Susan Hunt

Feasibility and Outcomes of a Home-Based Exercise Program on Improving Balance and Gait Stability in Women With Lower-Limb Osteoarthritis or Rheumatoid Arthritis: A Pilot Study

UNLABELLED Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. OBJECTIVE To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis. DESIGN Pre-post interventional study. SETTING General community. PARTICIPANTS Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study. INTERVENTION After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later. MAIN OUTCOME MEASURES Falls risk (Falls Risk of Older People-Community Setting) and balance measures. RESULTS Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People-Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006). CONCLUSIONS An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.

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.

The complexities of caring for child protection workers: the contexts of practice and supervision

This paper focuses on the challenges and complexities of caring for front-line child protection workers. It is organised in four main sections. After a brief explanation of the background, the paper reviews the silencing of children as a form of defensive denial. The second section presents research on the problems faced by child protection workers and the defences used in response to actual and threatened violence. The third section reflects on the resulting complexities of supervision in the face of organisational defensiveness. In the final section, examples of good staff support from outside social work are summarised. The paper draws on theoretical material and the primary authors experiences of undertaking research in a range of organisations.

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.

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.

‘If I feel like this, how does the child feel?’ Child protection workers, supervision, management and organisational responses to parental violence

This study analysed workers’ experiences of supervision following interactions with hostile and intimidating parents. This analysis examined management and organisational responses to worker stress, and assessed the adequacy of support that workers received. An online survey was designed to collect data on workers’ experiences and free text responses were qualitatively analysed for references to the supervision they received in response to working with parents. 590 participants responded to the survey. 402 were qualified social workers, and 423 worked in child protection. Participants had experienced a range of violent behaviour from parents. The overwhelming theme in responses was the lack of support and supervision workers received, often in stressful and frightening circumstances. Approximately one quarter of participants only used organisational procedures, guidelines or protocols on dealing with hostile parents. Workers reported that mismanaged parental hostility affected their practice and the quality of protection that children received. The violence experienced had a significant negative impact on their personal and professional lives. Organisational responses in the form of supervision and education were often inadequate and resulted in children receiving reduced quality of protection. Recommendations for policy and practice change are discussed, with the aim of caring for workers and the children they protect.

The Effects of Violence and Aggression From Parents on Child Protection Workers’ Personal, Family, and Professional Lives:

This article presents findings from a survey of the experiences of child protection workers in England when working with parents who exhibit aggression and violence. This work explores the effects on workers in their professional lives, and on themselves and their families in their private lives. The article examines workers’ thoughts and experiences about the effects of parental hostility on workers’ ability to protect children. The article also details workers’ experiences of the nature and effectiveness of training and support in this area. These findings are then examined in the light of the results of an analysis of the literature, including the findings from serious case review (SCR) reports in England (official inquiries into the causes of child deaths where the children are known to social and health services). The majority of the 590 respondents in the survey were social workers (n = 402; 68%), reflecting the fact that case management of child protection cases in the United Kingdom is the responsibility of social workers working in statutory agencies. This article addresses, from a consideration of the secondary analysis and the original research findings from the survey, how individual workers, managers, and agencies can best understand and then respond effectively to aggressive parental behaviors.

Prevalence of physical activity behaviour in older people: Findings from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project and Australian national survey data

Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the ‘old old’ (≥75 years).

A description and evaluation of an innovative rural rehabilitation programme in South Eastern Australia.

Purpose. To describe and evaluate the effectiveness of an innovative model of rehabilitation designed to meet the needs of a sparsely populated rural area in South Eastern Australia. Method. Five rural health services collaborated to establish a rehabilitation programme. Evaluation included comparing length of stay (LOS) and improvement in the Modified Barthel Index (BI) with the Victorian State average for Level 2 (non-specialist) rehabilitation. Surveys were conducted with staff, clients and carers in the programme. Results. An inpatient rehabilitation programme was successfully established through cooperation between five health services. Clients admitted to the programme improved functionally at least as well as the Victorian State average for similar client groups (BI change 26.5 compared with 22.3 points, p < 0.001), with a shorter LOS (13.8 compared with 22.3 days) but more were discharged to residential aged care (16.1% compared with 6%). Conclusions. The programme was successful in meeting its stated aims. The model described could be adopted in rural areas sharing similar characteristics. Key enablers to the success of the programme included: collaboration between hospitals; a skilled and enthusiastic leader; recruitment of allied health staff; consistent medical leadership; access to training and support from a major regional rehabilitation centre; and access to funding to enable the programme to establish itself and demonstrate outcomes for clients.

Evaluation of Alzheimer's Australia Vic Memory Lane Cafes

Background: This paper describes the evaluation of the Memory Lane Cafservice in Victoria, Australia. The Alzheimers Australia Vic Memory Lane Cafmodel 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 Caf´ es, and service providers with links to the Caf´ Results: This evaluation found that Memory Lane Caf´ es promote social inclusion, prevent isolation, and improve the social and emotional well-being of attendees. However, Cafdid not meet the needs of all potential attendees. Conclusions: The evaluation recommended that existing Caf´ e services be continued and possibilities for extending the Caf´ es be explored. Based on evaluation outcomes, the Department of Health Victoria is funding four additional pilot programs in cafstyle support services.