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Background The many changes in becoming a mother increase the risk of developing a mental illness in the perinatal period. Comprehensive, psychosocial assessment for risk of mental illness is recommended as part of routine perinatal care for all women. In Australia, this assessment was less likely to be undertaken for women who gave birth in a private hospital compared to women who gave birth in a public hospital. Therefore this study aimed to explore the experience of perinatal assessment of risk of mental illness for first-time mothers who gave birth in a private hospital. Method The results are from an explanatory mixed-methods study on the risk of the development of a perinatal mental illness and its relationship with the delivery of, or lack thereof, a parenting support service. Interviews were conducted with first-time mothers, midwives, nurses, obstetricians and paediatricians at two Australian metropolitan private hospitals. Content analysis of the interview data provided exploration and interpret their experience of assessment of risk of mental illness. Results Interview data were gathered from 32 participants. Four themes on assessment of risk of mental illness for these women were described: part of routine perinatal care; comprehensive psychosocial assessment; coordination between care providers and lack of mental health resources. Conclusion For mothers who gave birth in a private hospital, comprehensive psychosocial assessment of risk of mental illness may not have been provided as part of the routine perinatal care and not coordinated between care providers. A lack of mental health resources cannot be regarded as a barrier to provision of these services.

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.

This paper highlights the relationship between reflective practice and staff mindfulness, situation and movement awareness, and person-centredness during mobility care in nursing homes. An overview of relevant decision-making theory is followed by discussion of the place of reflective practice in optimizing mobility care. Two contrasting case scenarios, derived from observations of mobility care during a previous qualitative study, are used to illustrate and contrast how mindfulness, situation awareness and reflection-in-action may enable person-centredness. Implications for training designed to improve person-centredness during mobility care are considered. Training in situation and movement awareness, combined with observations and collaborative reflective practice, may provide a format for coaches and peer leaders to develop mindfulness and person-centredness of care staff during mobility care.

The increasing number of people reaching their 80s and 90s has triggered multidisciplinary consideration of how to address and capitalise on the longevity phenomenon.The aim of this article is to provide an overview of ways in which clinicians can work with older patients to optimise their health and wellbeing during the later years of life.Old age need not be burdensome to individuals or society. There is strong evidence to support the management of many chronic diseases presenting in - or extending into - old age. General practice will need to adapt to the demographic challenges of an ageing population by targeting conditions that impede people from contributing to family and societal life. General practitioners (GPs) will also need to adapt to the changing expectations of, and from, older patients across the upcoming generations.

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.

The research reported in this article investigated the nature and the purpose of older people's social interactions in their local neighbourhood shops. Data were collected through face-to-face interviews with and observation of 11 shoppers, aged 67 years and older, and six shopkeepers. Classic grounded theory analysis method revealed a previously uncharted psycho-social process associated with these interactions entitled by the authors as Civic Socialising; it highlights that older people's interactions in their local neighbourhood shops embody authentication of themselves as individuals and as community members, and their co-construction and co-preservation of the milieu of their local neighbourhood shopping precinct with a view to sustaining their ongoing autonomy. The new conceptual theory Civic Socialising highlights that older people can be proactive, resilient and capable, dimensions integral to human fulfilment, and demonstrates that older people can play an active role in their communities where the environment is enabling. The new conceptual theory Civic Socialising has significance for the way we determine and view older people's social relationships. Crucially, in light of a burgeoning older population world-wide, it is clear that policy makers and social planners must ensure that older people can continue to interact in their communities if ageing in place is to be a satisfying and cost-effective experience. Without such consideration, ageing in place could well create dependency and despondency.

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.

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.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.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.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.

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.

Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the 'old old' (≥75 years).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.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.We require more information about the 'oldest old' (85+ years). There is great scope for increasing physical activity, even walking, among older people.

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.