Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries. 

The Persistence of Torture: Explaining Coercive Interrogation in America’s Small Wars

Thesis (Ph.D.)--University of Washington, 2016-08

The Effect of Non-Audit Services on Auditor Independence : A study on 11 food retail- and wholesale companies in the United Kingdom

Purpose – The purpose of this study is to investigate the effect of non-audit services on auditor independence, and the importance of non-audit services as a source of income for audit firms in the United Kingdom. Design/method/approach – This study will examine 11 companies in the food retail- and wholesale industry during 2007 - 2014. Five indicators have been used; (1) Appointed auditor and provision of non-audit services to audit clients; (2) Auditor tenure; (3) Non-audit services in relation to total services; (4) Tax-services in relation to non-audit services, (5) Big Four’s revenue. Information has been collected using the quantitative approach through annual- and transparency reports. The threshold used to measure possible independence threats (self-review-, self-interest- and familiarity threat) has been set at 18,5 %. Findings – This study concludes that the jointly provision of audit- and nonaudit services possibly causes impairment of auditor independence, and that non-audit services is an important source of income for audit firms. The findings showed that in 99 %, companies purchased non-audit services from their statutory auditor. Non-audit services in relation to total services surpassed the threshold in 78 % of all financial years. Likewise, tax-services in comparison to non-audit services exceeded the threshold in 65 % of all financial years. The Big Four’s revenue from non-audit services to audit clients in relation to total revenue is almost constantly below the threshold. However, in all financial years except from one, total revenue from non-audit services surpassed revenue from audit services by far. Contribution – The study contributes to the ongoing discussion about nonaudit services effect on auditor independence. Originality/value – This study is one of few that provide detailed information about non-audit services in the food retail- and wholesale industry. It highlights social and ethical issues with regard to agency relationships.  

Place, policy and practitioners: on rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the United Kingdom

A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare. Authors have focused on various aspects of place and care, with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients’ homes and other sites. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives: To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods: We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. Selection criteria: We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis: Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Main results: Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the service. Authors' conclusions: There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.

How well are Australian children doing in the first year of school : a demographic analysis

Background: The transition to school is a sensitive period for children in relation to school success. In the early school years, children need to develop positive attitudes to school and have experiences that promote academic, behavioural and social competence. When children begin school there are higher expectations of responsibility and independence and in the year one class, there are more explicit academic goals for literacy and numeracy and more formal instruction. Most importantly, children’s early attitudes to learning and learning styles have an impact on later educational outcomes. Method: Data were drawn from The Longitudinal Study of Australian Children (LSAC). LSAC is a cross-sequential cohort study funded by the Australian Government. In these analyses, Wave 2 (2006) data for 2499 children in the Kindergarten Cohort were used. Children, at Wave 2, were in the first year of formal school. They had a mean age of 6.9 years (SD= 0.26). Measures included a 6-item measure of Approaches to Learning (task persistence, independence) and the Academic Rating Scales for language and literacy and mathematical thinking. Teachers rated their relationships with children on the short form of the STRS. Results: Girls were rated by their teachers as doing better than boys on Language and literacy, Approaches to learning; and they had a better relationship with their teacher. Children from an Aboriginal or Torres Strait Island (ATSI) background were rated as doing less well on Language and Literacy and Mathematical thinking and on their Approaches to learning. Children from high Socio Economic Position families are doing better on teacher rated Language and Literacy, Mathematical thinking, Approaches to learning and they had a better relationship with their teacher. Conclusions: Findings highlight the importance of key demographic variables in understanding children’s early school success.

Validation of the Flinders decision : making questionnaire in course decision making by students

The Flinders Decision Making Questionnaire (DMQ; Mann, 1982) was designed to measure decision making coping patterns identified by Janis and Mann (1977). The validity of four DMQ Scales (vigilance, defensive avoidance, hypervigilance, and decision self-esteem) were tested as predictors of students' course and career decision making. Students administered the DMQ scales were also measured on independence of choice, satisfaction, and planfulness relating to their university course and on planfulness and options relating to their future employment. Two samples were studied. In study 1, 40 students residing in a university college were the subjects. In Study 2, 42 second-year students who completed the DMQ one year earlier constituted the subjects. Modest but significant correlations were found in both samples between DMQ scores and measures of course and career decision making. The findings lend support to the validity of the DMQ as an instrument for measuring decision making behaviour.

Apples, oranges and fruit salad : a Delphi study of the IMC educational mix

Once, we thought that comparing advertising and public relations was a bit like comparing apples and oranges. But with integration the new flavour, many academics are trying to cut and combine and create a fruit salad that will entice their customers and satisfy their stakeholders. While this has produced some culinary triumphs, it has also produced heartburn in equal quantity. This paper seeks the perfect recipe for integrated marketing communication (IMC) education by asking a Delphi panel of IMC champions questions relating to the place of IMC in the university setting; the teaching, research and curriculum development issues and the future for IMC education. The panel draws a chaotic picture of IMC education and identifies some important obstacles to curriculum development. It also predicts a number of key challenges for the future, including turf wars; the lack of faculty experience and enthusiasm to embrace IMC and the desperate need to grow the IMC brand. But perhaps the greatest challenge is how to create a generalist education in a culture of pecialisation that exists both in the university and in the workplace.

How well are Australian children doing in the first year of school?

Background: The transition to school is a sensitive period for children in relation to school success. In the early school years, children need to develop positive attitudes to school and have experiences that promote academic, behavioural and social competence. When children begin school there are higher expectations of responsibility and independence and in the year one class, there are more explicit academic goals for literacy and numeracy and more formal instruction. Most importantly, children’s early attitudes to learning and learning styles have an impact on later educational outcomes. Method: Data were drawn from The Longitudinal Study of Australian Children (LSAC). LSAC is a cross-sequential cohort study funded by the Australian Government. In these analyses, Wave 2 (2006) data for 2499 children in the Kindergarten Cohort were used. Children, at Wave 2, were in the first year of formal school. They had a mean age of 6.9 years (SD= 0.26). Measures included a 6-item measure of Approaches to Learning (task persistence, independence) and the Academic Rating Scales for language and literacy and mathematical thinking. Teachers rated their relationships with children on the short form of the STRS. Results: Girls were rated by their teachers as doing better than boys on Language and literacy, Approaches to learning; and they had a better relationship with their teacher. Children from an Aboriginal or Torres Strait Island (ATSI) background were rated as doing less well on Language and Literacy and Mathematical thinking and on their Approaches to learning. Children from high Socio Economic Position families are doing better on teacher rated Language and Literacy, Mathematical thinking, Approaches to learning and they had a better relationship with their teacher. Conclusions: Findings highlight the importance of key demographic variables in understanding children’s early school success.

Internal audit quality, audit committee independence, growth opportunities and firm performance

This study explores whether the relation between internal audit quality and firm performance is associated with firm characteristics of information asymmetry and uncertainty (growth opportunities) and certain governance controls (audit committee effectiveness). The results from this preliminary study of 60 Malaysian companies show that the association between internal audit quality and firm performance is stronger for firms with high growth opportunities and that this positive association is weakened by increasing audit committee independence. These findings demonstrate the internal auditors conflicting roles and question the governance recommendations that require all members of the audit committee to be non-executive directors.

Elderly people's use of and attitudes towards assistive devices

People in developed countries are living longer with the help of medical advances. Literature has shown that older people prefer to stay independent and live at home for as long as possible. Therefore, it is important to find out how to best accommodate and assist them in maintaining quality of life and independence as well as easing human resources. Researchers have claimed that assistive devices assist in older people’s independence, however, only a small number of studies regarding the efficiency of assistive devices have been undertaken of which several have stated that devices are not being used. The overall aim of this research was to identify whether the disuse and ineffectiveness of assistive devices are related to change in abilities or related to the design of the devices. The objective was to gather information from the elderly; to identify what assistive devices are being used or not used and to gain an understanding on their attitudes towards assistive devices. Research was conducted in two phases. The initial phase of the research was conducted with the distribution of questionnaires to people over the age of fifty that asked general questions and specific questions on type of devices being used. Phase One was followed on by Phase Two, where participants from Phase One who had come in contact with assistive devices were invited to participate in a semi-structured interview. Questions were put forth to the interviewee on their use of and attitudes towards assistive devices. Findings indicated that the reasons for the disuse in assistive devices were mostly design related; bulkiness, reliability, performance of the device, difficulty of use. The other main reason for disuse was socially related; elderly people preferred to undertake activities on their own and only use a device as a precaution or when absolutely necessary. They would prefer not having to rely on the devices. Living situation and difference in gender did not affect the preference for the use of assistive devices over personal assistance. The majority strongly supported the idea of remaining independent for as long as possible. In conclusion, this study proposes that through these findings, product designers will have a better understanding of the requirements of an elderly user. This will enable the designers to produce assistive devices that are more practical, personalised, reliable, easy to use and tie in with the older people’s environments. Additional research with different variables is recommended to further justify these findings.