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A Dementia Enabling UniversityDr Lyn Phillipson, NHMRC-ARC Dementia Fellow(BAppSc, MPH, PhD)
Dementia Research - Global agenda• Currently 46 million people• By 2015, estimates 138 million• World Dementia Council Statement of
Purpose (2014) identified three key challenges:– Better research targeting a cure or modifying
therapy to achieve a 5 year delay in the onset of dementia
– Improvements in health and care;– Raising awareness and supporting dementia
friendly communities
Dementia Research - National Agenda• In Australia, 400, 000 people with dementia• By 2050 nearly 1 million• NHMRC National Institute for Dementia
Research - Strategic Roadmap (2017)1. Prevention2. Assessment and diagnosis3. Intervention and treatment4. Living with dementia5. Care
Dementia Research – UOW agenda• Examples of research at UOW • Making a difference locally, nationally and
globally• What makes us different?
– All disciplines engaged in the global challenges associated with dementia
– Take a disciplinary and interdisciplinary approach– Research occurs:
• across the continuum from lab, to risk reduction, to living well with dementia
• in collaboration with people with dementia and their care partners
• within health and aged care staff and systems• in the physical environment to improve and enable function
RESEARCH IN THE LAB
Understanding the cause of Alzheimer’s disease
• Researchers • Prof Brett Garner, Dr Lezanne Ooi, Dr Simon Brown, Prof Tim Karl (WSU)• Aims • To understand why some people get AD and others don’t.
Discover new avenues for AD therapeutic intervention.• Methods
Analyse the function of genes, proteins and lipids in the brain that may confer increased risk for AD.
• Results The team has discovered several new brain pathways related to AD. These include new protective roles for proteins called ABCA7, ApoE and apoD.
• ImpactIdentifying these new pathways provides an opportunity to develop therapeutic approaches to prevent or treat AD.
Garner lab Alzheimer’s disease research
Human post-mortem brain pathology
Use “transgenic” mice that have AD-like symptoms to study the role of human genes and to test new drugs.
Cell biology
Identify disease-associated changes in AD brain genes, proteins and lipids.
Replicate molecular changes in brain cells (neurons) grown in dishes in the lab. We can test new drugs to prevent the changes.
Alzheimer’s miceProtein structure changes
To understand the function of disease-associated proteins and what goes wrong in the AD brain.
DEMENTIA RISK REDUCTION
Can diet improve cognitive function?
https://www.smh.com.au/lifestyle/health-and-wellness/colourcode-your-diet-20110815-1itue.html
Document title10
Effect of anthocyanins from cherries on cognitive function in older adults with dementia: A Randomised Controlled Trial
Industry partners:Agritechnology Ltd.
Kent K, Charlton KE, Roodenrys S, Batterham M, Potter J, Traynor V. Consumption of anthocyanin-rich cherry juice for 12 weeks improves memory and cognition in older adults with mild-to-moderate dementia. Eur J Nutrition 2017; 56(1): 333-341.
12 week follow UpBlood sample Cognitive & physical assessment
6 week follow upStructured 3-day food diary Cognitive & physical assessment
BaselineBlood sample Cognitive & physical assessment
200ml/dayeither
Randomization (n = 49 dementia patients aged 70+y)Computer-block aided by independent statistician
RecruitmentGeriatric outpatient dementia clinic Residential aged care facilities
CONTROLLow-flavonoid
Low-anthocyanin
INTERVENTIONFlavonoid-rich
Anthocyanin-rich
HEALTH AND COMMUNITY SERVICES
12
Kara Capetta (PhD Candidate), Dr Lyn Phillipson, Dr Luise Lago• Understand factors associated with
hospitalisation in the lead up and following a ‘first admission’ for dementia.
• Retrospective study of patterns of hospitalisation 5-years pre & post first admission for dementia (n=7919).
• Emergency department use and inpatient admissions over a 10-year period
• Age- and sex-matched cohort (n=7910).• IMPACT - Opportunities for better recognition,
diagnosis and management people with dementia in the hospital setting.
Hospital Care
Community Care• Dr Lyn Phillipson (NHMRC-ARC Dementia Fellow)• Australian has undergone large aged care reforms
(DSS, 2015) – Consumer directed care – ‘choice based’
individualised, marketization– Focus on care in the community and accountability for
costs – How are people with dementia faring under new
system?– Using innovative methods to assess outcomes for
people with dementia against important domains
Domains Definitions
Control in Daily Life*
Having choice means you can decide what to do
Accommodation comfort & cleanliness
Having a clean home means that the kitchen, bathroom , bedrooms and other rooms are clean and tidy. Home a comfortable home means that you like how your home looks and feels.
Personal comfort & cleanliness
Being presentable means being clean. Having clothes and feeling comfortable in what you are wearing.
Food and Drink Think about whether you can have the food and drinks you like. Whether you have enough to keep you healthy? And whether you can eat and drink as often as you need to?
Safety Feeling safe means that you are not worried about: being bullied or abused; falling or getting hurt; being attacked or robbed (in the home; in your local area)
Social Participation*
Social Life means spending time with people you like. This could be friends, family or people in your community
Occupation* Think about things you do during the day (e.g. free time, working, volunteering, housework). Think about if: you can choose the things you do; you enjoy the things you do: you have enough things to do
Dignity in Care* How do you feel about the way other people treat you?
Results – Preliminary Analysis
0102030405060708090
100Accommodation
Cleanliness
Food & Drink
Safety
Social
Occupation
Control
Dignity
Average SCRQoL score in each domain as a percentage of the total possible score (unweighted)
%
Dignity 97.22
Accommodation cleanliness and comfort
80.56
Food and Drink 77.78
Personal safety 66.67
Control over daily life 66.67
Social Participation 58.33
Occupation 47.22
LIVING WELL WITH DEMENTIA
17
DEMENTIA FRIENDLY COMMUNITIES
‘A place or culture in which people with dementia and their carers are empowered, supported and included in society, understand their rights and recognise their full potential’
Dementia Friendly KiamaDr Lyn Phillipson, NHMRC-ARC Dementia Fellow
Dementia Friendly Kiama ‘Pilot Project’
• Australian first - Commenced 2014 – Dementia Australia, University Wollongong, Kiama Council
• Why Kiama?– ‘Sea-change’ community, high proportion of older
residents (22, 000 residents/1200 dementia)– Proximity to University– History of council community engagement & action on
health
Participatory Action Research
Mapping interviews
Out and about with dementia
Enabling and disabling
environments
Mapping
Dementia Friendly Places
Ideas for Action
Environmental Audits
Developed and use of
Community Environment
Audit Tool
(DFC-EAT)
Community and Business Surveys and
Focus Groups
Needs, Assets and Dementia
Attitudes
Education and training
• Local people living with dementia and their supporters presenting and involved in all education
• >1300 local people attended education• Carer groups, community organisations, local service
providers, GPs and PNs and the general public• Education & training (Two day workshops)
– Capacity Building - support for participation of people with dementia in community groups
– Stigma reduction – Contact with people with dementia – experts of the lived
experience
Communication and Information
• Local dementia services and information • Dementia Illawarra Shoalhaven - news,
calendar of events• Newsletter
• Community events• Library – Film launch, Book launch, Dementia
& Driving Workshop• Media and publicity
• Websites, radio, TV, print, twitter with 100+ appearances
Outdoor Spaces and Buildings
• Dementia Friendly Community Environment Assessment Tool– Helps show how public buildings can support, or hinder,
people with dementia and make plans for change
• ‘OurPlace’ maps – Gather and share information about ‘Dementia Friendly’
Places and Spaces – Ideas for action - used by Dementia Alliance and council
What have we achieved?
• Challenged the status quo about what it is like to live with dementia
• Greater awareness:– that each person’s experience is different – the importance of supporting a variety of
services and activities in Kiama
• Survey from 2014 - 2016– ‘People with dementia participate in a variety of
activities’– ‘It is easy to find information about dementia friendly
services and businesses in Kiama’
‘Acceptance goes with the awareness. And with the
attitude, there is a subtle change in the population when the word
dementia is mentioned.’
Dementia Advisory Group Member
What have we achieved?
• Greater acceptance of people living with dementia– Social & professional networks– ‘Dementia friends’ in clubs, organisations and
business
• Survey 2014 - 2016• Reduced Stigma
– ‘I would not want my family to know’ – ‘I would feel humiliated’,– ‘I would give up on life’– 84% would want to live in Kiama if they had
dementia
‘We have created this momentum so that it
now has a life of its own.’Dementia Alliance member
Project DARE
• Dementia knowledge, Art, Research & Education (DARE)• Objective: to change children’s knowledge and perception
of dementia. • Researchers: Dr Pippa Burns, Dr Michelle Eady, Dr Penny
Harris, Mrs Corinne Green & Professor Victoria Traynor, University of Wollongong;
• Partners: Dr Jess Baker, UNSW; Mrs Carinya Barkley, Thirroul Public School; Ms Jennine Primmer, Big Fat Smile.
Funded by UOW’s Global Challenges Program
Aims & Methods• Multidisciplinary team of teachers, artists and researchers
with the aim to increase awareness of dementia amongst Stage 2 children (ages 8-10 years).
• The intervention was piloted in May 2017 in three stages.• Stage 1: The children created their first artwork in collaboration
with the community artists.• Stage 2: The dementia lesson was given by a class teacher.• Stage 3: The children were able to add to/modify their artwork
based on what they’d learnt in Stage 2.
• Pre-post test design using mixed methods
Results• Pre and post matched data n=74• Significant improvements in children’s
attitudes – Spending time with people with dementia can be
fun– People with dementia can feel when others show
them love and understanding– People with dementia have hobbies and interests– Dementia is when something has gone wrong in
your brain– People with dementia can be creepy– You can “catch” dementia from other people– Dementia is unpredictable
Two community art exhibitions
Project DARE has since run in Aberdeen, Scotland.
Team UOW - Desert Rose House• >100 students and staff
from UOW and TAFE• International Solar
Decathalon (Dubai, 2018)• Environmentally friendly
and dementia friendly ‘house for life’
• http://desertrosehouse.com.au/
Closer Title