In their own words: An exploration of primary children's participation in a dementia education program.

ISSUE ADDRESSED: As the population ages the prevalence of dementia increases and children are increasingly experiencing family members and older friends living with dementia. Unfortunately, stigma about living with dementia is common. Increasing understanding about dementia among children has the potential to reduce this stigma. This paper reports on the qualitative findings of Project DARE (dementia knowledge, art, research and education), a school-based, multi-modal, arts program designed to increase understanding about dementia among children aged 8-10 years. METHODS: A constructivist grounded theory approach was used to understand students' experience of the intervention. Thematic analysis was used to identify key themes emerging from interviews with randomly selected students (n = 40) who had taken part in the program. RESULTS: The data analysis generated three themes related to students' awareness of dementia and experiences of the program: (1) nurturing empathy, (2) memory loss is complex, (3) learning about dementia through the arts to promote resilience. These themes show that the intervention increased students' awareness of dementia, and empathy towards people who are both directly and indirectly affected by dementia. CONCLUSIONS: Although dementia education can be viewed as too sensitive for primary aged students, the current study demonstrates that such initiatives are feasible and can be effectively implemented with this age group. SO WHAT?: Changing student's beliefs about dementia can positively impact their relationships with people living with dementia.

Evidence-Based Practice in Medical Education: Mapping a Research and Critical Analysis Program Against the Sicily Statement.

This paper describes how evidence-based practice (EBP) is taught through an integrated curriculum across a 4-year graduate MD program. Mapping of the curriculum to the domains of the Sicily Statement of EBP was an effective approach to evaluate integration of EBP into a graduate medical education program. The longitudinal integration of EBP engages students in multiple opportunities to learn, understand, and apply these concepts. The EBP program incorporates both traditional and innovative teaching approaches and can easily be adapted for other professional courses. This whole-course approach is graduating a new generation of doctors with a sound understanding of EBP.

Dementia knowledge, art, research and education - Teaching primary school children about dementia.

ISSUE ADDRESSED: To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children. METHODS: A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10 years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks. RESULTS: Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos. CONCLUSION: Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities.

A case-study of the experiences of junior medical officers in the emergency departments of a metropolitan hospital and rural hospital.

OBJECTIVE: Increased exposure to post-graduate rural medical training is associated with increased likelihood of future rural practice. Training rotations in rural emergency departments provide a possible avenue for such exposure, but have been under-investigated. This study aimed to compare junior medical officers' emergency department experiences in a metropolitan and a rural hospital to inform rural health workforce initiatives. DESIGN: Mixed-method case-study design. SETTING: Two 10-week periods in the respective emergency departments. PARTICIPANTS: Four junior medical officers at the rural site and 22 junior medical officers at the metropolitan hospital. MAIN OUTCOME MEASURES: Caseloads extracted from electronic medical records and training experience. RESULTS: Data were collected over 142 days. The average number of patients seen per day, per junior medical officer, was significantly higher at the rural hospital emergency department (7.2 patients per day) in comparison with the metropolitan hospital (4.3 patients per day). Junior medical officers at the rural hospital saw relatively more lower acuity patients. The seven junior medical officers who were interviewed provided consistently positive responses regarding their training experiences in both locations. This was particularly evident in the rural hospital and was attributed to one-on-one supervision. CONCLUSIONS: Most junior medical officers agreed that their expectations for support and learning opportunities were met and/or exceeded. However, junior medical officers reported feeling more supported at the rural hospital due to direct contact and communication with senior medical officers. Placement in a smaller hospital emergency department did not disadvantage the junior medical officers' training in this case-study and provided a positive rural training experience. These findings support workforce policies which encourage rural hospital emergency department training.

Hospitalisation for medication misadventures among older adults with and without dementia: A 5-year retrospective study.

OBJECTIVES: To compare rates and trends in hospital admissions due to medication misadventure for older adults (≥65 years) with and without dementia. METHODS: A retrospective analysis of hospital admissions that occurred between 2012 and 2016, for medication misadventures among older adults living in regional Australia. RESULTS: Medication misadventures contributed to 10 555 (4.6%) of the total 228 165 admissions for older adults over the study period. Among these admissions, older adults with dementia were three times more likely to be hospitalised with medication misadventures (14.0%), than their non-dementia counterparts (4.2%). Medication misadventures relating to "anticoagulants" and "opioids/related analgesics" accounted for the majority of admissions (24.3% dementia vs 30.7% non-dementia). CONCLUSIONS: This study highlights that the proportion of older adults hospitalised for a medication misadventure is much higher among those with dementia, than those without dementia. Strategies should target older adults, and especially those with dementia, to reduce medication-related harm and improve patient safety.

"She Would Love That": Identifying Community Needs in a Multisensory Environment.

BACKGROUND: CareWays Community, a not-for-profit organization that provides community care services within the Illawarra region of Australia, and researchers from the University of Wollongong (Australia) collaborated to conduct research into the requirements and requests of the local community regarding the creation of a multisensory environment (MSE). OBJECTIVES: Guided by the principles of community-based participatory research (CBPR), we sought to gain an understanding of what the community wanted with respect to the design and implementation of a MSE, before its construction at a local community center managed by CareWays. METHODS: A mixed methods approach was adopted to access as many participants as possible. Participants included both professional and familial caregivers and educators of potential clientele. A total of 24 people participated in either a focus group or a one-on-one telephone interview. Additionally, the Delphi method was used to survey a total of 87 respondents over two rounds to identify the specific equipment preferred for the MSE. RESULTS: Participants expressed both their wishes and concerns regarding the proposed MSE. They wanted a safe, noncategorical environment able to cater to a range of users. They preferred private access, and wanted the MSE to be available for bookings across a wide range of times. Participants wanted the MSE to contain equipment that stimulated all senses, and identified specific items of equipment most preferred. CONCLUSIONS: This research enabled the identification of what the local community is seeking in a MSE. The research findings have been incorporated, as far as practicable, into the design and construction of the Careways MSE.

Evaluating the Managing Medicines for People With Dementia Website Version 2.

The Managing Medicines for People With Dementia version 2 website was developed in three languages, English, Italian, and Macedonian, to assist informal caregivers in the task of managing medications. Medication management is a complex task with potentially high stakes health outcomes, including hospitalization and death. A mixed-methods evaluation was carried out. A survey was available to site users and Web log data were collected over a 3-month period. Subsequently, the quality and suitability of the information and readability and usability of the Web site were evaluated. Focus groups and interviews were conducted with end users from all three language groups. Data collected from the evaluation surveys during the pilot test showed that users were generally satisfied with site usability (77%). The results of the readability testing indicate that future versions could be improved. Feedback from the focus groups and interviews was generally positive. The use of multiple methodologies provided comprehensive testing that is likely to have identified the majority of usability issues. Ways in which the site can be maintained with up-to-date information and be promoted to the target population, informal carers, need to be explored.

What do Australian & New Zealand caregivers know about children's ibuprofen? The results of an online survey?

BACKGROUND: Children's formulations containing ibuprofen are frequently used to treat pain and fever. These medications, available over-the-counter, have the potential to cause adverse events if usage/safety information is not adhered to. This study aimed to investigate caregivers' knowledge about the safe use of a commonly purchased children's formulation containing ibuprofen. METHODS: A convenience sample of caregivers in Australia and New Zealand, who had purchased Nurofen® for Children, completed an online survey assessing their knowledge of product information and dosage instructions available on/in the product packaging. RESULTS: In total, 219 caregivers (mainly female 95%, mean age ± SD; 35 ± 6.82 years) completed the online survey. Responses suggest limitations in their knowledge about the active ingredients, contraindications and side effect profile associated with the product. Most respondents had a good understanding about the correct dosage to give children based on their weight and/or age, but many lacked a good understanding about the correct interval between doses and the maximum number of daily doses. CONCLUSIONS: These findings suggest that caregivers administering ibuprofen to children have gaps in their product knowledge. Strategies to help improve caregivers' knowledge about the safe administration of these products should be prioritised in an attempt to reduce the likelihood of children experiencing ibuprofen related adverse events. Improving caregiver knowledge to address these gaps is an important issue for all health care providers.

Impact of Interactive Education on Health Care Practitioners and Older Adults at Risk of Delirium: A Literature Review.

The current integrative literature review explored the impact of interactive delirium care education in facilitating knowledge transfer to health care practitioners and improving health outcomes for older adults. Academic databases, including MEDLINE, CINAHL, and Web of Science, were searched using the terms delirium and simulation or interactive education. Selected articles were analyzed using Critical Appraisals Skills Programme tools. Twenty studies were reviewed and three themes generated to explain the current understanding of the impact of interactive delirium care education on outcomes for: (a) individuals with delirium; (b) organizational health care; and (c) health care practitioners. The current review demonstrated that interactive education is a promising contemporary approach for raising awareness about best practice delirium care by health care practitioners. Due to gaps in the literature, future educational research in the area of delirium care education needs to adopt a more consistent method of reporting findings to ensure successful transferability across care settings. [Journal of Gerontological Nursing, 44(8), 41-48.].

Managing medications for individuals living with a dementia: Evaluating a web-based information resource for informal carers.

AIMS: The purpose of the study was to evaluate the usefulness of the "Managing Medicines for People with Dementia" (www.dementiameds.com) website for informal carers. BACKGROUND: The management of medications for individuals living with a dementia by informal carers is a neglected area of care. We know that informal carers find it difficult accessing reliable and comprehensive information about medications. We also know that the Internet is a contemporary and growing medium through which consumers access health information. This study was unique in that it brought these two elements together through an interdisciplinary study about the usefulness of a new website providing information on medication management. METHODS: Data collection consisted of focus groups with informal carers of individuals living with a dementia. Data were analysed through content analysis. FINDINGS: Four themes were generated from the data to explain the evaluation of the website by informal carers: (1) Suitability of the website; (2) Presentation of the website; (3) Unexpected benefits of the website content; (4) Future enhancements for website. Participants overwhelmingly agreed the content of the website filled a gap in information needs about medication management for individuals living with a dementia. IMPLICATIONS FOR PRACTICE: This qualitative evaluation demonstrated the value of the website as a resource for informal carers of individuals living with a dementia. The resource could also be used by community nurses and other healthcare practitioners to help informal carers better manage the medication regimes of individuals living with a dementia. The resource has the potential to reduce complications associated with mismanagement of medications and contribute to new policies for implementing safe medication practices.

Are older Australians with chronic diseases online?

ISSUE ADDRESSED: Health information can be easily and cheaply provided through the Internet. However, we do not know whether older adults, those people most likely to be living with a chronic disease, are online or whether they use the Internet to find health information. METHODS: In order to establish the proportion of older Australians online, the impact of their current health status and chronic disease diagnosis on Internet usage and whether they use the Internet to search for health information, a paper-based survey was developed and mailed to 9000 older adults, resident in New South Wales, Australia (response rate = 46.8% ). RESULTS: Results showed that many older Australians are online (52.3%) and that the majority who are use the Internet to find health information (68.5%). Respondents were more likely to use the Internet if they reported good health. The presence of most chronic diseases reduced use of the Internet; however, this was not the case for those reporting asthma, anxiety or sleep apnoea. Internet use decreased as the number of reported co-morbidities increased. However, once online, self-perceived overall health and number of chronic diseases did not affect use of the Internet to find health information. CONCLUSIONS: This study is important as there is currently little information available about Internet use for health information by older Australians. Findings show that the provision of health information online has the potential to reinforce existing barriers created by the social determinants of health. SO WHAT?: There is a role for the Internet in providing preventative, health promotion information, to older adults, who are already online and younger, computer literate audiences. However, practitioners need to consider the fact that this mode of delivery reinforces existing social divides; requires people to have Internet access and be both literate and e-literate.

Is it My Job? The Role of RNs in the Assessment and Identification of Delirium in Hospitalized Older Adults: An Exploratory Qualitative Study.

Delirium is characterized by acute and fluctuating cognitive decline, which is often missed in older adults who are assumed to be experiencing age-related changes or dementia. Delirium affects up to 50% of hospitalized older adults. The aim of the current study was to (a) explore current practices of RNs in assessing and identifying delirium in hospitalized older adults and (b) inform new educational initiatives. Qualitative methods were adopted using eight semi-structured group interviews with 24 RNs. Thematic analysis revealed a dichotomy in practice where RNs described delirium assessment and identification as (a) It's Not My Job, (b) It is My Job, and (c) It's Complex. The imperative to improve delirium assessment and identification to create safer and more caring health care environments means the current findings provide important evidence to build into practice and education strategies. The current authors have developed engaging educational interventions and begun implementation at the study site to develop delirium assessment and identification capacity, which moves clinicians beyond awareness and aims at practice adherence or the consistent application of evidence-based delirium assessment. [Journal of Gerontological Nursing, 43(4), 29-37.].

Consumer knowledge about over-the-counter NSAIDs: they don't know what they don't know.

OBJECTIVE: To investigate consumers' knowledge about commonly purchased over-the-counter (OTC) products containing ibuprofen. METHODS: Customers buying two popular OTC ibuprofen-containing products (Nurofen™ or Nurofen Plus™ ) were asked to complete a short survey assessing their knowledge about the products. RESULTS: The survey was completed by 262 respondents, most of whom were older than 50 years of age; female; well-educated; with adequate functional health literacy. The majority correctly identified ibuprofen as an active ingredient and knew the correct intervals between doses. However, almost a third couldn't correctly identify the maximum daily dose and were unaware of some contraindications. Furthermore, fewer than half recognised potential side effects. Those who hadn't completed high school were significantly less likely to seek medical advice (when required) and significantly less likely to know when it was safe to take these products. CONCLUSIONS: The gaps in consumer knowledge, especially about the maximum daily dose, contraindications and potential side effects may be placing consumers at risk of experiencing ibuprofen-related adverse events. Implications for public health: Improving consumer knowledge to address these gaps in their understanding about the safe use of popular OTC ibuprofen-containing products is an important public health concern.

'Involve Me and I Learn': Development of an Assessment Program for Research and Critical Analysis.

Evidence-based medical practice is best achieved by developing research understanding in medical practitioners. To this end, medical councils worldwide increasingly recognise the importance of medical schools graduating students with well-developed research skills and research capacity. To meet this need, the principles of programmatic assessment were implemented in designing a research and critical analysis curriculum and assessment program that aimed to enhance the research and critical analysis skills of medical students. The program was developed by mapping assessment tasks to a research capabilities framework that was in turn scaffolded to different levels of Miler's pyramid. The curriculum and assessments were integrated with the science, clinical, and professional aspects of the medical course. The progressive longitudinal development of research skills, with feedback and academic mentoring, culminated in the students' capacity to undertake an independent research project. Designing an assessment program for learning encouraged students to develop their research capacity by involving them in their learning.

Is delirium being detected in emergency?

OBJECTIVE: To report on the use of Delirium Care Pathways to screen for and recognise delirium by Aged Care Services in Emergency Teams (ASETs) at five metropolitan hospitals in New South Wales, Australia. Knowledge of delirium and the use of Delirium Care Pathways are vital to ensure that older people presenting with delirium receive best practice care. METHODS: An audit of 205 randomly selected medical records of clients over 65 years presenting to an ASET was conducted. RESULTS: Delirium was recorded in the medical records notes of four clients (2%). However, the auditors identified another 27 clients with symptoms of delirium. CONCLUSIONS: Delirium is still frequently undiagnosed and misdiagnosed in older people presenting to emergency departments. This indicates a need for further education and professional development for and by health-care practitioners. Only with greater awareness of delirium will the care and health outcomes of older adults presenting with delirium in acute care settings improve.

Internet self-management uniform reporting framework: the need for uniform reporting criteria when reporting internet interventions.

A review of the literature was conducted to identify the "active ingredients" needed to produce successful Internet interventions that support older adults in self-management of chronic disease. The term "Internet intervention" was used as an umbrella term to include all online self-management programs. Thirteen articles were found to meet the inclusion criteria from the initial 204 articles identified. Ritterband's Model of Internet Interventions was used as a framework to classify the intervention components reported. It was found that online self-management interventions can improve outcomes for some older adults. However, the wide diversity of interventions and the measures reported, coupled with the complex nature of the studies, made it difficult to identify the "active ingredients." To overcome this problem, the authors propose a minimum reporting set, the Internet Self-Management Uniform Reporting Framework, which can be used in the reporting of all interventions. Internet Self-Management Uniform Reporting Framework proposes the collection of specific data from six domains: Web site design, support, study design, Web site use, user characteristics and reporting outcomes. The adoption of Internet Self-Management Uniform Reporting Framework would enable easy comparison of online interventions targeting chronic diseases.

AsthmaWise - a field of dreams? The results of an online education program targeting older adults with asthma.

OBJECTIVES: The aim of this study was to establish the feasibility and acceptability of an online asthma self-management program developed for older Australians with asthma. METHODS: AsthmaWise, an internet education self-management program, was piloted for a 3-month period at the beginning of 2012. Participants were recruited using both online and offline strategies and were required to complete surveys, both pre- and post-intervention, in a repeated measures design. RESULTS: Matched data were collected from 51 participants; the results showed AsthmaWise to be a feasible and acceptable method of delivering asthma education to the target population. Self-reported measures showed an increase in participants' asthma knowledge, asthma control and quality of life. Results from the Perceived Health Web Site Usability Questionnaire (PHWSUQ) showed improvements between usability testing and implementation. CONCLUSION: The need for asthma self-management education will continue to increase as the population ages and a greater number of older adults are living with asthma. This small pilot study indicates that an online asthma self-management education program can result in improved outcome measures in a target group not normally considered technologically literate.

Usability testing of AsthmaWise with older adults.

There are many reasons why online self-management education is attractive to both patients and providers. AsthmaWise, an online self-management program, was developed using a Moodle platform, to enable older adults to learn asthma self-management skills. This study aimed to improve AsthmaWise through conducting: usability testing with a sample of end users; a cognitive walk-through undertaken by an independent health researcher; and assessment of content readability. A Perceived Health Web Site Usability Questionnaire score of 67% was achieved, indicating that there were usability issues that needed to be addressed. The cognitive walk-through and readability assessment identified unique issues that were not identified through usability testing with end users. The testing process allowed issues to be identified and rectified before piloting AsthmaWise, creating a more accessible and refined end product. The involvement of the site designer in the testing process was valuable and is highly recommended. This study shows that usability testing involving both end users and experts is an essential part of the design process that is relatively easy and inexpensive to undertake and can be effectively conducted by a nonexpert.

Riding the wave or paddling in the shallows? Understanding older Australians' use of the internet.

ISSUES ADDRESSED: Australia's ageing population is set to become an increasing burden on an already over-stretched primary health care system. Potential strategies to alleviate this pressure need to be investigated. Increased knowledge of older Australians' use of the internet would allow the appropriateness of online health intervention to be assessed. This initial, exploratory study examined the proportion of people aged 55 years and older who accessed the internet. It investigated their duration of use, level of comfort, use of the internet to seek health information and perceived reliability of information found on the internet. METHODS: A paper based survey was distributed to a purposive sample of adults in metropolitan New South Wales. Complete data was received from 115 respondents. RESULTS: Sixty-two per cent of respondents reported internet use, with use decreasing with age. The majority of respondents who used the internet reported high confidence levels and long-term use. The majority had used the internet to search for health information which was generally perceived to be reliable. Logistic regression showed tertiary education and household income greater than $40,000 per year predicted use of a computer to access the internet. CONCLUSIONS: The majority of older Australians surveyed were successfully riding the internet wave. They have both the skills and equipment to access health information online and many were already doing so.