Stacey Cynthia Masters

Measuring Energy Expenditure in Community-Dwelling Older Adults: Are Portable Methods Valid and Acceptable?

The objective of this study was to assess the validity and acceptability of a handheld indirect calorimeter for measurement of resting energy expenditure in a sample of community-dwelling older adults. It was a measurement study involving 48 healthy community-dwelling older adults. Assessment of resting energy expenditure was performed in 48 healthy older adults under fasting conditions using the Europa Gas Exchange Monitor (GEM; ventilated hood indirect calorimeter, NutrEn Technology Ltd, Cheshire, UK) and the MedGem (handheld indirect calorimeter, HealtheTech Inc, Golden, CO). An eight-item self-administered survey was used to determine the acceptability of the two measurement devices. Bias and limits of agreement were calculated to determine the level of agreement between the two measurements. The Wilcoxon signed-ranks test was used to test for significant differences across items of the self-administered survey. Participants mean age was 80 years and mean body mass index (calculated as kg/m(2)) was 23. Mean (95% confidence interval) resting energy expenditure was 1,149 kcal/day (1,086, 1,194) and 1,489 kcal/day (1,386, 1,592) for the traditional and handheld indirect calorimeter, respectively; paired t test P<0.001. Mean bias and limits of agreement were 349 kcal (-270, 969) or 5 kcal/kg/day (-3.6, 13.2) with least products regression resulting in a slope of b(1)=1.9 (95% confidence interval 1.2, 2.7, P<0.05). The handheld indirect calorimeter was less acceptable to participants than the ventilated hood indirect calorimeter. Measurement of resting energy expenditure from the handheld indirect calorimeter used in this study is not acceptable for use in healthy older adults given the magnitude of the overestimate, the wide limits of agreement, the significant slope of the bias, and the discomfort experienced by the participants.

Influence of health locus of control on recovery of function in recently hospitalized frail older adults

To investigate the influence of health locus of control on physical function, quality of life, depression and satisfaction with care transition in a sample of older adults after a hospital admission.

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared‐decision‐making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings.

What are the first quality reports from the transition care program in Australia telling us

Transition Care is a new program in Australia, jointly funded by the Commonwealth and State/Territory Governments. Implementation is undertaken by state health departments, in some cases through aged care organisations, against a set of key requirements. This paper examines reports from providers to reveal enablers and barriers to compliance with the requirements and to highlight emerging patterns of practice. The first 23 self‐reports were content analysed. Person‐centred and goal‐orientated care was evidenced. General practitioner, pharmacist and geriatrician involvement in care planning and review was low. While service agreements between Transition Care services, referring hospitals and community providers improved the efficiency of information transfer and discharge arrangements, these were rare, hindering entry and discharge from the program. Transition Care offers older people a flexible model of care. While the flexibility of the model is a strength, service providers are struggling to achieve integration with existing services.

Programmes to support chronic disease self-management: should we be concerned about the impact on spouses?

Chronic disease self-management support (CDSMS) programmes are widely advocated as an essential element of chronic disease care and have demonstrated increased engagement with self-care activities such as improving diet but may place additional strain on spouses. This study used an embedded mixed methods approach to explore the impact of CDSMS on spouses. Spouses were recruited as part of a larger randomised controlled trial to assess the efficacy of a health professional-led CDSMS programme (the Flinders Program) in older adults with multiple chronic conditions, compared with an attention control group. Spouses were recruited from the general community through General Practitioners located in the southern areas of Adelaide, Australia. Quantitative and qualitative data were collected between September 2009 and March 2011; a total of 25 spouses from each of the CDSMS and control groups provided data. Spousal strain was measured by the Caregiver Risk Screen (CRS). Few spouses had CRS scores indicative of moderate or high strain at baseline or upon completion of the study and CRS scores did not differ by programme allocation. Spouses of participants with poorer self-management (r = 0.34, P = 0.016) and more illness intrusiveness (r = 0.35, P = 0.013) had higher CRS scores at baseline (quantitative) and spousal strain was found to increase as a partners well-being and capacity to self-manage decreased (qualitative). Spouse presence at CDSMS sessions (20%) frequently signalled a reduced level of partner well-being. Overall, our findings suggest that CDSMS programmes in many cases will have little impact (either positive or negative) on spousal strain. A significant increase in spousal strain may occur, however, if there is deterioration in the health status of a CDSMS participant. The impact of decline in participant health status on carer strain needs to be considered in CDSMS programmes.

Development and testing of a questionnaire to measure older people's experience of the Transition Care Program in Australia.

Aim:  Transition Care (TC) is a new program for older adults in Australia. At present, program quality is assessed using provider reports of compliance with key requirements established by the Australian Government Department of Health and Ageing. As part of the National Evaluation of the Transition Care Program, the authors developed a questionnaire to measure recipient experience of TC.

Using local clinical educators and shared resources to deliver simulation training activities across rural and remote South Australia and south-west Victoria: A distributed collaborative model

PROBLEM There is a lack of access to simulation-based education (SBE) for professional entry students (PES) and health professionals at rural and remote locations. DESIGN A descriptive study. SETTING Health and education facilities in regional South Australia and south-west Victoria. KEY MEASURES FOR IMPROVEMENT Number of training recipients who participated in SBE; geographical distribution and locations where SBE was delivered; number of rural clinical educators providing SBE. STRATEGIES FOR CHANGE A distributed model to deliver SBE in rural and remote locations in collaboration with local health and community services, education providers and the general public. Face-to-face meetings with health services and education providers identified gaps in locally delivered clinical skills training and availability of simulation resources. Clinical leadership, professional development and community of practice strategies were implemented to enhance capacity of rural clinical educators to deliver SBE. EFFECTS OF CHANGE The number of SBE participants and training hours delivered exceeded targets. The distributed model enabled access to regular, localised training for PES and health professionals, minimising travel and staff backfill costs incurred when attending regional centres. The skills acquired by local educators remain in rural areas to support future training. LESSONS LEARNT The distributed collaborative model substantially increased access to clinical skills training for PES and health professionals in rural and remote locations. Developing the teaching skills of rural clinicians optimised the use of simulation resources. Consequently, health services were able to provide students with flexible and realistic learning opportunities in clinical procedures, communication techniques and teamwork skills.

Innovations in Aged Care: What are the first quality reports from the Transition Care Program in Australia telling us?: Quality reports from Transition Care

Transition Care is a new program in Australia, jointly funded by the Commonwealth and State/Territory Governments. Implementation is undertaken by state health departments, in some cases through aged care organisations, against a set of key requirements. This paper examines reports from providers to reveal enablers and barriers to compliance with the requirements and to highlight emerging patterns of practice. The first 23 self‐reports were content analysed. Person‐centred and goal‐orientated care was evidenced. General practitioner, pharmacist and geriatrician involvement in care planning and review was low. While service agreements between Transition Care services, referring hospitals and community providers improved the efficiency of information transfer and discharge arrangements, these were rare, hindering entry and discharge from the program. Transition Care offers older people a flexible model of care. While the flexibility of the model is a strength, service providers are struggling to achieve integration with existing services.