Start/end date: 2016 - 2026
Design and evaluation of integrated primary health care practices for dementia in rural and remote settings
Rural areas tend to have a larger share of older adults, but few dementia-specific services. With most specialists practicing in cities, most of the responsibility for dementia diagnosis and management in rural areas falls to local primary health care (PHC) providers. However, there is a knowledge gap in evidence-based best practices to guide rural dementia care. Given the tremendous diversity across rural settings and PHC teams, a “one size fits all” approach to designing rural best practices is not effective. There is a need for adaptable strategies that can be tailored to individual PHC teams in different contexts.
In partnership with rural PHC providers we are developing an inventory of evidence-based best practices for delivering comprehensive, integrated PHC for dementia that is adaptable, scalable, and sustainable across diverse rural settings and PHC teams.
This research program involves three linked research streams:
Stream 1:Interdisciplinary team-based care to support ongoing care management and education/support for patients and caregivers.
Stream 2: Remote specialist-to-primary care education and support through technology
Stream 3: Decision support tools for PHC providers that are embedded in the electronic medical record (EMR)
More information about the current study is highlighted on the Rural Primary Health Care Memory Clinic page.
Start/end date: 2019 - 2024
The CCNA Phase II brings together over 350 researchers across 19 teams, including CCNA Team 15: Rural Dementia Care. Formerly Team 20: Rural, in the CCNA Phase I (read more about Phase I in Completed Projects section of this page), Team 15 is led by Dr. Megan O’Connell and Dr. Debra Morgan.
Team 15 has two streams of research:
(1) Rural and Remote Memory Clinic-interventions or RRMC-i, a novel model of remote healthcare in which a PhD level Clinical Psychologist delivers a suite of interventions via Telehealth [Lead: Megan O’Connell]. Remote interventions include cognitive rehabilitation, cognitive behavioral therapy for insomnia (CBTi) adapted to dementia, psychological consequences of driving cessation, social inclusion intervention, Indigenous caregiver support, and an app for spousal caregivers of persons living with atypical, young-onset dementias (RuralCARES).
(2) Sustaining, spreading, and evaluating the impact of four rural memory clinics established in southeast Saskatchewan in CCNA Phase I [Leads Debra Morgan and Julie Kosteniuk]. Several research projects related to the rural memory clinics are underway.
Rural-urban Differences in Use of Health Services Before and After Dementia Diagnosis
Studies show that people with dementia use health services at different rates than those without dementia. However, how patterns of health service usage among persons with dementia vary by rural or urban residence has not been sufficiently examined. The purpose of this study was to compare yearly rural-urban differences in the proportion of patients using health services, and the mean number of services, in the 5-yr periods before and after a first diagnosis of dementia. A matched control cohort without diagnosed dementia was used for comparison purposes.
- This population-based retrospective study uses linked administrative health data from the Canadian province of Saskatchewan to investigate the use of health services (family physician, specialist physician, hospital admission, all-type drug prescriptions, and short-term institutional care admission) by rural and urban individuals with dementia, matched 1:1 with persons without dementia based on age group, sex, comorbidity, and geographic region (northern, central, and southern Saskatchewan).
Interprofessional collaborative primary care for older adults living with age-related chronic disease in rural and remote areas: A scoping review of implemented innovations and solutions (led by Valerie Elliot)
- Identify and describe solutions or innovations that have been implemented to promote interprofessional primary care in rural/remote communities for older adults living with chronic conditions.
- Identify and describe the strengths and challenges of rural/remote communities that impact interprofessional primary care service delivery for older adults living with chronic conditions.
- Identify and describe the benefits of interprofessional primary care service delivery for older adults living with chronic conditions in rural/remote communities (e.g., availability, accessibility, quality of care, patient outcomes).
RaDAR was part of Team 20 of the Canadian Consortium on Neurodegeneration in Aging. Team 20 was funded by SHRF in partnership with CIHR from 2014 to 2019. This video about our team was produced as part of a CCNA initiative to share information about our research. Our co-team members on the CCNA Team 20: Issues for Dementia Care in Indigenous Populations have also produced a video, and host more information about research focused on dementia in Indigenous people on the Indigenous Cognition and Aging Awareness Research Exchange (I-CAARE) website.
As lead of the RaDAR Team, Dr. Debra Morgan co-led Team 20 with Dr. Kristen Jacklin (Department of Family Medicine and BioBehavioral Health, University of Minnesota) and Dr. Carrie Bourassa (University of Saskatchewan). Team 20 focused on rural and Indigenous issues in dementia care, with the rural focus led by Dr. Morgan and the Indigenous focus co-led by Drs. Jacklin and Bourassa. The rural and Indigenous research streams were distinct but addressed three common research areas in the CCNA quality of life theme: community-based primary health care (PHC), appropriate tools, and capacity building.
As part of CCNA Team 20, RaDAR team members conducted several inter-related projects (2014-2019):
1. Our core project involved collaborating with primary health care (PHC) teams to adapt PHC dementia care practices to rural settings, and evaluate the adapted interventions and facilitators/barriers of successful adaptation;
2. A pilot project led by Dr. Julie Kosteniuk involved identifying and and adapting evidence-based clinical support tools to rural PHC settings;
3. A pilot project led by Dr. Megan O’Connell identified innovative ways that specialists (from the Rural and Remote Memory Clinic) can support and help build dementia care capacity in rural PHC providers, and provide diagnostic support to PHC providers.
- A 5-step approach for developing and implementing a rural primary health care model for dementia: A community-academic partnership (In press). Primary Health Care Research and Development.
- A scoping review of dementia-related education and support services availability, accessibility and use in rural areas: Barriers and promising solutions. (Accepted, March 2019). Canadian Journal on Aging/La revue Canadienne du viellissement.
- Collaborative approaches to team-based primary health care for individuals with dementia in rural and remote settings: A scoping review. (Accepted, September, 2018). Canadian Journal on Aging/La revue Canadienne du vieillissement.
Identity, relationship quality, and subjective burden in caregivers of persons with dementia. (2018).Dementia: The International Journal of Social Research and Practice.doi:10.1177/1471301218808607
- Protocol for a meta-integration: Investigating positive aspects of caregiving in dementia. (2018). BMJ Open. doi:10.1136/bmjopen-2017-021215
- Telehealth rehabilitation for cognitive impairment: Randomized controlled feasibility trial. (2018). Journal of Medical Internet Research Protocols.doi:10.2196/resprot.9420
- Reliable change and minimum clinically important difference (MCID) of the Repeatable Battery for the Assessment of Neuropsychology Status (RBANS) in a heterogeneous dementia sample: Support for reliable change methods but not the MCID. (2018). Applied Neuropsychology: Adult. doi:10.1080/23279095.2017.1413575
- Variance in caregiver burden predicted by patient behaviours versus neuropsychological profile. (2018). Applied Neuropsychology: Adult. doi:10.1080/23279095.2017.1323754
- A scoping review of multiple transitions across care setting among individuals with dementia. (In review). Canadian Journal on Aging/La revue Canadienne du vieillissement.
- Health-Related Stigma of Non-Communicable Neurological Disease in Rural Adult Populations: A Scoping Review. (ePub ahead of print Dec 12, 2018). Health and Social Care in the Community. doi:10.1111/hsc.12694
- Cognitive and neuropsychiatric correlates of functional impairment across the continuum of no cognitive impairment to dementia. (2017).Archives of Clinical Neuropsychology.doi:10.1093/arclin/acx112
- Focus on dementia care: Continuing education preferences, challenges, and catalysts among rural home care providers. (2016). Educational Gerontology. doi:10.1080/03601277.2016.1205404
- Dementia-related work activities of home care nurses and aides: Frequency, perceived competence and continuing education priorities. (2016). Educational Gerontology. doi:10.1080/03601277.2015.1083390
- Baseline Study of Dementia Care Landscape in Sun Country Health Region (2016).
CCNA Phase 1 was a 5-year initiative (2014-2019) led by cognitive neurologist Dr. Howard Chertkow Chair in Cognitive Neurology and Innovation Director at Baycrest. Launched by the federal government and the Canadian Institutes of Health Research(CIHR) in September, 2014, CCNA Phase 1 addressed the growing prevalence of neurodegenerative diseases affecting cognition such as Alzheimer Disease and other dementias. The CCNA brought together 340 Canadian researchers and experts organized into the 3 themes of primary prevention (preventing disease development), secondary prevention (delaying clinical manifestations), and quality of life. The CCNA received $31.5 million from CIHR and 13 public and private sector partners, plus $24 million from partners in Ontario and Quebec, to carry out the 5-year research program.
Health Services Use Before and After Dementia Diagnosis
Adjusted findings demonstrated that 5 years before diagnosis, usage of all health services except hospitalisation was lower among persons with dementia than persons without dementia (all p<0.001). After this point, differences in higher health service usage among persons with dementia compared to without dementia were greatest in the year before and year after diagnosis. In the year before diagnosis, specialist visits were 59.7% higher (p<0.001) and hospitalisations 90.5% higher (p<0.001). In the year after diagnosis, FP visits were 70.0% higher (p<0.001) and all-type drug prescriptions 29.1% higher (p<0.001).
Kosteniuk J., Acan Osman, B., Osman, M., Quail, J., Islam, N., O’Connell M.E., Kirk, A., Stewart, N., Morgan D. 2022. Health service use before and after dementia diagnosis: a retrospective matched case-control study. BMJ Open, 12(11):e067363. doi:10.1136/ bmjopen-2022-067363
Utilization of Health Service Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic
Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p < 0.001). The highest proportion of patients hospitalized was observed 1-yr pre-index, the highest average number of specialist visits was observed 1-yr post-index, and both demonstrated a significant decreasing trend in the 5-yr post-index period (p = 0.037).
Kosteniuk J., Morgan D., Acan Osman, B., Islam, N., O’Connell M.E., Kirk, A., Quail, J., Osman, M. Utilization of health services before and after diagnosis in a specialist rural and remote memory clinic. Canadian Geriatrics Journal. In Press.
RaDAR and HQC have formed a partnership to analyse administrative health data with the objective of investigating the epidemiology of dementia in Saskatchewan. These research findings provide key evidence to form policy recommendations, support health resource planning, and identify research priorities. The RaDAR-HQC Steering Committee guides the RaDAR-HQC research collaboration, and is comprised of researchers, health region and Alzheimer Society of Saskatchewan leadership, and health care professionals.
Phase 1 - Completed - Reports to download
- Multi-method Investigation of Dementia and Related Services in Saskatchewan: Final Report and Recommendations (2015)
- Simultaneous Time Trends in Dementia Incidence and Prevalence, 2005-2013, Saskatchewan, Canada (2015)
Does Early Stage Intervention Improve Caregiver Wellbeing or Their Ability to Provide Care to Persons with Mild Dementia or Mild Cognitive Impairment? (led by Dr. Melanie Bayly)
Twenty-two reports representing 18 randomized controlled trial (RCT)/controlled early-stage intervention studies were included for meta-analysis, measuring a variety of outcomes for which effect sizes were calculated using standardized mean differences. Findings suggest that early-stage intervention has a small positive effect on both caregiver well-being and ability to provide care, with the largest effects observed for caregiver anxiety and caring-related distress. Moderator analyses showed no statistically significant difference in effectiveness based on type of intervention (counseling/psychotherapy, psychoeducational, or multicomponent) or individual versus group-based interventions. However, interventions that were caregiver only (vs. dyadic) had larger positive effects on caregiver well-being and ability to provide care. None of the caregiver/recipient characteristics examined (sex, type of relationship, and type of dementia) were related to the effectiveness of early-stage interventions. Although published controlled/RCT trials were limited, findings support efforts to offer early-stage interventions to caregivers of persons with mild dementia or MCI. Further research to determine what intervention types or components are most efficacious would aid the provision of optimal support for caregivers early in their caregiving trajectory.
Bayly M., Morgan D., Elliot V., Kosteniuk J., Froehlich Chow A., Peacock S., O’Connell M. 2021. Does early stage intervention improve caregiver wellbeing or their ability to provide care to persons with mild dementia or mild cognitive impairment? A systematic review and meta-analysis. Psychology and Aging, 36(7): 834. doi.org/10.1037/pag0000642
Protocol for a Systematic Review on Interventions for Caregivers to Persons with Mild Cognitive Impairment and Early Dementia: Does Early Stage Intervention Improve Caregiver Wellbeing and Ability to Provide Care? (led by Dr. Melanie Bayly)
- Do interventions aimed at caregivers to persons with early stage dementia or MCI affect their wellbeing and ability to provide care?
- Are particular types of caregiver interventions more effective than others during early stage cognitive decline?
- To what extent do benefits to caregivers differ when early and later intervention are directly compared?
- Is there evidence to suggest that benefits of early stage intervention for caregivers vary based on care recipient and caregiver characteristics (e.g., relationship, sex, type of dementia, rural vs. urban residence)?
Bayly M., Morgan D., Kosteniuk J., Elliot V., Froehlich Chow A., Peacock S., McLean A., O’Connell M. 2019. Protocol for a systematic review on interventions for caregivers to persons with MCI and early dementia: Does early stage intervention improve caregiver wellbeing and ability to provide care? BMJ Open, 9: e028441. doi:10.1136/ bmjopen-2018-028441
A scoping review of dementia-related education and support service availability, accessibility and use in rural areas: Barriers and promising solutions (led by Dr. Melanie Bayly)
The current scoping review aimed to map and synthesize the published literature related to education and support services for individuals with dementia and their caregivers living rurally across the globe. Findings illustrate both challenges and promising innovations in rural dementia education and support services. Availability of rural dementia-related support and education services was low, particularly for respite care and day programs. Service use varied across studies, with barriers including low knowledge regarding services, practicality and resource issues (e.g., transportation, financial), values and beliefs, stigma, and negative perceptions of services. Solutions included tailored and person-centered services, technological service provision, accessibility assistance, inter-organization collaboration, education regarding services, and having a “point of entry” to service use.
Bayly M., Froehlich Chow A., Morgan D., Kosteniuk J., Elliot V. 2020. A scoping review of dementia-related education and support service availability, accessibility and use in rural areas: Barriers and promising solutions. Canadian Journal on Aging, Dec;39(4): 545-585. doi: 10.1017/S0714980819000564
Palliative and end-of-life care for people living with dementia in rural areas: A scoping review (led by Valerie Elliot)
The purpose of this review was to systematically identify, review, and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. Across the twenty-four items (12 peer-reviewed, original research studies; 12 less formal ‘grey literature’) were included for synthesis, all of which were described and illustrated by frequency distribution. Key findings were grouped thematically, and the following five main themes emerged: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap in the literature pertained to rural populations, particularly from locations outside of the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature.
Elliot V, Morgan D, Kosteniuk J, Bayly M, Froehlich Chow A, Cammer A, O’Connell ME. Palliative and end-of-life care for people living with dementia in rural areas: A scoping review. PloS one. 2021 Jan 14;16(1):e0244976. doi:10.1371/journal.pone.0244976
Elliot, V., Morgan, D., Kosteniuk, J., Bayly, M., Froehlich Chow, A. Cammer, A. & O’Connell, M.E. (2022). An overview of the experiences, needs, and shortfalls of dementia-related palliative and end-of-life care services and supports in rural areas. In Chapter 9 Late Stage, page 181-82, of Gauthier S, Webster C, Servaes S, Morais JA, Rosa-Neto P. 2022. World Alzheimer Report 2022: Life after diagnosis: Navigating treatment, care and support. London, England: Alzheimer’s Disease International.
Available at: https://www.alzint.org/resource/world-alzheimer-report-2022/
Health‐related stigma of noncommunicable neurological disease in rural adult populations: A scoping review (led by Valerie Elliot)
- Five types of stigma were identified: social; self; health professional; associative; structural
- Four main factors influencing stigma emerged: knowledge; familiarity; beliefs; rurality
- Four overarching stigma-related themes emerged: concealment; exclusion; disempowerment, discrimination and unequal opportunities; issues related to healthcare systems and providers
- While rural settings are unique with features that can both positive and negative effects on stigma, we found that in rural-urban comparison studies rural participants were in general less knowledgeable and more stigmatized
- Main gaps identified in the literature include:
o Apart from epilepsy, research focusing on the stigma of neurological disease in rural populations is sparse.
o Cross-cultural comparisons of stigma related to neurological disease in rural adult populations is limited.
o There is a lack of literature with gender included as a variable in the analysis of stigma-related outcomes.
Elliot V., Morgan D., Kosteniuk J., Froehlich Chow A., Bayly M. 2018. Health-related stigma of non-communicable disease in rural adult populations: A scoping review. Health & Social Care in the Community. https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12694
Collaborative Approaches to Team-Based Primary Health Care for Individuals with Dementia in Rural/Remote Settings: A Scoping Review (led by Dr. Amanda Froehlich Chow)
Among the 10 articles included in the scoping review there was a variation in the degree of collaboration and interaction among the care teams. Limited information existed about the collaboration strategies applied among care teams. A socio-ecological approach was employed to identify and categorize key factors (barriers and facilitators) shown to influence collaborative team-based approaches in rural settings.
Froehlich Chow A., Morgan D., Bayly M., Kosteniuk J., Elliot V. 2019. Collaborative Approaches to Team-Based Primary Health Care for Individuals with Dementia in Rural and Remote Settings: A Scoping Review. Canadian Journal on Aging, Sep;38(3):367-383. doi:10.1017/S0714980818000727
Factors Identified as Barriers or Facilitators to EMR/EHR Based Interprofessional Primary Care: A Scoping Review (led by Dr. Julie Kosteniuk)
Twelve studies were included in the review. Of six facilitator and barrier themes identified, the key facilitator was teamwork support and a significant barrier was data management. Other important barriers included usability related mainly to interoperability, and practice support primarily in terms of patient care. Additional themes were organization attributes and user features. Although EMR/EHR systems facilitated teamwork support, there is potential for team features to be strengthened further. Persistent barriers may be partly addressed by advances in software design, particularly if interprofessional perspectives are included. Organizations and teams might also consider strategies for working with existing EMR/EHR systems, for instance by developing guidelines for interprofessional use. Further research concerning the use of electronic records in interprofessional contexts is needed to support IPC in primary care.
Kosteniuk J., Morgan D., Elliot, V., Bayly M., Froehlich Chow A., Boden C., O’Connell, ME. Factors identified as barriers or facilitators to EMR/EHR based interprofessional primary care: A scoping review. Journal of Interprofessional Care. In Press.
A scoping review of multiple transitions across care settings among individuals with dementia (led by Dr. Julie Kosteniuk)
The objective of this review was to identify the peer-reviewed literature investigating routes of multiple transitions experienced by individuals with dementia, with specific attention to descriptions and definitions, care settings, timeframes, and factors associated with transitions. Across 33 articles, we identified 26 distinct routes of multiple transitions based on the starting location, number of transitions experienced, and other locations involved. The most frequently examined two-transition route involved admission from home to hospital followed by admission to long-term care. Considering routes with more than two transitions, the patterns identified in most studies were characterized by hospital admission and readmission from unspecified settings. There is a need for longitudinal studies that track transitions across care settings over several years, greater attention to sex differences in multiple transitions, and research that includes sub-populations of individuals with dementia.
Kosteniuk J., Morgan D., Elliot V., Froehlich Chow A., Bayly M., Watson E., Osman M., Acan Osman B., O’Connell M.E., Kirk A., Stewart N., Cammer A., Innes A. 2022. A scoping review of care trajectories across multiple settings for persons with dementia. Canadian Journal on Aging, 41(1):71-95. doi:10.1017/S0714980821000167
As part of the national AGE-WELL (Aging Gracefully across Environments using Technology to Support Wellness, Engagement, and Long Life) NCE, Megan O'Connell was the Project Lead for Rural/Remote Indigenous Technology needs Exploration (RRITE). Project co-lead and co-applicants were: Debra Morgan, Carrie Bourassa, Kristin Jacklin, & Wayne Warry.
Understanding user needs is fundamental to development of technology that individuals will try and continue to use. The user needs of two specific Canadian populations, older adults who reside in rural or remote areas and Indigenous older adults, will be explored in an attempt to increase accessibility of the technologies developed in AGE-WELL. The team explored issues related to access to sufficient connectivity infrastructure as experienced by rural/remote and Indigenous older adults. The team members also explored characteristics of rural/remote older adults that impact their needs for technology, such as their exposure to technology, attitudes toward technology, and cognitive abilities. In addition, they explored what rural/remote and Indigenous older adults find to be personally relevant goals for technology to support them while they age. Finally, the team explored how residing in rural/remote locations has unique implications for training to use new technology and how technologies developed in AGE-WELL can be adapted to increase cultural relevance for Indigenous older adults.
- Anticipated needs and worries about maintaining independence of rural/remote older adults: Opportunities for technology development in the context of the double digital divide. (2018). Gerontechnology.
- Telehealth rehabilitation for cognitive impairment: Randomized controlled feasibility trial. (2018). Journal of Medical Internet Research Protocols. doi:10.2196/resprot.9420
- Development and Use of Health-Related Technologies in Indigenous Communities: Critical Review. (2017). Journal of Medical Internet Research. doi:10.2196/jmir.7520
Begining in 2011 Megan O’Connell and her students collaborated with staff from the Alzheimer Society of SK to deliver a telehealth videoconferenced support group for caregivers of individuals diagnosed with atypical dementias or dementia due to frontotemporal lobardegeneration. Entry into the support groups is via the Alzheimer Society of Saskatchewan First Link Program. This collaborative work is based on participatory research previously published in the journal Dementia: The International Journal of Social Research and Practice. The collaboration with the Alzheimer Society allowed us to disseminate this novel intervention method more widely, and was a wonderful training opportunity for clinical psychology graduate students. Megan in collaboration with one of her students, Rachel Burton, and with Joanne Michael, Director of Programs and Operations at the Alzheimer Society of Saskatchewan, worked to evaluate the collaboration between researcher and community-based organization as part of this project.
eHealth Saskatchewan (the provincial organization that provides telehealth services across the province) produced a video about telehealth service which features Dr. Megan O'Connell and a member of the telehealth-delivered support group. Watch the video to learn more about how technology helps this novel support group come together.
In spring of 2012 three members of the support group traveled to Saskatoon and recorded their personal stories to share online. They are available on our resource page.
The Sun Country Health Region Dementia Working Group was formed as part of the health region’s 2013/14 Dementia Hoshin (priority) to address some of the challenges facing individuals with dementia and their families. A key initiative of the Working Group was an assessment of the educational needs of health care providers regarding dementia care, specifically home care providers. Performed by the RaDAR team, the assessment examined home care providers’ perspectives on their regular work activities and perceived competence related to dementia care, as well as available community support services. This study was funded by an Applied Chair in Health Services and Policy Research Award to Dr. Debra Morgan from the Saskatchewan Health Research Foundation and the Canadian Institutes of Health Research.
RaDAR Team investigator, Dorothy A. Forbes, RN, PhD, Professor, Faculty of Nursing, University of Alberta
Prior to becoming an academic, Dorothy was a public health nurse and home care nurse in rural and urban settings in Ontario, Saskatchewan, and Alberta. These community nursing experiences drive her program of research which focuses on supporting persons with dementia and their caregivers in rural Canada. The aim of her research is to improve the quality of life for persons with dementia, their family caregivers, and formal care providers through integrated knowledge translation strategies that enhance quality and safe dementia care in the home. Dorothy is currently examining the role of a knowledge broker in home care settings in northern Alberta. She continues to conduct Cochrane Reviews on interventions such as exercise and light therapy that manage the symptoms of dementia. In addition to working with Debra on her research, Dorothy is a co-applicant on several projects: (i) Development, implementation and evaluation of a provincial kidney conservative care clinical pathway (Davison, S., PA, & Fassbender, K. Co-PA; (ii) Innovative Community Approaches to Promote Optimal Aging for Older Adults with Multiple Chronic Conditions and Their Caregivers(Jennie Ploeg & Maureen Markle-Reid, PAs); and (iii) Understanding Emergency Department Care Transitions for Older Adults with Dementia Living in Rural Communities (Kathleen Hunter & Belinda Parke, PAs). Dorothy held a CIHR New Investigator award from 2003-2008 and was President of the Canadian Association for Nursing Research from 2003-2007. She is currently an Adjunct Professor, College of Graduate Studies and Research, University of Saskatchewan and Adjunct Professor, Faculty of Health Sciences, University of Western Ontario.
Sheena Walls-Ingram was the Research Manager for this study which was conducted to improve our understanding of the experiences of family caregivers and the supports and services that would help them in their role, both pre and post diagnosis. Family members of individuals referred to the Rural and Remote Memory Clinic were interviewed at the full-day clinic. Follow-up interviews were then conducted at six months and twelve months. This research was published in the journal Social Science and Medicine. Funding for this study was provided by a Canadian Centre for Health and Safety in Agriculture (CCHSA) - Canadian Institutes for Health Research (CIHR) Centre for Research Development Pilot Project grant.
Project Lead: Debra Morgan
This project explored the assessment and management of people with dementia by family physicians and nurse practitioners in rural and remote Saskatchewan. We investigated the dementia assessment process, as well as decisions concerning specialist referral, perceived roles of family physicians and nurse practitioners in the assessment and management process, their support needs, and their views regarding current gaps in the health care system to support people with dementia and their caregivers. This research was published in the journal Primary Health Care Research & Development.
Project Lead: Julie Kosteniuk
The purpose of this project, funded by the Ralston Brothers Medical Research Fund, was to examine the feasibility and acceptability of a telehealth-delivered exercise program for Rural and Remote Memory Clinic (RRMC) patients and their caregivers. In Phase 1, RRMC patients and caregivers were interviewed about current physical exercise and preferences regarding an exercise intervention design. This information was used to create the Phase 2 survey questionnaire that was mailed to RRMC patients and their caregivers. Preliminary analyses suggest that 61% of respondents are interested in participating in an exercise program conducted via telehealth. A research assistant investigated community resources for physical activity and exercise in each survey respondent’s community. Phase 3 involved a telehealth-delivered exercise intervention offered two times a week in two different health regions. This research was published in the journal Rural and Remote Health and in Journal of Aging and Physical Activity.
Project Leads: Vanina Dal Bello-Haas (PI) and Megan O'Connell
This study focused on the experiences of sons as caregivers over time for parents with dementia, who live in rural and remote areas of Saskatchewan. Earlier team research, published in the Journal of Applied Gerontology led to interest in the specific caregiving experiences of sons. The study involved interviewing sons who have self-identified as primary caregivers in the initial diagnostic Rural and Remote Memory Clinic visit over the past 6 years, with the aim of improving our understanding of their role in the context of the network of carers and services available to their parent with dementia. The funding to support this study was provided by a CCHSA - CIHR Centre for Research Development Pilot Project grant.
Project Lead: Norma Stewart
Cognitive screens for Indigenous seniors must address the cultural bias of existing assessment protocols, and be developed in consultation with front-line health care workers and health managers who work with Indigenous seniors, including partners from Northern and remote settings. Clinical researchers and graduate students at the University of Saskatchewan’s Rural and Remote Memory Clinic developed the Northern Cultural Assessment of Memory (N-CAM) in partnership with Keewatin Yatthé Regional Health Authority (KYRHA) Home Care Service staff and managers, in consultation with Indigenous seniors and health care staff from the Saskatoon Community Clinic, and with support from the Indigenous Peoples Health Research Centre (IPHRC) and Northern Medical Services. Intended as a dementia screening protocol for Indigenous seniors, the N-CAM does not assume or require formal education or fluency in English. The protocol incorporates colourful and familiar materials, includes a story-telling component, and can be administered in the preferred language of the senior with the assistance of a bilingual family member or other caregiver.
View an archived webinar about the N-CAM from October 29th, 2015 on vimeo.
If you would like to access the N-CAM or if you have any questions or concerns about the administration, scoring, or interpretation of the N-CAM, please contact the project lead Margaret Crossley.
The aim of this project was to identify and describe assisted living and long term care facilities located in First Nation and Métis communities in Saskatchewan. While there is a need for long term care beds in Aboriginal communities, establishing such facilities requires stakeholders to negotiate a range of complex jurisdictional and funding challenges. One finding of the research revealed a lack of care homes in northern Saskatchewan - an area identified by the Conference Board of Canada as having some of the lowest incomes and poorest housing stock in the country. As many care homes are privately owned and operated residences where clients are responsible for the cost of their care, the next step is to determine if there is a connection between housing stock, incomes, and access to care home facilities in the north.
Project Lead: Lesley McBain
The team's physical therapist, Vanina Dal Bello-Haas, PhD, PT, was funded by the Saskatchewan Health Research Foundation to study factors associated with falls and near-falls in community-dwelling older adults with early-stage dementia.
Research by members of the RaDAR team in rural long term care facilities identified a high rate of physically responsive behaviours for Special Care Aides (SCAs) [now referred to as Continuing Care Assistants (CCAs) in Saskatchewan] compared to other caregivers. CCAs provide the majority of hands-on care in nursing homes and are sometimes referred to as Nursing Aides or Personal Support Workers. The research also identified an association between more frequent experiences of physically responsive behaviours from residents and higher job stress.
In 2007 a research team further investigated Continuing Care Assistants' experiences of physically responsive behaviour, and their perceptions of the causes of the behaviour.
This research was published in the journal Qualitative Health Research, and published in the Journal of the American Medical Directors Association. As well, a Study Report was created to share study findings back with the participating CCAs and long term care facilities. The team felt that a direct, clear, report format would be the best way to ensure that CCAs had access to the study findings. The research team also traveled the province to meet with CCAs in each of the 11 participating facilities to review the report findings.
In 2010, Allison Cammer presented the keynote address on the results of this study at the Continuing Care Assistant Conference at the then Saskatchewan Institute of Applied Science and Technology (SIAST) [now Saskatchewan Polytechnic] campus in Saskatoon. Following the keynote presentation participants had the opportunity to participate in research focus groups aimed at learning more about incident reporting among Saskatchewan-based care aides. The discussions examined what reporting processes are in use, which are most useful, how they are best used within the workplace, and how they can be improved.
The team neuroradiologist, Sheri Harder, MD, FRCPC, received two years of external funding to evaluate magnetic resonance spectroscopy (MRS) in improving diagnostic accuracy in early AD and in predicting prognosis in patients with mild cognitive impairment. Consenting clinic patients underwent serial MRS at baseline (their first in-person follow-up appointment) and at one year.
As a CIHR New Investigator funded by the NET grant, Dorothy A. Forbes, RN, PhD, Associate Professor, Faculty of Nursing, University of Alberta conducted research on home and community-based services for people with dementia. Her work explored the use and satisfaction with home and community-based services for people with dementia from the perspective of the family caregivers. The findings suggest a need for an integrated continuing care model that includes the person living with dementia and their family caregivers as partners in care, addresses all of the determinants of health, and embraces sensitivity, diversity, flexibility, and supportive services to enhance the availability and acceptability of Canadian home and community-based services. She has further explored the impact of place (rural vs. urban) on Canadians with dementia and their use of health care services using data from the Canadian Community Health Survey. The results suggest that Canadians with dementia primarily required support services and that they were more likely than persons without dementia to report that their health care needs were unmet. It is recommended that publicly funded national home care programs be expanded to ensure that the supportive services needed by this population are available. Her research indicates that among Canadian females between 50 and 64 years old those with dementia were more likely than those without dementia to live in rural areas. As well, using data from the 2003 Canadian Community Health Survey, her work explored the role of gender in the use and availability of home and community-based services among Canadian men and women with dementia. In this study, women reported better health and received more supportive care yet had more unmet home care needs than men – suggesting consideration must be given to gender differences when policies and programs are developed. Selected publications resulting from this research program are listed on the Team Publications page.