The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Understanding the "black box" of a health-promotion program : keys to enable health among older persons aging in the context of migration

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

Unlicensed personnel administering medications to older persons living at home : a challenge for social and care services

BACKGROUND: Administration of medication to care recipients is delegated to home-care assistants working in the municipal social care, alongside responsibility for providing personal assistance for older people. Home-care assistants have practical administration skills, but lack formal medical knowledge. AIM: The aim of this study was to explore how home-care assistants perceive administration of medication to older people living at home, as delegated to them in the context of social care. METHODS: Four focus groups consisting of 19 home-care assistants were conducted. Data were analysed using qualitative content analysis. RESULTS: According to home-care assistants, health and social care depends on delegation arrangements to function effectively, but in the first place it relieves a burden for district nurses. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among home-care assistants about the content of the statutes of delegation. Accepting delegation to administer medications has become an implicit prerequisite for social care work in the municipality. CONCLUSIONS: Accepting the delegation to administer medication was inevitable and routine. In practice, the regulating statute is made subordinate and consequently patient safety can be threatened. The organisation of health and social care relies on the delegation arrangement to meet the needs of a growing number of older home-care recipients. IMPLICATIONS FOR PRACTICE: This is a crucial task which management within both the healthcare professions and municipal social care needs to address, to bridge the gap between statutes and practice, to create arenas for mutual collaboration in the care recipients' best interest and to ensure patient safety.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

A therapy dog's impact on daytime activity and night-time sleep for older persons with Alzheimer's disease : a case study

Background: Animal-Assisted Therapy using dogs have been described as having a calming effect, decrease sundowning and blood-pressure in persons with Alzheimer’s disease. The aim was to investigate how continuous and scheduled visits by a prescribed therapy dog affected daytime and night-time sleep for persons with Alzheimer’s disease. Methods: In this case study, registration of activity and sleep curves was conducted from five persons with moderate to severe Alzheimer’s disease living at a nursing home, over a period of 16 weeks using an Actiwatch. Data was analysed with descriptive statistics. Result: The study shows no clear pattern of effect on individual persons daytime activity and sleep when encounter with a therapy dog, but instead points to a great variety of possible different effects that brings an increased activity at different time points, for example during night-time sleep. Conclusions: Effects from the use of a Animal-Assisted Therapy with a dog in the care of persons with Alzheimer’s disease needs to be further investigated and analysed from a personcentred view including both daytime and nightime activities.

Samurai in the surf : the arrival of the Japanese on the Gold Coast in the 1980s

Samurai in the Surf explores the history of Japanese investment in the 1980s, following a money-trail that leads back to a ballooning Japanese economy and a colorful array of investment sources. The book also explores the local community's views of this unprecedented stream of foreign investment and provides a convincing illustration of the links between 1980s Queensland and Pauline Hanson's One Nation movement of the 1990s.

Heidegger and the Japanese connection

This collection of new essays on phenomenological themes reviews aspects of the philosophical movement which began with the publication in 1900-01 of Edmund Husserl's path-breaking Logical Investigations. A broad survey of phenomenology is particularly timely given that this philosophical movement is reaching a hundred years of its existence. The thirteen contributions represent a wide range of approaches and interests within the phenomenological framework. Some present approaches to Husserl, while others explore aspects of the fundamental texts of phenomenology and provide critical discussions of later thinkers such as Heidegger, Sartre, and Derrida whose relation to Husserl receives particular attention. The final section relates phenomenology to other disciplines and to broader issues in social thought and cultural studies. This book will enable students and professional philosophers alike to explore the various strands of this widely influential school of thought.

The value of work in younger and older adults' lives: an Australian perspective

In the present study we examined the perceived role of work in the lives of younger and older adults in three different occupations: teaching, nursing, and small business. On the basis of lifespan developmental theory of changes in work-related values across the lifespan we expected that (1) older adults would rate their job satisfaction and organisational commitment more highly than younger adults, and (2) younger adults would rate the importance of work more highly than older workers. Based on utility theory we expected that nurses and teachers would view early retirement more positively than small business employees because of early retirement incentives in these two careers. One-hundred-sixty-two participants completed a 118-item survey. Overall few age differences were found between older and younger workers. On average, all participants rated work as moderately important and their job satisfaction as moderately high. Nonetheless, older participants rated their job satisfaction higher than younger participants. On average, all groups believed they would retire before 65 years of age. The latter finding is important for workability theory and raises issues about how to change attitudes, perceptions and values about working past traditional retirement ages.

Using complemenatry therapies wisely in older people.

Key points
• Over 30%, of older people use complementary therapies.
• Nurses need to be able to use complementary therapies safely if indicated and provide objective. accurate information about them.
• Complementary therapies can be used with conventional medical treatment to improve diabetes balance and quality of life.
• Herb-drug and herb-herb interactions and other adverse events can occur when conventional and complementary therapies are combined inappropriately.
• Complementary therapy use and the reasons for their use should be ascertained when taking a routine history and assessment.

Kokusaika and Internationalisation: Australian and Japanese sister city type relationships

Sister city type relationships at local government level form an important part of Australian-Japanese relations. The original concept of sister cities was to increase international understanding and peace at local level. Over the years, that concept has changed and there is now a robust debate over the inclusion of commercial exchanges into sister city type relationships. This article describes the context of this debate by analysing the different perceptions of sister city type relationships in Australia and Japan. It begins with a discussion of the public policy contexts of sister cities in both Australia and Japan. The second section deals with an analysis of the results of surveys in Australia and Japan. Finally, case studies of two important issues related to SCTRs are discussed: economic and business relations and community involvement. The article concludes by suggesting that sister city type relationships between Australia and Japan are dependent upon the over-arching public policy contexts and sometimes lead to mismatched expectations between the two countries.