Tips for enhanced dementia care across the care continuum

Dementia care insights were explored last week as allied health professionals gathered for Dementia Training Australia’s inaugural Allied Health Symposium in Adelaide.

One of the sessions, Allied health working together through the care continuum, saw experts such as Ellie Newman, Dementia Lead and Head of Physiotherapy, Armadale Kalamunda Hospital, East Metropolitan Health Service, WA and Elizabeth Oliver, Occupational Therapist, Curtin University, discuss the diverse ways allied health professionals can influence change and spark positive outcomes. 

Dementia care in hospital

Ms Newman explained how Perth’s East Metropolitan Health Service (EMHS) is committed to delivering better care for people with cognitive impairment, including dementia and delirium. It established a cognitive impairment reference group and appointed a coordinator for cognitive impairment.

This pathway also led the EMHS to become a dementia friendly health service – at the time the first of its kind in Australia – based on a framework from abroad, the UK Dementia Friendly Hospital Charter. 

Allied health was, and still is, embedded in that process.

“The first principle of a dementia friendly community is that it starts at the individual level, with care provided by staff who are knowledgeable and skilled in identifying and addressing needs, and who demonstrate a proactive approach to caring for people with dementia,” Ms Newman added.

However, many staff stated they felt unprepared from a knowledge and skills perspective, and were under-resourced to support people living with dementia. EMHS introduced innovative and contemporary methods to enhance skills, knowledge and capacity.

“This has led to increased understanding of their roles in supporting patients with dementia, more timely referrals and coordination of care, and application of non-pharmacological interventions to support the person during their hospital stay,” Ms Newman said. 

Ongoing training with partners such as Dementia Training Australia and establishing 85 acute care dementia change champions (over half are allied health professionals) across five hospital sites has also resulted in quality outcomes. 

Ms Newman, one of the champions, added that this has also created genuine career development opportunities for allied health professionals.

Elsewhere, EMHS introduced an undergraduate physiotherapy student placement, while a dementia change champion idea inspired animal-assisted therapy.

Virtual reality tools support occupational therapists at a specialised palliative care hospital, and allied health staff have influenced building and infrastructure improvements to promote patient independence and safety. Even old resuscitation trolleys have been upcycled to provide accessible storage options for exercise or activity sessions. 

“A majority of the elements were not available when we first started this journey. It’s not always going to be easy, but together we can make a difference and enhance the outcomes and hospital experiences for people living with dementia,” Ms Newman added. 

Mealtimes matter

Ms Oliver was closely involved in the social experiment Maggie Beer’s Big Mission, which transformed meals and the dining experience at Meath Aged Care in Perth. She said mealtimes are about so much more than just eating, as they meet residents’ holistic needs. 

With malnutrition and unintended weight loss two of the greatest challenges, she explained that allied health professionals play a role in preventing these adverse outcomes. 

“Physiotherapists and exercise physiologists can ensure that people have pain relief, fatigue management, [overcome ]breathlessness so they can enjoy their meal,” Ms Oliver explained, “and help with their balance and mobility so they can get to the dining room and access the social benefits associated with meal times. 

“OTs can help residents to maintain their independence, lower the risk of choking, prevent them from feeling embarrassed about their loss of ability, and even help people to keep brushing their teeth so they can chew.”

These interventions are critical in a residential care environment where residents often lose their appetite, forget to eat, have difficulties swallowing, or simply find that their preferences and needs are not met. 

Contributing factors such as these led to the programs that inspired Maggie Beer’s Big Mission. 

Allied health professionals embedded change across ‘every layer of the mealtime experience’, backed by research, introducing changes such as staff mentoring and training, a redesigned menu, buffet-style meals, a more homely/dementia friendly environment, and increased resident involvement.

Ultimately, after eight months, 57% of residents gained or maintained weight, appetite, mood, and mealtime satisfaction showed significant improvement, while residents were more engaged and spent more time in the dining room. 

“Nearly every single resident experienced some benefit, and mealtime became something that people looked forward to. Staff were more confident and reported deeper relationships and a stronger sense of community,” Ms Oliver said.

“What made it work, in my opinion? Firstly, it was person-centred. The residents were the co-creators; nothing about me without me. Their feedback shaped every detail from the menu to the memory supports. 

“It was also multidisciplinary with allied health, hospitality, architecture, and landscaping. We worked together as a united team with the carers, and we had a great sense of passion and accountability. We poured our hearts into making the change.”

Care across the continuum

Ms Oliver and Ms Newman also featured in a panel discussion alongside Ambulance Victoria Intensive Care Paramedic Lindsay Bent and UNSW Sydney Senior Lecturer Dr Morag Taylor.

The quartet was asked about the most essential skill an allied health professional can bring to the dementia care team. 

Mr Bent said adaptability is essential. 

“You’re going to see people that are minimally or profoundly affected by dementia, people that aren’t going to disclose a diagnosis, or people who don’t even know they’re exhibiting signs of dementia,” he shared.

“There will be times when we need to go into their world, they can’t come back to ours. If someone says, ‘I need to get home to my husband, who died 20 years ago, don’t tell them that. Don’t make them relive that horrible event.”

Ms Newman added that it’s important to ‘be comfortable in being uncomfortable’ and that it is always okay to ask questions to colleagues or managers if you don’t know something. 

Ms Oliver chimed in with skilled observation, so staff know how to work through issues or even provide simple interventions like cold chips for a meal to help a resident eat more.

“The risk at the moment is that there’s so much paperwork and documentation that we need to complete, so we’re stuck on a computer writing care plans. We need to be out there on the floor, using our skills, using our clinical observation skills and being able to do something with that information,” she said.

Lastly, Ms Taylor spoke of the importance of advocacy as allied health professionals should be vocal supporters of multidisciplinary care. 

She also touched on what professionals can do to help mitigate the risk of agitation and escalation in challenging situations. 

“Understanding the person. Being proactive in getting information that will help you work with the person living with dementia so you’re not going to be the person who is doing something that triggers a behaviour,” she added. 

“Trying to understand and think about unmet needs. If you’re a physio in a hospital, does the person have a drink or a blanket? They’re little things we can all do to help.”

Ms Oliver said it is about ‘being a detective’ and exploring the reason behind behaviours. For example, one resident would always bang on the table in the dining room and disrupt other residents. Therefore, they embraced her love of the outdoors, assigned a carer to support one-on-one mealtimes, and helped her peacefully eat outside where she was not distressed. 

Ms Newman added that changing personnel can help if certain interactions are unsuccessful. 

Mr Bent finished by expressing that it’s all about capability and capacity, so you understand what an unmet need is and how to meet or manage it. 

“Don’t rush into a situation. Stand back, work out what’s going on, get the information, and then make my plan from there,” he said.