The interface of acute and aged care: the role of the nurse in provincial area

Objective: This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the latge amount of data collected during this project, that is, the role of the nurse in the continuum of health care involving elderly people.

Method: The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients.

Results: The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge.

Conclusion: The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Professional carers' knowledge and response to depression among their aged-care clients : the care recipients' perspective

Depression is an under-diagnosed disorder among the elderly, even in those who are in receipt of aged-care services. One factor associated with this under diagnosis has been identified as a reluctance amongst the elderly to discuss their mood and emotions with their medical practitioners. The current study focused on why depression is not recognised and acted on by those providing residential or home-based care to older people. We interviewed 15 elderly people residing in high-level or low-level aged-care facilities, and three elderly people who were receiving personal care in their homes. All participants had been identified by their care agencies as depressed. Participants reported their perceptions of their personal carers' knowledge and practices in managing the residents' depression. Although the participants described their carers in positive terms, they were critical of their knowledge and skills in recognising depression, and indicated that the communication between personal carers and care recipients about depressive symptomatology was seriously flawed. Training for personal carers in these areas, and efforts to change organisational culture are recommended.

Promoting social support and social networks among Irish pensioners in South London, UK

This paper explores the activities of an Irish-led voluntary sector project that sought to minimise social isolation and build social networks among Irish elderly people living in a socio-economically deprived borough in South London, UK. The study from which this paper is drawn aimed to explore the nature and extent of unmet mental health needs among Irish pensioners. Using a naturalistic and exploratory design, data were collected through 19 semi-structured interviews, observation of project activities and analysis of members' case files. The paper presents findings in relation to the significant themes that emerged from the data analysis, which used a grounded theory approach. It discusses the social support systems within the project and examines the ways in which they maintained the mental wellbeing of the projects' members and interconnected with other areas of the project's activities. The study's findings demonstrated that the project provided space for social interaction among otherwise isolated Irish pensioners, many of whom experienced multiple morbidity. The project worked successfully to overcome the sense of stigma that prevented many of its members accessing statutory services; it also identified needs among carers. There was an Irish cultural ambience at the project centre, which generated a sense of belonging among members, and assisted in the development of social networks. The project initiated other forms of social support through the use of volunteers and developed befriending and telephone support services. The project developed partnership working with other agencies, particularly community mental health services, in order to provide support to elderly people who might otherwise have been institutionalised. The project engaged with the cultural norms of this marginalised white minority ethnic community to promote both social interaction and social networks. It offered a model of good practice for agencies working with isolated elderly members of minority ethnic communities.

Migrant Houses in the village Zavoj, Republic of Macedonia, 1988-2010

The focus of this data is on the transformation of the village Zavoj in the Republic of Macedonia, due to emigration from the village, recorded through the architectural changes to the houses in the village. The village had become by default a place for the accommodation of elderly people who did not want to join their offspring abroad in the cities of immigration, or in the fringe suburbs of nearby towns.

The data documents the ‘material history’ of the houses, and constitutes a longitudinal research project tracing the transformation of the architectural fabric of the village since 1988. It includes visual documentation such as photographs and drawings, and includes the houses as HOUSE-STATES as follows:

House-Traditional: Vernacular architecture still in use and maintained as a dwelling.
House-Construction: Buildings that are still being constructed, the house as ongoing construction site.
House-Fragment: An eMigrant house-fragment is juxtaposed with the vernacular dwelling. Typical and affordable techniques of single brick cavity and reinforced concrete structure are evident in the new fragment.
House-Closed: Many new houses have only one door and one window, height, size and volume are minimal; and are closed a lot of the time.
House-Ruin: Vernacular traditional dwellings that are deteriorating. Traditional vernacular dwellings are rarely renovated, reconstructed or repaired.

The data is complemented by several field-work methods including participant observation, interviews, documentation of the village as a totality, recording of oral histories and myths, festivities, and archival statistical research about the vicinity.

This dataset comprises photographic documentation, sketch/drawing documentation, digital interview recordings, and interview notes.

Vitamin D and adult bone health in Australia and New Zealand : a position statement

• A significant number of Australians are deficient in vitamin D - it is a fallacy that Australians receive adequate vitamin D from casual exposure to sunlight.

• People at high risk of vitamin D deficiency include elderly people (particularly those in residential care), people with skin conditions where avoidance of sunlight is advised, those with dark skin (particularly if veiled), and those with malabsorption.

• Exposure of hands, face and arms to one-third of a minimal erythemal dose (MED) of sunlight (the amount that produces a faint redness of skin) most days is recommended for adequate endogenous vitamin D synthesis. However, deliberate sun exposure between 10:00 and 14:00 in summer (11:00-15:00 daylight saving time) is not advised.

• If this sun exposure is not possible, then a vitamin D supplement of at least 400IU (10 μg) per day is recommended.

• In vitamin D deficiency, supplementation with 3000-5000 IU ergocalciferol per day (Ostelin [Boots]; 3-5 capsules per day) for 6-12 weeks is recommended.

• Larger-dose preparations of ergocalciferol or cholecalciferol are available in New Zealand, Asia and the United States and would be useful in Australia to treat moderate to severe vitamin D deficiency states in the elderly and those with poor absorption; one or two annual intramuscular doses of 300 000 IU of cholecalciferol have been shown to reverse vitamin D deficiency states.

Aging and its effects on inflammation in skeletal muscle at rest and following exercise-induced muscle injury

The world's elderly population is expanding rapidly, and we are now faced with the significant challenge of maintaining or improving physical activity, independence, and quality of life in the elderly. Counteracting the progressive loss of muscle mass that occurs in the elderly, known as sarcopenia, represents a major hurdle in achieving these goals. Indirect evidence for a role of inflammation in sarcopenia is that markers of systemic inflammation correlate with the loss of muscle mass and strength in the elderly. More direct evidence is that compared with skeletal muscle of young people, the number of macrophages is lower, the gene expression of several cytokines is higher, and stress signaling proteins are activated in skeletal muscle of elderly people at rest. Sarcopenia may also result from inadequate repair and chronic maladaptation following muscle injury in the elderly. Macrophage infiltration and the gene expression of certain cytokines are reduced in skeletal muscle of elderly people compared with young people following exercise-induced muscle injury. Further research is required to identify the cause(s) of inflammation in skeletal muscle of elderly people. Additional work is also needed to expand our understanding of the cells, proteins, and transcription factors that regulate inflammation in the skeletal muscle of elderly people at rest and after exercise. This knowledge is critical for devising strategies to restrict sarcopenia, and improve the health of today's elderly population.

Reliability maps and probabilistic guarantee of task motion for robotic manipulators

There are many applications for which reliable and safe robots are desired. For example, assistant robots for disabled or elderly people and surgical robots are required to be safe and reliable to prevent human injury and task failure. However, different levels of safety and reliability are required for different tasks so that understanding the reliability of robots is paramount. Currently, it is possible to guarantee the completion of a task when the robot is fault tolerant and the task remains in the fault-tolerant workspace (FTW). The traditional definition of FTW does not consider different reliabilities for the robotic manipulator's different joints. The aim of this paper is to extend the concept of a FTW to address the reliability of different joints. Such an extension can offer a wider FTW while maintaining the required level of reliability. This is achieved by associating a probability with every part of the workspace to extend the FTW. As a result, reliable fault-tolerant workspaces (RFTWs) are introduced by using the novel concept of conditional reliability maps. Such a RFTW can be used to improve the performance of assistant robots while providing the confidence that the robot remains reliable for completion of its assigned tasks. © 2012 Copyright Taylor & Francis and The Robotics Society of Japan.

Correlates of aggressive behavior in dementia

Background and Objective: A review of current literature was undertaken in order to summarize some of the possible biopsychosocial contributions to the development of aggressive behavior in elderly people with dementia. It was intended that such a summary would provide a useful clinical aid when assessing patients with behavioral symptoms and a starting point for undertaking research in this area. Method: Information was gathered from literature searches conducted on several occasions between 1995 and 2001 using 3 databases (Medline, CINHAL and PsycINFO), as well as journals and books available from the libraries of the authors and from Monash University, Melbourne, Australia. Results: Associations between various conditions and the development of aggressive behavior were found, including the contributions of degrees of cognitive impairment, personality, sensory change, physical illness, language impairment, brain pathology, affective and psychotic disorders. The role of gender, sexuality and disruption of circadian rhythms is also discussed, as is the importance of environmental factors. Conclusion: Identification of correlates of aggressive behavior may assist clinicians to understand and manage aggressive behavior more effectively.

Hyponatraemia: an audit of aged psychiatry patients taking SSRIs and SNRIs

Objective: 

Dietary protein intake may reduce hospitalisation due to infection in Māori of advanced age: LiLACS NZ

OBJECTIVE: To investigate factors related to hospital admission for infection, specifically examining nutrient intakes of Māori in advanced age (80+ years). METHOD: Face-to-face interviews with 200 Māori (85 men) to obtain demographic, social and health information. Diagnoses were validated against medical records. Detailed nutritional assessment using the 24-hour multiple-pass recall method was collected on two separate days. FOODfiles was used to analyse nutrient intake. National Health Index (NHI) numbers were matched to hospitalisations over a two-year period (12 months prior and 12 months following dietary assessment). Selected International Classification of Disease (ICD) codes were used to identify admissions related to infection. RESULTS: A total of 18% of participants were hospitalised due to infection, most commonly lower respiratory tract infection. Controlling for age, gender, NZ deprivation index, diabetes, CVD and chronic lung disease, a lower energy-adjusted protein intake was independently associated with hospitalisation due to infection: OR (95%CI) 1.14 (1.00-1.29), p=0.046. CONCLUSIONS: Protein intake may have a protective effect on the nutrition-related morbidity of older Māori. Improving dietary protein intake is a simple strategy for dietary modification aiming to decrease the risk of infections that lead to hospitalisation and other morbidities.

Ageing well, ageing productively : the essential contribution of Australia's ageing population to the social and economic prosperity of the nation

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care

Who gets the cats...you or me? Analyzing contact and residence issues regarding pets upon divorce or separation

Mills and Akers outline the statistical incidence of pet ownership and people's need for domestic pets, discuss ownership or property rights in domestic pets, outline the criteria used by the courts when ruling on implied contact and residence rights regarding domestic pets upon the irretrievable breakdown between the "owners" of the particular pets, and highlight both the shortcomings in the existing law and possible means of overcoming those shortcomings.

A comparison of four functional test in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.
Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.
Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.
Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.

Treatment of depression in low-level residential care facilities for the elderly

Background: The rate of recognition and treatment of depressed older people in nursing homes is low. Data from the low-level residential care population have not been reported. This study aimed to collect information about the treatment of depression among older persons living in low-level residential care (hostels).

Method: The participants comprised 300 elderly residents from ten low-level residential care facilities from various suburbs in metropolitan Melbourne. The participants were interviewed by a trained clinical psychologist to determine the presence or absence of major or minor depressive disorder using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Each participant was also administered the Standardized Mini-mental State Examination (SMMSE) to determine level of cognitive function. The clinical psychologist then reviewed all cases in consultation with a geropsychiatrist experienced in the diagnosis of depression among older people, prior to assigning a diagnosis of depression.

Results: An important finding in this study was the low treatment for currently depressed residents, with less than half of those in the sample who were depressed receiving treatment. However, 61 of the 96 residents out of the sample of 300 who were on antidepressants were not currently depressed.

Conclusion: There is an under recognition and under treatment of currently depressed older people in low-level residential care facilities (hostels) just as has been reported in studies in nursing homes. However, there are high numbers receiving antidepressants who are not currently depressed.