Here is the standardised PICO analysis for the thirty-third uploaded article:
Full Title
Support for people with dementia experiencing severe responsive behaviours: Unpacking the disconnect between policy and practice
Authors: Anita Westera, David Fildes, Sonia Bird, Rob Gordon, Peter Samsa, Pam Grootemaat
Journal: Australasian Journal on Ageing, 2022; 41:e181–e189
DOI: 10.1111/ajag.13036
Type of Study
Pragmatic quasi-experimental evaluation using a cross-sectional telephone survey with clinical leads in residential aged care homes. Grounded theory informed data analysis.
PICO Summary
Population (P)
- Clinical leads (registered nurses) in residential aged care facilities (RACFs) across Australia
- All participants worked in homes that had not yet accessed the Severe Behaviour Response Team (SBRT) service
- Indirectly focused on residents with dementia experiencing severe responsive behaviours (BPSD)
Intervention (I)
- Severe Behaviour Response Team (SBRT) program—national specialist dementia outreach service launched in 2015
- Intended to respond within 48 hours to referrals for residents exhibiting very severe or extreme BPSD (Brodaty Tiers 6–7)
- Delivered via a fly-in, fly-out consultant nurse model (with DBMAS acting as the referral gateway)
Comparison (C)
- Implicit comparison between:
- SBRT model assumptions vs. real-world usage and needs of aged care services
- Homes with local clinical resources and established networks vs. reliance on national-level SBRT outreach
Outcomes (O)
Process outcomes:
- Only 460 referrals were received in year one vs. projected 2000
- Of 53 aged care homes surveyed:
- 32% were unaware of SBRT
- Of those aware, reasons for non-use included:
- Adequate in-house expertise and environmental design (56%)
- No residents with extreme behaviours (28%)
- Negative views or barriers via DBMAS referral pathway (12%)
- Concerns about timeliness or lack of personalisation from fly-in teams (33%)
System-level findings:
- Three key themes emerged:
- Low awareness of SBRT
- Concerns about responsiveness and referral process
- Preference for local service relationships and dementia care networks
- Despite increased marketing and minor referral improvements, uptake remained well below expectations
Findings Summary
This study found a clear disconnect between national dementia policy assumptions and aged care practice realities. The SBRT, while conceptually sound, struggled with uptake due to:
- Poor initial awareness
- Trust and usability issues with the referral pathway (DBMAS)
- Aged care providers favouring locally embedded, relationship-driven support structures over national fly-in teams
The authors argue for greater engagement of aged care clinicians in policy design, more realistic modelling of need, and integrated local health system partnerships for future dementia care initiatives .
Life In The Slower Lane 
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