Betty Haralambous

Physical activity recommendations for older Australians

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.

Outcomes from the implementation of a facility-specific evidence-based falls prevention intervention program in residential aged care

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in 9 Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to be facility- and patient-specific and included the following: environmental modifications such as low beds and height-adjustable chairs, movement alarms, hazard removal, and hip protectors. Participants included 670 residents and 650 staff from 9 facilities across 3 states. A significant reduction of falls were observed per site in the proportion of fallers (P = .044) and single fallers (P = .04). However, overall the number of falls was confounded by multiple falls in residents. Reduction in fallers was sustained in the 6-month follow-up phase. Positive outcomes from interventions varied between facilities. Further research is necessary to target frequent fallers.

A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities

BackgroundFalls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for residents with dementia. This paper reports the protocol of a project which aims to implement evidence based falls prevention strategies in nine residential aged care facilities (RACFs) in Australia. The facilities in the study include high and low care, small and large facilities, metropolitan and regional, facilities with a specific cultural focus, and target groups recognised as being more challenging to successful implementation of falls prevention practice (e.g. residents with dementia).MethodsThe project will be conducted from November 2007-November 2009. The project will involve baseline scoping of existing falls rates and falls prevention activities in each facility, an action research process, interactive falls prevention training, individual falls risk assessments, provision of equipment and modifications, organisation based steering committees, and an economic evaluation. In each RACF, staff will be invited to join an action research group that will lead the process of developing and implementing interventions designed to facilitate an evidence based approach to falls management in their facility. In all RACFs a pre/post design will be adopted with a range of standardised measures utilised to determine the impact of the interventions.DiscussionThe care gap in residential aged care that will be addressed through this project relates to the challenges in implementing best practice falls prevention actions despite the availability of best practice guidelines. There are numerous factors that may limit the uptake of best practice falls prevention guidelines in residential aged care facilities. A multi-factorial individualised (to the specific requirements of each facility) approach will be used to develop and implement an action plan in each participating facility based on the best available evidence.

Factors impacting on early detection of dementia in older people of Asian background in primary healthcare

The prevalence of dementia in people from Culturally and Linguistically Diverse (CALD) backgrounds is predicted to increase. By 2026, Chinese and Vietnamese languages are projected to be the first and fourth most prevalent languages spoken by older people from CALD backgrounds living in Australia. Varying expressions of dementia literacy within these groups sometimes result in presentation to health services at a later stage of the disease.

Evaluation of Alzheimer's Australia Vic Memory Lane Cafés

BACKGROUND This paper describes the evaluation of the Memory Lane Café service in Victoria, Australia. The Alzheimers Australia Vic Memory Lane Café model aims to provide a social and educational service to people living with dementia and their carers, family members or friends. Dementia is a serious health issue in Australia, with prevalence estimated at 6.5% of people over 65 years of age. Living with dementia has significant social and psychological ramifications, often negatively affecting quality of life. Social support groups can improve quality of life for people living with dementia. METHODS The evaluation included focus groups and surveys of people with dementia and their carers, staff consultation, service provider interviews, and researcher observation. The Melbourne Health Mental Health Human Research Ethics Committee approved the project. Participants included people with dementia (aged 60 to 93 years, previously enrolled in the Alzheimers Australia Vics six-week Living With Memory Loss Program), their carers, friends and/or family members, staff working in the Cafés, and service providers with links to the Cafés. RESULTS This evaluation found that Memory Lane Cafés promote social inclusion, prevent isolation, and improve the social and emotional well-being of attendees. However, Cafés did not meet the needs of all potential attendees. CONCLUSIONS The evaluation recommended that existing Café services be continued and possibilities for extending the Cafés be explored. Based on evaluation outcomes, the Department of Health Victoria is funding four additional pilot programs in café style support services.

The State of Physical Environments in Australian Residential Aged Care Facilities

OBJECTIVE This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). DESIGN Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. SETTING Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. CONCLUSIONS Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs.

Help seeking in older Asian people with dementia in Melbourne: Using the Cultural Exchange Model to explore barriers and enablers

The prevalence of dementia is increasing in Australia. Limited research is available on access to Cognitive Dementia and Memory Services (CDAMS) for people with dementia from Culturally and Linguistically Diverse (CALD) communities. This study aimed to determine the barriers and enablers to accessing CDAMS for people with dementia and their families of Chinese and Vietnamese backgrounds. Consultations with community members, community workers and health professionals were conducted using the “Cultural Exchange Model” framework. For carers, barriers to accessing services included the complexity of the health system, lack of time, travel required to get to services, language barriers, interpreters and lack of knowledge of services. Similarly, community workers and health professionals identified language, interpreters, and community perceptions as key barriers to service access. Strategies to increase knowledge included providing information via radio, printed material and education in community group settings. The “Cultural Exchange Model” enabled engagement with and modification of the approaches to meet the needs of the targeted CALD communities.

Screening for depression and anxiety among older Chinese immigrants living in Western countries: The use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI).

Depression and anxiety are two common mental health problems among older people. There is evidence that using well‐validated screening tools can improve detection of depression and anxiety among this group. The review explored the use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) for screening depression and anxiety among older Chinese immigrants, one of the largest and fastest growing groups of older immigrants in Western society. It focused on the GDS and GAI because both are designed specifically for older people.

Living Longer Living Stronger™: A community-delivered strength training program improving function and quality of life

This study investigated changes in function and quality of life for older adults participating in Living Longer Living Stronger™, a community‐delivered strength training program for people aged over 50.

‘All in a day's play’ – An intergenerational playgroup in a residential aged care facility

A playgroup was established in 2009 in a residential aged care facility. Qualitative data were collected at baseline and 6 months after commencement. Interviewer administered questionnaires were undertaken with residents at baseline and post implementation. Residents were also invited to attend a focus group. The parents and staff were asked to complete a questionnaire at baseline and at 6 months. This study focuses mainly on the experiences of residents involved in the playgroup. It also describes responses from parents about impact on residents and children and from staff about impact on residents and the facility to expand on the views of the residents. The playgroup, which comprised 16 weekly sessions, was found to have a positive effect for residents. The positive effects were identified as themes which included changing attitudes to residential aged care facilities and child behaviour, enjoyment, reflections on childhood, and increased intergenerational interaction and communication. A facilitated playgroup was effectively established in a residential aged care facility and residents reported overall positive experiences and were accepting of a playgroup in their place of residence. The paper considers the implications of this for wider application.