There are more than 50 million of people living with dementia across the world and this number is expected to rise rapidly to over 152 million by 2050 [1]. The total global estimated cost for dementia in 2015 was $957.56 billion USD and dementia is expected to cost $2.54 trillion USD in 2030 [2, 3]. China has the largest population of people with dementia in the world [1]. The population of people with dementia in China is expected to rise dramatically from 9.5 million in 2016 to over 16 million by 2030 [3]. The average cost per person with dementia per year is $19,144 USD, which far exceeds average per capita disposable income in China [4].
There is an urgent need to improve the healthcare for people living with dementia around the world now and in the future. Although dementia cannot be cured, people living with dementia can live well, delay disease progression and achieve health–related quality of life when they receive a timely diagnosis, effective treatment and high-quality care [5]. However, more than 50% of people living with dementia in developed countries are under-detected and under-diagnosed [3]. In developing countries, including China, the diagnosis rate is only 5-10% [3, 6]. Even when people with dementia receive a diagnosis, the care provided is often uncoordinated, fragmented and unresponsive to individual needs [3, 7].
High-quality dementia care requires inter-disciplinary collaboration in order to address individual care needs associated with the condition and other comorbidities [5, 8]. Health professionals, such as registered nurses, physicians, general practitioners, neuropsychologists and geriatricians, need to work collaboratively to contribute their specialist knowledge to the diagnosis, treatment, care and palliation of people living with dementia [5, 9]. To provide best-practice dementia care, health professionals also need to engage in shared decision-making to complement their roles and foster client-centred treatment and care [8, 10].
Undergraduate medical and nursing programs, as the major providers of education for health professionals, play a crucial role in the provision of dementia education to the healthcare workforce [11, 12]. Yet, the lack of dementia education in undergraduate curricula appears to be an international issue [13]. In Australia, dementia education is not included into the education curricula of 14 medical specialties [14]. In the USA, over half of health professionals feel that they are not equipped with adequate education and resources to manage people with dementia as their condition progresses [15]. Although the curricula of medicine and nursing undergraduate programs in China undergoes rigorous design, there is also no standard requirement for embedded or stand-alone topics specifically focusing on dementia [16]. Based on the first author’s academic experience, the study of dementia care is only 2 hours and 3 hours in the nursing and medical curriculum respectively at XX (blinded for review) University, one of the participating universities in this study. Often dementia education is delivered as a ‘tick-box’ exercise or an add-on, or there is an ad hoc approach. This kind of education has little value attached and does not positively impact on students’ knowledge, attitudes and skills in providing effective care for people with dementia [11].
Numerous studies have found a lack of knowledge and inappropriate attitudes towards dementia among students in health and non-health areas [17-20]. In a systematic review, Ahmad et al. found that the majority of college and university students reported low understanding of risk factors and causes related to dementia [20]. In a recent cross-sectional study involving 359 adolescent students, around 79% of them perceived that people with dementia demanded too much time to keep them clean, healthy and safe[19]. Moreover, in another study by Tullo et al., they found a lack of a person-centred approach to dementia care in medical students [21]. For example, most participants agreed that “it is acceptable to lie to people with dementia if you think the truth might be upsetting to hear ” and “it is preferable to try to talk to a member of the family of people with dementia first, before speaking to the patients”[21]. However, few studies were conducted to compare dementia care knowledge, attitudes and person-centred care approach among health professional students for the purpose of promoting inter-professional education in dementia care.
In recent years, some efforts have been made to improve dementia education for undergraduate medical and nursing students in a global context. The Higher Education Dementia Network (HEDN) in UK has developed dementia core skills education and training framework for undergraduate programs [22]. The Health and Social Care Board in Northern Ireland recently designed a Dementia Learning and Development Framework to facilitate development and provision of dementia education programs [22]. These initiatives are useful for supporting the development of dementia education in undergraduate programs. However, inter-disciplinary dementia education remains brief and inadequate [8, 23, 24]. The content, implementation and assessment of inter-disciplinary dementia education remain inherently challenging [8, 23, 24]. Identifying the current knowledge, attitudes and care approach of students from different disciplines is seen as a key component for the development of improved inter-disciplinary dementia education[8, 24].
Most of the previous studies assessing students’ dementia knowledge, attitudes and care approach were conducted in developed countries [25, 26]. There is currently little understanding of how Chinese undergraduate medical and nursing students perceive this important topic. To meet recommended clinical practice guidelines for inter-professional dementia care [8, 10], it is imperative to evaluate and compare undergraduate medical and nursing students’ dementia knowledge, attitudes and perception of care approach to provide evidence to inform reforms to inter-disciplinary dementia education undergraduate programs in China. Moreover, although studies have identified socio-demographic factors associated with dementia knowledge, attitudes and care approach in health professionals[27, 28], these factors have not been examined in a single study with undergraduate medical and nursing students. This study addressed the gap in the dementia care literature.