Internationally the provision of effective and appropriate care for people with dementia is a growing challenge. In Australia, it is estimated that in 2011, nearly 300,000 people had dementia out of a total population of 23 million. This number is projected to increase to 900,000 by 2050, with a parallel increase required in the number of health professionals to care for this vulnerable population [1
]. The quality of life as well as the functional status of people with dementia is affected by the quality of their care in a variety of health care environments, including acute and community care. Adequate knowledge of dementia among health care staff has been shown to affect critical issues in care, such as the timing of diagnosis and the subsequent implementation of interventions and the quality of care environments [2
], which are in turn, linked to improved patient outcomes [3
]. However, previous studies have shown that those responsible for the diagnosis of dementia, the implementation of treatment plans, and the daily care of people with dementia have deficits in dementia knowledge.
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
]; the person with dementia is given more opportunity and choices regarding disease management plans [4
]; 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
]. 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
]. 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
]. 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
]. 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
]. 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
]. 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?
2. Controlling for demographic characteristics, how are dementia-specific education or training and experience caring for someone with dementia related to knowledge about dementia?