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Objectives: To inform strategies to increase physical activity amongst Older Residential Care Facility Residents (ORCFR), this research explored self-identified motivators for, benefits of and barriers to physical activity engagement., Methods: The research was framed within a salutogenic model of health, viewing health as a continuum shaped by one's health resources and life stressors. This exploratory qualitative research examined the physical activity experiences of seven ORCFR in Brisbane, Australia. Semi-structured interviews with open-ended questions assessed basic demographics, Physical Activity (PA) levels, perceived benefits of and barriers to PA. The resulting data underwent thematic analysis., Results: After seven interviews, data saturation was reached, revealing three major themes and seven subthemes. These were positive socialisation (inclusion) with subthemes of enjoying social contact and avoiding "zombieland" (loneliness). Negative socialisation (isolation) with subthemes of avoiding conflict and feeling awkward. Maintaining independence was the benefit, with subthemes of getting around to socialise, activities of daily living and preserving health to socialise., Conclusion: Conventional physical activity programs emphasising medical and clinical benefits are disconnected from ORCFR motivators, as residents perceive benefits in terms of mobility and socialisation. This disconnect partially explains poor acceptability and uptake of ORCFR physical activity interventions over the last 25 years., (© 2021 Australian Health Promotion Association.)

Objective: To investigate functional limitations and life satisfaction among Asian-born migrants and Australian-born participants in the Household, Income and Labour Dynamics in Australia (HILDA) study., Methods: Information on 10 167 Australian-born participants and 650 Asian-born migrants from Waves 6 to 16 (2006-2016) of HILDA was analysed using multivariate linear regressions, adjusting for baseline covariates., Results: Middle-aged and older Asian-born migrants had a lower decline in functional limitations compared to the Australian-born participants (-1.74 vs -4.47 during the 5-year period and -5.66 vs -8.50 during the 10-year period). Decline in life satisfaction scores was relatively stable among older Australian-born participants, but there was a steeper decline among Asian-born migrants in the 5-year period. Notably, relative change was not statistically significant for both outcomes., Conclusion: This study reveals that middle-aged and older Asian-born migrants had less decline in physical health but not in life satisfaction. Monitoring health and well-being of migrants as they age could help to minimise health disparities in Australia., (© 2019 AJA Inc.)

A letter to the editor is presented in response to the article on the assessment of patients' decision-making capacity by professor Pēteris Dārzinņš in the 2010 issue of "Australian Occupational Therapy."

Healthy ageing refers to the development and maintenance of the functional ability of ageing individuals. Aged care nurses provide nursing care to elderly individuals and usually work in aged care residential facilities, nursing homes, home care services, and/or hospital departments. The registered nurse working in the aged care sector has several important roles. Key roles cover both therapeutic and preventative paradigms, as discussed in this paper. The aged care nurse is also "tasked with" holistic patient-centred care and the promotion of healthy ageing via advocacy and sociocultural roles. This paper examined, described, and analysed the multifaceted role of an aged care nurse from an Australian perspective. We conducted meticulous searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to aged care nursing in Australia. This paper relied upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. Multiple aspects of healthy ageing and holistic aged care nursing are discussed. The key roles of the aged care nurse are enumerated next, in accordance with the code of conduct from the Nursing and Midwifery Board of Australia (NMBA). The NMBA promotes evidence-based, culturally sensitive, consultative, holistic aged care clinical practice that includes input from care recipients, their decision makers, and/or their health care providers. The difficult issue of loneliness is discussed with strategies to ameliorate aspects of this. Good social networks, community interactions, meaningful friendships, and participation in personalised spiritual/religious practices improve the quality of aged care. The key topic of elder abuse and its forms are discussed apropos of aged care nursing. Healthy ageing is promoted by identifying and reporting elder abuse at the earliest. Current Australian law and recent federal legislation changes pertaining to aged care nursing are discussed next. As a result of these legislation changes, several new quality control imperatives (for aged care organisations/facilities) under the Aged Care Quality and Safety Commission (ACQSC) have been implemented. Residential and flexible aged care providers should now have robust ongoing documentation and a well-developed behaviour support plan (BSP) for each care recipient who currently requires or may require restrictive practices, which must be reported under the new serious incident reporting scheme (SIRS). Various strategies to promote healthy ageing and approaches to communicate effectively with aged care recipients are also discussed. Healthy ageing is promoted when age care recipients are empowered with making their own autonomous choices in "major and minor" aspects of life. Finally, approaches to optimise quality aged care nursing care are discussed. The Roper–Logan–Tierney model is one of the models used to assess and optimise nursing care. This is premised on the capability of an ageing individual to accomplish 12 basic activities of daily living. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross‐sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Methods: Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self‐report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. Results: A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. Conclusion: This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model. [ABSTRACT FROM AUTHOR]

Objective: With little research investigating older Australians' experience of companion animal (pet) ownership or wildlife encounters, this paper focuses on the value of animals in their lives. Methods: Three online focus groups explored 103 older adults' lived experience of home and community, with this paper focused on interactions with animals—companion animals and wildlife. Results: Most (60%) had at least one pet, which brought love and joy into their lives. Reflexive thematic analysis identified three themes: pets as family; challenges of pet ownership; and connection to everyday wildlife and nature. Conclusions: In addition to valuing companion animals (typically cats and dogs), this research is among the first to show that some older people also develop ongoing relationships with local Australian wildlife, such as kookaburras, kangaroos, lizards and birds, which raises the possibility that fostering connections with wildlife may enhance well‐being. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows. Method: A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1–8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave. Results: There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4–5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2–3 to 14–15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers. Conclusion: Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays. Significance: What is already known: Maternal labour force participation has been negatively affected by having a child with chronic health conditions, whereas paternal labour force participation is not significantly influenced. What this paper adds: Having a child at risk of developmental delays negatively influenced maternal and paternal labour force participation, where the influence on fathers was distinctly small and with narrower fluctuations during the 14 to 15 years of follow-up. [ABSTRACT FROM AUTHOR]

In a study on children, families and food messages in Victoria, Australia, we utilised a multi-methods approach that included visual data produced by primary-school aged children. Working with 50 families, we provided each child investigator with an iPad for 3–4 days and invited them to photograph family food events important to them. The analysis of visual data alongside child and family interviews revealed the diverse meaning-making practices children draw on to understand food practices at home and school. These research practices aspired to locate the researchers and children as co-creators. In this paper, we reflect on the challenges and (dis)comfort we faced as researchers as the implications of co-creation emerged and we engaged with children's voices, photos and families inside their homes. The multi-methods approach supported a comprehensive and rich engagement with commensality and pleasure in food practices at home for children, but illuminated the complex emotional and intellectual terrain of such research practices. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe the prevalence of cognitive impairment in hospital inpatients, the associated need for assistance with activities of daily living (ADL) and carer perceptions of hospital care. Methods: A prospective cross-sectional observational study was conducted in a large metropolitan teaching hospital in Brisbane, Australia. Participants were inpatients aged ≥65 years and their carers. Cognitive impairment was measured by clinician auditors using the validated 4 'A's test (4AT), with a score >0 indicating cognitive impairment (1–3, probable dementia; >3, probable delirium). The need for supervision and/or assistance with ADL was recorded from daily nursing documentation. Carers were invited to complete a brief questionnaire. Results: In all, 92 of 216 older inpatients (43%) had cognitive impairment, including 52 (24%) with probable delirium. The need for supervision and/or assistance with ADL increased significantly with 4AT score. Fifty-two carers of patients with cognitive impairment reported feeling welcome and that care was safe. They identified opportunities for better information, greater support and more inclusion of carers. Conclusions: Cognitive impairment is common in older inpatients and is associated with increased care needs. Workforce planning and health professional training need to acknowledge the needs of patients with cognitive impairment. There are opportunities for greater support and more involvement of carers. What is known about the topic?: Cognitive impairment due to delirium and dementia increases with age, and is common in older medical and surgical inpatients. However, cognitive impairment remains under-recognised by healthcare staff. Australian guidelines now recommend routine screening using valid tools, and including carers, when appropriate, when assessing, caring for and communicating with people with cognitive impairment. What does this paper add?: This cross-sectional study using the validated 4AT showed 43% of hospital inpatients aged ≥65 years had cognitive impairment. Participants with cognitive impairment had higher care needs and much longer hospitalisations. Carers of people with cognitive impairment reported unmet information needs in hospital and had limited involvement in assessment and care. What are the implications for practitioners?: Cognitive impairment is common in older inpatients. Hospitals and healthcare professionals must be prepared and equipped to recognise cognitive impairment, and address the accompanying patient and carer needs. [ABSTRACT FROM AUTHOR]

Aims This paper aims to report carers' perceptions of the impact of home telehealth on the provision of care and the sustainability of home telehealth use. Method This paper is reporting on a sample of 15 carers who were involved in the telehealth arm of a larger controlled trial. Results Carers primarily believed that telehealth helped to provide better care. None of the carers had organised, or planned to organise, ongoing telehealth monitoring beyond the study. The main reason given for non-sustained usage was the belief that the person they cared for no longer required, or would benefit from, the monitoring. Conclusion As the person being cared for was a frail older person with multiple chronic diseases and a history of recent hospitalisation, the non-sustained usage of home telehealth by carers raises questions about what is needed to ensure sustainability of use; this requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Adolescents and young adults (AYAs) bereaved by the death of a parent or sibling from cancer report unique psychosocial needs and can have difficulty adjusting to their loss. Unaddressed, this can result in poor long-term bereavement outcomes. This paper describes the development and evaluation of Good Grief – a 3-day camp-based program focused on meeting coping, social support, and respite needs of AYAs bereaved by familial cancer. Methods: One hundred and nine Australian AYAs (68% female; age: 12–25 years, M = 16.63) participated in the evaluation. Grief intensity (Texas Revised Inventory of Grief), meaning-making (Grief and Meaning Reconstruction Inventory), trauma coping (Perceived Ability to Cope with Trauma Scale) and unmet needs (Bereaved Cancer Needs Instrument) measures were administered pre-program and 3-months post-program. Acceptability was measured after each session and at the program's conclusion. Appropriateness was measured at 3-month follow-up. Thirteen participants were interviewed three months post-program on their perceptions of the program. Results: Participants reported high program satisfaction, engagement with psychosocial sessions, and enjoyment of recreational activities. Significant improvements were observed in trauma coping abilities and reductions in unmet needs for managing emotions, social support, respite, future planning, and accessing information and support domains. No change was evident in grief intensity or meaning-making as measured quantitatively. Interviews supported these quantitative findings but also identified evidence of personal growth, a component of meaning-making. Conclusions: Good Grief is a highly acceptable and beneficial intervention that addresses the unique needs of AYAs bereaved by familial cancer. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

palacios-ceña d., losa-iglesias m.e., álvarez-lópez c., cachón-pérez m., reyes r.a.r., salvadores-fuentes p. & fernández-de-las-peñas c. (2011) Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review. Journal of Advanced Nursing 67(12), 2537-2550. Abstract Aim. This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. Background. An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. Data sources. A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. Review Methods. Twenty-two papers were included. The Critical Appraisal Skills Programme and Prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. Findings. People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. Conclusion. Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face. [ABSTRACT FROM AUTHOR]

Introduction: Indigenous women experience high rates of family violence‐related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence‐related traumatic brain injury (TBI), including impacts on life, as well as decision‐making processes about healthcare access and engagement. Methods: Purposeful sampling was used to complete semi‐structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Results: Three themes were conceptualised based on the data and research aims: interweaving of the past and the present—ways women experience brain injury; factors that inform decision‐making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long‐term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. Conclusions: The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow‐up support, co‐designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Public or Patient Contribution: Indigenous women shared their views and experiences of TBI from family violence as well as decision‐making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research. [ABSTRACT FROM AUTHOR]

Objective: To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives. Design: Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis. Setting: Interviews of people across Australia. Participants: Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life. Main outcome Measure: Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020). Results: Policy changes surrounding border closures negatively impacted people's wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures. Conclusion: Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people's physical, financial, and emotional state. [ABSTRACT FROM AUTHOR]

Objectives In the increasingly competitive environment of aged care in Australasia, how can providers and consumers be sure that the care support delivered is efficient and makes a positive difference? Monitoring outcomes has long been emphasised for ensuring quality service delivery, yet there is currently no consistently applied approach available. Methods This paper considers the importance of measuring outcomes in community care and reports on the development and field trial of the Australian Community Care Outcomes Measure ( ACCOM). The ACCOM combines data already collected by services on the capabilities and care needs of individual consumers and their demographic characteristics with a short questionnaire on quality of life based on the Adult Social Care Outcomes Toolkit (ASCOT). It is completed by consumers and staff. Results In the first round of a field test of the ACCOM (2016), baseline data were successfully collected for over 200 individual aged care clients, each receiving consumer-directed care ( CDC) packages at home. Results show the measure to be practical and easy to use. A second round to measure change and enable the calculation of outcomes for each consumer was successfully completed 6 months later. Conclusion Field testing of the ACCOM shows promising results. More extensive trials of the measure are planned across Australia. [ABSTRACT FROM AUTHOR]

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [ SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs ( AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care ( N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department ( OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [ OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up ( AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. [ABSTRACT FROM AUTHOR]

Background and Aims: Clinicians treating paediatric chronic pain conditions understand that persistent pain, functional ability, and symptoms of depression often co-exist, yet these relationships have only been described to a limited extent by research. This paper more closely examines the relationship between symptoms of depression and subtypes of functional disability., Methods: Participants included a clinical sample of children and adolescents (N=239) referred to a paediatric multidisciplinary pain clinic for treatment of persistent or recurrent (chronic) pain in Australia. The majority of participants were female, (76.6%), and were aged 7-17 years (mean age at the time of presentation was 13.8 years). Data from standardized instruments and interview data were collected from a clinical file audit. The Pediatric Outcomes Data Collection Instrument (PODCI) was used as a measure of functional difficulties performing activities of daily living, and the Children's Depression Inventory (CDI) was used to measure depressive symptoms., Results: High rates of depression and functional disability were observed, but were not associated with one another beyond relatively weak associations. Contrary to prior studies using different measures of physical functioning, depression symptoms were not associated with PODCI functional disability beyond a minor association with anhedonia symptoms (primarily driven by the pain/comfort subscale of the PODCI)., Conclusions and Implications: We argue that prior research has measured physical functional limitations in paediatric pain sufferers in a way that is heavily influenced by psychosocial factors, in particular by the symptoms of clinical depression. In contrast, using a measure of physical functioning (PODCI) less influenced by psychosocial factors suggests that the relationship between physical functioning during activities of daily living (e.g., use of upper limbs, basic gross and fine motor skills, basic mobility) and depression is weaker, despite both being heightened in this sample. Unlike other functional disability measures, the Pediatric Outcomes Data Collection Instrument (PODCI) may allow researchers to assess functional limitations somewhat independently of depression symptoms. This conclusion requires replication in further studies, but if confirmed, then the PODCI could be advocated as a useful measure to obtain a more 'pure' measure of functional difficulties due to pain, relatively independent of depression., (Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.)

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations. [ABSTRACT FROM AUTHOR]

This paper explores which measures of health accurately reflect the functional capabilities of individuals -- that is, in what measures of health do those classified as having poorer health actually have poorer functional outcomes. Using the 2003 Survey of Disability, Ageing and Carers, cross-tabulations, chi-squared analysis, and logistic regression models were used to identify the relationship between functional outcomes (core activity limitations and employment and education participation) and various measures of health and disability (composite disability measure, health utility scores and general health assessment). Both the composite disability measure and the health utility score accurately capture individual functional capacity -- with both measures being related to employment participation, employment and education restrictions, and core activity imitations. The health utility scores can also be divided into a categorical measure and still reflect this functional capacity. The general health assessment measure is also related to functional capacity and can potentially be used in the place of both the composite disability measure and the health utility score. [ABSTRACT FROM AUTHOR]

There are no standard criteria for an occupational therapy (OT) home assessment for patients about to be discharged from an acute rehabilitation facility. This has implications for benchmarking, quality improvement and research. The aim of this paper is to establish 'core/essential' and 'ideal world' elements of OT home assessments for patients about to be discharged from acute rehabilitation settings. A piloted open-ended questionnaire initiated a Delphi study involving knowledgeable OTs working in Australian public and private acute rehabilitation settings. 'Core/essential' and 'ideal world' elements of OT home assessments were confirmed when 70% agreement was reached. Of 242 facilities in two Australian states, 110 were invited to participate, and 81 OTs from 84 facilities did so. Four Delphi rounds were required to reach consensus on 30 'core/essential' and 25 'ideal world' elements. Standard use of 'core/essential' pre-discharge home assessment elements should improve standards of care and the quality of discharge planning. OTs should consider including 'ideal world' criteria in pre-discharge assessments to optimize recently ill patients' community independence. [ABSTRACT FROM AUTHOR]

Background/aim The first evidence-based Clinical Practice Guidelines and Principles of Care for People with Dementia in Australia have been released. The Guidelines detail a number of important evidence-based recommendations for occupational therapists. The aim of this paper is (1) to provide an overview of Guideline development, and (2) to describe the evidence supporting a recommendation for occupational therapy. Common characteristics of effective occupational therapy programmes for people with dementia are described. Methods Guideline development involved adaptation of existing high-quality guidelines developed overseas and 17 systematic reviews to ensure that the most recent high-quality evidence was included. One of the systematic reviews involved examining the evidence for interventions to promote independence in people with dementia. Specifically, we looked at the evidence for occupational therapy and its effect on activities of daily living, quality of life and carer impact. Results A total of 109 recommendations are included in the Guidelines. Occupational therapy was found to significantly increase independence in activities of daily living and improve quality of life. Effective occupational therapy programmes involve: environmental assessment, problem solving strategies, carer education and interactive carer skills training. Conclusion Occupational therapists working with people with dementia in community settings should ensure that their time is spent on those aspects of intervention that are shown to be effective. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a preliminary psychometric evaluation of the electronic mobile shower commode assessment tool (eMAST) 1.0.Design/methodology/approach A cross-sectional validation study was undertaken with 32 adults with spinal cord injury (SCI), aged 18 years or older, who use mobile shower commodes for toileting and/or showering. The eMAST 1.0, Quebec user evaluation of satisfaction with assistive technology, Version 2.0 (QUEST 2.0), and modified system usability scale (SUS) were administered online via SurveyMonkey. The eMAST 1.0 was re-administered approximately seven days later. Psychometric properties of internal consistency, test-retest reliability, and convergent validity were assessed.Findings As hypothesised, the eMAST 1.0 demonstrated strong internal consistency (Cronbach’s α=0.73, N=32); acceptable test-retest reliability (intra-class coefficient (3, 1)=0.75 (0.53-0.88, 95 per cent confidence interval) (n=27)); and strong, positive correlations with the QUEST 2.0’s devices subscale and modified SUS (Pearson’s correlation coefficients 0.70 and 0.63, respectively).Research limitations/implications The sample was not fully representative of Australian data in terms of gender, or state of residence, but was representative in terms of SCI level. Age data were not assessed. The sample size was small but adequate for a preliminary psychometric evaluation.Originality/value The preliminary psychometric evaluation indicates the eMAST 1.0 is a valid and reliable instrument that measures usability of MSCs for adults with SCI. It may be useful for exploring relationships between usability and satisfaction of MSCs. [ABSTRACT FROM AUTHOR]

Objective: To examine the time, frequency and duration of each direct care activity conducted by personal carers in Australian residential aged care homes., Methods: A time-motion study was conducted to observe 46 personal carers at two high-care houses in two facilities (14 days at Site 1 and 16 days at Site 2). Twenty-three direct care activities were classified into eight categories for analysis., Results: Overall, a personal carer spent approximately 45% of their time on direct care, corresponding to 3.5h in an 8-h daytime shift. The two sites had similar ratios of personal carers to residents, and each resident received 30 min of direct care. No significant differences between the two sites were found in the time spent on oral communication, personal hygiene and continence activities. Personal carers at Site 1 spent significantly less time on toileting and mobility activities than those at Site 2, but more time on lunch activity. Although oral communication took the longest time (2h), it occurred concurrently with other activities (e.g. dressing) for 1.5h., Conclusions: The findings provide information that may assist decision makers in managing the operation of high-care residential aged care facilities, such as planning for task allocation and staffing. What is known about the topic? Overall, 30%-45% of the care staff's time is spent on direct care in residential aged care facilities. What does this paper add? This paper adds knowledge about how much time is required to conduct each direct care activity and the frequency and duration of conducting these activities to meet residents' day-to-day care needs in two high-care houses in two aged care facilities. What are the implications for practitioners? On average, a resident with high-care needs requires 30 min direct care. There may exist a basic minimum desirable ratio of personal carers to residents in high-care facilities. Residents' toileting needs are high after meals. Communication with residents represents an essential role in providing care.

Background: Stroke recovery is generally optimised through the provision of multidisciplinary rehabilitation. However not much is known about how equitably such services are utilised. This study examines the determinants of physiotherapy and speech therapy utilisation in rehabilitation within a cohort of young stroke survivors in Australia., Methods: Psychosocial Outcomes in StrokE (POISE) was a three-year prospective observational study involving stroke survivors between the ages of 18 and 65 years recruited within 28 days of stroke. It was conducted in 20 stroke units in Australia. Participants were interviewed at 28 days (baseline), 6 and 12 months after stroke about their demographic and socioeconomic background, economic and health outcomes and the use of services. The primary outcome in this paper is utilisation of rehabilitation in the 12 months after stroke., Results: Of 414 participants, 254 (61%) used some rehabilitation in the 12 months post stroke. The strongest predictor of use of these rehabilitation services was dependency at 28 days, as assessed by need for assistance in activities of daily living (OR=33.1; p<0.0001). Other significant variables were two dimensions of social capital--an individuals' ability to make important decisions, which had a negative relationship (OR = 0.43; p=0.04) and number of close friends (OR= 1.042; p=0.02)., Conclusion: These findings demonstrate that socio-demographic factors exert little influence on the use of rehabilitation services in working age stroke patients and that the use of such services is primarily determined by 'need'. Such findings suggest that services are being provided equitably., Trial Registration: ANZCTRN12608000459325.

Objective: To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital., Methods: The cohort was generated by consecutive sampling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected., Results: Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of individuals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk)., Conclusions: Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument's moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may 'slip through the net', as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.

Objective: Human 'functioning' is about how people live on a day-to-day basis. This paper sets out the case for adopting a common language about functioning that would improve population health information and information sharing across health and community service systems., Approach: Modern health systems recognise the importance of human functioning in addition to diagnosis and disease prevention. 'Functioning' is important in the context of chronic disease, mental health, healthy ageing, and the right of people with disabilities and their carers to participate in society. We outline major directions in the health system and their relationship to the concept of functioning., Conclusions and Implications: The concept of functioning has not been used explicitly and consistently in Australian health and human service systems, which nevertheless deal with the 20% of the population who experience difficulties in functioning. The International Classification of Functioning, Disability and Health (ICF) is the international standard for definition, classification, information and measurement of functioning. While it has been partially implemented in Australia, it should be used more broadly, across health and community services, as the basis for information on functioning. This is an intended parallel to the use of the ICD as the standard classification and code list for disease monitoring and related health information systems. Monitoring health status and planning interventions and resources require information about people's functioning in their daily lives as well as their diseases. Such information should be based on the international standards developed for this purpose., (© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.)

Background: The development of technology in dementia care has largely been without consultation with carers, and has primarily focused on safety, monitoring devices, and supporting activities of daily living. Further, while involving end-users in the design of technology has been recommended, this is yet to become common practice. Method: We conducted a mixed methods study with the aim of investigating carers' values and priorities for technology development, including prior experiences, barriers to use, and what they would like technology to do. Importantly, we asked carers for their design ideas and bespoke technology solutions for future development. Results: Carers of people living with dementia (N = 127), including both unpaid (n = 102) and paid carers (n = 25) residing in Australia, completed an online survey. In addition, a subsample of carers (n = 23) participated in semi-structured interviews. Findings demonstrate that carers want technology to be person-centred, customisable, and to increase opportunities for meaningful social connection. Findings also demonstrate the ability of carers to generate creative design solutions for dementia care. Conclusions: These findings and implications will be discussed in relation to the importance of co-design with carers and engineers during the design phase of assistive technology. Also, the importance of technology to enhance, not replace, human-to-human social interactions is highlighted. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Summary: We estimated the short-term impact of fragility fractures on community-dwelling women in five countries. Women with fragility fractures reported significantly more difficulties performing activities of daily living and significantly higher levels of lost productivity and caregiver support than those without fractures; results highlight the multi-country indirect burden of fragility fractures. Introduction: To estimate the impact of fragility fractures on activities of daily living (ADL), productivity loss and caregiver support in women with a recent fragility fracture. Methods: This multi-centre cross-sectional study enrolled community-dwelling women aged ≥ 50 years in South Korea, Spain, Germany, Australia and the United States. The fragility fracture cohort consisted of women with an index fragility fracture in the past 12 months; the fracture free cohort consisted of women with no fracture in the 18 months prior to study enrolment. Study participants completed three validated questionnaires: Lawton Instrumental ADL (IADL), Physical Self-Maintenance Scale (PSMS) and iMTA Productivity Cost Questionnaire (iPCQ). Results: In total, 1,253 participants from 41 sites across the five countries were included. Compared with the fracture free cohorts, fragility fracture cohorts had significantly lower function and were more dependent on support (p < 0.05 in all countries for Lawton IADL, and in South Korea, Spain, Australia and the United States for PSMS), significantly higher hours of paid absenteeism (p < 0.05, Spain, Germany, Australia), significantly higher unpaid lost productivity (p < 0.05, South Korea, Spain, Germany), significantly more days of paid help received in the home (p < 0.05 South Korea, Spain and the United States), and significantly more days of unpaid help from family members or friends (p < 0.05, all countries). Conclusion: In this multi-national study, fragility fractures in community-dwelling ≥ 50 years women were associated with several outcomes indicating higher indirect burden and lower quality of life, including more difficulties performing ADL and higher levels of lost productivity and caregiver support. [ABSTRACT FROM AUTHOR]

Aims: To assess the association of postoperative delirium developed in the post‐anaesthetic care unit (PACU) with older patients' ability to perform activities of daily living (ADL) during the first five postoperative days. Background: Previous studies have focused on the association between postoperative delirium and long‐term function decline, however the association between postoperative delirium and the ability to perform ADL, particularly in the immediate postoperative period, needs further investigation. Design: A prospective cohort study. Methods: A total of 271 older patients who underwent elective or emergency surgery at a tertiary care hospital in Victoria, Australia, participated in the study. Data were collected between July 2021 and December 2021. Delirium was assessed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‐5). The Katz Index of Independence in Activities of Daily Living (KATZ ADL) scale was used to measure ADL. ADL was assessed preoperatively and daily during the first five postoperative days. The STROBE checklist was used to report this study. Results: Results showed that 44 (16.2%) patients developed new episode of delirium. Postoperative delirium was independently associated with decline in ADL (RR = 2.83, 95% CI = 2.71–2.97; p < 0.001). Conclusions: Postoperative delirium was associated with a decline in ADL among older people during the first five postoperative days. Screening for delirium in the PACU is essential to identify delirium during the early stages of postoperative period and implement a timely comprehensive plan. Relevance to clinical practice: Delirium assessment of older patients in the PACU, and for at least the first five postoperative days, is strongly recommended. We also recommend engagement of patients in a focused physical and cognitive daily activity plan, particularly for older patients undergoing major surgery. Patient or public contribution: Patients and nurses helped in data collection at a tertiary care hospital. [ABSTRACT FROM AUTHOR]

This paper reports language ability and everyday functioning of 133 children with hearing impairment who were evaluated at 3 years of age, as part of the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. The language abilities of children were evaluated using the Preschool Language Scale (PLS-4), Peabody Picture Vocabulary Test (PPVT), Diagnostic Evaluation of Articulation and Phonology (DEAP) and Child Development Inventory (CDI). Everyday functioning of children was evaluated by interviewing parents using the Parents' Evaluation of Aural/oral performance of Children (PEACH) questionnaire. There were significant correlations among language measures, and also between the standardized language measures and the PEACH. On average, children who had language deficits exhibited difficulties in everyday functioning. The evidence lends support to a systematic use of parents' observations to evaluate communicative functioning of children in real life. On average, children's language attainment decreased as hearing loss increased, more so for children of less highly educated parents. Factors that were not significantly associated with speech and language outcomes at 3 years were age of amplification and socioeconomic status. As multiple factors affect children's outcomes, it will be possible to examine their effects on outcomes of children when all data in the LOCHI study are available.

Background: Australian government policy regards people with intellectual disability (ID) as citizens with equal rights, which means that they should have access to the same opportunities as the wider community. Ageing in place is central to aged care policy in Australia for the general population., Method: This paper reviews policy to support the provision of similar opportunities to age in place for people with ID, and the reasons for its slow development., Results: Due to lifestyle patterns earlier in the life course, many people with ID experience a mid-life disruption to their accommodation, and may live in a group home as they age or may move prematurely to residential aged care. The absence of mechanisms to adjust disability funding as needs change, and the existence of policy that denies residents in group homes access to community-based aged care, forces disability services to "go it alone" to support ageing in place., Conclusion: Despite a national priority to improve the interface between the disability and aged care sectors, administrative and funding characteristics continue to obstruct the development of implementation strategies to support ageing in place for people with ID, which remain at the stage of an exploration of the issues.

Purpose: A country's data may influence and inform its policy and services, if suitably designed. This paper describes how two related and interacting activities--work on disability concepts and classification as well as the preparation of national data dictionaries--have been carried out in Australia, with this purpose., Method: Three key ingredients were combined. A broadly based advisory group was established to ensure the use of disability concepts that are meaningful not only to policy makers but also to the Australian community. This group advised on two 'twin' activities: participation in the revision of the key international classification for disability, and specification of data elements for a national data dictionary according to international standards., Results: National data elements were developed, based on the Beta-2 draft ICIDH-2, and accepted for use in Australian national data dictionaries on a trial basis., Conclusion: The purpose and process have been accepted as valuable, and there is interested anticipation of new Australian standard data elements based on the ICF.

Increasing numbers of older people seek to age at home in their community in western countries including Australia. Whilst this aligns with community aged care policy, the nature and suitability of their housing to enable ageing in place, receives less policy attention. The increasing representation of older tenants in the private rental market, with limited resources and precarious tenure highlights the need to understand ageing in place in a privately rented home. This study aimed to explore the relationships between housing accessibility, financial status, health, and independence for older Australians renting privately. Home visits were conducted with 27 older adults, where the SF8, ADL Staircase, the Housing Enabler, the Financial Capability Questionnaire, and the 30:40 indicator of housing stress were completed. This preliminary research found that older private renters lived in inaccessible homes, with high scores on the Housing Enabler (mean = 185) indicating poor access. Inaccessible housing was correlated with worse physical health, lower perceived independence, less independence in instrumental activities of daily living, and activities of daily living being difficult to perform. Older tenants living with higher levels of financial disadvantage were also found to be less independent and have poorer mental health. The research reveals important policy implications for community aged care, housing, and social security, including removing barriers to enable free and easy access to home modifications for older renters experiencing financial disadvantage. Future research should examine a nationally representative, diverse sample of owners, private renters, and social housing tenants to further understand the influence of the home environment, including tenure, on the health and well-being of older adults as they age in place. [ABSTRACT FROM AUTHOR]

There is minimal understanding of how people with mild stroke experience health services. With recent acknowledgement of the difficulties this population faces, it is imperative that their views are sought on services required to meet their needs. This study aimed to answer the question: 'How do people with mild stroke perceive their experience of stroke-related healthcare services?'. Qualitative investigation using an interpretative phenomenological analysis. Five participants were interviewed at 1-, 3-, and 6- months post discharge. Three themes were identified that reflected the 'essence' of healthcare service experiences: 1) The difficult diagnosis, 2) Standard care: good but not good enough, and 3) A journey better not done alone. It was clear that people with mild stroke and health professionals experienced difficulty linking symptoms to stroke. Following hospital discharge, issues relating to service coordination, information provision, and secondary prevention were identified. A formal support person appeared to increase participants' feelings of support. [ABSTRACT FROM AUTHOR]

Background. During the normal ageing process, a person's cognitive functions and memory gradually decline, which can affect their ability to perform everyday activities including cooking, cleaning, managing finances, and shopping. Semantic memory encoding strategies benefit older adults' cognitive and functional performance. Such strategies can be taught by an accessible, cost-effective, and flexible app-based programme. Currently, no studies examine such an app-based programme focussed on everyday activities. Objectives. To determine if an app-based programme constructed on the principles of semantic memory encoding strategies, targeted towards older adults, called Enhancing Memory in Daily Life (E-MinD Life) is (1) feasible by examining acceptance, engagement, and attendance and (2) acceptable by examining the perceived effectiveness, relevancy, clarity, and convenience. Methods. Eleven participants were recruited to a nine-week (18 sessions) programme using E-MinD Life. Feasibility was measured by collecting data on recruitment and retention rates, attendance, and duration of sessions. Acceptability was measured via a Likert scale questionnaire and free comments. Likert scale responses were analysed using descriptive statistics; open-ended responses were categorised qualitatively via constant comparative approach. Results. Nine participants completed the programme. Overall, most participants found the programme relevant, convenient, logical, and easy to understand and perceived it to be effective to address functional cognitive problems impacting performance of everyday activities. The results from the qualitative analysis showed that participants found the programme enjoyable and the interaction with the research team throughout the intervention beneficial. Conclusion. E-MinD Life shows promise as the focus of further research to determine the effectiveness of the programme and sematic-based cognitive strategies in maintaining cognition and performance in everyday activities among older adults with and without cognitive impairment. [ABSTRACT FROM AUTHOR]

Introduction: Family carers play a crucial role in dementia care. As the condition progresses, people with dementia become increasingly dependent on their carers for all areas of daily living. The risk of carer burnout is significant. One of the more stressful events for family carers is when hospital admission is required for the person they care for. Living in regional Australia adds complexity to the experience. Hospital and health services in regional Australia could use a greater understanding of the issues associated with hospital care to inform patient and carer management, improve outcomes for this population and support the goal of 'ageing in place'. Objective: To explore the experience of carers of people with dementia in regional Australia when hospital care or treatment was required for the person they provide care for. Design: Six family carers living in regional Australia participated in this interpretative phenological study. Individual, semistructured interviews were held and transcribed verbatim shortly after. Data analysis occurred via three key processes: reading and highlighting, coding and grouping, which yielded the major themes and subthemes of the study. Findings: Three major themes and nine subthemes emerged from data analysis. The major themes were: (i) support and supply of specialist care; (ii) travel needs and negotiations; and (iii) empathy and experience make a difference. Discussion: Findings from this study highlight aspects of care that healthcare providers can address to improve outcomes for patients with dementia and their carers. Carers need opportunities to seek clarification and provide input on care plans. Good communication, involvement and relationship building between healthcare staff and carers are vital to achieving optimal patient outcomes. Staff training supporting understanding of appropriate dementia care is essential for improved patient and carer outcomes. Conclusion: Factors related to regional location, including lack of specialist care and support, compound carers' challenges. Healthcare provider education on dementia care and dementia‐friendly processes in hospitals will support optimal patient and carers outcomes. [ABSTRACT FROM AUTHOR]

Background: Cancer‐related fatigue (CRF) is a common debilitating condition. International evidence supports an exercise prescription for CRF. The majority of Australians with cancer do not meet recommended exercise targets. Aims: To analyse the effects of a guideline‐based supervised exercise programme on CRF among a representative private hospital cancer patient sample (n = 268). Methods: We collected data from 268 patients recruited from haematology and oncology over a 5‐year period. Participants underwent a 3‐month CRF exercise programme based on internationally recognised exercise guidelines. The programme, conducted by a multidisciplinary team, operated twice weekly sessions of 2 h duration comprising aerobic, resistance and balance exercises; hydrotherapy and condition counselling; fatigue management; and dietetic, speech pathology and swallowing education (head and neck cancers). The effect of the programme was measured in relation to the following outcomes: Functional Assessment of Chronic Illness Therapy, Fatigue (self‐reported fatigue); Functional Assessment of Cancer Therapy, general quality of life (health‐related quality of life in cancer); six‐minute walk test; and Lawton's Instrumental Activities of Daily Living Scale. Results: Multivariate outcomes showed statistically significant improvements in all four major outcome measures, plus a programme effect of greater than 0.7 for each outcome variable. The programme treatment outcomes were consistent over the 5 years of the programme. Conclusions: The outcomes of this programme contribute to exercise guidelines in Australia. Currently only position statements exist on the subject, but there are no programme guidelines. An exercise prescription is critical to cancer outcomes. This programme is likely to benefit cancer survivors experiencing CRF across private and public hospitals in Australia. [ABSTRACT FROM AUTHOR]

This paper describes the involvement of older people with intellectual disabilities in residential- and community-based activities and programmes. The 446 participants were selected from a national database of people of 55 years of age and over with intellectual disabilities in Australia. The data indicate that participants made infrequent use of public amenities and social and recreational facilities. With the exception of those living with relatives, most had limited contact with family and friends. The discussion draws attention to the need for independence training which will enable the current generation of middle-aged people with an intellectual disability to make decisions and choices about social and community activities.

Given the social burden and significant cost of dementia care in Australia, finding evidence-based approaches that improve outcomes, maintain independence, and reduce the impact on patients and families is essential. Finding effective ways to train and assist the healthcare staff who support these individuals is also critical, as they are considered to be at risk of workplace stress, burnout, and other psychological disturbances which negatively affects standards of care. The current paper describes a protocol for evaluating the effects of a Montessori-based approach to dementia care, in non-residential respite centres. An 18 month prospective observational, cohort controlled design is suggested that will compare participants from a community respite service that has undergone a Montessori-based workplace culture change and those from a service that provides a person-centred ‘care as usual’ approach. To achieve this, the protocol includes the assessment of participants across multiple variables on a monthly basis including the cognitive, behavioural, and emotional functioning of clients with dementia, levels of caregiver burden experienced by informal carers, and burnout, compassion satisfaction and workplace engagement among respite staff. The protocol also employs a qualitative evaluation of program fidelity. This approach will provide further insight into the potential benefits of early intervention with Montessori approaches for persons living with dementia in the community, their caregivers, and the staff and volunteers who assist them. [ABSTRACT FROM AUTHOR]

Young people living in residential out-of-home care (henceforth OoHC) are at increased risk of becoming overweight or obese. Currently, recognition of the everyday mechanisms that might be contributing to excess weight for children and young people in this setting is limited. The aim of this study was to better understand the barriers and complexities involved in the provision of a 'healthy' food environment in residential OoHC. Heightening awareness of these factors and how they might compromise a young person's physical health, will inform the development, refinement and evaluation of more sensitive and tailored weight-related interventions for this population. The paper presents a nuanced picture of the complexity of everyday food routines in residential care, and illustrates the ways in which food is 'done' in care; how food can be both symbolic of care but also used to exercise control; the way in which food can be used to create a 'family-like' environment; and the impact of traumatic experiences in childhood on subsequent behaviours and overall functioning in relation to food. It is argued that a health agenda designed for a mainstream population ignores the very complex relationship that children in residential OoHC may have with food. It is recommended that future intervention approaches account for personal food biographies, trauma and children's social backgrounds and how these are implicated in everyday practices and interactions around food. [ABSTRACT FROM AUTHOR]

Background: Refugee women exhibit some of the highest rates of chronic pain yet the diversity and challenges of health care systems across countries pose numerous challenges for refugee women trying to access quality health care. Objective: We sought to explore the experiences of Assyrian refugee women seeking care for chronic pain. Methods: Semi-structured interviews (face-to-face and virtual) were undertaken with 10 Assyrian women of refugee background living in Melbourne, Australia. Audio recordings and field notes of interviews were collected and themes were identified using a phenomenological approach. Women were required to be conversant in English or Arabic and willing to use a translator if necessary. Results: We identified five major themes of women's experiences accessing care for chronic pain: (1) the story of pain; (2) the experience of help seeking in Australia and home country; (3) factors shaping the ability to access appropriate care; (4) support seeking systems; and (5) influence of culture and gender roles. Conclusion: Exploring refugee women's experience of seeking care for chronic pain reinforces the need to explore hard to reach population's perspectives in research and helps to understand how vectors of disadvantage may intersect. For successful integration into health care systems of host countries, particularly for complex conditions such as chronic pain, there is a need to work with women community members to develop programs that are culturally aligned to enhance access pathways to care. [ABSTRACT FROM AUTHOR]

This is the first study to investigate instrumental activities of daily living in older autistic adults. We conducted interviews with fifteen adults (mean age = 60.1, SD = 7.4, range = 50–73) from Australia with no intellectual disability. Analysis included both deductive and inductive steps, to categorise responses using the Occupational Performance Model Australia and identify themes across participants' experiences. Strengths and challenges were unique to the individual, as were the methods they had developed to manage tasks. Challenges occurred mostly at the interaction between aspects of the environment (sensory, cognitive, social and cultural) and personal factors such as health conditions and sensory sensitivities. Enhanced person-environment fit is needed, as is a shift in wider sociocultural attitudes to enable comfort and autonomy in later life. [ABSTRACT FROM AUTHOR]

Juvenile populations face a substantial risk of emotional, physical, and psychological harm as a result of bullying and cyberbullying experiences. As a result, there is a need to assess the situational and individual factors contributing to the risk of bullying victimization. There is, however, little research examining cyberbullying victimization using frequency-based measures of victimization. To address this gap in the literature, this study utilized a sample of over 37,000 youth from South Australia to explore the risk factors associated with cyberbullying victimization through a routine activities framework while controlling for verbal, social, and physical bullying. The findings noted partial support for the routine activities theory framework to account for cyberbullying victimization. Additionally, the study found differences in cyberbullying risk factors relative to the frequency with which it was reported, as well as the role of school support from peers and adults in increasing risks. [ABSTRACT FROM AUTHOR]

The literature on subjective memory concerns (SMC) as a predictor for future cognitive decline is varied. Furthermore, recent research has pointed to additional complexity arising from variability in the experience of SMC themselves (i.e. whether they are remitting or sustained over time). We investigated the associations between SMC and objectively measured cognition in an Australian population-based cohort. Four waves (4-year intervals between waves) of data from 1236 participants (aged 62.4 ± 1.5 years, 53% male) were used. We categorized participants as experiencing SMC, when they indicated that their memory problems might interfere with their day-to-day life and/or they had seen a doctor about their memory. SMC was categorized as "no" reported SMC, "remitting", "new-onset" or "sustained" SMC. Cognitive assessment of immediate and delayed recall, working memory, psychomotor speed, attention and processing speed were assessed using a neuropsychological battery. Eighteen percent of participants were characterised as having SMC: 6% (77) "remitting", 6% (77) "new-onset" and 6% (69) "sustained" SMC. There was no consistent evidence for an association between SMC and subsequent decline in cognition. However, SMC was associated with poorer performance on contemporaneous tasks of attention and processing speed compared to "no" SMC. Asking about SMC may indicate a current decline in cognitive function but, in this sample at least, did not indicate an increased risk of future decline. [ABSTRACT FROM AUTHOR]

Self-management can lead to increased self-efficacy and improved quality of life for individuals with chronic conditions; however, there is little research exploring how self-management approaches can be used for chronic communication disorders, such as aphasia. Modifications to self-management approaches would be required to accommodate for aphasia; therefore, the input of people with aphasia (PwA) should be sought. The aims of the present study were: (1) To investigate and document the experiences and perspectives of PwA regarding self-management; (2) To explore how technology can be used to support aphasia self-management. In-depth, semi-structured interviews were conducted with 26 PwA living in Australia. Qualitative content analysis was used to analyse interview data. Analysis resulted in six themes: (1) In self-management, PwA take control of life with aphasia and assume responsibility for engaging in opportunities to improve overall communication; (2) Community aphasia groups are important enablers of self-management because they facilitate peer support; (3) Communication partners (CPs) provide multifaceted support in aphasia self-management; (4) SLPs provide integrated support and coordination in aphasia self-management; (5) Technology supports PwA to self-manage speech therapy and communication in daily life; (6) Psychological and physical health issues and societal factors may impact aphasia self-management abilities. From the perspective of PwA, aphasia self-management involves enhancing skills enabling communication and life participation. PwA are central to aphasia self-management, with support provided by CPs, peers, and SLPs. Technology has a range of applications in aphasia self-management. PwA identified potential personal and contextual barriers that may impact self-management. For people with aphasia, engaging in conversation and social interaction are primary means of managing/improving communicative life participation; therefore, this should be a key focus of aphasia self-management programs. Aphasia self-management approaches should maximise the use of available support and provide tailored information, education, and training in the area of self-management to key stakeholders (people with aphasia, communication partners, and speech-language pathologists). People with aphasia should be supported to use technology for aphasia self-management, encompassing communication specific and daily life use. People with aphasia should be heavily involved in the development of structured aphasia self-management approaches. [ABSTRACT FROM AUTHOR]

Introduction: Driver‐trained occupational therapists are advanced practitioners who work with people to help maintain their independence and autonomy through driving. There is a lack of investigation of professional reasoning processes for why interventions are recommended by driver‐trained occupational therapists. This research project sought to explore the reasoning of driver‐trained occupational therapists when they plan, implement, and reflect on driver rehabilitation interventions. Methods: In‐depth semistructured interviews (n = 7) and one focus group (n = 5) were conducted with 12 experienced driver‐trained occupational therapists, comprising a wide range of experience, client populations, and licensing jurisdictions. Data were analysed using a modified template analysis approach. Results: Seven higher order modes that reflect professional reasoning theory and hierarchical models were evident in the work of the driver‐trained occupational therapists, with no new modes of reasoning emerging. Ethical reasoning regarding the balance of safety versus client independence was an overarching shared framework, with therapists mostly using interactive and conditional reasoning in practice. Twenty‐three second‐level themes were identified that exemplify how the reasoning modes operate in practice. Therapists described assessment activity even when solely asked about intervention, indicating the importance of assessment to intervention design. The full hierarchy of reasoning was evident during the rehabilitation phase. Conclusion: These findings elucidate the application of professional reasoning in advanced occupational therapy practices and could support driver‐trained occupational therapists in making driving rehabilitation recommendations if used in reflective practices. [ABSTRACT FROM AUTHOR]

To investigate stroke survivors' activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation. Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis. Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants' orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans. Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives. Rehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments. Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations. Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person's activity/occupational participation during recovery from stroke. Returning to full activity/occupational participation after stroke is a dynamic and continuous process. Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the "right rehabilitation" at the "right time" throughout their recovery journey. [ABSTRACT FROM AUTHOR]

Background: The trochanteric bursa (TB) is an anatomic structure, which is dissected during posterior/lateral hip approaches in Total Hip Arthroplasty (THA). Some surgeons prefer to simply resect the bursa as they believe that it may be responsible for postoperative lateral trochanteric pain (LTP). Others advocate that this tissue acts as a buffer minimizing friction between soft tissue and bone, and therefore its repair may prevent LTP after THA. Aim: The purpose of this prospective randomized controlled trial was to compare the clinical results of either resecting or repairing the TB during posterior approach THA. Methods: Forty-two patients with primary hip osteoarthritis undergoing THA via a posterior hip approach were randomly assigned to two groups; Group A, or TB resection group and Group B, or TB repair group. All patients in both groups were evaluated postoperatively in terms of hip function, measured by the Harris Hip Score (HHS), at 6 weeks, 3 months, 6 months, and 12 months after surgery, as well as LTP during daily routine activities and lying on the operative side. Results: Forty patients completed the study. Postoperative difference in terms of leg length and femoral offset was similar among the two groups (P = 0.467 and P = 0.39, respectively). At 6 weeks, patients in Group B had higher HHS (P = 0.052) and experienced less LTP when lying on the operative side (P = 0.046) but not during activities (P = 0.759). Thereafter, all functional parameters measured had comparable values in both groups. Subgroup analysis failed to identify any correlation between high offset stems and LTP. Conclusion: TB repair in posterior approach THA improves hip functional recovery as well as patients' ability to lie on the operative side during the early postoperative period. [ABSTRACT FROM AUTHOR]