How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review.

AIM: To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older. DATA SOURCES: Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature. METHODS: A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles. RESULTS: Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment. CONCLUSION: The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions. IMPACT: The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care. PATIENT OR PUBLIC CONTRIBUTION: During the development phase, the study was presented to a consumer group from the researcher's workplace. PROSPERO REGISTRATION: CRD42022299336.

Online Dance Therapy for People With Parkinson's Disease: Feasibility and Impact on Consumer Engagement.

BACKGROUND: Therapeutic dancing can be beneficial for people living with Parkinson's disease (PD), yet community-based classes can be difficult to access. OBJECTIVE: To evaluate the feasibility and impact of online therapeutic dancing classes for people in the early to mid-stages of PD. METHODS: Co-produced with people living with PD, physiotherapists, dance teachers and the local PD association, the 'ParkinDANCE' program was adapted to enable online delivery during the COVID-19 pandemic. Participants completed 8 one-hour sessions of online therapeutic dancing. Each person was assigned their own dance teacher and together they selected music for the classes. A mixed-methods design enabled analysis of feasibility and impact. Feasibility was quantified by attendance and adverse events. Impact was determined from individual narratives pertaining to consumer experiences and engagement, analysed with qualitative methods through a phenomenological lens. RESULTS: Attendance was high, with people attending 100% sessions. There were no adverse events. Impact was illustrated by the key themes from the in-depth interviews: (i) a sense of achievement, enjoyment and mastery occurred with online dance; (ii) project co-design facilitated participant engagement; (iii) dance instructor capabilities, knowledge and skills facilitated positive outcomes; (iv) music choices were key; and (v) participants were able to quickly adapt to online delivery with support and resources. CONCLUSIONS: Online dance therapy was safe, feasible and perceived to be of benefit in this sample of early adopters. During the pandemic, it was a viable form of structured physical activity. For the future, online dance may afford benefits to health, well-being and social engagement.

Therapeutic Dancing for Frail Older People in Residential Aged Care: A Thematic Analysis of Barriers and Facilitators to Implementation.

BACKGROUND: Adults who live in residential aged care can have reduced participation in physical activities and sit for prolonged periods. Therapeutic dancing aims to optimize movement, creative expression, well-being, and social interaction. OBJECTIVES: To investigate the benefits, challenges, and facilitators to implementing therapeutic dancing in residential aged care. METHODS: Thematic analysis of semistructured interviews of residential aged care staff and therapists. Interviews were digitally audio-recorded and thematically analyzed. Findings: Four main themes were identified: (a) despite frailty, dancing classes afforded motor and nonmotor benefits, (b) music and dance genre selections were key to success, (c) the skills of the dance instructor were associated with successful outcomes, and (d) there were modifiable and nonmodifiable facilitators and barriers to implementation. CONCLUSION: Enablers included support from management, resident supervision, age-appropriate music with a strong rhythmical beat, and a dance instructor skilled in comprehensive care. Barriers included multimorbidity, frailty, severe cognitive impairment, and funding.

Can primary care team-based transition to insulin improve outcomes in adults with type 2 diabetes: the stepping up to insulin cluster randomized controlled trial protocol.

BACKGROUND: Type 2 diabetes (T2D) brings significant human and healthcare costs. Its progressive nature means achieving normoglycaemia is increasingly difficult, yet critical to avoiding long term vascular complications. Nearly one-half of people with T2D have glycaemic levels out of target. Insulin is effective in achieving glycaemic targets, yet initiation of insulin is often delayed, particularly in primary care. Given limited access to specialist resources and the size of the diabetes epidemic, primary care is where insulin initiation must become part of routine practice. This would also support integrated holistic care for people with diabetes. Our Stepping Up Program is based on a general practitioner (GP) and practice nurse (PN) model of care supported appropriately by endocrinologists and credentialed diabetes educator-registered nurses. Pilot work suggests the model facilitates integration of the technical work of insulin initiation within ongoing generalist care. METHODS: This protocol is for a cluster randomized controlled trial to examine the effectiveness of the Stepping Up Program to enhance the role of the GP-PN team in initiating insulin and improving glycaemic outcomes for people with T2D. 224 patients between the ages of 18 and 80 years with T2D, on two or more oral hypoglycaemic agents and with an HbA1c ≥7.5% in the last six months will be recruited from 74 general practices. The unit of randomization is the practice.Primary outcome is change in glycated haemoglobin HbA1c (measured as a continuous variable). We hypothesize that the intervention arm will achieve an absolute HbA1c mean difference of 0.5% lower than control group at 12 months follow up. Secondary outcomes include the number of participants who successfully transfer to insulin and the proportion who achieve HbA1c measurement of <7.0%. We will also collect data on patient psychosocial outcomes and healthcare utilization and costs. DISCUSSION: The study is a pragmatic translational study with important potential implications for people with T2D, healthcare professionals and funders of healthcare though making better use of scarce healthcare resources, improving timely access to therapy that can improve disease outcomes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12612001028897.