Investigating the perspectives of older adults in residential aged care on oral health-related quality of life.

OBJECTIVE: The objective of the study was to explore how older people living in a residential aged care facility perceived that their oral health influenced their food preferences and attitudes towards food, their social interactions and their self-esteem. BACKGROUND: Poor oral health can have biological, behavioural and social impacts on quality of life among older adults (aged 65+ years). In terms of biological impacts, oral health impairments may cause older adults to avoid many types of foods. This shift in dietary pattern can lead to malnutrition among older people, undermine general health and negatively impact quality of life (QOL). MATERIALS AND METHODS: Using a mixed methods approach, quantitative data from the General Oral Health Assessment Index (GOHAI) were explored and supported by data from semi-structured interviews with 10 older adults from a residential aged care facility in Perth, (Australia) to provide insights into their oral health-related quality of life. Thematic analysis of qualitative data was guided by the conceptual framework informed by Locker. RESULTS: The average GOHAI score was 32.9 ± 3.6, which indicated that participants had an average oral health-related quality of life. Participants coped with oral functional problems by adopting personal strategies and seeking organisational assistance. Some participants appeared to have accepted associated changes to their physical appearance, while others reported significant dissatisfaction and low self-esteem. Perceptions differed on their social interactions at the facility, from being self-conscious about their own oral health problems, to distaste at others' eating behaviours. CONCLUSIONS: Poor oral health had negative biological, behavioural and social impacts on daily activities and quality of life among some participants. However, changes at the organisation level may help to support participant QOL.

Nursing students doing gender: Implications for higher education and the nursing profession.

The average age of women nursing students in Australia is rising. With this comes the likelihood that more now begin university with family responsibilities, and with their lives structured by the roles of mother and partner. Women with more traditionally gendered ideas of these roles, such as nurturing others and self-sacrifice, are known to be attracted to nursing as a profession; once at university, however, these students can be vulnerable to gender role stress from the competing demands of study. A qualitative research design, guided by Gadamer's hermeneutic philosophy, explored the gendered behaviours and experiences of 22 women nursing students, all of whom had children and began university in a heterosexual intimate relationship. The findings reveal traditional ideas of gender were almost universal among participants, and these ideas had a significant influence on the nursing degree experience. Participants commonly prioritised family over the university and practiced maternal gatekeeping (prevention of male partner involvement in domestic work). These traditionally gendered behaviours, coupled with experiences of gender role stress, had a detrimental impact on participants' capacity to study and their personal wellbeing. The importance of these findings to the burgeoning nursing workforce shortage nursing is considered in terms of student retention and the supply of graduates into the profession. The implications to the nursing profession are also explored against the evidence that nursing students with traditional gender beliefs are less likely to develop as autonomous, critical thinking nurses compared to their gender-egalitarian peers. The introduction of gender theory via critical pedagogy in the undergraduate nursing degree curriculum is recommended to enlighten and empower women nursing students and promote the competence, agility, and sustainability of the nursing profession.

Improving the Transition of Older Adults into Residential Aged Care: A Scoping Review.

OBJECTIVES: The transition into residential aged care (RAC) is often associated with loss, grief, isolation and loneliness. This scoping review aimed to identify quantitative research which focused on reducing the negative effects associated with transition, thereby improving the transition experience. METHODS: A scoping review, which concentrated on quantitative research, was conducted. MEDLINE, CINAHL andPSYCHINFO databases were searched using the initial search terms "olderadults", "residential aged care" and "transition". RESULTS: From the 457 original citations identified, four met the inclusion criteria. The interventions used a range of professionals and clinicians, diverse content, and a mixture of outcomes. The content of the more successful studies were underpinned by mental wellness themes and helped to reduce depressive symptoms among new residents. CONCLUSIONS: Our review provides a summary of interventions aimed at improving the transition experience for older adults moving into RAC and highlights gaps in the literature. This review is limited by the paucity of quantitative research in this area. Further research is required to address the negative psychosocial effects associated with transition into RAC. CLINICAL IMPLICATIONS: Assessing which of the transition phases an individual is in can help individualize interventions to reduce negative symptoms relating to transition.

Applying the 4Ps of social marketing to retain and engage participants in longitudinal cohort studies: generation 2 Raine study participant perspectives.

BACKGROUND: Investigations of participant retention in longitudinal health and medical research, document  strategies that work best but overlook social marketing's capacity to influence participant retention. After applying the social marketing framework: the idea that determining what longitudinal participants 'buy' (product), at what cost (price), in what location (place) and through which communication channels (promotion),  this paper  aims to inform and enhance retention efforts. METHODS: This qualitative study was conducted through in-depth interviews with participants from the Raine Study that began in Western Australia in 1989. The Generation 2 participants, initially enrolled into the Raine Study as babies by their parents (Generation 1), are now young adults invited to attend follow-up studies and tests every few years. Our study defined 'active' participants (n = 17) as those who agreed to attend their 27 year follow-up, and 'inactive' (n = 12) participants as those who had attended neither of the past two follow-ups (22 and 27 years). RESULTS: Raine Study participants experienced core, actual and augmented product benefits. Inactive participants focused on the costs (price) associated with participation, and were more likely to suggest tele-health (place) strategies to overcome barriers to follow-up attendance. Both active and inactive participants found professional processes and friendly staff made the Raine Study environment appealing, suggested that social media (promotion) was underutilised, and offered novel ideas to enhance engagement. CONCLUSIONS: Social marketing can support the development of differentiated strategies addressing the unique needs and wants of active and inactive participants. Sophisticated cohort segmentation can reach participants in a more meaningful way, reinforce the study 'brand' and guard against attrition.

Mobile phone use and social interactions among caregivers can reduce their ability to provide constant supervision to children at Australian public swimming pools.

ISSUE ADDRESSED: Caregivers have a crucial role to play in keeping children safe at public swimming pool facilities, with the most common factor contributing to childhood drowning being a lapse in adult supervision. METHODS: A mixed methods approach was used to collect observations (n = 301) and interviews (n = 10) with caregivers of children aged 0-10 years at two public swimming pool facilities located in the Perth metropolitan area, Western Australia (WA). RESULTS: Of the 449 children observed, children aged 6-10 years were significantly less likely to be provided with ideal supervision (26%) compared to younger children aged 0-5 years (62%). Of the caregivers who were using their mobile phone while supervising children (n = 100, 22% of children observed), none provided ideal supervision. Overall supervision levels among caregivers differed with gender, with only 44% (n = 74) of female caregivers providing ideal supervision, compared to 72% (n = 96) of male caregivers. The 10 interviews revealed several themes, including the following: caregivers' perceptions of their supervision responsibilities; barriers to supervision; and awareness and perceptions of a communications campaign designed by the Royal Life Saving WA Branch, known as Watch Around Water (WAW). CONCLUSION: Caregiver supervision at public swimming pools remains an important issue, particularly the use of mobile phones and its deleterious impact on supervision. The WAW program plays an integral role in educating caregivers of supervision responsibilities. Furthermore, this study adds to the limited evaluation of the WAW program, and thus will help guide future improvements to ensure caregiver supervision is consistent. SO WHAT?: Further research is needed to create strategies to reduce mobile phone use among caregivers, in order to provide safer swimming environments.

Informing retention in longitudinal cohort studies through a social marketing lens: Raine Study Generation 2 participants' perspectives on benefits and barriers to participation.

BACKGROUND: Longitudinal cohort studies have made significant contributions to medical discoveries and provide the impetus for health interventions which reduce the risk of disease. Establishing and maintaining these cohorts is challenging and costly. While some attrition is unavoidable, maintaining a sufficient number of participants ensures that results remain representative and free from bias. Numerous studies have investigated ways to reduce attrition but few studies have sought to understand the experience of participants, and none have examined this through a social marketing framework. This first paper in a two part-series describes participants' experiences according to: benefits, barriers, motivators and influencers. The second paper uses this understanding to address issues relating to the 4Ps (product, price, place, promotion) of social marketing. METHODS: Participants were recruited from the Raine Study, a pregnancy cohort study that has been running in Western Australia since 1989. Qualitative interviews were conducted with 29 active and inactive participants from the Generation 2 cohort, who were originally enrolled in the Raine Study at birth by their parents (Generation 1). 'Active' participants (n = 17) were defined as those who agreed to attend their 27 year follow-up, while 'inactive' (n = 12) participants were defined as those who had not attended either of the past two follow-ups (at 22 and 27 years). RESULTS: There were considerable differences between active and inactive participants, with active participants perceiving far more personal and collective benefits from their participation. Inactive participants described being constrained by structural barriers around work and life, whereas active participants were able to overcome them to attend follow-ups. Inactive participants also described the value of extrinsic incentives which might motivate their attendance, and active participants described the role of their parents as significant influencers in their propensity to remain in the study. CONCLUSIONS: This paper provides rich descriptions of what participation in a long-running study means to participants. Use of a social marketing framework ensured that participants were constructed as 'human consumers' who are influenced by individual and broader social systems. Understanding participants in this way means that differentiated strategies can be tailored to enhance retention.

"Women of my age tend to drink": the social construction of alcohol use by Australian and Danish women aged 50-70 years.

In Australia and Denmark, women aged 50-70 years are more likely than younger women to consume alcohol at levels that exceed national low risk drinking guidelines. To explore and possibly help explain this sociocultural shift in patterns of alcohol use, this research investigated the social construction of alcohol use amongst 49 women (25 in Northern Denmark, 24 in Western Australia) aged 50-69 years. The women viewed drinking as normal and acceptable. While some women reported reducing their drinking due to health concerns, others neutralised alcohol-related health risks through compensatory behaviours including exercise. Such constructions arguably serve to sustain at-risk drinking amongst some women. Our research highlights that interventions to minimise alcohol-related health risks amongst middle-aged and young-old women should acknowledge that women's social construction of their drinking practices may prioritise subjective experiences of "being in control" while drinking, over biomedical understandings of the health impacts of alcohol.

It's Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care.

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants' physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

Social context, interaction and expectation play a role in alcohol use amongst Australian and Danish women aged 50 to 70 years.

In this study, researchers explored the relationship between alcohol use and life transitions among women aged 50 to 70 years in Australia and Denmark. Data were collected via semi-structured interviews of 49 women, with thematic analysis indicating that alcohol use is a normal and accepted activity among Australian and Danish women. Alcohol use was influenced by women's specific life transitions including their retirement status. Using alcohol as a crutch was not a legitimate story, but women found it acceptable to temporarily manage stress. The researchers provided insight to women's perceptions on drinking that may guide future international public health strategies for this group.

What makes a space safe? Consumers' perspectives on a mental health safe space.

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.

Transitions in midlife women's lives: contemporary experiences.

In this article I report on a research project conducted in Perth, Western Australia, which investigated how contemporary women experience physiological and psychosocial midlife transitions. Qualitative in-depth interviews explored the challenges confronting women during this period. In doing so, continuities and divergences that exist between existing literature on midlife transitions and women's own perspectives are highlighted. Based on key findings, I suggest that while most women manage the "classic" transitions of menopause and the "empty nest" relatively well, the impact of divorce and the aging and death of parents present more serious long-term challenges to women.

'A lot better than medicine' - Self-organised ocean swimming groups as facilitators for healthy ageing.

Exercise, spending time in nature and feeling part of a supportive community all contribute to better physical and mental health and to healthy ageing. This focused ethnography investigates how participation in self-organised ocean swimming groups contributes to healthy ageing amongst older men and women in the Australian coastal city of Perth. It explores the ways marine life, personal experiences and social connectedness mediate their group use of public blue space, and highlights that group membership promotes participants' enhanced health and wellbeing, and supports development of self-efficacy and resilience. These findings suggest that more inclusive access to ocean swimming and other forms of active or adventure-based leisure activities should be advocated from a public health perspective.

"The people make it fun, the activities we do just make sure we turn up on time." Factors influencing older adults' participation in community-based group programmes in Perth, Western Australia.

Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community-based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors' centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors' centres in developing activities attractive to a broader cohort of older people.

Community pharmacists require additional support to develop capacity in delivering alcohol-related health information to older adults.

OBJECTIVES: This qualitative study explored the barriers and enablers influencing Western Australian (WA) community pharmacists' knowledge, confidence, willingness and practice in engaging older clients (>60 years) in alcohol-related health discussions. METHODS: Two focus groups were conducted with a total of 14 community pharmacists who had previously completed a formative quantitative survey (n = 63), and indicated willingness to participate in a follow-up focus group. Focus group questions, informed by the survey results, explored participants' perceptions about barriers and enablers to delivering health information and advice about alcohol to older clients (60+ years). Shaw and colleagues' theoretical framework was used to understand barriers and enablers in relation to role legitimacy, role adequacy and role support. KEY FINDINGS: Participants acknowledged that providing health information about alcohol to older clients is a legitimate part of a community pharmacist's role, and most were confident performing this role in situations perceived as core to their professional practice, such as while dispensing medicines. However, many participants identified limited knowledge, skills and confidence in assisting older clients who may have alcohol issues, beyond advising them on medication and alcohol use. Structural barriers such as time and financial barriers were also identified. CONCLUSION: Routine professional practice including dispensing medicine and home medicine reviews may provide valuable opportunities to engage older clients in alcohol-related discussions. However, limited knowledge concerning appropriate strategies to assist older clients reduce their alcohol consumption, coupled with limited skills and confidence among community pharmacists in raising sensitive alcohol-related issues with clients, suggest the need for specific alcohol-related training and support.

Prescribing or dispensing medication represents the best opportunity for GPs and pharmacists to engage older people in alcohol-related clinical conversations.

OBJECTIVES: This research aimed to identify older Australian drinkers' knowledge about Australian Alcohol Guidelines and their beliefs about the risks and benefits of alcohol; their recall of alcohol-related issues being raised with them by their community pharmacist and General Practitioner (GP); and their receptiveness to alcohol-related information being provided by either health professional. METHODS: This research was conducted in Perth, Western Australia. Flyers calling for participants were placed in local health and service centres, and advertisements were placed in local media. Participants who met eligibility requirements were posted a survey pack (n = 190) including an information letter, consent form, quantitative survey, and return addressed, postage paid envelope. 188 people aged over 60 years returned completed questionnaires. KEY FINDINGS: Women were more familiar with national alcohol guidelines, and were more conservative about the potential health benefits of alcohol. While 90% of participants were receptive to their GP asking about their alcohol use, only 30% of men and 20% of women recalled their GP raising this issue with them in the prior 12 months. Of these, high-risk drinkers were six times more likely than low-risk drinkers to have been asked by their GP. Likewise, 50% of men and 65% of women were receptive to having alcohol-related health conversations with their community pharmacist, but less than 4% recalled their pharmacist raising this issue. Participants were most receptive to receiving information about alcohol-medication interactions. CONCLUSIONS: This research highlights that prescribing and dispensing medication represents the ideal opportunity for health professionals to deliver alcohol-related information to older people.

The influence of intimate partnerships on nurse student progression: An integrative literature review.

OBJECTIVE: To identify the best available evidence on the influence of intimate partnerships (marriage or de facto relationships) on nurse student progression. BACKGROUND: Projections of future nursing workforce shortages have provided renewed impetus to study pre-registration nurse student progression. Factors external to the university are highly influential for non-traditional student groups such as nursing. As the average age of nurse students' rise, the influence of intimate partnerships requires investigation. DATA SOURCES: An international integrative review was conducted in literature from 1990 to 2015 across a range of databases. REVIEW METHODS: A structured approach was used for data collection, analysis and evaluation, resulting in a selection of 17 international papers. RESULTS: There were few common definitions, and little agreement regarding measurement of key factors and variables across the literature. Research into partnership influences on nurse student progression was minimal however findings across a range of disciplines revealed partner support as a principal influence; enabling or hindering the student's social and academic university involvement. Given that nursing is a highly feminised profession, the finding that support was less forthcoming from female students' male partners than vice versa was a particular concern. Women students reported challenging their partners' traditional domestic gender role expectations, which sometimes led, to relationship conflict and breakdown, further impeding their ability to progress. CONCLUSION: Lesser support from their male partners may have unwelcome implications for the progression of the increasing population of mature-age women nurse students. The comparatively few studies and their diversity limit the applicability of the review findings to current nurse education. With workforce sustainability threatened, studies directly investigating the influence of partnerships on nurse student progression are required, employing standardised and transparent terms and measurements.

Shades of Grey: The Need for a Multi-disciplinary Approach to Research Investigating Alcohol and Ageing.

This paper calls for an increase in multi-disciplinary research on the issue of alcohol and ageing, to ensure public health interventions reflect the complex and diverse needs of older drinkers. Older people (65+ years) represent a unique segment of the population; compared to adolescents and younger people, they are more likely to have a range of co-morbid conditions and be taking prescribed medication, and are more physiologically vulnerable to the effects of alcohol. This suggests that from a public health perspective, alcohol use by older people is problematic. However, as with younger people, alcohol use is closely associated with socialisation and social engagement. While social engagement is important at all stages of life, it is particularly critical as people age, when many of the formal social roles which provide a catalyst for social integration shift or are lost. Currently, however, there is little evidence of an integrated public health response to the complex issue of alcohol and ageing. That is, what is needed is a concurrent acknowledgement of the health problems that may be associated with contraindicated alcohol use, versus the potential health benefits that can accrue from social drinking. This will require a holistic rather than reductionist approach that integrates biomedical and social science insights to develop a more comprehensive and nuanced understanding of the implications of alcohol use amongst diverse populations of older people. Significance for public healthWith the rapid ageing of the global population and concerns about recent increases in the consumption of alcohol amongst older people, the issue of alcohol and ageing is becoming an important public health issue. However, there remains little research that adopts a holistic multi-disciplinary perspective. Such research is important and may offer the best way forward in terms of unravelling the complexity of competing risks and benefits associated with low to moderate drinking amongst older people.

Social engagement, setting and alcohol use among a sample of older Australians.

The harms associated with risky alcohol consumption have long been researched and recognised in the health field. However, little available research has focused on older people or extended analysis of alcohol use by this segment of the population beyond a biomedical perspective. With the rapid ageing of the global population, research that investigates alcohol use among older people from a social perspective is important. This article reports on research with a group of older women and men, to identify and explain factors that influence alcohol consumption. In-depth interviews were conducted in Perth, Western Australia with 20 men and 22 women aged 65-74 years who were living in either private residences or retirement villages. The study findings indicated that alcohol use was linked with social engagement in activities across both settings, and that moderate alcohol use appeared to serve an important function as a 'social lubricant'. The major facilitating factors for alcohol use included the frequency of opportunities for social engagement and access to a ready-made social group in retirement villages. The major constraining factor across both settings was driving. Interestingly, health was not viewed as a major facilitating or constraining factor for alcohol consumption. Conclusions from the research were that alcohol serves an important role in enhancing social engagement, and there appear to be important associations between residential setting and alcohol use.