Australasian Journal on Ageing最新文献

Objective: The Short-Term Restorative Care program is an 8-week multidisciplinary early intervention funded by the Australian Government that aims to reverse or slow the functional decline of older Australians. Despite the large investment of tax-payer money to fund the program, very little peer-reviewed literature exists examining the ability of the program to deliver on its aims.

Methods: This was a retrospective cohort study.

Setting: Data were collected from an aged care provider (BallyCara Ltd) located in Australia.

Participants: Historical data from 1074 participants were analysed.

Outcome measures: This study reported descriptives of the population that undertook the program and the activities completed by participants during the program, and investigated if the program is associated with changes across four domains of function (Modified Barthel Index, Lower Extremity Functional Scale, Upper Extremity Functional Index and Berg Balance Scale).

Results: Findings suggest the program results in statistically significant improvements (p ≤ .0001) in disability and physical functioning as measured by the Modified Barthel Index, Lower Extremity Functional Scale, Upper Extremity Functional Index and Berg Balance Scale tools. Such findings validate the ability of the program to slow or reverse functional decline.

Conclusions: This study will help to inform future modifcations to the Short-Term Restorative Care program as well as inform program development of similar interventions.

Objectives: To examine (1) the knowledge of dementia among Aboriginal and Torres Strait Islander community members and health-care workers providing care to Aboriginal and Torres Strait Islander people; (2) the factors associated with higher levels of knowledge about dementia.

Methods: An online cross-sectional survey was conducted. Aboriginal and Torres Strait Islander community members were recruited through social media advertisements and an online market research platform. Health-care workers (general practitioners, nurses, Aboriginal health workers and allied health professionals) were recruited via emailed invitations from a peak body and a community service organisation. Participants answered an online survey containing 34 true/false items examining knowledge of dementia. Separate linear regressions were used to examine the factors associated with higher levels of knowledge about dementia among community members and health-care workers.

Results: Two hundred and twenty individuals (74 community members and 146 health-care workers) participated. The overall mean knowledge of dementia score for all participants was 26.80 (SD = 4.43). Health-care workers had higher knowledge (M = 27.23, SD = 4.66) than community members (M = 25.96, SD = 3.82, p = .04). Community members with higher levels of education answered 6% (95% CI 1%-11%) more items correctly than participants with lower levels of education. General practitioners and nurses had significantly higher knowledge of dementia; however, health-care workers who provided care to a family member or friend living with dementia had significantly lower knowledge of dementia.

Conclusion: Novel approaches are needed to increase knowledge of dementia amongst both Aboriginal and Torres Strait Islander community members and health-care workers who provide care to ensure culturally sensitive and effective support.

Objective: High-quality food, nutrition and dining are essential tenets of residential aged care facilities (RACF). Residential aged care facilities provide website information on their services for prospective residents, which may offer insight into food, nutrition and dining practices. This study aimed to describe the food, nutrition and dining information on RACF websites.

Methods: A cross-sectional website analysis was conducted on Southeast Queensland (SEQ) RACF websites. Food, nutrition and dining data were extracted verbatim under domains of nutrition care processes, food and menu planning, eating assistance and mealtime experiences, with further subdomains under each. Quantitative content analysis was conducted to describe the information reported on websites, descriptive statistics were used to describe RACF characteristics, and Pearsons χ² analyses were performed to detect associations between different food, nutrition and dining practices and RACF characteristics.

Results: A total of 268 websites were reviewed. Food, nutrition and dining information were limited, with no subdomains mentioned by all websites. The most frequently mentioned subdomains were the foodservice model (64%, n = 171), allied health services (72%, n = 173) and communal dining (73%, n = 193). Assistive/adaptive equipment to support independence (0%, n = 0), personalised nutrition care plan (0%, n = 1) and reference to food, nutrition or food safety standards (2%, n = 5) were the least mentioned subdomains. Facility characteristics had minimal associations with subdomains.

Conclusions: There are opportunities for RACF to improve the information on food, nutrition and dining information on websites to increase transparency to future residents. The subdomains developed in this study could provide guidance to RACF to enhance online information.

Objective: This study assessed perceived acceptability of online rural volunteer-led exercise classes among volunteer leaders and older people during the COVID-19 pandemic and interrogate differences in acceptability between older people who were currently participating in regular exercise and those who were not.

Method: A case study was conducted of an existing volunteer-led exercise program using a cross-sectional preintervention survey (38 volunteer exercise leaders and 172 program participants).

Results: Thirty per cent (n = 11) of the volunteer leaders reported an interest in running the online classes. Motivations included providing opportunities for participants and keeping themselves and participants fit. Thirty-four per cent (n = 42) of the older participants reported an intent to join the online classes, which was primarily attributed to the desire to keep active and to socialise. However, over 60% of the respondents across both categories did not want to engage in online exercise classes. This was primarily attributed to a preference for face-to-face classes and lack of confidence in conducting or using online activities or services. Older participants who did not regularly exercise were statistically more likely to report perceived challenges attending an online class, and to identify the use of internet-based technologies as a barrier to attendance.

Conclusion: Digital literacy was a challenge for the older respondents, particularly for those who were not currently engaged in regular exercise. Organisations implementing online exercise programs should recognise that this form of delivery will pose challenges to cohorts of rural older people who are not undertaking regular physical activity and address the individual and environmental barriers to digital uptake.

Objective: This paper reports on the design and implementation of an interactive online education package for the diverse Australian residential aged care workforce, in response to the findings of the Royal Commission into Aged Care Quality and Safety. A decade of reports has consistently highlighted the need for an educated workforce to care for the increasingly frail older people with complex care needs living in residential aged care. Cost, availability and timing of education have been identified as barriers to uptake of education for this workforce.

Methods: A heutagogical approach was used to design an evidence-based, modular, online education package for nurses, care workers and allied health practitioners working in the residential aged care sector. The subject matter was developed by experts and the education divided into modules. A key challenge was to design a package that was inclusive of the diversity of educational needs in this workforce. The package does not provide assessments on completion of the modules, relying solely on the motivation of the individual learner.

Results: This online education package provides choice and self-determination for users in their learning journey. Collaborating with experts to develop an online education program that is learner-driven, challenges the conventions of education. Users can navigate the package at their pace; choose the modules they have identified as knowledge gaps or are of interest; and complete the education in their own time.

Conclusion: As expected, most users are care workers and nurses and the five modules of the Dementia program are the most popular.

Objective: To explore the association between the implementation of medication safety-related processes measured with the Medication Safety Self-Assessment for Long-Term Care (MSSA-LTC) tool and medication use in residential aged care facilities (RACFs).

Methods: A descriptive cross-sectional study was conducted in Australian RACFs. Data on facility characteristics, aggregated medication use at the facility level for selected medications commonly associated with a high risk of harm and the MSSA-LTC were completed by clinical pharmacists providing clinical pharmacy services. The Spearman's correlation test was used to evaluate the association between the MSSA-LTC score and medication use. A scatter plot between the MSSA-LTC score and medication use data was generated, and a linear trend line was plotted using the least squares method.

Results: Data were collected from 31 RACFs servicing 2986 residents. Most medication safety-related processes were implemented in Australian RACFs. A higher facility MSSA-LTC score was associated with a lower proportion of residents with polypharmacy (r = -.48, p = .01) and one or more benzodiazepines (r = -.41, p = .03). In addition, a negative linear trend was observed between the MSSA-LTC score and the average number of medications per resident, the proportion of residents with one or more anticonvulsants and the proportion of residents using one or more opioid analgesics.

Conclusions: This study indicates that implementing medication safety-related processes may improve medication use in RACFs.

Objective: Older inpatients who fall are often frail, with multiple co-morbidities and polypharmacy. Although the causes of falls are multifactorial, sedating and delirium-inducing drugs increase that risk. The aims were to determine whether people who fell had a change in their sedative and anticholinergic medication burden during an admission compared to people who did not fall. A secondary aim was to determine the factors associated with change in drug burden.

Methods: A retrospective, observational, case-control study of inpatients who fell. Two hundred consecutive people who fell were compared with 200 randomly selected people who had not fallen. Demographics, functional ability, frailty and cognition were recorded. For each patient, their total medications and anticholinergic and sedative burden were calculated on admission and on discharge, using the drug burden index (DBI).

Results: People who fell were more dependent and cognitively impaired than people who did not fallen. People who fell had a higher DBI on admission, than people who had not fall (mean: .69 vs .43, respectively, p < .001) and discharge (.66 vs .38, p < .001). For both cohorts, the DBI decreased between admission and discharge (-.03 and -.05), but neither were clinically significant. Higher total medications and a higher number DBI medications on admission were both associated with greater DBI changes (p = .003 and <.001, respectively). However, the presence (or absence) of cognitive impairment, dependency, frailty and single vs multiple falls were not significantly associated with DBI changes.

Conclusions: In older people, DBI medications and falls are both common and have serious consequences, yet this study was unable to demonstrate any clinically relevant reduction in average DBI either in people who fell or people who had not fallen during a hospital admission.

Objectives: The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care.

Methods: Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis.

Results: Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models.

Conclusion: Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.