Effectiveness of psychological interventions for depressed elderly people in hostels

Thesis: Depression among older adults is a significant health concern. Research involved development and implementation of psychological intervention among older adults living in residential care. Poor participation was encountered amongst residential care facilities and older adults. The research identified barriers impeding provision of care for older adults with mental health concerns. The portfolio presents case studies demonstrating the flow-on effects of negative childhood experiences into adult relationships. The analyses illustrate how difficulties in childhood are associated with the development of depression and anxiety in later life.

Interactive effects of exercise plus calcium-vitamin D3 on bone strength in older men

The findings from this 18-month, community-based study revealed that an exercise program involving strength training and jumping activities was feasible and effective for improving bone density, muscle mass and strength in older men. There were no additional skeletal benefits derived from consuming a high calcium-vitamin D milk drink.

Reducing adverse events in older Australians taking newly released drugs

The number of older Australians with one or multiple chronic diseases is increasing. This thesis presents a model to assist in identifying current older patients with multiple illnesses and taking multiple medications who are at risk of experiencing an adverse drug reaction if they are prescribed a newly released drug.

Health-related beliefs, explanations and actions of older Anglo-Celtic-Australians

This thesis was an exploration of the health-related understandings and experiences of older Anglo-Celtic-Australians from a disadvantaged metropolitan locality. New insights were gained about the relationship between disadvantage and poor health outcomes; particularly the impact of limited self-care practices in combination with difficulties relating to the health care professionals.

Community nutrition : providing for older citizens

Diet quality is a contributing factor to the health of the increasing number of aged. A fortnightly small group meal program focusing on social interaction was trialled. It was concluded that the program had strong support from participants and that there is scope for expansions of existing food service programs to include alternative styles of presentations; and that the principle of the Community Meals Program should be continued and endorsed.

Older peoples' experience of accessing emergency care

Older ED users are more likely to be seriously ill, arrive by ambulance, spend more time in ED and require hospital admission. The aim of this study was to describe older people’s experiences of accessing Emergency Department (ED) care.

Perceived control and subjective wellbeing in older adults

Across age, the ability to accept what cannot be changed increases while feelings of control remain stable. The growth of acceptance preserves, rather than compensates for, older adults' sense of being in control. In later life, acceptance and control appear to operate together to maintain wellbeing. The professional portfolio uses four case studies to illustrate how Cognitive Behavioural Therapy (CBT) programs can be reinterpreted through and Acceptance and Committment Therapy (ACT) framework and elements of both employed within a single therapeutic program.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

Where will we live when we get older?

Ageing populations, although exhibiting marked differences across countries and cultures, are a global phenomenon. Old-age dependency ratios in most developed countries are projected to double by the year 2050. In Australia there will be a strain on economic growth as a large part of the population moves from pre-retirement to post-retirement age over the next 25 years. A disproportionate amount of this strain will be concentrated in aged-care housing or retirement accommodation. Current evidence suggests that existing housing stock for older people is inadequate. As the Australian population ages, the maintenance and long-term performance of retirement housing is a key concern of government and housing providers. This study looked at four aged-care or retirement providers across Australia and examined the performance of the current housing stock managed by these providers. The interviews revealed that housing design decisions in retirement stock, although critically important to the changing needs of occupants and the adequate supply of suitable housing, are often ill-considered. The findings critically question the idea of simply building ‘more of the same’ to relieve demand. This study has major implications for the future of Australian retirement housing, especially as the population ages dramatically.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.

A study of older Australians’ volunteering and quality of life : empirical evidence and policy implications

Older Australians are confronted by dramatic changes in their physical, social, financial, and psychological well-being. There are social costs to these changes related to their productivity and increased costs associated with caring for older Australians. Greater community engagement through voluntary work practice may minimize these costs, as well as positively influence volunteers' subjective quality of life (QOL). This study investigates the motivations for older Australians to engage in formal voluntary work. It seeks to identify whether the motivational factors to volunteer are associated with individuals' subjective QOL. The results indicate a positive relationship between older people's motivations to volunteer and their subjective QOL. This association is strengthened by respondents' community orientation, positive perception of voluntary work, positive personal attitudes toward volunteering, and their self-esteem. The role of policy makers in motivating larger participation by the older groups is discussed.

Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Health Ageing (MELSHA) : cross-sectional analysis of prevalence and risk factors

Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community.

Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000) in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk.

Results Self-reported medication side effects were reported by approximately 6.7% (67/1000) of the entire baseline MELSHA cohort, and by 8.5% (65/761) of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors.

Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

Robotics to enable older adults to remain living at home

Given the rapidly ageing population, interest is growing in robots to enable older people to remain living at home. We conducted a systematic review and critical evaluation of the scientific literature, from 1990 to the present, on the use of robots in aged care. The key research questions were as follows: (1) what is the range of robotic devices available to enable older people to remain mobile, independent, and safe? and, (2) what is the evidence demonstrating that robotic devices are effective in enabling independent living in community dwelling older people? Following database searches for relevant literature an initial yield of 161 articles was obtained. Titles and abstracts of articles were then reviewed by 2 independent people to determine suitability for inclusion. Forty-two articles met the criteria for question 1. Of these, 4 articles met the criteria for question 2. Results showed that robotics is currently available to assist older healthy people and people with disabilities to remain independent and to monitor their safety and social connectedness. Most studies were conducted in laboratories and hospital clinics. Currently limited evidence demonstrates that robots can be used to enable people to remain living at home, although this is an emerging smart technology that is rapidly evolving.

Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

Background The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated.
Methods/design 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined.
Discussion This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD.

Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition,Economics (DAnCE) fall prevention randomised controlled trial

Background:  Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fall prevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people.

Methods/design: A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed.

Discussion: This study offers a novel approach to balance training for older people. As a community-based approach to fall prevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise.