Let\u2019s CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial

Kate Bradley,Edward Strivens,Leon Flicker,Sandra Thompson,Jo-Anne Hughson,Dawn Bessarab,Kylie Radford,Irene Blackberry,David Atkinson,Kate Smith,Robyn Smith,Dina Logiudice

doi:10.1186/s12913-020-4985-1

Abstract

BackgroundDocumented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment.Methods/designThe prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation.The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families.DiscussionThe Let’s CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment.Trial registrationACTRN12618001485224. Date of registration: 04 of September 2019

Highlights

Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting
The Australian population of Aboriginal and Torres Strait Islander peoples is growing, and the number of people aged over 65 years is projected to nearly double by 2026 [1]
There is increasing evidence that prevention and management of vascular and other risk factors could delay progression of dementia [9], and this may be of particular relevance in Aboriginal and Torres Strait Islander communities where there are high rates of co-morbid conditions [10, 11] and onset at earlier ages, including past head injury – a key risk factor associated with decline from normal cognition to impairment [4], and other associations including age, stroke, non-aspirin analgesics, lower BMI, and higher systolic blood pressure (BP) [4]

Summary

Introduction

Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3–5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. Rates of dementia and CIND are up to 5 times those observed in the non-Indigenous population, with onset at younger ages, and are influenced by potentially modifiable risk factors such as head injury, cardiovascular disease and stroke. This is in contrast with other research internationally, that demonstrates a decrease in dementia rates in some developed nations in the last three decades [7, 8]. In addition childhood trauma was found to be a contributor to cognitive decline in urban regions [6, 12]

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