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Don’t Forget: Care Plans for Dementia
Nureet L. Gross
Edson College of Nursing and Health Innovation, Arizona State University

Author Note
Nureet L. Gross is now at the Edson College of Nursing and Health Innovation, Arizona
State University.
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Nureet L. Gross, Arizona
State University, 411 N Central Ave, Phoenix, AZ 85004. Email: nlgross2@asu.edu

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Abstract

Dementia can be a devastating diagnosis, and is clinically and financially burdensome. It is also
a diagnosis for which care plans are not typically used. High-quality evidence gathered from a
systematic search of the literature reveals that the standard use of care plans is associated with
improved quality of life and increased provider satisfaction for disease processes such as heart
failure and hypertension. Drawing on knowledge from experts in the field, a dementia-centric
care plan template was created for this project, with emphasis on ease of use and reduced
clinician burden, based on Bandura’s Social Learning Theory and built around the framework of
Lewin’s Change Model. Nine geriatrics clinicians in the Southwestern United States were
surveyed for self-satisfaction and self-efficacy, using the Implementation Self-Efficacy for
Evidence-Based Practice (ISE4EBP) scale and a brief satisfaction survey, before and after 12
weeks of the template’s use, with all human subjects protections pertaining. Descriptive and
summary statistics were performed on the data to stratify perceived self-efficacy across
education levels and years of experience. The results were consistent in the paper care plan
template having no significant bearing on self-efficacy, and it was recommended that the
template be implemented into the electronic medical record in future, for effectiveness.
Keywords: dementia, patient care planning, clinician satisfaction, and tool

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Early Detection of Dementia

Dementia is one of the fastest growing medical problems in the United States (U.S.). As
numbers increase, so does the need to increase the number of clinicians who can recognize and
appropriately treat the disease, beginning with its earliest stages – preclinical and prodromal –
for maximum impact (Budson & Solomon, 2022). The preclinical stage is defined by normal
cognitive ability and occurs before any gross memory deficits are detected. The prodromal phase
is characterized by mild cognitive impairment (MCI), which typically involves changes in
functioning and behavior, and episodic memory deficits (Delgado-Álvarez et al., 2023).
Individuals with MCI have an increased risk of progression to dementia, or alternatively their
decline may never worsen (Mayo Clinic, n.d.).
Problem Statement
Alzheimer Disease (AD) is the leading cause of dementia in the world. Currently in
Arizona, 150,000 people aged 65 and older are living with AD and it is estimated that by 2025,
that number could rise to 200,000 (Alzheimer's Association, 2022). More than 11 million people
in the U.S. provide in-home care for loved ones with AD or other dementia (Samuels, 2022).
Whether they provide the care directly by themselves, or with a combination of loved ones plus
external staff, the costs add up quickly. Genworth Financial (n.d.) states that in 2021, the average
hourly wage of an American home health aide was $27.00; however, aides with special dementia
training might charge more. In addition, the financial burden extends to cover home safety
construction modifications, such as walk-in bathtubs and grab bars, as well as the non-monetary
costs of caregiver burnout, emotional strain, and missed workdays. In 2022, dementia caregivers
also provided an estimated 18 billion hours of unpaid care in the U.S. alone, which the
Alzheimer’s Association values at an approximate contribution of $339.5 billion. Family

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caregivers bear 70% of the lifetime cost of dementia care, with an average lifetime cost per ill
individual estimated at $392,874 in U.S. dollars (Alzheimer’s Association, 2022). The National
Institutes of Health reports that the five-year incremental cost to the traditional Medicare
program is approximately $15,700 for each dementia patient (White et al., 2019).
Further contributing to the problem is a lack of gerontology specialists – physicians,
nurse practitioners, and physician assistants who specialize in the elderly population – for the
booming population. By 2034, experts expect the U.S. population to grow by 10.6%, with an
estimated 42% increase in individuals over the age of 65. Per the American Geriatrics Society
(AGS), currently the U.S. has only 7,300 geriatricians, yielding roughly 1.07 geriatricians for
every 10,000 geriatric patients. The AGS estimates that one geriatrician can reasonably care for
about 700 patients (ChenMed, 2022). Related to those figures is the number of geriatricians
specifically in Arizona. Per the Alzheimer's Association (2022), in 2021 there were only 92
geriatric specialists in the entire state of Arizona. The projected need by 2025, to serve merely
30% of those 65 and older, is 1,089 specialists, a startling contrast between the projected patient
numbers and the dearth of specialists.
Dementia screening tools are an obvious way to ameliorate the afore-mentioned
problems, assisting in early detection of dementia and reducing clinician burden. Targeted
screening can guide clinicians to early diagnoses, before persons with dementia (PWD) show
symptoms noticeable to themselves or family members. A more standardized usage of screening
tools can yield greater numbers of early diagnoses, and subsequently earlier development of
comprehensive care plans. Schmachtenberg et al. (2020) emphasize the criticality of documented
dementia care plans involving “communication, language, religious, spiritual, and cultural
needs… decision-making, preferences/expectations related to disease, diagnosis, and treatment”

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(p. 7). To alleviate the breadth of this need, once a diagnosis of dementia has been made, a
templated care plan can further reduce clinician burden for the next steps of treatment.
Purpose and Rationale
The World Alzheimer Report 2019 lists several worrying trends in current dementia
knowledge: nearly 62% of healthcare clinicians worldwide consider dementia to be a normal part
of the aging process, and 25% of the public is concerned that there is nothing that can be done to
prevent dementia. Additionally, a common public perception is that healthcare workers ignore
dementia patients (Alzheimer’s Disease International, 2019). Not only are targeted public health
campaigns evidently necessary, but it is also clear that specialized education about how to
provide person-centered dementia care for patients is crucial. Unfortunately, the significant lack
of trained geriatric specialists in the U.S., and particularly in Arizona, means that many patients
are not diagnosed with dementia until it is too late. To complicate matters, dementia medications
intended to slow the disease process are frequently not prescribed on a timely basis. This can
adversely affect patients who present to acute care facilities, increasing hospital length of stay
and worsening psychological symptoms associated with AD (Peacock et al., 2022; Pinkert et al.,
2018; Prato et al., 2018; Schneider et al., 2021). Greater accuracy in detection of early (less
obvious) dementia will yield better care for all patients. One solution to this problem is the use of
readily available dementia screenings, such as the Folstein Mini-Mental State Exam (MMSE).
Once a patient is diagnosed with dementia, what then? Pharmacological interventions are
available as applicable, and many community resources exist to help both patients and their
families. Of particular importance are home safety screenings and reduction of polypharmacy, as
well as arrangements for supportive care. Research has found that dementia care is best guided
by a palliative approach (Hopkins, 2017), and by federal mandate, all nursing homes must have

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an interdisciplinary care planning process with individualized written care plans to support
individuals with dementia (Sefcik et al., 2020). Research has shown that documented care plans
in the areas of heart failure, diabetes, hypertension, and cancer enhance quality of life (QoL) and
patient outcomes in general, while increasing clinicians’ feelings of self-efficacy, as well as
communication among the members of the treatment team (Casotto et al., 2017; Hey et al., 2021;
Hill, 2019; Hill et al., 2019; Ikolaba et al., 2023; Tezcan & Yilmaz, 2024). Considering the
importance of care plans for patients with other disease processes, it is important that care plans
be examined with relation to dementia. This author theorizes that with a dementia-centric
patient-focused plan of care, the various treatment options can be organized and ready to
decrease clinician burden.
Background/Significance
Population
In the state of Arizona, current regulations state that MDs and DOs must earn 40
Continuing Medical Education (CME) credits per licensure cycle, which is biennial, in order to
renew their medical licenses (AMA, n.d.). Of the hundreds of CME courses offered at this time
through the American Medical Association’s online education hub, 174 are dementia-related. Of
these, only a handful are specifically related to diagnosis of dementia, such as “Ocular
Biomarkers for Alzheimer Disease Dementia” and “Assessment of Racial/Ethnic Disparities in
Timeliness and Comprehensiveness of Dementia Diagnosis in California.” Comparably, the
American Association of Nurse Practitioners offers Continuing Education (CE) courses for
advanced practice nurses, currently only one of which deals directly with dementia,
“Alzheimer’s Disease Updates for Nurse Practitioners.” Physician Assistants face a similar
dilemma. In other words, if clinicians are not trained in school how to detect dementia in its early

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stages, it is unlikely that they will receive such rare training once they graduate, as well, leaving
all but the few geriatric specialists ill prepared when it comes to early diagnosis.
Intervention
Dementia-specific education is necessary to train clinicians in early detection of cognitive
impairment, and specialized education about how to provide person-centered dementia care for
patients is crucial. A plethora of dementia screenings exist to assist with the early diagnosis
problem – MMSE, Mini-Cog™, Montreal Cognitive Assessment (MoCA) – perhaps too many
tools to wade through easily. An extensive review of the literature reveals that many of the
screenings are of roughly equivalent value, with regards to reliability, validity, and ease of use;
this suggests that the choice of screening tool could matter less than the act of screening itself.
Upon screening for and diagnosis of dementia, a targeted dementia-centric patient-focused care
plan will then ease the path for clinicians to engage in next steps of care for the patient.
Current Practice
Currently, there are no established dementia care planning standards to be found. Several
studies speak of developing advance care plans for PWD, but very few address general care
plans specifically for PWD, which is a crucially distinct document. Drummond and Simpson
(2017) discuss the importance of written care plans in coordinating care and increasing
communication among clinicians, stating that such care plans are considered “fundamental in
supporting good quality care” (p. 378). The authors cite the need for electronic medical records
(EMRs) to be streamlined for ease of use and the incorporation of care plans for PWD, with the
conclusion that frontline staff must be included in the process of designing and updating the
EMR (Drummond & Simpson, 2017). Frank and Molnar (2022) additionally cite the critical
importance of involving family and caregivers in dementia care planning, as well as early

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identification of dementia so that appropriate referrals can be utilized as soon as possible.
However, the assertion remains that respecting patient autonomy and involving PWD in the
development of their own care plans can be time-consuming and difficult, due to the layers of
mobility or sensory disabilities secondary to cognitive deficits (Drummond & Simpson, 2017).
Perhaps it is for this reason that there is a scarcity of research investigating general dementia care
plans.
Outcomes
Early dementia detection provides the window for therapeutic medications to be
prescribed and administered, as well as providing patients and their families with the opportunity
to educate and prepare themselves regarding the disease. Medications which slow cognitive
decline can subsequently lead to increased QoL for dementia patients, by improving memory to
where it was 6 to 12 months before the point of testing (Budson & Solomon, 2022). Positive
outcomes of increasing early dementia detection should include greater knowledge for health
care clinicians (Hwang et al., 2019). Such education will decrease costs in both healthcare and
caregiver burden (Budson & Solomon, 2022; Alzheimer’s Disease International, 2019). In
addition, Alzheimer’s Disease International (2019) cites the need for reduced stigma surrounding
dementia, both among healthcare workers and within the public, as well as greater advocacy for
people with dementia. This reduction of stigma can be gained through increased understanding,
and likewise greater advocacy can be inspired through comprehension of the dementia disease
process. Earlier diagnoses of preclinical and prodromal dementia through screening will lead to
greater utilization of existing pharmacological therapies, ensuring that patients receive
appropriate therapy at the appropriate phase of their illness. Improved diagnostic skills will also
yield greater confidence and competence among clinicians. A templated plan of care for newly-

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diagnosed dementia patients is another tool to decrease clinician burden and increase patient
QoL.
Internal Evidence/Setting-Generated Data
In a nonprofit organization based in a southwestern U.S. metropolis, serving primarily
elderly patients and their families, there is concern for improved early recognition of dementia.
In addition to providing hospice care and palliative care, the organization also has recently
opened a dementia education hub. The stated purpose of this hub is to improve QoL for dementia
patients, through compassionate full-spectrum care as well as education and support for family
members and caregivers. The organization has been awarded a federal Administration for
Community Living three-year grant to further develop the education hub program.
Clinicians are concerned that there is insufficient capacity to recognize, diagnose and
manage dementia early, specifically because opportunities for screening are limited by scarce
availability and lack of time to invest in further learning. Part of the education hub’s mission is to
train practicing health care professionals, such as medical, nursing, social work, occupational
therapy, and nursing assistant students, as well as first responders (fire and police), in the early
detection of dementia. The hub offers continuing medical education credits and training for
topics such as “Assessment and Diagnosis of Dementia,” “Understanding the Medications that
Help and Harm in Dementia,” and “Decoding Behaviors in Dementia” (B. Volk-Craft, personal
communication, October 11, 2022). Bradford et al. (2009) note that the true prevalence of missed
and delayed diagnoses of dementia is impossible to calculate under current guidelines, which do
not recommend generalized screening for dementia. However, by abstracting quantitative data
from studies among primary care providers, they estimate a high rate of missed occurrences.

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Although this problem focuses on clinician practice, it is explicitly a problem for patients
who depend on those clinicians, who need diagnoses to be both accurate and timely, as well as
for patients’ families and caregivers. Along with these efforts to provide education and training
to healthcare professionals, there is a need for rapid and reliable dementia screening, so that
patients with potential dementia diagnoses are not overlooked; screening is an often-missed step,
largely due to the time burden on clinicians and perceived difficulty in administration by
unlicensed staff.
To build on these initial educational efforts, it is critical to understand the variety of
interventions and services which clinicians can turn to when treating a patient newly diagnosed
with dementia; however, administrative burden is cited among clinicians as a major cause of
clinician burnout (Dragatsi et al., 2019). It is only a beginning step to have clinicians increase
dementia screenings; by providing a templated plan of care to clinicians, services may be more
readily accessed and burden reduced. Molle and Froman (2017) list four guiding principles of
interdisciplinary care plans, including that they are dynamic and patient-centered, they are
unique to each patient, they reflect progress and outcomes of the patient, and they are
individualized so as to support each patient’s unique education needs. However, Brown et al.
(2022) find that although care plans for PWD are good starting points, they are incomplete, in
that inconsistencies abound between the written plan and the care delivered. Self-efficacy may be
the missing link, as it has been consistently shown to be an indicator of task engagement, task
perseverance, and task success (Molle & Froman, 2017). This knowledge has led to the clinically
relevant PICOT question: In clinicians caring for the elderly, does the provision of a dementiacentric patient-focused plan of care, as opposed to no plan, affect clinicians’ self-efficacy and
satisfaction?

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Search Strategy

An exhaustive search using key terms was performed in several online databases,
including Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and
APA PsycInfo. Search terms for research studies and gray literature included dementia, patient
care planning, clinician satisfaction, self-efficacy, and tool, as well as other more expansive
terms such as questionnaire and survey. Studies were drawn from these results, as well as from
the citations and “cited by” papers in these results (see Appendix E). Articles not originally
written in, or translated to, English were excluded. Articles dated prior to 2018 were also
excluded, so as to utilize only the most current research. A research librarian assisted in the
search. Retained studies included two systematic reviews, four quantitative studies, and four
qualitative studies (see Appendix A).
Critical Appraisal & Synthesis of Evidence
The ten studies included for focus in this project were disparate in terms of subject, tools,
and results (see Appendix B). Three studies focused on the perspectives of PWD, while the other
seven looked at healthcare workers’ experiences treating PWD. Although they all used different
tools, a common finding of the studies was that dementia-centric education and care plans were
worth investing in, as they lead to greater feelings of self-efficacy among the treating
professionals and increased quality of care among the patients.
Discussion
The MMSE has been translated into fifteen different languages and is used internationally
to detect early signs of dementia (Steis & Schrauf, 2009). It is a brief 30-point questionnaire with
orienting questions, memory prompts, and queries assessing spatial understanding, which can be

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administered and scored by an unlicensed professional such as a medical assistant. The higher
the score, the less likely cognitive impairment is present.
Opinions differ on whether the MMSE is the best targeted screening tool for
differentiating between MCI and normal aging, and sufficient evidence has not been gathered to
promote standardized dementia screening. However, the MMSE and the MoCA remain two of
the most reliable tools for many clinicians when attempting to diagnose MCI or prodromal
dementia. As individuals with MCI have an increased risk of progression to full dementia, it is
critical that these patients be detected in the early disease stages, so that interventions such as
memory-enhancing medications can be implemented swiftly. McDonald (1999) terms the care
plan formulation as the fourth stage of care management, not to be forgotten, and Molle and
Froman (2017) find that interdisciplinary care plans lead to improved quality and better patient
outcomes. Additionally, Boehm et al. (2017) find that focusing interventions on alleviating
workload burden facilitates procedural adherence. To that end, this project will use experts’ input
to create a care plan template encompassing pharmacological, psychosocial, and physical
interventions appropriate for early dementia, thereby reducing clinician burden.
Theory Application
Bandura’s Social Learning Theory is appropriate to apply to the dilemma of early
dementia detection (Appendix C). The theory and its multidimensional model emphasize a
learner’s degree of self-regulation over what is learned and how it is perceived, and that role
models have real power (Braungart & Braungart, 2011). If a respected clinician in a practice
consistently uses a targeted dementia screening tool, and thereby increases their rate of dementia
diagnosis and implementation of a dementia-centric plan of care, other clinicians can observe
this and, per Bandura, experience vicarious reinforcement. This is much the way mentoring

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programs are successful: an engaging environment or mentor promotes observational learning,
resulting in intrinsic reinforcement for the engaged self. The engaged self then proactively makes
a behavior change, which is reinforced in turn by the environment or mentor.
Bandura’s self-efficacy theory is also relevant here, as it is a way to assess clinicians’
confidence and self-satisfaction when implementing strategies which foster the application and
sustainability of evidence-based practice (EBP), in other words, an EBP-based dementia-centric
care plan. The Implementation Self-efficacy for EBP (ISE4EBP) Scale demonstrates content
validity, internal consistency reliability (Cronbach's alpha = 0.987), and construct validity
(Tucker et al., 2020), and thus is an appropriate tool to measure clinicians’ perceptions of selfefficacy in using a new dementia care plan template.
Implementation Framework
Lewin’s Change Model (Appendix D) is an appropriate implementation framework for
this project. The model emphasizes the necessity of a change becoming part of an organization’s
culture and consists of three phases: unfreeze, change, and refreeze. Per Lewin, change is a
dynamic force which drives some participants towards the new behavior while others resist the
shift. To implement a new behavior – such as widely screening for early dementia, or utilizing a
dementia-centric care plan – an organization must first unfreeze its current behavior,
destabilizing it and priming for change. A need for change is perceived, for example through the
understanding that dementia diagnosis opportunities are being missed. The new agenda moves
forward as resistance fades and enthusiasm for the change grows. Once the new behavior has
been implemented, there needs to be a refreezing process, anchoring the behavior and
establishing the change as the new norm. For this project, clinicians and management will alike

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play critical roles in the refreezing, validating their own and others’ increased screenings and
care plan usage.
Implications for Practice Change
The literature shows that the MMSE and others like it are effective screening tools for
dementia: accuracy, ease of use and scoring, and timely administration. An aim of this project is
to encourage clinicians to make dementia screening more widely available through use of these
tools. In turn, clinicians will be provided with a dementia-centric patient-focused care plan,
enabling them to comprehensively treat a greater number of patients with less burden.
Stakeholders in this mission include not only the patients themselves, but also their families and
caregivers, as well as clinicians and back-office staff such as medical assistants who can be
trained to consistently administer the tools. The intervention will purportedly lead to greater
numbers of dementia diagnoses, which will then result in collectible data. The timely diagnoses
may improve QoL for patients as well as their loved ones and caregivers, by enabling clinicians
to prescribe medications and implement a dementia-centric plan of care earlier in the disease
process. This plan of care will necessarily include resiliency-oriented patient goals, an emphasis
on shared decision-making, and achievable realistic objectives (Dragatsi et al., 2019). With the
aim of screening more patients, fewer diagnoses will likely be missed, and the next steps will be
simplified for clinicians, with a templated care plan reducing burden and simplifying the
prescription, resources, and referral process. Self-efficacy of clinicians will be evaluated
according to the ISE4EBP scale, and results analyzed and disseminated.
Methods
This project caused no physical, social, legal, economic, or psychological risks to
participants. The project received an expedited review approval on 9/13/23 from the Arizona

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State University IRB. The participating population consisted of physicians and nurse
practitioners employed by the site. Nine clinicians participated. Participants were asked to
slightly inconvenience themselves by sacrificing a small amount of their time for each relevant
patient, and were compensated for this inconvenience with a $5 Starbucks gift card (Operating
Budget, Appendix F). Direct benefits to participants were intended to be in the form of greater
treatment efficiency and reduced clinician burden. The project leader consented all participants
in English, and the informed consent process took place over email. The data collected contained
no private medical information or private identification information. Only the project leader had
access to the data, which was stored in a locked cabinet in the project leader’s home through
June, 2024. Data were shared with project mentor and project grader, in advance of being shared
with site champion and stakeholders through a final presentation. Presented data were kept
entirely confidential. This project involved no sensitive data. This project involved no audio or
video recordings. Electronically-signed consent forms were stored in a separate cabinet in the
project leader’s home, through June, 2024. No de-identification of data was necessary, as there
will be no sensitive data involved. No contact information was collected as there was no followup anticipated. Data were kept confidential. No pre-existing data sets were used. No data covered
under FERPA were used. This study was not sponsored by the Department of Health and Human
Services.
Results
Nine geriatrics clinicians participated in this study, completing a brief satisfaction survey
before implementation, and the same survey plus the ISE4EBP scale post-implementation.
Descriptive statistics were performed on the study population, within which the most frequently
observed category of age was 40 to 50 (n = 4, 44%). The most frequently observed category of

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gender was Female (n = 8, 89%). The most frequently observed category of years of experience
was >5 years (n = 5, 55%), and the most frequently observed category of degree was Master's
(n = 5, 56%), with the rest of the sample having doctorates. The sample size was so small that
results were not statistically significant.
As shown in Figure 1, years of experience (fewer than five or greater than five) were also
stratified across four select stems from the ISE4EBP which the project leader felt best
summarized the arc of self-efficacy, namely the following:
Item 7: Highlight the key evidence including expected outcome of the EBP;
Item 11: Use standardized templates (e.g., standing orders, pre-printed order sets) to
promote implementation of EBP;
Item 19: Pilot the practice change on one unit; and
Item 28: Celebrate and recognize program success in promoting implementation of the
EBP.
Figure 1
Profile Plot of Selected ISE4EBP Question Stems grouped by Years of Experience

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This analysis revealed that the average self-efficacy score across these questions was between 65
and 70% for both groups of years of experience.
Summary statistics were performed on the data to stratify perceived self-efficacy across
education levels and years of experience (see Figure 2).
Figure 2
Level of Perceived Self-

<5 Years of Experience

>5 Years of Experience

Low Self-Efficacy

2 (40%)

2 (50%)

Mid Self-Efficacy

1 (20%)

1 (25%)

High Self-Efficacy

2 (40%)

2 (35%)

Efficacy

The observations for Self-Efficacy had an average of 67% (SD = 24.12, Min = 12.00, Max =
94.00). These results revealed that providers with less than five years of experience sometimes
perceived greater self-efficacy than the providers with more than five years of experience. The
results were consistent in the paper care plan template having no significant bearing on selfefficacy, and it was recommended that the template be implemented into the electronic medical
record in future, for effectiveness. Building an application into the EMR is a multi-step complex
process that takes approximately four to six months (A. Bartholomew, personal communication,
March 28, 2024). As such, it is beyond the scope of this project, but would lend itself well to a
legacy project, to be continued by a future student.

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Conclusions

One of the fastest growing medical problems in the U.S., dementia is financially and
clinically burdensome, in addition to being potentially devastating for patients, their loved ones,
and their caregivers. Some relief exists in the form of memory-enhancing medications, but these
must be prescribed early in the disease process to be most effective. Targeted screening tools for
dementia abound, and the surplus can be overwhelming for clinicians; some choose to skip the
screening step entirely, leading to underdiagnosis. Consistent use of a tool such as the MMSE
will result in a greater number of diagnoses early in the disease progression. Research has shown
that documented care plans for other disease processes such as heart failure (Hey et al., 2021;
Hill, 2019; Hill et al., 2019) improve patient care and increase clinicians’ feelings of selfefficacy, however care plans have not yet been widely examined within a dementia context. This
author theorizes that clinicians’ use of a dementia-centric care plan, embedded into the electronic
medical record, will give dementia patients their best chance of taking advantage of medications,
resources, and referrals in a timely fashion, as well as increase clinicians’ feelings of selfefficacy and satisfaction.

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Appendix A

Citation

Evaluation Table for Quantitative Studies

Blum et al.,
Development
and validation
of a medical
chart review
checklist for
symptom
management
performance of
oncologists in
the routine care
of patients with
advanced
cancer, 2014
Country:
Norway
Funding:
Cancer League
Switzerland, the
Swiss State
Secretariat for

Evaluation Table

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

the number of
visits with a
symptom load
above a defined
threshold of the
five symptoms pain, depression,
shortness of
breath, fatigue,
and anorexia
without
immediate
intervention was compared
using data
derived with the
help of the
SyMPeC

Design: retrospective
analysis; feasibility
study

N= 247

IV1:
SyMPeC

Tools: CAT

Demographics:
patients

DV1: doctors
and nurses

Validity/
Reliability: The
CAT includes 100
elements with a
high inter-rater
reliability (>95%);
This results in a
77.7% agreement
(56/72), which
corresponds to
Fleiss’s kappa of
0.70 for three
raters (SE ¼ 0.07;
95% CI ¼ 0.57,
0.83).

Statistical
Tests Used:
Fleiss’s
kappa

Retrospective
chart review by
SyMPeC seems
reliable to detect
symptom
management
interventions by
oncologists in
outpatient
clinics.
Nonpharmacolog
ical interventions
were less
symptom
specific. A
template for
documentation is
needed for
standardization.

Method:
Retrospective chart
review compared
with direct
questioning of
patients.
Purpose: The aim of
this study was to
develop and test a
symptom
management
performance
checklist (SyMPeC)
to review medical
charts.

Setting: hospital
Exclusion: unclear
Attrition: unclear

When
compared
with
SyMPeC,
there was a
match in
1003 visits
(86%) and a
mismatch in
164 visits
(14%)
recorded. If
analyzed per
case (six
visits), 195
of 247 cases
(79%) had
one

Level of Evidence;
Application to
practice/
Generalization
Level of Evidence:
2
Strengths:
Potential bias
minimal
Weakness: requires
basic training and
standardization for
documentation and
the prospective use
of such checklists
Feasibility: not
feasible without
specific tool
(SyMPeC)
Application:
broadly applicable
without a specific
tool

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

29
Sample/Setting

Variables

Measurement/
Instrumentation

Education,
Research and
Innovation
(SERI), the
Swiss Group for
Clinical Cancer
Research
(SAKK), EURO
IMPACT-Marie
Curie PhD
training grant
Sanofi-Aventis
and Amgen.

Data
Analysis

Results/
Findings

Level of Evidence;
Application to
practice/
Generalization

IV1: mean score
of 46.96
DV1: mean of
43.06

Level of Evidence:

DV2: mean of
57.31

Variety of employee
units increases
generalizability

mismatch or
less

Bias: None
SchindelMartin et al.,
2016, An
education
intervention to
enhance staff
self-efficacy to
provide
dementia care in
an acute care
hospital in

Bandura’s
Theory of SelfEfficacy

Design:
Nonrandomized
controlled study;
Participants
completed selfefficacy for dementia
and satisfaction
measures and
provided written
descriptions of

N= 745
Demographics:
acute hospital
clinical personnel;
90.5% female for
the intervention
group and and
92.4% female for
the control group;

IV1: waitlisted group
DV1:
baseline,
before
intervention
DV2:
immediately

Tools: 10-item, 7point Likert-type
scale, SBMSEP
Validity/
Reliability:
Cronbach α .93

Statistical
Tests Used:
1-way and 2way repeated
measures
ANOVA;
iterative
Markov
chain Monte
Carlo

DV3: mean of
54.68

Level 4
Strengths:

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Canada: A
nonrandomized
controlled study
Country:
Canada
Funding:
Centre for
Healthcare
Optimization
Research and
Delivery
(CHORD)
award

30

Design/ Method/
Purpose

Sample/Setting

Variables

dementia care
collected at baseline,
postintervention (IG
only), and at 8-week
follow-up.

majority RNs or
LPNs

after
intervention

Setting: hospital
units

Method:
nonrandomized
controlled, repeatedmeasures research
design

DV3: 8
weeks postintervention

Exclusion:
Attrition:

Definitions:

N= 41

IV: control
nurses’ unit

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

procedure;
multiple
linear
regression;
independent
samples t test

Level of Evidence;
Application to
practice/
Generalization
Weakness:
Canadian study
Feasibility: very
Application:

Purpose: To increase
staff’s feelings of
self-efficacy through
a dementia care
education program

Bias: None

Sampling:
nonrandomized
Mackenzie &
Peragine, 2003,
Measuring and
enhancing selfefficacy among
professional
caregivers of

Bandura’s selfefficacy theory

Design:
Method: quasiexperimental design
with nursing
caregivers from a
long-term care

Cronbach’s alpha
was .96 and the
average item-total
correlation was
.83.

ANCOVA,
repeatedmeasures
ANOVA

Pretraining:
48.4
• Posttraining:
53.0
3 mo. Follow-up:
53.6
•

LOE: 4

Strengths:
Demographics:
evaluates
DV: nurses’
mean age 46.7
employees’
unit
receiving
years; majority
intervention
female; majority
health care aides;
Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

31

Design/ Method/
Purpose

Sample/Setting

Variables

individuals with
dementia

facility for 472
residents

majority working
day shift

Country: USA

Purpose: to describe
the development and
outcome of an
intervention for longterm care nurses
designed to decrease
stress and burnout by
enhancing their selfefficacy in managing
challenging team,
resident, and family
situations

Exclusions:
sickness; refusal to
participate

Baseline
(before
intervention),
immediately
after
intervention,
3 mos. postintervention

Design: cohort study

N=121

Method: researchers
evaluated feasibility,
usability,
acceptability, and
satisfaction of CPs
from patient and
clinician
perspectives;
additionally,
interviews described

Demographics: 51
gynecologic cancer
patients, 70 breast
cancer patients;
100% female; 86%
Caucasian; mean
age 56.3 years

Funding:
Morris Slivka
Fellowship
Bias: none

Brant et al.,
2019, Patient
and clinician
use of electronic
care plans
generated from
patient-reported
outcomes
Country: USA
Funding:
Carevive

Feasibility study

Setting: Cancer
clinics

feasibility,
usability,
acceptability,
and
satisfaction
of CPs;
patient
perceptions
of the CPs

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Level of Evidence;
Application to
practice/
Generalization
depersonalization
and burnout
Weaknesses: did
not use validated
tool
Application: broad
Generalizability:
small nursing units

Likert-type scale

(Rated on a scale
from 1 (not at all
useful) to 5 (very
useful)
“How useful
overall are the
care plans you
are given at your
visit(s)?” Mean
answer of 4
“I would
recommend that
other patients

Level of Evidence:
4
Application:
excellent, care plans
can be incorporated
broadly
Feasibility: the
specific program
used (Carevive) less
feasible as it’s not

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Systems, Inc.,
Moffitt Cancer
Center
Bias: None
noted

Design/ Method/
Purpose
patient perceptions of
the CPs.
Purpose: To
determine if patients
and clinicians
perceived improved
care processes
through the delivery
of personalized,
electronic CPs

32
Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings
with cancer
receive similar
care plans.”
Mean answer of
5

Inclusions: 18
years or older,
decision-making
capacity, Englishspeaking and reading, computerliterate

Level of Evidence;
Application to
practice/
Generalization
available
everywhere

Evaluation Table for Qualitative Studies
Kuusisto et al.,
2023,
Accessibility of
care plan
information
from previous
treatment
setting in
palliative care
unit: A
qualitative
study

Design: qualitative
descriptive study
Method: nurses,
social workers and
physicians were
interviewed and data
were analyzed by
deductive and
inductive content
analysis. The FITT
was used as a

Sample: n=33
Demographics:
nurses, social
workers and
physicians; mean
age 46 years; mean
6 years’ experience
in palliative care
Setting: palliative
care
Attrition: none

What is the
individualtechnology
fit?
What is the
individualtask fit?
What is the
tasktechnology
fit?

Medical,
nursing, and
social work staff
were promised a
plan with
palliative care
needs in HIS,
and they were
trying to get the
things they
needed into it.
Health
informatics skills
were seen as a
prerequisite for

Level: 5, cohort
study
Strengths: nonAmerican study;
multidisciplinary,
and especially,
nursing-oriented
focus
Application: The
HIS should be
reviewed as a whole
from a holistic and

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Country:
Finland

deductive analysis
framework.

Funding: State
Research
Funding
(Satakunta
Hospital
District); State
Research
Funding (the
expert
responsibility
area (ERVA) of
Tyks (Turku
University
Hospital)

Purpose: To describe
accessibility of care
plan information
from patients'
previous treatment
setting in palliative
care.

Bias: none
disclosed
Zhao et al.,
2021, Dementia
care education
interventions on
healthcare
clinicians'
outcomes in the
nursing home

Integrated model
of person‐
environment fit
and social
learning theory

33
Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings
care plan
information
access.
Structural factors
as a condition for
accessing care
plan information
included issues
related to privacy
and legislation.

Design: Systematic
review

Sample: 3269
articles

Method: cluster RCT

Demographics:

Purpose: to appraise
the evidence of the
effects of dementia

Exclusions: nonRCT; did not

What are the
effects of
dementia care
educational
programs on
improving
the
preparedness

13 criteria,
including
randomization,
allocation
concealment,
baseline balance,
blinding of
participants,

Metaanalysis; JBI
Critical
Appraisal
Checklist for
RCT

Nursing home
staff knowledge
and cultural
beliefs about
dementia affect
the quality of
dementia care

Level of Evidence;
Application to
practice/
Generalization
patient-oriented
perspective to
enable accessibility
of care plan
information.

Generalization:
wide

Level of Evidence:
1
Strengths:
international study
(8 countries)

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

setting: A
systematic
review
Country:
China/USA
Funding:
unclear

34

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

care educational
programs on
improving the
preparedness of
nursing home staff

examine staff
outcomes

of nursing
home staff?

intervention
clinicians, outcome
assessors,
treatment for
groups other than
the intervention,
completion of
follow‐up data,
analyzed according
to group
assignment,
outcome
measurement
(ways and
instruments),
statistical analysis
used, and the trial
design

Attrition: 12.3%
to 52.6%.

Data
Analysis

Results/
Findings
Competency‐
based
educational
programs in
dementia care
have shown
positive effects
on staff
outcomes, such
as understanding
dementia and
ability in
applying person‐
centered care,
improved
knowledge,
attitudes, and
self‐efficacy
related to
dementia and
dementia‐related
behaviors, and
strategies in
prevention and
management of
challenging
behaviors

Level of Evidence;
Application to
practice/
Generalization
Weaknesses: few
articles analyzed

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA

35

Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Chan et al.,
2016, End-oflife care
pathways for
improving
outcomes in
caring for the
dying.

Uses the
Liverpool Care
Pathway for
active dying in
palliative care

Design: Systematic
review

N= 1024

physical
symptom
severity,
psychological
symptom
severity,
quality of
life, and any
adverse
effects

Physical symptom
severity;
Psychological
symptom severity;
Quality of life;
Harms

Sensitivity
analysis;
investigation
of
heterogeneity

Very low-quality
evidence of no
difference was
found for pain
(OR 1.3, 95% CI
0.7 to 2.6, P =
0.461) and
nausea and
vomiting (OR
1.5, 95% CI 0.7
to 3.2, P =
0.252).

Country:
Australia
Funding: The
National
Institute for
Health Research
(NIHR)
Bias: none
disclosed
Toteh Osakwe,
et al., 2022,
Home health
aide perceived
information
needs for
dementiaspecific care
plans

Donabedian’s
conceptual
framework of
health care
quality

Purpose: To assess
the effects of end-oflife care pathways,
compared with usual
care (no pathway) or
with care guided by
another end-of-life
care pathway across
all healthcare settings
(e.g. hospitals,
residential aged care
facilities,
community).

Design: qualitative,
descriptive study
using in-depth, semistructured interviews
Purpose: to
determine the
information needs of
HHAs providing care

patients, carers and
families who
received care
guided by end-oflife care pathways
Attrition: 100%

Sample: n = 30
Attrition: 6%
Setting: home
healthcare settings

4 major
themes: (1)
ambiguities
related to
medication
management,
(2) clinical
information
needs, (3)

There are
important
information
needs of HHAs
essential to
deliver highquality care to
homebound
PLWD and

Level of Evidence;
Application to
practice/
Generalization
LOE: 1

LOE: 3
Highly applicable,
limited
generalization:
participants
recruited from the
NY metropolitan
area; recruitment

96% female; mean
age 49.8 years;
Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Country: USA
Funding: none

Design/ Method/
Purpose

Sample/Setting

Variables

for PLWD in the
home healthcare
setting

44% black, 56%
Hispanic; 36% of
participants had a
high school degree
or more; 8.6 mean
years of experience
working as HHAs.

dementiarelated
concerns, and
(4) going
above and
beyond

Design: Quasiexperimental;
Palliative Care for

N= 257

Bias: none

Bookbinder et
al., 2005,
Improving end-

Rogers’ fivestage diffusion
of innovations
theory

36

Definitions:

Measurement/
Instrumentation

Data
Analysis

Results/
Findings
support the HHA
workforce;
future research
should assess the
most effective
strategy to meet
ongoing training
needs for
Spanishspeaking HHAs
with limited
English
proficiency.
Results also
provide insight
to dementiaspecific
information
HHAs seek on
care plans and
can inform the
development of
strategies to
address them.

Tools: CAT, PAT,
PCQN

Statistical
Tests Used:

During the
PCAD
intervention,
dying patients

Level of Evidence;
Application to
practice/
Generalization
relied on agency
leadership reaching
out to their teams;
qualitative studies
conducted via
telephone
interviews raise
concerns about
inability to
appreciate nonverbal
communication;
furthermore,
although
participants were
assured of
confidentiality and
their responses
appeared candid,
unable to rule out
the possibility of
socially desirable
responses.
Level of Evidence:
RCT, level 2

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

of-life care:
Development
and pilot-test of
a clinical
pathway.
Country: USA
Funding: New
York State
Department of
Health Quality
Measurement
Grant
Bias: None

37

Design/ Method/
Purpose

Sample/Setting

Advanced Disease
pathway

Demographics:
83% female
nurses; mean age
44 years; 47% with
>10 years nursing
experience; 52%
BSN.

Purpose: to address
deficiencies in the
care provided to
patients dying from
advanced medical
illnesses in acute care
hospitals

Setting: hospital
units; to shape the
responses of staff
such that treatment
respected patients’
values and
decisions, reduced
unnecessary
interventions,
increased symptom
assessment and
treatment,
enhanced support
for families, and
facilitated
appropriate
referrals

Variables

Measurement/
Instrumentation

Validity/
Reliability:
CAT: Inter-rater
reliability among
four nurse and
physician coders
yielded greater
than 95%
consistency
PAT: An index
(total percent
adherence with 34
items) was
constructed to
assess adherence to
the PCAD pathway
PCQN: extensive
validity and
reliability testing

Data
Analysis

Results/
Findings

F test; pvalue

who resided on
Geriatrics,
Oncology and
palliative
care/hospice
units were more
likely to have
DNR orders than
the comparison
units, whereas
the comparison
units were more
likely to use
“morphine
infusions” and
cardiopulmonary
resuscitation
than the units
that received the
PCAD
intervention.

Greater than
5% increases
for 15 of 20
items.

Level of Evidence;
Application to
practice/
Generalization
Strengths:
Potential bias
minimal
Weakness: depends
upon tool

Feasibility:
Generally feasible
with use of tool
Application: broad

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA
Citation

Theoretical/
Conceptual
Framework

Design/ Method/
Purpose

38
Sample/Setting

Variables

Measurement/
Instrumentation

Data
Analysis

Results/
Findings

Level of Evidence;
Application to
practice/
Generalization

Carevive

Staff
perceptions

69% increase in
the
documentation
of barriers to
patient
progression/utiliz
ation of the
problem list,
10% increase in
documentation
of patient
medication
teaching, and
31% increase in
documentation
by ancillary staff
using
the computerized
pathway

LOE: 4

Exclusion:
patients who
“rallied” and were
discharged
Attrition: 7%
Hyde &
Murphy, 2012,
Computerized
clinical
pathways (care
plans): Piloting
a strategy to
enhance quality
patient care
Country: USA
Funding: none
Bias: none
noted

Feasibility study

Purpose: To conduct
a pilot study on 1
medical department
using computerized
pathway and
determine the
pathway’s sufficiency
for broader
implementation

N= 69
Nurses and clinical
ancillary staff

Limitations:
requires time and
effort investment of
clinical and
ancillary staff

Generalizability:
excellent

Key: ACP Advance care planning; CAT chart abstraction tool; CIS clinical information systems department; CNS clinical nurse specialist; CP Care plan; DPMPC
Departments of Pain Medicine and Palliative Care; EOL end-of-life; FITT fit between individuals, task and technology framework; GPA Gentle Persuasive
Approaches program; HHA home health aide; HIS health information system; MBI Maslach Burnout Inventory; PAT process audit tool; PCAD Palliative Care for
Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural Management Self-Efficacy
Profile; SyMPeC symptom management performance checklist

EARLY DETECTION OF DEMENTIA

39
Appendix B
Synthesis Table

Study

Blum et al.

Bookbinder
et al.

Brant et al.

Chan et al.

Hyde &
Murphy

Kuusisto et
al.

Mackenzie &
Peragine

Year
Level of
Evidence
Mean Age
Participants
N
Type of
study

2014
2

2005
2

2019
4

2016
1

2012
4

2023
5

2003
4

SchindelMartin et
al.
2016
4

44
HW
257

56.3
PWD
121

HW
1024

46
HW
33

46.7
HW
41

HW
745

PWD
247
Feasibility
Systematic
review
Self-efficacy
Quality
Acute care
Long-term care
Home health
Palliative care

Setting

X

-

X

HW
69

Toteh
Osakwe, et al.

Zhao et al.

2022
3

2021
1

-

HW
30

X
X

X
X

X

X
X

X

X
X

HW
3269

X

X

X

X
X

X
X

Outcomes

Needs
standardization

Increased
adherence

Recommendation
of care plans

Little to no
differences
found

Increased
quality
documentation

X
Informatics
skills
needed

Evaluates
depersonalization
and burnout

Tools

SyMPeC; CAT

PCAD, CAT,
PCQN, PAT

Likert-type scale

EOL care
pathway

Carevive

FITT

None validated

Increased
feelings
of selfefficacy
SBMSEP

Improvements
needed in
support for
HHAs
Interviews

Key: CAT chart abstraction tool; EOL end-of-life; FITT fit between individuals, task and technology framework; HW Healthcare workers; PAT process audit tool;
PCAD Palliative Care for Advanced Disease; PCQN Palliative Care Knowledge Quiz for Nurses; PWD persons with dementia; SBMSEP Self-Perceived Behavioural
Management Self-Efficacy Profile; SyMPeC symptom management performance checklist

Dementiacentric
interventions
needed
Interviews

EARLY DETECTION OF DEMENTIA

40
Appendix C
Bandura’s Social Learning Theory

(Virtanen, 2011)

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41
Appendix D
Lewin’s Change Model

(9m Consulting, 2018)

EARLY DETECTION OF DEMENTIA

42
Appendix E
CINAHL

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43
PubMed

EARLY DETECTION OF DEMENTIA

44
APA PsycInfo

EARLY DETECTION OF DEMENTIA

45
Appendix F
Operating Budget

Type

Activities

Cost

Subtotal

Total

Direct costs

Copying of care
plan

3 cents per 150
copies

$4.50

$4.50

Informed consent
forms

3 cents per 14
copies

$0.42

$4.92

Starbucks gift
cards for clinician
compensation

$5 per 14 cards

$70.00

$74.92

Presentation
materials

$1.50 per foam
core board

$1.50

$76.42

Direct costs, subtotal:
Indirect costs

$76.42

One hour of
Geriatric
Solutions’ staff
time

$112 per 14
clinicians

$1568

$1588.02

10 hours of site
champion’s staff
time

$80 per 10 hours

$800

$2388.02

20 hours of
project mentor’s

$67 per 20 hours

$1340

$3728.02

EARLY DETECTION OF DEMENTIA

46
and project
grader’s time
Unlimited hours
of student’s time

(unpaid)

Indirect costs, subtotal:
Potential
funding sources

0

$3728.02

$70.00

$70.00

0

$0

$3728.02

Student’s private
funding

Copying, gift
cards, and
uncompensated
student time

Potential funding sources,
subtotal:

$70.00

Cost versus
revenue/savings
Cost versus revenue/savings
Total outlay=

$0
$3798.02

Budget justification: Hourly wages are approximated from Glassdoor.com. Currently, site revenue is being lost due to
missed dementia screenings and thus missed opportunities for further dementia-specific care. Patients often have to go
through multiple visits before diagnosis, utilizing more staff time and costs, and leading to the need for more intensive
treatment when finally diagnosed. Implementing this project will encourage clinicians to screen more frequently, and then
utilize the templated care plan which will save time for the clinicians and patients, as well as generate revenue for the site.