Psychological interventions designed to reduce relocation stress for older people transitioning into permanent residential aged care: a systematic scoping review.

OBJECTIVES: This study aimed to identify and evaluate psychological interventions or strategies designed to reduce relocation stress in older people making the permanent transition into residential aged care. METHOD: A scoping review following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. An electronic search of nine databases and the search engine google scholar was completed in December 2022. Article screening and quality appraisal was undertaken independently by at least two reviewers. RESULTS: Eight full-text articles were included for review, from which four psychological interventions were identified: 1) Resident peer support; 2) Life review; 3) Mental Health Service for Older Adults; 4) The Program to Enhance Adjustment to Residential Living. No interventions were implemented before transitioning into care; all were implemented within three months of resident relocation into an aged care facility. CONCLUSION: The transition to residential aged care is an inherently distressing experience. The absence of interventions implemented during the pre- and mid-transition phases presents a gap in the literature and suggests an opportunity for early intervention. As population ageing continues to increase, there is a pressing need for the development and implementation of interventions aimed at reducing symptoms of depression and anxiety for older people undertaking this major life transition.

Conducting mental health research with rural and regional older Australians: Reflections and recommendations.

AIMS: This commentary aims to assist emerging leaders of mental health research with older rural Australians through (i) affirmation that others share the barriers, pitfalls and challenges being faced; (ii) reinforcing the rationale making this a pertinent area for research; and (iii) opening a dialogue for best practice to engage older rural Australians in mental health research. CONTEXT: Supporting the mental health of older adults is a pertinent global challenge, none more so than in rural Australia where restricted access to services and supports are compounded by limited help-seeking behaviours and capacity to engage with support. Paradoxically, such limitations also extend to impact researchers' ability to engage rural older Australians in mental health research, particularly when combined with the stoicism and stigma that often envelopes mental health, and the contemporary challenges posed by the emergence of technology. Such challenges are however not often discussed, more-often sidelined in favour of reporting positive research outcomes, or seeing emerging researchers eschew such focus entirely. APPROACH: Through this paper, the authors utilised critical self-appraisal and iterative reflection to identify four recommendations for undertaking contemporary mental health research with rural older Australians, namely to: plan realistically through a collaborative, authentic and respectful approach; identify community champions and build/maintain trust; diversify thought, approaches and methodology; and cast the research net far, wide and often. CONCLUSION: By adopting recommendations, researchers can maximise accessibility to and possible participation in mental health research, providing foundations for older rural Australians' contributions to inform the development of policies and strategies to promote their health and well-being.

Understanding the enablers to implementing sustainable health and well-being programs for older adults in rural Australia: A scoping review.

INTRODUCTION: Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities. OBJECTIVE: To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia. DESIGN: A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest. FINDINGS: Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models. DISCUSSION: The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians. CONCLUSION: Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities.

The representation of Australians living with dementia in voluntary assisted dying research: A scoping review.

OBJECTIVES: To critically examine which stakeholders are participating in voluntary assisted dying (VAD) research, to identify the representation of Australians living with dementia. METHODS: A scoping review of peer-reviewed literature to examine which stakeholders are represented in Australian VAD research was conducted. This review was informed by the Arksey and O'Malley Framework for Scoping Reviews, and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). Searches were conducted systematically across key academic databases to gather Australian research articles written in English that were published between 2017 and August 2023. RESULTS: After screening, 21 publications formed the dataset. Of the 21 publications, none of them represented Australians living with dementia. The voice of one person living with a terminal illness was included in a study of care partners, and four studies explored the views of community members. The most dominant voices in the dataset were health-care practitioners, who were represented in 16 studies. CONCLUSIONS: Australian VAD research is a contested space where all stakeholders with a relevant contribution to policy and practice must be represented in contemporary Australian research. As living experience experts with a wealth of experiential knowledge to contribute, the voices of people living with dementia need to be represented in future Australian VAD research through inclusive research design, to ensure a greater balance in stakeholder representation across the VAD literature.

Till death us do part? A critical analysis of obligation and choice for spousal caregivers.

Research demonstrates a significant number of carers identify obligation or lack of other alternatives as the reasons they undertake informal care. By utilizing critical discourse analysis, this research explores choice for informal caregivers in contemporary Australian social policy. Analysis demonstrates increasing shifts in policy toward choice in consumer-directed care, a feature absent for those who provide care. Familial care is a central pillar of Australian social policy, as it is in many liberal and conservative welfare regimes. Analysis reveals that these core social policies are fundamentally incongruent, with significant implications for individuals and social work practice.

Expectations of care within marriage for older couples.

OBJECTIVES: This study explores the intersection of marriage and caregiving amongst older spousal caregivers in regional Australia. Specifically, we address the research question: 'How do expectations of informal care impact spousal caregivers in later life?' METHODS: These comprise interpretive qualitative in-depth interviews in order to understand the lived experience of caregiving within the context of long-term marriage. RESULTS: Findings highlight the complexity and diversity of marital relationships as the context of informal care. Individual and social obligations were evident in key themes, demonstrating how spouses automatically assume and continue in caregiver roles in later life. CONCLUSION: Caregiving is an expectation of couples in long-term marriages, regardless of the relationship quality and willingness to care. Normative expectations also impact decision-making around future care planning and transitions away from home-based care. These are important considerations for both policy and practice with older adults and their caregivers.