Inverting the 'dementia triangle' as a salutogenic approach to avoiding the "treadmill of disasters" in changed...

People with dementia are likely to experience changes in behavior, and health and aged care services are struggling to effectively respond to these behaviors alongside a growing aging population. This research aimed to explore the experiences and recommendations of clinicians involved in providing care to people with dementia, including people experiencing changed behaviors, across multiple settings including community, acute, transitional and residential care.

This qualitative study used semi-structured interviews with clinicians, analyzed using reflexive thematic analysis. A stratified purposive sample from all relevant care settings was used in a metropolitan region.

Dementia experts (N = 25) from various settings provided information regarding experiences and recommendations to enable access to effective care services for people with dementia and their care partners in acute, community and residential dementia care. The six themes identified were: (1). Workforce, gerontological expertise and team composition to respond to acuity of needs; (2). Creating enabling and dementia-friendly environments; (3). Appropriate prescribing in the context of physical and mental comorbidities, (4). Safety and occupational violence as indicators for risk management; (5). Early intervention and de-escalation maximizing non-pharmacological interventions; and 6. Leadership of innovative and communicative transitional care services. This last theme was key in determining suitable community responsiveness and decreasing stigmatization of people with dementia to enable accessibility to residential care and other services.

Dementia experts from across settings provided information regarding experiences and recommendations to enable access to effective care services for people with dementia and their care partners in acute, community and residential dementia care. Early intervention, de-escalation, and education can enable better community responsiveness, but need health service investment. A visual framework was developed to represent the recommendations, "the Salutogenic Triangle," highlighting a broad base of community support services that focus on wellness, with additional targeted multidisciplinary transitional services, including clinicians with gerontological expertise to improve dementia care for all severity levels. This upstream/downstream public health policy approach is provided to guide policymakers, service providers and clinical leaders to positively and effectively impact changed behavior in people with dementia, the communities they live in, and the health services they deserve.