Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia.

INTRODUCTION: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

Understanding the Role, Quality of Life and Strategies Used by Older Carers of Older People to Maintain Their Own Health and Well-Being: A National Australian Survey.

Introduction: Carers play a critical role in supporting older people with health problems to remain living at home. This study aimed to understand the role and quality of life of older carers of older people and identify strategies used to manage their own health and well-being. Methods: Older carers (aged ≥50 years) of older people (aged ≥65 years) in Australia participated in a cross-sectional survey focused on carer roles, self-rated health, information and activities used to maintain their carer role and health, barriers to accessing health care, and assessment of quality of life (QoL) using the Dementia Quality of Life Scale for Older Family Carers. Multiple regression analysis examined relationships between variables and the QoL outcome. Results: The survey was completed by 189 older carers (mean age: 68 years; SD = 9.3). Most were female (83.5%), 80.2% providing care daily and 47.8% provided ≥six hours care daily. Almost half (45.1%) self-reported their health as average or below. Despite rating ensuring personal health as very important (mean importance 8/10), only 46.3% reported receiving support from their general practitioner for their carer role. The most common barrier to accessing care for themselves was "not having enough time". Factors independently associated with poorer carer QoL were living with the care-recipient, caring for someone with depression/anxiety and poor care-recipient health. Factors independently associated with higher carer QoL were placing high importance on personal health, receiving assistance from a specialist clinic as a carer, and older age. Conclusion: Older carers of older people provide high levels of care and experience reduced quality of life. Innovative approaches that provide integrated care and support for older carers to promote their QoL are urgently needed.

Evaluation of an abdominal fluid scoring system determined using abdominal focused assessment with sonography for trauma in 101 dogs with motor vehicle trauma.

OBJECTIVE: Evaluate an abdominal fluid scoring (AFS) system using an abdominal focused assessment with sonography for trauma (AFAST) protocol. DESIGN: Prospective study. SETTING: Private veterinary emergency center. ANIMALS: One hundred and one client-owned dogs with motor vehicle trauma. Interventions- AFAST performed on admission and 4 hours post-admission. MEASUREMENTS AND MAIN RESULTS: An AFS was assigned to each dog based on the number of AFAST fluid-positive quadrants identified using a 4-point scale: AFS 0 (negative for fluid in all quadrants) to AFS 4 (positive for fluid in all quadrants). Free abdominal fluid was identified in 27 of 101 dogs (27%). Dogs with AFS scores of 3 or 4 (14/27 [52%] AFS-positive dogs) experienced more marked decreases in packed cell volume and total plasma protein, increases in alanine aminotransferase, and needed more blood transfusions than dogs with lower AFS scores and AFS-negative dogs. Serial AFAST was performed in 71% of dogs (71/101); 17% (12/71) of these cases changed AFS score, and 75% (9/12) of the changes were higher (worsened) AFS, correlating with increasing amounts of free abdominal fluid. Ninety-eight percent of the study population was a primary presentation. Overall, median time from trauma to initial AFAST was 60 minutes, and median AFAST examination time was 3 minutes. CONCLUSIONS: Initial and serial AFAST with applied AFS allowed rapid, semiquantitative measure of free abdominal fluid in traumatized patients, was clinically associated with severity of injury, and reliably guided clinical management. Where possible, AFAST and AFS should be applied to the management of blunt trauma cases.