Evaluation of the implementation of an occupational therapy based dementia care program in the Australian health and aged context

Author: Miia Rahja

Rahja, Miia, 2019 Evaluation of the implementation of an occupational therapy based dementia care program in the Australian health and aged context, Flinders University, College of Medicine and Public Health

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Dementia is a public health priority worldwide. Evidence-based programs to improve the wellbeing of people with dementia and their caregivers exist, but are rarely implemented in routine care. The World Health Organization has called for member states to employ evidence-based research into daily practice with the aim of improving the lives of people living with dementia. To address this call, the Australian Government has provided funding to several initiatives. Included was ‘The COPE Australia project’ that was funded by the NHMRC Cognitive Decline Partnership Centre. The project is registered with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12617000238370). The project sees the implementation of an occupational therapy based dementia care program, Care of People with dementia in their Environments (COPE), in the Australian health and aged context (www.copeprogram.com.au). This thesis evaluates the implementation of the COPE program in Australia, and highlights the key implications for ongoing program implementation at policy, service provider, and consumer levels. The thesis begins with a preamble and background. Schemes available to access community-based services in Australia are identified and the role of non-pharmacological interventions, specifically occupational therapy, in supporting people with dementia is described. The aims for the thesis are also detailed and original contribution to research is outlined. Six interconnecting studies have been completed to evaluate the COPE program implementation. The first study, described in chapter two, is a systematic review of economic evaluations of occupational therapy services for people experiencing age related cognitive and/or functional decline. The purpose is to identify approaches to occupational therapy interventions that can deliver better functional and economic outcomes for people with age related decline. Next, chapters three and four detail the findings from two online population surveys (n=1,000) about the Australian public’s current level of knowledge about treatments for dementia and occupational therapy services for older people. These findings are used to evaluate the possible uptake of the COPE program, and explore the implications for program promotion. Chapter five describes a case note audit of current occupational therapy approaches for people with dementia living in the community. The audit reveals a gap between current evidence and practice in regard to services delivered by occupational therapists in Australia; recommendations are made for improvements to service delivery. Chapter six presents findings from interviews about how participating in the COPE program impacted on the lives of people living with dementia and their family caregivers. Chapter seven presents a detailed cost-benefit analysis of the COPE program implementation from multiple perspectives and confirms the beneficiaries of the program. The thesis concludes with chapter eight; a reiteration of the thesis aims and synthesis of the work completed. A discussion regarding the strengths and limitations, as well as key outcomes is presented. Practical implications for the COPE program implementation in Australia are also discussed, and areas for future research are identified.

Keywords: dementia, reablement, occupational therapy, implementation science, economic evaluation

Subject: Health Sciences thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Medicine and Public Health
Supervisor: Kate Laver