The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke.

PURPOSE: After stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients' experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback. MATERIALS AND METHODS: This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback. RESULTS: The analysis revealed the clinician's interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician's misjudged response to the patient's aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit. CONCLUSIONS: Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation.IMPLICATIONS FOR REHABILITATIONAfter stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients' psychological wellbeing and engagement in rehabilitation.

Improving care for older patients visiting emergency departments. Are they receiving falls prevention guideline care?

BACKGROUND: The primary objective was to examine whether the Emergency Department (ED) treatment of older adults who fall in Australia is concordant with falls prevention and management clinical guideline care recommendations. METHODS: A retrospective medical records audit was completed for patients 65years and older, who attended the ED with a fall and were discharged home. An audit tool was developed from local, national, and international falls clinical guidelines. RESULTS: One thousand and twenty-seven patients presented following a fall throughout 2020. One hundred and seven patient medical records were audited. Assessment of cognition (94%), medication review (76%) and use of a falls risk screen (76%) were commonly completed. Under half of the patients had a documented gait evaluation (40%) and review of vision (18%). Concordance with guideline care was more likely for older patients (p = 0.042), with higher levels of comorbidity (p = 0.013), who required care assistance (p = 0.008) and received treatment from a multidisciplinary team (p < 0.001) in an observation ward (p < 0.001). CONCLUSIONS: Older patients with increased comorbidities and higher care needs had more falls guideline care recommendations documented. This was likely to occur when patients were moved to the observation ward where more comprehensive care by a multidisciplinary team could occur.

Changing attitudes towards older adults: Eliciting empathy through digital storytelling.

Ageist attitudes ingrained within societies lead to negative health outcomes for older generations. Face-to-face storytelling is one method that is effective in combating negative attitudes but may be limited in its reach. This pilot study aimed to explore if empathy evoked through digital storytelling influenced the attitudes about older adults held by younger people. The Listening Lounge exhibition displayed ten digital stories containing narratives from older adults. Surveys captured 85 young adult participants' responses following viewing a digital story. A mixed-methods approach explored participant attitudes of older adults and their experience of empathy. The results showed a statistically significant positive change in participants' attitudes post-viewing compared to pre-viewing the digital stories; regardless of initial positive attitudes toward older adults. Participants reported that attitudinal change occurred when the digital stories challenged their generalizations about older adults, and when they felt empathy toward the storyteller. Empathy was fostered by the digital story components, particularly tone of voice and story content, which enabled a deeper understanding of the older adult's experience. This pilot study provides foundational research into the use of digital storytelling and its ability to evoke empathy and positively influence attitudes. The findings from this study may inform replication of this research on a larger scale.

Development of skills and attitudes through telling life stories: Reflections on work integrated learning.

INTRODUCTION: Preparing occupational therapists for work in care facilities for older adults is critical. Life stories of residents have been used in care facilities for older adults to challenge negative stereotypes, in terms of sharing who they are as a person. Occupational therapy students' complete work-integrated learning by creating life stories, presenting opportunities for students to develop professional skills and meaningful relationships with older adults. METHODS: A qualitative methodology, immersion/crystallization guided the research process. Twenty students (44%) from one work integrated learning unit participated by submitting their written reflections on the experience of the life story project for analysis. RESULTS: Thematic analysis identified four primary themes: learning the craft of occupational therapy; identifying enablers of development; articulating barriers to professional and personal development; and focussing on the person. CONCLUSION: Life story work as work-integrated learning supports occupational therapy students to develop key professional skills and challenges stereotypical misconceptions. Supervision, support, and strong links between faculty and elder care providers are deemed important to achieve positive outcomes.

'You've Got No Support': The Experiences of Older Male Caregivers When Their Partner Enters Residential Care.

This qualitative phenomenological study explored the experiences and needs of eight older male caregivers after their partner entered full-time residential aged care within the past 36 months. Semi-structured interviews were conducted, thematically analyzed, and member-checked for accuracy. This transition was a time of significant turmoil for caregivers. Feelings of grief, loss, guilt, and regret were experienced, intertwined with feelings of relief and reassurance that their partner would be well cared for within the care facility. Following the transition, caregivers also began thinking about building a new life. Helpful supports identified were friends and family, carer support groups, counseling services, and community support organizations. Participants described a need for further emotional support, assistance in understanding their partner's prognosis, and information about the expenses involved in entering residential care. It was suggested there is also a role for professional advisors or peer mentors to support male caregivers through this transition. Tailoring programs and services with consideration of the needs and experiences of older male caregivers will ensure that policies and programs are more supportive and responsive.

The 'tipping point': Exploring the factors associated with entry into residential care for people with dementia in Western Australia.

BACKGROUND: People with dementia usually prefer to live in the community. Research is needed to identify the 'tipping point' for residential care entry and to highlight how people with dementia can be supported to remain at home as long as possible. Few previous studies have examined caregivers' perceptions and explanations for the reasons people with dementia need to enter residential care in Australia. AIM: To explore the factors contributing to people with dementia entering residential care in Perth, Western Australia, from the perspectives of informal carers and care staff. METHOD: This phenomenological study used purposive sampling to recruit informal and formal caregivers of people with dementia. Semi-structured in-depth interviews were conducted with 13 family carers and 11 home care staff. Data were thematically analysed to identify individual, carer and contextual factors that impact on residential care entry. FINDINGS: The majority of participants identified a combination of factors as the 'tipping point' to residential care entry; a few also identified the cause as a sudden event or specific issue. Factors identified included deterioration related to worsening cognition, changed behaviours and a decline in the performance of activities of daily living; co-occurring health conditions; safety concerns; carer no longer able to meet care needs; impact of providing support becoming too much for the informal carer; lack of family or social support and needing assistance from services that were unavailable or inaccessible. Factors assisting people with dementia to remain living at home longer were family and social support, formal services and dog ownership. CONCLUSION: This study identified individual, carer and contextual factors that contribute to people with dementia entering residential care in Australia. The 'tipping point' was recognised as when the needs of a person with dementia outweigh the capacity of their informal and formal carers, services and supports to care for them.

Mind the gap: Comparing perspectives of service providers to the needs of people with dementia living in the community.

INTRODUCTION: Research with West Australian people with dementia and their carers living in the community identified that they have a diverse range of needs. However, little is known about the needs of people with dementia and their carers from the perspectives of service providers who provide formal support. This study aimed to investigate the needs of people with dementia and their carers living in the community from the perspectives of service providers, and compare this to service recipients. METHOD: This interpretive descriptive study used focus groups to collect qualitative data from service providers (N = 10). Data were analysed using a hybrid inductive-deductive approach to compare the needs identified by service providers to those identified by people with dementia and their carers. RESULTS: Three major themes were identified: (i) services and supports required by people with dementia and their carers should be flexible, tailored, and equitable; (ii) building capacity to support carers and people with dementia; and (iii) systems designed to care were fragmented and difficult to navigate. Service providers prioritise needs that are limited to their current capacity to provide in contrast to the holistic needs of people with dementia and their carers. CONCLUSION: There was poor alignment between the perceived needs of people with dementia and their carers and the needs prioritised by service providers in the West Australian community. This gap may reduce the ability of services to effectively support people with dementia to remain living in the community.

Needs of people with dementia and their spousal carers: A study of those living in the community.

OBJECTIVE: To identify care and support needs, as reported by people with dementia and their spousal carers living in the community in metropolitan Western Australia. METHODS: An interpretive description approach was utilised. Semi-structured interviews were conducted with 10 dyads of spousal carers and people with dementia. Comparative analysis was used to develop themes regarding need, which were reviewed using two focus groups of spousal carers. RESULTS: Three major themes were developed through analysis of data from the interviews and were refined by the focus groups: (a) environmental enablers to support care; (b) strong caring relationships; and (c) adaptation of daily life roles. CONCLUSIONS: As dementia progresses, continued support to maintain participation in meaningful activity is needed. Strong caring relationships, knowledge and an understanding of dementia among health professionals, service providers and family members were key to maintaining support for the needs of people with dementia and their spousal carers.

Do services meet the needs of people with dementia and carers living in the community? A scoping review of the international literature.

BACKGROUND: Providing effective support to the increasing number of people with dementia to remain at home is a challenge for families, health professionals, service providers, and governments worldwide. The aim of this paper was to summarize and disseminate the current international research evidence on the met and unmet needs of people with dementia and their carers, to inform researchers and policy-makers. METHOD: A scoping review methodology was used to guide a search of studies published between 2004 and 2015 using specified search terms; 27 studies relevant to the aim were included. A constant comparison approach was used to thematically analyze the data. RESULTS: Holistic needs encompassing basic human survival, medical, financial, and social needs were experienced by people with dementia and carers, regardless of country or methodology used to collect data. A gap was identified frequently between what was needed and the supports that were received; this gap encompassed quantity, quality, and flexibility of services underpinned by service delivery models. CONCLUSION: The needs of people with dementia and their carers were diverse and not always effectively met by the services designed to support them. Recommendations are offered to service providers, policy-makers, and researchers to support more effective service provision tailored to meet the needs of people with dementia and their carers while they are living in the community.