Wellness in older adults

Understanding perception of wellness in older adults is a question to be understood against the backdrop of concerns about whether global ageing and the ‘bulge’ of ageing baby boomers will increase health care cost beyond what modern economies can deal with. Older adults who age in a healthy way and who take responsibility for their own health offer a positive alternative and change the perception that older adults are a burden on their society’s health system. The concept of successful ageing introduced by Rowe and Kahn (1987; 1997) suggested that older adults age successfully if they avoid disease and disability, maintain high cognitive and physical functioning and remain actively engaged with life. This concept, however, did not reflect older adults’ own perceptions of what constitutes successful ageing or how perceptions of wellness or health-related quality of life influenced the older adult’s understanding of his or her own health and ageing. A research project was designed to examine older adults’ perceptions of wellness in order to gain an understanding of the factors that influence perception of their own wellness. Specifically, the research wanted to explore two aspects: whether belonging to a unique organisation, in this instance a Returned Services Club, influenced perceptions of wellness; and whether there are significant gender differences for the perception of wellness. A mixed method project with two consecutive studies was designed to answer these questions: a quantitative survey of members of a Returned Services Club and of the surrounding community in Queensland, Australia, and a qualitative study conducting focus groups to explore findings of the survey. The results of the survey were used to determine the composition of the focus groups. The participants for the first study, (N=257), community living adults 65 years and older, were chosen from the membership role of a Returned Services Club or recruited by personal approach from the community surrounding the Services Club. Participants completed a survey that consisted of a perception of wellness instrument, a health-related quality of life instrument, and questions on morbidities, modifiable life style factors and demographics. Data analysis found that a number of individual factors influenced perception of wellness and health-related quality of life. Positive influences were independent mobility, exercise and gambling at non-hazardous levels, and negative influences were hearing loss, memory problems, chronic disease and being single. Membership of the Services Club did not contribute to perception of wellness beyond being a member of a social group. While there may have been an expectation that members of an organisation that is traditionally associated with high alcohol use and problematic gambling may have lower perceptions of wellness, this study suggested that the negative influences may have been counteracted by the positive effects of social interaction, thus having neither negative nor positive influences on perception of wellness. There were significant differences in perception of wellness and in health-related quality of life for women and men. The most significant difference was for women aged 85-90 who had significantly lower scores for perception of wellness than men or than any other age group. This result was the impetus for conducting focus groups with adults aged 85-90 years of age. Focus groups were conducted with 24 women and four men aged 85-90 to explore the survey findings for this age group. Results from the focus groups indicated that for older adults perception of wellness was a multidimensional construct of more complexity than indicated by the survey instrument. Elite older women (women over 85 years of age) related their perception of wellness to their ability to do what they wanted to do, and what they wanted to do significantly more than anything else, was to stay connected to family, friends and the community to which they belonged. From the focus group results it appeared that elite older women identified with the three elements of successful ageing – low incidence of disability and disease, high physical and cognitive functioning, and active engagement with life – but not in a flat structure. It appears that for elite older women good physical and mental health function to enable social connectedness. It is the elements of health that impact on the ability to do what they wanted to do that were identified as key factors: independent mobility, hearing and memory - factors that impact on the ability to interact socially. These elements were only identified when they impacted on the person’s ability to do what they wanted to do, for example mobility problems that were managed were not considered a problem. The study also revealed that older women use selection, optimisation and compensation to meet their goal of staying socially connected. The shopping centre was a key factor in this goal and older women used shopping centres to stay connected to the community and for exercise as well as shopping. Personal and public safety and other environmental concerns were viewed in the same context of enabling or disabling social connectedness. This suggested that for elite older women the model of successful ageing was hierarchical rather than flat, with social connectedness at the top, supported by cognitive functioning and good physical and mental health. In conclusion, this research revealed that perception of wellness in older adults is a complex, multidimensional construct. For older adults good health is related to social connectedness and is not a goal in itself. Health professionals and the community at large have a responsibility to take into account the ability of the older adult to stay socially connected to their community and to enable this, if the goal is to keep older adults healthy for as long as possible. Maintaining or improving perception of wellness in older adults will require a broad biopsychosocial approach that utilises findings such as older adults’ use of shopping centres for non-shopping purposes, concerns about personal and environmental safety and supporting older adults to maintain or improve their social connectedness to their communities.

Hollywood dominance : will it continue?

Hollywood has dominated the global film business since the First World War. Economic formulas used by governments to assess levels of industry dominance typically measure market share to establish the degree of industry concentration. The business literature reveals that a marketing orientation strongly correlates with superior market performance and that market leaders that possess a set of six superior marketing capabilities are able to continually outperform rival firms. This paper argues that the historical evidence shows that the Hollywood Majors have consistently outperformed rival firms and rival film industries in each of those six marketing capabilities and that unless rivals develop a similarly integrated and cohesive strategic marketing management approach to the movie business and match the Major studios’ superior capabilities, then Hollywood’s dominance will continue. This paper also proposes that in cyberspace, whilst the Internet does provide a channel that democratises film distribution, the flat landscape of the world wide web means that in order to stand out from the clutter of millions of cyber-voices seeking attention, independent film companies need to possess superior strategic marketing management capabilities and develop effective e-marketing strategies to find a niche, attract a loyal online audience and prosper. However, mirroring a recent CIA report forecasting a multi-polar world economy, this paper also argues that potentially serious longer-term rivals are emerging and will increasingly take a larger slice of an expanding global box office as India, China and other major developing economies and their respective cultural channels grow and achieve economic parity with or surpass the advanced western economies. Thus, in terms of global market share over time, Hollywood’s slice of the pie will comparatively diminish in an emerging multi-polar movie business.

Workplace design in the knowledge economy : a case of the NetWorkPlace™©

This thesis explores a way to inform the architectural design process for contemporary workplace environments. It reports on both theoretical and practical outcomes through an exclusively Australian case study of a network enterprise comprised of collaborative, yet independent business entities. The internet revolution, substantial economic and cultural shifts, and an increased emphasis on lifestyle considerations have prompted a radical re-ordering of organisational relationships and the associated structures, processes, and places of doing business. The social milieu of the information age and the knowledge economy is characterised by an almost instantaneous flow of information and capital. This has culminated in a phenomenon termed by Manuel Castells as the network society, where physical locations are joined together by continuous communication and virtual connectivity. A new spatial logic encompassing redefined concepts of space and distance, and requiring a comprehensive shift in the approach to designing workplace environments for today’s adaptive, collaborative organisations in a dynamic business world, provides the backdrop for this research. Within the duality of space and an augmentation of the traditional notions of place, organisational and institutional structures pose new challenges for the design professions. The literature revealed that there has always been a mono-organisational focus in relation to workplace design strategies. The phenomenon of inter-organisational collaboration has enabled the identification of a gap in the knowledge relative to workplace design. This new context generated the formulation of a unique research construct, the NetWorkPlace™©, which captures the complexity of contemporary employment structures embracing both physical and virtual work environments and practices, and provided the basis for investigating the factors that are shaping and defining interactions within and across networked organisational settings. The methodological orientation and the methods employed follow a qualitative approach and an abductively driven strategy comprising two distinct components, a cross-sectional study of the whole of the network and a longitudinal study, focusing on a single discrete workplace site. The complexity of the context encountered dictated that a multi-dimensional investigative framework was required to be devised. The adoption of a pluralist ontology and the reconfiguration of approaches from traditional paradigms into a collaborative, trans-disciplinary, multi-method epistemology provided an explicit and replicatable method of investigation. The identification and introduction of the NetWorkPlace™© phenomenon, by necessity, spans a number of traditional disciplinary boundaries. Results confirm that in this context, architectural research, and by extension architectural practice, must engage with what other disciplines have to offer. The research concludes that no single disciplinary approach to either research or practice in this area of design can suffice. Pierre Bourdieau’s philosophy of ‘practice’ provides a framework within which the governance and technology structures, together with the mechanisms enabling the production of social order in this context, can be understood. This is achieved by applying the concepts of position and positioning to the corporate power dynamics, and integrating the conflict found to exist between enterprise standard and ferally conceived technology systems. By extending existing theory and conceptions of ‘place’ and the ‘person-environment relationship’, relevant understandings of the tensions created between Castells’ notions of the space of place and the space of flows are established. The trans-disciplinary approach adopted, and underpinned by a robust academic and practical framework, illustrates the potential for expanding the range and richness of understanding applicable to design in this context. The outcome informs workplace design by extending theoretical horizons, and by the development of a comprehensive investigative process comprising a suite of models and techniques for both architectural and interior design research and practice, collectively entitled the NetWorkPlace™© Application Framework. This work contributes to the body of knowledge within the design disciplines in substantive, theoretical, and methodological terms, whilst potentially also influencing future organisational network theories, management practices, and information and communication technology applications. The NetWorkPlace™© as reported in this thesis, constitutes a multi-dimensional concept having the capacity to deal with the fluidity and ambiguity characteristic of the network context, as both a topic of research and the way of going about it.

Low fat loss response after medium-term supervised exercise in obese is associated with exercise-induced increase in food reward

Objective: To examine exercise-induced changes in the reward value of food during medium-term supervised exercise in obese individuals. ---------- Subjects/Methods: The study was a 12-week supervised exercise intervention prescribed to expend 500 kcal/day, 5 d/week. 34 sedentary obese males and females were identified as responders (R) or non-responders (NR) to the intervention according to changes in body composition relative to measured energy expended during exercise. Food reward (ratings of liking and wanting, and relative preference by forced choice pairs) for an array of food images was assessed before and after an acute exercise bout. ---------- Results. 20 responders and 14 non-responders were identified. R lost 5.2 kg±2.4 of total fat mass and NR lost 1.7 kg±1.4. After acute exercise, liking for all foods increased in NR compared to no change in R. Furthermore, NR showed an increase in wanting and relative preference for high-fat sweet foods. These differences were independent of 12-weeks regular exercise and weight loss. ---------- Conclusion. Individuals who showed an immediate post-exercise increase in liking and increased wanting and preference for high-fat sweet foods displayed a smaller reduction in fat mass with exercise. For some individuals, exercise increases the reward value of food and diminishes the impact of exercise on fat loss.

Parents’ self-efficacy, outcome expectations, and self-reported task performance when managing atopic dermatitis in children: Instrument reliability and validity

BACKGROUND: Support and education for parents faced with managing a child with atopic dermatitis is crucial to the success of current treatments. Interventions aiming to improve parent management of this condition are promising. Unfortunately, evaluation is hampered by lack of precise research tools to measure change. OBJECTIVES: To develop a suite of valid and reliable research instruments to appraise parents' self-efficacy for performing atopic dermatitis management tasks; outcome expectations of performing management tasks; and self-reported task performance in a community sample of parents of children with atopic dermatitis. METHODS: The Parents' Eczema Management Scale (PEMS) and the Parents' Outcome Expectations of Eczema Management Scale (POEEMS) were developed from an existing self-efficacy scale, the Parental Self-Efficacy with Eczema Care Index (PASECI). Each scale was presented in a single self-administered questionnaire, to measure self-efficacy, outcome expectations, and self-reported task performance related to managing child atopic dermatitis. Each was tested with a community sample of parents of children with atopic dermatitis, and psychometric evaluation of the scales' reliability and validity was conducted. SETTING AND PARTICIPANTS: A community-based convenience sample of 120 parents of children with atopic dermatitis completed the self-administered questionnaire. Participants were recruited through schools across Australia. RESULTS: Satisfactory internal consistency and test-retest reliability was demonstrated for all three scales. Construct validity was satisfactory, with positive relationships between self-efficacy for managing atopic dermatitis and general perceived self-efficacy; self-efficacy for managing atopic dermatitis and self-reported task performance; and self-efficacy for managing atopic dermatitis and outcome expectations. Factor analyses revealed two-factor structures for PEMS and PASECI alike, with both scales containing factors related to performing routine management tasks, and managing the child's symptoms and behaviour. Factor analysis was also applied to POEEMS resulting in a three-factor structure. Factors relating to independent management of atopic dermatitis by the parent, involving healthcare professionals in management, and involving the child in the management of atopic dermatitis were found. Parents' self-efficacy and outcome expectations had a significant influence on self-reported task performance. CONCLUSIONS: Findings suggest that PEMS and POEEMS are valid and reliable instruments worthy of further psychometric evaluation. Likewise, validity and reliability of PASECI was confirmed.