A pilot RCT of a multi-component nutrition intervention for nursing home residents with dementia

Background Malnutrition and unintentional weight loss are major clinical issues in people with dementia living in residential aged care facilities (RACFs) and are associated with serious adverse outcomes. However, evidence regarding effective interventions is limited and strategies to improve the nutritional status of this population are required. This presentation describes the implementation and results of a pilot randomised controlled trial of a multi-component intervention for improving the nutritional status of RACF residents with dementia. Method Fifteen residents with moderate-severe dementia living in a secure long-term RACF participated in a five week pilot study. Participants were randomly allocated to either an Intervention (n=8) or Control group (n=7). The intervention comprised four elements delivered in a separate dining room at lunch and dinner: the systematic reinforcement of residents’ eating behaviors using a specific communication protocol; family-style dining; high ambiance table presentation; and routine Dietary-Nutrition Champion supervision. Control group participants ate their meals according to the facility’s standard practice. Baseline and follow-up assessments of nutritional status, food consumption, and body mass index were obtained by qualified nutritionists. Additional assessments included measures of cognitive functioning, mealtime agitation, depression, wandering status and multiple measures of intervention fidelity. Results No participant was malnourished at study commencement and participants in both groups gained weight from follow-up to baseline which was not significantly different between groups (t=0.43; p=0.67). A high degree of treatment fidelity was evident throughout the intervention. Qualitative data from staff indicate the intervention was perceived to be beneficial for residents. Conclusions This multi-component nutritional intervention was well received and was feasible in the RACF setting. Participants’ sound nutritional status at baseline likely accounts for the lack of an intervention effect. Further research using this protocol in malnourished residents is recommended. For success, a collaborative approach between researchers and facility staff, particularly dietary staff, is essential.

Social organization of household finance: Understanding artful financial systems in the home

In this paper we discuss results of a field study focused on understanding the ways money and financial issues are handled within family settings. Families develop ‘systems’ or methods through which they coordinate and manage their everyday financial activities. Through an analysis of our fieldwork data collected from fifteen families, we provide several examples of such systems, highlighting their qualities and illustrating how such systems come to support the handling of financial activities in the home. Our results show that these systems are developed with a careful consideration of familial values, relationships and routines; and incorporate the use of physical and digital tools. Consequently, we suggest that design should consider the use and non-use of technology when supporting household financial management, taking into account the richness of families’ existing organically formed practices surrounding financial systems. Finally, our findings point to the fact that financial management in the domestic setting is socially organized and is closely connected to supporting everyday household activities.

Carer perspectives of factors affecting placement trajectories of children in out-of-home care

Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.

Aaishah’s choice: Choosing home education in the Muslim community

In Australia, the decision to home educate is becoming increasingly popular (cf. Townsend, 2012). In spite of its increasing popularity, the reasons home education is chosen by Australian families is under-researched (cf. Jackson & Allan, 2010). In addition, the decision to home educate among minority groups, such as Australian Muslim families, is absent from the literature. This paper reports on an interview with one Muslim mother who chose to home educate her children. An in-depth, qualitative interview was conducted with Aaishah (pseudonym), a mother who lived in one of Australia’s most populated cities. Data were analysed using the Discourse Historical Approach to Critical Discourse Analysis. The analysis revealed that there were similarities between the discourses of Christian parents described in the literature, in terms of the reasons Aaishah had given for her decision to home educate. In particular, analysis reveals Aaishah’s fears about schools, their negative experiences on her children and her hopes for her children’s futures.

Techno Teacher Moms: Web 2.0 Connecting Mothers in the Home Education Community

Home education is on the rise in Australia. However, unlike parents who choose mainstream schooling, these parents often lack the support of a wider community to help them on their educational and parenting journey. This support is especially lacking as many people in the wider community find the choice to home education confronting. As such, these parents may feel isolated and alienated in the general population as their choice to home educate is questioned at best, and ridiculed at worst. These parents often find sanctuary online in homeschool groups on Facebook. This chapter explores the ways that Facebook Groups are used by marginalized and disenfranchised families who home educate to meet with others who are likeminded and aligned with their beliefs and philosophies. It is through these groups that parents, in relation to schooling it is especially mothers, are able to ask for advice, to vent, to explore options and find connections that may be lacking in the wider community.