Anthea Vreugdenhil

A community-based exercise programme to improve functional ability in people with Alzheimer's disease: A randomized controlled trial

RATIONALE Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition. AIMS AND OBJECTIVE This study assesses the effectiveness of a community-based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimers disease, the most common form of dementia. METHODS In a 4-month randomized controlled trial, 40 community-dwelling patients diagnosed with Alzheimers disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4-months follow-up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales. RESULTS Sixteen men and 24 women diagnosed with Alzheimers disease participated in the study. They had a mean age of 74.1 years (range 51-89) and a mean Mini Mental State Examination score of 22.0 (range 10-28), indicating mild to moderate dementia. At 4-months follow-up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). CONCLUSION This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimers disease.

Obesity, abdominal obesity and Alzheimer disease.

Background/Aims: Obesity has a strong association with vascular and metabolic diseases, which have been linked with Alzheimer disease (AD). While recent studies have reported an association between mid-life obesity and dementia, the role of later-life obesity is less clear. This study investigated the relation between AD, obesity and abdominal obesity at later-life in a case-control study. Methods: Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Height and weight [from which body mass index (BMI) was calculated] and hip and waist circumferences (from which waist-hip ratio was calculated) were measured. Participants were classified according to their BMI as: underweight (BMI <20.0 kg/m2); normal weight (BMI 20.0–24.9 kg/m2); overweight (BMI 25–29.9 kg/m2), or obese (BMI ≧30 kg/m2). They were classified as abdominally obese if their waist-hip ratio was >0.9 (men) or >0.8 (women). Results: AD was associated with obesity [OR 9.5, 95% CI 2.4–37.3, p = 0.001], underweight (OR 5.4, CI 0.9–33.7, p = 0.07) and abdominal obesity (OR 2.5, CI 1.1–5.7, p = 0.027) using logistic regression analyses adjusted for age, sex and location. The inclusion of metabolic risk factors in the model increased the ORs for obesity (OR 12.6, CI 2.8–56.5, p = 0.001) and underweight (OR 7.9, CI 1.0–66.3, p = 0.056). Conclusion: AD may be associated with obesity, underweight and abdominal obesity at later life. Larger prospective studies are required to investigate this further.

'Ageing-in-place': Frontline experiences of intergenerational family carers of people with dementia

Abstract The success of ‘ageing-in-place’ aged care policy in Australia relies heavily on the unpaid work of informal carers. While there is a wealth of research regarding informal carers more generally, we know relatively little about the experiences of the ‘sandwich generation: Adult children (mainly daughters) who provide care for a parent while often juggling paid work and the care of their own children or grandchildren. In this paper I undertake a critical analysis of ‘ageing-in-place’ policy through the lens of‘sandwich generation carers of people with dementia. Drawing from a composite case study, I argue that these carers are located at the interstices of powerful discourses such as ‘individualisation and ‘care’ and explore how the everyday practice of care is negotiated within these spaces. Inhabiting these spaces can be costly for carers and we need to consider how policies can better support intergenerational carers if ‘ageing-in-place’ is to be sustainable.

“What Are They Really Doing?” An Exploration of Student Learning Activities in Field Placement

Abstract Social work students consistently identify their field placement as having the most impact on their learning. Despite this, research on learning activities used during placement and the impact on practice competency and social work identity is limited. This is the second paper from a research study exploring student experiences of learning on placement. Data were gathered from 263 social work students about 14 key learning activities they experienced during placement. The more regularly students engaged in learning activities with their social work supervisor, the more likely they were to report a sense of social work identity and feelings of practice competence. However, the regular use of learning activities varied widely between placements. Surprisingly, approximately half the students did not regularly have the opportunity to observe social work practice, have their practice observed, or to link social work theory and the Code of Ethics to their practice with their social work supervisor.

Social Justice as Concept and Practice in Australian Social Work: An Analysis of Norma Parker Addresses, 1969–2008

Abstract Social justice is central to Australian social work. Principles of social justice underpin the definition of social work as a profession, its code of ethics, and its standards of practice and education. However, there is a dearth of empirical research regarding what social justice has meant to social work over time and how it has been enacted in practice, topical as social inequalities continue to escalate. As a first-stage study, this paper examines how social justice was represented within 19 Norma Parker Addresses delivered by Presidents of the Australian Association of Social Workers at national conferences between 1969 and 2008. Two key themes were evident: social justice as a concept and social justice as social work practice. Social justice was represented conceptually throughout the Addresses as an enduring guiding principle and moral responsibility for social work. How social justice was enacted in practice included themes of: standpoint; practices and strategies; educating social workers; and contested and constrained practice. The meanings and practices of social justice were embedded within the changing contexts within which the Addresses were delivered. Further historical studies can inform social work knowledge, practice, and critical reflection as the profession continues to evolve and confront persistent social justice challenges.

Working at the frontline in cases of elder abuse: ‘It keeps me awake at night’

To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse.

Kindness in Australia: an empirical critique of moral decline sociology

A new sociological agenda is emerging that interrogates how morality can be established in the absence of the moral certainties of the past but there is a shortage of empirical work on this topic. This article establishes a theoretical framework for the empirical analysis of everyday morality drawing on the work of theorists including Ahmed, Bauman and Taylor. It uses the Australian Survey of Social Attitudes to assess the state and shape of contemporary moralities by asking how kind are Australians, how is its expression socially distributed, and what are the motivations for kindness. The findings demonstrate that Australians exhibit a strong attachment and commitment to kindness as a moral value that is primarily motivated by interiorized sources of moral authority. We argue these findings support the work of theorists such as Ahmed and Taylor who argue authenticity and embodied emotion are legitimate sources of morality in todays secular societies. The research also provides new evidence that generational changes are shaping understandings and practices of kindness in unexpected ways.

Promoting readiness to practice: which learning activities promote competence and professional identity for student social workers during practice learning?

ABSTRACT Practice learning is integral to the curriculum for qualifying social work students. Accreditation standards require regular student supervision and exposure to specific learning activities. Most agencies offer high-quality placements, but organizational cutbacks may affect supervision and restrict the development of competence and professional identity. Undergraduate social work students in Northern Ireland universities (n=396) were surveyed about the usefulness of the learning activities they received on placement for developing practice competence and professional social work identity. Results suggest that students most valued regular supervision, constructive feedback, observing social workers, and thinking critically about the social work role. Differences were reported across placements with students feeling disadvantaged in agencies where there was no clear social work role.

Confronting ageism: The potential of intergenerational contemporary art events to increase understandings of older adults and ageing

To explore the impact of an innovative intergenerational art event showcasing retirement village life on attendees’ understandings of older adults and ageing.

A SURVEY OF SOCIAL WORK STUDENTS’ ATTITUDES TOWARDS WORKING WITH PEOPLE WITH DEMENTIA

ions, values and beliefs. Health care providers in all settings, but most notably in care environments where there may be privacy, consent and capacity concerns, face these challenges with very little support, few resources and much misinformation. Methods:The Alzheimer Society of Canada partnered with subject matter experts in both law and dementia care to develop a workshop to help health care providers address issues of intimacy in their dementia care practice. Two types of resources formed the basis of this workshop: 1) Plain language legal resources for health care providers to apply consent and capacity laws appropriately into practice. 2) “Responsive behaviour framework” to assist health care providers in understanding what triggers, including a desire for intimate contact, might be influencing an individual’s behaviour and to offer a systematic approach to intervention. Results:A collaboration of legal, practice and dementia subject matter experts has led to the development of resources to help health care providers to a) reflect on their values, attitudes and beliefs in considering the rights of adults living with dementia to express their sexuality and need for intimacy, b) understand how personal beliefs may influence practice, c) learn person centred strategies to enhance the quality of life of persons with dementia in their care. Conclusion: This session will solicit practice scenarios from participants in order to apply person-centred strategies and resources to increase staff skill and sensitivity when approaching challenging situations involving persons with dementia and the expression of their sexuality and need for intimacy.