Invisible Patients:

Attending to Dementia’s Burden on Caregivers by way of Social Marketing

Dementia is a burdensome condition, for both those afflicted by it and those caring for

them. Over one million Australians’ lives are presently impacted by dementia;1 this number will

increase in tandem with the prevalence of dementia as Australia’s population ages.2 While burden

alleviation is available for caregivers of individuals with dementia through respite care, such means

are not utilised to their potential.3 This arises through a complex interplay of motivations and

perceived barriers of both members of the caregiver-care recipient dyad.4 This paper maintains a

dyadic perspective in proposing a social marketing campaign promoting increased utilisation of

respite care by individuals caring for others with dementia. With the delay of institutionalisation

recommended for treatment of individuals with dementia5 and often sought by both members of

the dyad,6 minimisation of caregivers’ burden is paramount.

Dementia is an umbrella term referring to a condition characterised by impaired cognitive

functioning and associated with many different diseases.7 Manifestations include diminished

reasoning ability, behavioural disinhibition, memory impairments and depression.8 While the

1 Alzheimer’s Australia, Fight Dementia Campaign (Canberra: Alzheimer’s Australia, 2012), accessed August 16, 2014, http://www.fightdementia.org.au/common/files/NAT/20120410_FightDementiaActionPlan.pdf. 2 Australian Government, Dementia in Australia (Canberra: Australian Institute of Health and Welfare, 2012), accessed August 19, 2014, http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422943. 3 Alzheimer’s Australia, Dementia is Everybody’s Business (Sydney: Pfizer Australia Pty Ltd, 2011), accessed August 19, 2014, http://www.fightdementia.org.au/common/files/NAT/20110314_Nat_report_Pfizer-Health-Report-2011.pdf. 4 Katherine S Judge, Sarah J Yarry, Wendy J Looman and David M Bass, “Improved Strain and Psychosocial Outcomes for Caregivers of Individuals with Dementia: Findings from Project ANSWERS,” The Gerontologist, 53, no. 2 (2012): 280-292, accessed August 14, 2014, doi: 10.1093/geront/gns076. 5 Javier Olzarán, Barry Reisberg, Linda Clare, Isabel Cruz, Jordi Peña-Casanova, Teodoro del Ser, Bob Woods, Cornelia Beck, Stefanie Auer, Claudia Lai, Aimee Spector, Sam Fazio, John Bond, Miia Kivipelto, Henry Brodaty, José Manuel Rojo, Helen Collins, Linda Teri, Mary Mittelman, Martin Orrell, Howard H Feldman and Ruben Muñiz, “Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy,” Dementia and Geriatric Cognitive Disorders, 30, no. 2 (2010): 161-178, accessed August 18, 2014, doi: 10.1159/000316119. 6 Alzheimer’s Australia, Election 2013 (Canberra: Alzheimer’s Australia, 2013), accessed August 16, 2014, http://www.fightdementia.org.au/common/files/NAT/AA_FINAL_FD_campaign_election_2013_single.pdf. 7 Australian Government, Dementia in Australia. 8 ibid.

symptoms themselves, their severities and their development vary, dementia is typically of gradual

onset, progressive, and irreversible, leading to complete dependence and ultimately, death.9

Alzheimer’s disease is the most common form of dementia, accounting for approximately 70% of

Australian cases.10 Dementia is not a natural process, despite its prevalence increasing with age,11

and early symptoms can be incorrectly associated with aging or stress.12 Given its idiopathic nature,

there is presently no cure for the disease.1314 These notions, alongside Australia’s aging

population,15 foreshadow an increase in the number of cases and relative prevalence of dementia in

Australia alike.16 (See Appendix) In turn, this predicts greater numbers of caregivers in need of

respite.

Currently, over one million Australians’ lives are impacted by dementia, either afflicted by it

themselves or caring for someone who is.17 While caregivers’ roles may impact their lives physically,

economically, socially or psychologically,18 many do not seek to alleviate their own burden through

available means, such as respite care.19 This occurs despite many caregivers being spouses or

children of the individual with dementia, who often lack explicit training regarding such provision of

9 Australian Government, Dementia in Australia. 10 Alzheimer’s Australia, Dementia is Everybody’s Business. 11 Dementia is typically associated with people aged over 65; younger onset dementia refers to people below this age experiencing dementia. (Australian Government, Dementia in Australia.) The two will not be differentiated in this paper, as both categories burden caregivers. 12 G Waldemar, B Dubois, M Emre, J Georges, I G McKeith, M Rossor, P Scheltens, P Tariska and B Winblad, “Recommendations for the Diagnosis and Management of Alzheimer’s Disease and Other Disorders Associated with Dementia: EFNS Guideline,” European Journal of Neurology, 14, no. 1 (2007): 1-26, accessed August 20, 2014, doi: 10.1111/j.1468-1331.2006.01605.x. 13 Katrin Seeher, Adrienne Withall and Henry Brodaty, The Dementia Research Mapping Project: The 2010 Update: Final Report, Canberra: Department of Health and Ageing, 2011, accessed August 2, 2014, http://www.dementiaresearch.org.au/images/dcrc/pdf/drm.pdf. 14 While many risk and protective factors have been correlatively identified, few have been definitively established. (Seeher et al., The Dementia Research Mapping Project.) 15 Australian Government, op. cit. 16 ibid. 17 Alzheimer’s Australia, Fight Dementia Campaign. 18 Evridiki Papastavrou, Haritini Tsangari, George Karayiannis, Savvas Papacostas, Georgios Efstathiou and Panayiota Sourtzi, “Caring and Coping: The Dementia Caregivers,” Aging & Mental Health, 15, no. 6 (2011): 702-711, accessed August 18, 2014, doi: 10.1080/13607863.2011.562178. 19 Alzheimer’s Australia, Dementia is Everybody’s Business.

care.20 This arises from a complex interplay of behaviours by both members of the caregiver-care

recipient dyad.21

Many individuals with dementia are reluctant to admit their need for assistance.22

Furthermore, those afflicted are widely stigmatised; 22% of Australians report feeling uncomfortable

spending time with someone suffering from dementia,23 and 60% anticipate experiencing feelings of

shame if diagnosed with dementia.24 In tandem, these factors encourage dissociating oneself from

the condition. This contributes significantly to preliminary professional consultations regarding the

diagnoses of new cases occurring, on average, three years after symptoms are first noticed,25

thereby resulting in under-utilisation of available support and the underestimation of dementia’s

prevalence.26 16% of Australians report knowing someone who might have dementia but has sought

neither diagnosis nor treatment; this rises to 41% among caregivers.27 Delaying treatment worsens

symptoms, predicts higher health care utilisation, and exacerbates the burden borne by caregivers.28

Caregivers themselves bear their own barriers to seeking alleviation of their burden, which

largely arise through a sense of duty.29 In tandem, this sense of duty and desire for respite can result

in cognitive dissonance, discomfort arising from simultaneously holding contradictory attitudes.30

Respite care is consequently under-utilised in an effort to resolve this internal conflict.31 In addition,

caregivers cite concerns about the quality and flexibility of respite services presently available.32

20 Henry Brodaty and Marika Donkin, “Family Caregivers of People with Dementia,” Dialogues in Clinical Neuroscience, 11, no. 2 (2009): 217-228. 21 Judge et al., “Improved Strain and Psychosocial Outcomes for Caregivers of Individuals with Dementia: Findings from Project ANSWERS”. 22 Mark McCrindle, The ABC of XYZ, 3rd ed., (Bella Vista: McCrindle Research Pty Ltd, 2014). 23 Alzheimer’s Australia, Dementia is Everybody’s Business. 24 Alzheimer’s Australia, Fight Dementia Campaign. 25 Edward Strivens and Denise Craig, “Managing Dementia Related Cognitive Decline in Patients and Their Caregivers,” Australian Family Physician, 43, no.4 (2014): 170-174. 26 Australian Government, Dementia in Australia. 27 Alzheimer’s Australia, Dementia is Everybody’s Business. 28 Laura N Gitlin, “Good News for Dementia Care: Caregiver Interventions Reduce Behavioral Symptoms in People with Dementia and Family Distress,” American Journal of Psychiatry, 169, no. 9 (2012): 894-897. 29 Brodaty and Donkin, “Family Caregivers of People with Dementia.” 30 Leon Festinger, “Cognitive Dissonance,” Scientific American, 207, no. 4 (1962): 93-107. 31 Alzheimer’s Australia, Dementia is Everybody’s Business. 32 ibid.

Consequently, many caregivers are reluctant to permit themselves to utilise respite, particularly in

light of their most readily accessible referent; there can be an underlying sentiment of “they have it

worse than me”.33 This decisional conflict has been linked to poor health outcomes for caregivers

and earlier institutionalisation of care recipients.34 Furthermore, given the condition’s gradual

onset, caregivers may similarly acclimatise to their increased burdens, ignorant of the extent to

which their lives are impacted.35 Indeed, perceived strain is only somewhat correlated with

objective burden.36

The needs of the dyad’s constituents may differ, and indeed, interventions looking to

address the negative outcomes associated with dementia often target the caregiver and care

recipient separately.3738 While differences between the caregiver and care recipient’s experience of

dementia give credence to separate approaches, interventions founded upon this notion may fail to

capture the nature of everyday interaction that occurs within the dyad.39 Thus, opportunities for

insights subsequently prompting a more effective interaction between the dyad’s members are

inherently limited.40 Numerous studies have shown dyadic interventions to be effective thus

far.414243 These will hence play a significant role in alleviating the burden borne by increasing

33 Brodaty and Donkin, “Family Caregivers of People with Dementia.” 34 ibid. 35 ibid. 36 P Campbell, J Wright, J Oyebode, D Job, P Crome, P Bentham, L Jones and C Lendon, “Determinants of Burden in Those Who Care for Someone with Dementia,” International Journal of Geriatric Psychiatry, 23, no. 10 (2008): 1078-1085, accessed August 22, 2014, doi: 10.1002/gps.2071. 37 Marilyn Huckans, Lee Hutson, Elizabeth Twamley, Amy Jak, Jeffrey Kaye and Daniel Storzbach, “Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions,” Neuropsychology Review, 23, no. 1 (2013): 63-80, accessed August 21, 2014, doi: 10.1007/s11065-013-9230-9. 38 R R Whitebird, M Kreitzer, A L Crain, B A Lewis, L R Hanson and C J Enstad. “Mindfulness-Based Stress Reduction for Family Caregivers: A Randomized Controlled Trial,” The Gerontologist, 53, no. 4 (2012): 676-686, accessed August 21, 2014, doi: 10.1093/geront/gns126. 39 Judge et al., “Improved Strain and Psychosocial Outcomes for Caregivers of Individuals with Dementia: Findings from Project ANSWERS”. 40 ibid. 41 ibid. 42 Steven H Zarit, Elia E Femia, Jennifer Watson, Laura Rice-Oeschger and Bernadette Kakos, “Memory Club: A Group Intervention for People with Early-Stage Dementia and Their Care Partners,” The Gerontologist, 44, no. 2 (2004): 262-269. 43 Linda Teri, Laura E. Gibbons, Susan M. McCurry, Rebecca G. Logsdon, David M. Buchner, William E. Barlow, Walter A. Kukull, Andrea Z. LaCroix, Wayne McCormick and Eric B. Larson, “Exercise Plus Behavioral

numbers of caregivers as dementia becomes more prevalent among Australia’s aging population44

and be integral to the proposed social marketing campaign.

A suitable framework through which to offer a solution to dementia’s burden on caregivers,

augmented by caregivers’ own reluctance to acknowledge their burden, is Ansoff’s growth strategy

of market development45 through Porter’s generic strategy of focussed differentiation.46 In pursuing

market development, growth is sought through targeting new market segments with existing

products or, as in this instance, behaviours.47 A strategy centring on focussed differentiation targets

a narrow segment of the market in seeking to differentiate one’s offering from others.48 Again, this

hereby constitutes encouraging one behaviour as opposed to another.

In presenting a social marketing solution to the under-utilisation of respite care by

caregivers of individuals with dementia, there are three barriers which the solution must overcome

or bypass:

The shame widely associated with being afflicted by dementia49

The guilt experienced by caregivers in considering the use of respite care50

Caregivers’ concerns about the quality of the respite services available51

A media campaign targeting caregivers of individuals with dementia stressing the dyadic

benefits of employing respite care through personal information sessions presents a plausible social

marketing solution. In accordance with the aforementioned theoretical framework, this approach is

largely differentiated from existing ones in targeting one dyad member as a channel to benefit both

Management in Patients with Alzheimer Disease,” Journal of the American Medical Association, 290, no. 15 (2003): 2015-2022, accessed August 21, 2014, doi: 10.1001/jama.290.15.2015. 44 Australian Government, Dementia in Australia. 45 Igor H Ansoff, “A Model for Diversification,” Management Science, 4, no. 4 (1958): 392-414. 46 Michael Porter, Competitive Strategy: Techniques for Analyzing Industries and Competitors (New York: Free Press, 1980). 47 Ansoff, op. cit. 48 Porter, op. cit. 49 Alzheimer’s Australia, Fight Dementia Campaign. 50 Brodaty and Donkin, “Family Caregivers of People with Dementia.” 51 Alzheimer’s Australia, Dementia is Everybody’s Business.

members simultaneously, and narrow in targeting only a segment of the market, as discussed later

in the paper. The behaviour is existing in that respite care is presently available, and the market new

in that the campaign would be aimed at those not presently demonstrating the behaviour of utilising

it. Furthermore, the solution offers an answer for each of the three aforementioned barriers.

While targeting the caregiver rather than the care recipient circumvents the first barrier, it is

consequently dependent on overcoming the second. In light of the guilt caregivers experience in

considering utilising respite care, the campaign will appraise the situation from a dyadic perspective

and stress the benefits for both members. That is, in targeting the caregiver, the campaign will

emphasise how the care recipient benefits from the caregiver’s own respite, such as delayed

institutionalisation.52 Finally, providing face-to-face information sessions with staff involved in local

respite care services personalises the experience. It offers provision of more in-depth and case-

specific information and greater familiarisation with those involved than could be provided through

mass communication means such as a website. Information delivered via telephone, by the National

Dementia Helpline,53 could meet the first, but not the second, of these conditions.

This solution’s dyadic nature is evident in that it addresses the dyad’s members’ respective

barriers simultaneously. Caregivers’ guilt is assuaged by the long-term benefits of their actions for

the care recipient, while the latter’s shame is moderated through the experience’s personalisation.

Social comparison theory posits that people evaluate themselves relative to those around them.54

52 Olzarán et al., “Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy.” 53 The National Dementia Helpline is a telephone-based information and support service available throughout Australia, on 1800100500. (“National Dementia Helpline – Telephone Information and Support Service Across Australia,” Alzheimer’s Australia, accessed August 27, 2014, http://www.fightdementia.org.au/services/national-dementia-helpline.aspx.) 54 Leon Festinger, “A Theory of Social Comparison Processes,” Human Relations, 7, no. 2 (1954): 117-140, accessed August 24, 2014, doi: 10.1177/001872675400700202.

However, referents to whom an individual is close, such as friends and family, mediate this

evaluative process through familiarity.55

This solution can delivered as a market-based offering through the adaptation and adoption

of the Chartered Institute of Marketing approach to marketing, which defines marketing as “the

management process responsible for identifying, anticipating and satisfying customer requirements

profitably”.56 Akin to the methodology of matching benefits to barriers employed earlier, the

components of the definition can be matched to those of the solution. The customer parallels the

caregiver, who must be persuaded to acknowledge their own limitations and the benefits of respite.

Profit denotes the benefits the caregiver can obtain through utilising respite care; there exist direct

and indirect benefits alike. The former refers to the lessening of the burden borne, and the latter

encapsulates the care recipient’s benefit of delayed institutionalisation,57 thereby further benefitting

the caregiver themselves through reducing their barrier of guilt. Caregivers’ requirements have

been identified in that respite services are already available. However, barriers and their resultant

impact upon consumer behaviour thus far have been poorly anticipated, resulting in the under-

utilisation of the service. Consequently, caregiver needs are not presently being satisfied.

Here, the notion of profitability employs the existing behaviour, caregivers’ abstention from

respite, as a referent. Caregivers derive some form of benefit, alleviation of guilt, from not utilising

respite care, and must hence be persuaded that this does not yield the best possible outcome.

Caring for an individual with dementia allows the caregiver to avoid feelings of guilt associated with

offloading their responsibility derived from a sense of duty and perceived obligation to care for the

individual.58 Thus, the solution must be conceived of by caregivers as being of greater benefit to the

55 Abraham Tesser and Jennifer Campbell, “Self-Evaluation Maintenance and the Perception of Friends and Strangers,” Journal of Personality, 50, no. 3 (1982): 261-279, accessed August 24, 2014, doi: 10.1111/j.1467-6494.1982.tb00750.x. 56 Chartered Institute of Marketing, 2005, as cited in Bruce Clark, “Measuring Marketing Performance: Research, Practice and Challenges,” in Business Performance Management: Unifying Theory and Integrating Practice (2nd ed.), ed. Andy Neely (Cambridge: Cambridge University Press, 2007), 36-63. 57 Olzarán et al., “Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy.” 58 Brodaty and Donkin, “Family Caregivers of People with Dementia.”

care recipient than the caregiver’s own current behaviour. This emphasises the dyadic perspective

once more, in that behaviours benefitting the caregiver themselves will also benefit the care

recipient.

The relevant market can be segmented along two dimensions. The first is the role assumed

in the caregiver-care recipient dyad by the consumer; the second is the stage of Prochaska and

Diclemente’s transtheoretical model of behaviour change59 (TTM) presently occupied by the

consumer.

In appraisal of the first dimension, the two individuals involved in the dyad present different

barriers to be overcome and offer different opportunities in pursuit of a successful social marketing

campaign. Caregivers’ main barriers are their sense of duty and the guilt subsequently evoked by

the notion of utilising respite care,60 while the opportunity presented is their more objective

perception of the impact dementia is having on the care recipient’s life.61 Care recipients’ principal

barrier is the shame arising through their simultaneous reluctance to acknowledge their condition in

accordance with their valuing of independence.62 Nonetheless, they too present an opportunity, in

that demonstrating initiative and confronting the difficulties they face could be conceptually aligned

with independence. It should be noted that this opportunity is dependent upon the care recipient

themselves being in the early stages of disease, such that they can appraise and interact with the

world around them, as these abilities erode with the worsening of the recipient’s condition.63

Regarding the second, the TTM posits that there are five constituent stages of behaviour

change through which people progress; progressively, these are pre-contemplation, contemplation,

preparation, action and maintenance.64 Pre-contemplation constitutes a lack of acknowledgement

59 James O Prochaska and Carlo C DiClemente, “Transtheoretical Therapy: Toward a More Integrative Model of Change,” Psychotherapy: Therapy, Research & Practice, 19, no. 3 (1982): 276-288. 60 Brodaty and Donkin, “Family Caregivers of People with Dementia.” 61 Alzheimer’s Australia, Dementia is Everybody’s Business. 62 McCrindle, The ABC of XYZ. 63 Australian Government, Dementia in Australia. 64 Prochaska and DiClemente, op. cit.

that a problem exists and consequently that a change is required. Contemplation invokes the

recognition that a problem exists, while preparation involves making plans for change. Action

involves the first actual attempt to modify a problematic behaviour, which must subsequently be

maintained for a period of time. While not considered a stage itself per se, relapse constitutes

regressing from one stage to an earlier one.

As the two individuals involved in a given dyad may be at different stages of behaviour

change, there exists an array of segments which could be targeted by this social marketing

campaign. Pre-contemplative individuals with dementia and caregivers alike do not believe that

they themselves require assistance. The distinction between these two is the caregiver’s

acknowledgement of the impact dementia is having upon the care recipient’s life. Caregivers in

contemplation are likely concerned with their own quality of life, while corresponding care

recipients are beginning to acknowledge their requirement for care. Caregivers and care recipients

in the preparation stage both require access to information and must perceive there to be an

opportunity for the behaviour of interest, respite care, to occur and offer the benefits sought by

each. In pursuit of market development,65 individuals in either the action or maintenance stages

would not be targeted under this campaign, as they are already demonstrating the behaviour of

interest. Due to the potential for disparity between the stages of behaviour change presently

occupied by each of a given dyad’s constituents, while the campaign would emphasise dyadic

benefits, it would target only one member.

Thus far, campaigns have typically targeted care recipients.666768 In emphasising

differentiation, this campaign will target caregivers. This is logical from a barrier-centric perspective,

in that caregivers deny they need help with a problem, whereas care recipients may deny that there

65 Ansoff, “A Model for Diversification.” 66 C Shanley, “Promoting Advance Care Planning to Reduce the Impact of Dementia: A New Web Resource from Alzheimer’s Australia,” BMJ Supportive & Palliative Care, 3, no. 2 (2013): 237-237, accessed August 24, 2014, doi 10.1136/bmjspcare-2013-000491.32. 67 Alzheimer’s Australia, Fight Dementia Campaign. 68 Alzheimer’s Australia, Dementia is Everybody’s Business.

is a problem altogether. In light of delayed treatment of the care recipient exacerbating the burden

fronted by caregivers,69 the campaign will target caregivers in the contemplation stage of the TTM;

this would constitute the single market segment to be targeted mentioned earlier.

This target market will be more receptive than those in pre-contemplation, and the

transmission between contemplation and preparation will be quickened. This is arguably the most

significant bridging after that between pre-contemplation and contemplation, in that if the barriers

impeding the issue’s resolution are perceived to be too complex to confront, it is unlikely to be

resolved. Furthermore, cognitive dissonance is most likely to occur at this stage. The dyadic

perspective is integral to reconciling the conflicting attitudes. Furthermore, the conceptualisation of

respite care as benefitting the dyad must be internalised, thereby eliciting true attitude change.70

This is enabled through emphasising the benefits of the caregiver’s respite for the care recipient.

Caregivers’ ignorance of the impact upon their lives71 arises through excessive self-efficacy, whereby

they believe they are more capable of handling the burden than they truly are,72 and are thus less

likely to pursue respite. Caregivers in the contemplation stage of the TTM thus exhibit maximal

receptiveness to internalisation of the idea that respite care can benefit the dyad in that they are

presently acknowledging their own burden, but have had minimal time to acclimatise to it.

Despite dementia’s burden on caregivers, available respite care services are under-utilised,

due largely to barriers of guilt and the interdependent nature of the caregiver-care-recipient dyad. A

plausible means by which to increase utilisation of respite services is the promotion of the behaviour

through a media campaign targeting contemplative caregivers of individuals with dementia

emphasising the dyadic benefits of employing respite care through personal information sessions. In

pursuit of maximal effectiveness, the campaign should target caregivers presently in the

69 Gitlin, “Good News for Dementia Care: Caregiver Interventions Reduce Behavioral Symptoms in People with Dementia and Family Distress.” 70 Herbert C Kelman, “Compliance, Identification, and Internalization: Three Processes of Attitude Change,” Journal of Conflict Resolution, 2, no. 1 (1958): 51-60. 71 Campbell et al., “Determinants of Burden in Those Who Care for Someone with Dementia.” 72 Albert Bandura, “Self-Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychological Review, 84, no. 2 (1977): 191-215, accessed August 27, 2014, doi: 10.1037/0033-295x.84.2.191.

contemplation stage of Prochaska and DiClemente’s TTM,73 likely to offer peak receptiveness to

internalisation of a new attitude in an effort to resolve their current state of cognitive dissonance

before acclimatisation to their burden prompts excessive self-efficacy. This campaign should be

delivered through a framework of marketing theory centring on Ansoff’s growth strategy of market

development,74 targeting caregivers not presently utilising respite care. Furthermore, it should

employ Porter’s generic strategy of focussed differentiation,75 targeting only those deemed most

receptive. Amid Australia’s aging population,76 effective resolution of this situation is paramount;

7% of Australians presently care for an individual with dementia; 64% believe they will likely do so in

the future.77

73 Prochaska and DiClemente, “Transtheoretical Therapy: Toward a More Integrative Model of Change.” 74 Ansoff, “A Model for Diversification.” 75 Porter, Competitive Strategy: Techniques for Analyzing Industries and Competitors. 76 Australian Government, Dementia in Australia. 77 Alzheimer’s Australia. Dementia is Everybody’s Business.

Appendix: Forecast of Dementia in Australia

Figure 1: Projections of Australia’s population of people aged over 65 until 2050.78

Figure 2: Projections of cases of dementia in Australia until 2050.79

78 Australian Government, Dementia in Australia. 79 ibid.

References

Alzheimer’s Australia. Dementia is Everybody’s Business. Sydney: Pfizer Australia Pty Ltd, 2011.

Accessed August 19, 2014.

http://www.fightdementia.org.au/common/files/NAT/20110314_Nat_report_Pfizer-Health-Report-

2011.pdf.

Alzheimer’s Australia. Fight Dementia Campaign. Canberra: Alzheimer’s Australia, 2012. Accessed

August 16, 2014.

http://www.fightdementia.org.au/common/files/NAT/20120410_FightDementiaActionPlan.pdf.

Alzheimer’s Australia. Election 2013. Canberra: Alzheimer’s Australia, 2013. Accessed August 16,

2014.

http://www.fightdementia.org.au/common/files/NAT/AA_FINAL_FD_campaign_election_2013_singl

e.pdf.

Alzheimer’s Australia. “National Dementia Helpline – Telephone Information and Support Service

Across Australia.” Fightdementia.org.au. Accessed August 27, 2014.

http://www.fightdementia.org.au/services/national-dementia-helpline.aspx.

Ansoff, Igor H. “A Model for Diversification.” Management Science, 4, no. 4 (1958): 392-414.

Australian Government. Dementia in Australia. Canberra: Australian Institute of Health and Welfare,

2012. Accessed August 19, 2014.

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422943.

Bandura, Albert. “Self-Efficacy: Toward a Unifying Theory of Behavioral Change.” Psychological

Review, 84, no. 2 (1977): 191-215. Accessed August 27, 2014. doi: 10.1037/0033-295x.84.2.191.

Brodaty, Henry, and Marika Donkin. “Family Caregivers of People with Dementia.” Dialogues in

Clinical Neuroscience, 11, no. 2 (2009): 217-228.

Campbell, P, J Wright, J Oyebode, D Job, P Crome, P Bentham, L Jones, and C Lendon. “Determinants

of Burden in Those Who Care for Someone with Dementia.” International Journal of Geriatric

Psychiatry, 23, no. 10 (2008): 1078-1085. Accessed August 22, 2014. doi: 10.1002/gps.2071.

Clark, Bruce. “Measuring Marketing Performance: Research, Practice and Challenges.” In Business

Performance Management: Unifying Theory and Integrating Practice (2nd ed.), edited by Andy

Neely, 36-63. Cambridge: Cambridge University Press, 2007.

Festinger, Leon. “A Theory of Social Comparison Processes.” Human Relations, 7, no. 2 (1954): 117-

140. Accessed August 24, 2014. doi: 10.1177/001872675400700202.

Festinger, Leon. “Cognitive Dissonance.” Scientific American, 207, no. 4 (1962): 93-107.

Gitlin, Laura N. “Good News for Dementia Care: Caregiver Interventions Reduce Behavioral

Symptoms in People with Dementia and Family Distress.” American Journal of Psychiatry, 169, no. 9

(2012): 894-897.

Huckans, Marilyn, Lee Hutson, Elizabeth Twamley, Amy Jak, Jeffrey Kaye, and Daniel Storzbach.

“Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults:

Working Toward a Theoretical Model and Evidence-Based Interventions.” Neuropsychology Review,

23, no. 1 (2013): 63-80. Accessed August 21, 2014. doi: 10.1007/s11065-013-9230-9.

Judge, Katherine S, Sarah J Yarry, Wendy J Looman, and David M Bass. “Improved Strain and

Psychosocial Outcomes for Caregivers of Individuals with Dementia: Findings from Project

ANSWERS.” The Gerontologist, 53, no. 2 (2012): 280-292. Accessed August 14, 2014. doi:

10.1093/geront/gns076.

Kelman, Herbert C. “Compliance, Identification, and Internalization: Three Processes of Attitude

Change.” Journal of Conflict Resolution, 2, no. 1 (1958): 51-60.

McCrindle, Mark. The ABC of XYZ. 3rd ed. Bella Vista: McCrindle Research Pty Ltd, 2014.

Olzarán, Javier, Barry Reisberg, Linda Clare, Isabel Cruz, Jordi Peña-Casanova, Teodoro del Ser, Bob

Woods, Cornelia Beck, Stefanie Auer, Claudia Lai, Aimee Spector, Sam Fazio, John Bond, Miia

Kivipelto, Henry Brodaty, José Manuel Rojo, Helen Collins, Linda Teri, Mary Mittelman, Martin Orrell,

Howard H Feldman, and Ruben Muñiz. “Nonpharmacological Therapies in Alzheimer’s Disease: A

Systematic Review of Efficacy.” Dementia and Geriatric Cognitive Disorders, 30, no. 2 (2010): 161-

178. Accessed August 18, 2014. doi: 10.1159/000316119.

Papastavrou, Evridiki, Haritini Tsangari, George Karayiannis, Savvas Papacostas, Georgios Efstathiou,

and Panayiota Sourtzi. “Caring and Coping: The Dementia Caregivers.” Aging & Mental Health, 15,

no. 6 (2011): 702-711. Accessed August 18, 2014. doi: 10.1080/13607863.2011.562178.

Porter, Michael. Competitive Strategy: Techniques for Analyzing Industries and Competitors. New

York: Free Press, 1980.

Prochaska, James O, and Carlo C DiClemente. “Transtheoretical Therapy: Toward a More Integrative

Model of Change.” Psychotherapy: Therapy, Research & Practice, 19, no. 3 (1982): 276-288.

Seeher, Katrin, Adrienne Withall, and Henry Brodaty. The Dementia Research Mapping Project: The

2010 Update: Final Report. Canberra: Department of Health and Ageing, 2011. Accessed August 2,

2014. http://www.dementiaresearch.org.au/images/dcrc/pdf/drm.pdf.

Shanley, C. “Promoting Advance Care Planning to Reduce the Impact of Dementia: A New Web

Resource from Alzheimer’s Australia.” BMJ Supportive & Palliative Care, 3, no. 2 (2013): 237-237.

Accessed August 24, 2014. doi 10.1136/bmjspcare-2013-000491.32.

Strivens, Edward, and Denise Craig. “Managing Dementia Related Cognitive Decline in Patients and

Their Caregivers.” Australian Family Physician, 43, no.4 (2014): 170-174.

Teri, Linda, Laura E. Gibbons, Susan M. McCurry, Rebecca G. Logsdon, David M. Buchner, William E.

Barlow, Walter A. Kukull, Andrea Z. LaCroix, Wayne McCormick, and Eric B. Larson. “Exercise Plus

Behavioral Management in Patients with Alzheimer Disease.” Journal of the American Medical

Association, 290, no. 15 (2003): 2015-2022. Accessed August 21, 2014. doi:

10.1001/jama.290.15.2015.

Tesser, Abraham, and Jennifer Campbell. “Self-Evaluation Maintenance and the Perception of

Friends and Strangers.” Journal of Personality, 50, no. 3 (1982): 261-279. Accessed August 24, 2014.

doi: 10.1111/j.1467-6494.1982.tb00750.x.

Waldemar, G, B Dubois, M Emre, J Georges, I G McKeith, M Rossor, P Scheltens, P Tariska, and B

Winblad. “Recommendations for the Diagnosis and Management of Alzheimer’s Disease and Other

Disorders Associated with Dementia: EFNS Guideline.” European Journal of Neurology, 14, no. 1

(2007): 1-26. Accessed August 20, 2014. doi: 10.1111/j.1468-1331.2006.01605.x.

Whitebird, R R, M Kreitzer, A L Crain, B A Lewis, L R Hanson, and C J Enstad. “Mindfulness-Based

Stress Reduction for Family Caregivers: A Randomized Controlled Trial.” The Gerontologist, 53, no. 4

(2012): 676-686. Accessed August 21, 2014. doi: 10.1093/geront/gns126.

Zarit, Steven H, Elia E Femia, Jennifer Watson, Laura Rice-Oeschger, and Bernadette Kakos. “Memory

Club: A Group Intervention for People with Early-Stage Dementia and Their Care Partners.” The

Gerontologist, 44, no. 2 (2004): 262-269.