36 / 40
36
Australian Journal of Dementia Care
December 2016/January 2017 Vol 5 No 6
• A ‘boots on-the-ground’ approach,
building relationships with people.
• Being nationally consistent, while also
having a visible local presence.
• Providing a quick response, arriving on-
site in rural and remote areas.
• A tailored service for the individual, but
also one that is responsive to the specific
and diverse needs of the community,
residential and acute environments.
• Expert support, drawing on nursing,
allied health and medical expertise.
• Being proactive, outwardly focused and
transparently accountable.
Of vital importance is that all
consultants will be fully accredited by
DSAand have their accreditation renewed
annually across clinical and practice
measures.
In short, to deliver effective support to
meet the challenges faced by people with
dementia and their carers inAustralia, the
DSA’s DBMAS service is expert, local,
tailored and accountable.
The first step in achieving this was to
partner with other respected dementia
care providers who can offer strong local
presence across Australia, while having
consultants who benefit from the
nationally consistent approach and
accreditation.
We then established offices in every
capital city and in regional areas Australia-
wide so DSAconsultants can provide
timely on-the-ground support and
maintain local knowledge and
relationships.
Building capacity and knowledge
DSA’s DBMAS will also intentionally and
deliberately build dementia care capacity
and knowledge within the aged care
sector. To do this, DSAwill disseminate
and implement advice and expertise well
beyond its own consultants.
Akey ambition of DSA is that by 2019,
because of DBMAS, the skills, expertise
and applied knowledge regarding
‘dementia behaviour’ are attributes of the
many across aged care, not just the few.
We believe the dementia expertise we
are assembling in DSA to provide DBMAS
and SBRT services nationally is unrivalled
anywhere in the world, but even more
significant will be the sharing of this
expertise with hundreds of dedicated aged
care professionals and carers in coming
years.
Changing thinking and language
The national provision of DBMAS and
SBRT through DSAprovides a unique
opportunity to capture data and insights
into the incidence, types and triggers of
behavioural and psychological symptoms
of dementia (BPSD) and ‘severe
behaviours’.
It is hoped that not only will this data
give us a more accurate understanding of
the causes of behaviours and where they
are likely to occur, but also reshape our
understanding of these expressions of
need and the language used to describe
them.
As well, this process of data capture and
reviewwill assist in informing the sector
as to what services should be delivered to
support people living with dementia.
Continued improvement
With its partners, DSA is now
consolidating its service delivery plan
across Australia to meet the diverse needs
of aged care providers, acute care and
family carers. But DSA is also committed
to continuing to develop our services
through hearing the voices of
stakeholders, particularly consumers, and
ensuring this feedback shapes services and
responses.
To ensure DSA’s ongoing success we
will continue to be flexible in our
approaches – we are not a one-size-fits-all
service – and remain sensitive to
demographic and sector changes, whilst
championing collaboration across aged
and dementia care, including with the new
national training provider DTA.
Informing the future of dementia services
By
Associate Professor Colm Cunningham
Sector capacity building and informing the future direction of
dementia services are key elements of Dementia Support
Australia (DSA).
The national provision and linkage of the Dementia Behaviour
Management Advisory Service (DBMAS) and the Severe
Behaviour Response Teams (SBRT) provides a unique
opportunity to capture data on the cause, incidence and impact
of behavioural and psychological symptoms of dementia.
This enables a growing understanding and changing of language
in regards to the needs of people with dementia based on hearing
their stories and better understanding the reasons behind their
behaviours.
Already, through HammondCare’s previous provision of DBMAS
in NSW and the national provision of SBRT, research has
highlighted that many causes of BPSD or ‘severe behaviours’ can
be related to common contributing factors. In many cases, these
factors can be readily modified.
Unrecognised or undiagnosed pain has emerged as one
common factor contributing to behavioural concerns. In more
than 65 per cent of referrals to the previous NSW DBMAS and
35 per cent of referrals to SBRT, pain had been overlooked or not
adequately managed (McClean & Cunningham 2016).
Findings from the SBRT
In more recent findings from the national SBRT, environment and
pain are two key impacting factors in referrals for ‘severe
behaviours’ for people with dementia (more than 60 per cent of
referrals) followed by limited carer knowledge or limited life and
social history (more than 40 per cent). Other factors such as
depression, being a new resident to a service, delirium, over-
medication, post-traumatic stress disorder and culturally
inappropriate care approaches were also considerations in
understanding the impact of the behaviour.
For more than two thirds of referrals, three or more of these
contributing factors have been identified, which highlights that
behaviours which have often been described as a symptom of
dementia are in fact more likely to be outcomes of interaction with
care environments or other medical needs.
It is this kind of learning that will be vital to continuing discussions
in Australia and internationally about best-practice provision of
dementia care.
Reference
McClean W, Cunningham C (2016)
Intervene: pain care for older people
and people with dementia.
Sydney: HammondCare Media.
Associate Professor Colm Cunningham is Director of HammondCare’s
Dementia Centre and Dementia Support Australia