'They never talked to me about... ': Perspectives on aged care resident transfer to emergency departments.

AIMS: To explore perspectives of three groups concerning transfers from aged care facilities to emergency departments. We sought to reveal factors influencing transfer decisions; how active each group was in making decisions; and to what extent groups ceded decision-making to others. METHODS: Semi-structured interviews of 11 residents, 14 relatives and 17 staff with content analysis of interview transcripts. RESULTS: The three groups substantially differed in their involvement with initiating, and attitudes towards, transfer. Residents were least likely to be involved in the decision, yet most likely to support transfer. Staff felt conflicted between their desire to provide optimal treatment for one ill resident, and their obligations to other residents under care. Staff perspectives were largely consistent with published data, but we describe new results for other informant groups. CONCLUSIONS: Group expectations and preferences differ substantially. Service delivery to meet all preferences presents a challenge for health service design.

Decision to transfer to an emergency department from residential aged care: a systematic review of qualitative research.

AIM: If developing policies to optimize quality acute care within residential aged care facilities (RACF) is a goal, understanding the factors that influence the decision to transfer a resident from RACF to hospital emergency departments is important. The aim of the present study was to review the published literature pertaining to transfer decisions. METHODS: We carried out a systematic review of the qualitative literature to ascertain key influences on transfer decisions amongst three key stakeholder groups - residents, their family and carers. RESULTS: From 11 papers we found two themes encompassing seven domains of influence. Transfers are influenced by an expectation or goal of improved resident clinical or quality of life outcomes - these are domains within the "resident dominant" theme. However, transfers also occur where there is no expectation of resident benefit. These domains, such as inadequate facility resourcing and care planning, are categorized within the "resident subordinate" theme. CONCLUSION: Transfer decisions are often influenced by considerations beyond expected benefit to the individual resident. Conceptualizing influences on transfer decisions within this framework might assist clinicians and policy makers in the design and delivery of services for RACF residents.

Common factors that enhance the quality of life for women living in their own homes or in aged care facilities.

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.

Client satisfaction and unmet needs assessment: evaluation of an HIV ambulatory health care facility in Sydney, Australia.

A mixed-methods approach study was conducted at an ambulatory HIV health care facility in Sydney during 2007/2008. A quantitative self-administered structured questionnaire survey (phase 1) was conducted to assess client satisfaction levels, followed by qualitative semistructured interviews (phase 2) to investigate reasons for satisfaction/dissatisfaction and unmet needs. The mean overall satisfaction score of the 166 respondents in phase 1 was high (86 out of 100). Participants were most satisfied with the "knowledge" and "attitudes" of health care providers (HCP) and "maintenance of confidentiality." They were least satisfied with "waiting time before consultation." "Knowledge of HCP" and "rapport, care, and trust towards HCP" emerged as most important aspects of satisfaction. The broad range of HCP and services provided at one location was particularly appreciated. Health care service evaluation by assessing client satisfaction using mixed methods provided valuable insight into health care service quality. It can be applied to a broader range of health care services.

Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial.

RATIONALE: Excess mortality and residual disability are common after hip fracture. HYPOTHESIS: Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture. DESIGN: Randomized, controlled, parallel-group superiority study. SETTING: Outpatient clinic PARTICIPANTS: Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007. INTERVENTION: Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support. OUTCOMES: Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization. RESULTS: Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P < .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P < .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P < .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P < .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P < .0001-.05). CONCLUSION: The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.

Improving adherence with the use of hip protectors among older people living in nursing care facilities: a cluster randomized trial.

OBJECTIVES: To test different adherent strategies aimed at improving hip protector use among nursing care facility residents. DESIGN, SETTING AND PARTICIPANTS: A cluster randomized controlled trial with 234 residents older than 75 years from 9 units of 7 nursing care facilities in the Northern Sydney region, Australia. INTERVENTION: Residents were cluster randomized in 3 groups. The first group received hard shell hip protectors without cost (no cost group). The second group received an educational session, a demonstration of the use of hip protectors, and free choice of type of hip protectors without cost (combined group). The third group was the control group who received a brochure about hip protectors. MEASUREMENTS: Primary outcome was adherence with the use of hip protectors at 3 and 6 months after recruitment. Secondary outcomes were falls, injuries, and fractures. RESULTS: No participants in the control group purchased hip protectors at any stage. At 3 months, 33% of participants in the no cost group and 27% in the combined group wore a hip protector at the time of visit. This declined to 25% and 24% respectively at 6 months. No significant difference was seen in any of the 3 adherence outcomes between the 2 intervention groups. The number of falls or hospitalizations did not differ between groups, with 5 hip fractures reported during the intervention period. Residents were more likely to be adherent if they were female and had greater restriction in daily activities. CONCLUSION: Providing free hip protectors to older people living in nursing care facilities was necessary to increase initial acceptance and adherence. Nevertheless, after 6 months the achieved level of adherence was not high enough to be associated with a reduction of hip fractures. The provision of educational sessions and demonstrations to nursing staff and participants had no added value in this trial.

The role of a community kitchen for clients in a socio-economically disadvantaged neighbourhood.

ISSUE ADDRESSED: To investigate the role of a community kitchen for clients living in a socio-economically disadvantaged neighbourhood. METHODS: In 2005, semi-structured interviews were conducted with 21 clients attending a community kitchen located in a socio-economically disadvantaged neighbourhood in New South Wales. Participants were asked their reasons for attending the kitchen. Qualitative content analysis was used to categorise verbatim responses to the open-ended questions. RESULTS: The main reasons participants attended the community kitchen were to alleviate food insecurity and the opportunity to interact socially in a safe place, followed by obtaining advice on a broad range of services to address health and social problems. CONCLUSIONS: The community kitchen had a positive effect on the lives of socially isolated people who are usually hard to reach, by providing meals, and facilitating social interaction and access to a wide range of services.

Assessing quality of life in paediatric clinical practice.

The rising prevalence of children with chronic conditions has made quality of life an increasingly important outcome measure in paediatric practice. The discrepancy between doctors' and patients' perceptions of quality of life makes formal assessment necessary. In this paper we use a case scenario to answer commonly asked questions. What is quality of life and who can assess it? Why assess quality of life in the clinical setting? Is it feasible to measure in routine clinical practice? How is quality of life formally assessed? We provide a basic outline of the language and methods of quality of life assessment and use the case scenario to discuss the process of choosing an appropriate instrument. We conclude that quality of life assessment in clinical practice is feasible and provides benefits for both patients and doctors. The benefits include better informed doctors, improved patient doctor communication and a means to effectively monitor quality of life as a treatment outcome.

The Lidcombe program of early stuttering intervention: mothers' experiences.

UNLABELLED: The Lidcombe Program is a behavioral treatment for early stuttering which is implemented by parents, typically the mother. Despite this, there is limited detailed knowledge about mothers' experiences of administering the treatment. This article describes the findings of a qualitative study which explored the experiences of 16 mothers during their implementation of the Lidcombe Program. Information was collected using semi-structured, in-depth, face-to-face and telephone interviews. Participants were interviewed pre-treatment, and then regularly throughout the 6-month treatment period. Data were collected from nine interviews conducted with each participant. All interviews (n=140) were audio recorded and then transcribed verbatim. Thematic analysis was used to identify major issues and topics which emerged from the data. Practicalities of implementing the program are reported, including obstacles that mothers faced and solutions to address these. Positive aspects that mothers experienced through their involvement are discussed. The mothers' perceptions of the treatment are outlined and descriptions of the emotions mothers reported are also presented. Findings from the study will enable clinicians to better deliver the Lidcombe Program and will enable improved course instruction and clinical education about the procedure. EDUCATIONAL OBJECTIVES: The reader will be able to (1) describe the key components of the Lidcombe Program, (2) describe the rationale and methodology for this study, (3) outline the major findings regarding the mothers' experiences of the Lidcombe Program, (4) describe how the findings can be implemented in a clinical setting and (5) evaluate the strengths and limitations of a qualitative study.

Sleeping infants safely - considerations for GPs.

The sudden death of an infant is a traumatic experience for both families and health practitioners. The most common cause of sudden infant death is SIDS, defined as 'the sudden and unexpected death of an infant under 1 year of age, with onset of lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy review of the circumstances of death and clinical history'. In 2004, SIDS accounted for 4.5% of deaths in infants aged less than 1 year in New South Wales. Evidence suggests the most common age of death from SIDS is 2-5 months, with a peak incidence at around 3-4 months.

Acculturation, sexual behaviour, risk and knowledge in Vietnamese men living in metropolitan Sydney.

OBJECTIVES: To describe the relationship between acculturation, sexual risk and sexually transmissible infections (STIs) and blood borne viruses (BBVs) knowledge among Vietnamese men living in inner Sydney and to compare this prevalence with national data. METHOD: Telephone interviews were completed with a random sample of Vietnamese men, selected from the electronic phone book using a list of common Vietnamese surnames. RESULTS: Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. There was an association between lower acculturation scores and having more than 10 lifetime sexual partners, more than 50 lifetime sexual partners, never using a condom, ever or recently having commercial sex, ever having an STI, being hepatitis B carriers or ever being imprisoned. CONCLUSION: There is an association between acculturation and many aspects of sexual behaviour.

'Is it normal to feel these questions ...?': a content analysis of the health concerns of adolescent girls writing to a magazine.

BACKGROUND: There is a mismatch between presenting concerns of adolescents to GPs and behaviours that lead to adolescent morbidity and mortality. Better understanding of health concerns of this target group would enhance communication between health professionals and adolescent patients. OBJECTIVE: To explore and categorize the health concerns of adolescent girls sending unsolicited emails to a teenage girls' magazine. METHOD: We conducted a content analysis of 1000 systematic randomly selected unsolicited emails submitted to the health column of an Australian adolescent girls' magazine over a 6-month period. RESULTS: Three main foci of concern were identified: Context of Concern, Health Issue of Concern and Advice Sought for Concern. Within Health Issue of Concern, there were five categories: body (47.5%), sex (31.9%), relationship (14.7%), mind (4.7%) and violence and/or safety (1.2%). Concerns within the body and sex categories ranged enormously, but frequently expressed intimate descriptions of anatomy, feelings, sexual practices and relationships. Many concerns occurred in the context of adolescents' relationships with others. The proportion of concerns about physical or psychological symptoms or health issues commonly associated with the adolescent age group (such as health risk behaviours, mental health, pregnancy and sexually transmitted infections) was relatively small. CONCLUSIONS: GPs and other health professionals might engage more readily with adolescent patients with a deeper understanding of the concerns that adolescents have about their bodies, relationships and overall health. Seemingly 'trivial' issues, such as normal puberty, could be used as discussion triggers in health consultations to help alleviate anxiety and build rapport.

Health and wellbeing through work and retirement transitions in mature age: understanding pre-post and retrospective measures of change.

The capacity to measure change is essential in examining successful adaptation to ageing. Few studies measuring change have compared findings using pre-post approaches (employing difference scores) with those from retrospective approaches (employing self-ratings). Where this has occurred, differences have been attributed either to ceiling and floor effects or to the operation of social comparison (Choi, 2002, 2003). Our study compared pre-post and retrospective measures of change in health, health behaviors, and wellbeing over periods of 1 and 3 years among retirees. Retrospective measures were found to be more positive than pre-post measures. This discrepancy was associated with floor and ceiling effects and with a robust self-image, but not with recency, social comparison, or social desirability response sets. Pre-post difference scores have limitations as indicators of change, particularly where ceiling effects operate. A retrospective perception of improvement, combined with deterioration in scores, may result from successful psychological adaptation as people grow older.

Low knowledge and high infection rates of hepatitis in Vietnamese men in Sydney.

OBJECTIVE: To describe hepatitis B and C knowledge and self-reported infection and risk behaviour in a group of Vietnamese men living in inner-urban Sydney, in order to assist with future program planning. METHODS: Data were collected through telephone interviews conducted in Vietnamese using a structured questionnaire from 499 of 761 eligible men contacted, giving a response rate of 66%. The data were weighted to be consistent with the age distribution of Vietnamese men in the area. The findings were compared with a published national telephone study. RESULTS: Low knowledge levels of hepatitis B and C were found when compared with data from a published national telephone study. The factors associated with higher mean knowledge scores for hepatitis B were being highly acculturated (P < 0.001), ever having been tested for HIV (P < 0.001) and knowing someone with HIV (P < 0.0001). For hepatitis C, the factors were being highly acculturated (P < 0.001), ever injecting drugs (P < 0.05) and being vaccinated for hepatitis B (P < 0.001). Knowledge regarding hepatitis B was particularly poor. High rates of self-reported hepatitis B infection were noted. Of the participants, 7.2% were aware that they had ever been infected with hepatitis B, more than 10 times the rate in the national telephone study. CONCLUSION: Lower levels of hepatitis B knowledge have been identified in a community with higher numbers of people living with chronic hepatitis B. Targeted community-wide awareness-raising campaigns and health care worker education is required to improve knowledge of hepatitis B and rates of screening in the Australian Vietnamese community.

Outlooks for the future in independently living older Australians.

OBJECTIVES: To explore outlooks for the future which exist in an older population, through construction of a typology of combinations of absence or presence of reported hopes and fears for the future and a detailed analysis of the characteristics of older people in each of the four outlook categories created: optimistic, pessimistic, realistic or detached. METHODS: The findings are based on population survey responses from 8881 older Australians (65 + yr) living independently in the community. The Cochrane-Armitage test was used to detect the presence of trends, while logistic regression modelling was used to examine predictors of respondents expressing no main hope and/or no main fear. RESULTS: The logistic regression modelling identified predictors of outlook category, which have face validity and are consistent with the literature. In addition, the proportion of older people in the pessimistic category with scores indicating psychological distress (Kessler 6) was significantly higher than in the three other categories, providing support for the validity of the typology. CONCLUSION: The vast majority of independently living older Australians have realistic or optimistic outlooks about their future. The small minority who are pessimistic, and more likely to be experiencing psychological distress, can be identified through self-reported absence of hopes accompanied by presence of fears.

Perceptions of personal safety among older Australians.

INTRODUCTION: There is public perception, partly attributable to the media, that older people are disproportionately the victims of crime and are greatly concerned for their personal safety. OBJECTIVES: To identify at a population level older people's perceptions of their personal safety in their home and separately in their neighbourhood, and the predictors of feeling safe in each setting. METHODS: Logistic regression analysis of responses from randomly selected older Australians (65+ years) living independently in the community (n= 8881) to a cross-sectional telephone general health survey. RESULTS: The vast majority of respondents, although higher in men, reported feeling safe in their home (96%) and neighbourhood (92%) 'all' or 'most' of the time. Feeling safe did not decline with age. Significant predictors of feeling safe 'all' the time were identified and some gender differences were noted. CONCLUSIONS: The perception that older people are greatly concerned with their personal safety is not supported by these findings.