Development and review of vignettes representing older people with cognitive impairment

This paper describes a process undertaken to develop and review five clinical vignettes to be used in geriatric nursing educational research. The purpose of this process was to provide valid depictions of delirium and its subtypes and distinguish delirium from dementia. Five vignettes depicting hospital bedside interactions between nursing staff, family, and an older patient who displayed signs of one of the following conditions: delirium (hyper and hypo-active types respectively), dementia, or delirium (both types) superimposed on dementia were constructed. Vignette accuracy and reliability was established using a multistage process that culminated in formal review by a group of ten international nursing and medical delirium experts. The final five vignettes accurately depicted the given scenario as agreed by the experts and were at an appropriate level of simplicity and clarity. Given the increased interest in vignettes for both nursing research and educational purposes, the described method of vignette development and review has the ability to assist other vignette developers in creating reliable representations of their desired clinical scenarios.

Mobility and active ageing in suburban environments : findings from in-depth interviews and person-based GPS tracking

Background. Governments face a significant challenge to ensure that community environments meet the mobility needs of an ageing population. Therefore, it is critical to investigate the effect of suburban environments on the choice of transportation and its relation to participation and active ageing. Objective. This research explores if and how suburban environments impact older people’s mobility and their use of different modes of transport. Methods. Data derived from GPS tracking, travel diaries, brief questionnaires, and semistructured interviews were gathered from thirteen people aged from 56 to 87 years, living in low-density suburban environments in Brisbane, Australia. Results. The suburban environment influenced the choice of transportation and out-of-home mobility. Both walkability and public transportation (access and usability) impact older people’s transportation choices. Impracticality of active and public transportation within suburban environments creates car dependency in older age. Conclusion. Suburban environments often create barriers to mobility, which impedes older people’s engagement in their wider community and ability to actively age in place. Further research is needed to develop approaches towards age-friendly suburban environments which will encourage older people to remain active and engaged in older age.

The determinants of hiring older workers in Britain revisited: an analysis using WERS 2004

This article reexamines the role of specific human capital and back loading of compensation as deterrents to hiring older workers. We utilize the framework initially suggested by Hutchens (1986) and more recently implemented by Daniel and Heywood (2007). This approach identifies the extent to which firms hire older workers at a rate less than full replacement would imply. Using the 2004 British Workplace Employment Relations Survey, we examine whether a more favourable climate including a much tighter UK labour market combined with the abandonment of defined benefit pension schemes has increased the tendency to hire older workers. We also examine the impact of private health insurance.

Peer-led diabetes self-management programme for community-dwelling older people in China : study protocol for a quasi-experimental design

Aim. A protocol for a new peer-led self-management programme for communitydwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi-experimental. Methods. This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks,is especially promising considering healthcare resource shortage in China.

Physical activity amongst older adults with musculoskeletal disorders : a descriptive study

"The World Health Organisation has identified physical inactivity as the fourth leading effective cause of death globally. The burden of physical inactivity will increase as the population ages. In addition to increased risk or mortality, prior research has indicated older adults with chronic musculoskeletal conditions are likely to face increased morbidity and poorer prognoses if they are physically inactive. There is currently a scarcity of empirical research describing the physical activity profile of older adults with chronic musculoskeletal disorders. The aim of this investigation was to describe the self-reported physical activity profile and body mass index (BMI) profile of a sample of older adults with chronic musculoskeletal disorders accessing outpatient hospital services."--publisher website

The predictors of active ageing of older Australians : the triple a study

The concept of older adults contributing to society in a meaningful way has been termed ‘active ageing’. Active ageing reflects changes in prevailing theories of social and psychological aspects of ageing, with a focus on individuals' strengths as opposed to their deficits or pathology. In order to explore predictors of active ageing, the Australian Active Ageing (Triple A) project group undertook a national postal survey of participants over the age of 50 years recruited randomly through their 2004 membership of a large Australia-wide senior's organisation. The survey comprised 178 items covering paid and voluntary work, learning, social, spiritual, emotional, health and home, life events and demographic items. A 45% response rate (2655 returned surveys) reflected an expected balance of gender, age and geographic representation of participants. The data were analysed using data mining techniques to represent generalizations on individual situations. Data mining identifies the valid, novel, potentially useful and understandable patterns and trends in data. The results based on the clustering mining technique indicate that physical and emotional health combined with the desire to learn were the most significant factors when considering active ageing. The findings suggest that remaining active in later life is not only directly related to the maintenance of emotional and physical health, but may be significantly intertwined with the opportunity to engage in on-going learning activities that are relevant to the individual. The findings of this study suggest that practitioners and policy makers need to incorporate older peoples' learning needs within service and policy framework developments.

Factors influencing caregiver : care receiver communication and its impact on the well-being of older care receivers

Examined communication between frail older people and their caregiving spouses (CGSs), and its relation to well-being in older care receivers. 53 community residing spousal dyads completed questionnaires about their well-being, relational satisfaction, and communication patterns. Conversations between the dyads were also videotaped and analyzed. The type of communication used by the CGSs was influenced by their sex, their earlier relationship with their spouse, and their level of well-being. CGSs who used an overly directive communication tone with their spouse were likely to be wives and CGSs who had a high degree of autonomy in their earlier relationship with their spouse. Low levels of life satisfaction and high affect balance in CGSs were associated with CGSs using a more patronizing tone. The well-being of care receivers was also related to their perceptions of their CGSs' communication. Care receivers who perceived their CGSs' communication as patronizing reported low levels of affect balance and high levels of conflict in the relationship. Findings suggest that certain characteristics of CGSs are related to the type of communication they use when conversing with their partner, although the relations are not always as expected.

Communication predicaments of older health care consumers : what can 'we' do about it?

Focuses on the importance of communication to the well-being of older people in Australia. Role of communication for the design, delivery and evaluation of health services for the elderly; Impact of aging on communication; Importance of communication between health care providers and nursing home residents.

The association between objectively measured neighbourhood features and walking for transport in mid-aged adults

The aim of this paper is to examine the association between a range of objectively measured neighbourhood features and the likelihood of mid-aged adults walking for transport. Increased walking for transport would bring multiple benefits, including improved population and environmental health. As part of the baseline HABITAT study, 10,745 residents of Brisbane, Australia, aged 40–65 years, from 200 neighbourhoods were asked about the time they spent walking for transport. Walking data were collected by mail survey and the physical environmental features of neighbourhoods were compiled using a geographic information systems database. Walking for transport was categorised into four levels and the association between walking and each neighbourhood characteristic was examined using multilevel multinomial models. A number of threshold trends were evident; for example, off-road bikeways were consistently associated with walking between 60 and 150 min per week. Living within 500 m of public transit was also an important predictor but only for those who walked for less than 150 min per week. Interventions targeting these neighbourhood characteristics may lead to improved environmental quality, lower rates of overweight and obesity and associated chromic disease.

Approaches to designing for older adults' intuitive interaction with complex devices

Many older people have difficulties using modern consumer products due to increased product complexity both in terms of functionality and interface design. Previous research has shown that older people have more difficulty in using complex devices intuitively when compared to the younger. Furthermore, increased life expectancy and a falling birth rate have been catalysts for changes in world demographics over the past two decades. This trend also suggests a proportional increase of older people in the work-force. This realisation has led to research on the effective use of technology by older populations in an effort to engage them more productively and to assist them in leading independent lives. Ironically, not enough attention has been paid to the development of interaction design strategies that would actually enable older users to better exploit new technologies. Previous research suggests that if products are designed to reflect people's prior knowledge, they will appear intuitive to use. Since intuitive interfaces utilise domain-specific prior knowledge of users, they require minimal learning for effective interaction. However, older people are very diverse in their capabilities and domain-specific prior knowledge. In addition, ageing also slows down the process of acquiring new knowledge. Keeping these suggestions and limitations in view, the aim of this study was set to investigate possible approaches to developing interfaces that facilitate their intuitive use by older people. In this quest to develop intuitive interfaces for older people, two experiments were conducted that systematically investigated redundancy (the use of both text and icons) in interface design, complexity of interface structure (nested versus flat), and personal user factors such as cognitive abilities, perceived self-efficacy and technology anxiety. All of these factors could interfere with intuitive use. The results from the first experiment suggest that, contrary to what was hypothesised, older people (65+ years) completed the tasks on the text only based interface design faster than on the redundant interface design. The outcome of the second experiment showed that, as expected, older people took more time on a nested interface. However, they did not make significantly more errors compared with younger age groups. Contrary to what was expected, older age groups also did better under anxious conditions. The findings of this study also suggest that older age groups are more heterogeneous in their capabilities and their intuitive use of contemporary technological devices is mediated more by domain-specific technology prior knowledge and by their cognitive abilities, than chronological age. This makes it extremely difficult to develop product interfaces that are entirely intuitive to use. However, by keeping in view the cognitive limitations of older people when interfaces are developed, and using simple text-based interfaces with flat interface structure, would help them intuitively learn and use complex technological products successfully during early encounter with a product. These findings indicate that it might be more pragmatic if interfaces are designed for intuitive learning rather than for intuitive use. Based on this research and the existing literature, a model for adaptable interface design as a strategy for developing intuitively learnable product interfaces was proposed. An adaptable interface can initially use a simple text only interface to help older users to learn and successfully use the new system. Over time, this can be progressively changed to a symbols-based nested interface for more efficient and intuitive use.

An exploratory study of associations between Australian-Indian mothers’ use of controlling feeding practices, concerns and perceptions of children’s weight and children’s picky eating

Aim This cross-sectional study explores associations between migrant Indian mothers’ use of controlling feeding practices (pressure to eat, restriction and monitoring) and their concerns and perceptions regarding their children’s weight and picky eating behaviour. Methods Two hundred and thirty mothers with children aged 1-5 years, residing in Australia for 1-8 years, participated by completing a self-reported questionnaire. Results Perceptions and concerns regarding children’s weight were not associated with any of the controlling feeding practices. A positive association was noted between pressure feeding and perceptions of pickiness after adjusting for covariates: children’s age, gender and weight-for-age Z-score. Girls, older children, and children with higher weight-for-age z scores were pressure fed to a greater extent. Conclusions This study supports the generalisation of findings from Caucasian literature that pressure feeding and perceptions of pickiness are positively related.

Health status of Thai migrants in Brisbane : findings from a cross-sectional investigation

Australia is a multi-ethnic, multi-cultural country with a long history of migration. In 2006, 22% of the population was born overseas. Thai migrants accounted for 0.2% of the population at this time, with a nearly 40% increase from around 19,000 in 1996 to 30,555 in 2006.1 Despite this, little is known about the health of this migrant group. We investigated the health status and health service utilisation of a Thai community through a cross-sectional postal survey conducted from May to September 2010. Participants were members of a Brisbane Thai temple, aged 18 years and older, who self identified as being Thai. Current health status was assessed using the SF-36v22 and self-report of diagnosed medical conditions. Use of health services was assessed using questions adapted from the Welsh Health Survey.3 Socio-demographic variables included gender, age, language spoken at home, year of arrival in Australia and type of health care insurance.

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom

Objective The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives. Design A cross sectional study of self reported survey data. Settings Australia, New Zealand and the United Kingdom. Methods Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mother's age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables. Participants 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074). Results Amongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35–44 yrs aOR 1.71, 95% CI 1.41–2.08; 45–55 yrs aOR 1.90, 95%CI 1.56–2.31; 55–64 aOR 2.22, 95% CI 1.71–2.88), and male gender (aOR 1.46, 95% CI 1.15–1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06–1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11–1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70–0.94 and aOR 0.75, 95% CI 0.59–0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04–1.80). Conclusion Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease.