Functional Decline

Understanding risk and preventing falls and functional decline in older people with cognitive impairment

Susan Kurrle

Lead Investigators: Professor Jacqueline Close, Dr Morag Taylor and Professor Susan Kurrle

Falls are common in older people with dementia, with approximately 60% falling annually, twice the prevalence reported in cognitively intact older people. Falls in people with dementia are more likely to result in injury (e.g. hip fracture), death and institutionalisation while preventing falls in cognitively impaired older people will help reduce the enormous cost from falls to the individual (e.g. reduce harm from falls and institutionalization, improve quality of life) and the health care system. Currently there are no successful fall prevention trials in community-dwelling cognitively impaired older people.

The aim of this project was to explore the association between physical and cognitive performance, function, frailty and falls in older people with cognitive impairment and to use this information to develop novel approaches to preventing falls and fall related injury in this population. The four year postdoctoral study will improve our understanding of the relationship between cognitive and physical function and fall risk in older people with cognitive impairment, investigate the relationship between falls and both cognitive and physical decline over time in people with cognitive impairment and investigate new and novel approaches to fall prevention in dementia e.g. cognitive training, combination cognitive and exercise interventions and tailored exercise and home hazard reduction interventions.

Activity 19 was aligned to a large clinical trial looking at preventing falls in people with dementia and has been designed to build on existing research in this field so as to maximise learning opportunities and outcomes.

Final Report: Understanding risk and preventing falls and functional decline in older people with cognitive impairment

Implementing Care of Older Persons in their Environments (COPE) in the Australian health context.

Lee Fay
Kate Laver
Lindy Clemson

Lead Investigators: Professor Lindy Clemson, Dr Kate Laver, Prof Yun Hee Jeon, Professor Laura Gitlin, Dr Tracy Comans, A/Prof Lee Fay Low, Professor Maria Crotty, Professor Susan Kurrle and Dr Justin Scanlan

Functional decline is one of the core features of dementia. As the disease progresses, the person becomes increasingly dependent needing more assistance to perform activities of daily living. Functional decline is associated with reduced quality of life, considerable impact on carers and can lead to institutionalisation.

The aim of this project is to conduct implementation research to integrate an evidence based intervention, Care of Older Persons with Dementia in their Environments (COPE), within existing health systems in Australia and determine strategies for implementation and sustainability to enable wider dissemination.

COPE is a bio-behavioural program designed to improve function and proven effective in reducing dependency and increasing engagement of the person with dementia and in improving carer wellbeing in a randomised trial in the US. The program works at a very practical level using occupational therapy skills and complimentary nursing skills and centres around the needs of both the carer and the person with dementia.

This project will translate COPE to the Australian context within not for profit, private and government care systems and will examine facilitators and barriers at therapist, organisation and policy levels, explore funding models and build in features of sustainability.

Improving cognitive and functional capacity of older people with dementia in residential aged care through an exercise prescription approach

Megan Corlis
Gaynor Parfitt

Lead Investigators: A/Prof Gaynor Parfitt and Ms Megan Corlis

The positive effect of exercise on health and to prevent, or delay cognitive decline in older adults is well documented. As a result, Helping Hand received funding to implement an Exercise Physiologist (EP) in Aged Care project to provide targeted and group based exercise for residents who have significant dementia and other chronic conditions and disabilities. The project includes the design of pathways for integrating Exercise Physiology interventions into the ongoing care for residents within an aged care facility.

This project will undertake an evidence-based evaluation of outcomes from resident participation in exercise programs. The program will consider factors including level of cognition, functional abilities, and well-being of residents before and following EP interventions, as well as staff cooperation/perception, and the perceptions and impact of the program on the families of residents.

Read an article from Australian Journal of Dementia Care Changing hearts and minds

53:59 minutes

Understanding the impact of socialisation robots on the social engagement of older adults with cognitive decline


Lead Investigator: Dr Angelita Martini

Robotic aids for domestic duties and to support the elderly have been successfully designed and tested in a number of countries worldwide and the impact of devices such as Paro, the robotic companion seal, and Giraff, the teleprescence robot, on people with cognitive decline has been the subject of significant investigation within Australia.

The aim of this study is to improve the social engagement of older adults with cognitive decline by exploring the use of a humanoid socialisation robot, Zora, within Australian aged care facilities through group therapy programs compared to standard activity programs. The study will also explore staff attitudes to the use of socialisation robot technology within the Australian residential aged care context through qualitative methods.

Education tool for staff on the use of the socialisation robot in residential aged care

Final Report: Understanding the Impact of Socialisation Robots on the Social Engagement of Older]]
Adults with Cognitive Decline

Development of Dementia Reablement Guidelines and Programs


Lead Investigators: Professor Christopher Poulos and Meredith Gresham

The terms ‘reablement’ and ‘restorative care’ are becoming part of the vernacular in Australia, with many aged care providers claiming to offer ‘reablement-type’ services that improve individual function and/or purport to reduce health and community care costs into the future. Yet, much of the available research from the Australian community aged care sector about reablement, and cited within government guidelines, excludes people with dementia.

The recently released Clinical Practice Guidelines and Principles of Care for People with Dementia (CDPC, February 2016) are a major step forward in critically evaluating the evidence for interventions which could delay the onset of functional decline, or improve functioning and quality of life, for people with dementia.
The next step is to operationalise these guidelines.

This project will seek to gain an understanding of current provider knowledge and practice with respect to the meaning and utility of reablement for the person with dementia, as well as the perceived barriers to implementing reablement interventions. We will review the reablement interventions contained within the Clinical Practice Guidelines and Principles of Care for People with Dementia for suitability for implementation by aged care providers, and also review the literature for additional interventions published since, or not included within, the Practice Guidelines.

The project will produce a glossary of terms and bring together CDPC Partners and other stakeholders to produce a CDPC Practice Handbook for Reablement Interventions for People with Dementia, for use within the Australian aged care sector as well as people with dementia and their carers.