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Introduction: Restrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence‐based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes. Methods: This pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi‐structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation. Conclusion: This study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care. Patient or Public Contribution: A person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards. Trial Registration: ACTRN12624000044527. [ABSTRACT FROM AUTHOR]

Purpose: This study explored experiences of the management of challenging behaviours after traumatic brain injury (TBI) in the acute hospital setting from the perspectives of family members. Materials and Methods: A qualitative, interpretive phenomenological approach was adopted involving semi-structured interviews with 10 family members. Interviews were transcribed and analysed using thematic analysis, with Ecological Systems Theory applied as a guiding framework to discuss findings and implications for practice. Results: Four primary themes were identified: 1) The hospital environment; 2) Hospital staffing; 3) Identifying and preventing triggers, and 4) Family support and information. Conclusions: This qualitative study highlights the need for further information, education, and support to families of patients with TBI in the acute setting. Further research investigating the implementation of best practice approaches for managing challenging behaviours practice in acute settings is needed to overcome the barriers of the hospital environment, inexperienced and inconsistent staffing, and difficulties identifying triggers within the acute hospital setting, experienced by families. Approaches for family involvement in behaviour management strategies, and facilitation of communication for people with TBI in the acute setting requires exploration. IMPLICATIONS FOR REHABILITATION: Families reported the hospital environment, inexperienced and inconsistent staffing, and difficulty identifying triggers were challenges in effectively managing challenging behaviours after traumatic brain injury (TBI) in the acute setting. Clinicians can support family involvement in preventative strategies with patients with TBI. Clinicians can enable quality of care by building rapport and providing compassionate care to patients with TBI. Families need more support and information during the acute stage of TBI in hospital settings. [ABSTRACT FROM AUTHOR]

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person‐centred care. Walker and Avant's eight‐step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self‐Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care. [ABSTRACT FROM AUTHOR]

Objectives: To describe the perspectives of Australian medical practitioners about current practice, and the potential benefit of tools and resources to support fitness to drive assessment for older people with dementia and mild cognitive impairment (MCI). Methods: Semi‐structured interviews with 22 medical practitioners from cognitive/memory clinics, hospitals, general practice and driving fitness assessment services in Australia. Reflexive thematic analysis was conducted. Results: Two overarching themes were generated: (1) Uncomfortable decisions, describing feelings of discomfort expressed by practitioners about making fitness to drive recommendations, with two subthemes: (a) 'Feeling uncertain' and (b) 'Sticking your neck on the line'; and (2) Easing the discomfort, describing participants' desire for tools/resources to support practitioners to increase comfort with fitness to drive recommendations, with two subthemes: (a) 'Seeking certainty' and (b) 'Focusing on the process' conveying two different perspectives about how this may be achieved. There was a desire for a new in‐office assessment tool capable of accurately predicting fitness to drive outcomes and views that an evidence‐based clinical pathway could improve practitioners' confidence in decision‐making. Conclusions: Perceptions of discomfort relating to fitness to drive assessment of older people with dementia and MCI exist amongst medical practitioners from health‐care settings across Australia. In the absence of a well‐validated in‐office assessment tool, practitioners may benefit from an evidence‐based clinical pathway to guide driving recommendations. [ABSTRACT FROM AUTHOR]

Introduction: The creation of age‐friendly home environments enables middle‐aged and older aged people to live independently at home while adapting to age‐related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age. Methods: Prospective cohort study of healthy adults who received an age‐friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising. Results: Sixty age‐friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes. Conclusion: Affordable and accessible age‐friendly housing is required to support an ageing population. Education on age‐friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises. [ABSTRACT FROM AUTHOR]

Clinical practice guideline (CPG) recommendations for the management of challenging behaviours after traumatic brain injury (TBI) in hospital and inpatient rehabilitation settings are sparse. This systematic review aims to identify and appraise CPGs, and report high-quality recommendations for challenging behaviours after TBI in hospital and rehabilitation settings. A three-step search strategy was conducted to identify CPGs that met inclusion criteria. Two reviewers independently scored the AGREE II domains. Guideline quality was assessed based on CPGs adequately addressing four out of the six AGREE II domains. Data extraction was performed with a compilation of high-quality CPG recommendations. Seven CPGs out of 408 identified records met the inclusion criteria. Two CPGs were deemed high-quality. High-quality CPG recommendations with the strongest supporting evidence include behaviour management plans; beta-blockers for the treatment of aggression; selective serotonin reuptake inhibitors for moderate agitation; adamantanes for impaired arousal/attention in agitation; specialised, multi-disciplinary TBI behaviour management services. This systematic review identified and appraised the quality of CPGs relating to the management of challenging behaviours after TBI in acute hospital and rehabilitation settings. Further research to rigorously evaluate TBI behaviour management programs, investigation of evidence-practice gaps, and implementation strategies for adopting CPG recommendations into practice is needed. Two clinical practice guidelines appraised as high-quality outline recommendations for the management of challenging behaviours after traumatic brain injury in hospital and inpatient rehabilitation settings. High-quality guideline recommendations with the strongest supporting evidence for non-pharmacological treatment include behaviour management plans considering precipitating factors, antecedents, and reinforcing events. High-quality guideline recommendations with the strongest supporting evidence for pharmacological management include beta blockers for aggression in traumatic brain injury. Few guidelines provide comprehensive detail on the implementation of recommendations into clinical care which may limit adoption [ABSTRACT FROM AUTHOR]

Background: Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. Objectives: To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. Method: A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Results: Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Conclusion: Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI. [ABSTRACT FROM AUTHOR]

Successful ageing-in-place is dependent on the design and features of the home. In some cases, home modifications or relocation may be required. Accessible, affordable, age-friendly housing for older adults is required to encourage forward planning. To understand the views of middle and older aged adults and individuals with older relatives, about home safety, ageing in place and housing accessibility. A qualitative descriptive approach, using reflexive thematic analysis was used. Data were gathered through semi-structured interviews with 16 participants, comprising eight middle- older aged people and eight individuals with older relatives. Seven themes were identified. Most participants accepted the ageing process and could recognise home environment hazards and potential future housing needs. Others were determined to remain independent at home and resistant to making future changes until necessary. Participants were interested in obtaining more information about how to improve home safety or services to support ageing-in-place. Most older adults are open to conversations about planning for ageing-in-place and would like further information on home safety and home modifications. Educational forums and tools (such as flyers or checklists) which assist older people to plan future housing needs are recommended. Many older people are living in homes that present hazards and limited accessibility as they age. Earlier planning could lead to home modifications which will improve the capacity to age in place. Action to provide earlier education is needed as the population ages and suitable housing for older people is limited. Decision-making around home safety among the ageing population can be compromised by lack of awareness, inadequate access to information and the sudden onset of age-related changes. An education guide or tool to support forward planning and housing decisions may improve early awareness among the ageing population. [ABSTRACT FROM AUTHOR]