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Background and Aims People with end-stage kidney disease receiving haemodialysis are restricted to holidays where dialysis services are readily available. Holiday dialysis in regional, rural and remote areas is particularly challenging. The aims of this study were to evaluate the wellbeing of those who received dialysis in a holiday haemodialysis bus and to measure patient well-being with that of a comparable cohort of haemodialysis patients. Methods A three machine haemodialysis bus, the Big Red Kidney Bus, was built to enable people, their families and carers to take holidays across a range of tourist destinations in Victoria, Australia. Measures included pre-post subjective well-being, dialysis symptoms and mood questionnaires complemented by post semi-structured telephone interviews. Results Participating holidaymakers were positive about the haemodialysis bus service and the standard of care experienced. They reported decreased dialysis side effects of fatigue, muscle cramp and dry skin. The overall number of reported symptoms decreased, and the perceived level of bother associated with symptoms also decreased. No changes in subjective well-being and mood were detected. Mean Personal Wellbeing Index scores were significantly higher than in a comparative haemodialysis sample. Conclusion The Big Red Kidney Bus provided a safe and feasible holiday dialysis service. Holidaymakers' well-being was reflected by the decreased dialysis patient side effects.

The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. [Res Gerontol Nurs. 2014; 7(6):284–291.]

Aim To explore mobility care as provided by care staff in nursing homes. Background Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. Design A focused ethnography. Method The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of ‘situation awareness’ assisted data interpretation. Findings Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. Conclusion Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care.

Aims The aim of this study was to identify seminal Australasian Journal on Ageing papers published over 30 years through a Delphi consensus process. Method The main data collection was a three-round Delphi consensus study with 38 past and current members of the Australasian Journal on Ageing Editorial Board, Editorial Team and Management Committee. Results Three papers were agreed as top-ranking. One of the top-ranking articles was also highly cited. One article was published in the 1990s, two in 2001. Conclusions While it is difficult to judge how well the top-ranking papers represent seminal papers arising over 30 years, these papers do represent three different research strengths in Australasia, they do span three different disciplines, and they do reflect some of the diversity that characterises ageing research in Australasia over 30 years.

Purpose of the Study: Research is needed to demonstrate the application of person- and relationship-centered care to nursing home practice. This article aimed to find a suitable person/relationshipcentered framework to assist with mobility care practice improvements in nursing homes. Design and Method: The authors discuss the task of mobility care, the nature of person- and relationship-centered care, and the significance of such approaches to mobility care. The Senses Framework (Nolan, Davies, Ryan, & Keady, 2008) is employed to develop mobility care practice improvement objectives. Results: The objectives are used to evaluate outcomes from 2 hypothetical scenarios to illustrate the possible value of the Senses Framework. Implications: The Senses Framework facilitated development of objectives for mobility care practice improvement that considers the needs of all stakeholders.

Background With the aging of the population, increasing numbers of older people live in nursing homes. Discourse such as policies and standards highlight the need to optimize the mobility independence of residents. This is expected to occur in a way that is safe for residents and staff whilst meeting the residents' needs. The influence of discourse on health care delivery can be poorly understood, being at times hidden or taken for granted. The aim of this study was to uncover discourse relevant to resident mobility optimization to enable the origins and reasoning behind existing and intersecting policy and practice to be critically appraised. Design Narrative literature review and thematic analysis with a focus on discourse were employed for this study. Data sources Databases (CINAHL and Ovid Medline) and websites of relevant professional and governmental bodies were accessed. Method A literature search centered on retrieval of texts focused on discourses that influenced goals to optimize resident mobility. Database searches for texts covered the period from 1994 to 2011. Iterative thematic analysis focussed on the texts' socio-cultural context and influence. Findings Four discourses emerged that potentially influence goals to optimize resident mobility: safe manual handling; falls prevention; palliative care; and costs and funding constraints to individualized care. These discourses may influence mobility care in the direction of more routinized, passive and dependency support approaches. A common overarching theme was that of collaboration and communication. Conclusion Discourses such as safe manual handling, falls prevention, palliative care and cost constraints to individualized care can negatively impact on the goal to optimize the mobility of residents in nursing homes. Inter-professional approaches where staff work collaboratively and communicate well may counter such influences and ensure individualized care that focuses more effectively on resident mobility.

Aim Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the ‘old old’ (≥75 years). Method The Dynamic Analyses to Optimise Ageing (DYNOPTA) project's dataset provided physical activity data for 13 420 participants. Physical activity (walking, moderate- and vigorous-intensity activities in the previous week) was measured. Data were weighted and prevalence was calculated. Results The frequency of walking in DYNOPTA was similar to that in the national sample. Walking remained relatively stable until a decline among persons aged 80 years and over; moderate and vigorous activity declined in all but a minority of persons aged 70 years and over. Although DYNOPTA participants reported more physical activity than those in the contemporary national survey, the rates of sedentary behaviour were high. Conclusion We require more information about the ‘oldest old’ (85+ years). There is great scope for increasing physical activity, even walking, among older people.

Background Physical therapists often prescribe exercises for fall prevention. Understanding the factors influencing the clinical decision-making processes used by expert physical therapists working in specialist fall and balance clinics may assist other therapists in prescribing exercises for fall prevention with greater efficacy. Objectives The objective of this study was to describe the factors influencing the clinical decision-making processes used by expert physical therapists to prescribe exercises for fall prevention. Design This investigation was a qualitative study from a phenomenological perspective. Methods Semistructured telephone interviews were conducted with 24 expert physical therapists recruited primarily from the Victorian Falls Clinic Coalition. Interviews focused on 3 exercise prescription contexts: face-to-face individual therapy, group exercise programs, and home exercise programs. Interviews elicited information about therapist practices and the therapist, patient, and environmental factors influencing the clinical decision-making processes for the selection of exercise setting, type, dosage (intensity, quantity, rest periods, duration, and frequency), and progression. Strategies for promoting adherence and safety were also discussed. Data were analyzed with a framework approach by 3 investigators. Results Participants described highly individualized exercise prescription approaches tailored to address key findings from physical assessments. Dissonance between prescribing a program that was theoretically correct on the basis of physiological considerations and prescribing one that a client would adhere to was evident. Safety considerations also were highly influential on the exercise type and setting prescribed. Terminology for describing the intensity of balance exercises was vague relative to terminology for describing the intensity of strength exercises. Conclusions Physical therapists with expertise in fall prevention adopted an individualized approach to exercise prescription that was based on physical assessment findings rather than “off-the-shelf” exercise programs commonly used in fall prevention research. Training programs for people who prescribe exercises for older adults at risk of falling should encompass these findings.

Introduction. Most Australians are dependent on their cars for mobility, thus relinquishing driving licences for medical reasons poses challenges. Aims. To investigate how general practitioners (GPs) recognise and manage patients’ fitness to drive, GPs’ attitudes and beliefs about their role as assessors, and GPs’ experiences in assessing and reporting to driving authorities and identify GPs’ educational needs. Methods. Mixed methods: questionnaire mailed to GPs from three rural and two metropolitan Divisons of General Practice in Victoria, Australia. Results. 217/1028 completed questionnaires were returned: 85% recognised a patients’ fitness to drive, 54% felt confident in their assessment ability, 21% felt the GP should have primary responsibility for declaring patients’ fitness to drive, 79% felt that reporting a patient would negatively impact on the doctor-patient relationship, 74% expressed concern about legal liability, and 74% favoured further education. Discussion. This study provides considerable information including recommendations about GP education, the assessment forms, and legal clarification.

This systematic review aimed to investigate the impact of staff manual handling practices and physical training interventions on nursing home residents’ ability to transfer on and off furniture. Key words and subject headings were used to search databases for English language studies published after 1994. Ten studies met the inclusion criteria. Studies of physical activity interventions indicated that physical activity training will benefit residents’ transfer ability. One study examined the effect of a safe manual handling program on resident quality care outcomes. Further research is required into the nature and impact of the assistance provided by staff to residents during transfers. Innovative and sustainable approaches to safe manual handling that promote resident mobility are needed.

Background Cardiovascular disease (CVD) and death may be associated with depression and antidepressants, but published findings remain equivocal. The authors aimed to determine the risk of CVD incidence and death associated with several classifications of depression. Methods A prospective cohort study was conducted (1994–2006) in a regionally representative sample of 1000 non-institutionalised older Australians age 65+ years (47% men). Endpoints were non-fatal CVD incidence and death over 10 and 12-years, respectively. Depression incidence was assessed at 2-years. Depression related predictors were defined by symptoms (Psychogeriatric Assessment Scales, depression scale) and/or antidepressants to determine independent and/or joint effects on endpoints. Cox regressions determined unadjusted and multiple-adjusted (for significant covariates) hazard ratios (HR). Results Baseline response rate was 70.3%. Aggregate dropout rate was approximately 24% for survivors at biennial follow-ups, but death status was ascertained for all participants. Several classifications of depression predicted death in unadjusted analyses (39–60% >1), but effects disappeared in multiple-adjusted analyses (in which all HRs became

Aim: The aim of this research was to produce evidence-based recommendations on physical activity designed to improve and maintain the health of older Australians. Methods: The authors reviewed existing guidelines and consensus statements, systematic reviews, meta-analyses and research articles. Draft recommendations were circulated to stakeholder agencies and to an expert advisory group. Final recommendations were then forwarded to the Commonwealth Department of Health and Ageing for Ministerial approval. Results: The physical activity recommendations for older Australians complement the current National Physical Activity Guidelines for adults and the American College of Sports Medicine and American Heart Association recommendations for older adults. The recommendations provide advice developed specifically for older Australians. Conclusion: Although the recommendations may be manifested in different ways, according to specific populations or settings, they apply to older people across all levels of health and have application to community dwelling people and those in residential care accommodation.

Inactivity has been identified as a major contributor to the burden of disease among older Australians, particularly those in culturally-diverse communities. This study assessed the facilitators and barriers to physical activity in older people from culturally-diverse communities, and investigated the predictors of physical activity participation by recruiting 333 older people from seven different communities in the western suburbs of Melbourne, Australia. A survey questionnaire that recorded physical activity and the barriers to and facilitators of activity was interviewer-administered in the participants' preferred language. The data were analysed using bivariate and multivariate inferential statistical methods. Personal barriers to physical activity, such as poor health, lacking the energy to exercise, being too tired and low motivation, were highly prevalent in all groups. Specific factors, such as ‘being self-conscious about my looks’, were more prevalent among the Vietnamese, as were concerns about the weather among Macedonians and Croatians. Across all groups, perceptions of health and safety strongly influenced physical activity behaviour, more so than the external environment. Some of the barriers can be addressed with a common approach, but others in some communities will require particular strategies.

Objective The Regenerate pilot study explored whether a 10-week, community-based progressive resistance training (PRT) program could reduce depressive symptoms in depressed chronic stroke survivors. Methods Participants were screened for depressive status using the PHQ-9 and confirmed by psychiatric assessment. Eligible people (n = 45) were randomised to PRT or a waiting-list comparison group. The PRT program included two high intensity sessions/week for 10 weeks at a community-based gymnasium. Depressive status, physical and mental health and quality of life were measured at baseline, 10 weeks and 6 months. Muscle strength was assessed using 1 repetition maximum (1-RM) for upper and lower limbs. Results The participants' median age was 69 years: 27 were male. The intervention group had lower depression scores than the comparison group at all time points. At 6-month follow-up, there was a trend for PRT participants to be more likely to be no longer depressed than the comparison group, but the difference was not significant after adjusting for baseline scores. There were modest improvements in health and wellbeing over time, but many scores were lower than reported in non-depressed people. Intervention participants demonstrated significant improvements in strength. Program adherence was good: on average 75% of the 10-week program was completed. Conclusions The intervention appeared to be feasible within a community-based setting. To optimize stroke recovery and improve the quality of life of stroke survivors, health professionals should continue to focus on helping survivors' mental health recovery as well their physical rehabilitation. Copyright © 2008 John Wiley & Sons, Ltd.

Rowlands G and Sims J. A lesson learnt: the importance of modelling in randomized controlled trials for complex interventions in primary care. Family Practice 2005; 22: 132‐139. Background. The Randomised Controlled Trial (RCT) is recognised as the ‘gold standard’ in quantitative research. However RCTs testing health care interventions can be difficult to design and implement. Health care interventions are often complex in themselves and are always applied in complex settings. Such interventions require a process of careful ‘modelling’ to maximize the chances of successful trials that will add to knowledge. Objectives. To describe the terms ‘complex’ and ‘modelling’ as used in the setting of randomised controlled trials of complex interventions. To give a practical example of an RCT involving a complex intervention applied in a health care setting to illustrate how this might take place in practice. Methods. We describe an RCT designed and conducted by the authors. We then use our trial as an example to illustrate how complex interventions such as ours might benefit from modelling during the design of the intervention and the setting within which the intervention is to be tested. Results. Our project was designed and tested before current guidance on complex interventions was published; our RCT was therefore not ‘modelled’ but was based on the outcome of a single quantitative pilot study. As part of our study we ran a parallel qualitative study, which highlighted several areas of complexity both in our intervention, and in the setting within which we applied it. In this paper we show how modelling might have allowed us to recognise these complexities at an early stage and might therefore have resulted in a study more likely to have demonstrated useful outcomes. Conclusion. Careful modelling of complex interventions is an essential step in designing trials of innovations in health care and health care services. Such a process ensures that interventions fit with and reflect the complexities of the settings within which interventions will be applied, and should ensure that the outcomes chosen are those most appropriate to demonstrate any benefits or risks.

Issue addressed: This paper provides an overview of current and recently completed population health programs/projects in the Australian general practice setting.

Objective: The Commonwealth Government's Enhanced Primary Care initiative supports measures to enhance the role of general practitioners (GPs) in promoting healthy ageing as part of a population health approach. This paper comments on how the health assessments can be conducted to best effect, to strengthen the role of GPs in primary care and to promote autonomy and independence in older people. Method: The relevant literature was collated to produce a review of public health and health promotion approaches and to ascertain the effectiveness of health promotion interventions for older people. A broad definition of health promotion including primary, secondary and tertiary prevention was adopted. Results: The evidence base suggests there is scope for greater targeting of health promotion activities towards older people. The rationale fa the Australian GP to assume a major health promotion role with their older patients is provided. Associated barriers and enablers are discussed. Conclusions: Prevention of disability is a key public health issue. The new MBS items may enable systematic evaluation of function and assist healthy ageing for all older people, including the frail aged. An increase in the preventive advice given to older patients has the potential to increase healthy behaviours and alter health outcomes. Implications: The annual health assessment items on the Medicare Benefits Schedule, by enabling the GP to focus on prevention and coordination of care, have the potential to improve the health, physical, psychological and social function of older Australians.

There are potential benefits to giving the patient a more active role in the management of his or her care. This study explored the characteristics which influence a preference for participation and the extent to which hypertensive patients wish to participate in the management of their condition. A cross-sectional study with in-depth, face-to-face interviews was conducted with 49 hypertensive patients from one health centre. Interview themes were identified using content analysis. Characteristics predictive of participation desire were detected via quantitative analyses. Half of those interviewed were interested in participating in hypertension management. Those who had been hypertensive longer were less inclined to favour participation. Those with negative views of their `disease' status and with higher blood pressure were more likely to want to participate. Patients needed further information and advice before decisions about future level of participation could be properly considered.

BACKGROUND The assessment of levels of physical activity relies upon suitable measurement tools. OBJECTIVE We aimed to investigate whether a practice nurse, using a motivational interview technique, could encourage older patients to increase their physical activity. METHODS Health and well-being were monitored at baseline and 8 weeks following intervention. Physical activity levels were ascertained using both a self-report measure and ambulatory heart-rate monitoring. RESULTS Whilst patients reported higher levels of physical activity at follow-up, this finding was not confirmed by the heart-rate data. CONCLUSION The study concludes that patients tend to overestimate the amount of physical activity undertaken and that ambulatory heart-rate monitoring may be more useful for verifying actual behaviour.

The prevalence of neuroticism, as measured by the CIS-R, was compared across two groups: the statutorily homeless and those in private households, using data from the Psychiatric Morbidity Surveys. Homeless people, many of whom were young adults, experienced twice the rate of neurotic disorder. The raised prevalence was associated with stressful life events such as long-term illness, plus lack of social support. The homeless population visited the GP regularly, but management of their neuroses remained as variable as amongst their housed counterparts. Homeless neurotics were more likely to become in-patients than to be treated on an out-patient basis for their mental health problems. Holistic management of patients facing socio-economic adversity is needed to improve psychiatric morbidity.

We report on an evaluation of the practicality and acceptability of the 'Going Home Service', an early discharge intensive patient support scheme for orthopaedic patients in their own homes. Patient outcomes were assessed in terms of health and functional status and the impact on patient's carers was assessed. Eight-seven patients who were successfully discharged from the service were compared with 17 patients readmitted to hospital prior to their discharge from the service, 44 patients suitable for the service who did not take it up and 15 patients discharged from hospital traditionally immediately prior to the service becoming operational. Data were collected via face to face semistructured interviews and note searching. Twenty-six of the patients' informal carers were also interviewed. The majority of patients in all four groups were elderly women, readmitted patients being significantly older than those successfully discharged. The readmitted patients were also more likely to have been admitted originally for traumatic surgery and less likely to have been independently mobile prior to the initial admission. Hospital length of stay was shorter amongst Going Home Service patients than those cared for traditionally, but the total episode of care was greater. Patients and carers were well satisfied with the service. Although there was no evidence that quality of life or functionality were affected by their early discharge, at three months post operation, there was some evidence that Going Home Service patients were experiencing less pain than those discharged traditionally. This early discharge service provided a good quality of health and social care for the majority of patients. However, it did not suit all patients and a minority were re-admitted. The findings reported here add to those obtained in other settings and highlight new aspects for consideration in the planning and delivery of high quality hospital at home schemes.

Much of the literature regarding hospital at home schemes focuses upon the organisational and economic implications. In evaluating the success of such programmes, the emphasis has been on patient centred outcomes such as health and satisfaction with care. This paper focuses upon the health professional's perspective. The role of the staff and their attitudes towards such health care innovations are over-arching links between the patient and the organisation. As such, they are factors to be considered in order to contextualise the findings of any evaluation of new health care projects.

Objectives: Staff assistance during residents' mobility should be safe, meet residents' needs and provide residents with a positive experience that contributes to their quality of life [1, 2]. This project aimed to determine directions to integrate quality and safety within mobility care. Methodology: A critical, focused ethnography [3, 4], conducted in four nursing homes in Melbourne, Australia, included interviews with fifteen residents and eleven senior staff, twenty hours of observations of resident transfers in public areas, and three focus groups with eighteen care and lifestyle staff. A relationship-centred framework [5] was applied to two hypothetical cases. Discourses related to mobility care were analysed. Results: Residents valued independence and safety. Themes of residents' positive adaptation to mobility loss through motivation to remain mobile and acceptance of staff assistance emerged. Another theme was residents' acquiescence to loss of autonomy and control during mobility. Staff decision-making emerged as a theme from focus groups. Cognitive Continuum Theory (CCT) [6] was applied to these findings. Analysis of discourse highlighted conflicting messages regarding safety versus quality during mobility care. Conclusion: The Senses Framework and CCT provided directions for collaborative and integrated approaches to mobility care focused on shared decision-making, leadership and culture change.

Background Mobility contributes to the quality of life and independence of residents in nursing homes. To perform resident-centred mobility care, staff need to understand residents' physical capacity and perspectives of care. Aims and objectives The aim of the study was to explore residents' perspectives of intrinsic factors influencing their mobility and associations between these factors with a view to informing resident mobility care practice improvements. Design The study was part of a larger ethnographic project exploring safe resident mobility care in nursing homes. Methods Semi-structured interviews with nursing home residents supplemented by non-participant observations were conducted over a 20-month period from July 2010. Fifteen residents consented to be interviewed in three nursing homes in Melbourne, Australia. Unobtrusive observations of 46 mobility events took place in three nursing homes over 5 months from September, 2011. Results Participants identified intrinsic factors that influence their mobility including mobility capacity, strategies to cope with mobility loss, motivation and efforts to remain mobile. Three themes related to resident attitudes and responses to mobility loss emerged: acceptance of mobility loss and staff assistance; motivation to remain mobile; and acquiescence and loss of control during mobility events. A conceptual model developed from the study outlined associations between resident attitudes and mobility and quality of life outcomes. Discussion was framed by theories of ageing and adaptation: selection, optimisation and compensation; learned dependency; and learned helplessness. Conclusion Resident acceptance of mobility loss, and required staff assistance and realistic determination to remain mobile contribute to residents' quality of life. Mobility care based on considerations of resident choice, autonomy and the value of mobility is important. Implications for practice The model developed from this study can guide staff manual handling training and practice towards improved resident-centred approaches to mobility care.

BackgroundThe introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. ObjectiveTo compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. MethodsWe designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. ResultsFace-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). ConclusionsThe Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L)

To measure the prevalence of urinary incontinence (UI) in a community-dwelling sample and the impact of self-reported UI on well-being and activity in older men and women.Participants were older adults aged ≥65 years. Measures included the frequency of urgency incontinence, depression, positive and negative affect and social activity, independence in activities of daily living (IADL) and self-rated health. The data were collected by face to face interview (1994) and computer assisted telephone interviews (1996).Of the 796 participants, 28% experienced urgency incontinence and 21% reported stress incontinence occasionally or often, with higher rates among women. The threshold for the impact on depression, negative affect and IADL was with occasional occurrence of urinary urgency incontinence. For positive affect and self-rated health, the threshold was experiencing urinary urgency incontinence often. The presence of urinary stress incontinence was associated with depression, IADL dependence, self-rated health and positive affect. Overall, women with incontinence had higher negative affect scores, but men with stress incontinence had higher scores than those without.The impact of incontinence highlights the need for more effective management of the condition. The threshold for the effects of urinary urgency incontinence on mental health and functionality is lower than for the effects on general health. There is a need to consider how older people judge the impact of UI in the design of targeted health promotion programmes.

Objective Diabetes may be associated with depression and antidepressant medication (ADM) use, but published findings remain equivocal. The authors' aimed to determine the risk of diabetes incidence associated with baseline depression exposures (symptoms and/or ADM use). Methods A prospective cohort study was conducted in a regionally representative sample of non-institutionalised older Australian people (N = 1000, aged 65 + year), who were followed up biennially between 1994 and 2004 (attrition was ≈24%). Analyses excluded participants for prevalent diabetes at baseline, determined by self-report or specific medications. Diabetes incidence was ascertained by first self-report at any follow-up wave. Depression exposures (baseline predictors) were defined by the Psychogeriatric Assessment Scales (PAS) depression scale and ADM use, and classified as: (1) ‘symptomatic’ (PAS score 5+); (2) ‘ADM use’; (3) ‘symptomatic or ADM use’; (4) ‘symptomatic and no ADM use’; (5) ‘asymptomatic (PAS score

Stroke research and rehabilitation has traditionally focussed on the physical impact of a stroke, with less attention given to associated psychosocial factors. This study aimed to identify psychosocial predictors of health-related quality of life (HRQoL) in chronic stroke survivors and examine differences between nondepressed and depressed participants.Participants were recruited primarily from six major metropolitan hospital databases. A total of 135 first-ever stroke survivors aged 25-96 years who were 6 to 24 months post stroke and community-dwelling were studied longitudinally over 6 months. HRQoL and psychosocial factors (optimism, self-esteem, perceived control, depressive status, and social support) were measured at baseline, 10 weeks, and 6 months.Psychosocial factors were significantly associated with HRQoL at every time point, accounting for 33% to 53% of the variance after controlling for demographic and clinical characteristics. At least 26% of all participants reported clinically significant depressive symptoms throughout the study. Compared to nondepressed participants, depressed participants had significantly poorer scores for HRQoL, social support, optimism, self-esteem, perceived control, and physical functioning. There were improvements in participants' physical health, social participation, depressive status, and optimism over the course of the study.These findings highlight the important role that psychosocial factors play in chronic stroke survivors' HRQoL and have implications for stroke rehabilitation programs: rehabilitation that targets poststroke depression and psychosocial adjustment to stroke has the potential to improve HRQoL for chronic stroke survivors, independent of functional impairment.

OBJECTIVE: To test the feasibility (for a potential randomised controlled trial) of a computer intervention for improving social interaction and promoting the mental health of rural carers. DESIGN: The study combined pre- and post-intervention measures with interviews to determine the feasibility of the intervention and the acceptability of the study design to participants. The intervention consisted of providing 14 rural carers with computers and a 4-week training program on basic computer skills, using email and the Internet. SETTING: The study was conducted in a rural community setting. PARTICIPANTS: The carers were 12 women and two men, aged from 50 to 81 years, with an average of 65.5 years. MAIN OUTCOME MEASURES: Measures of social isolation (UCLA Loneliness Scale), depression (Geriatric Depression Scale), carer burden (Zarit Burden Interview) and computer confidence were taken at baseline and at a 3-month follow-up. Interviews were completed at follow-up to discuss outcomes of the study. A focus group discussion was conducted with 11 participants to discuss the study and resolve computer issues. RESULTS: Most carers reported increased confidence in email and Internet use. There was improvement for most participants in depressive symptoms and social isolation, but little change in carer burden. Participants identified many social benefits associated with the computer intervention, such as intergenerational connection, community building, skills and confidence and preparation for the future. CONCLUSION: The intervention was found to be practical and acceptable for a group of older carers. It was concluded that it would be feasible to conduct a large randomised controlled trial of the intervention.

Heart rate, systolic and diastolic blood pressure, and respiratory and metabolic activity were recorded prior to and during mental arithmetic and a video game task in 20 young men with mildly elevated casual systolic blood pressures. Twenty-five unambiguously normotensive young men were tested under the same protocol. For pretask baseline physiological activity, group differences emerged for all cardiovascular and metabolic variables; thus the elevated blood pressure group displayed not only higher resting cardiovascular levels than normotensive subjects, but higher levels of metabolic activity too. With regard to change in physiological activity from rest to task, the group with mildly elevated blood pressure showed reliably larger increases in heart rate to the mental arithmetic task than the normotensive subjects. These effects, however, were not paralleled by group differences in metabolic activity increase. Physiological measures were also taken prior to and during graded dynamic exercise. The subsequent calculation of individual heart rate-oxygen consumption exercise regression lines allowed the comparison of actual and predicted heart rates during psychological challenge. The subjects with mildly elevated blood pressure displayed significantly greater discrepancies between actual and predicted heart rate values than normotensives during the psychological tasks in general and mental arithmetic in particular. Group differences in physiological activity during exercise largely reflected the pattern seen at rest. A possible exception here was systolic blood pressure. Not only were systolic blood pressure levels higher throughout the exercise phase for mildly elevated blood pressure subjects, but this group evidenced more of an increase from rest to exercise than the normotensives.

Depression is a common condition among older district nursing clients. This two-cycle feasibility study trialled a process for depression screening by using the 15-item Geriatric Depression Scale (GDS) with a sample of older clients in an Australian district nursing organization. An education session about depression and use of the GDS preceded the screening process. The trial found that a number of barriers existed among participant nurses regarding screening for depression, although generally they acknowledged depression as a common problem among older clients and most believed that they potentially had a important role in the identification and support of clients with this condition. Lack of knowledge emerged as a major constraint, as did uneasiness about entering the mental health area, with some reluctance to use the GDS because of the type of questions included and not wanting to be intrusive regarding the ‘emotional matters’ of clients. Recommendations are offered about screening for depression with this client population.

Background Physical activity has a range of health benefits for older people. The aim of this study was to determine physical activity prevalence and attitudes amongst respondents to a trial screening survey. Methods A cross-sectional survey was conducted. Subjects were community dwelling older people aged ≥ 65 years, recruited via general practices in Victoria, Australia. Participants completed a mailed screening tool containing the Geriatric Depression Scale, the Active Australia survey and the Physical Activity Readiness Questionnaire. Results Of 330 participants, 20% were ≥ 80 years. Activity levels were similar to those reported in population studies. The proportion of participants reporting physical activity was greatest for the walking category, but decreased across categories of physical activity intensity. The oldest-old were represented at all physical activity intensity levels. Over half reported exercising at levels that, according to national criteria are, 'sufficient to attain health benefit'. A greater proportion of participants aged 85 years and older were unaware of key physical activity messages, compared to participants aged less than 85 years. Conclusion Most population surveys do not provide details of older people across age categories. This survey provided information on the physical activity of people up to 91 years old. Physical activity promotion strategies should be tailored according to the individual's needs. A better understanding of the determinants of physical activity behaviour amongst older sub-groups is needed to tailor and target physical activity promotion strategies and programs to maximise physical activity related health outcomes for older people.

A pilot interprofessional education (IPE) placement for undergraduate health care professional students was undertaken in rural Victoria, Australia from 2001 to 2003. Medical, nursing, physiotherapy and pharmacy students were involved, and the project is ongoing. This paper briefly outlines the educational model, then focuses on the evaluation methods and results obtained from student evaluations. The placement experience improved self-reported teamwork skills and knowledge, and supported participating students' belief in the value of interprofessional practice. Placements strengthened nursing and allied health students' intention to work in rural health settings after graduation. The rural interprofessional educational experience improved interprofessional abilities in a group of students who have the potential to influence change towards collaborative practices in their future workplaces. The results obtained provide sufficiently strong evidence to justify the continuation and expansion of this educational model in the Australian setting. Pedagogical and evaluation modifications are discussed that may benefit future IPE programs.

Background: The Active Script Programme (ASP) aimed to increase the number of general practitioners (GPs) in Victoria, Australia who deliver appropriate, consistent, and effective advice on physical activity to patients. To maximise GP participation, a capacity building strategy within Divisions of General Practice (DGPs) was used. The objectives of the programme were to (a) train and support GPs in advising sedentary patients, and (b) develop tools and resources to assist GPs. Objective: To evaluate the effectiveness of the ASP. Methods: A systems approach was used to promote capacity in Victorian general practice. Economic analyses were incorporated into the programme's evaluation. Participants were selected DGPs and their GP members. The programme worked with DGPs to train GPs and provide relevant resources. The main outcome measures were (a) changes in GP knowledge and behaviour and (b) cost effectiveness, based on modelled estimates of numbers of patients advised and adopting physical activity and gaining the associated health benefits. Results: GP awareness and provision of physical activity advice increased. Although the programme's reach was modest, based on actual GP involvement, the cost effectiveness figures ($138 per patient to become sufficiently active to gain health benefits, and $3647 per disability adjusted life year saved) are persuasive. Conclusions: The ASP increased DGPs' capacity to support GPs to promote physical activity. There is a strong economic argument for governments to invest in such programmes. However, caution is warranted about the maintenance of patients' activity levels. Programme refinement to encourage GPs to use community supports more effectively will guide future development. Further research on long term patient adherence through a multisectorial approach is warranted.

BackgroundExercise is an effective intervention for the prevention of falls; however, some forms of exercises have been shown to be more effective than others. There is a need to identify effective and efficient methods for training health professionals in exercise prescription for falls prevention. ObjectiveThe objective of our study was to compare two approaches for training clinicians in prescribing exercise to prevent falls. MethodsThis study was a head-to-head randomized trial design. Participants were physiotherapists, occupational therapists, nurses, and exercise physiologists working in Victoria, Australia. Participants randomly assigned to one group received face-to-face traditional education using a 1-day seminar format with additional video and written support material. The other participants received Web-based delivery of the equivalent educational material over a 4-week period with remote tutor facilitation. Outcomes were measured across levels 1 to 3 of Kirkpatrick’s hierarchy of educational outcomes, including attendance, adherence, satisfaction, knowledge, and self-reported change in practice. ResultsOf the 166 participants initially recruited, there was gradual attrition from randomization to participation in the trial (n = 67 Web-based, n = 68 face-to-face), to completion of the educational content (n = 44 Web-based, n = 50 face-to-face), to completion of the posteducation examinations (n = 43 Web-based, n = 49 face-to-face). Participant satisfaction was not significantly different between the intervention groups: mean (SD) satisfaction with content and relevance of course material was 25.73 (5.14) in the Web-based and 26.11 (5.41) in the face-to-face group; linear regression P = .75; and mean (SD) satisfaction with course facilitation and support was 11.61 (2.00) in the Web-based and 12.08 (1.54) in the face-to-face group; linear regression P = .25. Knowledge test results were comparable between the Web-based and face-to-face groups: median (interquartile range [IQR]) for the Web-based group was 90.00 (70.89–90.67) and for the face-to-face group was 80.56 (70.67–90.00); rank sum P = .07. The median (IQR) scores for the exercise assignment were also comparable: Web-based, 78.6 (68.5–85.1), and face-to-face, 78.6 (70.8–86.9); rank sum P = .61. No significant difference was identified in Kirkpatrick’s hierarchy domain change in practice: mean (SD) Web-based, 21.75 (4.40), and face-to-face, 21.88 (3.24); linear regression P = .89. ConclusionWeb-based and face-to-face approaches to the delivery of education to clinicians on the subject of exercise prescription for falls prevention produced equivalent results in all of the outcome domains. Practical considerations should arguably drive choice of delivery method, which may favor Web-based provision for its ability to overcome access issues for health professionals in regional and remote settings. Trial RegistrationAustralian New Zealand Clinical Trials Registry number: ACTRN12610000135011; http://www.anzctr.org.au/ACTRN12610000135011.aspx (Archived by WebCite at http://www.webcitation.org/63MicDjPV)

The genetic and environmental determinants of a brief assessment of metabolic rate at rest and under psychological stress were studied in 40 pairs of monozygotic and 40 pairs of dizygotic young adult male twins. Height, weight and age were employed as covariates. Univariate analyses showed a high heritability for height and weight and moderate heritability for metabolic rate. Classical twin analyses and multivariate genetic modeling indicated that genetic influences on resting metabolic rate were entirely explained by body weight: there was no independent genetic contribution to resting metabolic rate. Metabolic rate under psychological stress, on the other hand, showed a significant genetic effect. The exponent (3/4) in the power function relating body weight to resting metabolic rate was the same as that found in a wide variety of animal species, a value that has been proposed as defining a body weight set point. We speculate that an adult body weight set point is genetically transmitted. Independent genetic effects on resting metabolic rate would be observed only when the normal equilibrium between body weight and metabolic rate is unbalanced during development, aging or disease. The study illustrates the use of multivariate genetic analyses of twin data which may be readily applied to widely used metabolic rate assessments.

Aim: To describe the scope and nature of research capacity building activity within academic departments of general practice and rural health in Australia. Method: Document review of Annual Reports for the years 2000 and 2003 of 17 university departments of general practice and rural health, funded through the Research Capacity Building Initiative (RCBI) of the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy. Results: The review indicated that from 2000 to 2003, departments increased their activities in all areas of research capacity building activities. Mentoring and/or supervision other than higher degree students increased from 14 in 2000 to 266 in 2003. Twenty-two research networks involving over 1377 participants were operating in 2003. All departments were involved in collaborations either as part of grant applications, research projects or educational activities. Over 3630 people participated in 189 educational activities in 2003 compared to over 624 people attending 103 activities in 2000. Compared to $10.98 million in 2000, departments had obtained more than $15.6 million for research projects in 2003. While there were more peer reviewed papers published in 2000 (n � 178) compared to 2003 (n � 130), these 17 departments gave 187 conference presen-tations. Conclusions:This review shows that the RCBI has contributed towards a considerable increase in research activities in these university departments of general practice and rural health. This has provided a major boost to primary health care research in Australia. These activities would have been unlikely to occur without the support and assistance of the PHCRED Strategy. Clearly, the full impact of the RCBI will take some time to evolve.

The General Practice Education, Support and Community Linkages Program was introduced to formally support implementation and appropriate use of the Enhanced Primary Care Medicare Benefits Schedule items. This paper reports upon the Program?s implementation from the allied health professional?s perspective. Semi-structured interviews were conducted in 2002 with healthcare staff trained under the Program. While interviewees noted achievements in the items? uptake during the Program, allied health involvement in case conferencing and care planning had been impeded by GPs? limited adoption of the items. Allied health professionals were broadly interested in participating in care planning and case conferencing with GPs. The General Practice Education, Support and Community Linkages Program supported implementation and appropriate use of the Enhanced Primary Care Medicare Benefits Schedule items. While allied health professionals are generally interested in participating in care planning and case conferencing with GPs, such activity requires ongoing systems support and relationship building. Ample scope remains for awareness raising, relationship building and joint activities across the sector. Future item usage will need to be supported by resources and continued relationship building.

The cardiac reactivity of 40 monozygotic and 40 dizygotic pairs of young male twins was monitored during psychological challenge, as afforded by a video game. The observed pattern of variation could not be accounted for solely by environmental factors. In fact, a simple genetic model that implicated additive genetic effects, along with those stemming from individual environments, best fitted the data. In addition, cardiac reactions were substantially greater for subjects whose parents both had relatively elevated blood pressure. Overall, these data suggest individual differences in cardiac reactivity have a heritable component, and that high reactivity may be a precursor of elevated blood pressure.

In an earlier study of blood pressure variation in middle aged parents and their young adult twin offspring, the greater blood pressure variation observed in the parent sample was accounted for in terms of an increasing influence of individual environmental experiences with increasing age and a commensurate reduction in the impact of heredity. In the present study, the sample size was enlarged to provide a more powerful test of these effects. Maximum likelihood model-fitting techniques were applied to blood pressure covariation in balanced pedigrees, consisting of 85 families (40 MZ and 45 DZ twin pairs). As before, our analysis indicated that a developmental effect was a salient factor in the older age group.

Heart rate was monitored while 22 pairs of young male monozygotic and 29 pairs of young male dizygotic twins were exposed to a video game and a mental arithmetic task. The heart rate reactions of the monozygotic twins showed much greater concordance than those of the dizygotic twins. Analysis of the data for the 102 individuals demonstrated reliable inter-task consistency of heart rate reaction. In addition, comparison of the heart rate reactions of ten pairs of monozygotic and ten pairs of dizygotic twins who had been tested more than a year earlier and their present reactivities revealed impressive temporal consistency.

Heart rate, respiration, and metabolic activity were monitored at rest and during the mental challenge of a video game in 22 mild hypertensive and 53 normotensive young men. Subjects also completed the Eysenck Personality Questionnaire and the Jenkins Activity Survey. The mild hypertensive subjects displayed higher resting heart rates than the normotensives and larger magnitude heart rate increases to the video game. Although groups did not differ in resting respiratory activity, the metabolic rates tended to be higher in the mild hypertensives and they showed reliably greater increases in oxygen consumption and carbon dioxide production during mental challenge. These data were subjected to a variety of interpretations. However, in the absence of psychophysiological assessment during physical exertion, and without direct measurement of cardiao output and arteriovenous oxygen differences, the present results did not permit a choice to be made between rival explanations, and they certainly cannot discount the hypothesis that some borderline hypertensives display excessive cardiac activity and tissue overperfusion during stress. The personality measures did not differentiate groups. However, correlational analyses within each group revealed that whereas systolic blood pressure was positively and significantly related to neuroticism in the mild hypertensive group, for the normotensive subjects the direction of correlation was reversed. In addition, scores on the Jenkins Activity Survey correlated positively with heart rate reactivity to the video game for the mild hypertensives, but not for the normotensives.

Heart rate was monitored while 20 young males completed MATH, a computer-operated mental arithmetic task specifically designed for use in experiments involving subjects of heterogeneous numerical ability, and a standard mental arithmetic task used in this laboratory on several occasions. Both tasks elicited sizeable increases in heart rate, and comparison of subjects' reactivity scores revealed significant inter-task consistency of reaction.