Changing the focus: Facilitating engagement in physical activity for people with dementia in a local community - A feasibility study

Participation by: The number of people with dementia continuing with the program at 12 months (using >70% continuing with their selected program(s) at 12 months as a benchmark for success ;; Intervention acceptability for: People with mild dementia and their carer, assessed through a question at 6 and 12 month assessments (i.e. Is the “Changing the Focus” program acceptable (i.e. suitable for you and adequate to meet your needs-“Yes”, “No”, “Unsure” using a target criterion of >75% as a benchmark of acceptability from assessment question) ;; The total time of physical activity participation undertaken each week (frequency and duration of the selected physical activity opportunities recorded in a physical activity diary on a daily basis by the person with mild dementia or their carer).

"Changing the Focus" program addresses two significant health problems of older Australians: (a) Dementia. The incidence and prevalence of dementia in Australia is projected to grow from 459,000 in 2020, to 1,076,000 by 2058. While the major direct impacts of dementia are cognitive impairment and progressive cognitive decline, onset and progression of dementia are also associated with other health problems that have significant negative personal and carer impact, and add resource and economic cost to health and care systems. Impacts to the individual include reduced independence, physical function, balance, mobility, and community participation, poor mental health, and increased falls. (b) Low levels of physical activity. Older people generally have low physical activity levels, with only 25% of Australians aged >65 years meeting physical activity guidelines. People with dementia have even lower activity levels. Further, physical activity reduction post dementia diagnosis is associated with accelerated cognitive decline. For older people, higher physical activity levels reduce the risk of chronic disease and falls, and improve balance, mobility, function, psychological health, wellbeing and quality of life. Systematic review evidence supports that various forms of physical activity can be implemented safely, and achieve similar outcomes for people with dementia and improve or delay decline in cognition and structural brain changes. Other benefits include improved activities of daily living and reduced social isolation. No systematic approach exists for identifying physical activity needs, or promoting physical activity in people with dementia, despite growing evidence of physical activity benefits along the dementia pathway. This research addresses this major unmet need for an early, systematic approach to identify physical activity needs for people with mild dementia, and embed referral pathways/training opportunities for exercise leaders to support improved physical activity options. Effective management of physical inactivity is required to improve outcomes for the person with dementia and their carer before later stages of dementia, when problems become greater and less amenable to intervention.