Evidence check of Specialist Dementia Care Units
Department of Health
Duration: June – September 2017
Download the report
Masso M, Duncan C, Grootemaat P, Phillipson L, Samsa P, Fildes D and Gordon R (2017) Specialist dementia care units: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Commonwealth Department of Health.
The Commonwealth Department of Health is implementing Specialist Dementia Care Units (SDCUs) to meet the needs of elderly people experiencing very severe and extreme behavioural and psychological symptoms of dementia (BPSD). The intention is to establish at least one SDCU in each of the 31 Primary Health Networks across Australia. SDCUs are the planned ‘third tier’ in programs to assist aged care consumers experiencing BPSD, complementing the existing Dementia Behaviour Management Advisory Service (Tier 1) and Severe Behaviour Response Teams (Tier 2). CHSD was commissioned to review the evidence regarding the effective management and care of people with very severe and extreme BPSD to inform the implementation of SDCUs, with the Sax Institute acting as ‘broker’ for the review.
What we did
Searching the academic and grey literature resulted in the identification of 25 papers about 17 units in Australia and countries with comparable health systems. The papers reported on units catering to different populations of people with dementia and behavioural symptoms across a variety of settings, with little consistency in the findings.
The quality of the evidence was assessed using a framework developed by the National Health and Medical Research Council, which resulted in nine studies being identified as having the greatest potential to inform the development of SDCUs: one study categorised as best practice, two studies categorised as promising practice and six studies assessed as emerging practices.
Evidence of effectiveness in managing very severe or extreme BPSD was limited: four units demonstrated improvement in behavioural symptoms, but in three of these the results were based on a weak study design. The evidence for improvement in behavioural symptoms for the fourth unit was based on a good study design.
Synthesising the findings resulted in the identification of various common elements across the units studied, covering issues such as unit philosophy; physical environment; staff education; medical and allied health staffing; activity programs; assessment and care planning; and a multidisciplinary approach to care.
The Department of Health was impressed with the quality of the review and subsequently initiated a ‘policy dialogue’ with CHSD in October. This took the form of a teleconference, facilitated by the Sax Institute, to seek the advice of CHSD regarding the ongoing development of SDCUs, particularly in relation to program design, implementation and evaluation.
Project team: Malcolm Masso, Cathy Duncan, Pam Grootemaat, Lyn Phillipson, Peter Samsa, Dave Fildes, Rob Gordon