The effect of holiday haemodialysis treatments on patient mood, adverse symptoms and subjective wellbeing using the Big Red Kidney Bus.

BACKGROUND AND AIMS: People with end-stage kidney disease receiving haemodialysis are restricted to holidays where dialysis services are readily available. Holiday dialysis in regional, rural and remote areas is particularly challenging. The aims of this study were to evaluate the wellbeing of those who received dialysis in a holiday haemodialysis bus and to measure patient well-being with that of a comparable cohort of haemodialysis patients. METHODS: A three machine haemodialysis bus, the Big Red Kidney Bus, was built to enable people, their families and carers to take holidays across a range of tourist destinations in Victoria, Australia. Measures included pre-post subjective well-being, dialysis symptoms and mood questionnaires complemented by post semi-structured telephone interviews. RESULTS: Participating holidaymakers were positive about the haemodialysis bus service and the standard of care experienced. They reported decreased dialysis side effects of fatigue, muscle cramp and dry skin. The overall number of reported symptoms decreased, and the perceived level of bother associated with symptoms also decreased. No changes in subjective well-being and mood were detected. Mean Personal Wellbeing Index scores were significantly higher than in a comparative haemodialysis sample. CONCLUSION: The Big Red Kidney Bus provided a safe and feasible holiday dialysis service. Holidaymakers' well-being was reflected by the decreased dialysis patient side effects.

Healthy ageing.

BACKGROUND: The increasing number of people reaching their 80s and 90s has triggered multidisciplinary consideration of how to address and capitalise on the longevity phenomenon. OBJECTIVE: The aim of this article is to provide an overview of ways in which clinicians can work with older patients to optimise their health and wellbeing during the later years of life. DISCUSSION: Old age need not be burdensome to individuals or society. There is strong evidence to support the management of many chronic diseases presenting in - or extending into - old age. General practice will need to adapt to the demographic challenges of an ageing population by targeting conditions that impede people from contributing to family and societal life. General practitioners (GPs) will also need to adapt to the changing expectations of, and from, older patients across the upcoming generations.

The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study.

AIM: To explore mobility care as provided by care staff in nursing homes. BACKGROUND: Care staff regularly assist residents with their mobility. Nurses are increasingly reliant on such staff to provide safe and quality mobility care. However, the nature of care staff decision-making when providing assistance has not been fully addressed in the literature. DESIGN: A focused ethnography. METHOD: The study was conducted in four nursing homes in Melbourne, Australia. Non-participant observations of residents and staff in 2011. Focus groups with 18 nurses, care and lifestyle staff were conducted at three facilities in 2012. Thematic analysis was employed for focus groups and content analysis for observation data. Cognitive Continuum Theory and the notion of 'situation awareness' assisted data interpretation. FINDINGS: Decision-making during mobility care emerged as a major theme. Using Cognitive Continuum Theory as a guide, nursing home staff's decision-making was described as ranging from system-aided, through resident- and peer-aided, to reflective and intuitive. Staff seemed aware of the need for resident-aided decision-making consistent with person-centred care. Habitual mobility care based on shared mental models occurred. It was noted that levels of situation awareness may vary among staff. CONCLUSION: Care staff may benefit from support via collaborative and reflective practice to develop decision-making skills, situation awareness and person-centred mobility care. Further research is required to explore the connection between staff's skills in mobility care and their decision-making competence as well as how these factors link to quality mobility care.

Breakeven, cost benefit, cost effectiveness, and willingness to pay for web-based versus face-to-face education delivery for health professionals.

BACKGROUND: The introduction of Web-based education and open universities has seen an increase in access to professional development within the health professional education marketplace. Economic efficiencies of Web-based education and traditional face-to-face educational approaches have not been compared under randomized controlled trial conditions. OBJECTIVE: To compare costs and effects of Web-based and face-to-face short courses in falls prevention education for health professionals. METHODS: We designed two short courses to improve the clinical performance of health professionals in exercise prescription for falls prevention. One was developed for delivery in face-to-face mode and the other for online learning. Data were collected on learning outcomes including participation, satisfaction, knowledge acquisition, and change in practice, and combined with costs, savings, and benefits, to enable a break-even analysis from the perspective of the provider, cost-effectiveness analysis from the perspective of the health service, and cost-benefit analysis from the perspective of the participant. RESULTS: Face-to-face and Web-based delivery modalities produced comparable outcomes for participation, satisfaction, knowledge acquisition, and change in practice. Break-even analysis identified the Web-based educational approach to be robustly superior to face-to-face education, requiring a lower number of enrollments for the program to reach its break-even point. Cost-effectiveness analyses from the perspective of the health service and cost-benefit analysis from the perspective of the participant favored face-to-face education, although the outcomes were contingent on the sensitivity analysis applied (eg, the fee structure used). CONCLUSIONS: The Web-based educational approach was clearly more efficient from the perspective of the education provider. In the presence of relatively equivocal results for comparisons from other stakeholder perspectives, it is likely that providers would prefer to deliver education via a Web-based medium. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN): 12610000135011; http://www.anzctr.org.au/trial_view.aspx?id=335135 (Archived by WebCite at http://www.webcitation.org/668POww4L).

Fitness to drive - GP perspectives of assessing older and functionally impaired patients.

BACKGROUND: General practitioners have expressed concern about their ability to assess patients' driving fitness. This study explores GP perspectives regarding assessing fitness to drive in older and functionally impaired patients. METHODS: We held face-to-face interviews with seven metropolitan GPs and a focus group with nine rural GPs. Data were analysed using thematic analysis. RESULTS: General practitioners were unsure whether they or driving authorities should have responsibility for assessing patients' fitness to drive; recognised that driving is important for maintaining independence; described referral to an occupational therapist as useful, and expressed concern about the lack of access to alternative forms of transport and also about privacy issues. Opinion was divided about the merits of the VicRoads Medical Report Form and the usefulness of the Austroads guide. DISCUSSION: This qualitative study suggests that some GPs may find assessing fitness to drive to be challenging and problematic in general practice. Further resources and education could assist these GPs to increase their confidence and competence in assessing a patient's fitness to drive.

Cardiovascular disease and death associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA).

BACKGROUND: Cardiovascular disease (CVD) and death may be associated with depression and antidepressants, but published findings remain equivocal. The authors aimed to determine the risk of CVD incidence and death associated with several classifications of depression. METHODS: A prospective cohort study was conducted (1994-2006) in a regionally representative sample of 1000 non-institutionalised older Australians age 65+ years (47% men). Endpoints were non-fatal CVD incidence and death over 10 and 12-years, respectively. Depression incidence was assessed at 2-years. Depression related predictors were defined by symptoms (Psychogeriatric Assessment Scales, depression scale) and/or antidepressants to determine independent and/or joint effects on endpoints. Cox regressions determined unadjusted and multiple-adjusted (for significant covariates) hazard ratios (HR). RESULTS: Baseline response rate was 70.3%. Aggregate dropout rate was approximately 24% for survivors at biennial follow-ups, but death status was ascertained for all participants. Several classifications of depression predicted death in unadjusted analyses (39-60% >1), but effects disappeared in multiple-adjusted analyses (in which all HRs became <1 and non-significant). Depression related predictors were thus not associated with CVD incidence; or death after accounting for confounding mostly by CVD, diabetes and poor functional health covariates. Prevalent arthritis, respiratory disease and daily pain were predictors (P < 0.05) of depression incidence. CONCLUSIONS: Depression related predictors were not independently associated with CVD incidence or death in older people. Antidepressants were not associated with CVD or premature death, accounting for whether participants' remained symptomatic or not. Depression co-occurs with and might be partly caused by chronic disease and poor functional health.

Effectiveness of Web-based versus face-to-face delivery of education in prescription of falls-prevention exercise to health professionals: randomized trial.

BACKGROUND: Exercise is an effective intervention for the prevention of falls; however, some forms of exercises have been shown to be more effective than others. There is a need to identify effective and efficient methods for training health professionals in exercise prescription for falls prevention. OBJECTIVE: The objective of our study was to compare two approaches for training clinicians in prescribing exercise to prevent falls. METHODS: This study was a head-to-head randomized trial design. Participants were physiotherapists, occupational therapists, nurses, and exercise physiologists working in Victoria, Australia. Participants randomly assigned to one group received face-to-face traditional education using a 1-day seminar format with additional video and written support material. The other participants received Web-based delivery of the equivalent educational material over a 4-week period with remote tutor facilitation. Outcomes were measured across levels 1 to 3 of Kirkpatrick's hierarchy of educational outcomes, including attendance, adherence, satisfaction, knowledge, and self-reported change in practice. RESULTS: Of the 166 participants initially recruited, there was gradual attrition from randomization to participation in the trial (n = 67 Web-based, n = 68 face-to-face), to completion of the educational content (n = 44 Web-based, n = 50 face-to-face), to completion of the posteducation examinations (n = 43 Web-based, n = 49 face-to-face). Participant satisfaction was not significantly different between the intervention groups: mean (SD) satisfaction with content and relevance of course material was 25.73 (5.14) in the Web-based and 26.11 (5.41) in the face-to-face group; linear regression P = .75; and mean (SD) satisfaction with course facilitation and support was 11.61 (2.00) in the Web-based and 12.08 (1.54) in the face-to-face group; linear regression P = .25. Knowledge test results were comparable between the Web-based and face-to-face groups: median (interquartile range [IQR]) for the Web-based group was 90.00 (70.89-90.67) and for the face-to-face group was 80.56 (70.67-90.00); rank sum P = .07. The median (IQR) scores for the exercise assignment were also comparable: Web-based, 78.6 (68.5-85.1), and face-to-face, 78.6 (70.8-86.9); rank sum P = .61. No significant difference was identified in Kirkpatrick's hierarchy domain change in practice: mean (SD) Web-based, 21.75 (4.40), and face-to-face, 21.88 (3.24); linear regression P = .89. CONCLUSION: Web-based and face-to-face approaches to the delivery of education to clinicians on the subject of exercise prescription for falls prevention produced equivalent results in all of the outcome domains. Practical considerations should arguably drive choice of delivery method, which may favor Web-based provision for its ability to overcome access issues for health professionals in regional and remote settings. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number: ACTRN12610000135011; http://www.anzctr.org.au/ACTRN12610000135011.aspx (Archived by WebCite at http://www.webcitation.org/63MicDjPV).

The impact of manual handling on nursing home resident mobility during transfers on and off furniture: a systematic review.

This systematic review aimed to investigate the impact of staff manual handling practices and physical training interventions on nursing home residents' ability to transfer on and off furniture. Key words and subject headings were used to search databases for English language studies published after 1994. Ten studies met the inclusion criteria. Studies of physical activity interventions indicated that physical activity training will benefit residents' transfer ability. One study examined the effect of a safe manual handling program on resident quality care outcomes. Further research is required into the nature and impact of the assistance provided by staff to residents during transfers. Innovative and sustainable approaches to safe manual handling that promote resident mobility are needed.

Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA).

OBJECTIVE: Diabetes may be associated with depression and antidepressant medication (ADM) use, but published findings remain equivocal. The authors' aimed to determine the risk of diabetes incidence associated with baseline depression exposures (symptoms and/or ADM use). METHODS: A prospective cohort study was conducted in a regionally representative sample of non-institutionalised older Australian people (N = 1000, aged 65 + year), who were followed up biennially between 1994 and 2004 (attrition was approximately 24%). Analyses excluded participants for prevalent diabetes at baseline, determined by self-report or specific medications. Diabetes incidence was ascertained by first self-report at any follow-up wave. Depression exposures (baseline predictors) were defined by the Psychogeriatric Assessment Scales (PAS) depression scale and ADM use, and classified as: (1) 'symptomatic' (PAS score 5+); (2) 'ADM use'; (3) 'symptomatic or ADM use'; (4) 'symptomatic and no ADM use'; (5) 'asymptomatic (PAS score <5) and ADM use' and (6) 'symptomatic and ADM use'. Covariates were demographic, lifestyle, functional health and chronic disease factors. Cox regressions were used to determined hazard ratios with 95% confidence intervals (HR [95% CI]) for diabetes incidence according to depression exposures, adjusted for significant covariates. RESULTS: Baseline response rate was 70.3%. Depression predictors of diabetes incidence were 'symptomatic' (2.29 [1.28,4.10]), 'symptomatic or ADM use' (2.13 [1.32,3.44]) and 'symptomatic and no ADM use' (2.38 [1.28,4.45]), after adjustment for significant covariates. Being asymptomatic was not a protective factor among those prescribed antidepressants. CONCLUSIONS: Older people with depressive symptoms are at least twice more likely to develop diabetes than those without depressive symptoms, regardless of antidepressants.

Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: a longitudinal study.

BACKGROUND: Stroke research and rehabilitation has traditionally focussed on the physical impact of a stroke, with less attention given to associated psychosocial factors. This study aimed to identify psychosocial predictors of health-related quality of life (HRQoL) in chronic stroke survivors and examine differences between nondepressed and depressed participants. METHOD: Participants were recruited primarily from six major metropolitan hospital databases. A total of 135 first-ever stroke survivors aged 25-96 years who were 6 to 24 months post stroke and community-dwelling were studied longitudinally over 6 months. HRQoL and psychosocial factors (optimism, self-esteem, perceived control, depressive status, and social support) were measured at baseline, 10 weeks, and 6 months. RESULTS: Psychosocial factors were significantly associated with HRQoL at every time point, accounting for 33% to 53% of the variance after controlling for demographic and clinical characteristics. At least 26% of all participants reported clinically significant depressive symptoms throughout the study. Compared to nondepressed participants, depressed participants had significantly poorer scores for HRQoL, social support, optimism, self-esteem, perceived control, and physical functioning. There were improvements in participants' physical health, social participation, depressive status, and optimism over the course of the study. CONCLUSION: These findings highlight the important role that psychosocial factors play in chronic stroke survivors' HRQoL and have implications for stroke rehabilitation programs: rehabilitation that targets poststroke depression and psychosocial adjustment to stroke has the potential to improve HRQoL for chronic stroke survivors, independent of functional impairment.

Are general practice networks 'ready' for clinical data management?

BACKGROUND: Australian general practice networks (GPN) are required to report on national performance indicators under the Australian Government Department of Health and Ageing's National Quality Performance System (NQPS). OBJECTIVE: To investigate the extent to which Victorian GPN are 'ready' to manage clinical data from general practice for reporting under the NQPS. METHODS: A qualitative study using semistructured interviews from a purposive sample of chief executive officers from urban and rural Victorian GPN included those either participating or not participating in the Australian Primary Care Collaboratives Program. RESULTS: Australian Primary Care Collaborative experienced DGP have developed the range of skills and knowledge to undertake clinical data management for quality improvement and NQPS reporting. Trust by local general practices for the provision of clinical data has been developed through the demonstration of benefits to practices and improved patient health. General practice networks without Australian Primary Care Collaborative experience have a range of concerns about clinical data management for NQPS reporting, such as gaining cooperation from their practices, handling privacy issues and finding appropriately skilled staff. CONCLUSION: Victorian GPN involved in the Australian Primary Care Collaborative appear more 'ready' than GPN without this experience to undertake clinical data management for reporting purposes on the national performance indicators under the NQPS.

Predictors of physical activity behavior in older community-dwelling adults.

OBJECTIVES: Physical activity is important health behavior for functional independence and quality of life in older people. This study examined factors that influence older people's engagement in physical activity. METHODS: Data were analyzed from the first wave of the Melbourne Longitudinal Studies on Health Ageing program survey of 1000 persons aged 65 yrs and older living in noninstitutional settings in Melbourne, Australia. RESULTS: Most people reported doing some physical activity in the previous 2 wks. Agreement that there was much older people can do to keep healthy influenced reported physical activity behaviour. Most respondents believed they did enough activity. Age, educational status, and income were also correlates of physical activity behavior. The predictors of energetic physical activity behavior (defined as engaging in both energetic and light activities in the past fortnight) were age, education, personal security score, and positive health beliefs, independent of health status. DISCUSSION: These predictors have implications for planning and tailoring delivery of health promotion interventions.

Rural carers online: a feasibility study.

OBJECTIVE: To test the feasibility (for a potential randomised controlled trial) of a computer intervention for improving social interaction and promoting the mental health of rural carers. DESIGN: The study combined pre- and post-intervention measures with interviews to determine the feasibility of the intervention and the acceptability of the study design to participants. The intervention consisted of providing 14 rural carers with computers and a 4-week training program on basic computer skills, using email and the Internet. SETTING: The study was conducted in a rural community setting. PARTICIPANTS: The carers were 12 women and two men, aged from 50 to 81 years, with an average of 65.5 years. MAIN OUTCOME MEASURES: Measures of social isolation (UCLA Loneliness Scale), depression (Geriatric Depression Scale), carer burden (Zarit Burden Interview) and computer confidence were taken at baseline and at a 3-month follow-up. Interviews were completed at follow-up to discuss outcomes of the study. A focus group discussion was conducted with 11 participants to discuss the study and resolve computer issues. RESULTS: Most carers reported increased confidence in email and Internet use. There was improvement for most participants in depressive symptoms and social isolation, but little change in carer burden. Participants identified many social benefits associated with the computer intervention, such as intergenerational connection, community building, skills and confidence and preparation for the future. CONCLUSION: The intervention was found to be practical and acceptable for a group of older carers. It was concluded that it would be feasible to conduct a large randomised controlled trial of the intervention.

A snapshot of the prevalence of physical activity amongst older, community dwelling people in Victoria, Australia: patterns across the 'young-old' and 'old-old'.

BACKGROUND: Physical activity has a range of health benefits for older people. The aim of this study was to determine physical activity prevalence and attitudes amongst respondents to a trial screening survey. METHODS: A cross-sectional survey was conducted. Subjects were community dwelling older people aged > or = 65 years, recruited via general practices in Victoria, Australia. Participants completed a mailed screening tool containing the Geriatric Depression Scale, the Active Australia survey and the Physical Activity Readiness Questionnaire. RESULTS: Of 330 participants, 20% were > or = 80 years. Activity levels were similar to those reported in population studies. The proportion of participants reporting physical activity was greatest for the walking category, but decreased across categories of physical activity intensity. The oldest-old were represented at all physical activity intensity levels. Over half reported exercising at levels that, according to national criteria are, 'sufficient to attain health benefit'. A greater proportion of participants aged 85 years and older were unaware of key physical activity messages, compared to participants aged less than 85 years. CONCLUSION: Most population surveys do not provide details of older people across age categories. This survey provided information on the physical activity of people up to 91 years old. Physical activity promotion strategies should be tailored according to the individual's needs. A better understanding of the determinants of physical activity behaviour amongst older sub-groups is needed to tailor and target physical activity promotion strategies and programs to maximise physical activity related health outcomes for older people.

Screening for depression in older district nursing clients: feasibility study.

Depression is a common condition among older district nursing clients. This two-cycle feasibility study trialled a process for depression screening by using the 15-item Geriatric Depression Scale (GDS) with a sample of older clients in an Australian district nursing organization. An education session about depression and use of the GDS preceded the screening process. The trial found that a number of barriers existed among participant nurses regarding screening for depression, although generally they acknowledged depression as a common problem among older clients and most believed that they potentially had a important role in the identification and support of clients with this condition. Lack of knowledge emerged as a major constraint, as did uneasiness about entering the mental health area, with some reluctance to use the GDS because of the type of questions included and not wanting to be intrusive regarding the 'emotional matters' of clients. Recommendations are offered about screening for depression with this client population.