Exploring hospital mealtime experiences of older inpatients, caregivers and staff using photovoice methods.

AIM: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co-design of new mealtime interventions. METHODS: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo-elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. RESULTS: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. CONCLUSIONS: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co-design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. PRACTICE IMPLICATIONS: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co-designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. IMPACT: What problem did the study address? Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require. Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings? Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re-prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal. There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement. Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact? The research provides a framework for multidisciplinary teams to begin co-designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. REPORTING METHOD: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript).

Apps, Avatars, and Robots: The Future of Mental Healthcare.

From artificial intelligence, predictive analytics and biometric sensors, to advanced robotics, virtual reality and mobile applications, rapid advances in technology are transforming the design, delivery and experience of mental healthcare. This paper explores the promise and pitfalls of three technologies (apps, avatars and robots) posed to transform mental health education, practice and research. By highlighting potential practical and ethical implications, this paper argues mental health professionals must actively engage in the co-design and development of new technologies, and reflexively reflect on whether the future will be a techno-utopia or dystopia.

Perceptions of climate change and trust in information providers in rural Australia.

Disagreement within the global science community about the certainty and causes of climate change has led the general public to question what to believe and whom to trust on matters related to this issue. This paper reports on qualitative research undertaken with Australian residents from two rural areas to explore their perceptions of climate change and trust in information providers. While overall, residents tended to agree that climate change is a reality, perceptions varied in terms of its causes and how best to address it. Politicians, government, and the media were described as untrustworthy sources of information about climate change, with independent scientists being the most trusted. The vested interests of information providers appeared to be a key reason for their distrust. The findings highlight the importance of improved transparency and consultation with the public when communicating information about climate change and related policies.

The Black Saturday bushfire disaster: found poetry for arts-based knowledge translation in disaster risk and climate change communication.

This research uses the arts-based research method of found poetry, the creation of poem-like prose from existing text, to share the lived experience of the 2009 Black Saturday bushfire disaster in Australia which killed 173 people. After outlining the processes, this paper applies found poetry to an existing text: Peg Fraser's book, Black Saturday. Five found poems are shared, each conveying a different element of the disaster experience: "Armageddon," "Go - GET OUT," "Bushfire Chook," "Resisting the Poetry Tree," and "Lucky". Compared to normal prose, there is an authentic and vulnerable vibrancy to the language of these found poems, which offer unexpected visceral insight into the bushfire experience - the fear, the heat, the confusion, the anger, and the loss. Poetry, which resonates and draws people in emotionally, has significant potential as arts-based knowledge translation in disaster risk and climate change communication.

Dementia Friendly Communities: Micro-processes and practices observed locally in Queensland Australia.

Having the choice to stay living in one's home and community for as long as possible is a desire of people living with dementia. Yet, for many, this is not a reality due to a lack of appropriate support, unsuitable housing and built environments, social exclusion, and stigma. The global movement called Dementia Friendly Communities aims to address such barriers and bring about positive change. At the local place-based level, Dementia Friendly Community initiatives are typically planned and implemented by committees, yet little is known about how they operate to enact Dementia Friendly Community principles. Using micro-ethnography and a case study approach, two Australian - Queensland Dementia Friendly Community committees and their activities were studied to better understand implementation at the local level. This involved 16 semi-structured interviews, participant observation and field notes identifying goals, approaches, and tensions. While both committees showed the capacity to raise awareness of issues impacting people living with dementia, there were substantial differences in the implementation of the key Dementia Friendly Community principle of inclusion of people living with dementia and carers. Key differences were the way people living with dementia were positioned and the part they were expected to play in committees, whether they were empowered and valued or tokenistically included yet not listened to. Three aspects of practice are central to more meaningful inclusion: engagement, power-sharing, and leadership. Local action groups directed and led by people living with dementia and their carers, with the support of key local people and organizations, help to progress Dementia Friendly Communities locally.

Transforming aged care with virtual reality: How organisational culture impacts technology adoption and sustained uptake.

OBJECTIVES: Virtual reality (VR) is not a common leisure activity in aged care, despite pilot studies demonstrating its value as a tool to combat inactivity and loneliness. This study investigated the organisational enablers and barriers to sustained uptake of VR among aged care staff and organisations, who may lack familiarity or confidence with the technology. METHODS: Creative methods were adopted to co-design and develop a VR implementation toolkit tailored specifically for aged care staff. Three aged care homes in South-East Queensland participated, with 15 residents and seven staff engaging in up to four VR sessions facilitated by the research team. Participant observation of the VR sessions was complemented by interviews with aged care staff and residents. RESULTS: Guided by Normalisation Process Theory, a reflexive thematic analysis identified four key themes: (1) Positively Appreciating the VR Experience, (2) Staff VR Champions and the Importance of Personal Use and Experimentation with VR, (3) Management Support and (4) Technical Challenges. CONCLUSIONS: Our results indicate benefits and challenges of VR use in aged care, offering valuable insights into the factors that can lead to the long-term success of VR-based leisure activities for aged care. Providing time and resources for a VR champion to experiment and learn about the technology is critical. The development of an online implementation toolkit, based on our learning from this project, also provides aged care stakeholders with the evidence-based resources needed to ensure the successful implementation of VR-based leisure programs.

Introducing virtual reality to older adults: A qualitative analysis of a co-design innovation with care staff.

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context - including care and relational resources - in ensuring their successful design and implementation.

Literary, Found and Research Poetry: New Approaches to Representations of Aging and Aged Care.

At a time when rapid population aging is producing an emphasis on questions of healthy aging in the public discourse, conditions such as dementia, physical, and other disabilities still too often remain taboo, and this is particularly true in relation to the confronting subjects of aged care, neglect, and failures of care provision. This article considers the transformative potential of 2 different but complementary forms of poetry-research poetry and lyric poetry-to break these silences and represent experiences across the physical and emotional spectrum of aging, including the perspectives of older people and their families whose experiences are neutral, negative, or even distressing, as well as challenge and counter existing negative stereotypes of aging in the public and literary realms. Neither research poetry nor lyric poetry is common in gerontological research; however, they offer the radical potential to offer insight into the lived realities of older people and their loved ones. Research poetry uses the direct words of older people, drawing on transcripts and found texts, and giving voice to people who otherwise would not be heard. Lyric poetry, by contrast, draws more heavily on literary techniques such as metaphor and direct address to evoke sensory and intimate experiences of aging and aged care. This paper presents 2 poems comparing and contrasting the respective processes and techniques of these different poetic forms to represent the imaginary, feared, and hoped-for futures of older people, including those in aged care.

'Kookaburras, kangaroos and my frilly-necked lizard': The value of wildlife, nature and companion animals for older community-dwelling Australians.

OBJECTIVE: With little research investigating older Australians' experience of companion animal (pet) ownership or wildlife encounters, this paper focuses on the value of animals in their lives. METHODS: Three online focus groups explored 103 older adults' lived experience of home and community, with this paper focused on interactions with animals-companion animals and wildlife. RESULTS: Most (60%) had at least one pet, which brought love and joy into their lives. Reflexive thematic analysis identified three themes: pets as family; challenges of pet ownership; and connection to everyday wildlife and nature. CONCLUSIONS: In addition to valuing companion animals (typically cats and dogs), this research is among the first to show that some older people also develop ongoing relationships with local Australian wildlife, such as kookaburras, kangaroos, lizards and birds, which raises the possibility that fostering connections with wildlife may enhance well-being.

Intergenerational living and learning: The value and risks of co-locating retirement villages on secondary school campuses - Evaluating the GrandSchools vision.

OBJECTIVES: GrandSchools is a new concept which co-locates retirement villages with secondary schools in one physical environment. Designed to enhance the health and well-being of both younger and older generations, this intergenerational-shared campus model promotes intergenerational inclusivity and active learning and living. In this paper, we explore stakeholder experts' perceptions of current opportunities and impediments to this proposed intergenerational learning and living model. METHODS: A qualitative study reporting on findings from an industry seminar (n = 50) and key interviews (n = 10) from stakeholders in education, health, higher education, the management and operation of retirement villages, and design firms. RESULTS: Three key themes summarised participants' assessment of the value, risks and what needs to change in order for intergenerational living and learning to become a reality. CONCLUSIONS: By bringing younger and older generations together in one shared campus location, GrandSchools is a novel idea to promote intergenerational inclusivity, enhancing the health and well-being of our whole community.

Informed use of patients' records on trusted health care services.

Health care is an information-intensive business. Sharing information in health care processes is a smart use of data enabling informed decision-making whilst ensuring. the privacy and security of patient information. To achieve this, we propose data encryption techniques embedded Information Accountability Framework (IAF) that establishes transitions of the technological concept, thus enabling understanding of shared responsibility, accessibility, and efficient cost effective informed decisions between health care professionals and patients. The IAF results reveal possibilities of efficient informed medical decision making and minimisation of medical errors. Of achieving this will require significant cultural changes and research synergies to ensure the sustainability, acceptability and durability of the IAF.

Where were you during the Queen's visit? Using photographs to facilitate collective storytelling, resident identity and positive care relationships in aged care.

OBJECTIVES: This paper explores the potential of photographs as a tool to facilitate storytelling, reminiscence and social connections for older residents living in residential aged care and caregiving staff. METHODS: Fourteen residents and three staff attended two sessions in which residents brought and shared personal photographs. Narrative enquiry was used to elicit individual and collective stories. RESULTS: Narrative analysis of residents' selected photographs overwhelmingly showed a younger self (n = 6), highlighting relationships (n = 6) and achievements (n = 6). Sharing images with other residents and staff enhanced new connections and personal communications. CONCLUSION: This research highlights the communicative value of photographs in aged care. Residents were able to reflect upon shared personal and global events-from the role of pets in their lives to public events such as the Queen's visit to Australia-and through discussion build a collective shared narrative. This enabled new connections and sharing of stories between staff and residents.

My home in later life: A phenomenographic study of older adults' experience of home.

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults. This paper considers the breadth of home environments experienced by diverse older Australians and highlights the varied ways they use and think about their homes. Data from three national online focus groups (n1 = 33, n2 = 37, n3 = 33) with people aged 50-92 were analysed using phenomenographic approaches to explore the different ways older adults perceived their home environments, resulting in four hierarchical conceptions. People displayed vastly different lifetime housing pathways (Clapham, 2005), leading to diverse perceptions about the place and experience of home in their later lives. In assessing the suitability of their housing, older people considered a large number of household members: current, expected or desired co-residents; transitory, short, medium and long-term residents; near and extended family, friends and dependents. This has important implications for policy and design responses on older adult's homes, which are typically focussed on occupancy by one or two individuals. To avoid assumptions about household makeup and usage based solely on the chronological age of residents, the perspective of older adults must be embraced in designing their future housing.

Photovoice in aged care: What do residents value?

OBJECTIVES: This paper visually explores older aged care resident's day-to-day lived experience, as well as providing a brief introduction to the participatory documentary photography method of photovoice. METHODS: Ten residents from one Australian residential aged care facility collaborated with researchers and care staff to photograph, reflect on and share their lives. Photographs were shortlisted in individual and group discussions. RESULTS: Residents' photographs and narratives provide a visual understanding of what they value. Photographs captured three core themes: the restorative joy of nature (frangipanis); active engagement through leisure activities (football); and the value of social interactions and connections, especially with fellow residents and staff (friendship). CONCLUSIONS: As old age and aged care remain virtually invisible within popular visual culture, this research highlights the communicative value of participatory photography for challenging stereotypes, as well as the opportunities, challenges and value of visual methods with this cohort.

"We expect seniors to be able to prepare and recover from a cyclone as well as younger members of this community": Emergency Management's Expectations of Older Adults Residing in Aging, Remote Hamlets on Australia's Cyclone-Prone Coastline.

OBJECTIVE: To investigate the extent to which older residents feel they can remain "self-reliant" during future natural disasters and to compare the findings with the viewpoints of local policy-makers and with those charged with caring for the elderly both on a day-to-day basis and in times of crisis. METHODS: This study used an array of non-probability snowballing techniques to seek the participation of senior citizens over the age of 65 years, emergency services officers, community health carers, and local government disaster managers located in aging, remote, coastal Australian communities vulnerable to cyclones and storm surges. All respondents participated in either a face-to-face personal interview or a focus group, with senior citizens also completing a self-administered questionnaire. RESULTS: This research found a discrepancy between policy expectations and the experiences of both the elderly and those who care for them, as well as a lack of understanding with regard to the term "self-reliant." CONCLUSIONS: These results highlight the inability of older adults in aging, remote, coastal Australian communities to remain "self-reliant" in the future, impacting both disaster management policies and the future capacity of these communities to remain resilient. (Disaster Med Public Health Preparedness. 2018;12:14-18).

Understanding Older Adults' Resilience During the Brisbane Floods: Social Capital, Life Experience, and Optimism.

OBJECTIVE: The purpose of this study was to explore how social capital or the impact of life and previous disaster experience facilitated resilience in older adults who experienced the 2011 and 2013 floods in Brisbane, Australia. METHODS: Data were drawn from in-depth interviews of 10 older adults from Brisbane who were evacuated in both the 2011 and 2013 floods. A combined qualitative approach drawing from the methods of constructivist grounded theory and narrative inquiry was applied and the data were analyzed by using (inductive) line-by-line and axial coding. RESULTS: The narratives of the older adults revealed a strong theme of resilience linked to social capital (bonding, bridging, and linking) and previous disaster experience. The results reflected the changing face of disaster management strategies and sources of social capital. CONCLUSIONS: Changes in disaster management polices (toward self-reliance) and more formalized sources of social capital highlight the need to build strong and healthy resilient communities that are capable of positively recovering from natural disasters. The results from this research emphasize the importance of initiatives that enhance social cohesion, trust, and social capital within local communities. (Disaster Med Public Health Preparedness. 2017;11:72-79).

The disaster flood experience: Older people's poetic voices of resilience.

This paper explores the experiences of older community-dwelling Australians evacuated from their homes during the 2011 and 2013 Queensland floods, applying the novel creative methodology of poetic inquiry as an analysis and interpretative tool. As well as exploring how older adults managed during a natural disaster, the paper documents the process and potential of poetic inquiry in gerontological research. The first and second poems highlight the different social resources older people have to draw on in their lives, especially during a crisis. Poem 1 ("Nobody came to help me") illustrates how one older resident felt all alone during the flood, whereas Poem 2 ("They came from everywhere"), Poem 3 ("The Girls") and Poem 5 ("Man in Blue Shirt") shows how supported--from both family and the wider community--other older residents felt. Poem 4 ("I can't swim") highlights one participant's fear as the water rises. To date, few studies have explicitly explored older adult's disaster experience, with this paper the first to utilise a poetic lens. We argue that poetic presentation enhances understanding of older residents' unique experiences during a disaster, and may better engage a wider audience of policy-makers, practitioners, the general community and older people themselves in discussion about, and reflection on, the impact and experience of disasters.

Mobility and Active Ageing in Suburban Environments: Findings from In-Depth Interviews and Person-Based GPS Tracking.

Background. Governments face a significant challenge to ensure that community environments meet the mobility needs of an ageing population. Therefore, it is critical to investigate the effect of suburban environments on the choice of transportation and its relation to participation and active ageing. Objective. This research explores if and how suburban environments impact older people's mobility and their use of different modes of transport. Methods. Data derived from GPS tracking, travel diaries, brief questionnaires, and semistructured interviews were gathered from thirteen people aged from 56 to 87 years, living in low-density suburban environments in Brisbane, Australia. Results. The suburban environment influenced the choice of transportation and out-of-home mobility. Both walkability and public transportation (access and usability) impact older people's transportation choices. Impracticality of active and public transportation within suburban environments creates car dependency in older age. Conclusion. Suburban environments often create barriers to mobility, which impedes older people's engagement in their wider community and ability to actively age in place. Further research is needed to develop approaches towards age-friendly suburban environments which will encourage older people to remain active and engaged in older age.

Transportation behaviours of older adults: an investigation into car dependency in urban Australia.

AIM: Increased car dependency among Australia's ageing population may result in increased social isolation and other health impacts associated with the cessation of driving. While public transport represents an alternative to car usage, patronage remains low among older cohorts. This study investigates the facilitators and barriers to public transport patronage and the nature of car dependence among older Australians. METHODS: Data were gathered from a sample of 24 adults (mean age = 70 years) through a combination of quantitative (remote behavioural observation) and qualitative (interviews) investigation. RESULTS: Findings suggest that relative convenience, affordability and health/mobility may dictate transport mode choices. The car is considered more convenient for the majority of suburban trips irrespective of the availability of public transport. CONCLUSION: Policy attention should focus on providing better education and information regarding driving cessation and addressing older age specific social aspects of public transport including health and mobility issues.

Grandparenting a child with a disability: an emotional rollercoaster.

OBJECTIVES: As our knowledge about the experiences of grandparents when their grandchild has a disability is extremely limited, the purpose of this research was to explore the emotional journey of Australian grandparents. METHOD: This qualitative research utilised purposive sampling and semi-structured in-depth interviews to explore the experiences of 22 Australian grandparents, whose grandchild had been diagnosed with a disability. RESULTS: Three key themes characterized grandparent's emotional journey: adjusting (the transition from anger to acceptance), the 'double grief' (sadness about what might have been for both their child and grandchild) and pride in family (pride in family's ability to adjust to the challenges of the situation). CONCLUSION: As the first Australian study to explore the experiences of grandparents when their grandchild has a disability, the research provides important new knowledge about the emotional journey for grandparents. Unlike overseas research, Australian grandparents view themselves as being there to support their own children, rather than 'holding the family together'. The findings will provide current policy debates about the role of grandparents and highlight the importance of support services that help facilitate grandparent's role within their family.