Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE): protocol for a helix-counterbalanced randomised controlled trial.

INTRODUCTION: Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia's new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care. METHODS AND ANALYSIS: The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level. DISCUSSION: The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 - retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .

'Kookaburras, kangaroos and my frilly-necked lizard': The value of wildlife, nature and companion animals for older community-dwelling Australians.

OBJECTIVE: With little research investigating older Australians' experience of companion animal (pet) ownership or wildlife encounters, this paper focuses on the value of animals in their lives. METHODS: Three online focus groups explored 103 older adults' lived experience of home and community, with this paper focused on interactions with animals-companion animals and wildlife. RESULTS: Most (60%) had at least one pet, which brought love and joy into their lives. Reflexive thematic analysis identified three themes: pets as family; challenges of pet ownership; and connection to everyday wildlife and nature. CONCLUSIONS: In addition to valuing companion animals (typically cats and dogs), this research is among the first to show that some older people also develop ongoing relationships with local Australian wildlife, such as kookaburras, kangaroos, lizards and birds, which raises the possibility that fostering connections with wildlife may enhance well-being.

Fears and freedoms: A qualitative analysis of older adults' basic psychological needs for autonomy, competence, relatedness and beneficence.

OBJECTIVES: Self-determination theory posits three universal psychological needs: autonomy, competence and relatedness. Beneficence has recently been proposed as an important behaviour for improved well-being and eudaimonia. This study sought to qualitatively examine older adults' experiences of basic psychological needs satisfaction and frustration. METHODS: Three separate and simultaneous national online focus groups were undertaken over four consecutive days. Older Australians (n =103) explored home and community life. Themes were identified using reflexive thematic analysis. RESULTS: Older adults are challenged in satisfying their psychological needs, especially around the time - and after- they retire and as mobility decreases. Beneficence emerged as important for well-being, congruent with evidence that beneficence influences well-being beyond basic psychological need fulfilment. CONCLUSIONS: Satisfactions and frustration may manifest differently for older adults than for other groups. Thus, their experiences may not adequately be captured by self-report measures. Novel themes of 'fears and freedoms' were identified in the study. Fear pertained to the loss of autonomy and the freedom to spend time as one wishes.

My home in later life: A phenomenographic study of older adults' experience of home.

Home environments are especially important for older adults whose lives are more home-based than earlier life stages. Despite a focus on ageing in place, there often remains a mismatch between housing options prioritised by government and industry, and the needs and preferences of older adults. This paper considers the breadth of home environments experienced by diverse older Australians and highlights the varied ways they use and think about their homes. Data from three national online focus groups (n1 = 33, n2 = 37, n3 = 33) with people aged 50-92 were analysed using phenomenographic approaches to explore the different ways older adults perceived their home environments, resulting in four hierarchical conceptions. People displayed vastly different lifetime housing pathways (Clapham, 2005), leading to diverse perceptions about the place and experience of home in their later lives. In assessing the suitability of their housing, older people considered a large number of household members: current, expected or desired co-residents; transitory, short, medium and long-term residents; near and extended family, friends and dependents. This has important implications for policy and design responses on older adult's homes, which are typically focussed on occupancy by one or two individuals. To avoid assumptions about household makeup and usage based solely on the chronological age of residents, the perspective of older adults must be embraced in designing their future housing.

Online health communities, contributions to caregivers and resilience of older adults.

The aim of this paper is twofold. Firstly, to investigate the potential benefits of online health communities (OHCs) for informal caregivers by conducting a systematic literature review. Secondly, to identify the relationship between the potential benefits of OHCs and resilience factors of older adults. Performing a thematic analysis, we identified the potential benefits of OHCs for informal caregivers of older adults, including two salient themes: (a) caregivers sharing and receiving social support and (b) self and moral empowerment of caregivers. Then, we uncovered how these potential benefits can support resilience of older adults. Our findings show that sharing and receiving of social support by informal caregivers, and self and moral empowerment of informal caregivers in OHCs, can support four resilience factors among older adults, including self-care, independence, altruism and external connections. This review enables a better understanding of OHCs and Gerontology, and our outcomes also challenge the way healthcare and aged-care service providers view caregivers and older adults. Furthermore, the identified gap and opportunities would provide avenues for further research in OHCs.

Photovoice in aged care: What do residents value?

OBJECTIVES: This paper visually explores older aged care resident's day-to-day lived experience, as well as providing a brief introduction to the participatory documentary photography method of photovoice. METHODS: Ten residents from one Australian residential aged care facility collaborated with researchers and care staff to photograph, reflect on and share their lives. Photographs were shortlisted in individual and group discussions. RESULTS: Residents' photographs and narratives provide a visual understanding of what they value. Photographs captured three core themes: the restorative joy of nature (frangipanis); active engagement through leisure activities (football); and the value of social interactions and connections, especially with fellow residents and staff (friendship). CONCLUSIONS: As old age and aged care remain virtually invisible within popular visual culture, this research highlights the communicative value of participatory photography for challenging stereotypes, as well as the opportunities, challenges and value of visual methods with this cohort.

Availability of services in registered retirement villages in Queensland, Australia: A content analysis.

OBJECTIVE: The study investigates and compares the services available in different types of registered retirement villages in Queensland (QLD). METHODS: A content analysis based on official websites of 175 registered villages in QLD, Australia, is presented. RESULTS: This study identifies 82 services, with activity organisation, emergency response, hairdressing and transportation being most frequently available to residents. The number of services available is associated with the village size and financial type, with residents living in large private villages having access to significantly more services. CONCLUSION: The research findings reveal the state of the art of current industry practice. They provide useful implications for stakeholders. For instance, residents who prefer to get access to various services should focus more on large private villages. Developers can check their service delivery environment to confirm its balance with residents' competencies. The government can propose innovative initiatives to promote the delivery of appropriate services in villages.

Ageing and Learning in Australia: Arguing an Evidence Base for Informed and Equitable Policy.

BACKGROUND: Given Australia's population ageing and predicted impacts related to health, productivity, equity and enhancing quality of life outcomes for senior Australians, lifelong learning has been identified as a pathway for addressing the risks associated with an ageing population. To date Australian governments have paid little attention to addressing these needs and thus, there is an urgent need for policy development for lifelong learning as a national priority. The purpose of this article is to explore the current lifelong learning context in Australia and to propose a set of factors that are most likely to impact learning in later years. CONCLUSION: Evidence based policy that understands and incorporates learning opportunities for all citizens is required to meet emerging global challenges. Providing appropriate learning opportunities to seniors is one clear pathway for achieving diverse health, social and economic outcomes.

Older Australians: Structural barriers to learning in later life.

BACKGROUND: Learning in older age is associated with benefits including increases in skills, social interactions, self-satisfaction, coping ability, enjoyment, and resilience to age-related changes in the brain. It is also a fundamental component of active ageing and if active ageing objectives are to be met for the growing ageing population, barriers to learning need to be understood and addressed. This study aimed at determining the degree that structural factors deter people aged 55 years and older from engaging in learning activities. METHOD: The data were obtained from survey (n=421) with a purposive sample of Australian Seniors aged 55 to 75+, and open ended follow up interviews (n=40). The survey responses to the 22 barriers to learning questions were ranked and quantified. The issues identified in the interviews shed further light on the survey data. RESULTS: The analyses revealed that factors related to educational institutions as well as infrastructure were commonly cited as barriers to participation in learning. In particular expense of educational programmes (55.1%), long travelling time (45.6%) other transportation difficulties (38.9%), lack of interest in offered programmes ((36.4) and lack of information about courses (31.1%) were seen as barriers. The interviews revealed and confirmed five main barriers; money, offerings of interest/availability, travel/transport, information, computer skills and being employed. CONCLUSION: The findings should provide policy makers, institutions, organizations and government with a list of areas where changes might be made so as to improve older people's opportunities for learning as they proceed through older age.

Ageing and learning as conceptualized by senior adults in two cultures: Hong Kong and Australia.

BACKGROUND: This paper is about a study aimed to understand what successful ageing and later life learning mean to older adults in two cultures: Hong Kong and Australia. OBJECTIVE: It aims to shed light on (1) the meaning of ageing and learning as conceptualized by elders in Hong Kong and Australia; (2) the reasons for participation in later life learning, as well as, barriers for non-participation; (3) their learning interests and instructional preferences; and (4) the correlation between learning and successful ageing, and between learning and other well-being variables, including health, happiness and satisfaction. METHOD: Two large samples of elders from Hong Kong (n=519) and Australia (n=421) participated in the study. A self-developed questionnaire, called the "Learning and Ageing Survey 2013", was used. It included a total of 108 structured questions in three sections. RESULTS: Within group analysis of the data from the two locations indicated that there are more similarities, rather than differences, between elders in Hong Kong and Australia with respect to background characteristics, meanings of ageing and learning, reasons for participation, barriers for nonparticipation, learning interests and instructional preferences. CONCLUSIONS: The fact that there are more commonalities, rather than differences, between the two samples of elders from two different cultures supports the claim that cultures very often overlap and coincide, and need not be seen as polarized, where becoming bi-cultural is possible. It is therefore important for cross-cultural comparative research to identify cultural differences, while at the same time, to recognize the existence of similarities between cultures.

Active Aging: Exploration into Self-Ratings of "Being Active," Out-of-Home Physical Activity, and Participation among Older Australian Adults Living in Four Different Settings.

We examined whether self-ratings of "being active" among older people living in four different settings (major city high and lower density suburbs, a regional city, and a rural area) were associated with out-of-home participation and outdoor physical activity. A mixed-methods approach (survey, travel diary, and GPS tracking over a one-week period) was used to gather data from 48 individuals aged over 55 years. Self-ratings of "being active" were found to be positively correlated with the number of days older people spent time away from home but unrelated to time traveled by active means (walking and biking). No significant differences in active travel were found between the four study locations, despite differences in their respective built environments. The findings suggest that additional strategies to the creation of "age-friendly" environments are needed if older people are to increase their levels of outdoor physical activity. "Active aging" promotion campaigns may need to explicitly identify the benefits of walking outdoors to ambulatory older people as a means of maintaining their overall health, functional ability, and participation within society in the long-term and also encourage the development of community-based programs in order to facilitate regular walking for this group.

Systems Modelling of the Socio-Technical Aspects of Residential Electricity Use and Network Peak Demand.

Provision of network infrastructure to meet rising network peak demand is increasing the cost of electricity. Addressing this demand is a major imperative for Australian electricity agencies. The network peak demand model reported in this paper provides a quantified decision support tool and a means of understanding the key influences and impacts on network peak demand. An investigation of the system factors impacting residential consumers' peak demand for electricity was undertaken in Queensland, Australia. Technical factors, such as the customers' location, housing construction and appliances, were combined with social factors, such as household demographics, culture, trust and knowledge, and Change Management Options (CMOs) such as tariffs, price, managed supply, etc., in a conceptual 'map' of the system. A Bayesian network was used to quantify the model and provide insights into the major influential factors and their interactions. The model was also used to examine the reduction in network peak demand with different market-based and government interventions in various customer locations of interest and investigate the relative importance of instituting programs that build trust and knowledge through well designed customer-industry engagement activities. The Bayesian network was implemented via a spreadsheet with a tickbox interface. The model combined available data from industry-specific and public sources with relevant expert opinion. The results revealed that the most effective intervention strategies involve combining particular CMOs with associated education and engagement activities. The model demonstrated the importance of designing interventions that take into account the interactions of the various elements of the socio-technical system. The options that provided the greatest impact on peak demand were Off-Peak Tariffs and Managed Supply and increases in the price of electricity. The impact in peak demand reduction differed for each of the locations and highlighted that household numbers, demographics as well as the different climates were significant factors. It presented possible network peak demand reductions which would delay any upgrade of networks, resulting in savings for Queensland utilities and ultimately for households. The use of this systems approach using Bayesian networks to assist the management of peak demand in different modelled locations in Queensland provided insights about the most important elements in the system and the intervention strategies that could be tailored to the targeted customer segments.

Establishing and maintaining social connectivity: An understanding of the lived experiences of older adults residing in regional and rural communities.

OBJECTIVE: To better understand how to plan for an ageing demographic that resides in ever-changing community typologies. DESIGN: Semi-structured in-depth interviews. SETTING: Community settings in rural and regional towns in Queensland. PARTICIPANTS: Twenty-two people aged over 65 years living in regional and rural Australia. INTERVENTIONS: Qualitative study of social connectedness. MAIN OUTCOME MEASURE(S): Thematic qualitative analysis. RESULTS: Formal and informal social contact, through family, friends and social groups, was found to be important to the everyday lives of the participants. CONCLUSIONS: Social connections for older adults are important in maintaining independence and community engagement.

A framework for understanding and generating integrated solutions for residential peak energy demand.

Supplying peak energy demand in a cost effective, reliable manner is a critical focus for utilities internationally. Successfully addressing peak energy concerns requires understanding of all the factors that affect electricity demand especially at peak times. This paper is based on past attempts of proposing models designed to aid our understanding of the influences on residential peak energy demand in a systematic and comprehensive way. Our model has been developed through a group model building process as a systems framework of the problem situation to model the complexity within and between systems and indicate how changes in one element might flow on to others. It is comprised of themes (social, technical and change management options) networked together in a way that captures their influence and association with each other and also their influence, association and impact on appliance usage and residential peak energy demand. The real value of the model is in creating awareness, understanding and insight into the complexity of residential peak energy demand and in working with this complexity to identify and integrate the social, technical and change management option themes and their impact on appliance usage and residential energy demand at peak times.

Review of community facilities in Australian retirement villages: A content analysis.

AIM: Facilities in retirement villages form a supportive environment for older residents. The purpose of this paper is to investigate the provision of these facilities in retirement villages, which are regarded as a viable accommodation option for the increasing ageing population in Australia. METHODS: A content analysis of facilities in 124 retirement villages operated by 22 developers in Queensland and South Australia was conducted. RESULTS: The most widely provided facilities are community centres, libraries, barbeque facilities, hairdressers/salons and billiards/snooker/pool tables. Commercial operators provide more facilities than not-for-profit organisations, and larger retirement villages normally have more facilities due to the economies of scale involved. CONCLUSIONS: The results of the study provide a useful reference for providing facilities within retirement villages that may support the quality lifestyles of older residents.

Investigation into the effect of infrastructure on fly-in fly-out mining workers.

OBJECTIVE: To explore fly-in fly-out (FIFO) mining workers' attitudes towards the leisure time they spend in mining camps, the recreational and social aspects of mining camp culture, the camps' communal and recreational infrastructure and activities, and implications for health. DESIGN: In-depth semistructured interviews. SETTING: Individual interviews at locations convenient for each participant. PARTICIPANTS: A total of seven participants, one female and six males. The age group varied within 20-59 years. Marital status varied across participants. MAIN OUTCOME MEASURES: A qualitative approach was used to interview participants, with responses thematically analysed. Findings highlight how the recreational infrastructure and activities at mining camps impact participants' enjoyment of the camps and their feelings of community and social inclusion. RESULTS: Three main areas of need were identified in the interviews, as follows: (i) on-site facilities and activities; (ii) the role of infrastructure in facilitating a sense of community; and (iii) barriers to social interaction. CONCLUSION: Recreational infrastructure and activities enhance the experience of FIFO workers at mining camps. The availability of quality recreational facilities helps promote social interaction, provides for greater social inclusion and improves the experience of mining camps for their temporary FIFO residents. The infrastructure also needs to allow for privacy and individual recreational activities, which participants identified as important emotional needs. Developing appropriate recreational infrastructure at mining camps would enhance social interactions among FIFO workers, improve their well-being and foster a sense of community. Introducing infrastructure to promote social and recreational activities could also reduce alcohol-related social exclusion.

Moving from outsider to insider: peer status and partnerships between electricity utilities and residential consumers.

An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008. By 2011, both the peak demand and grid supplied electricity consumption had decreased to below pre-intervention levels. This case study research explored the relationship developed between the utility, community and individual consumer from the residential customer perspective through qualitative research of 22 residential households. It is proposed that an energy utility can be highly successful at peak demand reduction by becoming a community member and a peer to residential consumers and developing the necessary trust, access, influence and partnership required to create the responsive environment to change. A peer-community approach could provide policymakers with a pathway for implementing pro-environmental behaviour for low carbon communities, as well as peak demand reduction, thereby addressing government emission targets while limiting the cost of living increases from infrastructure expenditure.

Conceptions of 'community' among older adults living in high-density urban areas: an Australian case study.

AIM: The aim of this study was to explore the social networks of community and its connection to location for older people living in inner city high density (ICHD). METHOD: Using a case study approach employing qualitative (diaries, in-depth interviews) and quantitative (global positioning systems and geographical information systems mapping) methods, this paper explores the everyday interaction and social networks and where they manifest spatially for a group of older ICHD Australians. RESULTS: Social networks in two community territories were found to be of particular importance to participants in terms of influencing feelings of well-being, support, social inclusion and cohesion. These two territories include the building where older people reside and the area immediately surrounding the building. CONCLUSION: This study highlights the importance of recognising the spatial aspect of community to better understand the social networks of community and their effects on well-being and social cohesion for ICHD older people.

Perceptions of climate change and trust in information providers in rural Australia.

Disagreement within the global science community about the certainty and causes of climate change has led the general public to question what to believe and whom to trust on matters related to this issue. This paper reports on qualitative research undertaken with Australian residents from two rural areas to explore their perceptions of climate change and trust in information providers. While overall, residents tended to agree that climate change is a reality, perceptions varied in terms of its causes and how best to address it. Politicians, government, and the media were described as untrustworthy sources of information about climate change, with independent scientists being the most trusted. The vested interests of information providers appeared to be a key reason for their distrust. The findings highlight the importance of improved transparency and consultation with the public when communicating information about climate change and related policies.

Sustainability literacy of older people in retirement villages.

With many developed countries experiencing the aging of the population, older people play a large role in contributing to environmental problems but also to environmental solutions. The purpose of this research is to understand the awareness and behavior of current older people living in retirement villages towards sustainability development. To achieve this, a sustainability literacy survey was conducted with 65 older residents of a private retirement village located 10 Km outside the Brisbane, Australia's central business district (CBD). Most of residents recognized the importance of environment protection and would like to lead a more environmentally friendly lifestyle. In addition, the majority were willing to pay higher prices for a living environment with sustainable features. The importance of positive social communications was emphasized with most residents having established good relationships with others in the village. The findings provide an important insight into consumer perspectives regarding the sustainable features that should and can be incorporated into the village planning and development.