Domains and Tiers

Domain 1 focuses on improving understanding about dementia to help reduce stigma, improve awareness of risk reduction, promote timely diagnosis and intervention, and to enhance support for people living with dementia, their families and carers.

Themes:

• Types of dementia

• Prevalence and incidence

• Recognising signs and symptoms

• Impact of neurological changes

• Accessing diagnosis, support and services

• Reducing stigma and supporting inclusion

• Young-onset and childhood dementia

• Dementia risk reduction

This domain focuses on understanding the process of identifying and diagnosing dementia, and the importance of providing appropriate support and connection to services for individuals, their families and carers, no matter the age group or where the person may live.

Themes:

• Early signs and Identification

• Assessment

• Diagnosis of dementia in different age groups

• Advance care planning

• Immediate post diagnostic support

• Ongoing support and connection to services

Domain 3 recognises the importance of respecting the rights, responsibilities, dignity and wellbeing of individuals living with dementia. It reinforces a rights-based approach to care and supports the right of a person living with dementia to make informed choices.

Themes:

• Capacity, informed consent and supported decision-making

• Disability, equality and non-discrimination

• Right to risk and right to take that risk

• Right and dignity of choice

• Privacy and confidentiality

• Legal and policy frameworks

• Abuse and neglect

• Equal access to treatment and services

• Restrictive practices

Standards within Domain 4 focus on understanding the individuality of the lived experience of dementia and providing holistic care and person-led support for people living with dementia according to modern, evidence-based models of care.

Themes:

• Dementia paradigms

• Models of care

• Individuality and identity

• Human needs

• Implementing culture change

• Life history and personhood

• Relationship-focused and person-directed care

• Impact of malignant social psychology and stigma

Family and carers have needs and expectations of service delivery that require individualised and specific responses. Caring for a family member living with dementia can be challenging and emotionally and physically impacting. This domain recognises the needs of families and carers within their own right.

Themes:

• Carers and families as care partners in decision-making

• Drawing on carer and families' knowledge and relationship to support personhood

• Working with carers to assess needs and supports

• Access to support and information for families and carers

• Conflict of interest between needs and choices

• Diversity, culture and beliefs in the caring role

• Supporting young carers and family members

Domain 6 focuses on empowering individuals living with dementia to maximise their independence and quality of life, giving them opportunities to function at an optimal level, compensate for functional changes and retain or regain as much independence as possible.

Themes:

• Supporting choice, autonomy and supported decision-making

• Supporting independence and function

• Multidisciplinary approach to holistic care

• Access to rehabilitation services

• Enablement and reablement approaches

• Driving

Communication and connection through social engagement and meaningful relationships are vital to human wellbeing, yet may be particularly challenging for people living with dementia. This domain includes key areas that may impact communication, connection, meaningful relationships and social engagement.

Themes:

• Cognitive impact on communication

• Emotional intelligence

• Communication skills and techniques

• Enabling communication

• Culture and language

• Loneliness and isolation

• Connectedness

Holistic wellbeing for people living with dementia requires attention to mental health and emotional wellbeing, which may be impacted by the diagnosis of dementia and the multitude of life challenges arising from cognitive changes, including comorbidities and/or environmental and social factors.

Themes:

• Expression of spirituality

• Meaning and finding purpose

• Personal growth

• Sense of emotional security

• Experiencing joy

• Mental health comorbidities

• Engagement and socialisation

Optimum physical health is essential to overall wellbeing and quality of life, and it is important to understand the factors that impact physical wellbeing for people living with dementia. The themes covered in Domain 9 include a range of areas that may impact on a person living with dementia’s health and physical wellbeing.

Themes:

• Delirium

• Polypharmacy

• Pain, sensory impairment and other comorbidities

• Mobility and physical activity

• Nutrition and hydration

• Continence

• Sleep

Physical spaces and living environments should enhance the abilities of people with dementia and contribute to their autonomy and quality of life. Domain 10 encompasses understanding the physical environment’s effects on people living with dementia, and assessing, auditing and making improvements or systemic changes based on the latest evidence.

Themes:

• Knowledge and application of relevant design principles and guidelines

• Assessing the environment

• Implementing environmental change

• Assistive technology

• Access to outdoors and the natural world

• Developing meaningful engaging spaces

• Supporting community access and connection

The changes in the brain which occur in dementia affect people in different ways. These changes can lead to a person living with dementia behaving differently to how they may have behaved in the past. Sometimes people may have difficulty verbally communicating their needs, resulting in frustration, pain or distress, for example, being expressed through their behaviour.

Themes:

• Behaviour as communication

• Causes of illbeing and distress leading to changed behaviour

• Positive practice to meet needs including psycho-social-spiritual engagement

• Access to information and support

• Use and limitations of pharmacological interventions

• Language and labelling

• Psychological symptoms

In this domain the focus is on understanding the impact of diversity in all its forms to ensure that dementia care is inclusive and equal for all people living with dementia.

Themes:

• Respecting diversity

• Cultural competence

• Sexuality, gender and body diversity

• Regional, rural and remote challenges

• Perceptions and beliefs within different cultures

Domain 13 recognises that understanding cultural identities and specific needs of Aboriginal and Torres Strait Islander people living with dementia is a critical aspect of providing person-centred care.

Themes:

• Cultural understanding and application to practice

• Prevalence and incidence

• Assessment and diagnosis

• Access to culturally safe and appropriate services

• Community awareness and understanding

• Mob-based care

This domain addresses the complex and sensitive issues related to caring for people living with dementia who are approaching the end of their lives to ensure that individuals receive quality care that aligns with their physical, psychological, social, spiritual and cultural needs and preferences.

Themes:

• Reduce pain, distress and suffering as much as possible

• Physical care needs

• Respecting choices in end-of-life conversations and decisions

• Psychological, cultural and spiritual needs

• Maintain clinical and ethical standards

• Bereavement and grief support

• Palliative care