Measuring the success of programmes of care for people living with dementia: a protocol for consensus building with consumers to develop a set of Core Outcome Measures for Improving Care (COM-IC).

INTRODUCTION: The Core Outcome Measures for Improving Care (COM-IC) project aims to deliver practical recommendations on the selection and implementation of a suite of core outcomes to measure the effectiveness of interventions for dementia care. METHODS AND ANALYSIS: COM-IC embeds a participatory action approach to using the Alignment-Harmonisation-Results framework for measuring dementia care in Australia. Using this framework, suitable core outcome measures will be identified, analysed, implemented and audited. The methods for analysing each stage will be codesigned with stakeholders, through the conduit of a Stakeholder Reference Group including people living with dementia, formal and informal carers, aged care industry representatives, researchers, clinicians and policy actors. The codesigned evaluation methods consider two key factors: feasibility and acceptability. These considerations will be tested during a 6-month feasibility study embedded in aged care industry partner organisations. ETHICS AND DISSEMINATION: COM-IC has received ethical approval from The University of Queensland (HREC 2021/HE001932). Results will be disseminated through networks established over the project, and in accordance with both the publication schedule and requests from the Stakeholder Reference Group. Full access to publications and reports will be made available through UQ eSpace (https://espace.library.uq.edu.au/), an open access repository hosted by The University of Queensland.

Reconceptualizing Stigmas in Aged Care: A Typology of Stigmatizing Discourses in the Aged-Care Context.

BACKGROUND AND OBJECTIVES: Stigmatizing discourses surrounding aged care is complex. The stigma associated with people working in aged care is often conflated with negative evaluations about older adults who receive care and/or the institutions and systems that provide these services. This lack of nuance hampers productive dialogue in gerontology required for making sense of the stigmas attached to entities and systems. We propose that an interdisciplinary approach drawing on gerontology, psychology, and linguistics would facilitate a greater understanding of the stigma of aged care. Specifically, a discourse approach underpinned by Stigma Theory and Systemic Functional Linguistics can clarify the different stigmatizing discourses associated with aged-care entities and systems, and inform priorities for interventions targeting each discourse category identified. RESEARCH DESIGN AND METHODS: APPRAISAL, a linguistics framework, was employed to analyze evaluative language in 660 submissions published in the Australian Royal Commission into Aged Care. Through applying predefined language-based criteria, we distinguished between multiple stigmatizing discourses that were interrelated but conceptually distinct in terms of attitude types and targets. RESULTS: Twelve categories of stigmatizing discourses derived from the linguistic analysis established a typology. This typology conceptualized different ways stigma can be meaningfully understood in the aged-care context. By employing this typology, 12 intervention priorities were also identified. DISCUSSION AND IMPLICATIONS: This interdisciplinary approach enabled us to examine the diversity and complexity of the social construction of stigma in the public domain. We argue that understanding these linguistic patterns can assist with designing targeted aged-care interventions and policies.

Does Context Count? The Association Between Quality of Care and Job Characteristics in Residential Aged Care and Hospital Settings: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Within residential aged care settings, reduced quality of care (QoC), abuse, and neglect have been global phenomena which require urgent intervention. As the reported rate of these problems is much higher in aged care compared to hospital settings, we investigated whether differing job design characteristics between the 2 settings might explain the difference. RESEARCH DESIGN AND METHODS: We used a meta-analysis to compare differences in the relationships between high job demands, low job resources, and job strain with QoC and counterproductive work behaviors (CWBs) across aged care and hospital settings. RESULTS: Data were extracted from 42 studies (n = 55 effects). QoC was negatively correlated with high job demands (ρ¯ = -0.22, 95% confidence interval [CI]: -0.29, -0.15, k = 7), low job resources (ρ¯ = -0.40, 95% CI: -0.47, -0.32, k = 15), and job strain (ρ¯ = -0.32, 95% CI: -0.38, -0.25, k = 22), CWBs had a positive relationship with job demands (ρ¯ = 0.35, 95% CI: 0.10, 0.59, k = 3) and job strain (ρ¯ = 0.34, 95% CI: 0.13, 0.56, k = 6). The association between poor QoC and low job resources was stronger in aged care (r = -0.46, 95% CI: -0.55, -0.36, k = 8) than in hospital settings (r = -0.30, 95% CI: -0.41, -0.18, k = 7). DISCUSSION AND IMPLICATIONS: Our findings suggest that relationships between low job resources and poor QoC are exacerbated in residential aged care contexts. To improve care outcomes, stakeholders should improve job resources such as skill discretion, supervisory supports, and increased training and staffing levels in residential aged care.

"The Stigma is what you do": Examining the Relationship Between Occupational Stigma and Worker Outcomes in the Aged Care Context.

Negative social evaluations about aged-care work continue to discredit those who perform this type of work. Drawing on 'dirty work' literature from the field of management and stigma theory from the field of psychology, this study examines occupational stigma in the context of aged-care work and its relationship with negative outcomes for people who work in aged care. Findings from a path analysis revealed that aged-care workers (n = 185) who ascribe occupational taints and poor occupational conditions with aged-care work perceive aged-care work as being stigmatized, and in turn, are more likely to internalize this stigma. Through this process of perceiving and internalizing occupational stigma, aged-care workers experience greater psychological distress, job dissatisfaction, and turnover intentions. This research fills a void within the gerontology literature regarding the psychological processes underlying how occupational stigma may come to negatively impact this workforce. Findings offer practical implications for policy reform and managerial training.

The Social Construction of Stigma in Aged-Care Work: Implications for Health Professionals' Work Intentions.

BACKGROUND AND OBJECTIVES: Although society has cultivated a deeper appreciation for essential health services, societal discourses reinforce a stigma of working in aged care. Drawing on dirty work and Stigma Theory, this study aims to investigate stigma in the context of recruiting health professionals. RESEARCH DESIGN AND METHODS: We employed a mixed-methods design to examine the nature and implications of the stigma of working in aged care. A path analysis was used to test whether health professionals' (n = 159) negative perceptions of aged-care work would negatively predict their willingness to work in aged care. A linguistic analysis was conducted to understand how health professionals' (n = 168) use of language positions themselves toward or away from engaging in aged-care work. RESULTS: Quantitative findings revealed that perceptions of physical taint directly predicted lower willingness to perform aged-care work. Perceptions of social taint, moral taint, and poor occupational conditions negatively predicted willingness to work in institutional aged care, indirectly via social devaluation. Findings from the linguistic analysis demonstrated that health professionals (re)produce stigma through aligning themselves with devaluing discourses about aged-care workers, work, and institutions. DISCUSSION AND IMPLICATIONS: This study provides insight about the role that stigma plays in the aged-care recruitment crisis, with implications for aged-care institutions. Societal discourse may obstruct the employment of health professionals in aged care because it can (re)produce the stigma of working in aged care. Recommendations for ways to reduce the impact of this stigma include public messaging and training.

Deeply Discrediting: A Systematic Review Examining the Conceptualizations and Consequences of the Stigma of Working in Aged Care.

BACKGROUND AND OBJECTIVES: The stigma of working in aged care can discredit and devalue those working in gerontology. This overlooked workforce issue may underpin complex staffing challenges like chronic worker shortages and inadequate care delivery. Our review synthesizes the existing literature and introduces a conceptual framework based on linguistics to reconcile disparate conceptualizations and negative consequences of this stigma. RESEARCH DESIGN AND METHODS: We conducted a systematic review and assessed peer-reviewed articles published from 1973 to 2019 across 5 databases. Fifty-nine articles were selected based on criteria grounded in stigma theory. RESULTS: Only 10 articles explicitly used the term "stigma" when conceptualizing the stigma of working in aged care. An additional 49 articles conceptualized this stigma in terms of stigma processes (e.g., status loss). Findings from a deeper examination using a linguistic analysis revealed societal groups predominantly conceptualized stigma in 3 distinct ways based on (a) unfavorable character judgment of aged care workers, (b) lower value placed on aged care work, and (c) negative emotional reactions towards working in aged care. Last, stigma was associated with adverse psychological and job-related consequences. DISCUSSION AND IMPLICATIONS: Reconceptualizing this workforce issue and recognizing it as a societal challenge will enable policymakers to design evidence-based interventions at industry and societal levels. We propose workforce challenges in the aged care sector such as attraction, retention, and well-being may lessen with interventions aimed at mitigating the stigma of working in aged care.

Shaping attitudes: The association between prior contact with residential aged care and resistance to enter residential aged care.

BACKGROUND: The ageing population is increasing, and negative attitudes towards older people are all too common and largely overlooked. However, little research has examined how ageist, prejudice, and discrimination, that often occur in healthcare settings, impact the community's perceptions of entering Residential Aged Care (RAC) in the future. In particular, studies have not investigated how contact with RAC influences individuals' attitudes towards RAC facilities, residents and staff. This study is the first to examine individuals' resistance towards living in RAC using the contact hypothesis, a theory of prejudice reduction. AIMS: To explore how positive or negative contact with RAC residents and staff impacts individuals' behavioural intentions towards entering RAC in the future. To examine whether perceptions of trust, independence and RAC staff mediate the relationship between contact and behavioural intentions towards entering RAC in the future. DESIGN: A cross-sectional survey design. METHOD: Data were collected via online surveys using contact (positive or negative), trust, independence, perceptions of RAC staff and resistance levels (mild refusal or extreme refusal) measures. Participants (n = 373) from Australia and USA were recruited using social media, word of mouth and Amazons Mechanical Turk. FINDINGS: Individuals who experienced negative contact with RAC residents and staff were more likely to report intense resistance to RAC, "I would rather die than enter RAC". Whereas, positive contact with RAC residents and staff was associated with reductions in the adverse appraisal of RAC staff; a diminished perception that individuals lost their independence, and an increased trust in RAC residents, facilities and staff. Participants from USA reported greater levels of resistance towards RAC in comparison with participants from Australia. This study demonstrates how interactions with RAC residents, facilities and staff are critical in shaping attitudes towards RAC. IMPLICATIONS FOR PRACTICE: It is recommended that the public are exposed to opportunities where they can experience positive contact with RAC. RAC facilities can promote interaction between the public and RAC residents through encouraging participation in community partnership programs/intergenerational programs.