The relationship between chronic disease self-efficacy and nutritional status, functional ability and quality of life in older adults at risk of hospital readmission

Background and significance: Older adults with chronic diseases are at increasing risk of hospital admission and readmission. Approximately 75% of adults have at least one chronic condition, and the odds of developing a chronic condition increases with age. Chronic diseases consume about 70% of the total Australian health expenditure, and about 59% of hospital events for chronic conditions are potentially preventable. These figures have brought to light the importance of the management of chronic disease among the growing older population. Many studies have endeavoured to develop effective chronic disease management programs by applying social cognitive theory. However, limited studies have focused on chronic disease self-management in older adults at high risk of hospital readmission. Moreover, although the majority of studies have covered wide and valuable outcome measures, there is scant evidence on examining the fundamental health outcomes such as nutritional status, functional status and health-related quality of life. Aim: The aim of this research was to test social cognitive theory in relation to self-efficacy in managing chronic disease and three health outcomes, namely nutritional status, functional status, and health-related quality of life, in older adults at high risk of hospital readmission. Methods: A cross-sectional study design was employed for this research. Three studies were undertaken. Study One examined the nutritional status and validation of a nutritional screening tool; Study Two explored the relationships between participants. characteristics, self-efficacy beliefs, and health outcomes based on the study.s hypothesized model; Study Three tested a theoretical model based on social cognitive theory, which examines potential mechanisms of the mediation effects of social support and self-efficacy beliefs. One hundred and fifty-seven patients aged 65 years and older with a medical admission and at least one risk factor for readmission were recruited. Data were collected from medical records on demographics, medical history, and from self-report questionnaires. The nutrition data were collected by two registered nurses. For Study One, a contingency table and the kappa statistic was used to determine the validity of the Malnutrition Screening Tool. In Study Two, standard multiple regression, hierarchical multiple regression and logistic regression were undertaken to determine the significant influential predictors for the three health outcome measures. For Study Three, a structural equation modelling approach was taken to test the hypothesized self-efficacy model. Results: The findings of Study One suggested that a high prevalence of malnutrition continues to be a concern in older adults as the prevalence of malnutrition was 20.6% according to the Subjective Global Assessment. Additionally, the findings confirmed that the Malnutrition Screening Tool is a valid nutritional screening tool for hospitalized older adults at risk of readmission when compared to the Subjective Global Assessment with high sensitivity (94%), and specificity (89%) and substantial agreement between these two methods (k = .74, p < .001; 95% CI .62-.86). Analysis data for Study Two found that depressive symptoms and perceived social support were the two strongest influential factors for self-efficacy in managing chronic disease in a hierarchical multiple regression. Results of multivariable regression models suggested advancing age, depressive symptoms and less tangible support were three important predictors for malnutrition. In terms of functional status, a standard regression model found that social support was the strongest predictor for the Instrumental Activities of Daily Living, followed by self-efficacy in managing chronic disease. The results of standard multiple regression revealed that the number of hospital readmission risk factors adversely affected the physical component score, while depressive symptoms and self-efficacy beliefs were two significant predictors for the mental component score. In Study Three, the results of the structural equation modelling found that self-efficacy partially mediated the effect of health characteristics and depression on health-related quality of life. The health characteristics had strong direct effects on functional status and body mass index. The results also indicated that social support partially mediated the relationship between health characteristics and functional status. With regard to the joint effects of social support and self-efficacy, social support fully mediated the effect of health characteristics on self-efficacy, and self-efficacy partially mediated the effect of social support on functional status and health-related quality of life. The results also demonstrated that the models fitted the data well with relative high variance explained by the models, implying the hypothesized constructs under discussion were highly relevant, and hence the application for social cognitive theory in this context was supported. Conclusion: This thesis highlights the applicability of social cognitive theory on chronic disease self-management in older adults at risk of hospital readmission. Further studies are recommended to validate and continue to extend the development of social cognitive theory on chronic disease self-management in older adults to improve their nutritional and functional status, and health-related quality of life.

Building and construction industries supply chain project (domestic) : report for Commonwealth Department of Industry, Science and Resources

The Commonwealth Department of Industry, Science and Resources is identifying best practice case study examples of supply chain management within the building and construction industry to illustrate the concepts, innovations and initiatives that are at work. The projects provide individual enterprises with examples of how to improve their performance, and the competitiveness of the industry as a whole.

Report on INEX 2011

INEX investigates focused retrieval from structured documents by providing large test collections of structured documents, uniform evaluation measures, and a forum for organizations to compare their results. This paper reports on the INEX 2011 evaluation campaign, which consisted of a five active tracks: Books and Social Search, Data Centric, Question Answering, Relevance Feedback, and Snippet Retrieval. INEX 2011 saw a range of new tasks and tracks, such as Social Book Search, Faceted Search, Snippet Retrieval, and Tweet Contextualization.

The Roots of Danger: Violent Crime in Global Perspective

Prentice Hall’s Masters Series in Criminology brings the work of true masters to life for a new audience of readers, presenting brief and accessible introductions to crime and criminology topics from some of the leading scholars in criminology today. All authors in the series are true academic pioneers, and each book in the series pulls from the authors’ decades of research and writing in their fields. The first and only series of its kind, Prentice Hall’s Masters Series in Criminology introduces readers to the scholars and issues that are at the core of modern criminology.

Creating Institutions: Linking the Local and the Global in the Travel of Crime Policies

Institutions represent the ‘technologies of the social.’ They are increasingly modelled and transported to other cultures and societies, and criminal justice institutions—traditional, parochial, and local as they are—are no exception to this. Problems of crime and insecurity have engendered the travelling of institutions from the centre to the periphery and vice versa. This paper will explore the problems which arise from travelling and modelling, and from the transport and creation of institutions in the area of criminal justice. An important feature in the travel of criminal justice institutions is the use of ‘local knowledge’ and its role in this process.

Pre-sentence Report, Magisterial Discourse and Agency in Youth Courts in England

This article draws on interviews with Youth Court magistrates to examine if and how discourses, strategies and technologies of risk governance have affected Youth Court magistrates in England and Wales. The aim of the article is to detail the complex relationship between magisterial agency in decision making and youth justice policies which focus on risk control and management. The article demonstrates that, contrary to what might be assumed from the youth and risk governance theoretical literature, Youth Offending Team risk assessments form only one part of the information used by magistrates to explain young people’s presence in courts. This article concludes that magisterial decision making is framed not by formal, expert assessments of risk, but by magistrates’ claims that they are ‘knowing outsiders’, who through judicious use of information presented to them and their own life experiences are able to make objective judgements about both the risk assessments authored by Youth Offending Teams and the young lawbreakers before them.