Elizabeth Ozanne

Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review

BACKGROUND use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. OBJECTIVE to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. METHODS a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. RESULTS fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. CONCLUSIONS existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.

Smart-home technologies to assist older people to live well at home

Background: With the rapid population ageing that is occurring world-wide, there is increasing interest in “smart home” technologies that can assist older adults to continue living at home with safety and independence. This systematic review and critical evaluation of the world wide literature assesses the effectiveness and feasibility of smart-home technologies for promoting independence, health, well-being and quality of life, in older adults. Methods: A total of 1877 “smart home” publications were identified by the initial search of peer reviewed journals. Of these, 21 met our inclusion criteria for the review and were subject to data extraction and quality assessment. Results: Smart-home technologies included different types of active and passive sensors, monitoring devices, robotics and environmental control systems. One study assessed effectiveness of a smart home technology. Sixteen reported on the feasibility of smart-home technology and four were observational studies. Conclusion: Older adults were reported to readily accept smart-home technologies, especially if they benefited physical activity, independence and function and if privacy concerns were addressed. Given the modest number of objective analyses, there is a need for further scientific analysis of a range of smart home technologies to promote community living.

Robotics to Enable Older Adults to Remain Living at Home

Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1) what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2) what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.

Smart technologies to enhance social connectedness in older people who live at home

To examine the effectiveness of smart technologies in improving or maintaining the social connectedness of older people living at home.

Negotiating Identity in Late Life: Diversity Among Australian Baby Boomers

Abstract Much is expected of Australian Baby Boomers as they move through middle to late life over the coming decades. However, there is enormous diversity in the resources and lifestyles of the many birth cohorts that make up this population and some subgroups have been identified as at particular risk. The present article reviews the national and international research on the expectations and behaviours of baby boomers and explores the potentiality that this population, with their diversity and longer life, may contribute to the negotiation of a new social contract and cultural maturity in an Ageing Australia.

Facilitating transition : elements of successful case management practice for older parents of adults with intellectual disability

Abstract The increased life expectancy of people with intellectual disability raises the dual issues of supporting aging parental carers to continue in their role and ensuring a smooth transition for middle-aged adults with intellectual disability to non-parental care. However, few services are specifically designed to respond to these issues and older carers are not generally dissagregated from other groups. Two pilot programs, “Options for Older Families,” were funded by the Victorian Department of Human Services in 1995 to work with older carers on immediate needs and planning for the future. The pilots utilised intensive case management with access to discretionary funds. This paper reports on an evaluation that examined the characteristics of these families, the outcomes for carers and adults, and the strategies adopted to achieve these. The elements of successful case management practice with older carers demonstrated in the programs were proactivity and prevention with a dual emphasis on maintenance and change for both the carer and their adult child with intellectual disability. Demands on carers were reduced by the introduction of formal services such as “recreation as respite” whilst the environmental demands for adults were increased, thus effecting change and providing vital ingredients for preparation for the future. The pilots did not duplicate the type of support offered or the clients targeted by more traditional generic case management programs operating in Victoria.

Shifts in the model of service delivery in intellectual disability in Victoria

A fundamental restructuring of welfare states has occurred in the last decade and, in common with other fields of health and welfare, intellectual disability services have evolved from a largely institutional character to a diverse range of housing and community provision and individually tailored approaches to service delivery. Aspects of the shift towards marketisation which emphasise individualism and the power of the consumer and de-emphasise membership of categorical groups, are reflected in the values and principles that now drive intellectual disability policy and have to some extent been embraced by stakeholders in the field. However, these shifts have also led to tensions and pose inherent contradictions that may obstruct the realisation of policy objectives. Using a framework derived from Baldock and Evers, this paper explores some of the recent policy shifts in the field of intellectual disability, examines the dilemmas they pose and the major questions to be addressed in this field at the beginning of the 21st Century.

Social isolation of older people: the role of domestic technologies

This paper explores the role of domestic technologies for addressing social isolation of older people. Despite the increasing use of information and communication technologies, social isolation remains an issue amongst older people. Assistive technologies address important health needs, but there is a lack of social technologies that adequately deal with social isolation. This paper contributes to knowledge about the everyday life of older people for the purpose of designing appropriate social technology. We present an overview of the findings of a three-stage study---an expert survey, a field study and a design workshop---and describe a set of needs to inform the design of technology for ameliorating the social isolation of older people.

How do family carers respond to behavioral and psychological symptoms of dementia

BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) have been associated with increased carer burden and early institutionalization. BPSD are more responsive to treatment than are cognitive and functional decline. Little is known about how family carers understand and try to reduce these symptoms. This study aimed to explore the strategies used by carers looking after someone with high levels of BPSD. METHODS Twenty-five carers were interviewed using a semi-structured interview with the Neuropsychiatric Inventory (NPI). They were all caring for someone eligible for an Extended Aged Care at Home Dementia Package, which targets people with BPSD. RESULTS Participants reported high levels of BPSD with a mean score of 8.2 for symptoms (range 2-12, SD = 2.38) and a mean NPI score of 51.4 (range 14-111, SD = 28.74). Distress scores were also high with a mean of 18.5 (range 2-42, SD = 11.33). Carers described on average, fewer than four strategies for managing BPSD. Encouraging activity, utilizing psychotropic medications, identifying triggers, restraining or treating in a paternalistic manner, and meeting physiological needs were the most commonly used strategies. CONCLUSION While family carers are often at the forefront of identifying triggers and addressing unmet needs, findings from this study suggest that some carers have a limited repertoire of strategies despite experiencing a large number of symptoms. There is a clear need for ensuring evidence-based programs to educate and support carers in identifying triggers, understanding symptoms and learning to cope with these symptoms.

Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults

The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults’ expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area.