Both positive and negative outcomes of the level of dementia knowledge on the part of health professionals, family caregivers and the people with dementia themselves have been highlighted in previous research. When these groups possess a good level of knowledge about dementia, it has been found that: diagnosis will occur at an earlier stage as the person with dementia will seek medical advice earlier; family members may raise an alert earlier and health professionals will recognise the symptoms of early dementia [3,6-8]; the person with dementia is given more opportunity and choices regarding disease management plans [4,7,9,10]; and the incidence of stigma associated with a diagnosis of dementia may be reduced [7]. On the other hand, poor knowledge about dementia has been found to result in the underutilisation of support and treatment services [11] and in delayed diagnosis which prolongs the initiation of treatment plans and results in poorer outcomes for people with dementia and their caregivers such as inadequate care of the disease, misinterpretation of behaviours and increased caregiver stress due to failure to seek appropriate support [7,11]. Primary care physicians (general practitioners or GPs in Australia) receive minimal specific training in geriatrics during their undergraduate studies, and both GPs and nurses have self-reported that they have a knowledge deficit about dementia [2,3,6]. Similarly, certified nursing assistants are exposed to the least amount of formal knowledge regarding dementia during their training, yet are responsible for the provision of up to 90% of the basic care for people with dementia [12]. Assessing and addressing this knowledge deficit may be one of the keys to improving dementia care and health outcomes in the future.

In the early stages of dementia, many people first present with symptoms to a GP or to a health care worker in an acute hospital when seeking treatment for a seemingly unrelated condition [2]. However, these doctors and nurses, when not gerontological specialists, have been shown to be generally lacking in dementia knowledge [7]. In the acute care setting, with 15 – 50% of patients having a degree of cognitive impairment [13], knowledge of dementia among those involved in their care, including medical practitioners, allied health staff, social workers, clerical staff and nurses, is essential. Even cleaning, maintenance and security staff in acute care environments come into contact with people with cognitive impairments and might benefit from greater general knowledge about dementia. For example, acute care nurses without a good understanding of dementia have admitted to: having great difficulty interpreting behaviours of dementia; prioritising care to those without dementia as it would take too long to deal with the person with dementia who is unable to communicate; and to experiencing fear of caring for patients with dementia because they believe they are at risk of harm [14]. Other research has demonstrated that quality care of the person with dementia is feasible in the acute care setting, when attention to the special needs of patients with dementia is given [15].

Two recent studies conducted in Australia corroborate these points about the relationship between knowledge of dementia and quality of care in the acute care environment [13,16]. Partly because of lack of knowledge about dementia and the possible sources of patient confusion, acute care of cognitively impaired people was found to be inconsistent and to have emphasised safety at the expense of wellbeing and dignity [16]. Care staff displayed generally negative attitudes towards people with dementia [16] and nurses expressed reluctance to care for patients with dementia because they found it unrewarding [13]. Both of these sets of authors concluded that staff education and training was critical to improving the quality of care received by a person with dementia while in acute care [13,16]. The first step toward improving dementia knowledge of all types of health care staff is to assess their current level of dementia knowledge using a reliable tool that will identify knowledge gaps.

There are a number of dementia knowledge assessment tools that have been developed over the past decades. A recent review [7] of such tools concluded that while the Alzheimer’s Disease Knowledge Test (ADKT) [17] was the oldest and most widely used, a more recent tool, the Alzheimer’s Disease Knowledge Scale (ADKS) [18], was promising and showed good psychometric properties. Originally only used by its developers [19], two recently published articles have confirmed the utility of the ADKS in this context [20,21]. Assessing the level of dementia knowledge among health professionals is important to: assess the level of knowledge prior to the implementation of dementia knowledge programs as a baseline; identify the gaps in knowledge to be included in a program; and then to assess the effectiveness of a dementia knowledge education program [2,6,7,12,22]. This study aims to ascertain staff knowledge about dementia across a regional health service region in Queensland, Australia using the ADKS.

Two primary research questions guided this study. These were:

1. What knowledge of dementia do health care staff (nursing, medical, allied health, and support) in a large regional health district have?

The overall mean score of dementia knowledge as measured by the ADKS was 23.6 (SD=3.26) out of 30 (79% correct). The following variables displayed a statistically significant relationship with ADKS score: age, professional group, personal caring experience, professional caring experience, tertiary education, dementia training, and other dementia learning. In terms of specific categories of respondents for the multi-category variables, those less than 30years old and those in the medical professional group scored best on the ADKS, while support staff displayed significantly lower scores.

In rating their own knowledge of dementia on the 11-point scale, health district employees reported on average a moderate knowledge of dementia (mean=5.2, SD=2.23; Table1). Respondents who rated themselves as having more knowledge of dementia tended to score significantly higher on the ADKS (r=.37, p<.001).

As shown in Table2, respondents’ scores (in terms of percent correct out of total possible) on most of the seven domains within the ADKS were similar and in the range 80–87 percent. Two domains stood out as having lower scores—risk factors (percent correct=65%) and course of the disease (75%). These two domains contained the most medically oriented questions, such as those about what factors predispose people to developing dementia and how long the course of the disease typically lasts. Professional group was related to the knowledge of dementia in specific content domains, with the relationship being statistically significant in five of the seven content domains. Respondents with medical training scored particularly high in the risk factors domain compared to the other three groups, while scores for support staff were the lowest among all groups across all domains.

A linear regression analysis predicting ADKS score including all demographic variables yielded the parsimonious result (in which only significant predictors are included) shown in Model 1 of Table3. Being the largest category and in the absence of a substantive reason for choosing among professional groups, nursing was used as the omitted category in the regression. Age and professional group were independent predictors, with those less than 30 scoring about 1 point higher, those in the medicine group scoring 1.8 points higher and those in the support group 1.8 point lower on the ADKS (other things equal). This model explained about 12% of the variance in ADKS score. For the second model, personal caring experience and the three education/training variables were added with only personal experience and dementia-specific training emerging as additional significant predictors of ADKS (Model 2, Table3). Those with personal experience caring for someone with dementia had a predicted 0.7 point higher score on the ADKS compared with those without experience, and those who had undergone formal dementia-specific training showed a predicted 0.8 point higher score than those without such training. Professional group remained an independently significant predictor, while age was no longer important in this model.

Dementia education has been identified as a means of improving dementia knowledge especially for health professionals [9]. In recent studies, several dementia education programs and resources were tested for their effectiveness to improve knowledge of dementia. These included: an information video and written information developed by Alzheimer’s Australia [22]; a pamphlet developed by Alzheimer’s Australia (‘Mind Your Mind’) [6]; a one hour lecture covering the information tested in the knowledge of dementia measure [11]; a six hour course covering the physiology of dementia, common behaviours seen in dementia and management of behaviours such as wandering, confusion and communication difficulties [12]; and education on dementia integrated within an overall demonstration program to improve dementia care and management [13]. With the exception of the one hour lecture [11], all the education programs and resources studied were found to improve knowledge of dementia when assessed using the various tools available. In particular, Foreman and Gardner (2005) found that the education and training program improved attitudes towards caring for people with dementia as well as general knowledge of dementia among health care staff [13]. In confirming the link between dementia-specific training and knowledge of dementia, this study adds to the existing literature and has implications for both care and policy regarding acute and community care of people with dementia. Consequently, if we are to truly support quality dementia care, then one goal for health services could be to achieve a high proportion of staff who have undergone dementia-specific education. This may require that health service regions include dementia education as a mandatory component of both employment criteria and staff development programs for staff working and caring for older people. Any such education or training would need to target all staff who would potentially have contact with patients with dementia. Support staff cannot normally be expected to have had the health background or opportunity to learn specifically about this vulnerable population and their unique needs. The projected growth in numbers of older people with dementia in acute settings suggests that staff from all levels will come into contact with this group at some stage; therefore appropriate education and training will help in the delivery of quality dementia care.