Above: Dr Susan Koch, principal research fellow at the RDNS Institute, and chair of the Minister’s Dementia Advisory Group.
By Stephen Easton
Victoria’s largest in-home nursing service is trialling a new system to identify people who show signs of developing cognitive decline earlier, and put in place clinical interventions before a diagnosis of dementia has been made by a doctor.
The trial links research being conducted at the RDNS Institute with the home nursing services provided in Melbourne by both RDNS and Western Health.
The RDNS Institute’s principal research fellow, Dr Susan Koch, said that district nurses who visit the frail and elderly in their own homes could hold the key to identifying people predisposed to dementia.
“RDNS is doubly fortunate having a cutting edge, dedicated research institute on the one hand and teams of nurses at the coalface on the other,” said Dr Koch, who is also an Adjunct Associate Professor with La Trobe University and chair of the Minister’s Dementia Advisory Group.
A key part of the RDNS trial is Fleur Duane, a clinical nurse consultant with expertise in dementia care who provides specialist care for clients with cognitive impairment, from the RDNS site in the Melbourne suburb of Altona.
“This entails identifying symptoms and taking a strategic and clinical approach through the next steps, which includes helping the clients, their carers and their families through the journey – ideally before the first main destination – being formal diagnosis in the doctor’s surgery or in a hospital,” Dr Koch said.
“All this removes the suddenness and the shock of the oh-dear-what-now scenario seen daily in doctors’ surgeries around the country where the patient has not had the advantage of timely explanation and preparation for change.
“Hopefully the trial will move to being accepted practice, thus helping everyone from the client and their carers and families to the GP and the nurses – and society itself,”
Ms Duane said her position, which is funded by the Ian Potter Foundation, involved “bringing evidence-based knowledge into practice” and acting as a bridge between the RDNS Institute, the district nurses and external organisations like Alzheimer’s Australia and the Victorian Dementia Behaviour Management Advisory Service.
“[The trial is] about assisting clients and their families through the diagnostic process, if they are exhibiting signs of cognitive and functional decline, and involves linking them into support services and practical strategies that might help them,” she said.
“Normally you might get a referral but there is no-one to bring it all together, support them through that process and explain what it all means. Most people are aware these resources are out there but they might no know where to find them; clients quite often have no idea.”
Ms Duane added that district nurses get to know their clients as people and as such, were well placed to recognise any personality changes or functional decline.
“You get a true picture of someone when go into their home, and you have that rapport and that relationship,” she said. “We can get to know them as people and I think that is where RDNS is really fortunate.”
“We can guide them through the health care system; it’s like we’re bringing the healthcare system to their door. We can make those referrals on our laptops, right there. We can be that doorway to all the healthcare resources that are out there, which I think is unique.”
