Dementia Care

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Vol 5 No 5 October/November 2016 Australian Journal of Dementia Care 45
If the average age of dementia onset
could be delayed by five years, the
number of newly diagnosed people with
dementia would be halved by 2050 (Access
Economics 2004).
Attention to vascular risk factors,
improving physical and cognitive leisure
activities, and a healthy diet may improve
cognitive function and/or reduce
dementia risk (Ackermann et al 2013;
Barber et al 2012; Loef &Walach 2012).
Nurses and doctors in General Practice
have a critical role to play as some risk
reduction strategies are supported by
sufficient evidence for GPs to recommend
changes in behaviour to their patients
(Traverset al 2009).
However, there are barriers to
implementing a dementia prevention
program in primary care. We set out to
identify key knowledge translation (KT)
opportunities for doctors and nurses in
primary practice around dementia risk
reduction.
Focus groups
Input from focus groups of Registered
Nurses (RNs) and GPs will help us identify
which evidence is ready to implement into
clinical practice or public health
promotion, and where appropriate, to offer
suggestions on ways forward for
implementation. We recruited people from
two key areas of primary practice and
invited them to join separate focus groups:
one for GPs (n=5; QLD) and the other for
RNs who worked in General Practice (n=6;
NSW). Participants first read a literature
summary about dementia prevention, then
took part in a facilitated discussion around
three questions relevant to dementia
prevention:
•What evidence are you already
implementing in your practice?
•What evidence is ready for
implementation if it were presented in a
suitable format (define the format)?
•What evidence requires strengthening
before you think it is ready to influence
practice (define the specific area that needs
strengthening to improve adoption)?
Each group was asked to identify three
or four primary suggestions for research
that was ready to be implemented now or
suggestions for complementary research
which would lead to implementation of
current promising concepts in the next
decade. The task was to think of specific
suggestions which would guide future
work in the area of dementia prevention.
Finally, we used a voting method (the
RAND-UCLAConsensus Method (Fitch et
al 2001) on a scale of 1-9 (9 being optimum),
to get participants to rank suggestions in
order of priority. Important criteria were:
clinician readiness to accept the concept,
community readiness, strength of
evidence, ease of implementation and
clinical significance.
Dementia risk reduction
priority activity
While the nurse and GP focus groups met
independently, each identified that their
top priority, in terms of readiness for
implementing in General Practice, was the
inclusion of dementia prevention
information in general risk reduction/
lifestyle discussions with their patients.
They also recognised that many of the
risk factors for dementia overlap with
those for other chronic conditions (eg heart
disease) that are currently addressed in
preventative health (Farrow 2010). We
know that many people are unaware of the
full range of potential ways to reduce their
risk of dementia (Farrow 2008).
There is evidence that GPs can assist
patients to modify their lifestyle to reduce
the risk of chronic disease (such as cutting
down or quitting smoking and increasing
physical activity). In a General Practice
environment, clinicians can also be
involved in educating patients about the
risk factors associated with dementia,
helping themmake appropriate lifestyle
changes, and treating medical risk factors
(Farrow 2010).
The GPs and Practice Nurses (RNs) in
our study recognised the opportunity to
highlight to patients that making lifestyle
changes to lessen their risk of chronic
disease would also reduce their risk of
dementia. This could encourage more
people to heed the lifestyle improvement
message.
Participants identified that the best
opportunity for moving evidence from
theory to practice in General Practice is to
include dementia prevention messages in
patient education about the effects of
smoking, poor nutrition, alcohol use,
physical inactivity and obesity on vascular
health. Explaining that improved physical
fitness, mental health and social well-being
will help to decrease dementia risk can be
highlighted as yet another benefit of the
lifestyle changes already being promoted
to prevent chronic disease.
Future action
The doctors and nurses in our focus groups
suggested that future KT activities and
research in this area needs to focus on:
• Strategies to improve clinicians’
understanding of the potential for
dementia risk reduction.
• Effective messages for communicating
with at-risk patients which result in
modified behaviours and changed risk
levels.
•Apublic health approach which
continues the lifestyle improvement
message but incorporates dementia risk
reduction as a key motivator, along with
reduction of chronic disease.
Afocus group is also planned with
community stakeholders in the prevention
target age group to discuss the strategies
suggested by GPs and RNs. The group will
be asked to discuss perceptions of
community readiness to respond to
interventions with this focus, and to
recommend action steps.
Based on the recommendations of these
focus groups in primary care, a knowledge
translation strategy will be developed to
influence General Practice and public
health messages with the aim of increasing
the number of Australians willingly
participating in dementia risk reduction
activities.
GPs or the Alzheimer’s Australia’s website
) have
DCRC SPEC I AL I SSUE : THE B I G P I CTURE I N DEMENT I A RESEARCH
Dementia prevention priorities
in General Practice GPs and Practice Nurses
looked at the evidence for
dementia prevention and
opportunities for getting the
message to their patients.
Melinda Martin-Khan and
co-investigators* outline the
primary recommendation
arising from the experience
Researchers (including the author, far left)
and RNs from one of the focus groups