Healthcare in continuum for an ageing population: national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of lCTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

Population ageing and the politics of demographic alarmism : implications for the nursing profession

Objectives
This article provides a brief examination of the prejudices and politics framing current public debate on population ageing in Australia and the possible implications of this for the allocation of required health and social sector resources. The role and responsibility of nurses and professional nursing organisations to engage in and influence public policy debate concerning the health and social care of older people is highlighted.

Setting
Australia

Subjects
Australia's ageing population and succeeding generations over the next 40 years

Primary argument
According to the Australian government, population ageing in Australia is poised to cause unmanageable chaos for the nation's public services. The cost of meeting the future health and social care needs of older Australians is predicted to be unsustainable. Officials argue that government has a stringent responsibility to ration current and future resources in the health and social care sector, cautioning that if this is not done, the nation's public services will ultimately collapse under the strain of the ever increasing demands placed on these services by older people. This characterisation of population ageing and its consequences to the nation's social wellbeing may however be false and misleading and needs to be questioned.

Conclusion
The nursing profession has a fundamental role to play in ensuring responsible debate about population ageing and contributing to public policy agenda setting for the effective health and social care of Australia's ageing population.

Responding to the ageing profile of emergency department patients

Background
Older people with acute superimposed on chronic health problems are becoming a core aspect of emergency department (ED) caseload. This project explored the ED experience from the perspective of older patients and their carers.

Method
A convenience sample of thirty participants was recruited across three participating EDs: tw o metropolitan and one regional. The project utilised two approaches to data collection: 1) an observation approach where a project officer observed participants from the time of ED presentation until discharge, or for up to six hours; and 2) a subsequent interview was conducted with the participant and their carer within a week of the ED presentation. Data from both sources were integrated, and independently thematically analysed by two members of the team.

Results
Thirty participants aged over 65 were recruited. Their average age was 77.1 (sd=6.7) years, 59% w ere female, and 74% were triage category 1- 3 (indicating moderate/high acuity). Participants spent on average 7 hours 47 minutes in the ED, with 50% discharged home, 43% admitted to general wards or MAPU, and 7% discharged to residential care/hospice. Key themes in the factors influencing the patient experience and examples of quality care were identified, along with opportunities to improve the capacity for EDs to be “older person friendly”, and “person-centred.” Challenges include improving the effectiveness of communication between staff and patients/carers (including issues around people from culturally and linguistically diverse backgrounds), availability of allied health professionals to assist with discharge planning, and a tendency for older people not to seek ED care until the health problem was severe. Patient exemplars highlight key themes.

Discussion and implications
Results of the project highlight positive aspects of emergency department care for older people and inform targets for improvement strategies. These can be used to drive ongoing improvements in care for older people presenting to EDs.

Belonging to a Victorian community choir : ageing, music and culture

Australia's ageing population created challenges for maintaining well-being and combating social isolation. Older Australians frequently rely on community arts organizations to enhance quality of life, specifically in health, happiness and community. Arts engagement takes place in many different contexts, from formal to informal and throughout the lifespan of the individual. Culture shapes the way in which we age and cultural identity is celebrated through the arts. This study will explore ageing and cultural diversity within Australian society through an examination of community arts engagement, specifically a community choir in Melbourne, Victoria, Australia. Much previous research concerning music engagement by older people has focused on its therapeutic applications, but there have been less attention given to healthy older people still living in communities. This paper reports on how music engagement can facilitate successful ageing be encouraging a sense of community, enhancing well-being and supporting cultural identity.

Characterization of the moisture absorption and thermal ageing behaviour of polymeric composite systems using Raman spectroscopy

Advanced polymeric materials and their respective composites are fast becoming one of the world's most frequently used engineering materials. They find application in the manufacture of e.g. boat hulls, high performance motor vehicles, aircraft components and sports goods. Their high specific strength and specific stiffness give them the edge in applications where weight savings are critical, but their long-term durability is often questioned. These materials are susceptible to environmental conditions such as temperature and humidity. There is also a lack of relevant data, due to the long time-scales required for testing. In this study, the Raman technique has been used to monitor the degradation of two composite systems, namely: a rubber toughened vinylester material used in the marine industry and a high temperature bismaleimide/carbon fibre aerospace composite. Preliminary Raman studies show that the toughening rubber particles dispersed in the cured vinylester resin are leached out during hygrothermal ageing. The weight gain during ageing suggests that this leaching process occurs concurrently with the absorption of water molecules. An increase in the degree of cross-linking is observed when bismaleimide/carbon fibre composite is aged at high temperature. This cross- linking tendency decreases with increasing depth within the carbon fibre bundle.

Exploration of the multifaceted dimensions of successful ageing

This thesis explored older adults' experiences of successful ageing. Self-acceptance, attitudes to ageing, and flexibility emerged as influencing factors. Acceptance was described as a personal struggle and underpinned criteria of successful ageing. Overall, ageing successfully seems anchored in our need to become integrated and find meaning in life.

Factors that predict work ability : incorporating a measure of organisational values towards ageing

This research conducted in an Australian public sector organisation aimed to identify the main factors that predict work ability for employees. According to Ilmarinen's (1999) model of work ability, an individual's work ability is influenced by their general health, attitudes, values and motivation interacting with workplace and other environmental demands. However what is unknown is the influence of value incongruence (i.e. the lack of fit between individual and organisational values), particularly when that incongruence results in age discrimination. This is important in an Australian context where youth and symbols of youth are over-valued in business environments and where older workers themselves perceive age discrimination as the single most important cause of early exit from the labour force.

109 participants completed a survey about work ability. Differences between work ability and health were not found between older and younger workers suggesting that strategies for improving work ability could be targeted at all employees rather than just older employees. However there were significant differences found between older and younger workers on reasons that would influence employees to stay longer in the organisation. Older workers tended to be more influenced by the provision of less demanding work, and positive attitudes towards older workers. Younger workers tended to be more influenced by opportunities to be employed in another section of the organisation, skills training opportunities and career advancement opportunities.

Results from hierarchical regression analyses suggested that good physical and mental health, and low occupational stress related to workplace culture were significant predictors of increased work ability. Results also suggested that occupational stress is likely to decrease with: high work ability and work satisfaction; and high value congruence. Implications for wellbeing programs to include the development of targeted organisational values are discussed.

Aggregation, ageing and transport properties of surface modified fumed silica dispersions

We have investigated the aggregation, ageing and transport properties of surface modified silica dispersions in DMSO by photon correlation spectroscopy and conductivity measurements. The surface modification introduces Li+-ions that dissociate in the dispersion creating a single Li+-ion conducting electrolyte. We show that the surface modification changes the aggregation and ageing properties of the material. There is a pronounced ageing observed for the modified silica dispersions. At high concentrations of fumed silica a gel state is found, which in the case of the surface modified silica is a very weak gel that can be rejuvenated by ultrasonic treatment. The key parameter controlling the aggregation in this system is hydrogen bonding and the surface modification results in a very low number of sites for hydrogen bonding. In addition there is a contribution from repulsive electrostatic interactions in the surface modified silica dispersions due to the highly charged surfaces of these particles. Furthermore, the Li+-ion diffusion, at low silica concentration, is three orders of magnitude faster than that of the silica particles and in the gel state the silica particles are immobile. We also find that the Li+-ion diffusion is virtually independent of the silica concentration in the dispersions.

Ageing mallee eucalypt vegetation after fire : insights for successional trajectories in semi-arid mallee ecosystems

A critical requirement in the ecological management of fire is knowledge of the age-class distribution of the vegetation. Such knowledge is important because it underpins the distribution of ecological features important to plants and animals including retreat sites, food sources and foraging microhabitats. However, in many regions, knowledge of the age-class distribution of vegetation is severely constrained by the limited data available on fire history. Much fire-history mapping is restricted to post-1972 fires, following satellite imagery becoming widely available. To investigate fire history in the semi-arid Murray Mallee region in southern Australia, we developed regression models for six species of mallee eucalypt (Eucalyptus oleosa F.Muell. ex. Miq. subsp. oleosa, E. leptophylla F.Muell. ex. Miq., E. dumosa J. Oxley, E. costata subsp. murrayana L. A. S. Johnson & K. D. Hill, E. gracilis F.Muell. and E. socialis F.Muell. ex. Miq.) to quantify the relationship between mean stem diameter and stem age (indicated by fire-year) at sites of known time since fire. We then used these models to predict mean stem age, and thus infer fire-year, for sites where the time since fire was not known. Validation of the models with independent data revealed a highly significant correlation between the actual and predicted time since fire (r = 0.71, P < 0.001, n = 88), confirming the utility of this method for ageing stands of mallee eucalypt vegetation. Validation data suggest the models provide a conservative estimate of the age of a site (i.e. they may under-estimate the minimum age of sites >35 years since fire). Nevertheless, this approach enables examination of post-fire chronosequences in semi-arid mallee ecosystems to be extended from 35 years post-fire to over 100 years. The predicted ages identified for mallee stands imply a need for redefining what is meant by ‘old-growth’ mallee, and challenges current perceptions of an over-abundance of ‘long-unburnt’ mallee vegetation. Given the strong influence of fire on semi-arid mallee vegetation, this approach offers the potential for a better understanding of long-term successional dynamics and the status of biota in an ecosystem that encompasses more than 250 000 km² of southern Australia.