1
|
Ainsworth E, Aplin T, de Jonge D, Bennett S. Understanding home modification outcomes from the perspective of older people and people with a disability: informing home modification evaluation. Disabil Rehabil 2023; 45:4101-4110. [PMID: 36394257 DOI: 10.1080/09638288.2022.2146765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE There is limited evidence to guide therapists in home modification outcome evaluation. Involving consumers in evaluating home modifications is critical to progressing practice. This study investigated the home modification experience and outcomes most valued by older adults and individuals with a disability in Australia. MATERIALS AND METHODS An interpretive description approach was used. Twenty participants aged 24-93 who had received major home modifications were interviewed and transcripts were analysed thematically. RESULTS Two major themes emerged: life before and during modifications - "it was all hard," and life after modifications - "to have a life." People's prior experience of home, the circumstance of and time to plan modifications, the perceived value of the modifications, and the home modification process and funding influenced perceptions of outcomes. Valued home modification outcomes included those that enable people to experience emotional and physical health, and safety; do what they want; maintain the image of the home; and plan for the future. Experiences and perceptions of modifications ranged from supportive to disruptive. CONCLUSIONS These findings point to the need for therapists to deeply understand and evaluate their clients' experiences of home and life as an initial and critical step in the home modification process.Implications for rehabilitationMajor home modifications result in broad and meaningful outcomes of importance to clients.Occupational therapists need to partner with clients to understand their life before and during modifications to achieve positive outcomes.Evaluation of major home modifications needs to be integrated and prioritised in daily practice.
Collapse
Affiliation(s)
- Elizabeth Ainsworth
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Tammy Aplin
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Australia
| | - Desleigh de Jonge
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Sally Bennett
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| |
Collapse
|
2
|
Aclan R, George S, Block H, Lane R, Laver K. Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis. BMC Geriatr 2023; 23:707. [PMID: 37907851 PMCID: PMC10619279 DOI: 10.1186/s12877-023-04279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/05/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance. OBJECTIVE The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing. METHODS This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings. RESULTS A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection. CONCLUSION Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.
Collapse
Affiliation(s)
- Roslyn Aclan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Stacey George
- Occupational Therapy, Academic Lead and Research Lead, Allied Health Chair, Northern Adelaide Local Health Network, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Heather Block
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rachel Lane
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| |
Collapse
|
3
|
Gibson A, Pope N, Loeffler D, Ratliff S, Engelhardt E. Identifying Aging Adults' Housing Preferences: An Age-Friendly Initiative. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:43-63. [PMID: 36017586 DOI: 10.1080/01634372.2022.2113490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Community planning around housing needs of older adults is, at present, very understudied. This study stemmed from a practical need to determine the housing preferences of residents as part of an Age Friendly Community initiative. Data presented in this paper focus on the quantitative component of a sequential mixed methods study examining attitudes and preferences about housing. This first phase of this project involved data collected from 1,514 residents aged 30+ using a researcher-devised survey of 43 items. There was little difference in housing preferences between older and younger respondents or among those with varying financial means. Analysis revealed the most important housing considerations were safety in home, affordability, privacy, proximity to services frequently used, and accessibility. An unexpected finding was that almost half of older respondents expressed a willingness to share a home with a roommate. There were also differences in preferences on home environment based on current marital status. Data suggests that city planners and property developers should prioritize these preferences when planning for the housing-related needs of older residents. Future research should examine the interpretation of housing preferences, such as qualitative exploration of what it means for housing to be "safe" or 'affordable.'
Collapse
Affiliation(s)
- Allison Gibson
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Natalie Pope
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Diane Loeffler
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Stephanie Ratliff
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Ethan Engelhardt
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
4
|
Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice. Am J Occup Ther 2022; 76:24009. [PMID: 36735994 DOI: 10.5014/ajot.2022.76s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This position statement describes the role and importance of occupational therapy practitioners in integrating inclusive environments into their professional services and into their underlying science. Primary documents that define the occupational therapy profession clearly support its role in creating and ensuring inclusive environments.
Collapse
|
5
|
Kamil W, Kruger E, Turlach B, Tennant M. The evolving disparities in location and socioeconomics of an ageing Australian society. Australas J Ageing 2022. [PMID: 36254700 DOI: 10.1111/ajag.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 08/17/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES It is well known that there are associations between overall health, age, socioeconomic status and rural residency. The objective of this study was to determine the distribution of Australia's aged population by socioeconomic status, as well as remoteness. METHODS The study employed the Australian Statistical Geography Standard (Statistical Area Level 1 and Remoteness Areas). The database of the geographic boundaries was integrated into the ageing population and socioeconomic data using the Geographic Information System. The socioeconomic data was analysed through the Index of Relative Socioeconomic Disadvantage. RESULTS Over a decade, the older population in Australia has increased noticeably. In 2016, there was a high percentage of older people (≥65 years) in Tasmania (Tas), 19%, while the lowest percentage was recorded in the Northern Territory (NT), 7%. Across the country, Tasmania had the highest percentage of older citizens living in the most disadvantaged areas since 2006, with 48% recorded in 2016. There was an association between the remoteness areas and the education and income levels of the ageing cohort. However, this association differed between the states and territories. This socioeconomic gap becomes more evident in the very remote areas of the country. CONCLUSIONS The ageing population in Australia is increasing rapidly; this was associated with an evolving socioeconomic disparity among this ageing society. Our results demonstrated that socioeconomic inequalities were to be found among the older people based on their distribution over the remoteness areas in Australia. This information should be used to target healthcare and ageing policies that meet the specific needs of older people.
Collapse
Affiliation(s)
- Wisam Kamil
- Department of Anatomy, The University of Western Australia, Perth, Western Australia, Australia
| | - Estie Kruger
- Department of Anatomy, The University of Western Australia, Perth, Western Australia, Australia
| | - Berwin Turlach
- Department of Anatomy, The University of Western Australia, Perth, Western Australia, Australia
| | - Marc Tennant
- Department of Anatomy, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Self-assessment of the home environment to plan for successful ageing: Report from a digital health co-design workshop. PLOS DIGITAL HEALTH 2022; 1:e0000069. [PMID: 36812550 PMCID: PMC9931232 DOI: 10.1371/journal.pdig.0000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
Many middle aged and older people will need to adapt or modify their home in order to age in place. Arming older people and their families with the knowledge and tools to assess their home and plan simple modifications ahead of time will decrease reliance on professional assessment. The objective of this project was to co-design a tool which enables people to assess their own home environment and make future plans for ageing in the home. We recruited members of the public who were aged 60 or older to attend a series of two co-design workshops. Thirteen participants worked through a series of discussions and activities including appraising different types of tools available and mapping what a digital health tool might look like. Participants had a good understanding of the main types of home hazards in their own homes and the types of modifications which may be useful. Participants believed the concept of the tool would be worthwhile and identified a number of features which were important including a checklist, examples of good design which was both accessible and aesthetically pleasing and links to other resources such as websites which provide advice about to make basic home improvements. Some also wanted to share the results of their assessment with family or friends. Participants highlighted that features of the neighbourhood, such as safety and proximity to shops and cafes, were also important when considering the suitability of their home for ageing in place. Findings will be used to develop a prototype for usability testing.
Collapse
|
7
|
“If There Isn’t Love, It Isn’t Home”: An Exploration of Relationship Qualities and the Meaning of Home for Residents in Aged Care. RELIGIONS 2022. [DOI: 10.3390/rel13070604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Exploring the meaning of home is essential for the quality of life and well-being of older people in residential aged care. ‘Home’ is a spiritual concept that is deeply personal and important for older people. Using a qualitative, phenomenologically-based methodology, the meaning of home for ten older people living in residential aged care in Australia was examined using in-depth interviews to draw out the depth of meaning around the home. A key finding of the study showed that ‘home’ means connection through meaningful relationships and meaningful connection to place. The current paper focuses on meaningful relationships required for an older person to feel ‘at home’ in residential aged care. Drawing on residents’ personal narratives, fresh insights are provided into essential relationship qualities, and suggestions are made on how quality relationships can be facilitated and maintained, both for and by residents, to increase a sense of homeliness in residential aged care.
Collapse
|
8
|
Gordon S, Telford-Sharp F, Crowe W, Champion S. Effectiveness of a co-designed technology package on perceptions of safety in community-dwelling older adults. Australas J Ageing 2022; 41:e257-e265. [PMID: 35635481 DOI: 10.1111/ajag.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Increasing numbers of older people are living longer, often alone, in their own homes. Services and products that enable older people to remain safely in their own homes are required. The My Smart Home project recruited 30 community-dwelling people aged 65+ to co-design a package of technology to address their individual goals for safety and security at home. The technology package, up to the value of $4000, included installation of health monitoring, communication and entertainment devices, and security alarms, with 6 hours of technology coaching. METHODS Participants completed the Personal Wellbeing Index (PWI), the Australian Quality of Life-8 Dimensions (AQoL-8D) and the Canadian Occupational Performance Measure (COPM) at baseline, and after 4 weeks' use of the technology package. Semi-structured interviews were also used to qualitatively understand the challenges, enablers and outcomes of the project with respect to safety and security in the home. RESULTS Significant improvements in PWI (p < 0.01), AQoL-8D (p < 0.000) and COPM for goal performance (p < 0.000) and goal satisfaction (p < 0.000) were reported. Participants also reported feeling safer and more secure in their own homes. Common barriers to adoption of technology, cost, integration with already-owned technology and lack of confidence were overcome with this technology and coaching package. CONCLUSIONS An individualised package of technology, with coaching, that supports older people to realise their personal goals with technology resulted in improved well-being, quality of life and sense of safety and security in community-dwelling older people. Ultimately, this should support a longer and better quality of life at home.
Collapse
Affiliation(s)
- Susan Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,ACH Group Inc., Adelaide, South Australia, Australia
| | | | - William Crowe
- ACH Group Inc., Adelaide, South Australia, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
9
|
Kamil W, Kruger E, McGeachie J, Jean G, Tennant M. Distribution of Australian dental practices in relation to the ageing population. Gerodontology 2021; 39:302-309. [PMID: 34331336 DOI: 10.1111/ger.12585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia. BACKGROUND The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need. MATERIALS AND METHODS Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology. RESULTS There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5 km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities. CONCLUSION There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.
Collapse
Affiliation(s)
- Wisam Kamil
- Department of Anatomy Physiology & Human biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Estie Kruger
- Department of Anatomy Physiology & Human biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - John McGeachie
- Department of Anatomy Physiology & Human biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Gillian Jean
- Department of Anatomy Physiology & Human biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Marc Tennant
- Department of Anatomy Physiology & Human biology, School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
10
|
Dendle K, Miller E, Buys L, Vine D. My home in later life: A phenomenographic study of older adults' experience of home. J Aging Stud 2021; 57:100935. [PMID: 34083004 DOI: 10.1016/j.jaging.2021.100935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults. This paper considers the breadth of home environments experienced by diverse older Australians and highlights the varied ways they use and think about their homes. Data from three national online focus groups (n1 = 33, n2 = 37, n3 = 33) with people aged 50-92 were analysed using phenomenographic approaches to explore the different ways older adults perceived their home environments, resulting in four hierarchical conceptions. People displayed vastly different lifetime housing pathways (Clapham, 2005), leading to diverse perceptions about the place and experience of home in their later lives. In assessing the suitability of their housing, older people considered a large number of household members: current, expected or desired co-residents; transitory, short, medium and long-term residents; near and extended family, friends and dependents. This has important implications for policy and design responses on older adult's homes, which are typically focussed on occupancy by one or two individuals. To avoid assumptions about household makeup and usage based solely on the chronological age of residents, the perspective of older adults must be embraced in designing their future housing.
Collapse
Affiliation(s)
- Kelli Dendle
- School of Design, Queensland University of Technology, 2 George St, Brisbane, 4000, Queensland, Australia.
| | - Evonne Miller
- School of Design, Queensland University of Technology, 2 George St, Brisbane, 4000, Queensland, Australia.
| | - Laurie Buys
- Institute for Future Environments, Queensland University of Technology, 2 George St, Brisbane, 4000, Queensland, Australia.
| | - Desley Vine
- Institute for Future Environments, Queensland University of Technology, 2 George St, Brisbane, 4000, Queensland, Australia.
| |
Collapse
|
11
|
Tse T, Lentin P, Douglas J, Carey LM. Understanding activity participation 3-months after stroke: a mixed methodology study. Disabil Rehabil 2020; 44:2868-2878. [PMID: 33353413 DOI: 10.1080/09638288.2020.1849429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate stroke survivors' activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation. METHOD Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis. RESULTS Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants' orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans. CONCLUSION Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments.Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations.Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person's activity/occupational participation during recovery from stroke.Returning to full activity/occupational participation after stroke is a dynamic and continuous process.Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the "right rehabilitation" at the "right time" throughout their recovery journey.
Collapse
Affiliation(s)
- Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Primrose Lentin
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Summer Foundation, Blackburn, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| |
Collapse
|
12
|
Lockwood KJ, Harding KE, Boyd JN, Taylor NF. Home visits by occupational therapists improve adherence to recommendations: Process evaluation of a randomised controlled trial. Aust Occup Ther J 2020; 67:287-296. [PMID: 32133668 DOI: 10.1111/1440-1630.12651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/26/2020] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION As part of hospital discharge planning, occupational therapists often provide recommendations to improve the interaction between a person and their home environment. The aim of this study was to investigate the number and type of recommendations made by occupational therapists during a home assessment visit compared to hospital-based assessment for patients recovering from hip fracture. A secondary aim was to explore adherence rates to the different types of recommendations. METHODS Process evaluation of a randomised controlled trial of 65 participants recovering from hip fracture, returning to community living after hospital discharge. All participants received inpatient multidisciplinary rehabilitation and hospital-based assessment by an occupational therapist (usual care). In addition, the intervention group participated in a single home visit with an occupational therapist prior to hospital discharge. Analysis included the number and type of occupational therapy recommendations, adherence to recommendations at 30 days after discharge, and mediation analysis. RESULTS Participants in the home visit group received more recommendations than the usual care group (mean difference [MD] 2.8, 95% CI 1.6 to 3.9) and adhered to a greater proportion of recommendations for assistive technologies (MD 11.4%, 95% CI 2.6 to 20.2) and task modifications (MD 10.0%, 95% CI 0.7 to 19.3). Participants in both groups had lower rates of adherence to recommendations for home modifications compared with other types of recommendations. Adherence to recommendations was a mediator in the relationship between participants' involvement in a pre-discharge home visit and reduced hospital readmissions. CONCLUSION There was greater adherence to occupational therapy recommendations when patients recovering from hip fracture participated in a home visit compared to hospital-based assessment, contributing to reduced readmissions to hospital in the first 30 days. Home visits offer additional benefits to hospital-based assessment through the use of a collaborative approach to decision making in the home environment.
Collapse
Affiliation(s)
- Kylee J Lockwood
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Vic., Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Vic., Australia
| | - Katherine E Harding
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Vic., Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Vic., Australia
| | - Jude N Boyd
- Department of Occupational Therapy, Eastern Health, Melbourne, Vic., Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Vic., Australia.,Allied Health Clinical Research Office, Eastern Health, Melbourne, Vic., Australia
| |
Collapse
|
13
|
Ogrin R, Meyer C, Appannah A, McMillan S, Browning C. The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study. Int J Equity Health 2020; 19:16. [PMID: 31992306 PMCID: PMC6988242 DOI: 10.1186/s12939-020-1124-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. Methods Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants’ experiences and understanding of diversity concepts and their care needs. Results Fifteen older people (seven female, eight male), mean age 76 years (range 71–85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. Conclusion Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.
Collapse
Affiliation(s)
- Rajna Ogrin
- Bolton Clarke Research Institute, Level 1.01, 973 Nepean Hwy, Bentleigh, Victoria, 3204, Australia. .,Austin Health Clinical School, University of Melbourne, Heidelberg, Victoria, Australia. .,Biosignals and Affordable Healthcare, RMIT, Melbourne, Victoria, Australia. .,Department of Business Strategy and Innovation, Griffith University, Gold Coast, Australia.
| | - Claudia Meyer
- Bolton Clarke Research Institute, Level 1.01, 973 Nepean Hwy, Bentleigh, Victoria, 3204, Australia.,LaTrobe University, Centre for Health Communication and Participation, Bundoora, Victoria, 3086, Australia.,School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia
| | - Arti Appannah
- LaTrobe University, Bundoora, Victoria, 3086, Australia
| | - Sally McMillan
- Bolton Clarke Clinical Learning Team, Level 1.01, 973 Nepean Hwy, Bentleigh, 3204, Australia
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, Victoria, 3353, Australia.,International Institute for Primary Health Care Research, Shenzhen, China.,Research School of Population Health, Australian National University, Canberra, ACT, 0200, Australia
| |
Collapse
|
14
|
Kingston G, Pain T, Murphy K, Bennett M, Watson M. Perceptions of acute hospital occupational therapy services: developing a new model of care for occupational therapy on acute medical wards. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims This study was conducted at a regional tertiary referral facility in Australia. It was part of a project to implement a new model of care for occupational therapy services on medical wards. Before the new model was implemented, focus groups were conducted to explore the perceived role of the occupational therapist on the acute medical ward, identify potential barriers to changing the service and garner support for the change in service. Methods Three focus groups were held. The groups consisted of nursing, physiotherapy and speech pathology staff who worked on acute medical wards. Participants were asked for their perception of the role of occupational therapy on the acute medical ward. Audio-recordings of the groups were transcribed and analysed. Results Qualitative content analysis highlighted the following themes: assessment of patient function; ‘safe discharge’; more than assessment; equipment and home modifications; collaboration and communication; delegating tasks to assistants; and specialist intervention strategies. Conclusions Multidisciplinary team members' overriding perception is that occupational therapists in acute care settings provide assessment of patient function for the specific purpose of safe discharge. Some participants recalled that occupational therapists had a greater role in ensuring patients returned to their chosen function through rehabilitation and home visits, suggesting support for a change to our proposed post-acute model of care. Concerns highlighted by focus group members regarding increased workload for multidisciplinary team members and loss of communication need to be addressed to ensure the change in service is successful.
Collapse
Affiliation(s)
- Gail Kingston
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
| | - Tilley Pain
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
| | - Kym Murphy
- Care Coordination Team, Sir Charles Gairdner Hospital, Perth, Australia
| | - Michelle Bennett
- Community Based Rehabilitation and Aged Care Services, Canberra Hospital and Health Service, ACT Health, Canberra, Australia
| | - Michelle Watson
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
| |
Collapse
|
15
|
Dalmer NK. A logic of choice: Problematizing the documentary reality of Canadian aging in place policies. J Aging Stud 2019; 48:40-49. [PMID: 30832929 DOI: 10.1016/j.jaging.2019.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
The home environment is pivotal in the lives of older people, intimately intertwined with one's sense of self and belonging. Aging in place (AIP), continuing to live in the same or familiar place or community for as long as possible not only fulfills a neoliberal and economic imperative but aligns with the wishes of a majority of older Canadians, who prefer to age in place. Despite policies' contributions to differing experiences of aging, the potential bearing of the narratives embedded within AIP or age-friendly policies remains unexamined. Within an institutional ethnography method of inquiry, this study applied Bacchi's "What's the Problem Represented to be?" (WPR) approach to structure the discovery of governing narratives about familial care work embedded within seven Canadian aging in place policies at the municipal, provincial, and federal level. I analyzed these policies for their role in coordinating the experiences of caring for an older adult who is aging in place in London, Canada's first age-friendly city. Of particular interest for this study is uncovering whether these texts recognize the work, and in particular the information work, of providing care to an older adult who is AIP. The policies' overall focus on self-reliance, independence, and resourcefulness frames aging in place as a process that can and should be responsibly managed. Information is introduced as a helpful tool to secure and preserve older adults' independence and usefulness to their community. The policies' problematizations frame successful aging in place as governed through a logic of choice, where a complex problem is framed as a matter of choice. Ultimately, however, while the policies offer a number of different "choices" for older adults to AIP, a critical unpacking of the problematizations reveals the choice to AIP to be illusory. There is only one option presented in the policies and that is to AIP.
Collapse
Affiliation(s)
- Nicole K Dalmer
- Department of Sociology, Otonabee College, Trent University, Room 230, 1600 West Bank Drive, Peterborough, ON K9L 0G2, Canada.
| |
Collapse
|
16
|
Lau GWC, Yu ML, Brown T, Locke C. Clients' Perspectives of the Effectiveness of Home Modification Recommendations by Occupational Therapists. Occup Ther Health Care 2018; 32:230-250. [PMID: 30183439 DOI: 10.1080/07380577.2018.1491085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/22/2018] [Accepted: 06/17/2018] [Indexed: 06/08/2023]
Abstract
This study investigates the effectiveness of home modifications from clients' perspectives. Ten participants who received home assessments and modification recommendations were recruited from a rehabilitation agency. The dimension of home measure and qualitative interviews was conducted. The interviewers were transcribed verbatim and analyzed thematically. Participants found home modifications improved their safety, accessibility, privacy, and occupational performance, especially in performing self-care activities. Occupational therapists provided sufficient information and actively involved clients/carers in the decision-making process, which contributed to clients' perspectives of satisfaction and effectiveness with completed modifications.
Collapse
Affiliation(s)
- Guby Wai Chu Lau
- a Occupational Therapy Department, Forensicare , Thomas Embling Hospital , Fairfield , Australia
| | - Mong-Lin Yu
- b Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences , Monash University-Peninsula Campus , Frankston , Australia
| | - Ted Brown
- b Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences , Monash University-Peninsula Campus , Frankston , Australia
| | - Cassandra Locke
- c Home Assessment Services, Kingston Centre, Monash Health , Cheltenham , Australia
| |
Collapse
|
17
|
Jarling A, Rydström I, Ernsth-Bravell M, Nyström M, Dalheim-Englund AC. Becoming a guest in your own home: Home care in Sweden from the perspective of older people with multimorbidities. Int J Older People Nurs 2018; 13:e12194. [DOI: 10.1111/opn.12194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Aleksandra Jarling
- Faculty of Caring Science, Work Life and Social Welfare; University of Borås; Boras Sweden
| | - Ingela Rydström
- Faculty of Caring Science, Work Life and Social Welfare; University of Borås; Boras Sweden
| | | | - Maria Nyström
- Faculty of Caring Science, Work Life and Social Welfare; University of Borås; Boras Sweden
| | | |
Collapse
|
18
|
Holopainen A, Siltanen H, Pohjanvuori A, Mäkisalo-Ropponen M, Okkonen E. Factors Associated with the Quality of Life of People with Dementia and with Quality of Life-Improving Interventions: Scoping Review. DEMENTIA 2017; 18:1507-1537. [DOI: 10.1177/1471301217716725] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives To synthesise current research exploring the factors and interventions associated with the quality of life of people with dementia. Background Dementia is a progressive condition affecting an estimated 40 million people worldwide. The illness has a significant impact on the lives of the persons affected and their loved ones, and may thus impair the quality of life of both. As it progresses, dementia weakens the patients’ ability to express their own views about their quality of life and the factors associated with it. Design Scoping review. Data sources Electronic database search of MEDLINE, CINAHL, PsycINFO, Joanna Briggs Institute Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), EMBASE, Medic published up to March 2016; and incremental hand search. Review method: Systematic or other kinds of reviews and single studies were included for the review if they met the inclusion criteria. Results: A total of 20 reviews and 7 primary studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. The factors associated with the quality of life of people with dementia were sociodemographic factors, factors related to dementia and social and caring environment. Interventions supporting quality of life focused on the activation of people with dementia. Conclusions: This scoping review identified a large body of knowledge exploring the factors and interventions associated with the quality of life of people with dementia. The interventions were heterogeneous and the sample sizes small, which is why more research is needed.
Collapse
Affiliation(s)
- Arja Holopainen
- Nursing Research Foundation, Helsinki, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland; The WHO Collaborating Centre for Nursing, Helsinki, Finland
| | - Hannele Siltanen
- Nursing Research Foundation, Helsinki, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | | | | | - Eila Okkonen
- The Alzheimer Society of Finland, Helsinki, Finland
| |
Collapse
|
19
|
Labbé D, Jutras S, Coulombe S. Perceptions on well-being at home of families with people with disabilities: A psycho-environmental perspective. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2017. [DOI: 10.1016/j.erap.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
20
|
Hodson T, Aplin T, Gustafsson L. Understanding the dimensions of home for people returning home post stroke rehabilitation. Br J Occup Ther 2016. [DOI: 10.1177/0308022615619420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Home is a meaningful and important place and the transition to home from hospital is considered a significant point in recovery for people after stroke. Six dimensions of the home environment have previously been described as important for well-being and contributing to one's experience of home: the physical, social, personal, temporal, occupational and societal dimensions. The aim of this study was to understand the experience of home for people with stroke after discharge to home from hospital rehabilitation. Method A secondary template analysis applied the dimensions of home to semi-structured interviews that explored the transition to home experience for seven participants with stroke at 4–6 weeks post discharge. Results All six dimensions were present in the descriptions of returning to home from stroke rehabilitation. The social, personal and occupational dimensions appeared to be the most prominent and often centred on loss or change. Conclusion People returning home after a stroke enter a different home environment than the one they experienced prior to stroke, with changes experienced in all dimensions of home. Closer attention to the dimensions during discharge preparation may enhance the transition experience.
Collapse
Affiliation(s)
- Tenelle Hodson
- PhD student, School of Health and Rehabilitation Sciences, Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Tammy Aplin
- Lecturer, School of Health and Rehabilitation Sciences, Occupational Therapy, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- Senior Lecturer, School of Health and Rehabilitation Sciences, Occupational Therapy, The University of Queensland, Brisbane, Australia
| |
Collapse
|
21
|
Felix E, De Haan H, Vaandrager L, Koelen M. Beyond Thresholds: The Everyday Lived Experience of the House by Older People. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/02763893.2015.1055027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Ness TM, Hellzen O, Enmarker I. "Embracing the present and fearing the future": the meaning of being an oldest old woman in a rural area. Int J Qual Stud Health Well-being 2014; 9:25217. [PMID: 25361532 PMCID: PMC4216815 DOI: 10.3402/qhw.v9.25217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/23/2022] Open
Abstract
In Western countries, the number of older people receiving home nursing care is increasing, and in rural areas they are at additional risk because of the distance between people and health care facilities. The aim of this study was therefore to illuminate the meaning of being an oldest old woman living alone in a rural area and receiving home nursing care. A sample of 11 oldest old women living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and the data were analyzed using the phenomenological hermeneutic method. After a naïve reading and a structural analysis of the text, we identified four themes: being satisfied with life, being thankful, feeling vulnerable, and feeling secure. The comprehensive understanding implied that being an oldest old woman living alone in a rural area meant living in the intersection between embracing the present in solitude and fearing the future with additional declining health. Living in this complex situation meant to enjoy the present, but still fear the future, as the oldest old women knew their present life situations were limited. This challenging emotional situation meant using their inner strength by trying to be optimistic and seeing opportunities in present life, even if losses were many and extensive. By using their inner strength in facing losses and declining health, the oldest old women managed to appreciate aloneness as solitude, and find new meaning in life.
Collapse
Affiliation(s)
- Tove M Ness
- Department of Nursing, Mid-Sweden University, Østersund, Sweden; Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway;
| | - Ove Hellzen
- Department of Nursing, Mid-Sweden University, Østersund, Sweden
| | - Ingela Enmarker
- Department of Health Sciences, Nord-Trøndelag University College, Namsos, Norway; Centre of Care Research, Steinkjer, Mid-Norway
| |
Collapse
|
23
|
Aplin T, de Jonge D, Gustafsson L. Understanding home modifications impact on clients and their family's experience of home: A qualitative study. Aust Occup Ther J 2014; 62:123-31. [DOI: 10.1111/1440-1630.12156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Tammy Aplin
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St Lucia Queensland Australia
| | - Desleigh de Jonge
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St Lucia Queensland Australia
| | - Louise Gustafsson
- Division of Occupational Therapy; School of Health and Rehabilitation Sciences; The University of Queensland; St Lucia Queensland Australia
| |
Collapse
|
24
|
Abstract
ABSTRACTAs populations age, increased focus is given to the importance of enabling older people to age in place. The study reported in this paper explored the extent to which older people considered their homes and neighbourhoods to be ‘supportive’, and sought to increase understanding of the needs and experiences of older people and their expectations of future housing needs. This paper reports qualitative data from the Housing and Independent Living (HAIL) study carried out in Australia. Semi-structured interviews were conducted with 202 community-dwelling people aged 75–79 years. Interviews were transcribed, coded and analysed using computer-assisted qualitative analysis and a narrative approach to identify broad themes. Thematic analysis was used to examine and understand how occupants subjectively viewed their homes, and how they planned to adapt/modify either their activities or homes to accommodate changing needs. Six key themes emerged, namely housing choice, attachment to place, financial issues, changes to the home over time, transport, and anticipating the future. In this study, people who most strongly identified with and felt connected to their neighbours/communities had more positive perceptions of their homes and communities, and may be better able to remain in their home despite increasing disability or frailty. Housing policies and home and urban design should ensure home and neighbourhood environments are safe, accessible, promote positive associations, and are adaptable to facilitate independence and accommodate change as people age.
Collapse
|
25
|
Association between Sleep Disturbances and Leisure Activities in the Elderly: A Comparison between Men and Women. SLEEP DISORDERS 2014; 2014:595208. [PMID: 24575303 PMCID: PMC3915532 DOI: 10.1155/2014/595208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/19/2013] [Indexed: 12/18/2022]
Abstract
It has been suggested that physical or social activity is associated with fewer sleep disturbances among elderly people. Women report more sleep disturbances than men, which could indicate a variation in activity patterns between the genders. The aim of this study was to investigate associations between sleep disturbances and leisure activities in men and women (n = 945) aged ≥60 years in a Swedish population. Sleep disturbances were measured using eight dichotomous questions and seventeen variables, covering a wide range of leisure activities. Few leisure activities were found to be associated with sleep disturbances and their importance decreased when the models were adjusted for confounders and gender interactions. After clustering the leisure activities and investigating individual activities, sociointellectual activities were shown to be significant for sleep. However, following adjustment for confounders and gender interactions, home maintenance was the only activity significant for sleep. Being a female increased the effect of home maintenance. Besides those leisure activities, poor/fair self-rated health (OR 7.50, CI: 4.27–11.81) and being female (OR 4.86, CI: 2.75–8.61) were found to have the highest association with poor sleep. Leisure activities pursued by elderly people should focus on activities of a sociointellectual nature, especially among women, to promote sleep.
Collapse
|
26
|
Bharadwaj S, Bruce D. Effectiveness of 'rehabilitation in the home' service. AUST HEALTH REV 2014; 38:506-9. [DOI: 10.1071/ah14049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022]
Abstract
Objectives Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia. Methods The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes. This study was reviewed by the Institutional Review Board which deemed it not to require ethics approval. Results There were 1348 cases managed by RITH: 70.6% were aged ≥ 65 years; elective joint replacement (29.7%), medical conditions (20%), stroke (13%), hip fractures (10%) were major contributors. The majority (93.3%) were discharged after a median of 9 days. Negative outcomes occurred in 90 cases (6.7%), including five deaths (0.4%) and 85 readmissions (6.3%). Independent associations with negative outcomes included older age (odds ratio (OR) (95% CI); 1.02, P = 0.006), orthopaedic conditions (OR 1.91, P = 0.004) and longer inpatient LOS (OR 1.96, P = 0.003). Age above 80 years was independently associated with risk of negative outcome (OR 2.99, P = 0.004). Conclusions RITH had a low rate of negative outcomes. The database proved useful for monitoring quality of service provision. What is known about the topic? Rehabilitation in the home environment has proven cost effective for multiple conditions, particularly stroke and elective joint surgery, among others, facilitating better quality of life, with reduced rates of delirium and mortality. Overall there are few negative outcomes and death is rare. What does this paper add? Although RITH services are widely utilised as bed substitution services, there is scant literature on clinical outcomes while within the service. This study focuses on frequency of good and poor clinical outcomes in a well-established RITH service in Western Australia, suggesting pattern recognition of an at-risk cohort by identifying potentially useful predictors of poor outcome. What are the implications for practitioners? RITH services are a safe alternative for many, including older people. Health administration databases are useful tools to monitor clinical outcomes. Clinical indicators such as older age, long hospital stay and orthopaedic diagnoses may be useful predictors of poor outcomes in such services.
Collapse
|
27
|
Heggestad AKT, Nortvedt P, Slettebø Å. 'Like a prison without bars': dementia and experiences of dignity. Nurs Ethics 2013; 20:881-92. [PMID: 23702888 DOI: 10.1177/0969733013484484] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They also experience that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like.
Collapse
Affiliation(s)
- Anne Kari T Heggestad
- Oslo and Akershus University College of Applied Sciences, Norway; University of Oslo, Norway
| | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE The objective of this study was to report older Australians' views about what they want from aged care reforms expressed in submissions to the Productivity Commission's 'Inquiry into Caring for Older Australians' and the 'Conversations on Ageing' (Conversations). METHOD Consumer responses to the 'Inquiry into Caring for Older Australians' (n = 59) and findings from the Conversations (n = 31) conducted by the Honourable MarkButler with the Council on the Ageing were summarised. RESULTS Older people wanted to be included as full citizens in community life with their contributions acknowledged, including as carers. They wanted high quality, accessible and respectful services that supported their independence and over which they had control. They wanted fair and transparent funding arrangements and care that caters for diversity in Australia's older people. They wanted reform to be soon and to have bipartisan support. CONCLUSION This paper provides consumer perspectives to inform aged care policy, practice and research in Australia.
Collapse
Affiliation(s)
- Briony Dow
- National Ageing Research Institute, Melbourne, Victoria, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | |
Collapse
|
29
|
Aplin T, de Jonge D, Gustafsson L. Understanding the dimensions of home that impact on home modification decision making. Aust Occup Ther J 2013; 60:101-9. [PMID: 23551003 DOI: 10.1111/1440-1630.12022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIM The home environment is a multidimensional and personally meaningful place, and the complexity of this environment often impacts on the home modification process and outcomes. Home modifications can appear as a straightforward solution to safety and occupational performance concerns; nevertheless, clients sometimes reject modifications or are unsatisfied with the completed works. To understand this phenomenon, this study aimed to determine what aspects of the home environment impact home modification decision making. METHOD In this qualitative descriptive study, 42 in-depth interviews using a semi-structured questionnaire were undertaken and analysed using a template analysis. The interviews explored the experience of the home modification process, including concerns and the decisions made about the modifications. FINDINGS Four dimensions of the home environment were commonly found to affect decision making namely, the personal, societal, physical and temporal dimensions of home as well as social and occupational dimensions. CONCLUSIONS An understanding of the dimensions of home that impact decision making provides occupational therapists with a greater appreciation of the experience of home and allows them to enhance the effectiveness and acceptance of home modifications.
Collapse
Affiliation(s)
- Tammy Aplin
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia.
| | | | | |
Collapse
|
30
|
Randström KB, Wengler Y, Asplund K, Svedlund M. Working with ‘hands-off’ support: a qualitative study of multidisciplinary teams’ experiences of home rehabilitation for older people. Int J Older People Nurs 2012; 9:25-33. [DOI: 10.1111/opn.12013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Yvonne Wengler
- Department of Health Sciences; Mid Sweden University; Östersund Sweden
| | - Kenneth Asplund
- Department of Health Sciences; Mid Sweden University; Sundsvall Sweden
| | - Marianne Svedlund
- Department of Health Sciences; Mid Sweden University; Östersund Sweden
| |
Collapse
|
31
|
Falk H, Wijk H, Persson LO, Falk K. A sense of home in residential care. Scand J Caring Sci 2012; 27:999-1009. [PMID: 23170830 DOI: 10.1111/scs.12011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 09/24/2012] [Indexed: 12/01/2022]
Abstract
Moving into a residential care facility requires a great deal of adjustment to an environment and lifestyle entirely different from that of one's previous life. Attachment to place is believed to help create a sense of home and maintain self-identity, supporting successful adjustment to contingencies of ageing. The purpose of this study was to deepen our understanding of processes and strategies by which older people create a sense of home in residential care. Our findings show that a sense of home in residential care involves strategies related to three dimensions of the environment - attachment to place, to space and attachment beyond the institution - and that the circumstances under which older people manage or fail in creating attachment, consist of psychosocial processes involving both individual and shared attitudes and beliefs. Assuming that attachment is important to human existence regardless of age, attention must be paid to optimize the circumstances under which attachment is created in residential care, and how nursing interventions can help speed up this process due to the frail and vulnerable state of most older residents.
Collapse
Affiliation(s)
- Hanna Falk
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | | | | | | |
Collapse
|
32
|
Sinclair C, Auret KA, Burgess A. The balancing point: understanding uptake of advance directive forms in a rural Australian community. BMJ Support Palliat Care 2012; 3:358-65. [PMID: 24644756 DOI: 10.1136/bmjspcare-2012-000256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The study was conducted in Western Australia, focusing on the attitudes of older, rural, non-hospitalised people towards newly legislated advance care planning (ACP) documents. This study explored baseline awareness and perception of advance directive (AD) forms and factors relevant to their utilisation, using the transtheoretical model as a theoretical framework. METHODS Sixty-two adults were recruited from residential aged care facilities, community care organisations, general practice, an oncology service and a law firm. Semi-structured interviews were undertaken. These were transcribed and thematically analysed by the authors. RESULTS Participants gave responses that were consistent with different stages of the transtheoretical model. Perceived susceptibility to the negative consequences of not engaging in AD form utilisation was a trigger for further contemplation. The presence of adequate personal empowerment was important for successful completion of AD forms. There was also qualitative evidence of a negative relationship between perceived susceptibility and empowerment regarding AD form utilisation. CONCLUSIONS Promoting balance between a person's perceived susceptibility and empowerment may be an effective method of increasing engagement with AD forms.
Collapse
Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | | | | |
Collapse
|
33
|
Byles JE, Mackenzie L, Redman S, Parkinson L, Leigh L, Curryer C. Supporting housing and neighbourhoods for healthy ageing: Findings from the Housing and Independent Living Study (HAIL). Australas J Ageing 2012; 33:29-35. [DOI: 10.1111/j.1741-6612.2012.00646.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julie E Byles
- Research Centre for Gender, Health and Ageing; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute Public Health Capacity Building Group; University of Newcastle; Newcastle New South Wales Australia
- Australian Longitudinal Study on Women's Health; University of Newcastle; Newcastle New South Wales Australia
| | - Lynette Mackenzie
- Faculty of Health Sciences; University of Sydney; Sydney New South Wales Australia
| | - Sally Redman
- Sax Institute, Haymarket; Sydney New South Wales Australia
- School of Public Health; University of Sydney; Sydney New South Wales Australia
| | - Lynne Parkinson
- Research Centre for Gender, Health and Ageing; University of Newcastle; Newcastle New South Wales Australia
- School of Psychology; University of Newcastle; Newcastle New South Wales Australia
- Australasian Journal on Ageing; Richmond Victoria Australia
| | - Lucy Leigh
- Research Centre for Gender, Health and Ageing; Faculty of Health; University of Newcastle; Newcastle New South Wales Australia
| | - Cassie Curryer
- Research Centre for Gender, Health and Ageing; Faculty of Health; University of Newcastle; Newcastle New South Wales Australia
| |
Collapse
|