (9
12/1
,144
) wer
e id
entif
ied
at th
e po
int o
f adm
issi
on [t
here
fore
27.
89%
of a
ll in
cide
nt c
ases
(912
/1,1
44) w
ere
first
iden
tifie
d w
ith d
emen
tia a
t the
poi
nt o
f adm
issi
on to
LTC
] •
Amon
g ag
ed 8
5 ye
ars
and
olde
r, th
e un
adju
sted
inci
denc
e ra
te w
as 1
4% h
ighe
r am
ong
rura
l th
an u
rban
[p<0
.05]
•
Inci
denc
e (a
nd p
opul
atio
n at
risk
) was
hig
hest
in S
aska
toon
Hea
lth R
egio
n (8
80 n
ew c
ases
) an
d lo
wes
t in
the
Nor
ther
n H
ealth
Reg
ions
(32
new
cas
es)
• Th
e ag
e- a
nd s
ex-a
djus
ted
inci
denc
e ra
tes
wer
e hi
ghes
t in
Sun
Coun
try
Hea
lth R
egio
n (8
.77
per
1,00
0 PA
R) a
nd H
eart
land
Hea
lth R
egio
n (8
.63
per 1
,000
PAR
) vs.
the
adju
sted
rate
for a
ll he
alth
regi
ons
com
bine
d (7
.51
per 1
,000
PAR
) [p<
0.05
] •
The
age-
and
sex
-adj
uste
d in
cide
nce
rate
s w
ere
low
est i
n Pr
ince
Alb
ert P
arkl
and
(6.5
9 pe
r 1,
000
PAR)
and
the
Nor
ther
n H
ealth
Reg
ions
(6.6
6 pe
r 1,0
00 P
AR) v
s. th
e ad
just
ed ra
te fo
r all
heal
th re
gion
s co
mbi
ned
(7.5
1 pe
r 1,0
00 P
AR) [
p<0.
05]"
" P rev
alen
ce (2
012/
2013
) •
13,0
12 p
reva
lent
(exi
stin
g) c
ases
wer
e id
entif
ied
amon
g ad
ults
45
year
s an
d ol
der i
n Sa
skat
chew
an d
urin
g th
e 20
12/1
3 12
-mon
th p
erio
d [ra
te o
f 28.
16 p
er 1
,000
pop
ulat
ion
at ri
sk
( PAR
)] •
8,09
9 pr
eval
ent c
ases
am
ong
fem
ales
(34.
19 p
er 1
,000
PAR
) vs.
4,9
13 a
mon
g m
ales
(21,
92
per 1
,000
PAR
) [p<
0.05
] •
Adul
ts a
ged
45 to
64
acco
unte
d fo
r 8%
of p
reva
lent
cas
es, a
ged
65 to
84
acco
unte
d fo
r 39%
, an
d th
ose
85 y
ears
and
old
er c
ontri
bute
d 53
%
• Un
adju
sted
pre
vale
nce
rate
was
160
tim
es h
ighe
r am
ong
adul
ts a
ged
85 a
nd o
lder
than
am
ong
thos
e 45
to 5
4 ye
ars
of a
ge (2
21.3
0 vs
. 1.3
8 pe
r 1,0
00 P
AR)
• Th
e gr
eate
st p
ropo
rtio
n w
as fi
rst i
dent
ified
by
a di
agno
sis
in p
hysi
cian
ser
vice
s cl
aim
s (4
0.16
%),
follo
wed
by
a di
agno
sis
in L
TC (2
4.72
%, 3
,217
/13,
012)
, in
hosp
ital (
23.8
4%),
and
by a
ch
olin
este
rase
inhi
bito
r pre
scrip
tion
(11.
28%
) •
Of p
reva
lent
cas
es th
at w
ere
first
iden
tifie
d in
long
-term
car
e, 6
8.89
% (2
,216
/3,2
17) w
ere
iden
tifie
d at
the
poin
t of a
dmis
sion
to L
TC [t
here
fore
, 17.
03%
of a
ll pr
eval
ent c
ases
(2
,216
/13,
012)
wer
e fir
st id
entif
ied
with
dem
entia
at t
he p
oint
of a
dmis
sion
to lo
ng-te
rm c
are]
•
Amon
g th
ose
youn
ger t
han
85, t
he u
nadj
uste
d pr
eval
ence
rate
s w
ere
high
er a
mon
g ur
ban
than
ru
ral r
esid
ents
[p<0
.05]
; am
ong
thos
e ag
ed 8
5 ye
ars
and
olde
r, th
e un
adju
sted
pre
vale
nce
rate
w
as h
ighe
r am
ong
rura
l tha
n ur
ban
[p<0
.05]
. Am
ong
all a
ge g
roup
s co
mbi
ned,
the
unad
just
ed
prev
alen
ce ra
te w
as 6
% h
ighe
r am
ong
urba
n th
an ru
ral [
p<0.
05]
• Pr
eval
ence
(and
pop
ulat
ion
at ri
sk) w
as h
ighe
st in
Sas
kato
on H
ealth
Reg
ion
(3,2
86 c
ases
) and
Re
gina
Qu’
Appe
lle H
ealth
Reg
ion
(3,0
41 c
ases
). Pr
eval
ence
(and
pop
ulat
ion
at ri
sk) w
as lo
wes
t in
the
Nor
ther
n H
ealth
Reg
ions
(126
cas
es)
• Th
e ag
e- a
nd s
ex-a
djus
ted
prev
alen
ce ra
te w
as h
ighe
st in
Prin
ce A
lber
t Par
klan
d H
ealth
Reg
ion
(31.
91 p
er 1
,000
PAR
) and
Sun
Cou
ntry
Hea
lth R
egio
n (3
0.55
per
1,0
00 P
AR) [
not s
igni
fican
tly
high
er (p
<0.0
5) th
an a
ll he
alth
regi
ons
com
bine
d (2
8.16
per
1,0
00 P
AR)].
Tw
o ad
ditio
nal h
ealth
re
gion
s ha
d ad
just
ed p
reva
lenc
e ra
tes
that
wer
e si
gnifi
cant
ly h
ighe
r (p<
0.05
) tha
n al
l hea
lth
regi
ons
com
bine
d: S
unris
e at
29.
40 a
nd R
egin
a Qu
’App
elle
at 2
8.75
per
1,0
00 P
AR.
• Th
e ag
e- a
nd s
ex-a
djus
ted
prev
alen
ce ra
te w
as lo
wes
t in
the
Nor
ther
n H
ealth
Reg
ions
(25.
87
per 1
,000
PAR
) [no
t sig
nific
antly
low
er (p
<0.0
5) th
an a
ll he
alth
regi
ons
com
bine
d (2
8.16
per
1,
000
PAR)
]. Th
e ad
just
ed p
reva
lenc
e ra
te in
the
Sask
atoo
n H
ealth
Reg
ion
(26.
45 p
er 1
,000
PA
R) w
as s
igni
fican
tly lo
wer
than
the
adju
sted
rate
for a
ll he
alth
regi
ons
com
bine
d [p
<0.0
5].
" "
Best
Pra
ctic
e Re
view
R e
sear
ch Q
uest
ions
•
Wha
t are
the
curr
ent i
nter
natio
nal
best
pra
ctic
es in
dem
entia
car
e in
na
tiona
l pla
ns?
• W
hat b
est p
ract
ice
them
es a
re
repr
esen
ted
acro
ss a
ll na
tiona
l pl
ans?
Se
arch
stra
tegy
A to
tal o
f tw
elve
nat
iona
l pla
ns
wer
e id
entif
ied
from
the
Alzh
eim
er
Dis
ease
Inte
rnat
iona
l web
site
. In
clus
ion
crite
ria
A
nat
iona
l pla
n w
as c
onsi
dere
d fo
r if
it m
et a
ll of
the
follo
win
g cr
iteria
: •
A na
tiona
l dem
entia
pla
n lis
ted
on
the
“Gov
ernm
ent A
lzhe
imer
Pla
ns”
page
on
the
Alzh
eim
er’s
Dis
ease
In
tern
atio
nal w
ebpa
ge: h
ttp:/
/w
ww.
alz.
co.u
k/al
zhei
mer
-pla
ns
• N
ot a
sub
-nat
iona
l Alz
heim
er p
lan
nor a
non
-gov
ernm
enta
l dem
entia
st
rate
gy
• Av
aila
ble
in E
nglis
h •
Publ
ishe
d af
ter J
anua
ry 1
200
0 •
Publ
ical
ly a
vaila
ble
onlin
e D
ata
char
ting
and
extra
ctio
n
One
revi
ewer
ext
ract
ed th
e da
ta
from
eac
h na
tiona
l pla
n (K
K).
Com
mon
them
es in
bes
t pra
ctic
es
wer
e id
entif
ied
acro
ss th
e pl
ans.
KEY
FIN
DIN
GS
Nin
e na
tiona
l dem
entia
pla
ns w
ere
incl
uded
in th
e re
view
: Aus
tralia
, En
glan
d, F
inla
nd, F
ranc
e, N
orw
ay,
Scot
land
, Nor
ther
n Ire
land
, Uni
ted
Stat
es, a
nd W
ales
. S i
x be
st p
ract
ice
them
es w
ere
i den
tifie
d:
1) E
xpan
ding
Dem
entia
R e
sear
ch**
** in
volv
es a
n in
crea
sed
emph
asis
on
grow
ing
the
dem
entia
rese
arch
fiel
d.
2) Q
ualit
y Im
prov
emen
t in
Care
Se
rvic
es**
** e
ncom
pass
es
impr
oved
acc
ess,
ava
ilabi
lity,
and
coor
dina
tion
of c
urre
nt a
nd
futu
re s
ervi
ces
thro
ugho
ut th
e di
seas
e st
ages
alo
ng th
e co
ntin
uum
of c
are.
3 ) R
aisi
ng P
ublic
Aw
aren
ess*
**
incl
udes
reco
mm
enda
tions
to
assi
st w
ith th
e re
cogn
ition
of
sym
ptom
s an
d re
duct
ion
of
stig
ma.
4 ) E
arly
Dia
gnos
is a
nd
Trea
tmen
t**
emph
asiz
es
diss
emin
atin
g in
form
atio
n to
th
e pu
blic
and
hea
lth c
are
prof
essi
onal
s, to
impr
ove
early
di
agno
sis
and
enco
urag
e he
lp
seek
ing
in e
arly
sta
ge.
5) S
taff
Trai
ning
** in
volv
es
incr
easi
ng re
sour
ces
to im
prov
e aw
aren
ess,
kno
wle
dge,
and
tr
aini
ng a
mon
g he
alth
car
e pr
ofes
sion
als
resp
onsi
ble
for
prov
idin
g ca
re to
indi
vidu
als
with
dem
entia
. 6 ) F
amily
Sup
port
* em
phas
izes
th
e ne
ed to
impr
ove
the
avai
labi
lity
and
appr
opria
tene
ss
of c
omm
unity
sup
port
and
re
spite
opt
ions
to c
areg
iver
s an
d fa
mili
es o
f ind
ivid
uals
with
de
men
tia.
****
Sup
port
ed b
y al
l 9 c
ount
ries
**
* S
uppo
rted
by
8 co
untri
es
**
Sup
port
ed b
y 6
coun
tries
*
Supp
orte
d by
5 c
ount
ries
Envi
ronm
enta
l Sca
n
Stud
y ob
ject
ives
To
det
erm
ine,
with
in e
ach
of th
e 13
hea
lth re
gion
s of
Sas
katc
hew
an a
nd fo
r the
pro
vinc
e as
a w
hole
: •
the
avai
labi
lity
of d
emen
tia-re
late
d se
rvic
es a
nd re
sour
ces
acro
ss th
e co
ntin
uum
of c
are,
and
•
the
orie
ntat
ion
of d
emen
tia-re
late
d se
rvic
es to
war
d ke
y di
men
sion
s of
prim
ary
heal
th c
are
Sam
ple
and
data
col
lect
ion
• D
ata
colle
ctio
n be
twee
n Ju
ne a
nd D
ecem
ber,
2013
•
Stud
y po
pula
tion
cons
iste
d of
all
Hom
e Ca
re A
sses
sors
(Clie
nt C
are
Coor
dina
tors
, Cas
e M
anag
ers,
or T
eam
M
anag
ers)
ser
ving
Sas
k.
• A s
sess
ors
serv
ing
the
citie
s of
Sas
kato
on o
r Reg
ina
wer
e co
nsid
ered
‘urb
an’ a
nd A
sses
sors
ser
ving
out
side
of
S ask
atoo
n an
d Re
gina
wer
e co
nsid
ered
‘rur
al’
En
viro
nmen
tal S
can
inst
rum
ent
• Av
aila
bilit
y of
dem
entia
-rela
ted
serv
ices
: Res
pond
ents
indi
cate
d th
e av
aila
bilit
y of
43
serv
ices
in th
e m
ajor
ity
of c
omm
uniti
es fo
r whi
ch th
ey w
ere
prim
arily
resp
onsi
ble
(‘eve
ryda
y’, ‘
a fe
w ti
mes
a w
eek’
, ‘on
ce a
wee
k’,
‘onc
e a
mon
th’,
‘less
ofte
n th
an o
nce
a m
onth
’, an
d ‘n
ot a
vaila
ble’
) •
P rim
ary
Hea
lth C
are
Orie
ntat
ion
of d
emen
tia-re
late
d se
rvic
es: S
ix 5
-item
sca
les,
eac
h ite
m ra
ted
on a
5-p
oint
sc
ale
from
‘no,
not
at a
ll’ (1
) to
‘yes
, to
a ve
ry g
reat
ext
ent’
(5);
high
er s
core
s in
dica
ted
grea
ter o
rient
atio
n of
de
men
tia-re
late
d se
rvic
es to
key
dim
ensi
ons
of p
rimar
y he
alth
car
e.
Resp
onse
by
heal
th re
gion
•
Only
the
resu
lts fo
r hea
lth re
gion
s w
ith 4
+ su
rvey
resp
onde
nts
surv
ey w
ere
incl
uded
(the
exc
eptio
n w
as
Atha
basc
a H
ealth
Aut
horit
y, w
hich
had
1 re
spon
dent
and
was
gro
uped
with
Kee
wat
in Y
atth
e in
to th
e ‘N
orth
ern
Hea
lth R
egio
ns’)
• Re
spon
se ra
te o
f 45.
6% (8
2 of
180
): 68
rura
l and
14
urba
n (a
ll ur
ban
resp
onde
nts
wer
e fro
m R
egin
a Qu
’App
elle
Hea
lth R
egio
n)
K EY
FIN
DIN
GS
A vai
labi
lity
of D
emen
tia-re
late
d Se
rvic
es
• H
ealth
Pro
mot
ion
Prog
ram
s re
late
d to
dem
entia
car
e w
ere
repo
rted
to b
e w
idel
y un
avai
labl
e ac
cord
ing
to
mor
e th
an h
alf o
f res
pond
ents
. •
Prim
ary
Hea
lth C
are
serv
ices
rela
ted
to d
emen
tia c
are
that
wer
e av
aila
ble
at le
ast w
eekl
y ac
cord
ing
to m
ore
than
hal
f of r
espo
nden
ts, r
ank
orde
red,
incl
uded
bas
ic s
ervi
ces
– ph
arm
acis
ts, f
amily
phy
sici
ans,
phy
sica
l th
erap
ists
, and
occ
upat
iona
l the
rapi
sts.
How
ever
, Nur
se P
ract
ition
ers
and
mul
tidis
cipl
inar
y te
am a
sses
smen
t w
ere
unav
aila
ble
in n
early
hal
f of t
he c
omm
uniti
es s
erve
d by
resp
onde
nts.
•
Post
-dia
gnos
is S
uppo
rt s
ervi
ces
mos
t ava
ilabl
e w
eekl
y in
clud
ed th
e br
oad
heal
th s
ervi
ces
of p
allia
tive
care
, ad
ult d
ay p
rogr
ams,
cas
e m
anag
emen
t, an
d vo
lunt
eer s
ervi
ces/
visi
tors
. Mor
e th
an h
alf o
f res
pond
ents
re
port
ed th
at o
ther
pos
t-dia
gnos
tic s
uppo
rt w
as n
ot a
vaila
ble
in th
eir c
omm
uniti
es (p
rivat
e ca
regi
ving
, ca
regi
ver s
uppo
rt g
roup
s, a
nd c
ouns
ellin
g fo
r dia
gnos
ed in
divi
dual
s)
• H
ome
Care
ser
vice
s w
ere
wid
ely
avai
labl
e w
eekl
y (p
erso
nal c
are
serv
ices
, mea
ls o
n w
heel
s an
d m
eal
prep
arat
ion,
pla
nned
resp
ite, a
nd in
-hom
e re
spite
). H
ome
care
ser
vice
s th
at w
ere
unav
aila
ble
acco
rdin
g to
th
e m
ajor
ity o
f res
pond
ents
incl
uded
nig
ht re
spite
, wee
kend
resp
ite, a
nd tr
ansp
orta
tion
to h
ealth
car
e.
• Lo
ng-te
rm C
are
coun
selli
ng fo
r ind
ivid
uals
with
dem
entia
and
car
egiv
ers
was
repo
rted
to b
e w
idel
y un
avai
labl
e. L
ong-
term
car
e ho
usin
g av
aila
ble
in m
ost c
omm
uniti
es in
clud
ed s
enio
rs h
ousi
ng, s
peci
al c
are
hom
es, a
nd p
erso
nal c
are
hom
es. L
ong-
term
car
e ho
usin
g th
at w
as m
ore
likel
y to
be
unav
aila
ble
incl
uded
as
sist
ed li
ving
opt
ions
and
spe
cial
car
e un
its.
Prim
ary
Hea
lth C
are
Orie
ntat
ion
of D
emen
tia-re
late
d Se
rvic
es
Conc
lusi
ons
•
Whe
n co
mpa
red
to R
isin
g Ti
de
proj
ectio
ns fo
r Sas
k (S
met
anin
et a
l.,
2009
), ou
r fin
ding
s su
gges
t tha
t onl
y 79
% o
f inc
iden
t cas
es
(3,2
70/4
,154
) and
71%
of
prev
alen
t cas
es (1
3,01
2/18
,332
) w
ere
diag
nose
d or
oth
erw
ise
iden
tifie
d; i.
e., a
n es
timat
ed 2
1%
of in
cide
nt c
ases
and
29%
of
prev
alen
t cas
es w
ere
not
diag
nose
d or
oth
erw
ise
iden
tifie
d.
• Th
is s
tudy
hig
hlig
hts
sign
ifica
nt
gaps
bet
wee
n be
st p
ract
ices
in
dem
entia
car
e (B
est P
ract
ice
Revi
ew) a
nd a
ctua
l pra
ctic
es
(Env
ironm
enta
l Sca
n):
R e
fere
nces
Pr
ince
M, B
ryce
R, A
lban
ese
E, W
imo
A, R
ibei
ro W
, Fer
ri C
. The
glo
bal
prev
alen
ce o
f dem
entia
: a s
yste
mat
ic re
view
and
met
aana
lysi
s.
Alzh
eim
er’s
and
Dem
entia
201
3;9:
63-7
5. "
Sask
atch
ewan
Bur
eau
of S
tatis
tics.
Sas
katc
hew
an P
opul
atio
n by
5 Y
ear
Age
Gro
ups,
200
3 to
201
3. 2
014.
[http
://w
ww.
stat
s.go
v.sk.
ca/p
op/]"
Smet
anin
P, K
obak
P, B
riant
e C
, Stif
f D, S
harm
an G
, Ahm
ad S
. Ris
ing
Tide
: Th
e Im
pact
of D
emen
tia in
Sas
katc
hew
an 2
008
to 2
038.
200
9.
Ris
kAna
lytic
a an
d Al
zhei
mer
Soc
iety
of S
aska
tche
wan
, Can
ada."
Wor
ld H
ealth
Org
aniz
atio
n an
d Al
zhei
mer
’s D
isea
se In
tern
atio
nal.
Dem
entia
: A P
ublic
Hea
lth P
riorit
y. 2
012.
[http
://w
ww.
who
.int/
men
tal_
heal
th/p
ublic
atio
ns/d
emen
tia_r
epor
t_20
12/e
n/]"
" *Rur
al D
emen
tia A
ctio
n Re
sear
ch
web
site
: ht
tp:/
/ww
w.cc
hsa-
ccss
ma.
usas
k.ca
/ru
rald
emen
tiaca
re/r
adar
.htm
l
INQU
IRIE
S:
Dr.
Deb
ra M
orga
n. C
anad
ian
Cent
re fo
r H
ealth
& S
afet
y in
Agr
icul
ture
, Uni
vers
ity o
f Sa
skat
chew
an:
debr
a.m
orga
n@us
ask.
ca o
r 30
6-96
6-79
05
ACKN
OWLE
DG
EMEN
TS
• In
form
atio
n an
d Ed
ucat
ion.
Com
mun
ity-le
vel
dem
entia
-rela
ted
info
rmat
ion
and
educ
atio
n w
ere
perc
eive
d as
inad
equa
te, r
angi
ng fr
om
stro
ngly
neg
ativ
e (p
ublic
edu
catio
n to
redu
ce
stig
ma)
to s
omew
hat p
ositi
ve (d
emen
tia
awar
enes
s am
ong
loca
l hea
lth c
are
prof
essi
onal
). •
Acce
ssib
ility
. Res
pond
ents
hel
d ov
eral
l so
mew
hat n
egat
ive
perc
eptio
ns, p
artic
ular
ly
rega
rdin
g th
e in
fluen
ce o
f geo
grap
hic
loca
tion
on
acce
ssib
ility
and
ava
ilabi
lity
of s
ubsi
dize
d/fre
e tra
nspo
rtat
ion
serv
ices
. •
Popu
latio
n Or
ient
atio
n (c
omm
unity
fit).
Re
spon
dent
s he
ld s
omew
hat n
egat
ive
view
s ov
eral
l, sp
ecifi
cally
on
leve
l of c
areg
iver
sup
port
an
d le
vel o
f prim
ary
heal
th c
are
serv
ices
. •
Coor
dina
ted
Care
. Per
cept
ions
wer
e ne
utra
l on
the
seam
less
ness
of t
rans
ition
from
com
mun
ity
to lo
ng-te
rm c
are
as w
ell a
s ea
se o
f acc
ess
to
patie
nt h
ealth
his
tory
, and
som
ewha
t pos
itive
on
coor
dina
tion
of p
atie
nt c
are
and
serv
ice
deliv
ery.
•
Com
preh
ensi
vene
ss o
f Car
e. O
f the
6
dim
ensi
ons
cons
ider
ed, C
ompr
ehen
sive
ness
of
Care
fare
d th
e m
ost f
avor
ably
with
som
ewha
t po
sitiv
e vi
ews
over
all.
Perc
eptio
ns ra
nged
from
ne
utra
l reg
ardi
ng ti
mel
y re
ferr
al to
app
ropr
iate
se
rvic
es to
som
ewha
t pos
itive
with
resp
ect t
o on
e or
mor
e he
alth
car
e pr
ofes
sion
al b
eing
abl
e to
pro
vide
on-
goin
g m
anag
emen
t.
• Qu
ality
of C
are.
Thi
s di
men
sion
was
vie
wed
ne
utra
lly o
vera
ll, ra
ngin
g fro
m s
omew
hat
nega
tive
(tim
ely
diag
nosi
s) to
som
ewha
t pos
itive
(e
ffect
iven
ess
of s
cree
ning
tool
s).
• Ac
cord
ing
to a
sin
gle
sum
mar
y ite
m, t
he a
mou
nt
of s
uppo
rtiv
e re
sour
ces
and
serv
ices
ava
ilabl
e in
th
e co
mm
unity
was
som
ewha
t ina
dequ
ate
over
all.
Do
you
have
re
com
men
datio
ns
f or a
ctio
n on
de
men
tia?
Plea
se s
hare
Best
Prac*ce
(Best
Prac*ce
Review
)
Ac
tual Prac*ce
(Enviro
nmen
tal Scan)
Expanding
Demen-a
Research
Not examined
Quality
Improvem
ent in Care
Services
Across Sask: Low
accessibility to
dem
en-a-‐
related services, poo
r fit
between community
needs a
nd se
rvices, and
room
for improvem
ent in
coordinated care
Raising
Public
Awareness
Inadequate dem
en-a-‐
related info and
educa-on
Early
Diagno
sis
and
Treatm
ent
Room
for improvem
ent
in -mely diagno
sis and
use of standardize
d diagno
s-c crite
ria and
care pathw
ays
Staff
Training
Demen-a-‐specific
con-
nuing educa-on
for
health care professio
nals
is currently inadequate
Family
Support
Num
erou
s services n
eed
to be off
ered more
frequently: post-‐
diagno
s-c care
(cou
nselling, su
pport
grou
ps, private
caregiving), ho
me care
(transpo
rta-on
, respite)
and long-‐term care
(cou
nselling, assisted
living, sp
ecial care units)
The
Prov
ince
of
Sask
atch
ewan
(C
anad
a) c
over
s 65
1,00
0 km
2 an
d ha
s a
popu
latio
n of
ov
er 1
.08
mill
ion
(SK
Bure
au o
f Sta
tistic
s,
2014
)
Prov
ince
of S
aska
tche
wan
Attrib
ute
N Me
an
(max
. 25)
SD
(rang
e) Inf
ormati
on an
d Edu
catio
n 81
13
.0 3.9
(6-23
) Ad
equa
te aw
arene
ss ab
out ‘w
hat to
do’ o
r ‘whe
re to
go’
81
2.7
1.1 (1
-5)
Adeq
uate
inform
ation
for c
aregiv
ers
81
2.4
1.1 (1
-4)
Adeq
uate
aware
ness
of de
menti
a amo
ng he
alth c
are pr
ofessi
onals
in th
e com
munit
y 81
3.5
1.2
(1-5)
Adeq
uate
deme
ntia-s
pecifi
c con
tinuin
g edu
catio
n for
healt
h care
profe
ssion
als
81
2.5
1.1 (1
-5)
Adeq
uate
public
educ
ation
to re
duce
stigm
a of d
emen
tia
81
1.8
0.8 (1
-4)
Acce
ssibili
ty 80
12
.4 3.8
(5-22
) Ap
propri
ate fre
quen
cy of
servi
ces
81
2.4
1.1 (1
-5)
Appro
priate
wait t
ime f
or se
rvice
s 80
2.7
1.3
(1-5)
Av
ailable
public
trans
porta
tion t
o serv
ices (
for ol
der a
dults)
81
3.1
1.5
(1-5)
Av
ailable
subs
idized
/free t
ransp
ortati
on to
servi
ces (
for ol
der
ad
ults)
81
1.9
1.3 (1
-5)
Equa
lly ac
cessi
ble se
rvice
s, reg
ardles
s of g
eogra
phic l
ocati
on
80
2.2
1.2 (1
-5)
Popu
lation
Orie
ntatio
n 81
11
.9 3.8
(5-21
) Ap
propri
ate le
vel o
f PHC
servi
ces
81
2.2
1.0 (1
-5)
Appro
priate
leve
l of H
ome C
are se
rvice
s 81
2.7
1.2
(1-5)
Ap
propri
ate nu
mber
of LT
C bed
s 81
2.3
1.3
(1-5)
Ap
propri
ate te
lehea
lth se
rvice
s 81
2.7
1.1
(1-5)
Ap
propri
ate le
vel o
f sup
port f
or ca
regive
rs 81
2.0
0.9
(1-4)
Co
-ordin
ated C
are
81
15.6
3.6 (8
-24)
Servi
ce de
livery
by di
fferen
t hea
lth ca
re pro
fessio
nals i
n the
comm
unity
is co-o
rdina
ted
81
3.3
1.1 (1
-5)
All he
alth c
are pr
ofessi
onals
in th
e com
munit
y hav
e eas
y acce
ss
to pa
tient
healt
h histo
ry 81
2.8
1.3
(1-5)
Healt
h care
profe
ssion
als co
-ordin
ate we
ll with
each
othe
r to
m
anag
e [pa
tient
care
(with
in an
d outs
ide co
mmun
ity)
81
3.4
1.0 (1
-5)
Healt
h care
profe
ssion
als co
-ordin
ate we
ll with
comm
unity
agen
cies t
o man
age p
atien
t care
(with
in an
d outs
ide co
mmun
ity)
81
3.3
1.0 (1
-5)
Seam
less t
ransiti
on fro
m co
mmun
ity to
LTC
81
2.8
1.2 (1
-5)
Comp
rehen
siven
ess o
f Care
81
17
.1 3.9
(7-25
) On
e or m
ore he
alth c
are pr
ofessi
onal
is able
to di
agno
se
81
3.3
1.4 (1
-5)
One o
r more
healt
h care
profe
ssion
al is a
ble to
prov
ide on
-going
man
agem
ent
81
3.8
0.9 (2
-5)
There
is tim
ely re
ferral
to ap
propri
ate he
alth a
nd so
cial se
rvice
s 81
3.0
1.0
(1-5)
Mu
ltidisc
iplina
ry ca
re is a
vailab
le
81
3.6
1.1 (1
-5)
Healt
h care
profe
ssion
als co
nside
r dem
entia
a ch
ronic d
iseas
e 81
3.4
1.1
(1-5)
Qu
ality o
f care
81
14
.3 3.2
(8-21
) Tim
ely di
agno
sis oc
curs
81
2.5
0.9
(1-5)
He
alth c
are pr
ofessi
onals
use s
tanda
rdize
d diag
nostic
crite
ria
81
3.1
1.0 (1
-5)
Curre
nt scr
eenin
g too
ls are
effec
tive
81
3.3
0.9 (1
-5)
Care
and m
anag
emen
t are
guide
d by s
tanda
rdize
d care
pathw
ays
81
2.4
1.0 (1
-5)
Healt
h care
profe
ssion
als ad
equa
tely m
onito
r safe
ty of
indiv
iduals
with
deme
ntia l
iving a
t hom
e 81
2.9
1.1
(1-5)
Adeq
uate
amou
nt of
supp
ortive
reso
urces
and s
ervice
s 80
2.4
1.1
(1-4)
!Ite
m s
tatis
tics
of P
rimar
y H
ealth
Car
e Or
ient
atio
n of
Dem
entia
-rela
ted
Serv
ices
, Sa
skat
chew
an (N
= 8
3)
This
stu
dy w
as c
ondu
cted
, in
part,
with
dat
a pr
ovid
ed b
y th
e Sa
skat
chew
an M
inis
try o
f Hea
lth to
the
Hea
lth
Qua
lity
Cou
ncil.
The
inte
rpre
tatio
ns a
nd c
oncl
usio
ns
here
in d
o no
t nec
essa
rily
repr
esen
t tho
se o
f the
Sa
skat
chew
an M
inis
try o
f Hea
lth o
r Gov
ernm
ent o
f Sa
skat
chew
an.
regi
ons
resp
onsi
ble
for
prov
idin
g ba
sic
heal
th s
ervi
ces
to th
eir p
opul
atio
n.
the
publ
ic a
nd h
ealth
car
e pr
ofes
sion
als,
to im
prov
e ea
rly
diag
nosi
s an
d en
cour
age
help
se
ekin
g in
ear
ly s
tage
.5)
Staf
fTin
crea
sing
reso
urce
s to
impr
ove
awar
enes
s, k
now
ledg
e, a
nd
trai
ning
am
ong
heal
th c
are
prof
essi
onal
s re
spon
sibl
e fo
r pr
ovid
ing
care
to in
divi
dual
s w
ith d
emen
tia.
6)Fa
mily
the
need
to im
prov
e th
e av
aila
bilit
y an
d ap
prop
riate
ness
of
com
mun
ity s
uppo
rt a
nd
resp
ite o
ptio
ns to
car
egiv
ers
and
fam
ilies
of i
ndiv
idua
ls w
ith
dem
entia
. **
** S
uppo
rted
by
all 9
cou
ntrie
s
***
Sup
port
ed b
y 8
coun
tries
**
S
uppo
rted
by
6 co
untri
es
*
Su
ppor
ted
by 5
cou
ntrie
s
The
Prov
ince
of
Sask
atch
ewan
(C
anad
a) c
over
s 65
1,00
0 km
2
and
has
a po
pula
tion
of
over
1.0
8 m
illio
n (S
K Bu
reau
of S
tatis
tics,
20
14)
Prov
ince
of S
aska
tche
wan
For additional information contact:Debra Morgan, PhD, RNProfessorCIHR-SHRF Applied Chair in Health Services and Policy ResearchCollege of Medicine Chair, Rural Health DeliveryCanadian Centre for Health & Safety in Agriculture (CCHSA)University of Saskatchewan104 Clinic Pl, PO Box 23Saskatoon, SK S7N 2Z4
Telephone: (306) 966-7905Facsimilie: (306) 966-8799Email: [email protected]://cchsa-ccssma.usask.ca
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