Another minority group: use of aged care day programs and community leisure services by older people with lifelong disability

Objective: This study examined the extent to which programs available to the general aged community are accessible to older people with lifelong disability. Method: Forty Victorian generic aged day activity and community leisure programs used by older people responded to a survey that sought information on the extent to which such services are used by older people with a lifelong disability. Results: More than half of these services are accessed by a small number of people with lifelong disability and overall there was a willingness to include this group in generic services. Barriers and solutions to successful generic service use were reported. Conclusions: The findings indicate that the issues for people with lifelong disability differ little from those of other minority groups. It is proposed that disability services have a role in brokering services for their older clients, and continued planning and collaboration between disability and aged services will benefit all older people.

Retirement or just a change of pace: an Australian national survey of disability day services used by older people with disabilities

The increasing number of people with disabilities surviving to old age raises questions regarding the type of day support programs necessary to meet their needs. In this paper the results of a national survey of specialist disability day programs used by older2 people with a lifelong disability are discussed. A postal survey of 596 day programs for people with disabilities was conducted, with a response rate of 28%. Findings show that only 19% of service users were aged over 55, and the largest subgroup were people with intellectual disability. Many older people attended programs that were not age specific and a typology of the seven program types utilised was constructed. Individualised planning, flexibility and choice were perceived as fundamental to a successful program. The location of activities in the community, maintenance of social relationships, and opportunities to develop new contacts were also seen as important. Little understanding, however, of the diversity of the ageing process or notions of healthy ageing was demonstrated by service providers, many of whom had limited expectations of older people. Challenges identified in providing day support for older people were lack of financial resources, knowledge and expertise amongst staff, and difficulties interfacing with other service systems.

Challenges of managing medications for older people at transition points of care

In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem - that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

The information needs of older people who choose supportive care over dialysis: A case study approach

Background: Supportive care is increasingly being viewed as an appropriate alternative option to dialysis or transplantation for older people with advanced chronic kidney disease (ACKD). The purpose of this study was to explore the information needs of older people with ACKD who choose supportive care as their treatment. Methods: A case study approach using semi-structured interviews and medical case note review methods was used to explore the information needs of six older people receiving supportive care. Results: The majority of the information the participants had recalled receiving placed a greater emphasis on dialysis over supportive care. Although they did not want dialysis, they were not clear on what supportive care meant or whether they had a supportive care plan. Participants perceived they had never been given specific information about supportive care. Medical case note review revealed infrequent and non-systematic documentation in medical case notes. Conclusions: In the absence of a formal nephrology supportive care program, information may be provided in an unplanned, non-systematic approach to older people and their families who choose supportive care.

Protein requirements and recommendations for older people: a review

Declines in skeletal muscle mass and strength are major contributors to increased mortality, morbidity and reduced quality of life in older people. Recommended Dietary Allowances/Intakes have failed to adequately consider the protein requirements of the elderly with respect to function. The aim of this paper was to review definitions of optimal protein status and the evidence base for optimal dietary protein. Current recommended protein intakes for older people do not account for the compensatory loss of muscle mass that occurs on lower protein intakes. Older people have lower rates of protein synthesis and whole-body proteolysis in response to an anabolic stimulus (food or resistance exercise). Recommendations for the level of adequate dietary intake of protein for older people should be informed by evidence derived from functional outcomes. Randomized controlled trials report a clear benefit of increased dietary protein on lean mass gain and leg strength, particularly when combined with resistance exercise. There is good consistent evidence (level III-2 to IV) that consumption of 1.0 to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Older people appear to require 1.0 to 1.3 g/kg/day dietary protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations.

The impact of leisure participation on mental health for older people with depression: a systematic review

Aims: This systematic review aimed to discover whether participation in individually chosen leisure activities improved mental health for people aged over 65 who have depression. Methods: Twenty-six potentially relevant studies were identified from an electronic database review. Of these 12 met the inclusion criteria and scope of the review. Results: The current evidence base is relatively small, and includes a diversity of subject groups, subject situations, and study designs. In all cases, participants were either directed to choose from a number of leisure activities, or provided with a pre-designed program that did not allow for individual choice. Conclusion: Currently, there is insufficient evidence available to determine whether participation in individually chosen leisure activities improves mental health for people aged over 65 who have depression.

“You’re a whole group of people singing”: sharing and learning together in The Choir of the Hawthorn U3A

For older people group music making can assist them remain independent and active in the community. Across Melbourne there are many non-competitive leisure based choirs made of older, active volunteer participants. This paper presents the findings of a phenomenological qualitative case study that was undertaken with members of The Choir of the U3A Hawthorn. This group is auspiced by the international University of the Third Age (U3A) that promotes life-long learning and personal fulfilment amongst older people. In 2008 we began a large joint ongoing research project between Deakin University and Monash University, Well-being and ageing: community, diversity and the arts in Victoria. In 2013 members of the U3A Hawthorn Choir were interviewed about their perceived benefits concerning active music engagement in choir membership. Participants recounted joining the group for different reasons including a positive attitude to singing, convenience, and a desire for social connectedness. Those interviewed considered ongoing choir membership an effective use of leisure time that also provided opportunities for shared learning and personal validation. The data were analysed using Interpretative Phenomenological Analysis and are reported under two themes: Music engagement and Social connections. Membership of the Hawthorn U3A choir provided participants opportunities for friendship, companionship, happiness, a sense of belonging, and acceptance. This resilient community music group (first formed in 1996) has maintained a busy schedule of rehearsals and performances. This music making offers significant ways for older people to maintain well-being and contribute to the wider community.

Families and caregivers of older people: expectations, communication and care decisions

While family caregivers may temporarily relinquish responsibility for daily care to health professionals for the period of hospitalization, new expectations and demands are placed upon them. Family caregivers can be asked to commit to new relationships with health professionals, contribute to care decisions and discharge planning. For the caregivers of older patients these new expectations may be challenging, and contribute to feelings of burden and increased stress. The aim of this qualitative descriptive study was to explore the experience of family caregivers when their relative is an inpatient in this outer Melbourne geriatric evaluation and management facility. This study found that the burden associated with the experience of caregiving continued despite the hospitalization of their relative. The challenges faced by families included communicating with health professionals, and being asked to contribute to care decisions, in particular those regarding discharge planning, and managing conflict. In conclusion, the issues and challenges faced by family caregivers needs to be acknowledged and considered as an extension of patient care planning

Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS).

Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method.

Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice.

Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

A clinical nursing leadership model for enhancing continence care for older adults in a subacute inpatient care setting

This article describes the application and evaluation of a clinical nursing leadership model to enhance continence care in an inpatient rehabilitation setting for older adults. Multiple strategies were employed to optimize the uptake and sustainability of 3 practice initiatives: (1)  establishment of an enhanced role for wardbased nurses to provide clinical support to patients and other staff for the management of incontinence, (2) a new method for nursing assessment and management of bowel elimination, and (3) a framework for improved discharge care of patients with incontinence. Evaluation data indicated a high level of acceptance of the role of the ward-based continence resource nurses, improved assessment and management of bowel elimination, and enhanced discharge care for patients with incontinence. These initiatives were sustainable during a 2-year period after their introduction, despite the gradual withdrawal of the clinical leader.