Alison Ballantyne

Crushing or altering medications: what's happening in residential aged‐care facilities?

Objectives: To determine the extent to which medications are altered or crushed prior to administration to residents of aged‐care facilities, the medications involved and the methods employed.

Dementia and loneliness: an Australian perspective

AIM To explore the perceptions of loneliness according to people with early-stage dementia, living in community and long-term care and also the views of their family carers. BACKGROUND Research that specifically explores the influence of loneliness on dementia is limited and indicates the prevalence of loneliness and the negative relationship between loneliness and cognitive decline. There is a paucity of research that explores loneliness from the perspective of the person with dementia. DESIGN A descriptive exploratory qualitative approach was used. METHODS Data were collected through semi-structured audio-taped interviews. A purposive sample of 70 people with a diagnosis or probable dementia and 73 family carers were recruited from community and long-term care from South East Queensland, Australia. RESULTS Four themes were identified: staying connected to others; losing the ability to socially engage; experiencing loneliness; and overcoming loneliness. The results emphasise the importance of familiar human relationships in reducing the feelings of loneliness in people experiencing dementia. CONCLUSIONS People with dementia are at risk of loneliness, but placing them with unfamiliar people and environments may not improve their situation. RELEVANCE TO CLINICAL PRACTICE Better refinement of care that takes into account the potential for loneliness and an understanding of premorbid social tendency may assist in the implementation of individualised and evidence-based strategies to assist people with dementia to lead a better quality of life. To maintain well-being, the social needs of the person with dementia as well as the family need to be considered.

‘Nowadays you don’t even see your neighbours’: loneliness in the everyday lives of older Australians

Loneliness is a pressing social issue for older people globally. Despite this, there is a paucity of studies on how older people themselves perceive loneliness and how service providers can support them. This study sought to address the gap using in-depth and semi-structured interviews with 60 older people and eight focus groups with aged care service providers in Australia in 2007. A purposive sampling strategy was employed to incorporate maximum participant variation. People 65 years and over were recruited from four large service providers in two Australian states. Our findings show that loneliness is influenced by private, relational and temporal dimensions and whether older people feel that they have, or are seen by others as having, a sense of connectedness with the wider community. Participants expressed the importance of maintaining social contact and having a sense of connection and belonging to the community. Our study highlights both the significance of gathering the views of older people to generate an understanding about loneliness and the need to recognise loneliness as a diverse and complex experience, bound to the context in which it is understood and perceived and not synonymous with social isolation. Such an understanding can be used to both evaluate and improve upon programmes that address loneliness and to help maintain an integration of older people in the community.

Moving them on and in: The Process of Searching for and Selecting an Aged Care Facility

This exploratory, descriptive study examined the search and selection process for an aged care facility following discharge of a family member from an acute setting. Few studies have examined this process and its effects on families. Individuals from 25 families where a family member had been recently admitted to an aged care facility following discharge from an acute setting were interviewed. This article reports participants’ perceptions of the search and selection process and its effect on the family. Five major themes emerged from the data: good fortune, wear and tear on the sponsor, dealing with the system, urgency, and adjusting. The results can be used to inform and assist families and health professionals working with families in this situation.

Vietnamese women and pap smears: issues in promotion

Objective: Australian data indicate that Vietnamese‐born women in Australia have a significantly higher incidence of cervical cancer than other Australian women. This study explored self‐reported factors associated with Vietnamese‐born womens participation in cervical screening.

Being mobile: electric mobility-scooters and their use by older people

ABSTRACT There is increasing use of electric mobility-scooters by older people in South Australia, the fourth largest state in Australia. Although various issues about their use have been raised by users, carers, urban planners and legislators, to date they have received little research attention. The purpose of the study reported in this paper was to explore the factors that influence and impact upon older people who use mobility-scooters, particularly from their own perspectives. Data were collected through a survey of 67 current electric mobility-scooter older users, and through two focus groups with other older South Australian people who were users. The data showed that more than 71 per cent of the participants had owned their scooter for more than two years, most had purchased the scooter as new, and 80 per cent owned a four-wheel scooter. The scooter was used predominantly for getting to and from shops, visiting friends and family, and to go for rides. Most respondents used their scooters three to five times each week and travelled between two and five kilometres from their home. The key findings from the focus groups were categorised into three major themes of ‘obtaining a scooter’, ‘the meaning of mobility’ and ‘issues around sharing spaces’. Each is exemplified. The implications for environmental and building design, for the better training of users, and for public education are discussed.

Coping with crisis: how Australian families search for and select an aged care facility for a family member upon discharge from an acute care setting.

Abstract Searching for, and selecting, an aged care facility for a family member upon his or her discharge from an acute setting is known, anecdotally, to be a challenge; but the process itself, and its effects on families, has seldom been examined. In this exploratory/descriptive study, face-to-face in-depth interviews were conducted with sponsors (often family members) of residents who had been admitted to an aged care facility within the past 90 days, following their discharge from an acute care setting.Where possible, both sponsor and resident were interviewed. This paper reports on the participants’ perceptions of the search and selection process. Specific areas of interest were probed:Why and how the decision was made to seek residential placement; when and how the search for an aged care facility began; factors that were important in the family’s final selection process; what happened when families, either initially or in the long term, were unable to find a place in an aged care facility; and the family’s perspective about the efficacy of the search and selection process and its effect on the well being of the family. Residents are often passive in the search and selection process, while sponsors are often actively involved. Very few residents or sponsors consider planning for an aged care facility prior to hospitalisation, and there is often the perception by families of having very little support at this stressful and emotional time. The decision to relocate a family member in these circumstances is a stressful experience and should be viewed as a family crisis, particularly if unexpected such as upon discharge from an acute setting.These findings provide valuable insights that can be used to guide and assist families experiencing this process, as well as health care professionals working with families in this situation.

Factors Influencing the Implementation of Quality Use of Medicines in Residential Aged Care

BackgroundIn response to concerns about, and issues pertaining to, medication use practices in residential aged-care facilities (RACFs), the Australian Pharmaceutical Advisory Council (APAC) established a working party on quality use of medicines (QUM) in nursing homes and hostels. The APAC is a representative ministerial advisory forum bringing together key stakeholders from the medical, nursing and pharmacy professions, as well as pharmaceutical industry, consumer and government sectors. The working party developed the integrated best practice model for medication management in RACFs.ObjectivesThis study arose from concerns that, despite the availability of such guidelines to inform best practice in RACFs, there remain barriers to its implementation. Thus, the focus of this research was to explore factors influencing the implementation of best practice with respect to QUM in RACFs.MethodsThis multimethod, multidisciplinary study was conducted in a representative sample of 12 RACFs in one Australian state — South Australia. The methods used were Critical Incident Technique (CIT) interviews, focus groups, nominal groups and Participatory Action Research.ResultsIn stage one of the research the CIT interviews identified four major issues/factors influencing the implementation of best practice: contextual/structural, boundaries, day-to-day practices and keeping up. These themes were developed in the focus and nominal group sessions and the project team prepared a discussion paper summarising stage one results. In stage two participants were asked to use the discussion paper to develop a way forward. Medication Advisory Committees (MACs) emerged as a key strategy. Each participating RACF was then supported to establish and maintain a MAC. A second workshop heard feedback from the facilities on factors supporting the MACs and barriers to their functioning. Eleven of the 12 RACFs had a functioning MAC at the end of the project. Key support factors included: an external facilitator to help organise MAC meetings, provision of resources, such as terms of reference, agendas, policy statements and the sharing of information between MACs. In stage three a set of agreed recommendations was prepared and submitted to the funding body. The recommendations reported here informed the development of the peak guidelines for medication management and administration in Australia.ConclusionThis project has been groundbreaking in its impact on Australian aged-care practice. A major outcome has been significantly improved communication and collaboration between industry organisations, academic disciplines, professional bodies and educators involved in the RACFs.

Improving care transitions of older people: Challenges for today and tomorrow

Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.

Providing residential care to older Australians: issues for registered nurses

Abstract Contemporary nursing in residential aged care facilities poses many challenges. Issues impacting on registered nurses providing care to older Australians living in residential aged care settings are explored and described in this paper. Five broad themes emerged from the analysis of thirty interviews with Registered Nurses, eleven focus groups with participants who worked with registered nurses in the residential aged care facilities selected in the sample, and five nominal groups which consisted of key stakeholders from the aged care industry and professional nursing forums. These themes were: a changing and increasingly complex role; perceptions of the registered nurse in residential aged care and how to deal with them; the need for strategies to work with others; coping with the everyday demands; and dealing with a sense of powerlessness and lack of control.The identified themes form the basis of the discussion to follow.