Experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries: a systematic review and meta-synthesis.

BACKGROUND: The cultural and religious beliefs and values of family caregivers of people with dementia have a profound impact on the use of dementia care services in high-income countries. Yet, little is known about how caregivers of people with dementia from a Muslim migrant background in high-income countries perceive their caregiving journey. AIM: To synthesise findings from rigorous qualitative studies on the experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries. METHODS: Meta-ethnography of qualitative studies was applied to address the aim. Five databases including MEDLINE, CINHAL, PsycINFO, Web of Science and Scopus were searched. Inclusion criteria were qualitative or mixed study design studies on family caregivers of people with dementia from a Muslim migrant background in a home care setting in high-income countries. Studies were excluded if they used a quantitative research design, were not written in English and were not original studies. FINDINGS: In total 17 articles met the inclusion criteria and were included in the study. Meta-synthesis of the data revealed three themes from the life course intersectionality perspective: caregiving as both positive and negative experiences; factors affecting caregivers' experiences; and coping strategies used by caregivers. CONCLUSION: Caregivers of people with dementia from a Muslim migrant background living in high-income countries have both positive and negative caregiving experiences. However, dementia care services were not tailored to address their care needs and expectations arising from their religious and cultural beliefs.

Allied health professionals' contribution to care at end of life in aged care settings.

BACKGROUND: The Australian population is aging, and the proportion of older Australians will continue to grow over the coming decades. However, there is a lack of research published on the specific roles and responsibilities of allied health professionals (AHPs) providing palliative care within an aged care context. Understanding the roles and needs of AHPs providing care during the last months of life in the community and aged care facilities could contribute to workforce planning, targeted information and improved care. METHODS: In total, 108 eSurveys were collected between November 2019 to May 2020 from three allied health professions working in government-funded aged care; the majority of these being in residential aged care. Descriptive data are reported on the provision of care in key palliative care domains, care settings and practice activity. RESULTS: Nearly all respondents reported they had worked with older Australians who had palliative care needs. However, over one-third of respondents reported low levels of confidence in supporting clients or residents with palliative care needs. The majority indicated they would benefit from additional education and training and support in palliative care. CONCLUSIONS: This study investigated the role of the allied health workforce in contributing to the care of older Australians at the end of life. It has also demonstrated that there are gaps in practice activity and work role that must be addressed to ensure this workforce can support older people with palliative care needs in receipt of aged care services.

Comparisons on factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes: a qualitative study.

BACKGROUND: Studies revealed that supporting residents fulfilling self-determination is positively associated with their health, wellbeing and quality of life. Cross-cultural care poses significant challenges for nursing home residents to fulfil their self-determination in control of own care and maintaining meaningful connections with others. The aim of the study was to compare factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes. METHODS: A qualitative descriptive approach was applied to the study. Culturally competent care and person-centred care were employed as guiding frameworks. Individual interviews or a focus group with residents and family members were conducted to collect data. RESULTS: In total, 29 participants participated in the study. Three main themes were identified: communicating needs and preferences; mastering own care; and maintaining meaningful relationships. Each theme includes sub-themes that detail similarities and differences of factors affecting residents fulfilling self-determination in the two type nursing homes. Findings indicate that residents from both types of nursing homes experienced challenges to communicate their care needs and preferences in daily care activities. Moreover, residents or their representatives from both types of nursing homes demonstrated motivation and competence to master residents' care based on their individual preferences, but also perceived that their motivation was not always supported by staff or the nursing home environment. Residents' competence in mastering their care activities in ethno-specific nursing homes was based on the condition that they were given opportunities to use a language of choice in communication and staff and the nursing home demonstrated culturally competent care for them. In addition, ethno-specific nursing homes showed more recourse to support residents to maintain meaningful relationships with peers and others. CONCLUSIONS: Culturally competent care created by staff, nursing homes and the aged care system is a basic condition for residents from ethnic minority groups to fulfil self-determination. In addition, person-centred care approach enables residents to optimise self-determination.

Staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes.

AIMS AND OBJECTIVES: To explore and compare staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes. BACKGROUND: Staff and residents in ethno-specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio-demographic change poses significant challenges for staff to support resident self-determination of their own care. In-depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse-led nursing home care settings. METHOD: A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno-specific nursing homes and a mainstream nursing home in Australia between March-September 2020. The study report followed the COREQ checklist. RESULTS: Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno-specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno-specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home. CONCLUSIONS: Staff in ethno-specific nursing homes experience more challenges in supporting resident self-determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home. RELEVANCE TO CLINICAL PRACTICE: Findings provide new insights into challenges and practical solutions in supporting residents to self-determine their own care in cross-cultural aged care. PATIENT OR PUBLIC CONTRIBUTION: This study was co-designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study.

Balance provocation tests identify near falls in healthy community adults aged 40-75 years; an observational study.

BACKGROUND: Near falls, such as stumbles or slips without falling to the ground, are more common than falls and often lead to a fall. PURPOSE: The objective of this study was to investigate which balance tests differentiate near fallers from fallers and non-fallers. METHODS: This cross-sectional, observational study assessed balance in healthy community dwelling adults aged 40-75 years. Participants reported falls and near falls in the previous 6 months. Balance testing was completed in the local community for static (i.e. feet together and single-leg stance) and dynamic balance (i.e. tandem walk, Functional Movement Screen hurdle step and lunge). Between-group comparative analysis of pass-fail for each balance test was undertaken. RESULTS: Of 627 participants, there were 99 fallers (15.8%), 121 near fallers (19.3%) and 407 non-fallers (64.9%). Near fallers were twice as likely as non-fallers to fail single-leg stance eyes (OR 2.7, 95% CI 1.5-4.9), five tandem steps (OR 2.5, 95% CI 1.5-5.7), hurdle step (OR 2.9, 95% CI 1.4-5.8), and lunge (OR 2.5. 95% CI 1.5-4.1). The predictive capacity differentiates near fallers with a sensitivity of 73.3%. DISCUSSION: A new battery of tests assessing static and dynamic balance identifies near fallers in seemingly healthy, community dwelling middle- and young-older-aged adults.

Avoiding false negatives: are some auditory hallucinations an evolved design flaw?

BACKGROUND: This paper draws on cognitive psychology research and clinical observation to propose a model for the formation of auditory hallucinations that are located externally, and experienced in noisy environments. METHOD: This model highlights a series of cognitive processes that may make an individual prone to detecting false positives, i.e. believing they have heard something that is absent. A case study is used to illustrate the model. RESULTS: It is suggested that the false positives may be a by-product of a perceptual system that has evolved to reduce false negatives in conditions of threat. The term hypervigilance hallucination is proposed for this type of experience. CONCLUSION: The clinical implications of the model are discussed.

Indoor air quality in homes of patients with chronic obstructive pulmonary disease.

RATIONALE: Outdoor air quality is associated with respiratory morbidity and mortality. Less is known of the relationship of indoor air quality to respiratory health of groups vulnerable to outdoor air, such as those with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To investigate among patients with COPD the association of health status with indoor air quality in their homes. METHODS: Observational study of indoor environmental characteristics of homes of 148 patients with severe COPD in North East Scotland. MEASUREMENTS AND MAIN RESULTS: Airborne living room levels of particulate matter with a diameter of 2.5 microm or less (PM(2.5)) (microg/m(3)) were measured over 8 to 14 hours using DustTrak monitors. Nitrogen dioxide exposure (ppb) in living rooms was measured over 1 week. Endotoxin (EU [endotoxin units]/mg) in living room dust was measured. Health status of participants was assessed by the St. George's Respiratory Health Questionnaire (symptoms, activity limitation, and disease impact). The mean age of participants was 69 years. Approximately 45% were male, 39% were smokers, and 49% lived in smoking households. Average indoor PM(2.5) levels were 18 mug/m(3), nitrogen dioxide was 7.8 ppb, and endotoxin levels were 95.8 EU/mg of dust. PM(2.5) was significantly higher in smoking households (P < 0.001) and was associated with higher levels of endotoxin and NO(2). PM(2.5) was significantly associated with increased symptom burden (P < 0.01), with greater effect for current smokers. Endotoxin and nitrogen dioxide exposure were not related to health status. CONCLUSIONS: Higher levels of PM(2.5) are associated with worse health status of these patients with severe COPD. Indoor levels of PM(2.5) are significantly higher in homes with smokers.

Intake of nutrients from pasture by poultry.

EC legislation requires the land to which free-range poultry have access to be 'mainly covered with vegetation', but the nature of this vegetation is not specified. In practice, most free-range land will be grass pasture. Modern poultry nutrition is a highly-developed science, and to house poultry in an environment in which they may consume an unknown quantity of vegetation, itself of unknown nutritive value, introduces uncertainty into a predictable system. In recent years the contribution of grazing to the nutrition of the birds has been considered negligible. However, birds on range appear to ingest a little grass, and therefore the quality of the pasture may affect their performance. If poultry consumed largely grass, then the nutritional value derived from it would be relatively poor. The grass would constitute a source of energy and fibre, but would make little contribution in terms of protein. The likely approach that poultry nutritionists would take is a precautionary one. They would need to know the full nutritive value of the pasture and the likely quantitative intake by the birds, and they would then make adjustments to feed formulations at what they considered to be a 'safe' level, in order to minimise the risks of impairing performance. A small (0-5) percentage contribution is probably the most that could be achieved, but given that feed accounts for about 70% of the variable costs of poultry production, such a contribution is economically important.

A laboratory technique for investigation of diffusion and transformation of volatile organic compounds in low permeability media.

A laboratory diffusion cell technique that permits spatial and temporal estimates of porewater concentrations over short intervals suitable for estimation of effective diffusion coefficients (De) and degradation rate constants (k) of volatile organic compounds (VOCs) in saturated low permeability media is presented. The diffusion cell is a sealed cylinder containing vapour reservoirs for sampling, including a vapour reservoir source and an array of vapour-filled "mini-boreholes", which are maintained water- and sediment-free by slightly negative porewater pressures. The vapour reservoirs were sampled by Solid Phase Micro-Extraction (SPME), resulting in minimal disturbance to the experimental system. Porewater concentrations are estimated from the measured vapour concentrations. Experiments were conducted using a non-reactive medium and five VOCs with a range in partitioning properties. Calibration experiments showed that equilibrium partition coefficients could be used for calculating concentrations in the vapour reservoir source from concentrations in the SPME coating after a 1-min microextraction and that the reservoir concentration was insignificantly affected by sampling. However, equilibrium was not reached during the one-min extraction of the boreholes; the microextraction reduced the borehole vapour concentrations, leading to diffusion of VOCs from porewater into the vapour-filled borehole. Thus, empirical partitioning coefficients were required for the determination of porewater VOC concentrations. The experimental data and numerical modelling indicate masses extracted by SPME extraction are relatively small, with minimal perturbation on processes studied in diffusion experiments. This technique shows promise for laboratory investigation of diffusion and transformation processes in low permeability media.