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Aim To identify evidence based signs and symptoms indicative of end stage dementia, and develop the REACH toolkit as an aid for staff to consider a palliative approach. Method A systematic literature review was conducted of policy, position documents, guidelines and publications from 1988 to 2011. Inclusion criteria were any report or article identifying the signs and symptoms of end stage dementia which were associated with increased mortality and morbidity. Results Eight signs and symptoms associated with worsening function and increased mortality were identified. These were incorporated into a toolkit. Experienced clinicians reviewed the toolkit. It was then trialled in six aged care facilities (ACFs) and as a result of the trial 182 residents with dementia were identified as being at the end stage. Conclusions Use of the toolkit improved the recognition of end stage dementia among staff in ACFs.

Aims: To trial a staff education and training program designed to facilitate the adoption of a palliative care approach for residents with end stage dementia in aged care facilities. Methods: A cluster randomised controlled trial of 12 residential aged care facilities in regional and rural setting with 530 residents in the intervention and 520 in the control facilities. The intervention was delivering a tailor made evaluated education tool and training program for aged care staff conducted in two stages. The outcomes recorded were Incidence of presentations to Emergency Department, hospital admissions and mortality. Results: Post intervention a signifi cant difference was observed in Emergency presentations χ2 = 18.8, p < 0.0001; OR = 0.44; 95% CI 0.31–0.65, 8.8% of intervention residents versus 17.88% of control residents. (The intervention group had a −5.88% reduction in Emergency presentations and control group an increase of 14.6%.) Similar results were found for the number of hospital admissions (intervention 6.9% versus control 11.3%), χ2 = 6.16, p < 0.013; OR = 0.58 95%CI 0.38 to 0.89. The mortality was not signifi cantly different p = 0.6. Conclusions: A specifi c education and training program can signifi cantly reduce emergency presentations and hospital admissions without compromising resident care or mortality. Training is a crucial and cost effective way to improve care at end of life in dementia.

Aim: This paper examines the impact of the global financial crisis (GFC) on employed Australian baby boomers. Methods: A nationally representative sample of 1009 boomers aged 50-64 years completed a survey by telephone interview mid 2009. Results: Compared with 1 year ago, 38.9% of working boomers reported being financially worse off and this was more so for women (42.4%) than men (35.6%). Following the GFC, 41.4% of women and 31.9% of men had decided to postpone their retirement plans. Conclusion: The GFC is affecting the retirement preparations and plans of Australia's baby boomers. Policy implications include reduced resources for retirement needs, and uneven and differential impacts for those with interrupted employment histories, notably women.

To evaluate the impact of the environment on the physical activity levels of people with dementia living in residential aged care facilities

Background Evidence is growing on the benefit of physical activity to improve well-being following a cancer diagnosis. This study examined changes in physical activity from pre to post diagnosis and explored this relationship with quality of life and depression. Methods Participants were recruited by posters and by letter of invitation. The questionnaire was completed by 59 prostate and 32 breast cancer survivors. Results Physical activity decreased by 72 minutes per week from pre to post diagnosis, although 20.9% reported having increased activity post diagnosis. Over 30% were considered depressed. Breast cancer participants who increased physical activity post diagnosis reported higher scores for Physical Wellbeing subscale (26 versus 21; F[1,29] = 5.19, p < .03), Emotional Wellbeing subscale (22 versus 19; F[1,30] = 4.57, p < .04) and Functional Wellbeing subscale (26 versus 19; F[1,30] = 9.03, p < .001). A greater proportion of participants taking part in no physical activity were depressed (55.6%; χ2 = 6.83, p < .04). Conclusion Over 25% of participants identified with emotional and/or well being problems, and more than half reported insufficient physical activity to yield benefits. Future research needs to gain a better understanding of why cancer survivors decrease their physical activity following a cancer diagnosis and what is necessary for them in order to retain or increase their physical activity.

Both self-help print materials and telephone-assisted counseling have generally proved useful strategies to increase physical activity. This study examined their effectiveness in an intervention aimed specifically at promoting walking for specific purposes. Methods: Participants (n = 399) were randomly allocated to one of two 3-week intervention programs. The Print program comprised multiple mailing of brochures that emphasized walking within the local community environments. The Print plus Telephone program received the same brochures plus three telephone calls. Data collected via mailed self-completed surveys were analyzed by exploring outcomes related to walking for specific purposes. Results: There were no significant differences between the two programs in any of the walking measures. Both groups significantly increased time reported walking for exercise per week [Print: t(1,277) = -3.50, P < 0.001; Print plus telephone: t(1,106) = -2.44, P < 0.016]. Significantly, more participants in the Print plus Telephone group reported receiving and reading the materials (χ² = 20.11, P < 0.0001). Conclusions: The intervention programs were more successful at increasing walking for exercise than for any other purpose. The addition of brief telephone support was successful in focusing participants' attention on the print materials, but did not result in any additional increase in walking.

BACKGROUND: Identifying environmental factors that can influence physical activity is a public health priority. We examined associations of perceived environmental attributes with walking for four different purposes: general neighborhood walking, walking for exercise, walking for pleasure, and walking to get to and from places. METHODS: Participants (n =399; 57% women) were surveyed by mail. They reported place of residence, walking behaviors, and perceptions of neighborhood environmental attributes. RESULTS: Men with the most positive perceptions of neighborhood "aesthetics" were significantly more likely (odds ratio [OR]=7.4) to be in the highest category of neighborhood walking. Men who perceived the weather as not inhibiting their walking were much more likely (OR=4.7) to be high exercise walkers. Women who perceived the weather as not inhibiting their walking were significantly more likely to be high neighborhood walkers (OR=3.8) and those with moderate perceptions of "accessibility" were much more likely to do more walking for pleasure (OR=3.5). CONCLUSIONS: Different environmental attributes were associated with different types of walking and these differed between men and women. Approaches to increasing physical activity might usefully focus on those attributes of the local environment that might influence particular subsets of walking behavior.

Women of all ages have been found to overestimate both the incidence and the mortality rate from breast cancer and the reasons for this are unclear. A qualitative study asked eighty three women (mean age = 44 years) how likely they thought they were to get breast cancer and to explain the reasoning behind their choice. Based on their responses, women's perceptions were categorised as: no risk (5%); reasonably accurate (30%); overestimated (22%); and greatly overestimated (43%). Four main themes emerged from the reasons given: 'Don't know/guess', 'family history' of breast cancer, 'age' related reasoning, and making their decision from the information sheet read prior to answering the questions. The information currently available to women may be creating falsely high estimates of their risk of developing breast cancer as the risk factors of age and family history appear to be poorly understood. Meaningful communication of health risk in need of further improvement if it is to be useful in changing health related knowledge and behaviours.

Background: Understanding how environmental attributes can influence particular physical activity behaviors is a public health research priority. Walking is the most common physical activity behavior of adults; environmental innovations may be able to influence rates of participation. Method: Review of studies on relationships of objectively assessed and perceived environmental attributes with walking. Associations with environmental attributes were examined separately for exercise and recreational walking, walking to get to and from places, and total walking. Results: Eighteen studies were identified. Aesthetic attributes, convenience of facilities for walking (sidewalks, trails); accessibility of destinations (stores, park, beach); and perceptions about traffic and busy roads were found to be associated with walking for particular purposes. Attributes associated with walking for exercise were different from those associated with walking to get to and from places. Conclusions: While few studies have examined specific environment–walking relationships, early evidence is promising. Key elements of the research agenda are developing reliable and valid measures of environmental attributes and walking behaviors, determining whether environment– behavior relationships are causal, and developing theoretical models that account for environmental influences and their interactions with other determinants.

Physical inactivity is associated with increased risk of developing chronic diseases. evidence linking physical activity and health outcomes has led to the development of national physical activity guidelines, which focus on moderate-intensity activities.Walking is the most commonly reported moderate-intensity activity and is arguably the most relevant activity for public health interventions targeting adults. Public health strategies to increase participation in physical activity are now starting focus on supportive factors in the physical environment. A behaviour-specific ecological approach was taken in this thesis. Ecological models of physical activity behaviour identify multiple levels of influence from intrapersonal, interpersonal, social and broader environmental domains, with particular attention to the physical environment. A literature review of studies that assessed associations of environmental attributes physical activity found research on environmental influences shows promise to identify significant and potentially modifiable influences on physical activity in general, and specific to walking behaviour. Studies were found to be limited to cross-sectional design and a need was identified for both prospective and intervention studies in order to advance the field. The main aims of this thesis were to develop and test measures of perceptions of environmental attributes; to examine cross-sectional relationships of perceptions of environmental attributes and an objective measure of location with walking behaviour and, to examine prospective relationships of changes in environmental perceptions with changes in walking behaviour. The studies of these relationships are reported for a workplace sample in Part 3 and for a community sample in Part 4. The cross-sectional study of Part 3 found for men, significant positive relationships 'aesthetics' 'convenience' 'access' to services, and for coastal place of residence with neighbourhood walking; and a negative r

Background: Promoting physical activity is a public health priority, and changes in the environmental contexts of adults’ activity choices are believed to be crucial. However, of the factors associated with physical activity, environmental influences are among the least understood. Method: Using journal scans and computerized literature database searches, we identified 19 quantitative studies that assessed the relationships with physical activity behavior of perceived and objectively determined physical environment attributes. Findings were categorized into those examining five categories: accessibility of facilities, opportunities for activity, weather, safety, and aesthetic attributes. Results: Accessibility, opportunities, and aesthetic attributes had significant associations with physical activity. Weather and safety showed less-strong relationships. Where studies pooled different categories to create composite variables, the associations were less likely to be statistically significant. Conclusions: Physical environment factors have consistent associations with physical activity behavior. Further development of ecologic and environmental models, together with behaviorspecific and context-specific measurement strategies, should help in further understanding of these associations. Prospective studies are required to identify possible causal relationships.