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Duffy, Francis. "A Critical Perspective on Advance Care Planning for Older People." British Journal of Social Work 50, no. 4 (August 8, 2019): 1013–30. http://dx.doi.org/10.1093/bjsw/bcz092.
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Abstract How older people plan ahead for ageing in relation to accommodation, care arrangements, healthcare and medical treatment, and end of life decisions has attracted particular attention in recent years and as a result there has been considerable promotion of the importance of planning ahead and executing planning instruments with the aim of making one’s wishes and preferences known in advance. Planning ahead is promoted as allowing older people to have their voices heard, to advance their autonomy, choice and self-determination and to allow them to decide what treatment they may not want to receive. This article provides a critique of advance care planning, based on a subset of findings from a qualitative intergenerational study on ageing in Australia. The findings suggest that advance care planning is a much more complex and at times problematic endeavour, compared to what is promoted about advance care planning, in particular with regard to the use of planning instruments.
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Wilson, Mark AG, Susan E. Kurrle, and Ian Wilson. "Understanding Australian medical student attitudes towards older people." Australasian Journal on Ageing 37, no. 2 (January 14, 2018): 93–98. http://dx.doi.org/10.1111/ajag.12495.
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Cordato, Nicholas J., Sabari Saha, and Michael A. Price. "Geriatric interventions: the evidence base for comprehensive health care services for older people." Australian Health Review 29, no. 2 (2005): 151. http://dx.doi.org/10.1071/ah050151.
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Specialist geriatric services apply a comprehensive, multidisciplinary evaluation and management approach to the multidimensional and usually interrelated medical, functional and psychosocial problems faced by at-risk frail elderly people. This paper examines currently available data on geriatric interventions and finds ample evidence supporting both the efficacy and the cost-effectiveness of these specialist interventions when utilised in appropriately targeted patients. It is proposed that substantial investment in these programs is required to meet the future demands of Australia?s ageing population.
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Faulkner, Debbie, and Julia Law. "The ‘unnecessary’ use of emergency departments by older people: findings from hospital data, hospital staff and older people." Australian Health Review 39, no. 5 (2015): 544. http://dx.doi.org/10.1071/ah14185.
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Objective Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of ‘potentially avoidable general practitioner-type presentations.’ Methods The study used three sources of data from two emergency departments: hospital data for the financial year 2010–11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. Results The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. Conclusions For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this. What is known about the topic? Increasing demands are being placed on hospital emergency departments and there are concerns that a growing number of presentations are ‘inappropriate presentations’. Older people are considered to be one group that overuse emergency department services. What does this paper add? Most studies use hospital statistics to examine primary care presentations at emergency departments or present the viewpoints of medical staff within hospitals about the necessity of these visits. This paper compares and contrasts the available data from hospitals, the opinions of medical and allied health professionals and information collected from older people themselves to provide greater insight into why older people triaged as three, four or five attend emergency departments in Adelaide. What are the implications for practitioners? For a range of reasons including availability of quality care, familiarity with hospital services, and a lack of community based services, older people will continue to present to emergency departments. With increasing numbers of older people in the population, hospital emergency departments will need to continuously adapt to accommodate the needs of this older demographic and for staff to acquire necessary geriatric skills.
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Duckett, Stephen. "Expanding the breadth of Medicare: learning from Australia." Health Economics, Policy and Law 13, no. 3-4 (January 24, 2018): 344–68. http://dx.doi.org/10.1017/s1744133117000421.
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AbstractThe design of Australia’s Medicare programme was based on the Canadian scheme, adapted somewhat to take account of differences in the constitutional division of powers in the two countries and differences in history. The key elements are very similar: access to hospital services without charge being the core similarity, universal coverage for necessary medical services, albeit with a variable co-payment in Australia, the other. But there are significant differences between the two countries in health programmes – whether or not they are labelled as ‘Medicare’. This paper discusses four areas where Canada could potentially learn from Australia in a positive way. First, Australia has had a national Pharmaceutical Benefits Scheme for almost 70 years. Second, there have been hesitant extensions to Australia’s Medicare to address the increasing prevalence of people with chronic conditions – extensions which include some payments for allied health professionals, ‘care coordination’ payments, and exploration of ‘health care homes’. Third, Australia has a much more extensive system of support for older people to live in their homes or to move into supported residential care. Fourth, Australia has gone further in driving efficiency in the hospital sector than has Canada. Finally, the paper examines aspects of the Australian health care system that Canada should avoid, including the very high level of out-of-pocket costs, and the role of private acute inpatient provision.
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Chater, Alan B. "Looking after health care in the bush." Australian Health Review 32, no. 2 (2008): 313. http://dx.doi.org/10.1071/ah080313.
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LOOKING AFTER health care in rural Australia involves providing adequate services to meet the urgent and non-urgent needs of rural patients in a timely, cost-effective and safe manner. The very provision of these services requires an appropriate workforce and facilities in rural areas. This provides challenges for clinicians, administrators and medical educators. While preventive medicine has made some significant gains globally in reducing the need for acute care and hospitalisation in some areas of medicine such as infectious disease and asthma, these demands have been replaced by an increase in trauma, chronic disease and mental illness1 which, with an ageing population, eventually means presentations at an older age which can require hospitalisation. Rural patients have always had to deal with a relative undersupply of health practitioners. Rural people have coped valiantly with this. The legendary stoicism of rural people has been shown by Schrapnel2 and Davies to be a prominent feature of the rural personality. This both allowed them to cope with lack of services and to suffer in silence while their health status fell below the Australian average.3 Rural Australians use fewer Medicare services and see the doctor less per annum than the Australian average.
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Edmiston, Natalie, Erin Passmore, David J. Smith, and Kathy Petoumenos. "Multimorbidity among people with HIV in regional New South Wales, Australia." Sexual Health 12, no. 5 (2015): 425. http://dx.doi.org/10.1071/sh14070.
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Background Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and healthcare costs while decreasing quality of life. The prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service are described. Methods: A record review of all HIV positive patients attending the service between 1 July 2011 and 30 June 2012 was conducted. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Univariate and multivariate linear regression analyses were used to determine factors associated with a higher CIRS score. Results: One hundred and eighty-nine individuals were included in the study; the mean age was 51.8 years and 92.6% were men. One-quarter (25.4%) had ever been diagnosed with AIDS. Multimorbidity was extremely common, with 54.5% of individuals having two or more chronic health conditions in addition to HIV; the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on an antiretroviral regimen other than two nucleosides and a non-nucleoside reverse transcriptase inhibitor or protease inhibitor were associated with a higher CIRS score. Conclusion: To the best of our knowledge, this is the first study looking at associations with multimorbidity in the Australian setting. Care models for HIV positive patients should include assessing and managing multimorbidity, particularly in older people and those that have ever been diagnosed with AIDS.
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Davis, Jenny, Amee Morgans, and Joan Stewart. "Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface." Australian Health Review 40, no. 4 (2016): 420. http://dx.doi.org/10.1071/ah15005.
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Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.
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Calma, Kaara Ray B., Elizabeth Halcomb, and Moira Stephens. "An exploration of the experiences of Australian Grey Nomads travelling with chronic conditions." Australian Journal of Primary Health 24, no. 2 (2018): 183. http://dx.doi.org/10.1071/py17043.
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Internationally, the population is ageing and people are living well, longer. In Australia, extended travelling has gained popularity among older Grey Nomads due to time and opportunity post retirement. However, there is limited research available focusing on older Australians’ health while travelling. This paper reports the qualitative phase of a larger mixed-method project that explores the experience of Australian Grey Nomads travelling with chronic conditions. Eight Grey Nomads participated in telephone interviews. Data were analysed using inductive thematic analysis. Two themes emerged, namely: continuity of care while travelling and experts on the road. Participants described encountering a fragmented health system, with challenges regarding finding health services; a lack of shared medical records; and difficulties accessing regular medications. Despite these challenges, participants demonstrated health preparedness, an ability to accommodate health on the road, and were all travelling for their health. This study highlights key systems issues that challenge health care while travelling, and identifies opportunities for both usual practices and rural health services to enhance the care provided to this group.
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Detering, Karen M., Kimberly Buck, Marcus Sellars, Helana Kelly, Craig Sinclair, Ben White, and Linda Nolte. "Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study." BMJ Open 9, no. 10 (October 2019): e031691. http://dx.doi.org/10.1136/bmjopen-2019-031691.
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IntroductionAdvance care planning (ACP), an ongoing communication and planning process, aims to clarify a person’s values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices.Methods and analysisThis is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person’s documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored.Ethics and disseminationProtocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings.
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Hendrie, Delia, Sonja E. Hall, Gina Arena, and Matthew Legge. "Health system costs of falls of older adults in Western Australia." Australian Health Review 28, no. 3 (2004): 363. http://dx.doi.org/10.1071/ah040363.
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The aim of this study was to determine the health system costs associated with falls in older adults who had attended an emergency department (ED) in Western Australia. The data relating to the ED presentations and hospital admissions were obtained from population-based hospital administrative records for 2001?2002. The type of other health services (eg, outpatient, medical, community, ancillary and residential care), the quantity, and their cost were estimated from the literature. In adults aged 65 years and above, there were 18 706 ED presentations and 6222 hospital admissions for fall-related injuries. The estimated cost of falls to the health system was $86.4 million, with more than half of this attributable to hospital inpatient treatment. Assuming the current rate of falls remains constant for each age group and gender, the projected health system costs of falls in older adults will increase to $181 million in 2021 (expressed in 2001?02 Australian dollars). The economic burden to the health services imposed by falls in older adults is substantial, and a long-term strategic approach to falls prevention needs to be adopted. Policy in this area should be targeted at both reducing the current rate of falls through preventing injury in people from high-risk groups and reducing the future rate of falls through reducing population risk.
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Dolton, Michael J., Lisa Pont, Gerard Stevens, and Andrew J. McLachlan. "Prevalence of Potentially Harmful Drug Interactions in Older People in Australian Aged-Care Facilities." Journal of Pharmacy Practice and Research 42, no. 1 (March 2012): 33–36. http://dx.doi.org/10.1002/j.2055-2335.2012.tb00128.x.
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Field, Courtney, and Vicki Archer. "Comparing health status, disability, and access to care in older and younger inmates in the New South Wales corrections system." International Journal of Prisoner Health 15, no. 2 (June 10, 2019): 153–61. http://dx.doi.org/10.1108/ijph-04-2018-0017.
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Purpose The purpose of this paper is to compare the rates of chronic illness, disability and access to care between older and younger inmates who took part in a large epidemiological study in New South Wales, Australia. Design/methodology/approach Data are presented from a cross-sectional study based on a sample of inmates from correctional sites in NSW. The inclusion of results here was guided by the literature with regard to their relevance to older people, and older inmates in particular. Findings Results indicate that a higher proportion of older inmates suffer a range of chronic illnesses, with prevalence often many times higher than that of younger inmates. Older inmates are more likely to be classified as disabled and have a disability which impacts their mobility. Older inmates also reported accessing medical services in prison more recently than younger inmates and were more likely to have seen both nurses and general practitioners. Practical implications Older inmates appear to be considerably more resource intensive than younger inmates. The increasing proportion of inmates who are classified as older thus poses a pressing challenge to those working in the carceral space and, in particular, those responsible for providing healthcare to incarcerated people. Originality/value The impact of aging prisoners on resource demand has yet to be effectively measured. This study provides an important first step towards that goal.
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Mudge, Alison M., Karen Lee-Steere, Elise Treleaven, Margaret Cahill, Simon Finnigan, and Prue McRae. "Cognitive impairment in older hospital inpatients: prevalence, care needs and carer perceptions." Australian Health Review 46, no. 2 (December 3, 2021): 244–50. http://dx.doi.org/10.1071/ah20286.
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Objectives The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 ‘A’s test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic? Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add? This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners? Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs.
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BRADFORD, DANA KAI, YASMIN VAN KASTEREN, QING ZHANG, and MOHAN KARUNANITHI. "Watching over me: positive, negative and neutral perceptions of in-home monitoring held by independent-living older residents in an Australian pilot study." Ageing and Society 38, no. 7 (February 27, 2017): 1377–98. http://dx.doi.org/10.1017/s0144686x1700006x.
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ABSTRACTWith an increase in the proportion of Australians aged over 65, and high government expenditure on residential care, there is a strong imperative to find smart, safe solutions to support older people to stay in their own homes. There is a growing interest in Australia for assistive technologies that provide home monitoring to promote health and wellbeing. This solution will only be viable if it meets with the expectations of older residents and their families. In the first smart homes pilot in Australia, we sought to ascertain barriers and facilitators of this technology. There was an overall positive response to the system, despite a slight tendency for residents to modify their behaviour due to perceived surveillance. Positive outcomes included increases in family communication, health autonomy and advances in technology uptake. Our findings suggest that a combination of considered placement of in-home technology, straightforward medical devices and a supportive human element will ensure that the technology meets the balance of service provision and preservation of dignity. Smart homes could mitigate the challenges associated with aged care while affording peace of mind for seniors and families.
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Etherton-Beer, Christopher D. "Poisoning among older people with dementia: a wake up call." International Psychogeriatrics 27, no. 11 (September 25, 2015): 1755–56. http://dx.doi.org/10.1017/s1041610215001416.
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Medical care can be both “a blessing and a curse”. The contributions of medicines to increased human lifespan and falling mortality from the major cardiovascular diseases are undisputed. However, in lockstep with remarkable extension of human lifespan has been increase in the numbers of people living with chronic age related neurodegenerative conditions and frailty. In frail, multi-morbid populations, with limited homeostatic reserve and life expectancy, the balance between the risk and harms of medicines can be in equipoise. In this context the number of older people living with dementia is increasing, and understanding threats to the quality of life of people with dementia is of growing significance. Among the myriad potential causes of harm to older people with dementia, in this issue of the journal Mitchell and colleagues present new Australian data reminding us of the importance of admissions due to both intentional and unintentional poisoning.
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Qasim, Haider, Maree Simpson, Yann Guisard, and Barbora de Courten. "A Comprehensive Evaluation of Studies on the Adverse Effects of Medications in Australian Aged care Facilities: A Scoping Review." Pharmacy 8, no. 2 (March 31, 2020): 56. http://dx.doi.org/10.3390/pharmacy8020056.
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Aim: this scoping review was designed to identify studies that assess adverse drug reactions (ADRs) for older people in Australian aged care facilities. This review critically evaluates each published study to identify the risk of, or actual, adverse drug events in older people. Inclusion criteria: this review considered any clinical studies that examined the adverse effects of medications in older people who were living in aged care facilities. This review considered qualitative studies, analytical studies, randomized controlled trials (RCTs), descriptive cross-sectional studies, and analytic observational studies that explored the use of medications and their adverse effects on older people in clinical settings (including aged care facilities). Methods: an initial search of the PubMed (United State National Library of Medicine), OvidSP, EBSCOHost, ScienceDirect, Wiley Online, SAGE, and SCOPUS databases, with full text was performed, followed by an analysis of the article’s title and abstract. Additionally, MeSH (Medical Subject Headings) was used to describe the article. The initial round of the database search was based on inclusion criteria from studies that assessed tools or protocols aiming to identify the adverse effects of medications on the elderly population suffering chronic conditions or multiple co-morbidities. Two reviewers screened the retrieved papers for inclusion. The data presented in this review are in tabular forms and accompanied by a narrative summary which aligns with the review’s objectives. Results: seven studies were identified, and the extracted data from these studies were grouped according their characteristics and the auditing results of each study. Conclusion: it would be beneficial to design a comprehensive or broadly adverse drug reaction assessment tool derived from Australian data that has been used on the elderly in an Australian healthcare setting.
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Powell, Alice, Paul Finucane, Martin Jude, Jenna Mewburn, Katherine Mohr, and Stephen Kerr. "007 The impact of demographic changes on the presentation and outcome of stroke: experiences of the oldest old in the murrumbidgee region." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 6 (May 24, 2018): A4.2—A4. http://dx.doi.org/10.1136/jnnp-2018-anzan.7.
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IntroductionDemographic changes are leading to an ageing population with a disproportionate increase in the oldest old. Stroke is a leading cause of death and disability in Australia and is particularly prevalent in the elderly. The Murrumbidgee region has a population profile that is 14 years ahead of national Australia and therefore data from this population portends how stroke may present nationally in the future. Existing research suggests that stroke risk factors, subtype, treatment provided and outcomes differ between younger and older demographic groups. This study seeks to build a profile of the experiences of stroke in the oldest old and compare variables with two younger cohorts to test a number of hypotheses about background, treatment and outcomes.MethodsData was collected retrospectively from the electronic medical records of 100 stroke patients consecutively admitted to the Wagga Wagga Rural Referral Hospital Acute Stroke Unit. They were split into three demographic groups; young old, 65–74 old (75 to 84) and oldest old (85 and older) and comparisons were made of baseline functional status and risk factor profile, stroke type, stroke treatment and outcomes.ResultsOlder people admitted with stroke were more likely to be female with poorer premorbid functional status and higher numbers living in residential care. Atrial fibrillation (p=0.008) and hypertension (p=0.01) were significantly more common with advancing age while rates of smoking (p=0.006) were higher in younger patients. Stroke mechanism was predominantly cardioembolic in older patients and embolic stroke of undetermined source (ESUS) in the youngest group. Stroke severity and stroke treatment did not vary according to age. However, outcomes were poorer with rates of dependency (p=0.03) and residential aged care facility placement (p=0.06) increased among older patients post stroke.ConclusionThese data provide an indication of how stroke may manifest in our ageing population in the future.
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Tonkin-Hill, Gina, Chloe Hanna, Roberto Bonelli, Rowena Mortimer, Michele A. O’Connell, and Sonia R. Grover. "Identifying the Resource Needs of Young People with Differences of Sex Development." Journal of Clinical Medicine 11, no. 15 (July 27, 2022): 4372. http://dx.doi.org/10.3390/jcm11154372.
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Adolescents with differences of sex development (DSD) often have complex medical, surgical, and psychological care needs and require age-appropriate resources. This cross-sectional study describes the past and current experiences of adolescents and young adults with DSD and their need for information and support. Participants aged 14–30 years with DSD diagnoses were identified, either from departmental records at the Royal Children’s Hospital (RCH), Melbourne, Australia, or from the private practice of a gynecologist linked to RCH. Anonymized data were collected from a specifically designed online survey. Of the 314 successfully traced patients, 91 (28.9%) completed the survey. Amongst respondents, older age was strongly correlated with higher levels of distress at the time of disclosure (b = 0.67, p < 0.001). People who reported greater understanding of their condition (b = −0.45, p = 0.010) and higher levels of support (b = −0.40, p = 0.003) identified lower levels of current distress. Respondents preferred to receive information from a specialist doctor, GP, or websites and reported information needs being highest during adolescence. Only one in four respondents recalled ever being offered psychological support. A number of perceived barriers to accessing support were identified. Our findings indicate that young people’s information and support needs may be best met by improving online resources, as well as increasing introductions to knowledgeable and appropriate primary care physicians, psychological services, and peer support groups. Further work to promote and increase engagement with psychological and peer support for those with DSD will be important.
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Kotynia-English, Ria, Helen McGowan, and Osvaldo P. Almeida. "A randomized trial of early psychiatric intervention in residential care: impact on health outcomes." International Psychogeriatrics 17, no. 3 (September 2005): 475–85. http://dx.doi.org/10.1017/s1041610205001572.
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Background: The prevalence of psychological and behavioral disturbances among older adults living in residential care facilities is high, and it has been shown previously that people with such symptoms have poorer health outcomes. This study was designed to assess the efficacy of an early psychiatric intervention on the 12-month health outcomes of older adults admitted to residential care facilities in Perth, Western Australia. We hypothesized that subjects in the intervention group would have better mental and physical health outcomes than controls.Methods: The study was designed as a randomized, single-blinded, controlled trial. All subjects aged 65 years or over admitted to one of the 22/26 participating residential care facilities of the Inner City area of Perth were approached to join the study and were allocated randomly to the intervention or usual care group. Demographic and clinical information (including medications and use of physical restraint) was gathered systematically from all participants at baseline, and at 6 and 12 months. At each assessment, the Geriatric Depression Scale (GDS), the Health of the Nation Outcome Scales for older adults (HoNOS 65+), the Mini-mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered. Subjects in the intervention group who screened positive at the baseline assessment for psychiatric morbidity were reviewed within a 2-week period by the Inner City Mental Health Service of Older Adults (ICMHSOA). If clinically appropriate, mental health services were introduced without the involvement of the research team.Results: One hundred and six subjects and their next of kin consented to participate in the study (53 in each group). Mental health screening and early referral to a psychogeriatric service did not significantly change the average number of medical contacts, self-rated health, use of psychotropic or PRN medication, use of physical restraint, 12-month mortality, or mental health outcomes, as measured by the GDS-15, HoNOS 65+ and NPI (p>0.05 for all relevant outcomes).Conclusion: Systematic mental health screening of older adults admitted to residential care facilities and early clinical intervention does not change 12-month health outcomes. More effective interventions to improve the health outcomes of older adults with psychological and behavioral disturbances admitted to residential care facilities are needed.
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Parfitt, Gaynor, Dannielle Post, Lisa Kalisch Ellett, Renly Lim, Alison Penington, Megan Corlis, and Elizabeth Roughead. "A cross-sectional assessment of the relationship between sedative medication and anticholinergic medication use and the movement behaviour of older adults living in residential aged care." PeerJ 8 (July 24, 2020): e9605. http://dx.doi.org/10.7717/peerj.9605.
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Objectives Medications with anticholinergic or sedative effects are frequently used by older people but can increase risk of falls and adverse events; however, less is known about their effect on movement behaviour. Here we examine the cross-sectional association between medication use and movement behaviour in older adults living in residential aged care. Materials and Methods Twenty-eight older adults living in residential aged care in metropolitan Australia participated. Medication data were collected from participants’ medical charts and sedative load and anticholinergic burden were determined. Seven-day movement behaviour was objectively assessed by a wrist-worn triaxial accelerometer. Raw accelerations were converted to sleep, sedentary time, and time in light, moderate, and moderate-to-vigorous physical activity. To explore the relationship between medication and movement behaviour, Spearman’s Rho correlations were conducted, as the data were not normally distributed. Results Analyses indicated that while anticholinergic burden was not associated with movement behaviour, sedative load was negatively correlated with a number of variables, accounting for 14% variance in moderate-to-vigorous physical activity (MVPA), and 17% in the bout length of MVPA (p < .02). Conclusion The findings of this study showed a negative association between sedative load, due to medicines, and an individual’s movement behaviour. The impact of this could be a reduction in the ability of this population to maintain or improve their functional mobility, which may overshadow any benefits of the medicine in some circumstances.
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Heong, Valerie, Hui-Li Wong, Jeanne Tie, Michael Jefford, Kathryn Maree Field, Suzanne Kosmider, Jayesh Desai, Matthew Croxford, Ian Jones, and Peter Gibbs. "Understanding why some people with stage III colon cancer do not receive adjuvant chemotherapy." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e14608-e14608. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e14608.
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e14608 Background: Adjuvant chemotherapy is a standard of care for patients (pts) with stage III colon cancer. While many retrospective series have concluded that treatment is underutilised in routine clinical practice, particularly in older pts, reasons for this remain unexplored. Methods: Data was collected on all pts with stage III colon cancer attending four community hospitals in Australia between January 2003 and July 2012. Every patient was referred to a medical oncologist. For each case where adjuvant therapy was not delivered, reason(s) were prospectively documented by clinicians in a consensus database. Results: Data was collected on 875 pts. Median age 67 years (range 15 - 92). Overall, 147 (25.9%) did not receive adjuvant therapy. Comorbidity was the main reason for non-treatment in all age groups. Age alone was the reason for not recommending treatment in a small number of elderly pts (n=20, 20.4%). Risk of recurrence (N1 vs N2 disease) did not impact recommendations of clinicians (75% vs 76%) or pt acceptance (92% vs 93%). Pts with a lower socioeconomic status were less likely to be offered treatment; however this reflected greater comorbidity in these pts. Treatment acceptance was similar across all socioeconomic groups (data not shown). Conclusions: In routine clinical practice adjuvant chemotherapy should be recommended to, and can be safely delivered to a very high proportion of younger patients. Clinicians are comfortable recommending adjuvant chemotherapy to older pts, with co-morbidity the dominant reason that treatment was not recommended for pts >65 years. The rate of pts declining treatment increased with age, and further study of the factors involved in treatment refusal should be pursued [Table: see text]
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Lenart, Marta, Maria Mackowiak, Adrianna Senczyszyn, Dorota Szczesniak, Clarissa Giebel, Rabih Chattat, Mark Gabbay, et al. "Social health of people with dementia during the SARS-CoV-2 pandemic." International Psychogeriatrics 33, S1 (October 2021): 24–25. http://dx.doi.org/10.1017/s1041610221001551.
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Background:Limited access to medical and social services during the coronavirus outbreak has contributed to the exclusion of vulnerable populations, such as people with dementia and older adults. These limitations and the resulting social isolation have highlighted the importance of social relationships and their relationship to the mental health of these people. In the context of dementia, ‘social health’ (SH) can be defined as the role of social abilities for achieving a dynamic balance between opportunities and limitations. The concept encompasses the capacity and independency of an individual to participate in social activities alongside the influences of the surrounding social network.Methods:Using a qualitative and quantitative approach, we will present social health and its determinants of people with dementia related to social care service closures and self-isolation during the SARS-CoV-2 pandemic. We present an analysis of the survey data from the cross-country population- based study and the semi-structured telephone interviews with people with and without dementia from Poland, UK, Australia and Italy aged 65 and over.Results:Measuring the Social Health Index in relation to experiencing self-isolation and changes in the use of services before and during the pandemic among the people with dementia, allow us to identify the level of SH and its determinants. Also, the qualitative results revealed the indirect consequences of the pandemic-related restrictions in the access to social care service and social isolation. Reduction of social support was significantly related to deficits in social health and well-being.Conclusions:Our results highlight the emerging impact of health the current global epidemiological situation upon social health, with a particular focus on those affected by social disadvantage and isolation.
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Davison, Tanya E., John Snowdon, Nathan Castle, Marita P. McCabe, David Mellor, Gery Karantzas, and Janelle Allan. "An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities." International Psychogeriatrics 24, no. 4 (December 5, 2011): 631–41. http://dx.doi.org/10.1017/s1041610211002146.
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ABSTRACTBackground: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument.Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.
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Sambrook, P. N., J. S. Chen, L. M. March, I. D. Cameron, R. G. Cumming, S. R. Lord, J. Schwarz, and M. J. Seibel. "Serum Parathyroid Hormone Is Associated with Increased Mortality Independent of 25-Hydroxy Vitamin D Status, Bone Mass, and Renal Function in the Frail and Very Old: A Cohort Study." Journal of Clinical Endocrinology & Metabolism 89, no. 11 (November 1, 2004): 5477–81. http://dx.doi.org/10.1210/jc.2004-0307.
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Abstract Very frail older people constitute an increasing proportion of the aging population and often have vitamin D deficiency and impaired renal function. Primary hyperparathyroidism has been associated with increased mortality, but it is unclear whether secondary hyperparathyroidism is associated with increased mortality independent of renal function and vitamin D status. This study aimed to examine the effect of vitamin D deficiency and secondary hyperparathyroidism on mortality in frail older people after accounting for renal function and general measures of health. We evaluated 842 subjects (182 men with a mean age of 81.9 yr and 660 women with a mean age of 86.2 yr) living in residential aged care facilities in Sydney, Australia in a prospective, cohort study. Over a mean duration of follow-up of 31 months, 345 subjects died. Baseline serum 25-hydroxy vitamin D, serum PTH, and bone ultrasound attenuation were significantly associated with mortality in univariate and multivariate analyses (for PTH, a hazard ratio of 1.39 for time to death) after correcting for age and gender. In multivariate analyses that corrected for health status, nutritional status, and renal function, PTH remained a significant predictor of mortality but not 25-hydroxy vitamin D or bone ultrasound attenuation. Serum PTH appears to be associated with increased mortality in the frail elderly independent of vitamin D status, renal function, bone mass, and measures of general health. The mechanism of this effect requires further investigation.
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Bowden, Jocelyn L., Rod Lamberts, David J. Hunter, Luciano Ricardo Melo, and Kathryn Mills. "Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study." BMJ Open 10, no. 7 (July 2020): e035030. http://dx.doi.org/10.1136/bmjopen-2019-035030.
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ObjectivesMusculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation.DesignAnonymous online observational survey.SettingAustralia.ParticipantsA convenience sample of 831 community-based individuals (18+ years).Outcome measuresDescriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information.ResultsOf the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information.ConclusionIntelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.
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Huynh, Elizabeth, David Basic, Rinaldo Gonzales, and Chris Shanley. "Structured interdisciplinary bedside rounds do not reduce length of hospital stay and 28-day re-admission rate among older people hospitalised with acute illness: an Australian study." Australian Health Review 41, no. 6 (2017): 599. http://dx.doi.org/10.1071/ah16019.
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Objective Structured interdisciplinary bedside rounds (SIBR) are being implemented across many hospitals in Australia despite limited evidence of their effectiveness. This study evaluated the effect of SIBR on two interconnected outcomes, namely length of stay (LOS) and 28-day re-admission. Methods In the present before-after study of 3644 patients, twice-weekly SIBR were implemented on two aged care wards. Although weekly case conferences were shortened during SIBR, all other practices remained unchanged. Demographic, medical and frailty measures were considered in appropriate analyses. Results There was no significant difference in median (interquartile range) LOS before and during SIBR (8 (5–15) vs 8 (4–15) days respectively; P = 0.51). In an adjusted analysis, SIBR had no effect on LOS (hazard ratio 0.97; 95% confidence interval 0.90–1.05). The presence of dementia or delirium, or the ability to speak English, did not modify the effect of SIBR (P > 0.05 for all). Similarly, SIBR had no effect on 28-day re-admission rates (20.3% vs 19.0% before and during SIBR respectively; P = 0.36). Conclusions Although ineffective interdisciplinary communication is associated with negative outcomes for patients and healthcare services, models of care that aim to improve communication are not necessarily effective in reducing LOS or early re-admission. Clinical services implementing SIBR are encouraged to independently evaluate their effects. What is known about the topic? Ineffective interdisciplinary communication may harm patients and increase LOS. Only two publications have evaluated the implementation of SIBR, a new model of care that aims to improve interdisciplinary communication and collaboration. One paper reported that SIBR reduced unadjusted LOS and in-hospital mortality, whereas the other found that SIBR improved teamwork, communication and staff efficiency. What does this paper add? The effect of SIBR among acutely unwell older people on aged care wards is unknown. The present study is the first to evaluate the effects of SIBR in this population. It shows that the implementation of SIBR did not reduce LOS or early re-admission, and suggests that existing communication strategies may have weakened the effects of SIBR. What are the implications for practitioners? Policies and practice that promote the addition of communication strategies, such as SIBR, may not be effective in all patient populations. More research is needed to determine whether SIBR reduce these and other outcomes, particularly for services with weaker communication frameworks and protocols.
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Green, Anna, Natalia Jerzmanowska, Safrina Thristiawati, Marguerite Green, and Elizabeth A. Lobb. "Culturally and linguistically diverse palliative care patients’ journeys at the end-of-life." Palliative and Supportive Care 17, no. 2 (June 4, 2018): 227–33. http://dx.doi.org/10.1017/s1478951518000147.
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AbstractObjectiveTo understand the clinical and psychosocial journey of culturally and linguistically diverse (CALD) palliative care patients.MethodThis study was conducted at a subacute hospital with a specialist palliative care unit and a community palliative care service in a metropolitan region of New South Wales, Australia. Medical records of 100 deceased patients from CALD backgrounds over a 12-month period from 2014 to 2015 were recorded on a data mining tool. The cohort had transitioned to either community or inpatient palliative care services with a life-limiting illness. We used descriptive statistical analyses to identify the patients’ end-of-life journeys in the physical, psychological, spiritual, and social palliative care domains. Staff case notes were used to enrich the quantitative data.ResultThe most common symptoms burdening the patients were decreased mobility (82%), pain (76%), and poor appetite (60%). The majority of patients (87%) were diagnosed with cancer. Language was a major barrier to the assessment and management of symptoms. The vast majority of patients were born in Europe and Asia. Twenty-nine percent of the patients preferred to use English. However, among patients who required an interpreter on admission, only 9% used professional interpreters. Family distress around patients’ lack of food consumption was prominent, along with provider concern when this led to families “force feeding” patients. Only 5% of files documented patients’, and 21% of files documented families’, cultural wishes or needs. Care of the body after death was only documented in 20% of files.Significance of resultsThe increasing cohort of older people from CALD backgrounds will have significant implications for the planning and delivery of palliative care services. There is an emerging need to address the physical, psychological, spiritual, and social palliative care domains in the end-of-life journeys of patients from CALD backgrounds to ensure the provision of quality care.
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Katzenellenbogen, Judith M., Laura J. Miller, Peter Somerford, Suzanne McEvoy, and Dawn Bessarab. "Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia." Australian Health Review 39, no. 4 (2015): 429. http://dx.doi.org/10.1071/ah14102.
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Objectives The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. Methods A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006–11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. Results There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital re-admissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Conclusions Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes. What is known about the topic? The health gap between Aboriginal and non-Aboriginal Australians is well documented. Aboriginal people have significantly higher hospital utilisation rates, as well as higher rates of complications, comorbidities and discharges against medical advice (DAMA). Aboriginal patients receive most of their specialist services in hospital; however, detailed person-based analyses are limited and planning is often based on crude data. What does this paper add? This is the first analysis of linked data focusing on Aboriginal patient flows and volume and 28-day health system outcomes following hospital admission for all causes in a large metropolitan setting. Because the data were linked, admissions belonging to a single episode of care were combined, ensuring that transfers were not counted as re-admissions. Linkage also allowed follow up across time. The results highlight the main disease groups for which Aboriginal patients are admitted, how this varies by age and the high proportion of patients returning to (any) hospital within 28 days, either through EDs or as booked (pre-arranged) admissions. These data aid in the planning of hospital-based Aboriginal health liaison services. What are the implications for practitioners? The paper outlines the complexity with which many Aboriginal patients present to hospital and the risk of DAMA and re-admission. Clinical and organisational strategies can be put in place in hospitals to address these risks and ensure improved continuity of care with community-based primary health services. The Western Australian South Metropolitan Health Service is reviewing these data and will monitor the impact of the hospital-based AHLO program.
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Ronquillo, Charlene, and Ken Stein. "PP102 Developing A Contextually-Informed Deprescribing Intervention." International Journal of Technology Assessment in Health Care 34, S1 (2018): 104–5. http://dx.doi.org/10.1017/s0266462318002441.
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Introduction:Deprescribing – a process for reducing or stopping drugs when the balance of benefits and harms may no longer be in a person's interests – is a key aspect of managing multimorbidity and polypharmcacy in older people. Several deprescribing interventions have been developed (e.g. in Australia and Canada), although significant challenges for successful implementation remain. Through key stakeholder consultation in the care home setting in South West England, we take the initial steps to develop a context-informed deprescribing approach. Engaging stakeholders from the outset gains insight into acceptability, feasibility, and relevance of deprescribing interventions developed elsewhere informing co-production of an effective, implementable approach.Methods:Consultation workshops were held with two groups of stakeholders: (i) care home residents and their families; (ii) care home staff and health care professionals (general practitioners, medical specialists, pharmacists, nurses, allied health professionals). Focus groups were held with each group separately to understand perspectives on: deprescribing in general; contextual considerations; and, perspectives on deprescribing interventions developed in other countries. A combined focus group then considered components of a deprescribing intervention for care homes. Qualitative data were audio recorded, transcribed, and thematically coded.Results:Participants described the nature of local relationships, dynamics, structures, and resources, as important considerations in the development of a deprescribing approach in care homes. Perspectives and concerns around deprescribing among the stakeholder groups varied, although the importance of eliciting local stakeholder feedback in the early stages of developing a deprescribing intervention was a common thread.Conclusions:Early engagement and co-production are crucial in developing an approach to deprescribing in care homes. The combination of stakeholder involvement and qualitative research is important for developing an effective, contextually relevant intervention as the balance between interests can be incorporated into the approach. Leveraging the experience in other countries is a novel and valuable step.
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Wales, Kylie, Glenn Salkeld, Lindy Clemson, Natasha A. Lannin, Laura Gitlin, Laurence Rubenstein, Kirsten Howard, Martin Howell, and Ian D. Cameron. "A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial." Clinical Rehabilitation 32, no. 7 (March 23, 2018): 919–29. http://dx.doi.org/10.1177/0269215518764249.
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Objective: To compare the cost effectiveness of two occupational therapy–led discharge planning interventions from the HOME trial. Design: An economic evaluation was conducted within the superiority randomized HOME trial to assess the difference in costs and health-related outcomes associated with the enhanced program and the in-hospital consultation. Total costs of health and community service utilization were used to calculate incremental cost-effectiveness ratios, activities of daily living and quality-adjusted life years. Setting: Medical and acute care wards of Australian hospitals ( n=5). Subjects: A total of 400 people ≥ 70 years of age. Interventions: Participants were randomized to either (1) an enhanced program (HOME), involving pre/post discharge visits and two follow-up phone calls, or (2) an in-hospital consultation using the home and community environment assessment and the Lawton Instrumental Activities of Daily Living assessment. Main measures: Nottingham Extended Activities of Daily Living (global measure of activities of daily living) and SF-12V2, transformed into SF-6D (quality-adjusted life year) measured at baseline and three months post discharge. Results: The cost of the enhanced program was higher than that of the in-hospital consultation. However, a higher proportion of patients showed improvement in activities of daily living in the enhanced program with an incremental cost-effectiveness ratio of $61,906.00 per person with clinically meaningful improvement. Conclusion: Health services would not save money by implementing the enhanced program as a routine intervention in medical and acute care wards. Future research should incorporate longer time horizons and consider which patient groups would benefit from home visits.
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Ho (何式怡), Elsie Seckyee, and Lan-hung Nora Chiang (姜蘭虹). "Translocal Families: The Challenges of Practicing Filial Piety through Transnational Parental Care (台灣澳洲移民為盡孝道而跨國照顧年長父母的挑戰)." Translocal Chinese: East Asian Perspectives 10, no. 2 (October 20, 2016): 232–58. http://dx.doi.org/10.1163/24522015-01002004.
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The values of filial piety have strongly influenced the care of older people in traditional Chinese societies. Changes in family structure and relationships have occurred and in recent decades, transnational migration has become a factor in how filial piety is perceived and practiced in contemporary translocal Chinese families. Through the use of in-depth interviews, this pilot study explores transnational family patterns, elder care practices, attitudes towards filial piety, and opinions of the medical systems in Taiwan and Australia among 14 Taiwanese families who have lived in Australia for over 20 years. The study finds that despite immigration, filial piety remains an important value for these families. Most participants have/had provided care to their aged parents at the site of immigration and back home, and some of these parents were immigrants who had returned to Taiwan in their old age. Participants generally felt that older people are better looked after in Taiwan than in Australia, as Taiwan has a better healthcare system, and hired caregivers are more readily available. Elders’ expectations of filial piety from their children varied among participants, but all were prepared for a weakening of filiality and ongoing changes in intergenerational relations while living in a Western country. 傳統中國社會的老人照顧，受到孝道價值觀的影響很深。因為家庭結構及成員關係的改變，特別是近三十年來移民國外人口的增加，對當代華人家庭對孝道的認知與實踐產生了新的影響。本研究透過深入訪談居住澳洲二十年以上的台灣移民，探索跨國家庭類型、照顧年長父母的方式、對孝道的看法，以及台灣及澳洲兩地醫療體系的差異。研究發現雖然移民海外，盡孝道仍是重要的家庭價值。大部分的受訪者都曾為長者提供資源或參與照顧，無論是在澳洲或在台灣。年長父母也曾經在成年子女居住澳洲期間前往探視、短期逗留或移民。他們大部分都已回流台灣，原因是在台灣的年長者會得到較好的照顧，台灣的健保制度較適合年長者的需要，而且可以僱用外傭幫忙。已定居澳洲的台灣移民，對孝道的看法雖有差異，但對自己的成年子女是否能在環境不同的西方國家盡孝道，均有所保留。 (This article is in English.)
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Ferreira, Giovanni E., Gustavo C. Machado, Christina Abdel Shaheed, Chung-Wei Christine Lin, Chris Needs, James Edwards, Rochelle Facer, Eileen Rogan, Bethan Richards, and Christopher G. Maher. "Management of low back pain in Australian emergency departments." BMJ Quality & Safety 28, no. 10 (June 4, 2019): 826–34. http://dx.doi.org/10.1136/bmjqs-2019-009383.
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BackgroundTo describe the diagnoses of people who present to the emergency department (ED) with low back pain (LBP), the proportion of people with a lumbar spine condition who arrived by ambulance, received imaging, opioids and were admitted to hospital; and to explore factors associated with these four outcomes.MethodsIn this retrospective study, we analysed electronic medical records for all adults presenting with LBP at three Australian EDs from January 2016 to June 2018. Outcomes included discharge diagnoses and key aspects of care (ambulance transport, lumbar spine imaging, provision of opioids, admission). We explored factors associated with these care outcomes using multilevel mixed-effects logistic regression models and reported data as ORs.ResultsThere were 14 024 presentations with a ‘visit reason’ for low back pain, of which 6393 (45.6%) had a diagnosis of a lumbar spine condition. Of these, 31.4% arrived by ambulance, 23.6% received lumbar imaging, 69.6% received opioids and 17.6% were admitted to hospital. Older patients (OR 1.79, 95% CI 1.56 to 2.04) were more likely to be imaged. Opioids were less used during working hours (OR 0.81, 95% CI 0.67 to 0.98) and in patients with non-serious LBP compared with patients with serious spinal pathology (OR 1.65, 95% CI 1.07 to 2.55). Hospital admission was more likely to occur during working hours (OR 1.74, 95% CI 1.48 to 2.05) and for those who arrived by ambulance (OR 2.98, 95% CI 2.53 to 3.51).ConclusionMany ED presentations of LBP were not due to a lumbar spine condition. Of those that were, we noted relatively high rates of lumbar imaging, opioid use and hospital admission.
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Hosie, Annmarie, Jane Phillips, Lawrence Lam, Slavica Kochovska, Beverly Noble, Meg Brassil, Susan E. Kurrle, et al. "Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: study protocol for a phase II cluster randomised controlled trial." BMJ Open 9, no. 1 (January 2019): e026177. http://dx.doi.org/10.1136/bmjopen-2018-026177.
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IntroductionDelirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group.Methods and analysisThe study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial.Ethics and disseminationEthical approval was obtained for all four sites. Trial results, qualitative substudy findings and implementation of the intervention will be submitted for publication in peer-reviewed journals, and reported at conferences, to study sites and key peak bodies.Trial registration numberACTRN12617001070325; Pre-results.
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MCCORMACK, JOHN. "Acute hospitals and older people in Australia." Ageing and Society 22, no. 5 (September 2002): 637–46. http://dx.doi.org/10.1017/s0144686x02008802.
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The Australian health care system is frequently portrayed as being in crisis, with reference to either large financial burdens in the form of hospital deficits, or declining service levels. Older people, characterised as a homogeneous category, are repeatedly identified as a major contributor to the crisis, by unnecessarily occupying acute beds while they await a vacancy in a residential facility. Several enquiries and hospital taskforce management groups have been set up to tackle the problem. This article reviews their findings and strategic recommendations, particularly as they relate to older people. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care, and which, while claiming positive intentions, may introduce new forms of age discrimination into the health system. Few of the currently favoured proposals promote age-inclusivity and older people's rights to equal access to acute care.
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McCormack, John, Alun C. Jackson, and Shane A. Thomas. "Gambling and older people in Australia." Australasian Journal on Ageing 22, no. 3 (September 2003): 120–26. http://dx.doi.org/10.1111/j.1741-6612.2003.tb00481.x.
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Healy, Judith. "The Care of Older People: Australia and the United Kingdom." Social Policy and Administration 36, no. 1 (February 2002): 1–19. http://dx.doi.org/10.1111/1467-9515.00266.
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Henderson, Emily J., and Gideon A. Caplan. "Home Sweet Home? Community Care for Older People in Australia." Journal of the American Medical Directors Association 9, no. 2 (February 2008): 88–94. http://dx.doi.org/10.1016/j.jamda.2007.11.010.
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Farooq, Saeed, Paul Kingston, and Jemma Regan. "Working through interpreters in old age psychiatry: a literature review." Mental Health Review Journal 20, no. 1 (March 9, 2015): 36–47. http://dx.doi.org/10.1108/mhrj-12-2013-0040.
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Purpose – The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health. Design/methodology/approach – The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies. Findings – Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003). Practical implications – Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics. Social implications – The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012). Originality/value – Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.
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Waling, Andrea, Anthony Lyons, Beatrice Alba, Victor Minichiello, Catherine Barrett, Mark Hughes, Karen Fredriksen-Goldsen, and Samantha Edmonds. "Trans Women’s Perceptions of Residential Aged Care in Australia." British Journal of Social Work 50, no. 5 (October 24, 2019): 1304–23. http://dx.doi.org/10.1093/bjsw/bcz122.
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Abstract Many older people in trans communities in Australia and elsewhere have experienced long histories of violence and discrimination in the health and social care sectors, making some of them fearful of interacting with contemporary health and social care providers. This study explored older trans women’s perceptions of these services. It involved a qualitative, thematic analysis of semi-structured, one-on-one audio-recorded interviews with ten trans women aged sixty years and older in Australia. Participants expressed a number of concerns about using residential facilities for older people in Australia, including potential for abuse and discrimination as a result of being trans, and not having access to appropriate treatments. Participants indicated a range of alternatives in using services, such as renovating the home, relocating to areas with greater access to trans-inclusive services and potential euthanasia. Participants perceived that service providers were not adequately trained for trans and gender diverse needs, and highlighted a number of ways aged care services could better support the trans and gender diverse community. The findings provide important information to assist health and social care professionals, including social workers, as well as residential care service providers, in supporting the health and well-being of older trans women.
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Alderman, Chris. "Special Pharmacy Challenges for Older People in Difficult Times." Senior Care Pharmacist 35, no. 3 (March 1, 2020): 108–9. http://dx.doi.org/10.4140/tcp.n.2020.108.
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Older people are especially vulnerable to the impacts of natural disasters such as the fires in Australia and elsewhere around the world. Health care professionals have a duty of care under these circumstances, and among those who respond are pharmacists who contribute their expertise, energy, and dedication to help where needed.
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Parker, D. "KNOWLEDGE INTO PRACTICE: IMPROVING ADVANCE CARE PLANNING FOR OLDER PEOPLE IN AUSTRALIA." Innovation in Aging 1, suppl_1 (June 30, 2017): 1266. http://dx.doi.org/10.1093/geroni/igx004.4611.
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Meyer, Judy, and Maria Oliva. "Beware: The Gaps in Medical Care for Older People." American Journal of Nursing 85, no. 4 (April 1985): 490. http://dx.doi.org/10.2307/3425112.
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&NA;, &NA;. "Beware: The Gaps In Medical Care For Older People." AJN, American Journal of Nursing 85, no. 4 (April 1985): 490. http://dx.doi.org/10.1097/00000446-198504000-00055.
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Brodaty, Henry, Brian M. Draper, and David C. Lie. "Psychogeriatrics and General Practice in Australia." International Journal of Psychiatry in Medicine 27, no. 3 (September 1997): 205–13. http://dx.doi.org/10.2190/r7yg-7qlj-qjmh-v1cr.
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We describe the interface between general practice and psychogeriatrics in Australia. While aged care services are complex and there are serious deficiencies in the management of the elderly, several initiatives appear set to improve the level of care. Economic considerations, mutual education of general practitioners and psychogeriatricians, and social factors are strong determinants of good primary care of the mental health needs of older people.
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PETERSEN, MAREE, and JENI WARBURTON. "Residential complexes in Queensland, Australia: a space of segregation and ageism?" Ageing and Society 32, no. 1 (February 7, 2011): 60–84. http://dx.doi.org/10.1017/s0144686x10001534.
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ABSTRACTIn western countries, large residential complexes comprising retirement villages and care facilities have become synonymous with specialised housing for older people, but gerontology has tended to view retirement villages and care facilities as separate and different spaces. By researching these spaces separately, gerontology's examination of the development of residential complexes and older people's housing has been hindered. This paper explores the geographies of residential complexes in south-east Queensland, Australia, by employing data from a larger study that utilised Lefebvre's spatial framework, social space. Its specific focus is Lefebvre's concept of representations of space, part of the triad of social space. The paper outlines how the professional knowledge of designers, planners and policy makers shape and frame the place of older people in contemporary society. The findings indicate that professional knowledge is characterised by contradictions, and that business interests sustain stereotypes of older people as either ageless or dependent. Furthermore, spaces designed for older people reinforce historical legacies of separation from the community. This form of built environment can thus be seen as both a cause and effect of ageism. Generally, the lack of attention by gerontology to these spaces has hampered discussion of alternatives for older people's housing in Australia and, importantly, the development of responsive urban and social planning.
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Tinker, Anthea, Victoria Berdugo, Michael Buckland, Lois Crabtree, Anistta Maheswaran, Andrea Ong, Jasmine Patel, Emilia Pusey, and Chandini Sureshkumar. "Volunteering with older people in a care home." Working with Older People 21, no. 4 (December 11, 2017): 229–35. http://dx.doi.org/10.1108/wwop-08-2017-0019.
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Purpose The purpose of this paper is to investigate the influence that volunteering before medical school with older people in a care home has on the perceptions of older people. Design/methodology/approach Eight medical students answered an anonymous questionnaire relating to their experiences of volunteering in a care home before medical school. This was combined with an analysis of the relevant literature. Findings All the students had initially volunteered to enhance their CV for medical school. After volunteering, they had a greater realisation of the variety of older people. They also gained a number of transferable skills related to communicating with older people, especially those with cognitive impairment. The greatest learning experience was around the issues to do with dementia. Research limitations/implications The research is based on eight students although they were from different areas. Practical implications It would be beneficial if care homes could be more proactive in encouraging prospective medical students to volunteer. Medical schools could also provide clearer advice or take a more active stance such as encouraging prospective students to volunteer with older people. Further research should be with a larger sample to gain insight into varying perspectives. It would also be useful to conduct research into older adults’ attitudes towards the contribution of potential medical students to their own lives and to the home. Social implications Volunteering before medical school should be encouraged as it will enhance the chances of getting a place as well as being an eye opening experience and equip them with lifelong skills. Originality/value Original.
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Tan, Heather, Robin Digby, Melissa Bloomer, Yixin Wang, and Margaret O'Connor. "End-of-life care in a rehabilitation centre for older people in Australia." Australasian Journal on Ageing 32, no. 3 (January 31, 2013): 184–87. http://dx.doi.org/10.1111/j.1741-6612.2012.00654.x.
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Braithwaite, J. "Regulating nursing homes: The challenge of regulating care for older people in Australia." BMJ 323, no. 7310 (August 25, 2001): 443–46. http://dx.doi.org/10.1136/bmj.323.7310.443.
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Mackenzie, Lynette, and Amanda Clifford. "Perceptions of older people in Ireland and Australia about the use of technology to address falls prevention." Ageing and Society 40, no. 2 (August 28, 2018): 369–88. http://dx.doi.org/10.1017/s0144686x18000983.
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AbstractFalls are common events with serious consequences for older people. With an ageing population and increasing health-care costs, information and communication technologies (ICT) will have a potential role in future health-care delivery. However, research on technology acceptance in health care for older people is limited and its application to falls prevention is unknown. The aims of this study were to explore and describe the perceptions of community-dwelling Australian and Irish older people about their current use of technology, and the potential use of technology for falls prevention. Qualitative data were collected from three focus groups conducted in and around Limerick in Ireland, and three in the Sydney area, Australia. A total of 35 older people participated. Data were analysed using thematic analysis. Four themes emerged from the data: (a) perceptions of vulnerability to falls, (b) preferences for exercise interventions, (c) participation in and ownership of technology, and (d) perceptions about applications of technology for falls prevention. As the use of technology is an instrumental activity of daily living, health professionals need to assess the capacity of older people to adopt these technologies, and provide falls prevention interventions to accommodate the technology skills of older people. Some participants were reluctant to embrace technology and barriers to the effective use of technology to assist in preventing falls may conflict with future health service trends.