Claudia Meyer

Validation of the de Morton Mobility Index (DEMMI) with older community care recipients

Aim:  To validate the de Morton Mobility Index (DEMMI) in community‐dwelling older adults who require informal care.

Translating Falls Prevention Knowledge to Community-Dwelling Older PLWD: A Mixed-Method Systematic Review

PURPOSE OF THE STUDY Falls prevention evidence is strong, but little is known about uptake of strategies for people living with dementia (PLWD). This mixed-method systematic review aimed to integrate evidence of falls prevention efficacy with views/experiences of PLWD. DESIGN AND METHODS Eight electronic databases were searched. Inclusion criteria included quantitative or qualitative studies examining knowledge translation of falls prevention strategies in community-dwelling PLWD and/or their caregiver. Study quality was assessed, and findings are narratively described. RESULTS Six quantitative and five qualitative studies were included. Study quality was mixed. Quantitative studies showed limited evidence of effectiveness on reduction in falls risk, falls and hospitalization rates, nursing home admission, decline in activities of daily living, and adherence to strategies. Qualitative themes showed inclusion of caregiver and health professionals as key to program success, but many factors influence participation. IMPLICATIONS Synthesizing the findings generated a new understanding of falls prevention for this high-risk group. A focus upon health professional and caregiver involvement and accommodation of individual preferences may result in increased engagement with falls prevention strategies.

Aging in Australia

An aging population, growing awareness of chronic disease, and access and navigation of health care services prompt much discussion regarding aging in Australia. Debate within academic and policy circles directs attention toward preventive health, with a growing interest in “healthy aging” and “active aging” where quality of life, rather than years of life, is important. There is little doubt that an aging population places pressure on governments and broader society, but these challenges also present opportunities for positive change.

The impact of care recipient falls on caregivers

OBJECTIVE This study sought to explore the impact of care recipient falls on caregivers. METHODS Ninety-six community-dwelling caregiver-care recipient dyads participated in a 12-month prospective study. Falls and other accidents and service use were recorded. Dyads were assessed at baseline and after each fall. Assessment included the Zarit Burden Interview and a post-accident survey developed for the present study. Focus groups were then conducted to further explore the impact of falls on caregivers. RESULTS Fifty-four care recipients (56%) experienced falls within the 12 months of the study. There was a significant increase in caregiver burden after the first fall (Zarit Burden Interview score increased from 24.2±14.2 to 27.6±14.5, P<0.01). Twenty-four percent of caregivers reported that they had altered their usual routine after the fall, mainly not wanting to leave the care recipient alone. However, there was no increase in the number of services used. Focus group discussions highlighted the need for constant vigilance of the care recipient, a lack of knowledge about support services and concerns related to utilising respite care. CONCLUSION Falls among care recipients have a significant impact on carers, including an increased fear of falling, prompting the need for even closer vigilance. WHAT IS KNOWN ABOUT THE TOPIC? Falls are a significant problem for older people as one in three older people fall each year and injurious falls are the leading cause of injury-related hospitalisation in older people. In Australia falls cost the economy over

Caring and Retirement: Crossroads and Consequences

500 million per year. WHAT DOES THIS PAPER ADD? This paper adds a unique perspective to the falls literature, that of the older persons carer. Falls are a significant problem for community-dwelling carers of older people, contributing to carer burden and impeding the carers ability to undertake activities of daily living because of the perceived need for constant vigilance to prevent the person they care for from falling. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners should ensure that carers are aware of evidence-based falls-prevention practices and services, such as group and individual exercise programs, home modifications and podiatry, that might assist to prevent falls in the person they care for and therefore reduce the burden of care.

Falls in older people receiving in-home informal care across Victoria: influence on care recipients and caregivers.

As older workers move closer to retirement, they are more likely to take on caring roles. This may affect their health, retirement plans, and income security. Retired men and women experience the caring role differently, with men less likely to be adversely affected and more likely to accept services and to derive satisfaction from caring. Carers make an important contribution to the lives of the people they care for and to the community. Caring is a productive role that can be sustained into older age, as long as the carers health and well-being are maintained. More research is needed on the relationship between retirement and caring, to explore the extent of caring and its impact on retirement plans, income, and the physical and mental health of retired carers. This information could then be built into retirement planning to better prepare older workers for this important role. Caring roles and retirement intersect in several ways. About 6 million Americans, 2.6 million Australians, and 6 million people in the United Kingdom are informal carers. People (especially men) are more likely to take on caring roles as they get older and leave the paid workforce. The need to care for a spouse or older relative can be an unanticipated outcome or a precipitator of retirement. Retirement may coincide with illness or disability of a parent or spouse, or may be forced by the demands of caring. Caring may bring about major changes to retirement plans. The financial impact of having been a carer during ones working life may also be felt most keenly on retirement, through the lack of opportunities for savings and retirement fund co-contributions.

Translating Falls Prevention Knowledge for Community-Dwelling People Living With Dementia: Design Protocol for a Mixed-Method Intervention

Aim:  Older people receiving informal care at home appear at high falls risk. This study investigates frequency, circumstances and factors associated with falls risk for older care recipients, and their informal caregivers.

Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses

Background: There are a growing number of older people living with dementia (PLWD) across the globe, and this population has a higher rate of falls than cognitively intact older people. Strong research evidence does not yet exist for preventing falls in community-dwelling PLWD, but best practice guidelines suggest using similar strategies to those used for cognitively intact older adults. This study will use a knowledge translation theoretical framework, supported by several behaviour change theories, to seek to understand the complex phenomenon of moving falls prevention research evidence into practice for PLWD. Methods: A mixed-method design will be employed, with two components investigating falls prevention knowledge translation. Study 1 for PLWD and their caregivers will consist of an initial interview and data collectionabout falls risk, self-efficacy and carer burden. Goal setting will be used to develop a collaborative plan of action, which will be followed by monthly home visits over 6 months to implement the targeted falls prevention strategies according to the readiness by PLWD and their caregiver to change behaviour. Subsequent assessments will be conducted at 6- and 12-months.Study 2 for staff of community care agencies will consist of four action research sessions over 6 months to implement change in practice, related to translating falls prevention knowledge. Discussion: Data will be analysed qualitatively and quantitatively, using a variety of appropriate methods. Drawing together all of the qualitative and quantitative data from various data collection points, a discussion aid, including a set of algorithms for each falls risk factor, will be developed. This study offers the opportunity to explore how falls prevention strategies can be best adopted by PLWD and their caregivers, taking into account their individual needs, preferences and abilities. Community care health professionals have a key role in the translation of falls prevention knowledge. This study will consider the factors influencing this process for PLWD and their caregivers.

Diversity training for the community aged care workers: A conceptual framework for evaluation

INTRODUCTION Falls as a complication of diabetes mellitus (DM) can have a major impact on the health of older adults. Previous reviews have demonstrated that certain exercise interventions are effective at reducing falls in older people; however, no studies have quantified the effectiveness of exercise interventions on falls-related outcomes among older adults with DM. METHODS A systematic search for all years to September 2015 identified available literature. Eligibility criteria included: appropriate exercise intervention/s; assessed falls-related outcomes; older adults with DM. Effect sizes were pooled using a random effects model. Positive effect sizes favoured the intervention. RESULTS Ten RCTs were eligible for the meta-analyses. Exercise interventions were more effective than the control condition for static balance (0.53, 95% CI: 0.13 to 0.93), lower-limb strength (0.63, 95% CI: 0.09 to 1.18), and gait (0.59, 95% CI: 0.22 to 0.96). No RCTs assessed falls-risk; one RCT reported 12month falls-rate, with no differential treatment effect observed. CONCLUSION Exercise interventions can improve certain falls-related outcomes among older adults with DM. Substantial heterogeneity and limited numbers of studies should be considered when interpreting results. Among older adults, where DM burden is increasing, exercise interventions may provide promising approaches to assist the improvement of falls-related outcomes.

Promoting healthy ageing: development of the Healthy Ageing Quiz.

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older peoples experience of healthcare.