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Sinclair C, Yeoh L, Karusoo‐Musumeci A, Auret KA, Clayton JM, Hilgeman M, Halcomb E, Sinclair R, Martini A, Meller A, Walton R, Wei L, Dao‐Tran T, Kurrle S, Comans T. Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults. Health Expect 2024; 27:e14010. [PMID: 38450803 PMCID: PMC10918722 DOI: 10.1111/hex.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. METHODS Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. RESULTS Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31-.37, p < .001), and ACP engagement (r's = -.41 to -.37, p < .001) indicated convergent validity. CONCLUSION A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. PATIENT OR PUBLIC CONTRIBUTION The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.
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Affiliation(s)
- Craig Sinclair
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
| | - Ling Yeoh
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Kirsten A. Auret
- Rural Clinical School of Western AustraliaUniversity of Western AustraliaAlbanyWestern AustraliaAustralia
| | - Josephine M. Clayton
- The Palliative Centre, HammondCareSydneyNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Michelle Hilgeman
- Tuscaloosa Veterans Affairs Medical CenterTuscaloosaAlabamaUSA
- Department of PsychologyThe University of AlabamaTuscaloosaAlabamaUSA
| | - Elizabeth Halcomb
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Ron Sinclair
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Angelita Martini
- Brightwater GroupPerthWestern AustraliaAustralia
- University of Western AustraliaPerthWestern AustraliaAustralia
| | - Anne Meller
- Prince of Wales Hospital, South Eastern Sydney Local Health DistrictSydneyNew South WalesAustralia
| | | | - Li Wei
- College of Science, Health, Engineering and EducationMurdoch UniversityPerthWestern AustraliaAustralia
| | - Tiet‐Hanh Dao‐Tran
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Susan Kurrle
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Tracy Comans
- Centre for Health Services ResearchUniversity of QueenslandBrisbaneQueenslandAustralia
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Macfarlane S, Kurrle S, Grosvenor S, Cunningham C. Editorial: Behavior support for people with dementia. Front Psychiatry 2024; 15:1389668. [PMID: 38600986 PMCID: PMC11004467 DOI: 10.3389/fpsyt.2024.1389668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024] Open
Affiliation(s)
- Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Susan Kurrle
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Darlington, NSW, Australia
| | - Sally Grosvenor
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Darlington, NSW, Australia
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D'Cunha NM, Holloway H, Cave B, Mulhall S, Blair A, Anderson K, Castro De Jong D, Kurrle S, Isbel S. A pilot study of an intergenerational program for people in residential aged care with cognitive impairment and children from a co-located early learning centre during COVID-19. Dementia (London) 2024:14713012241235378. [PMID: 38373711 DOI: 10.1177/14713012241235378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Intergenerational programs in residential aged care may improve well-being and combat loneliness and social isolation in older people with cognitive impairment. This pilot study investigated the effects of a semi-structured intergenerational group, including children from a co-located early learning centre and people living in residential aged care with cognitive impairment. This 9-week study used a mixed methods pre- and post-program design. Sessions were designed and delivered once per week by Occupational Therapists and took into account residents' interests and children's developmental needs and interests, identified in pre-program interviews. Nine older people with cognitive impairment and 13 children participated. The program was well attended despite disruptions and complications caused by COVID-19 and weather conditions. Older people valued the opportunity to engage with the children. Children were observed to gain confidence in communicating and forming friendships with older people with different levels of ability. There did not appear to be any change in loneliness or neuropsychiatric symptoms. The intergenerational program benefited participants and received strong support from family members and staff of the early learning centre and aged care home.
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Affiliation(s)
- Nathan M D'Cunha
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Helen Holloway
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Breanna Cave
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Stephanie Mulhall
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Annaliese Blair
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, NSW, Australia
- School of Medicine and Psychology, Australian National University, Acton, ACT, Australia
| | - Katrina Anderson
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, NSW, Australia
- School of Medicine and Psychology, Australian National University, Acton, ACT, Australia
| | - Daniela Castro De Jong
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Susan Kurrle
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stephen Isbel
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Pham BD, Kim BG, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang TH, Nguyen TDH, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam. BMC Health Serv Res 2024; 24:86. [PMID: 38233921 PMCID: PMC10792887 DOI: 10.1186/s12913-023-10460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
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Affiliation(s)
- Bich Diep Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bao Giang Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - Adrian Esterman
- UniSA: Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Kurrle
- The University of Sydney, Sydney, NSW, Australia
| | | | | | - Elizabeth Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- University of California, Davis, Sacramento, CA, USA
| | - Thu Ha Dang
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Thi Diem Huong Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kham Tran
- National Ageing Research Institute, Melbourne, VIC, Australia
- Flinders University, Adelaide, SA, Australia
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Duc Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuan Anh Nguyen
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Kosowicz L, Tran KV, Brodaty H, Roughead E, Esterman A, Hinton L, Kim GB, Kurrle S, Dang TH, Crotty M, Gilbert A, Tan E, Nguyen TA. Vietnam's Responses to Dementia - An Assessment of Service Delivery. Dementia (London) 2023; 22:1372-1391. [PMID: 37621009 DOI: 10.1177/14713012231181167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND This study was conducted to assess Vietnam's dementia service delivery. METHODS Using WHO methodology, website searches of key organisations focused on three aspects of Vietnam's healthcare system: (1) Health and social workforce; (2) Services, supports and treatment programs; and (3) Promotion of awareness and understanding. Data were analysed using content analysis. RESULTS While key members of the healthcare workforce receive some education in dementia competencies during their training, the skill-mix of staff in the current workforce appears inadequate to address the complex needs of people with dementia. Although Vietnam's general healthcare system comprises a good variety of service types, there is a lack of dementia-specific services. Available diagnosis and treatment services are concentrated in the hospital system and are mainly located in metropolitan areas, impacting their accessibility. While both community-based and institutional long-term care is available, institutional care is not universally accessible and home-based care is mainly provided by family carers who don't have access to dementia care training. There is no active dementia prevention or public awareness campaign. CONCLUSIONS To improve the ability of Vietnam's service delivery to meet the needs of people with dementia and their carers, the skill-mix of the healthcare workforce should be strengthened by ensuring that dementia core competencies are embedded within undergraduate and graduate education programs and making post-qualification dementia care training available. The capacity of existing community-level health and social services should be expanded to ensure that integrated, specialised and comprehensive health and social services are accessible to all people with dementia. Expanding access to institutional long-term care and making dementia education available to family and other informal carers could increase choice and improve quality of care. Finally, Vietnam could look to other countries in the region with regards to the development of a dementia prevention and public awareness campaign.
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Affiliation(s)
- Leona Kosowicz
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Kham Van Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Roughead
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | | | - Susan Kurrle
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Andrew Gilbert
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Esther Tan
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
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O'Connor CM, Poulos CJ, Kurrle S, Anstey KJ. Bridging the gap: Study protocol for development of an implementation strategy for evidence-informed reablement and rehabilitation for community-dwelling people with dementia. Arch Gerontol Geriatr 2023; 108:104943. [PMID: 36701945 DOI: 10.1016/j.archger.2023.104943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Extensive research supports the use of goal-directed reablement and rehabilitation interventions to address a range of physical, functional, cognitive and behavioural needs of people living with dementia. Despite this, evidence-informed multidisciplinary reablement and rehabilitation interventions are not being offered in usual dementia care across Australia. An examination is needed of how best to implement reablement and rehabilitation interventions within the community-based dementia care sector. METHODS Drawing on implementation science, this study uses a four-phase mixed-methods retrospective and prospective approach: (1) clinical audit to evaluate current clinical practice, and through focus groups with practitioners, identify practitioner-led goals and targets for practice change; (2) Delphi survey to converge opinions from the diverse stakeholders involved in reablement in dementia, to reach national consensus around an implementation strategy; (3) hybrid pragmatic effectiveness-implementation pilot will facilitate testing of the implementation strategy in parallel with exploring effectiveness of the reablement intervention specifically within a real-world Australian community aged care context; (4) implementation capacity building. DISCUSSION This study will result in a freely available, nationally relevant implementation protocol, designed and tailored via input from key stakeholders over a series of iterative project activities. By testing this protocol via a pilot implementation-effectiveness study, we will generate national information about effectiveness of evidence-informed reablement programs for people living with dementia across various community aged care settings. Outcomes have potential to influence policy and drive widespread practice change, increasing access to evidence-informed reablement and rehabilitation for people living with dementia across Australia.
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Affiliation(s)
- Claire Mc O'Connor
- University of New South Wales, School of Psychology, Sydney, Australia; HammondCare, Centre for Positive Ageing, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Ageing Futures Institute, Sydney, Australia.
| | - Christopher J Poulos
- HammondCare, Centre for Positive Ageing, Sydney, Australia; University of New South Wales, School of Population Health, Sydney, Australia
| | | | - Kaarin J Anstey
- University of New South Wales, School of Psychology, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; University of New South Wales, Ageing Futures Institute, Sydney, Australia
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7
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Nguyen TA, Tran KV, Hinton L, Roughead EE, Esterman A, Dang TH, Kim GB, Pham DB, Nguyen HTD, Crotty M, Kurrle S, Pham T, Pham TL, Hoang P, Brodaty H. Experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora: a systematic review of qualitative studies. Aging Ment Health 2023; 27:301-316. [PMID: 35549573 DOI: 10.1080/13607863.2022.2056136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: This paper aimed to review and synthesise the qualitative research evidence on the experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora.Methods: Systematic searches were conducted in June 2019 using Medline, Embase, Emcare, PsycINFO and Cochrane electronic databases, as well as grey literature. Keywords and Medical Subject Headings [MeSH terms] for dementia and associated terms were combined with keywords for Vietnam and its provinces. Qualitative research articles published in English or Vietnamese were included to examine evidence on the life experiences of Vietnamese people with dementia using thematic analysis.Results: Our searches resulted in 3,940 papers, from which 21 qualitative research studies were included for final analysis. The majority of research has not been undertaken in Vietnam but with the Vietnamese diaspora in Western countries and has taken a cultural perspective to analyses. Research in Western countries has focused on the need for culturally adapted and culturally sensitive models of care. Emerging themes about the life experiences of Vietnamese people with dementia identified from the studies included: many people do not have diagnostic terms for dementia but use the descriptive language of symptoms; stigma was a reported problem and on occasions can be observed in the descriptive language used for people with dementia; cultural and traditional values create both an opportunity and a barrier, supporting compassion, family care and relaxation, but creating barriers to accessing health services or long-term residential care.Conclusions: This is the first systematic review reporting qualitative evidence on the life experiences of people with dementia in Vietnam and among the Vietnamese diaspora. Future research is needed on the voice of people with dementia themselves and their caregivers particularly in Vietnam, and low and middle-income countries with regards to living with dementia, pathways to care from diagnosis, treatment, care and support, additional social care and preparedness for end of life care for people with dementia.
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Affiliation(s)
- Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Kham Van Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Elizabeth E Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Esterman
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Giang Bao Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Diep Bich Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Diem Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Maria Crotty
- College of Medicine and Public Health, Rehabilitation, Aged & Extended Care, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Thang Pham
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | - Tuan Le Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Hoang
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, NSW, Australia
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D’Cunha NM, Holloway H, Gibson D, Thompson J, Bail K, Kurrle S, Day S, Olson J, Smith N, Clarke H, Buckley C, Isbel S. Designing an Alternative, Community Integrated Model of Residential Aged Care for People Living with Dementia: Nominal Group Technique and Thematic Analysis. J Alzheimers Dis 2023; 94:1247-1263. [PMID: 37393506 PMCID: PMC10473074 DOI: 10.3233/jad-230368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Small-scale models of dementia care are a potential solution to deinstitutionalize residential aged care and have been associated with improved resident outcomes, including quality of life and reduced hospitalizations for people living with dementia. OBJECTIVE This study aimed to generate strategies and ideas on how homes for people living with dementia in a village setting within a suburban community, could be designed and function without external boundaries. In particular, how could residents of the village and members of the surrounding community access and engage safely and equitably so that interpersonal connections might be fostered? METHODS Twenty-one participants provided an idea for discussion at three Nominal Group Technique workshops, including people living with dementia, carers or former carers, academics, researchers, and clinicians. Discussion and ranking of ideas were facilitated in each workshop, and qualitative data were analyzed thematically. RESULTS All three workshops highlighted the importance of a surrounding community invested in the village; education and dementia awareness training for staff, families, services, and the community; and the necessity for adequately and appropriately trained staff. An appropriate mission, vision, and values of the organization providing care were deemed essential to facilitate an inclusive culture that promotes dignity of risk and meaningful activities. CONCLUSION These principles can be used to develop an improved model of residential aged care for people living with dementia. In particular, inclusivity, enablement, and dignity of risk are essential principles for residents to live meaningful lives free from stigma in a village without external boundaries.
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Affiliation(s)
- Nathan M. D’Cunha
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- The Neighbourhood Canberra, Campbell, ACT, Australia
| | - Helen Holloway
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Diane Gibson
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Jane Thompson
- The Neighbourhood Canberra, Campbell, ACT, Australia
| | - Kasia Bail
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Susan Kurrle
- The Neighbourhood Canberra, Campbell, ACT, Australia
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sally Day
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James Olson
- Community Home Australia, Gordon, ACT, Australia
| | - Nicole Smith
- The Neighbourhood Canberra, Campbell, ACT, Australia
- Community Home Australia, Gordon, ACT, Australia
| | | | | | - Stephen Isbel
- School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Ageing Research Group, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Daly RM, Iuliano S, Fyfe JJ, Scott D, Kirk B, Thompson MQ, Dent E, Fetterplace K, Wright ORL, Lynch GS, Zanker J, Yu S, Kurrle S, Visvanathan R, Maier AB. Screening, Diagnosis and Management of Sarcopenia and Frailty in Hospitalized Older Adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group. J Nutr Health Aging 2022; 26:637-651. [PMID: 35718874 DOI: 10.1007/s12603-022-1801-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of 'champions' to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers' education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.
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Affiliation(s)
- R M Daly
- Professor Robin M. Daly, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, Australia 3125, Phone: +61 3 9244 6040, , ORCID ID: 0000-0002-9897-1598
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10
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Nguyen TA, Tran K, Hinton L, Roughead EE, Esterman A, Dang TH, Kim GB, Pham DB, Nguyen HTD, Crotty M, Kurrle S, Pham T, Le Pham T, Brodaty H. Life experiences of people with dementia in Vietnam and among the Vietnamese diaspora: A systematic review of qualitative studies. Alzheimers Dement 2021. [DOI: 10.1002/alz.054820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tuan Anh Nguyen
- University of South Australia Adelaide SA Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
| | - Kham Tran
- University of South Australia Adelaide SA Australia
| | - Ladson Hinton
- University of California, Davis School of Medicine Sacramento CA USA
| | | | | | - Thu Ha Dang
- Swinburne University of Technology Melbourne VIC Australia
| | | | | | | | | | | | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney Sydney NSW Australia
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11
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Dang TH, Tran K, Esterman A, Roughead EE, Brodaty H, Hinton L, Kim GB, Kurrle S, Crotty M, Pham T, Le Pham T, Hoang P, Nguyen TA. Healthcare services for people with dementia in Vietnam: A situational analysis. Alzheimers Dement 2021. [DOI: 10.1002/alz.057659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Thu Ha Dang
- Peter MacCallum Cancer Centre Melbourne VIC Australia
- Swinburne University of Technology Melbourne VIC Australia
| | - Kham Tran
- University of South Australia Adelaide SA Australia
| | | | | | | | - Ladson Hinton
- University of California, Davis School of Medicine Sacramento CA USA
| | | | | | | | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
| | | | - Phuong Hoang
- University of South Australia Adelaide SA Australia
| | - Tuan Anh Nguyen
- Swinburne University of Technology Melbourne VIC Australia
- National Ageing Research Institution Melbourne VIC Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
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Taylor ME, Wesson J, Sherrington C, Hill KD, Kurrle S, Lord SR, Brodaty H, Howard K, O’Rourke SD, Clemson L, Payne N, Toson B, Webster L, Savage R, Zelma G, Koch C, John B, Lockwood K, Close JCT. Erratum to: Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 77:e108. [DOI: 10.1093/gerona/glab316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morag E Taylor
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline Wesson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Susan Kurrle
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra D O’Rourke
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Narelle Payne
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Barbara Toson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyndell Webster
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Roslyn Savage
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Genevieve Zelma
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Cecelia Koch
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Beatrice John
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Keri Lockwood
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
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Nguyen TA, Tran K, Esterman A, Brijnath B, Xiao LD, Schofield P, Bhar S, Wickramasinghe N, Sinclair R, Dang TH, Cullum S, Turana Y, Hinton L, Seeher K, Andrade AQ, Crotty M, Kurrle S, Freel S, Pham T, Nguyen TB, Brodaty H. Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e33572. [PMID: 34783660 PMCID: PMC8663455 DOI: 10.2196/33572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). Objective This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Methods Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. Results This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). Conclusions This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz International Registered Report Identifier (IRRID) PRR1-10.2196/33572
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Affiliation(s)
- Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Kham Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Penelope Schofield
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Thu Ha Dang
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sarah Cullum
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yuda Turana
- School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Katrin Seeher
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stefanie Freel
- Department of Germanic Languages and Literature, University of Toronto, Toronto, ON, Canada
| | - Thang Pham
- Department of Neurology and Alzheimer Disease, Vietnam National Geriatric Hospital, Hanoi, Vietnam
| | - Thanh Binh Nguyen
- Department of Neurology and Alzheimer Disease, Vietnam National Geriatric Hospital, Hanoi, Vietnam
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
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14
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Liu E, Killington M, Cameron ID, Li R, Kurrle S, Crotty M. Life expectancy of older people living in aged care facilities after a hip fracture. Sci Rep 2021; 11:20266. [PMID: 34642410 PMCID: PMC8511118 DOI: 10.1038/s41598-021-99685-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
To the authors’ knowledge, no study has been conducted on life expectancy for aged care facility residents with hip fracture. We assessed life expectancy of 240 residents of aged care facilities in Australia who experienced recent hip fracture treated with surgery. 149 deaths occurred over a mean follow-up of 1.2 years. Being female and having better cognition were associated with longer life expectancy. Increased age was associated with shorter life expectancy. The cumulative mortality rate within three months after hip fracture was 25.0% while the cumulative mortality rate for the whole study period was 62.1%. Life expectancy was 8.2 years, 4.8 years and 2.8 years for 70, 80 and 90-years old female patients. Life expectancy was 3.8 years, 2.2 years and 1.3 years for 70, 80 and 90 years old male patients, respectively. In conclusion, age, gender and cognition level were associated with life expectancy of hip fracture patients living in aged care facilities and their life expectancy was much shorter than that of the general Australian population.
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Affiliation(s)
- Enwu Liu
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Maggie Killington
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Raymond Li
- Monash School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan Kurrle
- Curran Ageing Research Unit, Faculty of Medicine and Health, Hornsby Ku-Ring-Gai Hospital, University of Sydney and, Hornsby, NSW, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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15
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Han CY, Crotty M, Thomas S, Cameron ID, Whitehead C, Kurrle S, Mackintosh S, Miller M. Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE). Nutrients 2021; 13:nu13093182. [PMID: 34579060 PMCID: PMC8468965 DOI: 10.3390/nu13093182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.
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Affiliation(s)
- Chad Yixian Han
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Maria Crotty
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susie Thomas
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2065, Australia;
| | - Craig Whitehead
- Rehabilitation and Ageing Studies Unit, Flinders University, Adelaide, SA 5042, Australia; (M.C.); (S.T.); (C.W.)
| | - Susan Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Shylie Mackintosh
- Allied Health and Human Performance, University of South Australia, Adelaide, SA 5042, Australia;
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
- Correspondence: ; Tel.: +61-8-82012421
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de la Perrelle L, Cations M, Barbery G, Radisic G, Kaambwa B, Crotty M, Fitzgerald JA, Kurrle S, Cameron I, Whitehead C, Thompson J, Laver K. How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation. BMJ Open Qual 2021; 10:bmjoq-2020-001147. [PMID: 33990392 PMCID: PMC8127967 DOI: 10.1136/bmjoq-2020-001147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246.
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Affiliation(s)
- Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Gaery Barbery
- Health Services Management School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Janna Anneke Fitzgerald
- Business Strategy and Innovation, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Susan Kurrle
- Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Jane Thompson
- NNIDR Consumer Involvement Reference Group, NHMRC CDPC, Hornsby, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
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Nguyen TA, Dang TH, Tran K, Kim GB, Brodaty H, Pham T, Pham TL, Crotty M, Kurrle S, Hinton L, Esterman A, Nguyen TA, Roughead EE. Dementia in Vietnam: A situational analysis. Alzheimers Dement 2020. [DOI: 10.1002/alz.039252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tuan Anh Nguyen
- University of South Australia Adelaide Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
| | - Thu Ha Dang
- University of South Australia Adelaide Australia
| | - Kham Tran
- University of South Australia Adelaide Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing UNSW Sydney Australia
| | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
| | | | | | | | - Ladson Hinton
- University of California Davis School of Medicine Sacramento CA USA
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Walker P, Kifley A, Kurrle S, Cameron ID. Increasing the uptake of vitamin D supplement use in Australian residential aged care facilities: results from the vitamin D implementation (ViDAus) study. BMC Geriatr 2020; 20:383. [PMID: 33023492 PMCID: PMC7542101 DOI: 10.1186/s12877-020-01784-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adequate (≥800 IU/day) vitamin D supplement use in Australian residential aged care facilities (RACFs) is variable and non-optimal. The vitamin D implementation (ViDAus) study aimed to employ a range of strategies to support the uptake of this best practice in participating facilities. The aim of this paper is to report on facility level prevalence outcomes and factors associated with vitamin D supplement use. METHODS This trial followed a stepped wedge cluster, non-randomised design with 41 individual facilities serving as clusters pragmatically allocated into two wedges that commenced the intervention six months apart. This multifaceted, interdisciplinary knowledge translation intervention was led by a project officer, who worked with nominated champions at participating facilities to provide education and undertake quality improvement (QI) planning. Local barriers and responsive strategies were identified to engage stakeholders and promote widespread uptake of vitamin D supplement use. RESULTS This study found no significant difference in the change of vitamin D supplement use between the intervention (17 facilities with approx. 1500 residents) and control group (24 facilities with approx. 1900 residents) at six months (difference in prevalence change between groups was 1.10, 95% CI - 3.8 to 6.0, p = 0.6). The average overall facility change in adequate (≥800 IU/day) vitamin D supplement use over 12 months was 3.86% (95% CI 0.6 to 7.2, p = 0.02), which achieved a facility level average prevalence of 59.6%. The variation in uptake at 12 months ranged from 25 to 88% of residents at each facility. In terms of the types of strategies employed for implementation, there were no statistical differences between facilities that achieved a clinically meaningful improvement (≥10%) or a desired prevalence of vitamin D supplement use (80% of residents) compared to those that did not. CONCLUSIONS This work confirms the complex nature of implementation of best practice in the RACF setting and indicates that more needs to be done to ensure best practice is translated into action. Whilst some strategies appeared to be associated with better outcomes, the statistical insignificance of these findings and the overall limited impact of the intervention suggests that the role of broader organisational and governmental support for implementation should be investigated further. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ).
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Affiliation(s)
- Pippy Walker
- Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia. .,John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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19
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Laver K, Cations M, Radisic G, de la Perrelle L, Woodman R, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, Crotty M. Improving adherence to guideline recommendations in dementia care through establishing a quality improvement collaborative of agents of change: an interrupted time series study. Implement Sci Commun 2020; 1:80. [PMID: 32984846 PMCID: PMC7513321 DOI: 10.1186/s43058-020-00073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Non-pharmacological interventions including physical activity programmes, occupational therapy and caregiver education programmes have been shown to lead to better outcomes for people with dementia and their care partners. Yet, there are gaps between what is recommended in guidelines and what happens in practice. The aim of this study was to bring together clinicians working in dementia care and establish a quality improvement collaborative. The aim of the quality improvement collaborative was to increase self-reported guideline adherence to three guideline recommendations. METHODS Interrupted time series. We recruited health professionals from community, hospital and aged care settings across Australia to join the collaborative. Members of the collaborative participated in a start-up meeting, completed an online learning course with clinical and quality improvement content, formed a quality improvement plan which was reviewed by a team of experts, received feedback following an audit of their current practice and were able to share experiences with their peers. The primary outcome was self-reported adherence to their guideline recommendation of interest which was measured using checklists. Data were collected monthly over a period of 18 months, and the study used an interrupted time series design and multilevel Poisson regression analysis to evaluate changes in self-reported adherence. RESULTS A total of 45 health professionals (78% therapists) from different sites joined the collaborative and 28 completed all requirements. Data from 1717 checklists were included in the analyses. Over the duration of the project, there was a significant increase in clinician self-reported adherence to guideline recommendations with a 42.1% immediate increase in adherence (incidence rate ratio = 1.42; 95% confidence interval = 1.08-1.87; p = 0.012). CONCLUSION Health professionals working with people with dementia are interested in and willing to join a quality improvement collaborative with the goal of improving non-pharmacological aspects of care. Participation in the collaborative improved the quality of care for people with dementia as measured through self-reported adherence to guideline recommendations. Although there are challenges in implementation of guideline recommendations within dementia care, the quality improvement collaborative method was considered successful. A strength was that it equipped and empowered clinicians to lead improvement activities and allowed for heterogeneity in terms of service and setting. TRIAL REGISTRATION ACTRN12618000268246.
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Affiliation(s)
- Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Monica Cations
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Janna Anneke Fitzgerald
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ian D. Cameron
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Jane Thompson
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Hayes
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
- Griffith Business School, Griffith University, Gold Coast, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NHMRC Cognitive Decline Partnership Centre, Sydney, Australia
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20
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Taylor ME, Wesson J, Sherrington C, Hill KD, Kurrle S, Lord SR, Brodaty H, Howard K, O’Rourke SD, Clemson L, Payne N, Toson B, Webster L, Savage R, Zelma G, Koch C, John B, Lockwood K, Close JCT. Tailored Exercise and Home Hazard Reduction Program for Fall Prevention in Older People With Cognitive Impairment: The i-FOCIS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 76:655-665. [DOI: 10.1093/gerona/glaa241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The evidence to support effective fall prevention strategies in older people with cognitive impairment (CI) is limited. The aim of this randomized controlled trial (RCT) was to determine the efficacy of a fall prevention intervention in older people with CI.
Method
RCT involving 309 community-dwelling older people with CI. The intervention group (n = 153) received an individually prescribed home hazard reduction and home-based exercise program during the 12-month study period. The control group (n = 156) received usual care. The primary outcome was rate of falls. Secondary outcomes included faller/multiple faller status, physical function, and quality of life.
Results
Participants’ average age was 82 years (95% CI 82–83) and 49% were female. There was no significant difference in the rate of falls (incidence rate ratio [IRR] 1.05; 95% confidence interval [95% CI] 0.73–1.51). A sensitivity analysis, controlling for baseline differences and capping the number of falls at 12 (4 participants), revealed a nonsignificant reduction in fall rate in the intervention group (IRR 0.78; 95% CI 0.57–1.07). Analyses of secondary outcomes indicated the intervention significantly reduced the number of multiple fallers by 26% (RR 0.74; 95% CI 0.54–0.99) when adjusting for baseline differences. There was a differential impact on falls in relation to physical function (interaction term p-value = .023) with a significant reduction in fall rate in intervention group participants with better baseline physical function (IRR 0.60; 95% CI 0.37–0.98). There were no significant between-group differences for other secondary outcomes.
Conclusions
This intervention did not significantly reduce the fall rate in community-dwelling older people with CI. The intervention did reduce the fall rate in participants with better baseline physical function.
Clinical Trials Registration Number
Australian and New Zealand Trials Registry ACTRN12614000603617.
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Affiliation(s)
- Morag E Taylor
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Jacqueline Wesson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Susan Kurrle
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra D O’Rourke
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Excellence for Population Ageing Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Narelle Payne
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Barbara Toson
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lyndell Webster
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Roslyn Savage
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Genevieve Zelma
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Cecelia Koch
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
| | - Beatrice John
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Keri Lockwood
- Department of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Randwick, New South Wales, Australia
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21
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Hosie A, Phillips J, Lam L, Kochovska S, Noble B, Brassil M, Kurrle S, Cumming A, Caplan GA, Chye R, Ely EW, Lawlor PG, Bush SH, Davis JM, Lovell M, Parr C, Williams S, Hauser K, McArdle S, Jacquier K, Phillipson C, Kuwahata L, Kerfoot J, Brown L, Fazekas B, Cheah SL, Edwards L, Green A, Hunt J, Attwood R, Assen T, Garcia M, Wilcock J, Agar M. A Multicomponent Nonpharmacological Intervention to Prevent Delirium for Hospitalized People with Advanced Cancer: A Phase II Cluster Randomized Waitlist Controlled Trial (The PRESERVE Pilot Study). J Palliat Med 2020; 23:1314-1322. [PMID: 32343634 DOI: 10.1089/jpm.2019.0632] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Delirium is a common debilitating complication of advanced cancer. Objective: To determine if a multicomponent nonpharmacological delirium prevention intervention was feasible for adult patients with advanced cancer, before a phase III (efficacy) trial. Design: Phase II (feasibility) cluster randomized controlled trial. All sites implemented delirium screening and diagnostic assessment. Strategies within sleep, vision and hearing, hydration, orientation, mobility, and family domains were delivered to enrolled patients at intervention site admission days 1-7. Control sites then implemented the intervention ("waitlist sites"). Setting: Four Australian palliative care units. Measurements: The primary outcome was adherence, with an a priori endpoint of at least 60% patients achieving full adherence. Secondary outcomes were interdisciplinary care delivery, delirium measures, and adverse events, analyzed descriptively and inferentially. Results: Sixty-five enrolled patients (25 control, 20 intervention, and 20 waitlist) had 98% delirium screens and 75% diagnostic assessments completed. Nurses (67%), physicians (16%), allied health (8.4%), family (7%), patients (1%), and volunteers (0.5%) delivered the intervention. There was full adherence for 5% patients at intervention sites, partial for 25%. Both full and partial adherence were higher at waitlist sites: 25% and 45%, respectively. One-third of control site patients (32%) became delirious within seven days of admission compared to one-fifth (20%) at both intervention and waitlist sites (p = 0.5). Mean (standard deviation) Delirium Rating Scale-Revised-1998 scores were 16.8 + 12.0 control sites versus 18.4 + 8.2 (p = 0.6) intervention and 18.7 + 7.8 (p = 0.5) waitlist sites. The intervention caused no adverse events. Conclusion: The intervention requires modification for optimal adherence in a phase III trial.
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Affiliation(s)
- Annmarie Hosie
- School of Nursing Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.,St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lawrence Lam
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Beverly Noble
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Meg Brassil
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Susan Kurrle
- Northern Clinical School, Hornsby Ku-ring-gai Health Service, University of Sydney, Hornsby, New South Wales, Australia
| | - Anne Cumming
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Prince of Wales Hospital, Geriatric Medicine, Randwick, New South Wales, Australia.,UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Richard Chye
- St. Vincent's Health Network Sydney, Darlinghurst, New South Wales, Australia.,UNSW Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Eugene Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University, Nashville, Tennessee, USA.,Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Peter G Lawlor
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Palliative Care, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Palliative Care, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jan Maree Davis
- Department of Palliative Care, Calvary Health Care Kogarah, Kogarah, New South Wales, Australia
| | - Melanie Lovell
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia Parr
- HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia
| | - Sally Williams
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Katherine Hauser
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Susan McArdle
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Karen Jacquier
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Carl Phillipson
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | | | - Linda Brown
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Belinda Fazekas
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Seong Leang Cheah
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Layla Edwards
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Anna Green
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane Hunt
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Robyn Attwood
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Teresa Assen
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Maja Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Julie Wilcock
- Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Ingham Institute, Liverpool Hospital, Liverpool, New South Wales, Australia
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22
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Killington M, Davies O, Crotty M, Crane R, Pratt N, Mills K, McInnes A, Kurrle S, Cameron ID. People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway. BMC Geriatr 2020; 20:128. [PMID: 32272888 PMCID: PMC7147061 DOI: 10.1186/s12877-019-1321-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture. In addition, there are no clinical guidelines for rehabilitation and recovery following hip fracture for nursing home residents. METHODS As part of a randomised trial (SACRED trial), which investigated the efficacy of a four week in-reach rehabilitation program, data were collected which described routine care for 240 people living in 76 nursing care facilities in South Australia who fractured their hips. The in-reach rehabilitation provided to 119 intervention participants is described, including intensity, type and methods used to encourage participation in rehabilitation. Adverse events that occurred, in particular falls, are also reported. RESULTS NCF records indicated that, over the four weeks following discharge from hospital after hip fracture, 76% of patients receiving usual care had a consultation with their general practitioner. Physiotherapy was provided to 79% of patients in usual care (median of 1.96 h over the 4 weeks, which is less than 30 min each week of physiotherapy). In-reach rehabilitation was provided by the hospital team for 13 h over the 4 weeks with almost full attendance at physiotherapy sessions (median of 1 missed session, range 0-7 with a median of 14 physiotherapy sessions attended by participants, range 1-18). Experienced therapists provided a flexible approach to the rehabilitation to account for patients' dementia and associated neuropsychiatric symptoms while providing dietetic support, mobility training and education to nursing home staff. The number of falls experienced by those in the intervention group was higher compared to those in usual care (Relative Risk 1.38 (95%CI 1.04-1.84, p = 0.03). CONCLUSIONS Rehabilitation can be provided to people living in NCFs following hip fracture, even when they have moderate to severe dementia but the model needs to be flexible. Provision of rehabilitation may increase the rate of falls in this population. Further studies are required to establish the feasibility of the intervention in other long term care settings. (327 words). TRIAL REGISTRATION ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Maggie Killington
- Flinders University, South Australia, Australia. .,Southern Adelaide Local Health Network, South Australia, Australia.
| | - Owen Davies
- Flinders University, South Australia, Australia.,Southern Adelaide Local Health Network, South Australia, Australia
| | - Maria Crotty
- Flinders University, South Australia, Australia.,Southern Adelaide Local Health Network, South Australia, Australia
| | - Rhiannon Crane
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Naomi Pratt
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Kylie Mills
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Arabella McInnes
- Southern Adelaide Local Health Network, South Australia, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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23
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Nguyen TA, Pham T, Dang TH, Hinton WL, Nguyen AT, Pham TL, Crotty M, Kurrle S, Bui QT, Nguyen H, Roughead EE. Towards the development of Vietnam's national dementia plan-the first step of action. Australas J Ageing 2019; 39:137-141. [PMID: 31814244 DOI: 10.1111/ajag.12755] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To foster a national dialogue on addressing dementia as an emerging public health problem and formulating a strategy for developing Vietnam's national dementia plan. METHODS In September 2018, the Vietnamese National Geriatric Hospital supported by University staff in Australia and the United States organised the first Vietnam National Dementia Conference in Hanoi. RESULTS Over 270 Vietnamese dementia stakeholders and international dementia experts participated in the conference. The participants agreed dementia was a public health priority in Vietnam and identified the need for the development of Vietnam's national dementia plan. Policymakers supported positioning dementia as a priority in the national health agenda. Research institutions created collaboration to generate scientific information for policymaking process. Funding and international supports were obtained to develop Vietnam's national dementia plan. CONCLUSION Strong leadership, stakeholder engagement and international support are critical in raising awareness and advocating for the development of Vietnam's national dementia plan.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Thang Pham
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | - Thu Ha Dang
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Walter Ladson Hinton
- School of Medicine, University of California, Davis, Sacramento, California, USA
| | | | | | - Maria Crotty
- NHMRC Cognitive Decline Partnership Centre, Rehabilitation, Aged & Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Huong Nguyen
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth E Roughead
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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24
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Biggs S, Haapala I, Kurrle S. Organising care, practice and participative research: Papers from the cognitive decline partnership centre. Australas J Ageing 2019; 38 Suppl 2:3-5. [PMID: 31496069 PMCID: PMC6973169 DOI: 10.1111/ajag.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Simon Biggs
- School of Social and Political Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Brotherhood of St Laurence, Melbourne, Victoria, Australia.,Faculty of Social Science, University of Helsinki, Helsinki, Finland
| | - Irja Haapala
- School of Social and Political Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,School of Applied Educational Science and Teacher Education, University of Eastern Finland, Joensuu Campus, Joensuu, Finland
| | - Susan Kurrle
- Division of Rehabilitation and Aged Care, Hornsby Ku-ring-gai Health Service, Hornsby, New South Wales, Australia
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25
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Kurrle S, Bateman C, Cumming A, Pang G, Patterson S, Temple A. Implementation of a model of care for hospitalised older persons with cognitive impairment (the Confused Hospitalised Older Persons program) in six New South Wales hospitals. Australas J Ageing 2019; 38 Suppl 2:98-106. [DOI: 10.1111/ajag.12690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Susan Kurrle
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Cath Bateman
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Anne Cumming
- Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Glen Pang
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Sigrid Patterson
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Anthea Temple
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
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26
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Sinclair C, Bajic-Smith J, Gresham M, Blake M, Bucks RS, Field S, Clayton JM, Radoslovich H, Agar M, Kurrle S. Professionals' views and experiences in supporting decision-making involvement for people living with dementia. Dementia (London) 2019; 20:84-105. [PMID: 31349752 DOI: 10.1177/1471301219864849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The provision of supported decision-making for people living with disabilities is an emerging area of practice and rights-based law reform, and is required under international law. OBJECTIVES This qualitative study aimed to understand how Australian health and legal professionals conceptualised their professional roles in the practice of providing decision-making support for people living with dementia. METHODS The methods were informed by grounded theory principles. In-depth, semi-structured interviews were conducted with 28 health and legal professionals involved in providing care or services for people with dementia. Interviews explored how professionals described their practice of providing support for decision-making and how they conceptualised their roles. The analysis was underpinned by the theoretical perspective of symbolic interactionism. RESULTS Participants described providing support across a range of decision domains, some of which were specific to their professional role. Four key themes were identified: 'establishing a basis for decision-making', 'the supportive toolbox', 'managing professional boundaries' and 'individualist advocacy versus relational practice'. Participants identified a range of generic and specialised techniques they used to provide support for people with dementia. These techniques were applied subject to resource limitations and perceived professional obligations and boundaries. A continuum of professional practice, ranging from 'individualist advocacy' to 'relational practice' describes the approaches adopted by different professionals. DISCUSSION Professionals conceptualised their role in providing support for decision-making through the lens of their own profession. Differences in positioning on the continuum of 'individualist advocacy' through to 'relational practice' had practical implications for capacity assessment, engaging with persons with impaired decision-making capacity, and the inclusion of supporters and family members in decision-making processes. Further progress in implementing supported decision-making (including through law and policy reform) will require an understanding of these inter-professional differences in perceived roles relating to the practice of providing decision-making support.
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Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Australia; Centre of Excellence in Population Ageing Research, University of New South Wales, Australia
| | | | | | - Meredith Blake
- UWA Law School, University of Western Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Australia
| | - Sue Field
- UWA Law School, University of Western Australia, Australia
| | - Josephine M Clayton
- HammondCare, Australia; Sydney Medical School, University of Sydney, Australia
| | | | - Meera Agar
- Faculty of Health, University of Technology Sydney, Australia
| | - Susan Kurrle
- Faculty of Medicine and Health, University of Sydney, Australia
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27
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Walker P, Kifley A, Kurrle S, Cameron ID. Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study. BMC Geriatr 2019; 19:177. [PMID: 31238882 PMCID: PMC6593532 DOI: 10.1186/s12877-019-1187-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention. METHODS Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP). RESULTS Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs. CONCLUSIONS The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ) on 15 June 2016.
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Affiliation(s)
- Pippy Walker
- Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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28
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Crotty M, Killington M, Liu E, Cameron ID, Kurrle S, Kaambwa B, Davies O, Miller M, Chehade M, Ratcliffe J. Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial. Age Ageing 2019; 48:373-380. [PMID: 30794284 PMCID: PMC6503935 DOI: 10.1093/ageing/afz005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care. DESIGN parallel randomised controlled trial with integrated health economic study. SETTING NCFs, in Adelaide South Australia. SUBJECTS people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture. MEASUREMENTS primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months. RESULTS participants were randomised to treatment (n = 121) or control (n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference -1.9; 95% CI: -3.3, -0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = -7.4; 95% CI: -12.5 to -2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: -0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056). CONCLUSIONS the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective. TRIAL REGISTRATION ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 361980.
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Affiliation(s)
- Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Maggie Killington
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Enwu Liu
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
- Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Vic, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Royal North Shore Hospital, St Leonards NSW, Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Hornsby Ku-ring-gai Hospital, Hornsby NSW, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, Flinders University, Health Sciences Building, Sturt Road, Bedford Park SA, Australia
| | - Owen Davies
- Rehabilitation, Aged and Extended Care, Flinders University, Finders Medical Centre, Level 4 Rehabilitation Building, Flinders Drive, Bedford Park SA, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park SA, Australia
| | - Mellick Chehade
- Centre for Orthopaedic Trauma and Research, University of Adelaide, Adelaide SA, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide SA, Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide SA, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Flinders University, Sturt Road, Bedford Park SA, Australia
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Wilson MAG, Tran Y, Wilson I, Kurrle S. Development of the Australian Ageing Semantic Differential, a new instrument for measuring Australian medical student attitudes towards older people. Australas J Ageing 2019; 38:e67-e74. [PMID: 30784154 DOI: 10.1111/ajag.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study outlines development of an instrument for measuring attitudes of medical students towards older people, the Australian Ageing Semantic Differential (AASD). METHODS Words for AASD scales were derived from the reflections of 151 third year medical students attending two Australian medical schools. A pilot study of the AASD was then undertaken with third year students at another medical school to confirm usability and reliability of the instrument. After slight modification, a larger study using the AASD was then undertaken of medical students attending the three institutions, in order to obtain sufficient data for exploratory factor analysis. RESULTS n = 321 (response rate 73%). Mean AASD score 73.2/114. Cronbach's α = 0.86. There was no evidence of sequence bias. Exploratory factor analysis (EFA) demonstrated four factors: Instrumentality; Personal Appeal; Experience; and Sociability. A lower mean instrumentality subscore for all students and a higher mean experience subscore for female students were noted. CONCLUSIONS The AASD instrument proved internally reliable, and its use was generalisable to different groups of medical students. Its design ensured construct and face validity, and responses were not affected by sequencing bias. This study has revealed positive student attitudes towards older people. Variation in attitudes requires further investigation.
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Affiliation(s)
- Mark A G Wilson
- Community Based Health Education, Graduate Medicine, School of Medicine, University of Wollongong, Bowral, New South Wales, Australia
| | - Yvonne Tran
- Australasian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ian Wilson
- Learning and Teaching, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan Kurrle
- Health Care of Older People, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Cations M, Crotty M, Fitzgerald JA, Kurrle S, Cameron ID, Whitehead C, Thompson J, Kaambwa B, Hayes K, de la Perrelle L, Radisic G, Laver KE. Agents of change: establishing quality improvement collaboratives to improve adherence to Australian clinical guidelines for dementia care. Implement Sci 2018; 13:123. [PMID: 30249276 PMCID: PMC6154830 DOI: 10.1186/s13012-018-0820-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/12/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Dissemination of clinical practice guidelines alone is insufficient to create meaningful change in clinical practice. Quality improvement collaborative models have potential to address the evidence-practice gap in dementia care because they capitalise on known knowledge translation enablers and incorporate optimal approaches to implementation. Non-pharmacological interventions focused on promoting independence are effective and favoured by people with dementia and their carers but are not routinely implemented. The objective of this translational project is to assess the impact of quality improvement collaboratives (QICs) on adherence to non-pharmacological recommendations from the Clinical Practice Guidelines for Dementia in Australia. METHODS This project will employ an interrupted time-series design with process evaluation to assess the impact, uptake, feasibility, accessibility, cost, and sustainability of the QICs over 18 months. Thirty clinicians from across Australia will be invited to join the QICs to build their capacity in leading innovation in dementia care. Clinicians will participate in a training program and be supported to develop and implement a quality improvement project unique to their service context using plan-do-study-act cycles. Regular online meetings with their peers in the QIC will facilitate benchmarking and problem-solving. Clinicians will describe their practice via monthly checklists, and guideline adherence will be determined against a set of defined criteria. Phone interviews with up to 180 client dyads will be used to assess satisfaction with care and client outcomes. Clinician interviews and field note data will be used to explore implementation and costs. Involvement of people with dementia and carers will be embedded in the study design, conduct, and reporting, in addition to clinical and industry expertise. DISCUSSION The quality of dementia care in Australia is largely dependent on the clinician involved and the extent to which they apply best available evidence in their practice. This study will determine the elements of this multifaceted implementation strategy that contributed to guideline adherence and client outcomes. The findings will inform future translational approaches to improving care and outcomes for people with dementia and their carers. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trials Registry 21 February 2018 ( ACTRN12618000268246 ).
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Affiliation(s)
- Monica Cations
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Janna Anneke Fitzgerald
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- Northern Clinical School, The University of Sydney, Camperdown, New South Wales Australia
| | - Ian D. Cameron
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Jane Thompson
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
| | - Kate Hayes
- Griffith Business School, Griffith University, Gold Coast, Queensland Australia
- Healthcare and Hospital Process Improvement, Brisbane, Queensland Australia
| | - Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
| | - Kate E. Laver
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Camperdown, New South Wales Australia
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Abstract
Families living with younger onset dementia face unique social challenges, which services do not currently address. There is a gap in understanding the experiences of families affected by younger onset dementia, including the interactions and relationships within the family units, and with existing services and supports. In this qualitative research study, semi-structured interviews were conducted across Australia with seven health and social care providers, five persons living with younger onset dementia, six spouse/carers, and 17 children. A thematic analysis was conducted using a theoretical lens drawn from the combined perspectives of the social model of disability and family systems-illness model. Two central themes emerged in the data: (1) Understanding the social demands on the family – lifecycle challenges living with younger onset dementia from a social and family context; and (2) Interactions of health and social care providers with families living with younger onset dementia – opportunities and challenges in providing support and services geared to a whole family approach. In order to provide families for those living with younger onset dementia with optimal assistance and support, co-creation of a family-focused services model is proposed. Its purpose is to support effective therapeutic interactions and service development among service users, service providers, and stakeholders.
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Affiliation(s)
- Karen Hutchinson
- Northern Clinical School – Hornsby, University of Sydney, Australia
| | - Chris Roberts
- Northern Clinical School and Office of Education, University of Sydney, Australia
| | - Pamela Roach
- Department of Community Health Sciences, University of Calgary, Canada
| | - Susan Kurrle
- Cognitive Decline Partnership Centre, University of Sydney, Australia; Hornsby Ku-ring-gai Hospital, Australia
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Cameron I, Kurrle S, Walker P. Implementation of evidence based treatment into clinical practice for older people – A negative trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clemson L, Laver K, Jeon YH, Comans TA, Scanlan J, Rahja M, Culph J, Low LF, Day S, Cations M, Crotty M, Kurrle S, Piersol C, Gitlin LN. Implementation of an evidence-based intervention to improve the wellbeing of people with dementia and their carers: study protocol for 'Care of People with dementia in their Environments (COPE)' in the Australian context. BMC Geriatr 2018; 18:108. [PMID: 29739358 PMCID: PMC5941473 DOI: 10.1186/s12877-018-0790-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are effective non-pharmacological treatment programs that reduce functional disability and changed behaviours in people with dementia. However, these programs (such as the Care of People with dementia in their Environments (COPE) program) are not widely available. The primary aim of this study is to determine the strategies and processes that enable the COPE program to be implemented into existing dementia care services in Australia. METHODS This study uses a mixed methods approach to test an implementation strategy. The COPE intervention (up to ten consultations with an occupational therapist and up to two consultations with a nurse) will be implemented using a number of strategies including planning (such as developing and building relationships with dementia care community service providers), educating (training nurses and occupational therapists in how to apply the intervention), restructuring (organisations establishing referral systems; therapist commitment to provide COPE to five clients following training) and quality management (coaching, support, reminders and fidelity checks). Qualitative and quantitative data will contribute to understanding how COPE is adopted and implemented. Feasibility, fidelity, acceptability, uptake and service delivery contexts will be explored and a cost/benefit evaluation conducted. Client outcomes of activity engagement and caregiver wellbeing will be assessed in a pragmatic pre-post evaluation. DISCUSSION While interventions that promote independence and wellbeing are effective and highly valued by people with dementia and their carers, access to such programs is limited. Barriers to translation that have been previously identified are addressed in this study, including limited training opportunities and a lack of confidence in clinicians working with complex symptoms of dementia. A strength of the study is that it involves implementation within different types of existing services, such as government and private providers, so the study will provide useful guidance for further future rollout. TRIAL REGISTRATION 16 February 2017; ACTRN12617000238370 .
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Affiliation(s)
- Lindy Clemson
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia.
| | - Kate Laver
- Flinders University, Adelaide, Australia
| | - Yun-Hee Jeon
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
| | | | - Justin Scanlan
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
| | - Miia Rahja
- Flinders University, Adelaide, Australia
| | - Jennifer Culph
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
| | - Sally Day
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
| | | | | | - Susan Kurrle
- Faculty of Health Sciences, The University of Sydney, Centre of Excellence in Population Ageing Research, Sydney, 2006, Australia
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Laver K, Gnanamanickam E, Whitehead C, Kurrle S, Corlis M, Ratcliffe J, Shulver W, Crotty M. Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens' jury. J Health Serv Res Policy 2018. [PMID: 29523047 DOI: 10.1177/1355819618764223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable and are associated with high levels of satisfaction among users.
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Affiliation(s)
- Kate Laver
- 1 NHMRC-ARC Dementia Research Development Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Emmanuel Gnanamanickam
- 2 Research Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Craig Whitehead
- 3 Director of Rehabilitation and Aged Care, Southern Adelaide Local Health Network, South Australia
| | - Susan Kurrle
- 4 Curran Chair in Health Care of Older People, Faculty of Medicine, University of Sydney and Hornsby Ku-ring-gai Hospital, Australia
| | - Megan Corlis
- 5 Director Research and Development, Helping Hand Aged Care, South Australia
| | - Julie Ratcliffe
- 6 Professor of Health Economics, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Wendy Shulver
- 2 Research Fellow, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
| | - Maria Crotty
- 7 Professor of Rehabilitation, Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
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Janssens JFAM, de Kort SJ, Achterberg WP, Kurrle S, Kerse N, Cameron ID, Touwen DP. Medical and moral considerations regarding complex medical decisions in older patients with multimorbidity: a compact deliberation framework. BMC Geriatr 2018; 18:25. [PMID: 29370767 PMCID: PMC5785799 DOI: 10.1186/s12877-018-0707-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022] Open
Abstract
In health care for older adults, patients with multimorbidity usually receive the same interventions as those patients without multimorbidity. However, standard curative or life-sustaining treatment options have to be considered carefully in view of the maximally attainable result in older and frail patients. To guide such complex medical decisions, we present a compact deliberation framework that could assist physician(s) in charge of the medical treatment of a specific elderly patient to systematize his own thinking about treatment and decisional responsibilities, in case of an intercurrent disease. The framework includes four questions to be addressed when deciding on a single urgent standard curative or life-sustaining intervention in acute medical problems of an elderly patient with multimorbidity: 1) What is known about the patient’s aims and preferences? 2) Will the intervention be effective? 3) Will the intervention support the aims and preferences of the patient? 4) In view of the aims and preferences, will the risks and benefits be in balance? If all four considerations are answered favorably, the intervention will fit patient-centered and appropriate care for frail older patients with multimorbidity. Application to a patient case illustrates how our framework can improve the quality of the shared decision-making process in care for older people and helps clarify medical and moral considerations regarding how to appropriately treat the individual patient.
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Affiliation(s)
- Jeroen F A M Janssens
- Department of public health and primary care, Leiden University Medical Center, Postal adres: V06-P, Postbus 9600, 2300 RC, Leiden, The Netherlands. .,Novicare, Laan van Vredenoord 33, 2289 DA, Rijswijk, The Netherlands.
| | - Susanne J de Kort
- Topaz-Zuydtwijck, Aaltje Noordewierlaan 50, 2324 KS, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of public health and primary care, Leiden University Medical Center, The Netherlands, Postal adres: V06-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Susan Kurrle
- Curran Ageing Research Unit, University of Sydney, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, 1001, New Zealand
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Dorothea P Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, The Netherlands, Postal adres: J1-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
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Wilson MAG, Kurrle S, Wilson I. Medical student attitudes towards older people: a critical review of quantitative measures. BMC Res Notes 2018; 11:71. [PMID: 29361969 PMCID: PMC5781287 DOI: 10.1186/s13104-018-3186-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Further research into medical student attitudes towards older people is important, and requires accurate and detailed evaluative methodology. The two objectives for this paper are: (1) From the literature, to critically review instruments of measure for medical student attitudes towards older people, and (2) To recommend the most appropriate quantitative instrument for future research into medical student attitudes towards older people. RESULTS A SCOPUS and Ovid cross search was performed using the keywords Attitude and medical student and aged or older or elderly. This search was supplemented by manual searching, guided by citations in articles identified by the initial literature search, using the SCOPUS and PubMed databases. International studies quantifying medical student attitudes have demonstrated neutral to positive attitudes towards older people, using various instruments. The most commonly used instruments are the Ageing Semantic Differential (ASD) and the University of California Los Angeles Geriatric Attitudes Scale, with several other measures occasionally used. All instruments used to date have inherent weaknesses. A reliable and valid instrument with which to quantify modern medical student attitudes towards older people has not yet been developed. Adaptation of the ASD for contemporary usage is recommended.
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Affiliation(s)
- Mark A G Wilson
- Graduate Medicine, School of Medicine, University of Wollongong, PO Box 1782, Bowral, NSW, 2576, Australia.
| | - Susan Kurrle
- Health Care of Older People, Faculty of Medicine, University of Sydney, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian Wilson
- Learning and Teaching, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Building 28 Rm 115, Wollongong, NSW, 2522, Australia
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Vecchio N, Fitzgerald JA, Radford K, Kurrle S. Respite service use among caregivers of older people: comparative analysis of family dementia caregivers with musculoskeletal and circulatory system disorder caregivers. Aging Ment Health 2018; 22:92-99. [PMID: 27661453 DOI: 10.1080/13607863.2016.1232368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify the main drivers of the use of respite services and the need for respite services among caregivers of people experiencing dementia relative to family caregivers of people with other health conditions. METHOD Based on nationally representative secondary data regression analysis was used to test the association between selected health conditions and the utilisation of and need for respite services. RESULTS For a person living with dementia the odds of using respite care are higher than for a person with either a musculoskeletal or circulatory condition. Family caregivers of people living with dementia report the odds of the need for more respite as 5.3 times higher than for family caregivers of people with musculoskeletal conditions and 7.7 times higher than for family caregivers of people with circulatory conditions. The main reason for never using respite services is largely driven by the type of health condition, age of care recipient, existence of a spouse, and level of disability. CONCLUSIONS Respite services that cater to the specific needs of families experiencing dementia at home should become a higher priority within the aged care sector. Alternative models of respite care that focus on prevention and early intervention would be cost effective.
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Affiliation(s)
- Nerina Vecchio
- a Griffith Business School, Griffith Health Institute , Griffith University , Southport , Australia
| | - Janna A Fitzgerald
- b Department of International Business and Asian Studies, Griffith Business School , Griffith University , Southport , Australia
| | - Katrina Radford
- b Department of International Business and Asian Studies, Griffith Business School , Griffith University , Southport , Australia
| | - Susan Kurrle
- c Faculty of Medicine , University of Sydney , Sydney , Australia.,d Rehabilitation and Aged Care Service , Hornsby Hospital , Sydney , Australia
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Walker P, Miller Amberber A, Kurrle S, Kifley A, Cameron ID. Prevalence of vitamin D supplement use in Australian residential aged care facilities in November 2014. BMC Res Notes 2017; 10:385. [PMID: 28797304 PMCID: PMC5553921 DOI: 10.1186/s13104-017-2721-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/29/2017] [Indexed: 12/03/2022] Open
Abstract
Objective We sought to establish the prevalence and predictors of adequate vitamin D supplement use, as per current falls prevention guidelines in Australian aged care homes. De-identified medication chart data from November 2014 were collected from pharmacists. The proportion of residents prescribed vitamin D and associations between adequate vitamin D supplementation and state, calcium use and osteoporosis medication use were assessed. Results The prevalence of adequate vitamin D supplement use (≥800 IU) was 47.1% of residents (95% CI 41.4, 52.8%). There was no significant difference between states (p = 0.3), however there was large variation between individual facilities (15.9–85.0%). Residents were more likely to be prescribed an adequate dose of vitamin D if they were prescribed a calcium supplement (p = 0.0001) or an osteoporosis medication (p = 0.03).
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Affiliation(s)
- Pippy Walker
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Amanda Miller Amberber
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Cations M, Laver K, Whitehead C, Ratcliffe J, Kurrle S, Shulver W, Crotty M. FACILITATING CONSUMER-DIRECTED DECISION MAKING IN LONG-TERM CARE: RESULTS FROM A CITIZENS’ JURY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Cations
- Flinders University, Adelaide, South Australia, Australia,
- UNSW Australia, Sydney, South Australia, Australia,
| | - K. Laver
- Flinders University, Adelaide, South Australia, Australia,
| | - C. Whitehead
- Flinders University, Adelaide, South Australia, Australia,
| | - J. Ratcliffe
- Flinders University, Adelaide, South Australia, Australia,
| | - S. Kurrle
- University of Sydney, Sydney, South Australia, Australia
| | - W. Shulver
- Flinders University, Adelaide, South Australia, Australia,
| | - M. Crotty
- Flinders University, Adelaide, South Australia, Australia,
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Kurrle S. COGNITIVE IMPAIRMENT AFTER HIP FRACTURE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Kurrle
- University of Sydney, Sydney, New South Wales, Australia
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Kaambwa B, Ratcliffe J, Killington M, Liu E, Cameron I, Kurrle S, Davies O, Crotty M. IS HIP FRACTURE REHABILITATION FOR NURSING HOME RESIDENTS COST-EFFECTIVE? RESULTS FROM AN RCT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Kaambwa
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - J. Ratcliffe
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - M. Killington
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - E. Liu
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - I. Cameron
- University of Sydney, Sydney, New South Wales, Australia
| | - S. Kurrle
- University of Sydney, Sydney, New South Wales, Australia
| | - O. Davies
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
| | - M. Crotty
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia,
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Kurrle S, Poulos C. A COLLABORATIVE RESEARCH MODEL TO IMPROVE THE LIVES OF PEOPLE LIVING WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Kurrle
- University of Sydney, Hornsby, New South Wales, Australia
| | - C. Poulos
- HammondCare, Sydney, New South Wales, Australia
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Kurrle S. CONSUMER ENGAGEMENT: FROM RESEARCH QUESTION TO IMPLEMENTATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Kurrle
- University of Sydney, Hornsby, New South Wales, Australia,
- Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
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Crotty M, Killington M, Liu E, Cameron I, Kurrle S, Kaambwa B, Ratcliffe J, Chehade M. HIP FRACTURE REHABILITATION FOR PEOPLE LIVING IN NURSING HOMES: RESULTS OF A RCT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M. Crotty
- Flinders University, Adelaide, South Australia, Australia,
- Repatriation General Hospital, Adelaide, South Australia, Australia,
| | - M. Killington
- Flinders University, Adelaide, South Australia, Australia,
- Repatriation General Hospital, Adelaide, South Australia, Australia,
| | - E. Liu
- Flinders University, Adelaide, South Australia, Australia,
- Repatriation General Hospital, Adelaide, South Australia, Australia,
| | - I. Cameron
- Sydney University, Sydney, New South Wales, Australia,
| | - S. Kurrle
- Sydney University, Sydney, New South Wales, Australia,
| | - B. Kaambwa
- Flinders University, Adelaide, South Australia, Australia,
| | - J. Ratcliffe
- Flinders University, Adelaide, South Australia, Australia,
| | - M. Chehade
- Adelaide University, Adelaide, South Australia, Australia
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Cameron I, Fairhall N, John B, Lockwood K, Monaghan N, Sherrington C, Lord S, Kurrle S. A MULTIFACTORIAL INTERDISCIPLINARY INTERVENTION IN PRE-FRAIL OLDER PEOPLE: RANDOMISED TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I. Cameron
- University of Sydney, St Leonards, New South Wales, Australia,
| | - N. Fairhall
- University of Sydney, St Leonards, New South Wales, Australia,
| | - B. John
- Hornsby Ku-ring-gai Health Service, Hornsby, New South Wales, Australia,
| | - K. Lockwood
- University of Sydney, St Leonards, New South Wales, Australia,
| | - N. Monaghan
- University of Sydney, St Leonards, New South Wales, Australia,
| | - C. Sherrington
- University of Sydney, St Leonards, New South Wales, Australia,
| | - S. Lord
- University of New South Wales, Randwick, New South Wales, Australia
| | - S. Kurrle
- University of Sydney, St Leonards, New South Wales, Australia,
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Ratcliffe J, Flint T, Easton T, Killington M, Cameron I, Davies O, Whitehead C, Kurrle S, Miller M, Liu E, Crotty M. An Empirical Comparison of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U in a Post-Hospitalisation Population of Frail Older People Living in Residential Aged Care. Appl Health Econ Health Policy 2017; 15:399-412. [PMID: 27882528 DOI: 10.1007/s40258-016-0293-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To empirically compare the measurement properties of the DEMQOL-U and DEMQOL-Proxy-U instruments to the EQ-5D-5L and its proxy version (CEQ-5D-5L) in a population of frail older people living in residential aged care in the post-hospitalisation period following a hip fracture. METHODS A battery of instruments to measure health-related quality of life (HRQoL), cognition, and clinical indicators of depression, pain and functioning were administered at baseline and repeated at 4 weeks' follow-up. Descriptive summary statistics were produced and psychometric analyses were conducted to assess the levels of agreement, convergent validity and known group validity between clinical indicators and HRQoL measures. RESULTS There was a large divergence in mean (SD) utility scores at baseline for the EQ-5D-5L and DEMQOL-U [EQ-5D-5L mean 0.21 (0.19); DEMQOL-U mean 0.79 (0.14)]. At 4 weeks' follow-up, there was a marked improvement in EQ-5D-5L scores whereas DEMQOL-U scores had deteriorated. [EQ-5D-5L mean 0.45 (0.38); DEMQOL-U mean 0.58 (0.38)]. The EQ-5D and CEQ-5D-5L were more responsive to the physical recovery trajectory experienced by frail older people following surgery to repair a fractured hip, whereas the DEMQOL-U and DEMQOL-Proxy-U appeared more responsive to the changes in delirium and dementia symptoms often experienced by frail older people in this period. CONCLUSIONS This study presents important insights into the HRQoL of a relatively under-researched population of post-hospitalisation frail older people in residential care. Further research should investigate the implications for economic evaluation of self-complete versus proxy assessment of HRQoL and the choice of preference-based instrument for the measurement and valuation of HRQoL in older people exhibiting cognitive decline, dementia and other co-morbidities.
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Affiliation(s)
- Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Thomas Flint
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Tiffany Easton
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maggie Killington
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Owen Davies
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Craig Whitehead
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Enwu Liu
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, School of Health Sciences, Flinders University, Adelaide, Australia
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Goeman D, Comans T, Enticott JC, Renehan E, Beattie E, Kurrle S, Koch S. Evaluating the Efficacy of the "Support for Life" Program for People with Dementia and Their Families and Carers' to Enable Them to Live Well: A Protocol for a Cluster Stepped Wedge Randomized Controlled Trial. Front Public Health 2016; 4:245. [PMID: 27843893 PMCID: PMC5086896 DOI: 10.3389/fpubh.2016.00245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction Assistance provided to support people living with dementia and carers is highly valued by them. However, current support systems in Australia are disjointed, inaccessible to all, poorly coordinated, and focus on dysfunction rather than ability. Support workers for people with dementia are in short supply, and there is little consistency in their roles. To address this large service gap and unmet need, we have developed an evidence-based optimized model of holistic support for people with dementia and their carers and families. This article describes the “Support for Life” model intervention. Methods A stepped wedge cluster randomized controlled trial will be conducted over 3 years across three Australian states. One hundred participants with dementia and/or their carers/family members will be randomly selected from community health center client lists in each state to receive either the dementia “Support for Life” intervention (Group A) or routine care (Group B). Group A participants will have access to the intervention from year 1. Group B participants will continue to receive usual care and will not be denied information on dementia or dementia services in year 1. In year 2, Group B participants will have access to the intervention. A highly trained expert dementia support worker will provide the “Support for Life” intervention, which is a flexible, individually tailored, holistic support that is relationship-centered, focused on enablement as opposed to dysfunction, and facilitate participants’ continued engagement in their community and the workforce. Additionally, dementia education, information resources, advocacy, and practical support to navigate and access dementia services and health care will be provided. The mode of support will include face to face, telephone, and internet interaction on an “as needed basis” for 12 months. The primary hypothesis is that the intervention will improve the quality of life of people with dementia and the health and well-being of carers/family through facilitating the continuation and enhancement of regular daily activities. Secondary hypotheses will examine other health and service usage outcomes. The outputs will also include a health economic analysis to investigate the costs (and savings) of any associated reduction in unnecessary health services use and delay in accessing permanent residential aged care. Trial registration number Australian and New Zealand Clinical Trials Registry: ACTRN12616000927426p.
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Affiliation(s)
- Dianne Goeman
- Royal District Nursing Service Ltd., RDNS Institute, St. Kilda, VIC, Australia; Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Tracy Comans
- Metro North Hospital and Health Service District, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | | | - Emma Renehan
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
| | - Elizabeth Beattie
- Dementia and Collaborative Research Centre (DCRC), School of Nursing, Queensland University of Technology , Brisbane, QLD , Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre (CDPC), Sydney Medical School - Northern, Hornsby Ku-ring-gai Hospital, The University of Sydney , Sydney, NSW , Australia
| | - Susan Koch
- Royal District Nursing Service Ltd., RDNS Institute , St. Kilda, VIC , Australia
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Laver K, Cumming RG, Dyer SM, Agar MR, Anstey KJ, Beattie E, Brodaty H, Broe T, Clemson L, Crotty M, Dietz M, Draper BM, Flicker L, Friel M, Heuzenroeder LM, Koch S, Kurrle S, Nay R, Pond CD, Thompson J, Santalucia Y, Whitehead C, Yates MW. Clinical practice guidelines for dementia in Australia. Med J Aust 2016; 204:191-3. [DOI: 10.5694/mja15.01339] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/28/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Meera R Agar
- Braeside Hospital, Sydney, NSW
- UNSW Australia, Sydney, NSW
| | | | | | | | - Tony Broe
- Neuroscience Research Australia, Sydney, NSW
| | | | | | | | | | | | | | | | - Susan Koch
- Royal District Nursing Service, Melbourne, VIC
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Milte R, Miller M, Crotty M, Mackintosh S, Thomas S, Cameron I, Whitehead C, Kurrle S, Ratcliffe J. Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med 2016; 48:378-85. [DOI: 10.2340/16501977-2070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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