Recovery and exercise interventions following breast cancer [Abstract]

Over 13,000 women are diagnosed with breast cancer each year in Australia and approximately 90% of these women will survive longer than 5-years. However, survival following treatment for breast cancer is often associated with adverse physical and psychosocial side effects, which persist beyond treatment cessation. As incidence and survival rates associated with breast cancer continue to rise, there is an imperative need to understand the extent of treatment-related concerns and ways in which these concerns can be minimized and/or overcome. A growing body of scientific evidence demonstrates that extensive quality of life benefits can be attained through exercise during and following breast cancer treatment. Such benefits observed include improvements in psychosocial and physical outcomes, as well as better compliance with treatment regimens and reduced impact of disease symptoms and treatment-related side effects. There is also evidence to suggest that post-diagnosis physical activity can improve survival. However, the majority of women newly diagnosed with breast cancer in Australia are not sufficiently active and the majority experience further declines in their physical activity levels during treatment. Throughout the course of this presentation, which draws on data from cohort studies and randomized trials of exercise interventions conducted in Queensland, the potential benefits of exercising during and following breast cancer treatment, the exercise prescription recommended for breast cancer survivors, the limits of our evidence-based knowledge and the issues faced by clinicians and patients with respect to exercise following a cancer diagnosis will be discussed. The question is no longer whether people with breast cancer should be active during and following their treatment, but is how do health care professionals best assist people to become and stay active in an endeavor to live healthy lives beyond their cancer experience.

“I want to see the Queen” : experiences of service use by ageing people with an intellectual disability

People with intellectual disability are a relatively new but growing minority group within Australia's ageing population. Disability policies point to the equal right of people with disabilities to a quality of life similar to that of other citizens. Disability services are increasingly required to provide individualised and responsive services, irrespective of age, for people with lifelong disabilities. The present study explored the everyday lives of older people with intellectual disability in Victoria and Queensland, examining their experiences of using disability services and the ways in which services responded to their ageing. The aim of the study was to inform practice and service development for older people with intellectual disability. The findings suggest that services facilitate important social relationships with other service users and staff. Most older people had a sense of belonging and led busy but directionless lives in two disconnected worlds. Their lives were subject to significant external present-focused control. Yet, despite this, neither services nor family members took responsibility for ensuring their sense of continuity or supporting the development of plans about their future. The experiences described suggest an urgent need for, but significant challenges in the implementation of, holistic indivdualised planning similar to the UK concept of person-centred planning.

Examination of social demographic status, disease status, health behaviours and quality of life in older Australians using the theory of planned behaviour model

The increase of life expectancy worldwide during the last three decades has increased age-related disability leading to the risk of loss of quality of life. How to improve quality of life including physical health and mental health for older people and optimize their life potential has become an important health issue. This study used the Theory of Planned Behaviour Model to examine factors influencing health behaviours, and the relationship with quality of life. A cross-sectional mailed survey of 1300 Australians over 50 years was conducted at the beginning of 2009, with 730 completed questionnaires returned (response rate 63%). Preliminary analysis reveals that physiological changes of old age, especially increasing waist circumference and co morbidity was closely related to health status, especially worse physical health summary score. Physical activity was the least adherent behaviour among the respondents compared to eating healthy food and taking medication regularly as prescribed. Increasing number of older people living alone with co morbidity of disease may be the barriers that influence their attitude and self control toward physical activity. A multidisciplinary and integrated approach including hospital and non hospital care is required to provide appropriate services and facilities toward older people.

Chart of accounts : a framework for measuring the economic and social contributions by older Australians

National Seniors Australia (2008) acknowledged the huge contributions that older people have made to Australian society in its policy statement, AdvantAGE Australia. National Seniors Australia commissioned this study to find out more about the extent of these contributions and the factors that influence these contributions. The key outcome of this study is a framework or ‘Chart of Accounts’ that allows users to a) track the participation of older Australians in paid and unpaid work; and b) estimate the value of economic and social contributions by older Australians as well as the value of losses for not utilising the knowledge and skills that older Australians have built up over a lifetime. Users can also make predictions of future contributions and participation in paid and unpaid work by using existing data as the baseline.

Building climate change resilience and adaptive capacity in Australia’s community sector using social media and technology innovation

Public and private sector organisations worldwide are putting strategies in place to manage the commercial and operational risks of climate change. However, community organisations are lagging behind in their understanding and preparedness, despite them being among the most exposed to the effects of climate change impacts and regulation. This poster presents a proposal for a multidisciplinary study that addresses this issue by developing, testing and applying a novel climate risk assessment methodology that is tailored to the needs of Australia’s community sector and its clients. Strategies to mitigate risks and build resilience and adaptive capacity will be identified including new opportunities afforded by urban informatics, social media, and technologies of scale making.

Community engagement and groundwater investigation in a rural/peri urban basaltic aquifier system, Tamborine Mountain, South East Queensland

The Tamborine Mt area is a popular residential and tourist area in the Gold Coast hinterland, SE Qld. The 15km2 area occurs on elevated remnant Tertiary Basalts of the Beechmont Group, which comprise a number of mappable flow units originally derived from the Tweed volcanic centre to the south. The older Albert Basalt (Tertiary), which underlies the Beechmont Basalt at the southern end of the investigation area, is thought to be derived from the Focal Peak volcanic centre to the south west. The Basalts contain a locally significant ‘un-declared’ groundwater resource, which is utilised by the Tamborine Mt community for: • domestic purposes to supplement rainwater tank supplies, • commercial scale horticulture and • commercial export off-Mountain for bottled water. There is no reticulated water supply, and all waste water is treated on-site through domestic scale WTPs. Rainforest and other riparian ecosystems that attract residents and tourist dollars to the area, are also reliant on the groundwater that discharges to springs and surface streams on and around the plateau. Issues regarding a lack of compiled groundwater information, groundwater contamination, and groundwater sustainability are being investigated by QUT, utilising funding provided by the Federal Government’s ‘Caring for our Country’ programme through SEQ Catchments Ltd. The objectives of the two year project, which started in April 2009, are to: • Characterise the nature and condition of groundwater / surface water systems in the Tamborine Mountain area in terms of the issues being raised; • Engage and build capacity within the community to source local knowledge, encourage participation, raise awareness and improve understanding of the impacts of land and water use; • Develop a stand-alone 3D Visualisation model for dissemination into the community and use as a communication tool.

Road safety issues for older road users : CARRS-Q Monograph 1

[Selection of papers from the Older Road User Safety Symposium, 26 November 2000, Brisbane, Australia.]----- This publication is a selection of papers on older road user safety which were presented at the Older Road User Safety Symposium on Sunday 26 November 2000 at the Sheraton Brisbane Hotel, Queensland, Australia. The Symposium was held on the day before Australia’s annual Road Safety Research, Policing and Education Conference, which provided an opportunity to garner both presenters and participants from the wider road safety community in Australia. Road safety is a large and diverse area of scholarship and practice, and many disciplines are drawn on in the processes of understanding and addressing road safety problems. The safety of older road users is no different. As this selection shows, work on older road user safety can be informed by demography, research on the mental and physical effects of ageing, social research on older people as road users, evaluation of educational and behavioural interventions, road crash analysis, engineering research and practice, and reviews of policy approaches within Australia and elsewhere. It is possible to summarise these into four constellations, which are reflected in the papers selected for this publication: social impacts and responses; physical and cognitive capability; specific road use performance; and environment/ecology. Though three years have passed since the Symposium, the issues raised in these papers remain current.

Global civil society and adult education for social change : a postcolonial perspective

Adult education plays an important role in global economic development and features prominently in debates about changing requirements of post-industrial knowledge societies. This dominant technical-instrumental understanding of adult education in public discourse masks the transformative function of certain types of adult education - that is, the possibilities of adult education to improve social justice issues such as workers’ rights, human rights, civic participation in governance and socially just development. Given the increasing social stratification between and within the North and South in the global era, the potential of adult education to effect social change has been rediscovered by organisations within global civil society, namely international non-governmental organisations (INGOs). The broad objective of this research was to carry out an in-depth qualitative case study of a human rights advocacy program provided by a Northern INGO predominantly operating within the global South. The study analyses how participants see this program in terms of its potential to contribute to progressive social change in their home communities across the Asia-Pacific region. The following questions guided the study: 1. To what extent does this adult education program challenge existing systems of domination and marginalisation? 2. How did completion of the program affect participants’ views of their abilities to facilitate social action within their communities? Data sources for this research were interviews with 19 participants and staff and questionnaires from 28 participants of the program from a variety of countries in the Asia-pacific region. The gap in the literature that this study addressed is that existing empirical research sidelines the analysis of the globalisation, adult education, and social change nexus from a perspective that takes the marginalised other seriously, tending instead to mirror the material subjugation of the South in discursive practices. Social change is highly context-specific and strategies to advance it depend on the way in which people understand their reality and are affected by adverse social conditions. The present study employed a postcolonial framework that provided a holistic approach to analysing adult education for social change inclusive of material, political, and social conditions and the interplay between these from the local to the global level. The program convincingly exemplified an example of adult education for counter-hegemonic resistance against the dominant neoliberal discourse. It achieved this by enabling participants, based on Freirian pedagogical principles, to locate the problem of social change and frame their strategies to address it within mutually constitutive local and global developments and the discourses that describe them. It provided the underpinning knowledge and skills for effective advocacy and created opportunities to build networks between various stakeholders. At minimum, most advocates accord their participation in the program a supporting role in enhancing their ability to examine causes for social injustices and ways to address these. Some advocates even regarded their program participation as fundamental in understanding these issues. Almost all participants reported an increased skill-set that enabled them to become more effective advocates.

The neglected dimension of community liveability : impact on social connectedness and active ageing in higher density accommodation

Purpose This thesis is about liveability, place and ageing in the high density urban landscape of Brisbane, Australia. As with other major developed cities around the globe, Brisbane has adopted policies to increase urban residential densities to meet the main liveability and sustainability aim of decreasing car dependence and therefore pollution, as well as to minimise the loss of greenfield areas and habitats to developers. This objective hinges on urban neighbourhoods/communities being liveable places, which residents do not have to leave for everyday living. Community/neighbourhood liveability is an essential ingredient in healthy ageing in place and has a substantial impact upon the safety, independence and well-being of older adults. It is generally accepted that ageing in place is optimal for both older people and the state. The optimality of ageing in place generally assumes that there is a particular quality to environments or standard of liveability in which people successfully age in place. The aim of this thesis was to examine if there are particular environmental qualities or aspects of liveability that test optimality and to better understand the key liveability factors that contribute to successful ageing in place. Method A strength of this thesis is that it draws on two separate studies to address the research question of what makes high density liveable for older people. In Chapter 3, the two methods are identified and differentiated as Method 1 (used in Paper 1) and Method 2 (used in Papers 2, 3, 4 and 5). Method 1 involved qualitative interviews with 24 inner city high density Brisbane residents. The major strength of this thesis is the innovative methodology outlined in the thesis as Method 2. Method 2 involved a case study approach employing qualitative and quantitative methods. Qualitative data was collected using semi-structured, in-depth interviews and time-use diaries completed by participants during the week of tracking. The quantitative data was gathered using Global Positioning Systems for tracking and Geographical Information Systems for mapping and analysis of participants’ activities. The combination of quantitative and qualitative analysis captured both participants’ subjective perceptions of their neighbourhoods and their patterns of movement. This enhanced understanding of how neighbourhoods and communities function and of the various liveability dimensions that contribute to active ageing and ageing in place for older people living in high density environments. Both studies’ participants were inner-city high density residents of Brisbane. The study based on Method 1 drew on a wider age demographic than the study based on Method 2. Findings The five papers presented in this thesis by publication indicate a complex inter-relationship of the factors that make a place liveable. The first three papers identify what is comparable and different between the physical and social factors of high density communities/neighbourhoods. The last two papers explore relationships between social engagement and broader community variables such as infrastructure and the physical built environments that are risk or protective factors relevant to community liveability, active ageing and ageing in place in high density. The research highlights the importance of creating and/or maintaining a barrier-free environment and liveable community for ageing adults. Together, the papers promote liveability, social engagement and active ageing in high density neighbourhoods by identifying factors that constitute liveability and strategies that foster active ageing and ageing in place, social connections and well-being. Recommendations There is a strong need to offer more support for active ageing and ageing in place. While the data analyses of this research provide insight into the lived experience of high density residents, further research is warranted. Further qualitative and quantitative research is needed to explore in more depth, the urban experience and opinions of older people living in urban environments. In particular, more empirical research and theory-building is needed in order to expand understanding of the particular environmental qualities that enable successful ageing in place in our cities and to guide efforts aimed at meeting this objective. The results suggest that encouraging the presence of more inner city retail outlets, particularly services that are utilised frequently in people’s daily lives such as supermarkets, medical services and pharmacies, would potentially help ensure residents fully engage in their local community. The connectivity of streets, footpaths and their role in facilitating the reaching of destinations are well understood as an important dimension of liveability. To encourage uptake of sustainable transport, the built environment must provide easy, accessible connections between buildings, walkways, cycle paths and public transport nodes. Wider streets, given that they take more time to cross than narrow streets, tend to .compromise safety - especially for older people. Similarly, the width of footpaths, the level of buffering, the presence of trees, lighting, seating and design of and distance between pedestrian crossings significantly affects the pedestrian experience for older people and impacts upon their choice of transportation. High density neighbourhoods also require greater levels of street fixtures and furniture for everyday life to make places more useable and comfortable for regular use. The importance of making the public realm useful and habitable for older people cannot be over-emphasised. Originality/value While older people are attracted to high density settings, there has been little empirical evidence linking liveability satisfaction with older people’s use of urban neighbourhoods. The current study examined the relationships between community/neighbourhood liveability, place and ageing to better understand the implications for those adults who age in place. The five papers presented in this thesis add to the understanding of what high density liveable age-friendly communities/ neighbourhoods are and what makes them so for older Australians. Neighbourhood liveability for older people is about being able to age in place and remain active. Issues of ageing in Australia and other areas of the developed world will become more critical in the coming decades. Creating livable communities for all ages calls for partnerships across all levels of government agencies and among different sectors within communities. The increasing percentage of older people in the community will have increasing political influence and it will be a foolish government who ignores the needs of an older society.

Augmenting public participation : enhancing planning outcomes through the use of social media and web 2.0

Social media and web 2.0 tools offer opportunities to devise novel participation strategies that can engage previously difficult to reach as well as new segments of society in urban planning. This paper examines participatory planning in the four local government areas of Brisbane City Council, Gold Coast City Council, Redland City Council, and Toowoomba Regional Council, all situated in South East Queensland, Australia. The paper discusses how social media and web 2.0 tools can deliver a more engaging planning experience to citizens, and investigates local government’s current use and receptiveness to social media tools for plan making and community engagement. The study’s research informed the development of criteria to assess the level of participation reached through the current use of social media and web 2.0 in the four local government areas. This resulted in an adaptation of the International Association for Public Participation (IAP2) Toolbox to integrate these new tools which is being presented to encourage further discussion and evaluation by planning professionals.

Approaches to designing for older adults' intuitive interaction with complex devices

Many older people have difficulties using modern consumer products due to increased product complexity both in terms of functionality and interface design. Previous research has shown that older people have more difficulty in using complex devices intuitively when compared to the younger. Furthermore, increased life expectancy and a falling birth rate have been catalysts for changes in world demographics over the past two decades. This trend also suggests a proportional increase of older people in the work-force. This realisation has led to research on the effective use of technology by older populations in an effort to engage them more productively and to assist them in leading independent lives. Ironically, not enough attention has been paid to the development of interaction design strategies that would actually enable older users to better exploit new technologies. Previous research suggests that if products are designed to reflect people's prior knowledge, they will appear intuitive to use. Since intuitive interfaces utilise domain-specific prior knowledge of users, they require minimal learning for effective interaction. However, older people are very diverse in their capabilities and domain-specific prior knowledge. In addition, ageing also slows down the process of acquiring new knowledge. Keeping these suggestions and limitations in view, the aim of this study was set to investigate possible approaches to developing interfaces that facilitate their intuitive use by older people. In this quest to develop intuitive interfaces for older people, two experiments were conducted that systematically investigated redundancy (the use of both text and icons) in interface design, complexity of interface structure (nested versus flat), and personal user factors such as cognitive abilities, perceived self-efficacy and technology anxiety. All of these factors could interfere with intuitive use. The results from the first experiment suggest that, contrary to what was hypothesised, older people (65+ years) completed the tasks on the text only based interface design faster than on the redundant interface design. The outcome of the second experiment showed that, as expected, older people took more time on a nested interface. However, they did not make significantly more errors compared with younger age groups. Contrary to what was expected, older age groups also did better under anxious conditions. The findings of this study also suggest that older age groups are more heterogeneous in their capabilities and their intuitive use of contemporary technological devices is mediated more by domain-specific technology prior knowledge and by their cognitive abilities, than chronological age. This makes it extremely difficult to develop product interfaces that are entirely intuitive to use. However, by keeping in view the cognitive limitations of older people when interfaces are developed, and using simple text-based interfaces with flat interface structure, would help them intuitively learn and use complex technological products successfully during early encounter with a product. These findings indicate that it might be more pragmatic if interfaces are designed for intuitive learning rather than for intuitive use. Based on this research and the existing literature, a model for adaptable interface design as a strategy for developing intuitively learnable product interfaces was proposed. An adaptable interface can initially use a simple text only interface to help older users to learn and successfully use the new system. Over time, this can be progressively changed to a symbols-based nested interface for more efficient and intuitive use.

Making more sustainable urban environments by responding to neurodiversity in later life

The ageing population is increasing worldwide, as are a range of chronic diseases, conditions, and physical and cognitive disabilities associated with later life. The older population is also neurologically diverse, with unique and specific challenges around mobility and engagement with the urban environment. Older people tend to interact less with cities and neighbourhoods, putting them at risk of further illnesses and co-morbidities associated with being less physically and socially active. Empirical evidence has shown that reduced access to healthcare services, health-related resources and social interaction opportunities is associated with increases in morbidity and premature mortality. While it is crucial to respond to the needs of this ageing population, there is insufficient evidence for interventions regarding their experiences of public space from the vantage point of neurodiversity. This paper provides a conceptual and methodological framework to investigate relationships between the sensory and cognitive abilities of older people, and their use and negotiation of the urban environment. The paper will refer to a case example of the city of Logan, an urban area in Queensland, Australia, where current urban development provides opportunities for the design of spaces that take experiences of neurodiversity into account. The framework will inform the development of principles for urban design for increasingly neurologically diverse populations.

A Framework for Adaptation of Australian Households to Heat Waves

Climate change is leading to an increased frequency and severity of heat waves. Spells of several consecutive days of unusually high temperatures have led to increased mortality rates for the more vulnerable in the community. The problem is compounded by the escalating energy costs and increasing peak electrical demand as people become more reliant on air conditioning. Domestic air conditioning is the primary determinant of peak power demand which has been a major driver of higher electricity costs. This report presents the findings of multidisciplinary research which develops a national framework to evaluate the potential impacts of heat waves. It presents a technical, social and economic approach to adapt Australian residential buildings to ameliorate the impact of heat waves in the community and reduce the risk of its adverse outcomes. Through the development of a methodology for estimating the impact of global warming on key weather parameters in 2030 and 2050, it is possible to re-evaluate the size and anticipated energy consumption of air conditioners in future years for various climate zones in Australia. Over the coming decades it is likely that mainland Australia will require more cooling than heating. While in some parts the total electricity usage for heating and cooling may remain unchanged, there is an overall significant increase in peak electricity demand, likely to further drive electricity prices. Through monitoring groups of households in South Australia, New South Wales and Queensland, the impact of heat waves on both thermal comfort sensation and energy consumption for air conditioning has been evaluated. The results show that households are likely to be able to tolerate slightly increased temperature levels indoors during periods of high outside temperatures. The research identified that household electricity costs are likely to rise above what is currently projected due to the impact of climate change. Through a number of regulatory changes to both household design and air conditioners, this impact can be minimised. A number of proposed retrofit and design measures are provided, which can readily reduce electricity usage for cooling at minimal cost to the household. Using a number of social research instruments, it is evident that households are willing to change behaviour rather than to spend money. Those on lower income and elderly individuals are the least able to afford the use of air conditioning and should be a priority for interventions and assistance. Increasing community awareness of cost effective strategies to manage comfort and health during heat waves is a high priority recommended action. Overall, the research showed that a combined approach including behaviour change, dwelling modification and improved air conditioner selection can readily adapt Australian households to the impact of heat waves, reducing the risk of heat related deaths and household energy costs.