Video-interpreting for cognitive assessments: An intervention study and micro-costing analysis.

INTRODUCTION: Evidence in the literature demonstrates the reliability of cognitive screening assessments using video technology in English-speaking older populations. However, this has not been tested in older culturally and linguistically diverse (CALD) populations who require an interpreter, and what the associated costs would be. The aim was to determine if the Rowland Universal Dementia Assessment Scale (RUDAS) and the Geriatric Depression Scale (GDS) could be reliably administered over video-interpreting methods compared with face-to-face interpreting. In addition, the study aims to compare the costs of video-interpreting with the costs of face-to-face interpreting. METHODS: We compared similarity of the RUDAS and GDS scores when administered face-to-face and via video-interpreting. The similarity of scores between methods was analysed using paired t-tests and Bland-Altman plots. A costing analysis was done using a micro-costing approach to estimate the costs of video-interpreting compared with face-to-face, extrapolated to a national level. RESULTS: Analysis found no significant differences in the mean assessment scores between video-interpreting and face-to-face (RUDAS mean difference: -0.36; 95% confidence interval (CI): -1.09, 0.38, GDS mean difference: 0.22; 95% CI: -0.38, 0.83). Bland-Altman plots demonstrated that 71% of RUDAS scores and 82% of GDS scores were within the maximum allowed difference of ±2 units. Costing analysis showed a A$7 saving per assessment when using video-interpreting compared with face-to-face, with a total national saving of A$247,350. DISCUSSION: Video-interpreting was found to be as reliable as face-to-face interpreting for both RUDAS and GDS assessments. Cost analysis indicates that video-interpreting is cheaper than face-to-face interpreting.

The perceptions of translation apps for everyday health care in healthcare workers and older people: A multi-method study.

AIMS AND OBJECTIVES: To understand the attitudes and perceptions of older people with limited English proficiency (LEP) and healthcare workers to using mobile translation technology for overcoming language barriers in the healthcare setting. BACKGROUND: Australia's cohort of people aged 65 and over has a sizeable population with LEP. In healthcare settings, difficulties with communication may potentially result in inadequate care. Mobile language translation applications have been identified as a potential way to improve communication between patients and healthcare staff when used as an adjunct to professional interpreters in low-risk scenarios; however, the perceptions of the use of mobile translation applications for such communication is unknown. METHODS: A multi-method design was used. Focus group discussions were conducted with older people from culturally and linguistically diverse (CALD) backgrounds and nursing and allied health professionals to understand their perceptions of translation technology. Qualitative data were analysed using inductive content analysis. Qualitative findings were reported using the Standards for Reporting of Qualitative Research (SRQR) checklist. Participants also appraised three existing translation apps via survey and results were analysed using descriptive statistics. RESULTS: Overall, older people from CALD backgrounds (n = 12) and healthcare staff (n = 17) agreed that translation technology could play a role in reducing communication barriers. There was enthusiasm amongst older people to learn and use the technology, while healthcare staff saw the potential to address communication barriers in their own work. Barriers identified by older people and healthcare staff included: accuracy of translation and phrases, possible technological learning curves, risk of mistranslation in high-risk conversation and inability to check accuracy of translation. Fixed-phrase translation apps were seen as more favourable than real-time voice-to-voice mobile translation applications. CONCLUSIONS: Older people from CALD backgrounds and healthcare staff were open to the use of mobile translation applications for everyday healthcare communications. RELEVANCE TO CLINICAL PRACTICE: Translation applications may have a role in reducing language barriers in everyday healthcare communication but context, accuracy and ease of use need to be considered.

Language Translation Apps in Health Care Settings: Expert Opinion.

BACKGROUND: Currently, over 300 languages are spoken in Australian homes. People without proficient English from non-English speaking countries may not receive equitable care if their health care workers do not speak their primary language. Use of professional interpreters is considered the gold standard; however, for a variety of reasons, it is often limited to key aspects of care such as diagnosis and consent. With the emergence of mobile technologies, health care workers are increasingly using digital translation tools to fill this gap. However, many of these technologies have not been developed for health care settings and their use has not been evaluated. OBJECTIVE: This study aimed to evaluate iPad-compatible language translation apps to determine their suitability for enabling everyday conversations in health care settings. METHODS: Translation apps were identified by searching the Apple iTunes Store and published and grey literature. Criteria for inclusion were that the apps were available at no cost, able to translate at least one of the top 10 languages spoken in Australia, and available for use on iPad. Apps that met inclusion criteria were reviewed in 2 stages. Stage 1 was the feature analysis conducted by 2 independent researchers, where apps were evaluated for offline use, input and output methods, and number of languages. Stage 2 was the analysis of suitability for everyday communication in the health care setting, conducted by 2 independent professionals with expertise in translation and cross-cultural communication. Apps that enabled key aspects of care normally within the realm of professional interpreters, such as assessment, treatment and discharge planning, and seeking consent for medical treatments, were considered unsuitable. RESULTS: In total, 15 apps were evaluated. Of these, 8 apps contained voice-to-voice and voice-to-text translation options. In addition, 6 apps were restricted to using preset health phrases, whereas 1 app used a combination of free input and preset phrases. However, 5 apps were excluded before stage 2. In addition, 6 of the 10 remaining apps reviewed in stage 2 were specifically designed for health care translation purposes. Of these, 2 apps were rated as suitable for everyday communication in the health care setting-culturally and linguistically diverse Assist and Talk To Me. Both apps contained simple and appropriate preset health phrases and did not contain conversations that are normally within the realm of professional interpreters. CONCLUSIONS: All iPad-compatible translation apps require a degree of caution and consideration when used in health care settings, and none should replace professional interpreters. However, some apps may be suitable for everyday conversations, such as those that enable preset phrases to be translated on subject matters that do not require a professional interpreter. Further research into the use of translation technology for these types of conversations is needed.

A narrative review of the evidence regarding the use of telemedicine to deliver video-interpreting during dementia assessments for older people.

INTRODUCTION: As Australia's aging population increases and diversifies, there will be a growing need to address the burden of dementia among culturally and linguistically diverse (CALD) communities. Due to a lack of CALD-appropriate services and bilingual health professionals, older people from CALD backgrounds often receive a delayed diagnosis of dementia. The use of telemedicine (TM) to deliver video-interpreting services may overcome the barriers of interpreter availability when diagnosing and assessing dementia in older people from CALD backgrounds. METHODS: This paper aims to present a review of the literature on the use of TM to deliver video-interpreting during dementia assessments. Factors affecting the reliability and agreement, feasibility, and satisfaction and acceptability when using TM or video-interpreting have been described. RESULTS: The review found evidence that dementia assessments conducted via TM are as reliable as face-to-face (FTF) assessments and that participants are satisfied and find TM acceptable. There was less evidence about the feasibility of TM from the health care perspective, particularly regarding the acceptability and potential financial cost-savings. Only five studies investigated the use of video-interpreting during clinical assessments with CALD patients. Although video-interpreting was found to be satisfactory among CALD patients and clinicians, a common finding was the preference for FTF interpreting. DISCUSSION: More research is needed to examine the financial feasibility and the health care perspective on the implementation and adoption of TM for dementia assessments. The use of TM to deliver video-interpreting for dementia assessments has never been investigated and represents a significant gap in the literature.

Facilitators and barriers to advance care planning implementation in Australian aged care settings: A systematic review and thematic analysis.

OBJECTIVES: There are many studies investigating implementation of advance care planning (ACP) in aged care around the world, but few studies have investigated Australian settings. The objective of this study was to determine facilitators and barriers to implementation of ACP in Australian residential and community aged care. METHODS: Evidence from Australian studies published between 2007 and September 2017 of ACP in residential and community aged care was sourced from electronic databases using predetermined search strategies. Data were extracted and synthesised using thematic analysis, and summarised according to themes. RESULTS: Nine studies described facilitators and barriers of ACP implementation. Six themes were identified: "Education and Knowledge," "Skills and Training," "Procedures and Resources," "Perceptions and Culture," "Legislation" and "Systems." CONCLUSIONS: A whole of systems approach is necessary to facilitate uptake of ACP in residential aged care settings. More research is needed to understand facilitators and barriers to ACP in community aged care.

Improving health literacy about dementia among older Chinese and Vietnamese Australians.

The number of older people in the population is increasing faster than for any other age group. This population growth, while positive, is associated with increasing incidence of chronic and progressive diseases such as dementia. This requires older people to navigate services that may not be designed to meet their needs. This issue can be further amplified in culturally and linguistically diverse populations who often have limited English language proficiency and limited knowledge of diseases such as dementia. Health literacy, a person's ability to access, understand, appraise and apply information about their health and health care, including navigating health services, is low among older people and even lower among older people born overseas. This paper describes findings from a recent research study which developed and used the Cultural Exchange Model. The model is based on a process of collaboration, whereby researchers, service providers and community members work together to build evidence about a particular topic, in this case dementia. The study demonstrated that the Cultural Exchange Model facilitates opportunities for researchers, health professionals, community workers and carers to improve their knowledge of conditions such as dementia and rapidly translate evidence into practice. It also showed that it is possible to recruit, engage and generate new knowledge within populations that are traditionally excluded from research but have high prevalence of dementia. This study shows health literacy is an evolving process. Access to ongoing education for professionals, not only of the clinical condition and the service system, but also the cultural elements of the communities they are working with, requires consideration.

Reliability, concurrent validity, and cultural adaptation of the Geriatric Depression Scale and the Geriatric Anxiety Inventory for detecting depression and anxiety symptoms among older Chinese immigrants: an Australian study.

ABSTRACTBackground:Older Chinese people are one of the largest and fastest growing immigrant groups in Western countries. The Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) are screening tools that have been specifically designed for older people. This study explored their validity, concurrent reliability, and cultural appropriateness for detecting depression and anxiety symptoms among older Chinese immigrants living in Melbourne, Australia. METHODS: A total of 87 Chinese people were recruited from Chinese senior groups. Five screening tools were used, including the GDS, the GAI, the Hospital Anxiety and Depression Scale (HADS), the Kessler 10 (K10), and the Patient Health Questionnaire (PHQ-9). Data were collected through standardized interviews. RESULTS: The GDS and the GAI were found to be reliable and valid tools for detecting depression and anxiety in this sample. Based on the results of the five screening tools, approximately 20% of participants exhibited clinically significant symptoms of depression and 8% of anxiety. Unexpectedly, there was a higher rate of depression and anxiety symptoms among Mandarin speaking people compared with Cantonese speaking people. CONCLUSION: This study adds to the evidence that older Chinese immigrants are at greater risk of depression than the general older population. It suggests that primary care and mental health services should be aware of and responsive to the increased risk of depression among this group and that further studies are needed to investigate what is contributing to this increased risk.

Interpreter-mediated Cognitive Assessments: Who Wins and Who Loses?

OBJECTIVES: The number of people with dementia from culturally and linguistically diverse (CALD) backgrounds is increasing dramatically in Australia. Accurate cognitive assessments of people from CALD backgrounds can be achieved with the use of skilled interpreters. This study aimed to explore the experience of interpreter-mediated assessments from the perspectives of clinicians, interpreters and carers. METHODS: Consultations with interpreters, clinicians and carers were conducted through individual interviews and focus groups. The consultations explored participants' experiences of interpreter-mediated assessments, including perception of the interpreting process, roles of interpreters, and challenges associated with interpreter-mediated assessments. RESULTS: Four themes emerged across groups: (1) the importance of having professional interpreters, (2) different perceptions of the roles of interpreters, (3) clinicians' feelings of having less control over assessments, and (4) particular challenges associated with cognitive assessments. CONCLUSIONS: Finding from this study highlight the important role that interpreters play in cognitive assessments with immigrants. However, there appears to be different perceptions of the role between clinicians and interpreters. When these different understandings are not resolved, they will lead to tension between clinicians and interpreters. These findings highlight the importance of relational aspects in interpreter-mediated assessment and suggest that the negotiation of the relationships between clinicians and interpreters is an important factor that determines the effectiveness and accuracy of these assessments. CLINICAL IMPLICATIONS: This study highlights the need for clinicians and interpreters education of roles of all parties in interpreter-mediated cognitive assessment. Areas to be covered in education could include: common misunderstandings of interpreters roles, and practice tips on how to improve communications in assessments, such as briefing before and after the assessment. Such education will enable more accurate assessment and less stress for patients and their families.

Role of art centres for Aboriginal Australians living with dementia in remote communities.

OBJECTIVE: To explore the role art centres in remote communities play for Aboriginal and Torres Strait Islander Australians living with dementia. METHODS: A comprehensive literature search was undertaken, with no restrictions on articles regarding year of publication. RESULTS: Art programmes have been found to be of benefit to both people living with dementia and their carers, particularly when programmes are administered in environments that are culturally revered. Findings indicate remote art centres play a key role in maintaining traditions, culture and practices unique to Aboriginal and Torres Strait Islanders, but there is a gap in knowledge regarding how they cater for the needs of people with dementia. CONCLUSION: Addressing this gap will be helpful in remote areas where prevalence of dementia is up to five times that of non-Aboriginal people, and there are limited health and support services. Further research is required to explore strengths and gaps of current practices.

'Depression is not an illness. It's up to you to make yourself happy': Perceptions of Chinese health professionals and community workers about older Chinese immigrants' experiences of depression and anxiety.

AIM: The aim of this study was to improve our understanding of depression and anxiety among older immigrant Chinese Australians. METHODS: The study was based on the National Ageing Research Institute's Cultural Exchange Model, an iterative process of exchange between researchers and stakeholders. The project involved a range of components including consultations with health professionals and community workers about perceptions of depression and anxiety within the Chinese community. This paper reports on these consultation findings. RESULTS: Thematic analysis generated five main categories to explain participants' perceptions of depression and anxiety within the Chinese community. Themes included: lack of knowledge; personal weakness rather than illness; stigma; somatisation; and experience of migration in later life. Responses to questions about education and information dissemination were collated separately and reported. CONCLUSION: Views of depression and anxiety among older Chinese people suggest that educating the community may be an important way to improve mental health literacy and help-seeking behaviour.

Developing networks between residential aged care facilities as a result of engagement in a falls prevention project: an action research study.

BACKGROUND: Residential aged care facility (RACF) staff often operate in isolation. Research is lacking on networking between facilities. AIMS: To explore outcomes associated with network formation between two RACFs as part of an action research approach to reducing falls. DESIGN: Action research approach with qualitative data collected. METHODS: Twelve RACF staff from two facilities in regional Tasmania, Australia, formed a falls prevention action research group. Thematic analysis was undertaken of 22 audio-recorded fortnightly group meetings. RESULTS: This was the first opportunity for participants to meet colleagues from another facility in a professional context. The formation of an inter-facility network enabled the sharing of ideas and systems related to evidence-based falls prevention activities and other issues and galvanised a collaborative focus for action. CONCLUSIONS: An action research process can be used to create an inter-facility network. Such networks can decrease staff isolation and facilitate best resident care.

Screening for depression and anxiety among older Chinese immigrants living in Western countries: The use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI).

BACKGROUND: Depression and anxiety are two common mental health problems among older people. There is evidence that using well-validated screening tools can improve detection of depression and anxiety among this group. The review explored the use of the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) for screening depression and anxiety among older Chinese immigrants, one of the largest and fastest growing groups of older immigrants in Western society. It focused on the GDS and GAI because both are designed specifically for older people. METHODS: Online literature searches were conducted in MEDLINE, CINAHL, and PsycINFO. A narrative approach was used to review included papers. RESULTS: A total of 21 articles were included. There were limited data on anxiety among older Chinese immigrants, with only one unpublished report identified. There were 13 studies (20 articles) using the GDS with this group. Results of these studies indicated that the GDS is a reliable tool in this population; however, there was limited validity data. Two versions of the GDS-15 have been used with older Chinese immigrants, including the standard GDS-15 and Mui's GDS-15. Prevalence of depression ranged between 20% and 30% in most reviewed studies. DISCUSSION: Results of this review have practical implications for clinicians in their use of these tools with older Chinese immigrants in Western countries, such as the different GDS versions. It also suggests a number of directions for future research, such as the inclusion of clinical samples and consideration of the diversity within this group.

Living Longer Living Stronger™: a community-delivered strength training program improving function and quality of life.

AIM: This study investigated changes in function and quality of life for older adults participating in Living Longer Living Stronger™, a community-delivered strength training program for people aged over 50. METHODS: Assessments were conducted at baseline, 4 and 8 months using measures of function, balance, mobility, strength, mental health and quality of life. RESULTS: Thirty-five participants (mean age 66 years, 69% female) completed 4 months of the program; 24 completed 8 months. Using repeated-measures anova, significant improvements were found at 4 and 8 months for step test, gait stride length, 6-minute walk test, timed sit to stand, physical performance test and reported health transition (SF-36). At 4 months (n = 35), vitality (SF-36), quality of life and left shoulder abductor strength significantly improved; at 8 months (n = 24), role physical and mental health (SF-36) and gait velocity significantly improved. CONCLUSION: The program appears to be an effective community-delivered strength training program.

Aged Care Assessment Service practitioners: a review of current practice for assessment of cognition of older people of culturally and linguistically diverse backgrounds in Victoria.

AIM: This paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria. METHOD: A web-based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues. RESULTS: Seventy-nine web-based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients. CONCLUSION: ACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff.

Help seeking in older Asian people with dementia in Melbourne: using the Cultural Exchange Model to explore barriers and enablers.

The prevalence of dementia is increasing in Australia. Limited research is available on access to Cognitive Dementia and Memory Services (CDAMS) for people with dementia from Culturally and Linguistically Diverse (CALD) communities. This study aimed to determine the barriers and enablers to accessing CDAMS for people with dementia and their families of Chinese and Vietnamese backgrounds. Consultations with community members, community workers and health professionals were conducted using the "Cultural Exchange Model" framework. For carers, barriers to accessing services included the complexity of the health system, lack of time, travel required to get to services, language barriers, interpreters and lack of knowledge of services. Similarly, community workers and health professionals identified language, interpreters, and community perceptions as key barriers to service access. Strategies to increase knowledge included providing information via radio, printed material and education in community group settings. The "Cultural Exchange Model" enabled engagement with and modification of the approaches to meet the needs of the targeted CALD communities.

Development and initial testing of the Person-Centred Health Care for Older Adults Survey.

BACKGROUND: Health services are encouraged to adopt a strong person-centered approach to the provision of care and services for older people. The aim of this project was to establish a user-friendly, psychometrically valid, and reliable measure of healthcare staff's practice, attitudes, and beliefs regarding person-centered healthcare. METHODS: Item reduction (factor analysis) of a previously developed "benchmarking person-centred care" survey, followed by psychometric evaluations of the internal consistency reliability and construct validity, was conducted. The initial survey was completed by 1,428 healthcare staff from 17 health services across Victoria, Australia. RESULTS: After removing 17 items from the previously developed "benchmarking person-centred care" survey, the revised 31-item survey (Person-Centred Health Care for Older Adults Survey) attained eight factors that explain 62.7% of the total variance with a Cronbach's α coefficient of 0.91, indicating excellent internal consistency. Expert consultation confirmed that the revised survey had content validity. CONCLUSIONS: The results indicated that the Person-Centred Health Care for Older Adults Survey is a user-friendly, psychometrically valid, and reliable measure of staff perceptions of person-centered healthcare for use in hospital settings.

Evaluation of a transition care cognitive assessment and management pilot.

This paper describes the evaluation of the Transition Care Cognitive Assessment and Management Pilot (TC CAMP) at a residential care facility in Victoria, Australia. Transition care aims to provide a goal-oriented, time-limited service to older people at the conclusion of an episode of hospital care. The TC CAMP was established to specifically meet the needs of people with cognitive impairment. The purpose of this study was to evaluate the implementation and effectiveness of the TC CAMP. The evaluation sought to explore the perceptions of staff and family carers, and outcomes for the person with dementia. Methods consisted of file audits, focus groups and individual interviews with nursing staff and carers. This evaluation found that it was possible to provide appropriate transition care to people with cognitive impairment who exhibited behavioural and psychological symptoms of dementia. The TC CAMP achieved length of stay and readmission rates that were comparable with transition care for cognitively intact people. The role of the Clinical Nurse Consultant was highly valued by staff and families involved in TC CAMP. The findings from TC CAMP suggest a suitable environment, availability of trained and resourced nursing and clinical staff and clear roles and expectations for all stakeholders should be considered in implementation of this model of care.

Cost per fall: a potentially misleading indicator of burden of disease in health and residential care settings.

RATIONALE: Little scrutiny has been applied to how 'cost per fall' values have been calculated and applied. This paper presents discourse discussing how the cost of fall statistic could potentially be misleading when applied to inpatient health or residential care settings and provides estimates of the cost of falls and cost of falls per person. METHOD: Burden of disease was estimated using a decision tree approach. Data informing the decision tree were drawn from a retrospective audit of 545 falls in a residential care facility, a visual observation study of 46 residents from the same facility and a cohort study of 186 residents from nine different facilities in Australia. Acute care and transportation costs were extracted from the retrospective audit using incident reports and care note review. The distribution of falls per person and associations between falls, fractures and change in resident mobility were extracted from the cohort study. The association between resident mobility and the amount of time required to perform toileting, transfer and dressing activities was extracted from the visual observational study. RESULTS: The minimum 'cost per fall' was estimated to be $AUD 841 and the maximum was $AUD 1024. The 'cost of falls per person' estimate was $AUD 1887 (2008 base year). CONCLUSIONS: This cost per fall estimate was substantially lower than three previous internationally derived estimates possibly as a consequence of how fall data were collected and modelled in these studies. Cost of falls per person may be a preferable statistic for future use.

Beyond the 'tick and flick': facilitating best practice falls prevention through an action research approach.

AIMS AND OBJECTIVES: To examine residential aged care facility staff views on using falls risk assessment tools and the implications for developing falls prevention practices in the context of an action research project. BACKGROUND: Falls risk assessments play an important role in care planning by identifying and monitoring aged care facility residents most at risk of falls. Yet while such assessments are recommended in falls prevention best practice guidelines, there is little published research that examines staff procedures and views related to conducting falls risk assessments. DESIGN: Falls risk assessments were undertaken in the context of an action research project. METHOD: Twelve staff members from two residential aged care facilities (RACFs) in Tasmania formed a single Falls Action Research Group, which met 22 times over a year, providing the study's qualitative data. During this time, key group members assessed 178 residents using a new falls risk assessment tool (FROP-Resi). RESULTS: According to group members, facilities evolved from a 'tick-and-flick' approach to falls risk assessment to a more individualised, face-to-face assessment process. Group members perceived the process to be more meaningful and enjoyable for staff involved in the assessment process resulting in higher quality of assessments and leading to improved levels of falls awareness among staff, residents and family caregivers. CONCLUSIONS: An action research process is useful for facilitating a new approach to falls risk assessments, engaging aged care facility staff with falls prevention and prompting improvements in falls prevention practices. RELEVANCE TO CLINICAL PRACTICE: RACFs need to provide opportunities for staff to meet regularly to discuss practice, identify issues and take action. By doing so, staff can engage meaningfully with best practice activities such as optimising falls risk assessment processes.

Outcomes from the implementation of a facility-specific evidence-based falls prevention intervention program in residential aged care.

For residents in long-term care facilities, falling is a major concern requiring preventive intervention. A prospective cohort study measured the impact of falls reduction following the implementation of evidence-based fall prevention interventions in 9 Australian residential care facilities. An external project team provided a comprehensive audit of current practice. Facilitated by an action research approach, interventions were individualized to be facility- and patient-specific and included the following: environmental modifications such as low beds and height-adjustable chairs, movement alarms, hazard removal, and hip protectors. Participants included 670 residents and 650 staff from 9 facilities across 3 states. A significant reduction of falls were observed per site in the proportion of fallers (P = .044) and single fallers (P = .04). However, overall the number of falls was confounded by multiple falls in residents. Reduction in fallers was sustained in the 6-month follow-up phase. Positive outcomes from interventions varied between facilities. Further research is necessary to target frequent fallers.