Quality of life of older Australians receiving home nursing services for complex care needs.

Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.

Age effects on step adaptation during treadmill walking with continuous step length biofeedback.

BACKGROUND: The inability to adjust step length can lead to falls in older people when navigating everyday terrain. Precisely targeted forward placement of the leading foot, constituting step length adjustment, is required for adaptive gait control, but this ability may reduce with ageing. The objective of this study was to investigate ageing effects on step length adaptation using real-time biofeedback. RESEARCH QUESTION: Does ageing affect the ability to adapt step length to match a target using real-time biofeedback? METHODS: Fifteen older adults (67 ± 3 years; 8 females) and 27 young adults (24 ± 4 years; 13 females) completed a step length adaptation test while walking at preferred speed on a treadmill. The test involved walking while viewing a monitor at the front of the treadmill that showed a real-time signal of absolute left-right foot displacement. The task was to match the local maxima of the signal (i.e. step length) to two target conditions, at 10 % longer or 10 % shorter than mean baseline step length. When the target was displayed, it remained unchanged for a set of 10 consecutive step attempts. Three sets of 10 attempts for each target condition were allocated in random order, for a total of 30 step attempts per target. Average absolute error and average error (bias) of step length accuracy was computed for each target condition and compared between groups. RESULTS: The step adaptation test identified that older adults had greater mean absolute error for both short and long step targets and showed a step length-dependent bias significantly different to the young. SIGNIFICANCE: Real-time foot position feedback could be a useful tool to train and evaluate step adaptation in older people.

The use of sensory nerve stimulation and compression bandaging to improve sensory nerve function and healing of chronic venous leg ulcers.

UNLABELLED: Low frequency transcutaneous sensory nerve stimulation (LF-SNS) [International Patent PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z.)] improves sensory nerve function and accelerates wound healing of older animals. INTERVENTION: Double blind, placebo controlled randomised trial of LF-SNS for 5 minutes, twice daily for up to 12 weeks, on healing of chronic venous leg ulcers in older people. Four layer compression bandaging was the standard therapy. OUTCOME MEASURES (METHODS): Wound healing and the rate of epithelialisation (calculated from serial wound area estimation), microvascular blood flow (measured using LASER Doppler flowmetry), transcutaneous oxygen tension (measured using a transcutaneous oxygen monitor, TCM400 Radiometer). Sensory nerve activity (assessed via measuring electrical cutaneous perception threshold using the Neurometer((R))CPT and the flare response to 5% capsaicin (a selective activator of C fibres). PARTICIPANTS: 14 older people with chronic venous ulcers randomly allocated to active (mean age 74.8+/-2.3 years) and 15 to Sham nerve stimulation (mean age 76.5+/-2.6 years). RESULTS: Microvascular blood flow improved in all participants. A high proportion of wounds healed ( approximately 60%). There were trends for better C-fibre function and faster healing rates in the Active group (1.1+/-0.3 cm(2)/wk) compared to the Sham group (0.6+/-0.2 cm(2)/wk) but failed to reach statistical significance due to the small sample size. CONCLUSIONS: The improvement in microvascular blood flow in both groups was an unexpected finding that has not previously been described. Most likely this was due to the four layer compression bandaging provided to all participants. Improved microvascular blood flow may be a significant contributor to wound healing. The observed trends to increased healing rates and improvements in C-fibre function in the actively stimulated group compared to the sham group warrant further studies of LF-SNS as an adjunct therapy for chronic venous leg ulcers. An exploration of the possibility that LF-SNS induced-improvement in C-fibre function could protect against future ulceration is also warranted.

The effect of sensory nerve stimulation on sensory nerve function in people with peripheral neuropathy associated with diabetes.

OBJECTIVE: To assess the effect of sensory nerve stimulation in older people with peripheral neuropathy associated with diabetes (DPN). MATERIALS AND METHODS: A randomized, placebo controlled, double blind trial was used to assess the effect of 12 weeks of low frequency sensory nerve stimulation (LF-SNS) in the lower limb [International Patent Application No. PCT/AU2004/001079: 'nerve function and tissue healing' (Z. Khalil)]. Response to capsaicin, basal microvascular blood flow, electric cutaneous threshold and oxygen tension were assessed pre- and post-treatment and between limbs. PARTICIPANTS: People 55 years of age or older diagnosed with DPN: 35 active and 31 placebo participants. RESULTS: Between groups comparisons: no significant differences occurred between stimulation groups. Within subject comparisons: in the active LF-SNS group, comparing stimulated to contralateral legs, there were significant increases in size of capsaicin flare [t(1,33)=3.65, p<0.05] and capillary blood flow [t(1,34)=-0.33, p<0.05]. There was a trend to improvement in time to initial flare response [t(1,34)=-1.86, p=0.07]. No changes were evident in the placebo group. RESPONDER ANALYSES: In a group of 'responders', the time to initial flare response (p<0.05, r=0.64), size of capsaicin flare (p<0.05 r=1.0) and microvascular blood flow (p<0.05, r=0.60) improved significantly after LF-SNS. CONCLUSIONS: The observed data suggest that LF-SNS improves nerve function in a subset of people with DPN. Targeting toward probably 'responders' may deliver the greatest benefit from short-term therapy. Testing optimal application in others seems warranted.

Use of the sensory nerve stimulator to accelerate healing of a venous leg ulcer with sensory nerve dysfunction: a case study.

A new therapy using sensory nerve stimulation [International Patent Application Number PCT/AU2004/001079: "nerve function and tissue healing" (Khalil, Z)] has been developed in our vascular physiology laboratory. This treatment has been found to improve the deficient sensory nerve function and associated deficient wound healing of older persons to levels seen in young people. An 82-year-old man with a small but persistent venous leg ulcer for 18 months, despite apparently appropriate wound dressings and compression therapy, was seen in a specialist wound management service. The patient's sensory and microvascular function was assessed in great detail using the vascular physiology laboratory techniques, and he was provided the sensory nerve stimulation therapy in addition to conventional therapy. His wound healed after 4 weeks. We report the case here. Prior to nerve stimulation therapy, cutaneous sensation, microvascular blood flow and oxygen tension were found to be reduced near the ulcer when compared with the opposite, non ulcerated leg. After therapy, oxygen tension and microvascular blood flow had improved. This case provides further evidence that sensory nerve stimulation therapy at the stipulated parameters improves wound healing. The observation that sensory nerve function improved provides support for the notion that improvement in healing is mediated by improved nerve function.