Search

Data specifically comparing outcomes for people with and without intellectual disability is limited. This paper reports perceived health and wellbeing of older Australians resident in metropolitan and rural locations in New South Wales and Queensland. Respondents were community-residing individuals with intellectual disability and mainstream age peers [age = 60]. Measures included SF12; Cummings well-being scales; DSSI; Adverse Life Events; and financial hardship status. The sample was composed of 391 adults with intellectual disability and 920 age peers. Adults with intellectual disability were significantly more likely to note adverse life events, worse mental health, and lower levels of social support, but reported higher mean wellbeing scores and had higher scores for physical health. Results indicated higher likelihood of adults with intellectual disability reporting comparative disadvantage across multiple key areas when compared to age peers.

Medical professionals need to be equipped with competencies to provide sustainable healthcare and promote planetary health. The aims of this study were to map the presence of planetary health themes in one Australian medical program, develop and pilot a planetary health blended-learning module drawing on constructivism learning theory, and evaluate the effectiveness of the activities. A mixed methods approach was used comprising quantitative mapping of learning outcomes, measurement of pre- and post-intervention planetary health knowledge, and a feedback survey. Mapping revealed little integration of environmental issues across the medical program. Student's knowledge score increased by 2.37 points on average (95% confidence interval 1.66-3.09) (response rate 46%); 84.2% of respondents rated the activities as excellent/good. Since planetary health education is not currently required in Australian medical curricula, there is still little information for local medical educators on how to develop it, therefore studies such as this can provide some preliminary guidance.

Background: Although a 'person-centred focus' is a legislated objective for both aged-care and disability services sectors in Australia, evidence suggests limited translation into systems and practices due to entrenched silos. This paper proposes a Best Practice Framework to mitigate these silos. Methods: Mixed-methods research comprising key informant interviews with major stakeholders across both sectors; a survey of people with/without intellectual disability aged 60+ years; qualitative in-depth interviews; and survey of health professionals. Results: There is an urgent need to develop inter-sectoral 'integrated care systems'. Key components include choice in accommodation; regular assessment of health and well-being indicators; development and adoption of nationally consistent policies/standards across integrated aged- and disability-care sectors; improved strategies for workforce planning; and upskilling of existing staff including place-based collaboration. Conclusions: An integrated service model requires collaboration on broader public policy instruments, appropriate planning and resourcing. A strategic shift is required to ensure better quality person-centred support systems.

Background: There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods: A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results: Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions: There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.

Background: This study investigated perceived quality of life (QoL) of community-dwelling middle-aged adults (30-50 years) with an intellectual disability and/or developmental disability living in rural or urban areas in New South Wales and Queensland, Australia. The specific aim of the current paper was to provide a descriptive evidence base of QoL and its specific domains by various key demographic characteristics of middle-aged individuals. This cohort is likely to have either experienced or reached adulthood during and after large-scale deinstitutionalisation in Australia. Methods and procedures: A cross-sectional design was utilised, based on the QoL-Q survey, testing domains of satisfaction; Competence/Productivity; Empowerment/Independence; and social belonging/community integration. The survey included demographic questions and was distributed to participants through disability support agencies across two states. The final sample included 291 respondents. Results: The overall QoL-Q scores ranged from 3.0 to 29.5 (Mean = 20.4, SD , 4.1), with considerable variation in mean scores both across and within domains. The two demographic areas that showed greatest predictive value for QoL were work status and accommodation issues. The loss of agency and control in choice of co-residents influenced perceived QoL for empowerment and independence domain of QoL-Q. Conclusions: The findings highlight QoL issues associated with policy decisions and support programmes for middle-aged adults. The two key recommendations arising from the project are that future planning for post-retirement or reduced working hours needs to commence at a much younger age than currently expected, and more attention needs to focus on facilitating individual decision-making and choice within shared accommodation options.

Aims: Life expectancy for both sexes in Australia exceeds 80 years, with individuals with intellectual disability also increasingly living into older age. This research aimed to comparatively examine perceptions of staff supporting either older adults or age peers with lifelong intellectual disability. Methods: This project asked 420 medical, health, and support workers about training adequacy, health services access, and trigger points for premature institutionalisation. This paper is based on a subsample of 196 respondents who provided quantitative and qualitative responses. Results: There was considerable variation in confidence in supporting ageing individuals, while only 23.7% of doctors reported their training was adequate to support adults ageing with intellectual disability. A lack of services and poor carer health were identified as triggers for premature institutionalisation. Conclusions: The study revealed key differences in staff perceptions of support provision and training adequacy when comparing ageing individuals with intellectual disability to the general ageing population.

Australian education service provision includes the delivery of quality educational programmes to rural and remote living children. However, according to their parents, many children with developmental disabilities (such as Down Syndrome and Autism Spectrum Disorders) who are living in rural country areas in New South Wales (NSW) still do not have access to an acceptable education programme. This study aimed to use quality of life factors via a family quality of life scale to explore 51 parents' experience of educational service provision for their children with developmental disabilities in rural NSW. The results indicated that successful engagement with the school system is strongly affected by the views, assumptions, expertise and prejudices of teaching and care professionals. Further research into how local educational service providers may assist rural Australian families with a child with IDD in rural and remote locations is warranted.

Background: Access to support services in rural areas is known to be problematic both in Australia, and in other countries around the world, but the majority of research on the population of people ageing with learning disability has so far focussed on metropolitan residents. The authors report about select aspects of the lived experience of older adults with learning disability resident in rural locations in two states of Australia. Materials and Methods: This pilot project examined data drawn from 34 semi-structured interviews conducted with 17 older adults and 17 carers. Responses were analysed for thematic areas. Results: It was observed that the capacity of certain rural areas to support meaningful choice-making was limited due to constraints of access to key services, including community-based aged care, generic and specialist health services, and both supported disability and aged-care residential options. Responses indicated that those living in both small- and medium-sized congregate care settings (such as group homes and residential aged-care facilities) had more limited choices and only partial (if any) control over their living situation. Conclusion: An understanding of the needs of older adults with learning disability resident in rural areas is important to ensure that both aged-care and disability support structures are built on individuals' needs.

Despite infidelity being a highly traumatic experience, not all couples end their relationship after discovery of the affair. The present study provides insights into the experience of couples who remained together after having experienced infidelity by one partner. Narrative inquiry methods were used to undertake and analyze in-depth interviews with eligible participants from eastern Australia who responded to advertisements. The key themes acknowledged by participants as reasons for maintaining the relationship were motivation to stay together, treasuring acts of kindness, meaning making, and social support. However, the reconciliation process was tortuous and involved forgiveness, seeking counseling, managing memories, vicarious learning, and changing couple dynamics. In rebuilding the relationship, a modification often took place, resulting in a shift in the power dynamic. The article outlines professional considerations for counselors and other therapists in relation to professional practice. (Contains 1 table.)

Background: Disability research data often exist in the form of individual records located within discrete registers that may extend across sensitive political boundaries. Method: This paper discusses the opportunities and challenges associated with using linked health and administrative data for disability research, with examples from research projects conducted both in Australia and overseas. Results: Linked data offer distinct value in providing a comprehensive profile for a range of health issues, such as morbidity, mortality, assessing health care costs and/or quality of service provision. Conclusions: While the use of record linkage in health research is not a novel concept, recent advances in technology and electronic data management plus improved data linkage protocols have markedly increased the feasibility and opportunity for successfully utilising data linkage for the purposes of research, while at the same time protecting the privacy of the individual. An awareness and appropriate management of the associated challenges is required to maximise the outcomes of disability research using linked data. (Contains 1 table.)

In Australia, general health and medical services are subsidised by the government. This includes care for people with disabilities, screening and diagnostic services for common diseases, including cancer, and care and treatment for various medical conditions. In Western Australia, the majority of state-provided health services are well documented in linkable databases. We have examined data from a large cohort of people receiving services for learning disability from the state and linked this with the state cancer registry and hospital records. While people with learning disability appear to be at similar risk for cancer, they may have poorer treatment outcomes as they already experience a range of health conditions which can exacerbate medical complications associated with treatment and/or other primary or secondary co-morbid conditions. Our results show that the mean number of hospital admissions were higher for the cancer group, even when adjustments were made for conditions such as childhood leukaemia and renal dialysis both of which often require frequent hospitalisations. Multivariate regression analyses showed that younger age, female sex and severe or unspecified level of disability were significant contributors to the frequency of hospital admissions. Qualitative information gleaned from detailed chart reviews showed that in addition to considerable morbidity, some patients were admitted repeatedly either because of lack of supportive environments and/or lack of compliance with treatment. Issues in providing appropriate support services for individuals and their carers are discussed.

This study examines the psychological health correlates of domestic violence in a large random sample of mid-aged Australian women (N = 11,310, age 47 to 52 years). Logistic regressions were used to investigate the associations between domestic violence and depression, anxiety, and psychological wellbeing, after adjusting for demographic variables (marital status, income management, area). Results indicate increased odds of having experienced domestic violence for those who had: ever experienced a diagnosis of depression, anxiety, or an "other" psychiatric disorder; recent symptoms of depression and anxiety; used psychoactive medication for depression or anxiety in the 4 weeks prior to the survey; and who reported current depression. Current psychological well-being had an inverse association with a history of domestic violence: As psychological well-being decreased, the odds of having ever experienced domestic violence increased. The results indicate that a history of domestic violence is associated with decreased psychological well-being in mid-aged Australian women. (Contains 4 tables.)

Background: Non‐communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill‐health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid‐aged and older‐aged people with mild intellectual disability. Method: Comparative data comes from two cross‐sectional surveys using similar methodology and timeframes. The analysis sample comprises mid‐aged group (30–50 years, N = 291) and older‐aged group (≥60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid‐adulthood and increases with age. The mean number of NCDs in mid‐aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement. [ABSTRACT FROM AUTHOR]

There is little research comparatively assessing prevalence of pain between older people either with or without intellectual disability. This paper explores health and social factors associated with chronic pain in these two groups. A cross-sectional survey was undertaken in New South Wales and Queensland, Australia. Inclusion criteria were adults either with or without intellectual disability, aged 60 years and older, and currently living in community-settings. Univariate and multivariable analyses were undertaken on a sample of 391 adults with intellectual disability and 920 adults without intellectual disability. Key findings included higher prevalence of pain in the intellectual disability group, along with higher rates of osteoarthritis, falls, oral health problems, and mood disorders. Mitigating risk factors for conditions that cause chronic pain in older adults is crucial. As longevity increases, the healthcare sector needs to prioritise chronic pain management for people with intellectual disabilities through appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

Medical professionals need to be equipped with competencies to provide sustainable healthcare and promote planetary health. The aims of this study were to map the presence of planetary health themes in one Australian medical program, develop and pilot a planetary health blended-learning module drawing on constructivism learning theory, and evaluate the effectiveness of the activities. A mixed methods approach was used comprising quantitative mapping of learning outcomes, measurement of pre- and post-intervention planetary health knowledge, and a feedback survey. Mapping revealed little integration of environmental issues across the medical program. Student's knowledge score increased by 2.37 points on average (95% confidence interval 1.66–3.09) (response rate 46%); 84.2% of respondents rated the activities as excellent/good. Since planetary health education is not currently required in Australian medical curricula, there is still little information for local medical educators on how to develop it, therefore studies such as this can provide some preliminary guidance. Supplemental data for this article is available online at https://doi.org/10.1080/13504622.2021.2025343. [ABSTRACT FROM AUTHOR]

Australia's Intergenerational Reports (2010, 2015) make a case for restraining public expenditure on an ageing population given the sizeable post-WWII baby boom cohort, increasing longevity, and uncertain economic prospects for younger generations. There also is concern for major disparities within older and younger generations resulting from cumulative advantages or disadvantages over the life course. Drawing on national survey data from the Attitudes to Ageing in Australia study, this article investigates perceptions of inequity between age cohorts at two time points (2009–10, 2015–17) focusing on variations by age and gender around lifelong opportunities for baby boomers compared to other groups, share of government benefits, and support for increasing pension age eligibility. The findings indicate a shift in attitudes between 2009–10 and 2015–17 with more in the younger cohorts in 2015–17 reporting better lifelong opportunities for baby boomers; and baby boomers receiving a fair share/more than a fair share of government benefits. With pension age eligibility, there is a small but significant shift in attitudes supporting the increase and a corresponding drop in those opposing it, however opposition is highly gendered with more women in each of the age cohorts opposing it at both time points. While there is a perceptible shift in younger cohorts' attitudes towards baby boomers' perceived advantages, overall attitudes are not totally supportive of government arguments for expenditure restraint; although a more overt public discourse on intergenerational inequity is emerging as the declining life prospects of younger cohorts are juxtaposed with tax-advantaged housing and retirement wealth of many older age Australians. [ABSTRACT FROM AUTHOR]

Background: There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods: A cross‐sectional survey was used with community‐dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi‐prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results: Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2–6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions: There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID. [ABSTRACT FROM AUTHOR]

Attitudes to ageing can predispose decision-making as governments, interest groups and electorates negotiate competing demands in the context of economic constraints and social change. This paper, based on national survey data, investigates change and stability in Australian attitudes to intergenerational equity from 2009–2010 to 2015–2017, alongside concurrent socio-economic and policy change as well as cohort succession. The emphasis is on the baby-boom cohort who are viewed as significant beneficiaries of social change relative to opportunities of younger and older cohorts. Views of older people as a needy group may be changing slightly as more enter later life with substantial wealth and resources. Our results show that there is little perception of intergenerational conflict with the exception of the Millennial cohort whose life chances are compromised by economic and expenditure constraint over the past decade. Overall, attitudes remain sympathetic to older people, especially among women and people rendered vulnerable by poor health, non-home-ownership and low socio-economic positions. The findings do not align with government portrayals of intergenerational inequalities notwithstanding many having negative views of the future and ongoing expenditure restraint strategies. At what appears to be a critical turning point in the life chances of successive cohorts, the findings indicate the interplay between attitudes and social and policy change, as well as implications for social equity and processes of attitudinal change. [ABSTRACT FROM AUTHOR]

Introduction: Rural health workforce shortages are a global phenomenon. Countries like Australia, with industrialised economies, large land masses and broadly dispersed populations, face unique rural health challenges in providing adequate services and addressing workforce shortages. This article focuses on retention of early-career nursing and allied health professionals working in rural and remote Australia. Some of Australia’s most severe and protracted rural workforce shortages, particularly among early-career health professionals, are in public sector community mental health (CMH), a multidisciplinary workforce staffed primarily by nurses and allied health professionals. This study investigated how employment and rural-living factors impacted the turnover intention of early-career, rural-based CMH professionals in their first few years of working. Methods: A constructivist grounded theory methodological approach, primarily guided by the work of Charmaz, was selected for the study. By implication, the choice of a grounded theory approach meant that the research question would be answered through the development of a substantive theory. Twenty-six nursing and allied health professionals working in CMH in rural New South Wales (NSW) for the state health department services participated in in-depth, semi-structured interviews. The study sought to identify the particular life factors – workplace conditions, careeradvancement opportunities and social and personal determinants – affecting workers’ turnover intention. The substantive grounded theory was developed from an identified core category and basic social process. Results: The turnover intention theory provides a whole-of-person explanation of turnover intention. It was developed based on an identified core category of professional and personal expectations being met and an identified basic social process of adjusting to change. The theory posits that an individual’s decision to stay or leave their job is determined by the meeting of life aspirations, and this relates to the extent of the gap between individuals’ professional and personal expectations and the reality of their current employment and rural-living experience. The extent of individuals’ professional and personal expectations can be measured by their satisfaction levels. A major finding from the identification of the basic social process was that, in the adjustment stages (initial and continuing), turnover intention was most strongly affected by professional experiences, in particular those relating to the job role, workplace relationships and level of access to continuing professional development. In this stage, personal satisfaction mostly concerned those with limited social connections in the town (ie non-local – newcomers). Having reached the ‘having adapted’ stage, the major influence on turnover intention shifted to personal satisfaction, and this was strongly impacted by individuals’ life stage. By drawing on the turnover intention theory and the basic social process, it is possible to make a risk assessment of individuals’ turnover intention. Three levels of risk were identified: highly vulnerable, moderately vulnerable and not very vulnerable. Conclusions: The study offers a holistic explanation of life factors influencing the turnover intention of early-career health professionals working in public health services in rural NSW. These findings and the turnover intention risk matrix are thought to be suitable for use by Australian public health services and governments, as well as in other highly industrialised countries, to assist in the development of policies and strategies tailored for individual health professionals’ work-experience level and life stage. By adopting such a whole-of-person approach, health services and governments will be better positioned to address the life aspirations of rural-based, early-career health professionals and this is likely to assist in the reduction of avoidable turnover. [ABSTRACT FROM AUTHOR]

Background Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods Focus group interviews were undertaken with 35 direct-care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed. Results Frequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of 'isolation,' 'support from doctors,' 'general health support access' and 'internal staffing issues.' Conclusions Improved access to end-of-life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers. [ABSTRACT FROM AUTHOR]

The article reports on the effort of the Australian government to address concerns for fairness in the distribution of public resources between generations of Australians. The government’s Intergenerational Reports (IGRs) were created due to the ongoing budgetary pressures and growing concern for the economic future.

The article reports on societal perceptions of ageist attitudes of health professionals in Australia. There is a common perception that older people in health systems often face covert ageism which is largely due to the language of health-care professionals. The perceptions of older people by others is said to be a social construct.

The article reports on the Australian Human Rights Commission (AHRC) starting campaigns to improve attitudes to ageing and combat ageism in the workplace. An Age Discrimination Commissioner was appointed by AHRC to address age discrimination nationally, particularly within employment. Negative attitudes and portrayals of older people are considered to be a key factor impacting on those in mid-to-later life.

Objective: To investigate differences in self-reported health among Australian women with a history of intimate partner violence (IPV) in relation to rurality of residence. Methods: Data were drawn from six survey waves of the Australian Longitudinal Study on Women’s Health 1973–78 birth cohort. Self-reported general and mental health scores derived from the SF-36 scale were compared for women with a history of IPV living in metropolitan, regional and rural areas. Multivariable generalised estimating equations were constructed adjusting for income hardship, number of children, education, social support, age and marital status. Results: Women with a history of IPV living in regional and rural areas had no significant differences in self-reported general health scores compared to their metropolitan counterparts. Rural women affected by IPV had slightly better self-reported mental health than equivalent women living in metropolitan or regional areas. The socio-demographic factors with the strongest association with self-reported health were income, education, social support, and number of children. Conclusions: Women in regional and rural areas were no more disadvantaged, in terms of self-reported general health or mental health, than IPV affected women living in major cities in Australia. [ABSTRACT FROM AUTHOR]

The aims of the present study were to explore aspects of sexually transmissible infections (STI) prevention in general practice and to examine general practitioners' (GPs) perceived barriers to sexual-health promotion. The data from a postal survey of 409 GPs practising in New South Wales, Australia (response rate 45.4%) are analysed to explore the prevention of STI in general practice and to examine practitioners' perceived barriers to sexual-health promotion. About 49% of GPs reported having STI leaflets/ pamphlets for patients in their clinic, while 21% had posters on STI displayed in their waiting room. Two-third (67%) of GPs provided STI-specific printed materials/leaflets to patients with STI. Female GPs were more likely to be proactive in STI prevention. Time and funding appear to be the major barriers to sexual-health promotion, followed by inadequate access to counselling. One-fifth (22%) of GPs felt that they had little influence in changing patients' risk behaviour, while about 28% emphasized the need for further preventive care training. The present study identifies inconsistencies in STI-prevention activities in general practice along with barriers to undertake sexual-health promotion. This area warrants further attention if GPs are to contribute fully to the control of STI. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The study investigates the demographic profile, caseload and treatment for depression provided by homeopathic practitioners in Australia. Design: A postal survey comprising a self-administered questionnaire which included a combination of close-ended and open-ended response categories. Setting: The questionnaire was mailed to 128 homeopathic practitioners working in the metropolitan areas of Sydney, Australia. Results: The demographic profile of the respondents showed that most were in the 45–50 year age group, and female practitioners comprised 68% of the sample. Symptoms of depression reported in the homeopathic practice had parallel description of symptoms listed in the ICD-10. Overall, treatment of mental health disorders, such as depression, grief, anxiety and phobia were a significant feature of the practice caseload of the respondents. Eighty-four percent of the respondents had patients presenting for homeopathic treatment that were also receiving some form of external therapy, most commonly antidepressant medications. Sixty percent of the respondents incorporated ‘concurrent’ therapies in the treatment approach, most commonly counselling, nutrition and lifestyle management. Conclusion: The paper shows that most homeopathic practitioners provide a pluralistic approach to management of depression which is in accordance with principles of holistic care. The implications of the research findings are discussed. [Copyright &y& Elsevier]