Impact of memory clinics on carers of people living with dementia: An integrative review

Abstract

People living with dementia and their carers require ongoing support in the community. Memory clinics can provide a range of supports including education, respite and symptom management. While these clinics improve consumer outcomes, their impact on the carers of people living with dementia is unclear. This review sought to identify and critically synthesise the literature on the effectiveness of memory clinics in supporting carers. An integrative review process was used to identify papers from CINAHL and Medline databases. Of the eight included papers, two were qualitative and six were quantitative studies. Three themes were identified, namely; psychological heath, carer burden and satisfaction with memory clinics. Four studies found decreases in caregiver burden, distress, and psychological symptoms such as anxiety and worry. Satisfaction with the clinic model was discussed as a source of support by carers, highlighting the memory clinics. The variable outcomes seen in this review require further research to elucidate the impacts of memory clinics on carers along the dementia trajectory.

Introduction

Approximately 50 million people worldwide were living with dementia in 2017, and this number is projected to triple by 2050 (World Health Organisation, 2021). In Australia, given that two in three people living with dementia are being cared for in the community (Australian Institute of Health and Welfare, 2023), some 219,000 people and their carers require support in navigating living with dementia (Australian Bureau of Statistics, 2020).

Carers are individuals who provide unpaid care services to a friend or family member who is unable to care for themselves due to their health circumstances (Carers Trust, 2021). Carers for people living with dementia are crucial as they provide essential support to address the complex health needs associated with living with dementia (Lee et al., 2018). Carers help maintain dignity and independence by assisting with daily activities and ensuring safety and well-being (Hochgraeber et al., 2023). They also play a key role in managing challenging behaviours and the emotional distress that is often associated with dementia (Jackson & Browne, 2017). Carers find themselves taking charge of their household, are faced regularly with new challenges as the persons’ health needs change and often need to develop new knowledge and skills about how to better support the person living with dementia (Abendstern et al., 2019).

Embracing the role of caring for a person with dementia is often an unexpected challenge and requires a period of transition (Hooper & Collins, 2019). The demanding nature of being a carer can generate a significant burden and impact psychological well-being as dementia progresses and the person loses functional capacity (Large & Slinger, 2015). Yet, the role of the carer is essential if the person with dementia is to remain living within the community. Living in the community provides a sense of independence for people living with dementia as they retain a feeling of normalcy (Cornelis et al., 2018). Continuing care in the community holds significance for families of people living with dementia as it maintains relationships and family structures. Caring in the community also provides the opportunity to continue to engage in recreational and social activities as well as maintaining family routines (World Health Organisation, 2021). Additionally, keeping people with dementia living in the community for as long as possible reduces the burden on the health care and residential aged care system (Waymouth et al., 2023).

Out-patient memory clinics have been established to facilitate the care of people with dementia in the community and provide resources and support for carers (Cornelis et al., 2018; Lertkratoke et al., 2021). Staffing for memory clinics can be multidisciplinary or can be led by specialist Nurse Practitioners who provide referrals to further services (Phillipson et al., 2021). The various models of memory clinics can provide comprehensive outpatient care for people living with dementia and their carers, empowering care to continue in the community (Kovaleva et al., 2021). Despite the growing popularity of this model and the importance of supporting carers in the community, there have been few attempts to synthesise the literature regarding memory clinics and their impacts on carers. Therefore, this integrative review aims to identify and critically synthesise the literature examining memory clinics’ impact on carers of people living with dementia.

Methods

Given the heterogeneous nature of memory clinic interventions reported in the literature, an integrative review was completed using the five-step approach advocated by Whittemore and Knafl (2005).

Search strategy

A search strategy was developed using keywords selected following several preliminary searches and Boolean operators (Table 1). In February 2023, CINAHL and Medline were searched for English-language, peer-reviewed papers that reported original research evaluating the impact of memory clinics on carers of people living with dementia. Papers were included if the research included both people living with dementia and carers if the data from carers could be separated. Papers were excluded if they focused on interventions for only one population group, did not include an intervention, or focused only on people living with dementia rather than carers. To ensure that papers reflected the current situation, only papers published since 2012 were included.

Table 1.

Search strategy.

memory clinic OR dementia clinic OR primary care-based memory clinic OR specialist dementia clinic

AND

carers OR carers OR family carers OR support people

AND

dementia OR Alzheimer’s OR people with dementia OR memory loss OR cognitive impairment

Study selection and data extraction

Ninety-four papers were identified from the database search. After removing duplicates, 91 papers were imported into Covidence (Veritas Health Innovation, n.d) for screening. Further review of abstracts revealed that 69 papers were not relevant. This left 22 papers, which were retrieved for full-text review by two authors (AB and AM). Disagreements were resolved by a third reviewer (EH). As 14 papers were excluded, eight papers remained and were included in the review. The selection process is displayed using the Preferred Reporting Items for Systematic Reviews (PRISMA) (Moher et al., 2009) (Figure 1).

Figure 1.

PRISMA flow-chart.

Data extraction and quality assessment

Data such as the aim, sample, interventions, methods, and key findings of each paper were extracted into a summary table (Table 2). The quality of studies was then assessed using the Mixed Methods Appraisal Tool (Hong et al., 2018) for the mixed method studies and Joanne Briggs Institute (n.d) critical appraisal tools for qualitative, quasi-experimental and cohort studies. Each paper was assessed independently by two reviewers (AB and AM) and disagreements were resolved by a third reviewer (EH). Given that there is no clear cut-off for exclusion based on quality criteria, the small number of included studies and the overall good quality of the studies, no papers were excluded based on quality assessment.

Table 2.

Summary table.

Author/Country	Participants	Intervention	Design/Methods	Key findings
Clevenger et al. (2018) USA	96 carers Mean age PLWD 78.6 years Carers: 63.3% female; 35.3% spouse; 49.6% adult child a	IMCC led by advanced practice nurses (APRN) with support from a social worker and geriatricianAPRNs conducted screening and assessments, vaccine administration, medication reconciliation, and phone support to manage issues and symptoms and carer support. Also involves: (i) Individualised care plans (ii) Behavioural symptom management (iii) Adult day programs, assistance with meals and transportation	Baseline and six monthly assessment of mood, neuropsychiatric symptoms and function for the person with dementia, and carer confidence. Annual cognitive assessment of PLWD − PLWD and carers completed experience surveys − Neuropsychiatric Inventory Questionnaire (NPI-Q) [Carer distress] − Pearlin’s Carer Competence Scale: Carer Competence and Management of Situation	• 28.1% carers participated in support group/class • Non-significant improvement in neuropsychiatric symptom severity (p = 0.07) and carer distress (mean change 0.6 ± 10.5; p = 0.69) related to these symptoms • Non-significant improvement in carer competence (mean change -1.1 ± 3.6; p = 0.18)
Clevenger et al. (2018) UK	30 PLWD. Mean age 75.9 years 30 carers: 80% spouses and 20% adult children 22 pairs completed program	A multicomponent rehabilitation program delivered by a multidisciplinary team (geriatrician, neurologist, occupational therapist, nurse, and psychologist) lasting up to one year, consisting of: (i) assessment and goal setting (ii) rehabilitation (iii) evaluation phase (iv) 25 counselling sessions (60 mins) (v) two mandatory home visits	Retrospective, pre-test–post-test study Assessment conducted at baseline and 12 months after the last session. Assessment included measurement of activities of daily living (ADLs), cognition, depression, psychopathology, QoL, and carer burden − Zarit Burden Interview (ZARIT-BI) − NPI-Q	• Cognitive performance of PLWD significantly declined (p = 0.046) • Significant improvement in QoL (p = 0.006) & ADLs for PLWD (p = 0.001) • No significant reduction in carers emotional distress (p = 0.984). However, 45.5% had reduced NPI-Q compared to baseline • No significant difference in carer burden (p = 0.116). However, 59.1% were better on the ZARIT-BI compared to baseline
Kovaleva et al. (2021) USA	42 PLWD. Mean age 77.2 years 42 carers. Mean age 63.8 years. 71% women; 53.1% spouses	IMCC led by APRNs with support from a social worker and geriatrician APRNs conduct screening and assessments, vaccine administration, medication reconciliation, and phone support to manage the person with dementia healthcare issues and symptoms and engage with carers	Longitudinal cohort study Carer surveys: baseline, three and six months − Perceived Stress Scale − ZBI Short Form − Center for Epidemiologic Studies Depression − Patient-Reported Outcomes Measurement Information System - Anxiety Short Form − Short Form Health Survey (SF-36) − Neuropsychiatric Inventory (NPI)/ NPI-Q	• Participants had average of 3.2 visits • Carers had mild anxiety and approached the depression cutoff at baseline • PLWD had decreased severity of delusions (p = 0.028), depression/ dysphoria severity (p < 0.001) and total symptom severity (p = 0.007) • Significant decrease in carer distress related to delusions (p = 0.043) and anxiety of the person with dementia (p = 0.017) • No significant changes in any other outcomes
Lee et al. (2018) Canada	12 PLWD. Mean age 75.1 years 16 carers; 75.0% female, 62.5% spouses	Primary Care Collaborative Memory Clinic (PCCMC) consists of a multidisciplinary team (doctors, nurses and other allied health professionals, including social workers, pharmacists, occupational therapists and representatives from the local Alzheimer Society) and provides: (i) Assessment of cognition, function, depression and carer burden to develop individualised plans of care (ii) New assessment sessions - 120 minutes, and 75 minutes for follow-ups	Qualitative semi-structured interviews	• Positive feelings of support and satisfaction of clinic were reported by both carers and people living with dementia • Carer and people with dementia participants did not like repeated testing, questions asked, language used but understood the needs for the testing • Gaps identified by carers in the healthcare system for older adults included communication, difficulties finding at-home services and respite care, highlighted by carers
Liu et al. (2021) USA	124 PLWD. Age 65-102 years 132 carers; 72.7% female	Single hospital-based memory clinic providing diagnostic and treatment support for dementia. Delivered by a multidisciplinary team (geriatrician, nurse, nurse practitioner, and social worker) (i) Counselling following diagnosis (ii) Navigation of the aged care system (iii) Comprehensive geriatric assessment, functional assessment, medication reconciliation, formulation of goals of care, social support, mental wellbeing assessment and education	Mixed methods design consisting of: • Retrospective cohort study of health care utilisation • Prospective surveys of carer burden and PLWD QoL at baseline and 12-month • Qualitative interviews with carers Carer Burden Inventory (CBI)	• CBI score at baseline was 29.4±16.9 • After adjusting for severity and career demographics there was no significant difference in carer burden at six (p = 0.101) or 12 months (p = 0.362) • Carers were often overwhelmed by a dementia diagnosis • Carers were largely positive about the clinic and the support provided • The navigator component of the clinic was highly valued
Meeuwsen et al. (2012) Netherlands	175 PLWD. Mean age 78.1 years Carers: Mean age 63.5 years; 54% spouses & 41% adult children From 9 memory clinics and 159 general practitioners.	Memory Clinic (intervention group): followed the specialist dementia guideline of the Dutch Institute for Healthcare Improvement: (i) prescribing and guidance of anti-dementia drugs (cholinesterase inhibitors and memantine) (ii) non-drug interventions; occupational therapy, providing day structure, or nurse specialist referrals, day care, or home care Usual Care (control group): General practitioner (GP) who provided treatment and care, following the Dutch general practice and homecare dementia guidelines.	Randomised control trial Measures: Baseline, six and 12 months Primary outcomes: QoL of PLWD as rated by carer and carer burden Secondary outcomes: depression, neuropsychiatric symptoms, ADLs for PLWD. Secondary measures related to the carer were: depression, anxiety, personality, mastery, distress related to neuropsychiatric symptoms, and social support − Sense of competence questionnaire − QoL-AD carer − Pearlin mastery scale − NPI/NPI-Q − Inventory for measuring social involvement − State-trait anxiety inventory − Centre for Epidemiologic Studies depression scale − Eysenck personality questionnaire (neuroticism)	• Carer burden was 2.4 points lower in the memory clinic group than the GP group at 12 months • While anxiety and depression scores were higher in the memory clinic group compared to the GP group, both were well below the cut-off scores for anxiety and depression after 12 months • At six months there was a significant difference between groups in terms of social support in favour of the GP group, but this did not remain significant at 12 months • There was a significant difference between groups in terms of state anxiety at 6 (p = 0.002) and 12 (p = 0.02) months in favour of the GP group • There was a significant difference between groups at 12 months in levels of neuroticism (p = 0.05) and trait anxiety (p = 0.03) in favour of the GP group
Ngoc Huong Lien et al. (2020) Singapore	344 PLWD with behaviours deemed challenging by carers. Mean age 78 years; 66% female Carers: Mean age 51.2 years; 82.8% adult children	The interdisciplinary clinic model provides: (i) case management, (ii) carer education and support, and (iii) home-based services such as counselling and elder-companionship	Quasi-experiment cross-sectional within-subject design Assessments: baseline, four to six months Assessment included measurement of QoL, behavioural problems of the person with dementia, and carer burden and satisfaction with the model of care − EQ-5D-3L − ZBI − Client Satisfaction Questionnaire 8 (CSQ8)	• People with dementia had significantly improved QoL (p < 0.001) and fewer behavioural problems (p < 0.001) • Significant decrease in carer burden from baseline (p = 0.001) • Most carers rated “Agree” or “Strongly Agree” on each item about satisfaction. An average total score of 42.9/48 in the CSQ8
Saisunee et al. (2021) Thailand	38 PLWD Mean age 78.3 years (intervention) & 82.1 years (control) 38 carers, mean age 51.73 years (intervention) and 61.89 years (control); most female	12-week program implemented by a multidisciplinary team (nurses, doctor, physiotherapist, community leader and health volunteers): (i) three two-hour carer education sessions (ii) self-management support (iii) rehabilitation program (iv) case management (v) multidisciplinary home health care Usual Care: monthly check-ups, medical treatment and health education	Quasi-experimental, pretest-post test − Surveys: baseline and 12-weeks − ZBI	• The QoL of the intervention group remained stable (32.68 vs. 32.63), but the control group had a lower baseline QoL • Carer burden in the intervention group reduced significantly (19.37 vs. 15.53, p < 0.01), while there was an increase for the control group (19.63 vs. 23.47, p < 0.05) • Carer burden significantly differed between groups post-intervention (p < 0.05)

ADL activities of daily living; APRN advanced practice nurses; CBI Carer Burden Inventory; CSQ8 Client Satisfaction Questionnaire 8; EQ-5D-3L Euro-Quality-of-Life-5-Dimensions- 3-Levels; GP General Practitioner; IMCC Integrated Memory Care Clinic; NPI/NPI-Q Neuropsychiatric Inventory/Neuropsychiatric Inventory Questionnaire; NPI-Q Neuropsychiatric Inventory Questionnaire; PCCMC Primary Care Collaborative Memory Clinic; PLWD person living with dementia; QoL-AD quality of life in Alzheimer’s disease; QoL quality of life; SF-36 short form health survey; ZBI Zarit Burden Interview; ZARIT-BI Zarit Burden Interview.

^aAdult child refers to the child of a person living with dementia who is now an adult.

Results

Characteristics of included studies

Of the eight included studies, three (37.5%) were undertaken in America (Clevenger et al., 2018; Kovaleva et al., 2021; Liu et al., 2021), with one (12.5%) study each reported from Canada, the Netherlands, Singapore, Thailand and the United Kingdom (Table 2). There were four (50.0%) quasi-experimental studies (Clevenger et al., 2018; Cornelis et al., 2018; Ngoc Huong Lien et al., 2020; Saisunee et al., 2021), one randomised control trial (12.5%) (Meeuwsen et al., 2012), one qualitative study (12.5%) (Lee et al., 2018), one cohort study (12.5%) (Kovaleva et al., 2021) and one mixed-method study (12.5%) (Liu et al., 2021).

All studies included both carers and people living with dementia. Sample sizes ranged from 12 (Lee et al., 2018) to 344 (Ngoc Huong Lien et al., 2020) participants. Two studies (25.0%) implemented the same care model, the Integrated Memory Clinic (IMCC) (Clevenger et al., 2018; Kovaleva et al., 2021), while the remaining studies varied in intervention design. In three studies (37.5%), the specific model of care delivered was unclear (Cornelis et al., 2018; Liu et al., 2021; Saisunee et al., 2021).

Two studies (25.0%) focused primarily on carer burden and quality of life (QoL) (Meeuwsen et al., 2012; Saisunee et al., 2021), while the remainder discussed psychological symptoms. The included studies discussed three themes, namely: (1) psychological health, (2) carer burden, and (3) satisfaction with the memory clinic.

Themes

Psychological health

The psychological health of carers was explored in terms of carer distress (4 studies) (Clevenger et al., 2018; Cornelis et al., 2018; Kovaleva et al., 2021; Meeuwsen et al., 2012), depression (2 studies) (Kovaleva et al., 2021; Meeuwsen et al., 2012) and anxiety (2 studies) (Kovaleva et al., 2021; Meeuwsen et al., 2012). All four studies that examined carer distress measured it using the NPI-Q. While Kovaleva et al. (2021) found a significant decrease in symptoms of carer distress in response to the delusions and anxiety of people with dementia, the other studies found no significant reduction in carer distress following attendance at the memory clinic (Clevenger et al., 2018; Cornelis et al., 2018; Meeuwsen et al., 2012).

Anxiety was explored by two (25.0%) studies (Kovaleva et al., 2021; Meeuwsen et al., 2012). A statistical significance reported by Kovaleva et al. (2021) from mild depression at baseline and decreasing after three or six months (p = 0.001), with a decrease in distress related to anxiety of their person living with dementia was also reported within the same timeframe (p = 0.017). Meeuwsen et al. (2012) also recorded a significant difference in anxiety between the study groups in favour of the GP group over the memory clinic group at 12 months (p = 0.03).

Carer burden

Five (62.5%) studies examined carer burden (Cornelis et al., 2018; Kovaleva et al., 2021; Liu et al., 2021; Ngoc Huong Lien et al., 2020; Saisunee et al., 2021). Versions of the Zarit Burden Interview (ZBI) measured carer burden in four (80.0%) studies (Cornelis et al., 2018; Kovaleva et al., 2021; Ngoc Huong Lien et al., 2020; Saisunee et al., 2021), while the remaining study used the Caregiver Burden Inventory (CBI) (Liu et al., 2021).

While three studies (75.0%) reported no significant improvement (Cornelis et al., 2018; Kovaleva et al., 2021; Liu et al., 2021), the remaining two (25.0%) studies reported significant decreases in carer burden following the intervention (Ngoc Huong Lien et al., 2020; Saisunee et al., 2021). Saisunee et al. (2021) found both a significant decrease in carer burden in the intervention group from baseline (p = 0.03) and a significant difference between intervention and control groups (p ≤ 0.05). Similarly, in their study of people with dementia with challenging behaviours, Ngoc Huong Lien et al. (2020) showed significant reductions in carer burden from baseline (p = 0.001). In the three studies that failed to detect a significant difference in carer burden, it was hypothesised that this could either indicate stability in carer burden and levels of stress as positive outcomes for clinics or may show more research is required (Cornelis et al., 2018; Kovaleva et al., 2021; Liu et al., 2021).

Satisfaction with memory clinics

Satisfaction with the memory clinics was explored in three studies (37.5%) (Lee et al., 2018; Liu et al., 2021; Ngoc Huong Lien et al., 2020). Two studies collected qualitative data about the clinic experience for carers and their perceptions of support (Lee et al., 2018; Liu et al., 2021), while Ngoc Huong Lien et al. (2020) used the Client Satisfaction Questionnaire (CSQ8) to measure carer satisfaction. Satisfaction with the clinics stemmed from the social support, individualised care and person-centred approach created, allowing carers to feel that their concerns were heard (Lee et al., 2018; Liu et al., 2021). In their study, Lee et al. (2018) reported that the clinic staff were perceived as knowledgeable, and the clinic environment was found to be welcoming. Additionally, carers drew comparisons between the clinics and primary care visits, expressing appreciation for the longer time allocated for clinic visits (Lee et al., 2018). Interviews conducted by Liu et al. (2021) highlighted the experiences of carers attending the clinic, stating “the memory clinic has been… essential” in their experience of caring for a person living with dementia. Similarly, Ngoc Huong Lien et al. (2020) reported high satisfaction scores among carers.

Discussion

This integrative review has identified and critically synthesised the limited available evidence on the impact of memory clinics on carers of people living with dementia. The focus on caregiver health is paramount to ensuring carers can provide consistent, compassionate care for people living with dementia. Indeed, carer well-being directly influences the quality and sustainability of care provided (Mansfield et al., 2023). This review highlights the limited and mixed evidence to demonstrate the impact of memory clinic interventions on carer burden and psychological health. However, the relatively small number of included studies and challenges in measuring carer outcomes demonstrate the need for further evaluation of memory clinics to provide clearer evidence for future practice. What was clear, however, was the satisfaction of carers with the clinic model as a source of valued support (Lee et al., 2018; Liu et al., 2021; Ngoc Huong Lien et al., 2020). Such a finding encourages further exploration of this model in clinical practice.

This review demonstrated inconsistent findings in terms of carer distress, anxiety, and depression when pre- and post-scores were compared. However, this finding needs to be considered in the wider context. As a person living with dementia experiences disease progression, the carer may be required to adapt to increasing care needs and higher levels of impairment (Liu et al., 2021; Teahan et al., 2021). Carers may also experience increasing levels of distress due to worsening behavioural symptoms of the person living with dementia (Brennan et al., 2017; Teahan et al., 2021). Carers experience significant changes in their daily routines as they revolve more around care requirements. Increasing caring responsibilities may also leave the carer with less time to engage in self-care and meaningful activities for themselves, creating a higher risk for carer burden to develop (Hooper & Collins, 2019).

The limited statistically significant differences in outcome measures seen in this review could be due to the difficulties in measuring outcomes in a group caring for people on a downward health trajectory (Moore et al., 2020). Although there are likely to be periods of stability, people living with dementia and their carers are going to see a general decline in cognition and function over time (Teahan et al., 2021). The unpredictable decline of dementia can have direct implications on the health of the carer as they experience numerous losses throughout their caring journey, as the person with dementia loses cognitive, communication and motor skills (Large & Slinger, 2015). Therefore, the absence of significant worsening should be highlighted as potentially suggesting a positive outcome, that carers have maintained well-being despite the declining disease trajectory (Kovaleva et al., 2021). This complexity highlights the need to consider how to best measure the success of support interventions such as memory clinics.

The relatively small sample sizes, short follow-up duration and research designs may have also impeded the ability of the findings to show statistical significance. Additionally, using single-memory clinics to deliver the interventions may introduce bias (Lee et al., 2018). As such, this review evidences the need for further large-scale, robust studies to provide clearer evidence around outcomes and the impact of this kind of intervention.

This review has demonstrated that qualitative data can provide important insights into the impact of the memory clinic intervention on carers. Qualitative data highlighted several key insights into the experiences of carers, who commonly expressed feelings of being overwhelmed and stressed due to the relentless nature of caring, including managing challenging behaviours, assisting with daily tasks, and coping with their own emotional responses (Liu et al., 2021). Some carers report feeling alienated from the person living with dementia as the disease progresses, and many described a sense of social isolation and a lack of support from their diminishing social networks, exacerbating feelings of carer burden (Engel et al., 2022; Hooper & Collins, 2019). However, the limited qualitative research captured within this review highlights the need for future work to include qualitative data to explore carers’ experiences and their perspectives on interventions such as memory clinics.

Strengths and limitations

A strength of this review is that it has identified and critically synthesised the body of literature on the impact of memory clinics for dementia on carers. A further strength was using an established process to guide the integrative review. The small number of papers included in this review has demonstrated that this area is undervalued in the literature. Additionally, the variations in interventions around the structure of the clinics and the scope of the interventions precluded meta-analysis. The increased burden on carers during the study period may not have been accounted for when comparing pre- and post-intervention scores due to increased caring responsibilities. While the included studies all measured carer outcomes, these were often secondary to the outcomes related to the person living with dementia. Given the carers’ important role in keeping the person living with dementia in the community, further research should be designed to more carefully evaluate the impact of the clinic on their health and well-being and the caring role.

Conclusion

The literature examined in this review highlighted the lived experiences of carers for people living with dementia attending memory clinics through key elements of psychological health, carer burden and satisfaction with clinics. The psychological well-being of carers requires constant adaptation due to the increasing care needs of people living with dementia. This review identified that carers had significant support needs that the memory clinics addressed to some extent. However, further qualitative research examining carers’ experiences attending memory clinics may provide deeper insight into the carers’ experiences and the value of the clinic to their health and well-being.

Biography

Asha Beattie graduated from the University of Wollongong with a Bachelor of Nursing (Honours) and is currently a PhD candidate. She has a special interest in aged care and dementia and appreciates the impact family members and carers have on the patients she encounters as a registered nurse.

Dr. Amy Montgomery is a Lecturer at UOW and an Aged Care Nurse Practitioner with clinical expertise in dementia, delirium and aged care. She has worked in residential, community, and acute aged care for over 16 years. In 2022, Dr. Montgomery established a post-diagnostic memory clinic, Enhance.

Prof Elizabeth Halcomb is an international award-winning nurse academic and the inaugural Professor of Primary Health Care Nursing at the University of Wollongong. She leads a strong research program in primary care nursing, with particular emphasis on nursing in general practice, chronic conditions and nursing workforce issues.

ORCID iDs

Asha Beattie https://orcid.org/0009-0007-3053-1434

Amy Montgomery https://orcid.org/0000-0001-7720-9513

Elizabeth Halcomb https://orcid.org/0000-0001-8099-986X

Data Availability Statement

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.*