Using citizen science to empower older adults to improve a food security initiative in Australia.

Food security is an increasing problem for older adults who are living longer and having to stretch their resources further. Initiatives such as subsidized community market days are increasingly important in bolstering food security amongst these groups but there have been few attempts to understand these initiatives from the perspective of community members. This exploratory study examined the utility of a novel citizen science approach to engage older adults in evaluating and improving a local food security initiative. Using the Our Voice methodology, citizen scientists recorded their perceptions of their local Market Day via photographs and audio narratives. Thirteen citizen scientists captured 127 photographs and 125 commentaries. Citizen scientists participated in workshops to discuss, code and synthesize their data, and used their findings to advocate for change. A number of improvements to the Market Day were made by key stakeholders on the basis of citizen scientist recommendations, including improving the processes for sourcing and storing food and changing the layout to improve access. This study demonstrates that citizen science is a useful and feasible approach to engaging community members in capturing data and advocating for change to ensure that local initiatives meet the needs of communities.

Progressive Resistance Plus Balance Training for Older Australians Receiving In-Home Care Services: Cost-Effectiveness Analyses Alongside the Muscling Up Against Disability Stepped-Wedge Randomized Control Trial.

In this article, the authors assessed the cost-effectiveness of center-based exercise training for older Australians. The participants were recipients of in-home care services, and they completed 24 weeks of progressive resistance plus balance training. Transport was offered to all participants. A stepped-wedge randomized control trial produced pre-, post-, and follow-up outcomes and cost data, which were used to calculate incremental cost-effectiveness ratios per quality-adjusted life year gained. Analyses were conducted from a health provider perspective and from a government perspective. From a health-service provider perspective, the direct cost of program provision was $303 per person, with transport adding an additional $1,920 per person. The incremental cost-utility ratio of the program relative to usual care was $70,540 per quality-adjusted life year over 6 months, decreasing to $37,816 per quality-adjusted life year over 12 months. The findings suggest that Muscling Up Against Disability offers good value for the money within commonly accepted threshold values.

active@home: Investigating the Value of a Home Care Worker-Led Exercise Program for Older Adults With Complex Care Needs.

Exercise has proven health benefits for older adults independent of age, disability, and disease. However, barriers to exercise participation exist, including travel to, and access to, appropriate facilities and programs. Evidence shows that in-home exercise delivered by allied health professionals can improve physical health and prolong independence among individuals with government supported aged care packages. A less costly alternative is program delivery by home care workers. However, effective training for workers and resources to guide the consumer is required. This project evaluated an exercise training module for home care workers and a consumer resource to promote in-home exercise participation among older Australians with government supported aged care packages. Outcomes included a significant improvement in functional capacity as measured by the short physical performance battery (mean increase of 1.4 points), a 19% reduction in participants classified as frail and a reduction in healthcare service access of 47% across the intervention.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

OBJECTIVE: To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. DESIGN: Intervention study. SETTING: Community-based older adult-specific exercise clinic. PARTICIPANTS: Older adults (N=245) with complex care needs who were receiving government-funded aged care support. INTERVENTIONS: Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. MAIN OUTCOME MEASURES: The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. RESULTS: At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. CONCLUSIONS: This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults.

Assessing the real world effectiveness of the Healthy Eating Activity and Lifestyle (HEAL) program.

ISSUE ADDRESSED: Community-based lifestyle modification programs can be a valuable strategy to reduce risk factors for chronic disease. However, few government-funded programs report their results in the peer-reviewed literature. Our aim was to report on the effectiveness of the Healthy Eating Activity and Lifestyle (HEAL) program, a program funded under the Australian government's Healthy Communities Initiative. METHODS: Participants (n = 2827) were recruited to the program from a broad range of backgrounds and each week completed an hour of group-based physical activity followed by an hour of lifestyle education for 8 weeks. Physical activity, sitting time, fruit and vegetable consumption, anthropometric measures, blood pressure and functional capacity data were gathered at baseline and post-program. RESULTS: HEAL participation resulted in significant acute improvements in frequency and volume of physical activity, reductions in daily sitting time and increases in fruit and vegetable consumption. HEAL participation led to reductions in total body mass, body mass index, waist circumference and blood pressure and to improvements in functional capacity (P < 0.001). CONCLUSIONS: Based on these findings and the coordinated approach to program delivery, the HEAL program warrants consideration as a behaviour change strategy in primary health care networks, local government or community settings. SO WHAT? These findings should inform future policy development around implementation of lifestyle modification programs; they strengthen the case for support and promotion of lifestyle modification programs to improve public health, lessening the financial and personal burden of chronic conditions.

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program.

ISSUE ADDRESSED: Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program. METHOD: Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically. RESULTS: Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas. CONCLUSION: Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

Predicting the progressive resistance and balance training response of community-dwelling older adults accessing aged care support services: A stepped-wedge randomised controlled trial.

OBJECTIVE: To quantify the variation in body composition, physical function and cognitive health changes resulting from the Muscling Up Against Disability (MUAD) resistance and balance training program and the potential for baseline characteristics to predict the magnitude of training-related response. METHODS: The study represented a secondary analysis of a stepped-wedge randomised controlled trial involving 245 community-dwelling adults receiving Australian Government-funded aged care services who performed 26 weeks of supervised progressive resistance and balance training (PRBT). The primary outcome was the proportion of response that described the number of individuals expected to make any positive change due to the intervention and not external factors. RESULTS: For all outcomes, the observed average change in the PRBT group was more favourable than the control. Analyses identified that most participants completing the PRBT program would be expected to respond positively to the intervention (86%-99%) with respect to their physical performance (SPPB summary, grip strength, chair stand and isometric knee strength). A smaller proportion completing the PRBT program group would be expected to respond positively in aspects of body composition (45%-60%) or cognitive function (44%-84%). The strongest predictors of positive change were baseline physical function, whereby those with the poorest baseline function experienced the greatest benefits. CONCLUSIONS: This study strongly supports the promotion of PRBT as a standard component of any care plan for community-dwelling older adults, especially those with low levels of physical function.

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship.

BACKGROUND: This study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia. METHODS: This manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively. RESULTS: Significant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r =  - 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5-79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r =  - 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40-2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively. DISCUSSION: The results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults' perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults' muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks. CONCLUSIONS: Results of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F's sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

Older Adults Using Our Voice Citizen Science to Create Change in Their Neighborhood Environment.

Physical activity, primarily comprised of walking in older adults, confers benefits for psychological health and mental well-being, functional status outcomes and social outcomes. In many communities, however, access to physical activity opportunities are limited, especially for older adults. This exploratory study engaged a small sample (N = 8) of adults aged 65 or older as citizen scientists to assess and then work to improve their communities. Using a uniquely designed mobile application (the Stanford Healthy Neighborhood Discovery Tool), participants recorded a total of 83 geocoded photos and audio narratives of physical environment features that served to help or hinder physical activity in and around their community center. In a facilitated process the citizen scientists then discussed, coded and synthesized their data. The citizen scientists then leveraged their findings to advocate with local decision-makers for specific community improvements to promote physical activity. These changes focused on: parks/playgrounds, footpaths, and traffic related safety/parking. Project results suggest that the Our Voice approach can be an effective strategy for the global goals of advancing rights and increasing self-determination among older adults.

Rural dementia carers: formal and informal sources of support.

Primary carers provide much of the day-to-day care for community-dwelling people living with dementia (PWD). Maintaining that contribution will require a more in-depth understanding of the primary carer role and the support needs that flow from that role. This study explored patterns of formal and informal support utilisation by people caring for a PWD in a rural-regional context. In-depth semi-structured interviews were conducted with 18 rural primary carers of a PWD and thematically analysed. Participant primary carers' almost total commitment to, and absorption in their role and their assumption of ultimate responsibility for the PWD's wellbeing meant that external social context, such as rurality, became less relevant. Carer networks effectively contracted to those key individuals who were central to supporting them in their caring task. External sources of support were tightly managed with strong boundaries around the provision of direct care to the PWD largely excluding all but professional providers. Primary carers are generally categorised along with other family and friends as informal care. However, in assuming primary responsible for the care and wellbeing for the PWD they effectively become the key care provider, suggesting that it would be productive in both research and practice to treat primary carers as key members of a care partnership alongside professional carers, rather than as adjuncts to formal care and/or another client.