The three study objectives were to: compare the activity levels of older people who had received ... more The three study objectives were to: compare the activity levels of older people who had received a restorative home care service with those who had received "usual" home care; explore the predictors of physical activity in these two groups; and, determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1490 clients who had been referred for a home care service between 2006-2009. Older people who had received a restorative care service were more active than those who had received "usual" care (p=.049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.
Journal of aging and physical activity, Jan 23, 2014
The proportion of older people living in our communities is rising and to live independently some... more The proportion of older people living in our communities is rising and to live independently some require assistance from home care services. Physical activity can improve and maintain function, strength and balance, which is important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialled with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain "real world" know...
To identify the risk factors associated with the development of skin tears in older persons four ... more To identify the risk factors associated with the development of skin tears in older persons four hundred and fifty three patients (151 cases and 302 controls) were enrolled in a case-control study in a 500-bed metropolitan tertiary hospital in Western Australia between December 2008 and June 2009. Case eligibility was defined by a skin tear on admission, which had occurred in the last 5 days; or, a skin tear developed during hospitalisation. For each case, two controls who did not have a skin tear and had been admitted within 1 day of the case, were also enrolled. Data collected from the nursing staff and inpatient medical records included characteristics known, or hypothesised, to be associated with increased vulnerability to skin tears. Data analysis included a series of multivariate stepwise regressions to identify a number of different potential explanatory models. The most parsimonious model for predicting skin tear development comprised six variables: ecchymosis (bruising); se...
The 3 study objectives were to compare the activity levels of older people who had received a res... more The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.
Fall prevention recommendations and plans have been prolific in Australia since 1986, but Commonw... more Fall prevention recommendations and plans have been prolific in Australia since 1986, but Commonwealth recommendations have rarely been acted on from a national perspective and the funds for prevention at a national level have been limited. At a state level, although increasing annually, funds for fall prevention have also remained as only a low proportion of total health spending. Several Australian states have developed their own strategic plans and their activities have developed separately and uniquely, although referring to national guidelines. This article presents a perspective of Australian fall prevention policy over time, provides insights into the current focus, and draws on some specific examples of activities from the 2 most populous Australian states (New South Wales and Victoria) and from our largest geographic state, Western Australia.
International Journal of Older People Nursing, 2014
Physical activity contributes to an older person'... more Physical activity contributes to an older person's health and well-being by maintaining strength, balance and mobility, all of which are important for older people who wish to remain living in their home for as long as possible. It is therefore essential that community nurses and those working with home care clients promote being physically active. To do this effectively requires an understanding of the type of physical activity older home care clients prefer to engage in. The aims of this study were to identify the physical activity preferences of older people who received a home care service and to determine whether being physically active is important to this population. Twenty older home care clients were interviewed using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. Walking, housework and gardening were identified as the activities of choice. The majority of interviewees suggested that it was important to be physically active. Structured exercise programmes are not the activity of choice for older home care clients. Therefore, when community nurses and allied health workers promote physical activity to their clients, they should suggest activities such as walking, housework and gardening and also endorse the benefits of physical activity for well-being and staying independent. Health and community nurses and organisations should routinely encourage home care clients to increase their activity levels, especially utilising those activities they most enjoy.
... change. ... Improving care transitions of older people: Challenges for today and tomorrow Jul... more ... change. ... Improving care transitions of older people: Challenges for today and tomorrow Julianne Cheek1, Alison Ballantyne1, David Gillham1, Jane Mussared2, Penny Flett3, Gill Lewin4, Marita Walker5, Gerda Roder-Allen6, James Quan1 and Suzanne Vandermeulen4 ...
This seminar marks the Western Australian launch of the report of a major multi-site Randomised C... more This seminar marks the Western Australian launch of the report of a major multi-site Randomised Controlled Trial. In 2005, Royal District Nursing Service in Victoria and Silver Chain in Western Australia received funding from the Angior Family Foundation to undertake a number of studies examining best practice in lower leg ulcer management. The most significant component of this work was
To determine if self-monitoring via home-based telehealth equipment could, when combined with ong... more To determine if self-monitoring via home-based telehealth equipment could, when combined with ongoing remote monitoring by a nurse, reduce the incidence of hospitalizations and emergency department (ED) presentations for people with chronic obstructive pulmonary disease (COPD). A randomized controlled trial was used to compare the outcomes for participants receiving the telehealth equipment and monitoring with those for participants in an information-only control group, over a period of 6 months. Participants receiving the telehealth intervention were taught to measure and record their vital signs (blood pressure, weight, temperature, pulse, and oxygen saturation levels) on a daily basis. These were then transmitted automatically via telephone to a secure Web site where they were monitored each day by the telehealth nurse. The telehealth group had fewer ED presentations and hospital admissions and a reduced length of stay in comparison with the control group. These results were not statistically significant. However, the reduction in health service use was large enough to result in significant cost savings, with the annual cost savings of the telehealth group compared with the control group being $2,931 per person. Telehealth monitoring of patient vital signs reduced health service utilization for individuals with COPD and resulted in significant cost savings. In terms of individual health benefits, improvements in participants' self-management behaviors and control over their condition was evident.
Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria f... more Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria for long-term home oxygen therapy are not met. Is palliative oxygen less likely to be prescribed when a person lives alone at the end of life? Three years of consecutively collected clinical data from a regional community palliative care program in Western Australia were used in univariate analyses utilizing chi(2) and analysis of variance, as appropriate. Multivariable logistic regression was used to identify characteristics of people for who oxygen has been prescribed. Of the study population (n = 5203), 9.8% (n = 507) did not have a caregiver. Oxygen was less likely to be prescribed for patients living alone (11.8% versus caregiver 20.6%; p < 0.001), those with cancer (18.8% versus noncancer 26.5%; p < 0.001), and older people (oxygen 68.1 years versus no oxygen 69.6 years; p = 0.005), and more likely to be prescribed for those with worse dyspnea (mean score 7/10, oxygen 7.6 versus no oxygen 4.2; p < 0.001). With severe dyspnea (= 7/10), people who lived alone had twice as many clinician visits before oxygen was prescribed (4.2 versus caregiver 1.7; p = 0.03). In multifactor analyses lung disease, dyspnea severity, and female gender predicted oxygen prescription, while not having a caregiver reduced the likelihood significantly (odds ration [OR] 0.51, 95% confidence interval [CI] 0.35-0.74; p < 0.001). Presence of a caregiver in the home is associated with palliative oxygen prescription having controlled for time in hospital. This study raises questions about the reasons for oxygen prescription, and the role caregivers may play in initiating requests for therapy.
Older adults requiring home care service have a high risk of depression. Instruments for detectin... more Older adults requiring home care service have a high risk of depression. Instruments for detecting depression among older adults, however, are often too long and detailed for easy administration by nontrained staff in large service-based settings.This study examined the measurement properties (test—retest reliability, concurrent validity, and cross-modality correspondence) of a single-item screener for depressive symptoms among older adults receiving home
The Home Independence Program (HIP) is a short-term restorative programme targeted at older home-... more The Home Independence Program (HIP) is a short-term restorative programme targeted at older home-care clients, who do not have a diagnosis of dementia, when they are first referred for assistance or when they are referred for additional services because their needs have increased. This study compared the outcomes for individuals who participated in HIP with those of individuals who received 'usual' home-care services. The study was conducted in metropolitan Perth, Western Australia, between 2001 and 2003, when HIP was being trialled as a service in just one region. One hundred clients were recruited into each group and were visited at home on three occasions--service start and at 3 months and 1 year. Standardised outcome measures were used to measure functional dependency, morale, confidence in performing everyday activities without falling and functional mobility. Service outcomes were also examined at 3 months and 1 year. The HIP group showed improvements on all personal outcome measures compared with the control group. These improvements were, except for the morale scale, significantly associated with group assignment even when baseline differences between the groups were adjusted for. As regards service outcomes, the odds of the individuals who received HIP still requiring services was 0.07 (95% CI = 0.03-0.15, P < 0.001) times those for the individuals in the control group at 3 months and 0.14 times at 12 months (95% CI = 0.07-0.29, P < 0.001). The results of this study supported the hypothesis that older individuals referred for home care who participated in a programme to promote their independence had better individual and service outcomes than individuals who received usual home care.
The objectives of this study were to determine whether older individuals who participated in a re... more The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.
The three study objectives were to: compare the activity levels of older people who had received ... more The three study objectives were to: compare the activity levels of older people who had received a restorative home care service with those who had received "usual" home care; explore the predictors of physical activity in these two groups; and, determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1490 clients who had been referred for a home care service between 2006-2009. Older people who had received a restorative care service were more active than those who had received "usual" care (p=.049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.
Journal of aging and physical activity, Jan 23, 2014
The proportion of older people living in our communities is rising and to live independently some... more The proportion of older people living in our communities is rising and to live independently some require assistance from home care services. Physical activity can improve and maintain function, strength and balance, which is important for those receiving home care. This study reviewed the evidence on physical activity/exercise interventions trialled with older people receiving a home care service. A systematic review of studies published from January 1982 to September 2012, from five databases, was undertaken. Inclusion criteria were: aged 65+ years; community dwelling; no dementia diagnosis; receiving home care services; and a physical activity/exercise program. Eight articles were included and results show there were few consistencies between intervention types, groups, outcome measures and follow-up. Study quality was mixed. Future studies should include pragmatic randomized controlled trials involving home care practitioners and their clients to gain "real world" know...
To identify the risk factors associated with the development of skin tears in older persons four ... more To identify the risk factors associated with the development of skin tears in older persons four hundred and fifty three patients (151 cases and 302 controls) were enrolled in a case-control study in a 500-bed metropolitan tertiary hospital in Western Australia between December 2008 and June 2009. Case eligibility was defined by a skin tear on admission, which had occurred in the last 5 days; or, a skin tear developed during hospitalisation. For each case, two controls who did not have a skin tear and had been admitted within 1 day of the case, were also enrolled. Data collected from the nursing staff and inpatient medical records included characteristics known, or hypothesised, to be associated with increased vulnerability to skin tears. Data analysis included a series of multivariate stepwise regressions to identify a number of different potential explanatory models. The most parsimonious model for predicting skin tear development comprised six variables: ecchymosis (bruising); se...
The 3 study objectives were to compare the activity levels of older people who had received a res... more The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.
Fall prevention recommendations and plans have been prolific in Australia since 1986, but Commonw... more Fall prevention recommendations and plans have been prolific in Australia since 1986, but Commonwealth recommendations have rarely been acted on from a national perspective and the funds for prevention at a national level have been limited. At a state level, although increasing annually, funds for fall prevention have also remained as only a low proportion of total health spending. Several Australian states have developed their own strategic plans and their activities have developed separately and uniquely, although referring to national guidelines. This article presents a perspective of Australian fall prevention policy over time, provides insights into the current focus, and draws on some specific examples of activities from the 2 most populous Australian states (New South Wales and Victoria) and from our largest geographic state, Western Australia.
International Journal of Older People Nursing, 2014
Physical activity contributes to an older person'... more Physical activity contributes to an older person's health and well-being by maintaining strength, balance and mobility, all of which are important for older people who wish to remain living in their home for as long as possible. It is therefore essential that community nurses and those working with home care clients promote being physically active. To do this effectively requires an understanding of the type of physical activity older home care clients prefer to engage in. The aims of this study were to identify the physical activity preferences of older people who received a home care service and to determine whether being physically active is important to this population. Twenty older home care clients were interviewed using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. Walking, housework and gardening were identified as the activities of choice. The majority of interviewees suggested that it was important to be physically active. Structured exercise programmes are not the activity of choice for older home care clients. Therefore, when community nurses and allied health workers promote physical activity to their clients, they should suggest activities such as walking, housework and gardening and also endorse the benefits of physical activity for well-being and staying independent. Health and community nurses and organisations should routinely encourage home care clients to increase their activity levels, especially utilising those activities they most enjoy.
... change. ... Improving care transitions of older people: Challenges for today and tomorrow Jul... more ... change. ... Improving care transitions of older people: Challenges for today and tomorrow Julianne Cheek1, Alison Ballantyne1, David Gillham1, Jane Mussared2, Penny Flett3, Gill Lewin4, Marita Walker5, Gerda Roder-Allen6, James Quan1 and Suzanne Vandermeulen4 ...
This seminar marks the Western Australian launch of the report of a major multi-site Randomised C... more This seminar marks the Western Australian launch of the report of a major multi-site Randomised Controlled Trial. In 2005, Royal District Nursing Service in Victoria and Silver Chain in Western Australia received funding from the Angior Family Foundation to undertake a number of studies examining best practice in lower leg ulcer management. The most significant component of this work was
To determine if self-monitoring via home-based telehealth equipment could, when combined with ong... more To determine if self-monitoring via home-based telehealth equipment could, when combined with ongoing remote monitoring by a nurse, reduce the incidence of hospitalizations and emergency department (ED) presentations for people with chronic obstructive pulmonary disease (COPD). A randomized controlled trial was used to compare the outcomes for participants receiving the telehealth equipment and monitoring with those for participants in an information-only control group, over a period of 6 months. Participants receiving the telehealth intervention were taught to measure and record their vital signs (blood pressure, weight, temperature, pulse, and oxygen saturation levels) on a daily basis. These were then transmitted automatically via telephone to a secure Web site where they were monitored each day by the telehealth nurse. The telehealth group had fewer ED presentations and hospital admissions and a reduced length of stay in comparison with the control group. These results were not statistically significant. However, the reduction in health service use was large enough to result in significant cost savings, with the annual cost savings of the telehealth group compared with the control group being $2,931 per person. Telehealth monitoring of patient vital signs reduced health service utilization for individuals with COPD and resulted in significant cost savings. In terms of individual health benefits, improvements in participants' self-management behaviors and control over their condition was evident.
Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria f... more Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria for long-term home oxygen therapy are not met. Is palliative oxygen less likely to be prescribed when a person lives alone at the end of life? Three years of consecutively collected clinical data from a regional community palliative care program in Western Australia were used in univariate analyses utilizing chi(2) and analysis of variance, as appropriate. Multivariable logistic regression was used to identify characteristics of people for who oxygen has been prescribed. Of the study population (n = 5203), 9.8% (n = 507) did not have a caregiver. Oxygen was less likely to be prescribed for patients living alone (11.8% versus caregiver 20.6%; p < 0.001), those with cancer (18.8% versus noncancer 26.5%; p < 0.001), and older people (oxygen 68.1 years versus no oxygen 69.6 years; p = 0.005), and more likely to be prescribed for those with worse dyspnea (mean score 7/10, oxygen 7.6 versus no oxygen 4.2; p < 0.001). With severe dyspnea (= 7/10), people who lived alone had twice as many clinician visits before oxygen was prescribed (4.2 versus caregiver 1.7; p = 0.03). In multifactor analyses lung disease, dyspnea severity, and female gender predicted oxygen prescription, while not having a caregiver reduced the likelihood significantly (odds ration [OR] 0.51, 95% confidence interval [CI] 0.35-0.74; p < 0.001). Presence of a caregiver in the home is associated with palliative oxygen prescription having controlled for time in hospital. This study raises questions about the reasons for oxygen prescription, and the role caregivers may play in initiating requests for therapy.
Older adults requiring home care service have a high risk of depression. Instruments for detectin... more Older adults requiring home care service have a high risk of depression. Instruments for detecting depression among older adults, however, are often too long and detailed for easy administration by nontrained staff in large service-based settings.This study examined the measurement properties (test—retest reliability, concurrent validity, and cross-modality correspondence) of a single-item screener for depressive symptoms among older adults receiving home
The Home Independence Program (HIP) is a short-term restorative programme targeted at older home-... more The Home Independence Program (HIP) is a short-term restorative programme targeted at older home-care clients, who do not have a diagnosis of dementia, when they are first referred for assistance or when they are referred for additional services because their needs have increased. This study compared the outcomes for individuals who participated in HIP with those of individuals who received 'usual' home-care services. The study was conducted in metropolitan Perth, Western Australia, between 2001 and 2003, when HIP was being trialled as a service in just one region. One hundred clients were recruited into each group and were visited at home on three occasions--service start and at 3 months and 1 year. Standardised outcome measures were used to measure functional dependency, morale, confidence in performing everyday activities without falling and functional mobility. Service outcomes were also examined at 3 months and 1 year. The HIP group showed improvements on all personal outcome measures compared with the control group. These improvements were, except for the morale scale, significantly associated with group assignment even when baseline differences between the groups were adjusted for. As regards service outcomes, the odds of the individuals who received HIP still requiring services was 0.07 (95% CI = 0.03-0.15, P < 0.001) times those for the individuals in the control group at 3 months and 0.14 times at 12 months (95% CI = 0.07-0.29, P < 0.001). The results of this study supported the hypothesis that older individuals referred for home care who participated in a programme to promote their independence had better individual and service outcomes than individuals who received usual home care.
The objectives of this study were to determine whether older individuals who participated in a re... more The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.
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