ORCID Profile
0000-0002-9780-5256
Current Organisations
University of Sharjah
,
Bolton Clarke
,
Ending Loneliness Together
,
Maryborough District Health Service
,
Monash University
,
University of Queensland
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Publisher: Wiley
Date: 12-2018
DOI: 10.1002/JPPR.1498
Publisher: AMPCo
Date: 02-2012
DOI: 10.5694/MJA11.10955
Abstract: To measure the increase in volume and age-specific rates of presentations to public hospital emergency departments (EDs), as well as any changes in ED length of stay (LOS) and to describe trends in ED utilisation. Population-based retrospective analysis of Department of Health public hospital ED data for metropolitan Melbourne for 1999-00 to 2008-09. Presentation numbers presentation rates per 1000 person-years ED LOS. ED presentations increased from 550,662 in 1999-00 to 853,940 in 2008-09. This corresponded to a 32% rise in rate of presentation (95% CI, 29%-35%), an average annual increase of 3.6% (95% CI, 3.4%-3.8%) after adjustment for population changes. Almost 40% of all patients remained in the ED for ≥4 hours in 2008-09, with LOS increasing over time for patients who were more acutely unwell. The likelihood of presentation rose with increasing age, with people aged≥85 years being 3.9 times as likely to present as those aged 35-59 years (95% CI, 3.8-4.0). The volume of older people presenting more than doubled over the decade. They were more likely to arrive by emergency ambulance and were more acutely unwell than 35-59 year olds, with 75% having an LOS≥4 hours and 61% requiring admission in 2008-09. The rise in presentation numbers and presentation rates per 1000 person-years over 10 years was beyond that expected from demographic changes. Current models of emergency and primary care are failing to meet community needs at times of acute illness. Given these trends, the proposed 4-hour targets in 2012 may be unachievable unless there is significant redesign of the whole system.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2011
DOI: 10.1161/STROKEAHA.111.615674
Abstract: Warfarin is an effective drug for the prevention of thromboembolism in the elderly. The major risk for patients taking warfarin is bleeding. We aimed to assess the impact of psychosocial factors, including mood, cognition, social isolation, and health literacy on warfarin instability among community-based elderly patients. A case–control study was conducted between March 2008 and June 2009 in a community-based setting. Cases were patients previously stabilized on warfarin who recorded an international normalized ratio ≥6.0. Control subjects were patients whose international normalized ratio measurement was maintained within the therapeutic range. Patient interviews investigated potential predisposing factors to elevated International Normalized Ratio levels. A total of 486 patients were interviewed: 157 cases and 329 control subjects, with an approximate mean age of 75 years. Atrial fibrillation was the most common primary indication. Adjusted multivariate logistic regression revealed impaired cognition (OR, 1.9 95% CI, 1.0 to 3.6), depressed mood (OR, 2.2 95% CI, 1.2 to 3.9), and inadequate health literacy (OR, 4.0 % CI, 2.1 to 7.4) were associated with increased risk of an elevated International Normalized Ratio. This study identified impaired cognition, depressed mood, and inadequate health literacy as risk factors for warfarin instability. These had a similar impact to well-recognized demographic, clinical, and medication-related factors and are prevalent among the elderly. These findings suggest that elderly patients prescribed warfarin should be reviewed regularly for psychosocial deficits.
Publisher: MDPI AG
Date: 14-11-2022
DOI: 10.3390/EN15228494
Abstract: Photovoltaic-thermal (PVT) technologies have demonstrated several attractive features, such as higher power and comparative efficiencies. Improving the thermal recovery from the PVT system would further improve the power output and the efficiency of the PVT system. This paper identifies the best operating factors of nanofluid-based PV thermal/nano-enhanced phase change material using artificial intelligence. The target is the maximization of thermal energy and exergy outputs. The suggested approach combines ANFIS modelling and particle swarm optimization (PSO). Four operating factors are taken into consideration: PCM (phase change material) layer thickness, HTF (heat transfer fluid) mass flow rate, MFNPCM (“mass fraction of nanoparticles in PCM”) and MFNfluid (“mass fraction of nanoparticles in nanofluid”). Using a dataset, an “adaptive neuro-fuzzy inference system” (ANFIS) model has been established for simulating the thermal energy and exergy outputs in terms of the mentioned operating factors. Then, using PSO, the best values of PCM thickness, mass flow rate, MFNPCM and MFNfluid are estimated. The proposed model’s accuracy was examined by comparing the results with those obtained by response surface methodology and the experimental dataset.
Publisher: Wiley
Date: 06-2012
Publisher: University of Toronto Press Inc. (UTPress)
Date: 02-2022
Abstract: LAY SUMMARY Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analyzed data from a Melbourne, Australia, home care organization’s electronic care records to explore the differences between clients supported by the Department of Veterans’ Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.
Publisher: Wiley
Date: 13-01-2015
Abstract: The 4 h National Emergency Access Target was introduced in 2011. The Alfred Hospital in Melbourne implemented a hospital-wide clinical service framework, Timely Quality Care (TQC), to enhance patient experience and care quality by improving timeliness of interventions and investigations through the emergency episode and admission to discharge in 2012. We evaluated TQC's effect on achieving the National Emergency Access Target and associated safety and quality indicators. Retrospective analysis with piecewise regression of 215 125 ED attendances before/after implementation, November 2009 to August 2013 with comparison of proportions of patients discharged, admitted or transferred from ED within 4 h of arrival left at risk unplanned ED re-attendances up to 28 days ED length of stay and in-hospital mortality. The percentage of patients admitted, discharged or transferred within 4 h rose from 60% in 2010, to 74% in 2013. Median ED length of stay decreased significantly. Rate of unplanned ED re-presentations decreased by 27%, 22% and 17% within 24 h, 48 h and 7 days, respectively and patient numbers leaving at risk halved from 8% to 4%. Mortality for admitted patients declined from 3.5% to 2.2%. All results were statistically significant. TQC resulted in improvement in timeliness of care for emergency patients without compromising safety and quality. Success is attributed to effective engagement of stakeholders with a hospital-wide approach to redesigning the care pathway and establishing a new set of principles that underpin care from the time of ED arrival.
Publisher: Hindawi Limited
Date: 09-02-2023
DOI: 10.1155/2023/9332777
Abstract: Older people prefer to remain living in their own home for as long as possible however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, in iduals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: Wiley
Date: 18-06-2020
DOI: 10.1111/AJAG.12803
Abstract: People living in residential aged care (RAC) frequently experience ambulance call‐out. These episodes may have unintended consequences, yet remain under‐investigated. Our aim was to examine clinical and sociodemographic features associated with transfer to hospital for this population. Retrospective cohort study using 6 years of clinical data from Ambulance Victoria (AV). Data analysis included multilevel multivariable logistic regression analysis of factors associated with transport to hospital. Odds of transfer were greater for people in rural areas, those with a history of depression, cardiovascular disease and osteoporosis, and residents prescribed antipsychotic and antidepressant medication. Ambulance call‐out for trauma (commonly low‐level fall) was less frequently transferred to hospital than that for a medical complaint. These results will improve prediction of call‐outs likely to require transfer. Findings include identification of clinical features to be targeted by community and preventative health programs to reduce risk of acute health deterioration and requirement for emergency hospital transfer.
Publisher: MDPI AG
Date: 30-12-2022
DOI: 10.3390/EN16010444
Abstract: Adsorption heat storage is the most feasible technology for heating decarbonization, which can store large quantities of waste and renewable heat for an exceptionally long time. However, utilizing adsorption heat storage in geographical locations with sub-zero ambient conditions is challenging. Therefore, this paper experimentally investigates the use of ethanol as a working fluid paired with silica gel for adsorption heat storage and utilizes sub-zero ambient as the heat source. The heat storage characteristics, heat charging/discharging cyclic performance, and energy conversion performance via exergy analysis were determined under realistic operating conditions and benchmarked against the widely investigated silica gel/water. Ethanol adsorbate was successfully utilized as a working fluid to employ the evaporators operating under sub-zero ambient conditions. Silica gel/ethanol showed the most significant net cyclic uptake, twice that of silica gel/water. However, the physical characteristics of ethanol molecules led to a degree of non-desorbed fluid, which h ered such potential to store 18.08 kJ/kgads under a sub-zero evaporator temperature and 24.84 kJ/kgads for an above-zero evaporator temperature compared to silica gel of 155.12 kJ/kgads operating an above-zero evaporator temperature. On the other hand, silica gel/ethanol showed the fastest heat charging/discharging rate that can shorten the cycle time by 45%. The major contributor to exergy destruction was the exergy transferred by charging heat, which was five times the discharging heat due to the high charging temperature.
Publisher: Cambridge University Press (CUP)
Date: 24-09-2022
DOI: 10.1017/S0144686X20001245
Abstract: Older women living alone are at risk of being socially and financially disadvantaged, which impacts their wellbeing. Currently there is a significant gap in knowledge relating to older women living alone. This study aimed to identify the barriers and enablers to service access in this group. We undertook a qualitative study comprising semi-structured interviews in metropolitan Melbourne, Australia. Thematic analysis was conducted to elucidate key themes. Thirty-seven women were interviewed between May and August 2017. Six key themes were identified: financial mental and emotional health mobility and ability transport social connections and knowledge. Access issues for older women living alone are multifaceted and interconnected. Barriers and enablers to service access, as well as their intersections with gender and living situation, should be considered in service design and re-design.
Publisher: Informa UK Limited
Date: 05-07-2021
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.ANNEMERGMED.2019.12.011
Abstract: This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.
Publisher: Informa UK Limited
Date: 23-05-2019
DOI: 10.1080/13607863.2018.1474445
Abstract: To ascertain the trajectories of mental health among women in Australia assessed in repeat waves from their early 70 s to the end of their lives or their mid 80 s. Secondary analysis of data contributed by the 1921-26 cohort of the Australian Longitudinal Study of Women's Health Waves 1-6. Primary outcome was the 4-item SF-36 Vitality Subscale, which assesses mental health as life satisfaction, social participation, energy and enthusiasm. Structural, in idual and intermediary factors were assessed using study-specific and standardised measures. Trajectories were identified using Growth Mixture Modelling and associations with baseline characteristics with Structural Equation Modelling. 12,432 women completed Survey One. Three mental health trajectories: stable high (77%) stable low (18.2%) and declining from high to low (4.8%) were identified. Compared to the stable high group, women in the stable low group were significantly less physically active, had more nutritional risks, more recent adverse life events, fewer social interactions and less social support, reported more stress and were more likely to have a serious illness or disability at Survey One. The declining group had similar characteristics to the stable high group, but were significantly more likely to report at baseline that they had experienced recent financial, physical and emotional elder abuse. These interact, but not directly with socioeconomic position and marital status. Mental health among older women is related to social relationships, general health, access to physical activity and healthy nutrition, coincidental adverse life events and experiences of interpersonal violence, in particular elder abuse.
Publisher: Wiley
Date: 30-07-2018
DOI: 10.1111/AJAG.12565
Abstract: The purpose of this rapid review was to explore how residential aged care staff conceptualise and identify elder abuse. English-language publications, between 2000 and 2017, about elder abuse in residential aged care in developed countries were sought from three academic databases. Only perspectives on staff-to-resident and resident-to-resident abuse were included. Over 2000 articles were screened, and 19 journal articles were included in the review. A wide range of abusive behaviours was identified, but there was little common understanding of what constituted elder abuse. Furthermore, disparities in conceptualisations were greater for certain types of abuse (e.g. verbal, psychological and caregiving). Elder abuse in residential aged care was conceptualised and identified by staff in erse and different ways. This lack of common understanding hinders the development of effective interventions and prevention strategies, which include staff education and training as well as significant structural and institutional changes.
Publisher: Wiley
Date: 24-05-2019
Abstract: To explore health professionals' perspectives about caring for community-dwelling older patients in the ED. This exploratory qualitative study was undertaken with emergency nursing, medical and allied health staff from the ED of a large metropolitan public hospital in Melbourne. Nine focus groups (n = 54) and seven interviews were conducted between 2013 and 2014. Data were thematically analysed. Health professionals described tailoring their approach when caring for older patients, including adopting a specific communication approach (i.e. increased voice volume, slower rate of speech). Caring for older patients was perceived as challenging given the need to balance the expectations of family members to deal with associated complex needs and limited time for transitional care planning in the ED. The environment and equipment were perceived as unsuitable, alongside a lack of geriatric-specific knowledge contributing to what health professionals described as a poor fit between the ED system and older patients' needs. The growing number of older patients presents numerous challenges for emergency health professionals and necessitates a tailored approach to care. Understanding health professionals' perspectives about caring for older patients can inform strategies that may improve the quality of care. Creating older person-friendly areas, improving transitional care and providing staff with specific education would foster an environment that promotes person-centred care, safety, independence and functional wellbeing.
Publisher: Wiley
Date: 05-05-2022
DOI: 10.1111/AJAG.12960
Abstract: To describe the demographic profile and clinical case mix of older adults following calls for an emergency ambulance in rural Victoria, Australia. Retrospective cohort study using ambulance electronic patient care records from rural-dwelling older adults (≥65 years old) who requested emergency ambulance attendance during 2017. A total of 84 785 older adults requested emergency ambulance attendance, representing a rate of 278 per 1000 population aged ≥65 years. More than 10% of calls were to residential aged care homes. Medical complaints and trauma accounted for 69% and 18% of attendances, respectively. The predominant cause of trauma was ground-level falls. Common reasons for call-outs were for pain (17.5%), respiratory problems (9.7%) and cardiovascular problems (8.5%). Increased demand was associated with increasing age and winter months. Older adults from rural Victoria have high rates of emergency ambulance attendance and transportation to an emergency department, particularly with increasing age.
Publisher: Wiley
Date: 11-06-2019
DOI: 10.1111/HEX.12923
Publisher: Springer Science and Business Media LLC
Date: 23-01-2018
DOI: 10.1017/CEM.2017.426
Publisher: Hindawi Limited
Date: 06-10-2022
DOI: 10.1111/HSC.14046
Abstract: Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Wiley
Date: 11-09-2012
DOI: 10.1111/J.1742-6723.2012.01609.X
Abstract: To describe the trends in emergency admissions over 10 years in terms of volume, age-specific rates, hospital length of stay (LOS) and clinical reasons. A retrospective analysis of population-based linked Department of Health ED and hospital admission data for metropolitan Melbourne 1999/2000 to 2008/2009 was conducted. Outcome measures included: hospital admission numbers (total, single day/overnight, ≥2 days LOS) admission rates per 1000 person-years (total, single day/overnight, ≥2 days LOS) hospital LOS. The volume of patients admitted to hospital through EDs rose by 56% over the 10 years to June 2009. The number of same day/overnight admissions rose by 60%, equating to a 6.1% average annual increase beyond that accounted for by demographic change (95% CI 5.7-6.5%). The volume of patients admitted for ≥2 days also increased however, the admission rate per 1000 persons for these longer-stay patients declined over the decade by 9% (95% CI 5-12%). The most frequent discharge diagnoses were injury or poisoning, and disorders of the circulatory, respiratory or digestive systems. The numbers and mortality rate for ED admissions declined over the decade. Emergency hospital admissions have risen over the last decade even after adjustment for population changes. There was a disproportionate rise in same day/overnight admissions, with overrepresentation of the elderly. This is possibly related to changes in ED models of care, including introduction of short-stay units, improved diagnostic and therapeutic capability, and risk-averse management to optimise safe discharge, within the context of time-based performance targets.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH13217
Abstract: Objective To assess the time taken to complete a Synthesised Geriatric Assessment (SGA) in an Emergency Department (ED) and to determine what secondary patient characteristics affect results. Methods A convenience s le of 25 patients aged over 65 from an Australian single-centre ED was used for this pilot study. Primary outcome measures included the overall time taken as well as the times for in idual screening instruments. Data regarding patient characteristics were taken as secondary outcome measures to assess impact on times. For each of the screening instruments, the mean, median, interquartile range and the 90th percentile for the test duration was calculated. Linear regression was used to evaluate univariate associations between times and patient characteristics. P-values 0.05 were considered as statistically significant. Results Time required for completion of the SGA by 90% of the study population was 20 min and 40 s. This represents approximately 8.6% of new 4-h ED targets. Secondary characteristics that affected the time taken for screening included patients from non-English-speaking backgrounds (P 0.05). Conclusions Use of the SGA for intra-ED geriatric risk stratification is feasible and practical in the time-critical National Emergency Access Target (NEAT) environment. The relatively short amount of time used for screening this vulnerable demographic has implications for interdisciplinary management and potentially represents an efficient intervention to reduce future re-presentations and overcrowding in Australian EDs. Future high-quality trials are required to assess the clinical benefit of the SGA. What is known about the topic? The newly introduced ED NEAT encourages patient discharge from ED within 4 h of arrival, placing increased pressure on ED protocols to be time efficient, while still maintaining safe quality care. The Comprehensive Geriatric Assessment in inpatient and ED settings has demonstrated improved outcomes in populations aged 65, including parameters of ED re-presentations, functional independence and short-term mortality. Geriatric emergency patient guidelines have been recently adopted in the US and UK which incorporate intra-ED geriatric screening processes. Studies focusing on the feasibility of geriatric screening in Australian EDs are scarce. What does this paper add? Our pilot study focuses on the timing requirements of geriatric screening in time-critical ED environments. We analysed the time taken to conduct a SGA that was developed for a large research project, and the secondary patient characteristics that affected these times. Our paper provides valuable information for Australian EDs when considering the introduction of geriatric screening into EDs to optimise the care and outcomes of this patient group. Analysis of secondary patient characteristics and data patterns will further help EDs and future research into design of new protocols. What are the implications for practitioners? The results of our pilot study suggest that use of the SGA in Australian ED settings is feasible and practical. By using the results of our pilot study, EDs and clinician researchers can make informed decisions about implementation of new protocol to manage older patients. We suggest that implementation of intra-ED geriatric screening assessments will result in improved patient outcomes, including long-term functional independence and decreased rates of ED re-presentation. This in turn would help to unclog our currently overloaded EDs.
Publisher: IMR Press
Date: 12-04-2022
Publisher: Public Library of Science (PLoS)
Date: 24-05-2019
Publisher: Cambridge University Press (CUP)
Date: 07-01-2021
DOI: 10.1017/S0144686X19001818
Abstract: The global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.
Publisher: Wiley
Date: 11-06-2019
DOI: 10.1111/HEX.12923
Publisher: Wiley
Date: 24-11-2009
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17047
Abstract: Medicare Benefits Schedule (MBS) items designed to support the wellbeing of older people may reduce unnecessary emergency department utilisation, however it is unclear to what extent such items are used. This study examined general practitioner (GP) utilisation of these MBS items through an analysis of the Melbourne East Monash General Practice Database (MAGNET), which contains information collected from GP clinics within the inner east Melbourne region. Sociodemographic and MBS claim data were extracted for patients aged ≥75 years attending a GP between 2005 and 2012. Utilisation of 75+ Health Assessments, General Practitioner Management Plans (GPMP), Team Care Arrangements (TCAs) or reviews, or Medication Management Reviews (MMRs) was assessed. There were 12962 (60.6%) patients assigned at least one of the MBS items. The highest level of claiming was for GPMPs (n=4754 35.8%) and TCAs (n=4476 33.7%), with MMRs having the lowest use (n=1023 6.8%). Examination of GP and patient barriers to the uptake of these items is needed, along with a greater understanding as to whether those most at risk of hospitalisation are receiving these services. Strategies that support capacity to implement these items are also required.
Publisher: BMJ
Date: 31-07-2013
DOI: 10.1136/BMJQS-2011-000582
Abstract: To determine the effectiveness of patient safety culture strategies to improve hospital patient safety climate. Electronic search of the Cochrane Library, OVID Medline, Embase, CINAHL, proQuest and psychinfo databases, with manual searches of quality and safety websites, bibliographies of included articles and key journals. English language studies published between January 1996 and April 2011 that measured the effectiveness of patient safety culture strategies using a quantitative measure of patient safety climate in a hospital setting. Studies included were randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series and historically controlled studies. Data extraction and critical appraisal were conducted by two independent reviewers. Study design, intervention, level of application, setting, study participants, safety climate outcome measures and implementation lessons were extracted from each article. Over 2000 articles were screened, with 21 studies meeting the inclusion criteria, one cluster RCT, seven controlled before and after studies, and 13 historically controlled studies. There was marked methodological heterogeneity amongst studies. Impacts of 11 different strategies were reported. There was some evidence to support that leadership walk rounds (p=0.02) and multi-faceted unit-based programmes (p < 0.05) may have a positive impact on patient safety climate. Despite strong face validity for a variety of patient safety culture strategies, there is limited evidence to support definitive impacts on patient safety climate outcomes. Organisations are advised to consider robust evaluation designs when implementing these potentially resource intensive strategies.
Publisher: Hindawi Limited
Date: 06-05-2022
DOI: 10.1111/HSC.13818
Publisher: Oxford University Press (OUP)
Date: 24-04-2018
Abstract: to examine demand for emergency ambulances by older people. retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. Victoria, Australia. people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. rates of emergency ambulance attendance. older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate in idual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.
Publisher: BMJ
Date: 14-11-2009
DOI: 10.1136/INJURYPREV-2014-041453
Abstract: Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. This programme evaluation is linked to the RESPOND RCT which is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
Publisher: Wiley
Date: 05-2013
DOI: 10.1111/IMJ.12061
Abstract: Population ageing is projected to impact on health services utilisation including Emergency Departments (ED), with older patients reportedly having a high rate of return visits. We describe and compare patterns in ED utilisation between older and younger adults, and quantify the proportion and rate of return visits. Population-based retrospective analysis of metropolitan Melbourne public hospital ED data, 1999/2000 to 2008/2009. Numbers of patients, presentations, re-presentations and rates per 1000 population were calculated, with comparison of older (aged ≥ 70 years) and younger (15-69 years) attendances. Population growth in each age group was similar over the study period, yet ED presentations rose by 72% for older adults compared with a 59% increase for younger adults. Rates per 1000 population rose with increasing age. Of the population aged ≥ 70 years, 39% presented to ED compared with 17% of the population aged 15-69 years in 2008/2009. Twenty-seven per cent of the increase in older adult presentations was driven by a cohort who attended ≥ 4 times in 2008/2009. The number of older patients presenting ≥ 4 times doubled over the decade, contributing to 23% of all older presentations in 2008/2009. ED length of stay rose with increasing age 69% of older adults remained in ED for ≥ 4 h compared with 39% of younger adults in 2008/2009. The number of older adult ED hospital admissions doubled over the decade. Older patients are disproportionately represented among ED attendances. They also have an increasing propensity to re-present to ED, indicating a need to identify the clinical, social and health system-related risk factors for re-attendance by specific patients.
Publisher: Cold Spring Harbor Laboratory
Date: 14-08-2020
DOI: 10.1101/2020.08.11.20173153
Abstract: Emergency Departments have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of this study was to gain perspectives from consumer, referrer and health services personnel regarding the concept of emergency wait time visibility. In 2019, 103 semi-structured interviews and one focus group were conducted with emergency medicine patients/families, paramedics, well community members and hospital aramedic administrators. Nine emergency departments and multiple organisations in Victoria, Australia, contributed data. Transcripts were coded and themes are presented. Consumers and paramedics face physical and psychological difficulties when wait times aren’t visible. Consumers believe about a 2-hour wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times paramedics want door to off-stretcher times (for all possible transport destinations) with 47/50 consumers and 30/31 paramedics potentially using this information. Twenty-eight of 50 consumers would use times to inform facility or provider choice, 19/50 want information once in the waiting room. During prolonged waits, 1/52 consumers would consider not seeking care. Visibility of approximate waits would better inform decision-making, improve load-spreading, allow planning and access to basic needs and might reduce anxiety. Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre-hospital and whilst waiting for care.
Publisher: BMJ
Date: 06-2018
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA16.00218
Abstract: To examine how older people use an after-hours medical deputising service that arranges home visits by locum general practitioners to identify differences in how people who live in the community and those who live in residential aged care facilities (RACFs) use this service. Retrospective analysis of routinely collected administrative data from the Melbourne Medical Deputising Service (MMDS) for the 5-year period, 1 January 2008 - 31 December 2012. Data for older people (≥ 70 years old) residing in greater Melbourne and surrounding areas were analysed. Numbers and rates of MMDS bookings for acute after-hours care, stratified according to living arrangements (RACF v community-dwelling residents). Of the 357 112 bookings logged for older patients during 2008-2012, 81% were for RACF patients, a disproportionate use of the service compared with that by older people dwelling in the community. Most MMDS bookings resulted in a locum GP visiting the patient. During 2008-2012, the booking rate for RACFs increased from 121 to 168 per 1000 people aged 70 years or more, a 39% increase the booking rate for people not living in RACFs increased from 33 to 40 per 1000 people aged 70 years or more, a 21% increase. After-hours locum GPs booked through the MMDS mainly attended patients living in RACFs during 2008-2012. Further research is required to determine the reasons for differences in the use of locum services by older people living in RACFs and in the community.
Publisher: Oxford University Press (OUP)
Date: 10-08-2015
Abstract: a decline in health state and re-attendance are common in people aged ≥65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.99-1.76 n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95% CI 0.70-1.16 n = 1,389) or mortality up to 18 months (OR 1.04, 95% CI 0.83-1.29 n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.
Publisher: Oxford University Press (OUP)
Date: 2016
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-043223
Abstract: The population is ageing, with increasing health and supportive care needs. For older people, complex chronic health conditions and frailty can lead to a cascade of repeated hospitalisations and further decline. Existing solutions are fragmented and not person centred. The proposed Being Your Best programme integrates care across hospital and community settings to address symptoms of frailty. A multicentre pragmatic mixed methods study aiming to recruit 80 community-dwelling patients aged ≥65 years recently discharged from hospital. Being Your Best is a codesigned 6-month programme that provides referral and linkage with existing services comprising four modules to prevent or mitigate symptoms of physical, nutritional, cognitive and social frailty. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in frailty (Modified Reported Edmonton Frail Scale), cognition (Mini-Mental State Examination), functional ability (Barthel and Lawton), loneliness (University of California Los Angeles Loneliness Scale-3 items) and nutrition (Malnutrition Screening Tool) will also be measured at 6 and 12 months. The study has received approval from Monash Health Human Research Ethics Committee (RES-19-0000904L). Results will be disseminated through peer-reviewed journals, conference and seminar presentations. ACTRN12620000533998 Pre-results.
Publisher: MDPI AG
Date: 05-11-2021
DOI: 10.3390/EN14217373
Abstract: Metal–air batteries are a promising technology that could be used in several applications, from portable devices to large-scale energy storage applications. This work is a comprehensive review of the recent progress made in metal-air batteries MABs. It covers the theoretical considerations and mechanisms of MABs, electrochemical performance, and the progress made in the development of different structures of MABs. The operational concepts and recent developments in MABs are thoroughly discussed, with a particular focus on innovative materials design and cell structures. The classical research on traditional MABs was chosen and contrasted with metal–air flow systems, demonstrating the merits associated with the latter in terms of achieving higher energy density and efficiency, along with stability. Furthermore, the recent applications of MABs were discussed. Finally, a broad overview of challenges/opportunities and potential directions for commercializing this technology is carefully discussed. The primary focus of this investigation is to present a concise summary and to establish future directions in the development of MABs from traditional static to advanced flow technologies. A systematic analysis of this subject from a material and chemistry standpoint is presented as well.
Publisher: Wiley
Date: 13-06-2019
DOI: 10.1111/JGS.16015
Publisher: Springer Science and Business Media LLC
Date: 10-03-2021
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JAMDA.2015.03.007
Abstract: With an aging population, a growing number of older adults experience physical or cognitive decline that necessitates admission to residential aged care facilities (RACF). Each year a considerable proportion of these residents has at least 1 emergency transfer to hospital, which may result in a number of adverse outcomes. Rates of transfer from RACF to hospital can vary considerably between different RACFs suggesting the presence of potentially modifiable risk factors for emergency department (ED) transfer. A systematic and comprehensive search of the peer-reviewed literature using 4 electronic databases was conducted. Included papers were those reporting on determinants of unplanned transfer to hospital for elderly people (aged 65 years and above) living in RACFs. Studies were assessed for quality and key concepts and themes extracted. There are both in idual patient factors and health system factors, which influence rates of transfer to hospital for elderly RACF residents. For in iduals, increased risk of ED transfer has been associated with presence of particular comorbidities such as chronic airways disease, congestive cardiac failure, and diabetes presence of indwelling devices absence of an advance care plan and reduced functional ability. For organizations, "for profit" facilities and those with poorer staff to patient ratios also have higher rates of transfer to hospital, compared with those owned by not-for-profit organizations and those with improved registered nurse and medical practitioner staffing. This review has identified a number of potentially modifiable patient and organizational factors that should reduce the need for burdensome transfer to the ED and improve the quality of both acute care and end-of-life care for this population of frail, elderly in iduals. A number of these determinants, including facility staffing, the role of specialist geriatricians, and advance directives, should be further examined, ideally through interventional trials to evaluate their impact on the pre-hospital and emergency management of these patients.
Publisher: AMPCo
Date: 08-2013
DOI: 10.5694/MJA12.11863
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH17228
Abstract: Objective A growing body of research indicates that paramedics may have a greater role to play in health care service provision, beyond the traditional models of emergency health care. The aim of this study was to identify and synthesise the literature pertaining to the role of paramedic-initiated health education within Australia, with specific consideration of metropolitan, rural and remote contexts. Methods A literature review was undertaken using the Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and Scopus databases. The search time frame was limited from January 2007 to November 2017. The search was performed using key paramedic search terms in combination with keywords such as health education, rural, metropolitan, remote and Australia. Reference lists from relevant papers were also reviewed. Results Fourteen articles met the inclusion criteria for synthesis. Health education in the Australian paramedic context relates largely to expanded-scope paramedics, health promotion and the role of paramedics as key members of local communities. There were no studies specifically related to the paramedic role in health education, although many papers referred to health education as one of many roles paramedics engage in today. Conclusion This review highlights a broadening of paramedicine’s traditional scope of practice, and an indication of how vital paramedics could be to local communities, particularly in rural and remote areas. An expanded role may help address health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers. What is known about the topic? A broadening of paramedicine’s traditional scope of practice has been linked to improvements in health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers, such as rural and remote Australia. Health education, as well as health promotion, primary health care and chronic disease management, have been proposed as potential activities that paramedics could be well placed to participate in, contributing to the health and well-being of local communities. What does this paper add? This paper identifies and synthesises literature focusing on paramedic-initiated health education in the Australian context, assessing the current health education role of paramedics in metropolitan, rural and remote areas. It provides an understanding of different geographical areas that may benefit from expanded-scope prehospital practice, indicating that the involvement of paramedics in health education in Australia is significantly determined by their geographical place of work, reflecting the influence of the availability of healthcare resources on in idual communities. What are the implications for practitioners? Today’s paramedics fill broader roles than those encompassed within traditional models of prehospital care. Rural and remote communities facing increasing difficulty in obtaining health service provision appear to benefit strongly from the presence of expanded-scope paramedics trained in health promotion, primary injury prevention, chronic disease management and health education: this should be a consideration for medical and allied health practitioners in these areas. Australian paramedics are uniquely placed to ‘fill the gaps’ left by shortages of healthcare professionals in rural and remote areas of the country.
Publisher: Wiley
Date: 06-02-2022
DOI: 10.1111/JEP.13660
Abstract: The field of implementation science is critical for embedding research evidence into healthcare practice, benefiting in iduals, organizations, governments, and the broader community. Implementation science is messy and complex, underpinned by many theories and frameworks. Efficacious interventions for older people with multiple comorbidities exist, yet many lack effectiveness evaluation relevant to pragmatic implementation within aged care practice. This article outlines the conceptualization and development of an Implementation Framework for Aged Care (IFAC), fit-for-purpose for an aged care organization, Bolton Clarke, intent on embedding evidence into practice. A four-stage process was adopted to (1) explore context and relevant literature to conceptualize the IFAC (2) identify key elements for a draft IFAC (3) expand elements and refine the draft in consultation with experts and (4) apply the IFAC to three existing projects, identifying key learnings. A checklist to operationalize the IFAC was then developed. The IFAC is grounded in codesign principles and encapsulated by the implementation context, from a social, cultural and political perspective. The IFAC addresses the questions of (1) why do we need to change? (2) what do we know? (3) who will benefit? (4) who will make the change? (5) what strategies will be used? and (6) what difference are we making? Three pilot projects: early adoption of a Wellness and Reablement approach a care worker and virtual physiotherapist-led program to prevent falls and a therapeutic horticulture program for residential communities, highlight learnings of applying the IFAC in practice. This fit-for-purpose IFAC was developed for a proactive and responsive aged care provider. The simplicity of the six-question IFAC is underpinned by substantial theoretical perspectives for its elements and their connections. This complexity is then consolidated into an 18-question checklist to operationalize the IFAC, necessary to advance the translation of evidence into clinical practice.
Publisher: Wiley
Date: 2013
DOI: 10.1111/J.1445-5994.2012.02842.X
Abstract: To examine non-clinical factors associated with emergency department (ED) attendance by lower urgency older patients. An exploratory descriptive study comprising structured interviews with lower urgency community-dwelling patients aged ≥70 years presenting to a tertiary metropolitan Melbourne public hospital ED. Demographical and clinical characteristics, self-reported feelings of social connectedness, perceived accessibility to primary care, reason for attending ED were measured. One hundred patients were interviewed: mean age 82 years, 56% female, 57% lived alone 73% presented during business hours, 58% arrived by ambulance, 80% presented for illness, and 65% were discharged home within 48 h. Fifty-six per cent of patients reported feeling socially disconnected, comprising 49% living alone compared with 65% who lived with their spouse/family. All patients attended a regular general practitioner, 31% reporting regular review appointments. Thirty-five per cent reported waiting times >2-3 days for urgent problems 59% stated accessing care 'after hours' without attending ED as difficult, with 20% having attended ED 3-6 times in the previous 12 months. Reasons for attending ED were referral by a third party, difficulty with accessibility to primary care, patient preferences for timely care and fast-track access to specialist care. Most older patients of lower clinical urgency presented to ED because of perceived access block to primary or specialist services, alongside an expectation of more timely and specialised care. This suggests that EDs should be redesigned and/or integrated community-based models of care developed to meet the specific needs of this age group who have growing demand for acute care.
Publisher: Wiley
Date: 19-09-2021
DOI: 10.1002/HPJA.539
Abstract: Australia's ageing population has growing health care needs, challenging timely health service provision. In rural and regional areas, older Australians have poorer health care outcomes and higher rates of potentially preventable hospital (PPH) admissions. The objective of this study was to identify Australian Governmental initiatives designed to reduce PPH of older adults (65 years and over) in rural and regional areas. An internet search, underpinned by an environmental scan methodology, was utilised to systematically search the websites of Australian government health departments for relevant initiatives. Stakeholder interviews were then conducted to enrich the findings of the environmental scan. Thematic analysis was utilised to analyse all data. We identified 13 initiatives currently in existence in Australia that fulfilled the search criteria. Stakeholder interviews revealed a range of other local interventions in rural communities across the country, driven largely by community need and a lack of health service accessibility. The identified small number of Governmental health initiatives designed to reduce the PPH of older people living in rural and regional Australia may indicate gaps in the provision of services designed to enable older adults to remain at home and avoid subsequent hospital admissions. A coordinated, systemic approach to health promotion targeting older people in rural and regional areas should be explored, with a focus on collaboration between sectors (including primary care, allied health and prehospital services).
Publisher: Elsevier BV
Date: 11-2007
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/23337214221149772
Abstract: The home care workforce provides essential support for older people with dementia to live a life of fulfillment. “ Enabling Choices,” an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.
Publisher: Springer Science and Business Media LLC
Date: 29-08-2017
Publisher: Oxford University Press (OUP)
Date: 12-01-2016
Abstract: an emergency department (ED) visit is a sentinel event for an older person, with increased likelihood of adverse outcomes post-discharge including early re-presentation. to determine factors associated with early re-presentation. prospective cohort study conducted in the ED of a large acute Melbourne tertiary hospital. Community-dwelling patients ≥65 years were interviewed including comprehensive assessment of cognitive and functional status, and mood. Logistic regression was used to identify risk factors for return within 30 days. nine hundred and fifty-nine patients, median age 77 years, were recruited. One hundred and forty patients (14.6%) re-presented within 30 days, including 22 patients (2.3%) on ≥2 occasions and 75 patients (7.8%) within 7 days. Risk factors for re-presentation included depressive symptoms, cognitive impairment, co-morbidity, triaged as less urgent (ATS 4) and attendance in the previous 12 months, with a decline in risk after 85 years of age. Logistic regression identified chronic obstructive pulmonary disease (OR 1.78, 95% CI 1.02-3.11), moderate cognitive impairment (OR 2.07, 95% CI 1.09-3.90), previous ED visit (OR 2.11, 95% CI 1.43-3.12) and ATS 4 (OR 2.34, 95% CI 1.10-4.99) as independent risk factors for re-presentation. Age ≥85 years was associated with reduced risk (OR 0.81, 95% CI 0.70-0.93). older discharged patients had a high rate of early re-presentation. Previously identified risk factors-increased age, living alone, functional dependence and polypharmacy-were not associated with early return in this study. It is not clear whether these inconsistencies represent a change in patient case-mix or strategies implemented to reduce re-attendance. This remains an important area for future research.
Publisher: Wiley
Date: 21-07-2022
DOI: 10.1111/AJAG.13114
Abstract: Cycling Without Age (CWA) involves taking residents on outdoor trishaw (electric bicycle) rides driven by trained ‘pilots’. This study explored the CWA experience from the perspective of residents and family members, staff and volunteer pilots from a residential aged care home in Queensland, Australia. A qualitative descriptive design was used. Interviews were conducted with 21 participants. Transcripts were analysed thematically, with the interview questions determining a priori categories followed by coding of central themes. Several themes emerged. For residents, seeing familiar places prompted reminiscences, and being outdoors elicited positive emotions. Family members reported CWA was a novel way to be with their loved one. Enabling residents to have time away from the care home with community contact was rewarding for pilots. Staff noted improvement in residents' mood post‐ride, however, rides needed to be scheduled to fit in with their workflow. Cycling Without Age was perceived to offer a unique and meaningful experience, with benefits including sharing stories, being outside, and feeling part of the community.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16191
Abstract: Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.
Publisher: Wiley
Date: 22-12-2022
DOI: 10.1111/AJAG.13034
Abstract: Residential aged care (RAC) quality is often measured as part of regulatory compliance. To inform care delivery and service improvements, we developed a consumer experience survey. Validation study incorporating 2018–2019 survey data ( n = 1504 in iduals, 25 RAC homes) and test‐retest reliability evaluation. Most of the respondents were women (67%) with 38% of the surveys completed by residents, 39% with staff support, and 23% by family members. Moderate‐to‐high correlations (0.46–0.84) between in idual items indicate the survey is a coherent measure of satisfaction good inter‐item correlation was found across all sections (0.61–0.70) with high internal consistency (Cronbach's alpha 0.90–0.94) and moderate correlation for test‐retest reliability was found on the same in idual when providing an overall recommendation score (in idual ICC 0.684). The RAC Consumer Experience Survey is a validated measure of lived experience and satisfaction that aligns closely with the Australian Aged Care Quality Standards, affording providers a standardised tool for benchmarking and informing care quality across the sector.
Publisher: AMPCo
Date: 02-2018
DOI: 10.5694/MJA17.00642
Publisher: Wiley
Date: 2008
Publisher: AMPCo
Date: 05-2013
DOI: 10.5694/MJA13.10357
Publisher: BMJ
Date: 20-10-2011
Abstract: Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion c aigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand.
Publisher: BMJ
Date: 12-2016
Publisher: Elsevier BV
Date: 07-2022
Publisher: Oxford University Press (OUP)
Date: 13-09-2017
Publisher: Health Affairs (Project Hope)
Date: 10-2013
Publisher: Oxford University Press (OUP)
Date: 23-06-2018
DOI: 10.1002/BJS5.80
Publisher: Wiley
Date: 28-09-2020
Publisher: Elsevier BV
Date: 2016
Publisher: Wiley
Date: 20-05-2013
Abstract: The present paper presents an agenda for geriatric emergency medicine research, education and policy development. Herein we will argue: Population ageing is the definitive health policy challenge in Australasia, and the greatest stressor for emergency medicine posed by population ageing is the disproportionate contribution of older people to hospital occupancy. ED practices and models of care may on occasions contribute to rather than reduce high hospital occupancy in older people, benefitting neither in idual patients nor the community at large. Geriatric emergency medicine priorities can be conceptualised using a simple framework, and this process will facilitate a research and policy focus on how to achieve equivalent or improved care for older people with less hospital occupancy.
Publisher: Hindawi Limited
Date: 07-11-2021
DOI: 10.1111/HSC.13636
Abstract: Frailty is a condition characterised by increased vulnerability and decline of physical and cognitive reserves, most often affecting older people. This can lead to a cascade of repeated hospitalisations, further decline and ultimately loss of independence. Frailty and pre-frailty are modifiable interventions such as physical exercise, cognitive training, social connection and improved nutrition, especially in a group setting, can mitigate frailty. Existing healthcare guidelines for managing frailty focus predominantly on falls, delirium, acute confusion and immobility. Uptake of referrals to services following hospital discharge is sub-optimal, indicating that a more proactive, person-centred and integrated approach to frailty is required. The aim was to co-design a program to help pre-frail and frail older people return to their homes following hospital discharge by increasing resilience and promoting independence. We engaged healthcare consumers, and healthcare professionals from three tertiary hospitals in metropolitan Melbourne (Alfred Hospital, Monash Health and Cabrini Health), and from Bolton Clarke home-based support services. Co-design is a process whereby the input of service consumers is included in the development of a program. In the healthcare sector, co-design involves discussions with healthcare consumers alongside healthcare professionals to identify issues and build knowledge to ultimately work on improving the healthcare system. From co-design sessions with 23 healthcare consumers and 17 healthcare professionals, it was apparent that frailty was perceived to affect physical and mental well-being. The co-design process resulted in refinement of the Being Your Best program to incorporate a holistic approach, addressing four domains supported by research evidence, to improve health and well-being through community- or home-based physical activity, cognitive training, social support and nutritional support. Being Your Best was developed in consultation with older people with lived experience as well as healthcare professionals and aims to mitigate the effects of frailty, and will now be tested for feasibility and acceptability.
Publisher: Wiley
Date: 18-01-2018
Abstract: To describe patterns for potentially avoidable general practice (PAGP)-type and non-PAGP-type ED presentations by older patients during 2008 and 2012. Retrospective analysis of ED presentations by patients ≥70 years for 2008 and 2012. Metropolitan Melbourne public hospital data were obtained from the Victorian Emergency Minimum Dataset. Outcomes were characteristics of PAGP-type and non-PAGP-type presentations as defined by the Australian Institute of Health and Welfare numbers and rates per 1000 population ≥70 years of repeat (×2-3/year) and frequent (≥ ×4/year) PAGP-type and non-PAGP-type presentations. The older metropolitan Melbourne population increased by 10.3% between 2008 and 2012, whereas the number of ED presentations increased by 12.7%. The volume of PAGP-type presentations decreased by 2.6%, with declining rates per 1000 population ≥70 years of repeat (7.2-6.2) and frequent (0.7-0.4) presentation. In contrast, the volume of non-PAGP-type presentations grew by 15.4%, with increasing repeat (57.6-60.7) and frequent (13.1-14.2) presentation rates per 1000 population ≥70 years. The majority (39%) of non-PAGP-type presentations by frequent ED attenders were due to cardiovascular or respiratory problems. The rate of repeat and frequent PAGP-type presentations by older people decreased in 2012 compared with 2008, suggesting that initiatives implemented to reduce avoidable presentations may have had an effect. However, an increase in the rate of frequent non-PAGP-type presentations, predominately for acute exacerbation of cardiovascular and respiratory conditions, has important implications for planning future healthcare delivery hence, the importance of initiatives such as the Health Care Home.
Publisher: BMJ
Date: 23-06-2015
DOI: 10.1136/INJURYPREV-2014-041271
Abstract: Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk live in residential aged care or >50 km from the trial hospital have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis are receiving palliative care or are unable to use a telephone will be excluded. Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. RESPOND builds on prior falls prevention learnings and aims to help in iduals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease however, evidence to support this approach in falls prevention is limited. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).
Publisher: Hindawi Limited
Date: 30-10-2020
DOI: 10.1111/HSC.12882
Abstract: For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of in iduals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.
Publisher: Computers, Materials and Continua (Tech Science Press)
Date: 2021
Publisher: Oxford University Press (OUP)
Date: 14-10-2014
Abstract: residential aged care facility (RACF) resident numbers are increasing. Residents are frequently frail with substantial co-morbidity, functional and cognitive impairment with high susceptibility to acute illness. Despite living in facilities staffed by health professionals, a considerable proportion of residents are transferred to hospital for management of acute deteriorations in health. This model of emergency care may have unintended consequences for patients and the healthcare system. This review describes available evidence about the consequences of transfers from RACF to hospital. a comprehensive search of the peer-reviewed literature using four electronic databases. Inclusion criteria were participants lived in nursing homes, care homes or long-term care, aged at least 65 years, and studies reported outcomes of acute ED transfer or hospital admission. Findings were synthesized and key factors identified. residents of RACF frequently presented severely unwell with multi-system disease. In-hospital complications included pressure ulcers and delirium, in 19 and 38% of residents, respectively and up to 80% experienced potentially invasive interventions. Despite specialist emergency care, mortality was high with up to 34% dying in hospital. Furthermore, there was extensive use of healthcare resources with large proportions of residents undergoing emergency ambulance transport (up to 95%), and inpatient admission (up to 81%). acute emergency department (ED) transfer is a considerable burden for residents of RACF. From available evidence, it is not clear if benefits of in-hospital emergency care outweigh potential adverse complications of transfer. Future research is needed to better understand patient-centred outcomes of transfer and to explore alternative models of emergency healthcare.
Publisher: Wiley
Date: 15-10-2020
DOI: 10.1111/AJAG.12735
Abstract: To profile changes in older women accessing home nursing between 2006 and 2015, focussing on living circumstances. Data pertaining to Australian women aged 55+ who accessed a home nursing service between 2006 and 2015 were analysed, stratified by living status. Comparisons were made between the years 2006 and 2015 rates and relative rates of use per 1000 clients were calculated. Fewer women lived alone in 2015 compared with 2006. Women were older, less likely to be born in Australia, speak English at home, had more diagnoses and higher average Charlson Comorbidity Index scores in 2015. Relative rates of service use for older women living with others increased slightly over the 10 years, while decreasing by 13% for those living alone. Women using home nursing services are older than previously, more medically complex, more likely to be born from countries other than Australia and speak a preferred language other than English.
Publisher: Edward Elgar Publishing
Date: 20-10-2023
Publisher: BMJ
Date: 20-10-2017
DOI: 10.1136/INJURYPREV-2016-042169
Abstract: Falls remain common for community-dwelling older people and impose a substantial economic burden to the healthcare system. RESPOND is a novel falls prevention programme that aims to reduce secondary falls and fall injuries among older people who present to a hospital emergency department (ED) with a fall. The present protocol describes a prospective economic evaluation examining the incremental cost-effectiveness of the RESPOND programme, compared with usual care practice, from the Australian health system perspective. This economic evaluation will recruit 528 participants from two major tertiary hospital EDs in Australia and will be undertaken alongside a multisite randomised controlled trial. Outcome and costing data will be collected for all participants over the 12-month trial. It will compare the RESPOND falls prevention programme with usual care practice (current community-based falls prevention practices) to determine its incremental cost-effectiveness according to three intermediate clinical outcomes: (1) falls prevented, (2) fall injuries prevented and (3) injurious falls prevented. In addition, utilities will be derived from a generic quality-of-life measure (EQ-5D-5L) and used to calculate the 'incremental cost per quality-adjusted life years gained'. The results of this study will provide healthcare decision makers with evidence to assist with setting spending thresholds for preventive health programmes and inform selection of emergency and community service models of care. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684) Pre-results.
Publisher: Wiley
Date: 07-05-2018
DOI: 10.1111/AJAG.12535
Abstract: Management of older patients during acute illness or injury does not occur in isolation in emergency departments. We aimed to develop a collaborative Consensus Statement to enunciate principles of integrated emergency care. Briefing notes, informed by research and evidence reviews, were developed and evaluated by a Consensus Working Party comprising cross-specialty representation from clinical experts, service providers, consumers and policymakers. The Consensus Working Party then convened to discuss and develop the statement's content. A subcommittee produced a draft, which was reviewed and edited by the Consensus Working Party. Consensus was reached after three rounds of discussion, with 12 principles and six recommendations for how to follow these principles, including an integrated care framework for action. Dissemination will encourage stakeholders and associated policy bodies to embrace the principles and priorities for action, potentially leading to collaborative work practices and improvement of care during and after acute illness or injury.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH09866
Abstract: Background. Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied. Aims. To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase. Method. A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. Findings. Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed. Conclusion. The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand. What is known about the topic? Ambulance utilisation is increasing annually throughout the developed world, with previous research suggesting numerous underlying factors. What does this paper add? These factors have not been previously synthesised in the international literature. This narrative review clearly articulates the underlying problems. What are the implications for practitioners? This paper outlines the need for further research of the causes of increased emergency ambulance utilisation, to enable the development of appropriate strategies to manage demand in the future.
Publisher: Wiley
Date: 23-12-2011
Publisher: SAGE Publications
Date: 28-09-2022
DOI: 10.1177/00178969221125622
Abstract: In rural and regional areas, older Australians have poorer health outcomes and higher rates of potentially preventable hospital admissions than their metropolitan counterparts. Paramedics may be uniquely placed to improve health outcomes of rural-dwelling older adults through involvement in primary and preventive healthcare, health promotion and health education. However, the feasibility and acceptability of this remains unexplored. To investigate the utility, feasibility and acceptability of paramedic involvement in health education initiatives aimed at rural-dwelling older people. Semi-structured telephone interviews were conducted with key stakeholders between July and September 2021. Interviews were transcribed verbatim and reflexive thematic analysis was undertaken. Participants (older people and their carers, n = 3 health service representatives, n = 4 and ambulance service representatives, n = 3) linked acceptability to the position of trust and visibility paramedics held within the community. The coverage provided by ambulance services in rural and regional areas, and the enhanced skills and collaborative relationships that rural paramedics develop, were seen as enabling factors to expanded roles. Key stakeholders’ perspectives on the role of paramedics in health education for rural-dwelling older people highlighted the trust placed in paramedics. Meeting identified needs without competing with established health initiatives was seen as important with respect to paramedic engagement in broader primary health care opportunities.
Publisher: Oxford University Press (OUP)
Date: 08-12-2017
Abstract: to profile the trajectory of, and risk factors for, functional decline in older patients in the 30 days following Emergency Department (ED) discharge. prospective cohort study of community-dwelling patients aged ≥65 years, discharged home from a metropolitan Melbourne ED, 31 July 2012 to 30 November 2013. The primary outcome was functional decline, comprising either increased dependency in personal activities of daily living (ADL) or in skills required for living independently instrumental ADL (IADL), deterioration in cognitive function, nursing home admission or death. Univariate analyses were used to select risk factors and logistic regression models constructed to predict functional decline. at 30 days, 34.4% experienced functional decline with 16.7% becoming more dependent in personal ADL, 17.5% more dependant in IADL and 18.4% suffering deterioration in cognitive function. Factors independently associated with decline were functional impairment prior to the visit in personal ADL (Odds Ratio [OR] 3.21, 95% confidence interval [CI] 2.26–4.53) or in IADL (OR 6.69, 95% CI 4.31–10.38). The relative odds were less for patients with moderately impaired cognition relative to those with normal cognition (OR 0.38, 95% CI 0.19–0.75). There was a 68% decline in the relative odds of functional decline for those with any impairment in IADL who used an aid for mobility (OR 0.32, 95% CI 0.14–0.7). older people with pre-existing ADL impairment were at high risk of functional decline in the 30 days following ED presentation. This effect was largely mitigated for those who used a mobility aid. Early intervention with functional assessments and appropriate implementation of support services and mobility aids could reduce functional decline after discharge.
Publisher: Wiley
Date: 27-03-2023
DOI: 10.1111/AJAG.13188
Abstract: Incontinence is one of the main reasons for institutionalisation into residential aged care. It is linked with increased falls, skin breakdown, depression, social isolation and impaired quality of life. Studies over the past decade have demonstrated poor‐quality incontinence care, which has led to ongoing development of best practice guidelines and educational resources. This study investigated current practices, and staff and resident experiences with continence assessment and management, in comparison with best practice guidelines. This concurrent mixed methods study was conducted in a 120‐bed residential aged care home. Secondary analysis of data from clinical records provided a snapshot of how continence was assessed and managed. Semistructured interviews with four staff and five residents explored their experiences to understand the impact of current practice on resident emotional well‐being. Mixing methods allowed for comparison between quantitative and qualitative findings, enabling a deeper understanding. Findings from the two data sets were highly congruent and identified: (1) lack of communication with residents and family members about continence needs (2) heavy reliance on product usage and limited other conservative strategies (3) staff frustration at inability to respond to calls in a timely manner and (4) positive staff–resident relationships protect resident emotional well‐being. Current practices are not consistent with best practice guidelines, which raises the question as to why nothing has changed. We argue that a stronger focus on implementation underpinned by a relationship‐centred approach is required to improve continence care practices among residential care staff, and the quality of life for adults living with incontinence.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-042351
Abstract: Most calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services however, little is known about the appropriateness of subsequent secondary dispatches. To examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch. A retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted. The secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period. There were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses. Descriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients. The dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51 CI 0.48 to 0.55 p .001). Increasing age was associated with decreasing treatment (p .005) and increasing transportation rates (p .005). Secondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.
Publisher: Wiley
Date: 10-10-2020
Publisher: Wiley
Date: 28-03-2019
Abstract: This study compared the prevalence of homelessness in consecutive patients presenting to a metropolitan hospital ED measured via a prospective housing screen with the prevalence of homelessness determined via retrospective audit of hospital data. Factors that altered the odds of patients being homeless and service outcomes that differed were examined for screened patients. All patients presenting to the ED during a 7 day period in 2017 were invited to complete a housing screen. A retrospective audit of all ED presentations during the same period also occurred. Demographic (e.g. age, gender), clinical (e.g. reason for presentation, ED presentation history) and arrival mode (e.g. time, how arrived) predictors of homeless status were examined alongside care outcomes (e.g. ED length of stay, admission and 28 day re-presentation). Of 1208 presenting patients, 504 were prospectively screened and 7.9% were homeless. This compared with 0.8% of ED presentations coded as homeless in the Victorian Emergency Minimum Dataset and 2.3% of the 704 non-screened patients identified as homeless using Victorian Emergency Minimum Dataset Usual Accommodation alongside primary diagnosis and registration address. Within the screened s le, homeless patients were more likely to be male, arrive by emergency ambulance/with police, have a psychosocial diagnosis, and be frequent presenters. Re-presentation within 28 days occurred for 43% of homeless and 15% of not-homeless patients. Hospital ED administrative data substantially under-recognises the prevalence of homelessness in presenting patients. Standardised use of brief housing screens could improve identification of and provision of support to this often highly vulnerable population.
Publisher: AMPCo
Date: 05-2012
DOI: 10.5694/MJA12.10353
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1016/J.JAMDA.2019.11.007
Abstract: To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone. A retrospective cohort study using routinely collected data. Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015. Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode. A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode. Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.
Publisher: Elsevier BV
Date: 08-2021
Publisher: MDPI AG
Date: 14-12-2022
DOI: 10.3390/EN15249501
Abstract: The use of solar thermal systems (STSs) has recently reached a significant edge. The increasing research on developing an alternative power supply for limiting fossil fuel usage and climate change are the driving forces of STSs. The current work explores the recent progress in STSs’ applications, including PV/T or “photovoltaic/thermal” systems, zero-energy buildings, greenhouse solar thermal applications, solar thermal for pumping water, solar thermal refrigerators, solar chimneys, water desalination, and solar collectors, along with the benefits and challenges of these applications. Then, the potential contribution of STSs in achieving the various SDGs or “Sustainable development goals”, including barriers and research gaps, are elaborated. In brief, STSs significantly contribute to the seventeen SDGs’ achievement directly and indirectly. Recent developments in the engineering applications of STSs are strongly based on the materials of construction, as well as their design, process optimisation, and integration with multidisciplinary sciences and technologies such as modelling, nanoscience/nanotechnology, and artificial intelligence.
Publisher: Wiley
Date: 30-03-2021
DOI: 10.1111/AJAG.12929
Abstract: Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self‐esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target in iduals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi‐level approach to addressing loneliness.
Publisher: Elsevier BV
Date: 08-2022
Start Date: 2021
End Date: 2025
Funder: Ian Potter Foundation
View Funded ActivityStart Date: 2021
End Date: 2022
Funder: Canada Foundation for Innovation
View Funded ActivityStart Date: 1996
End Date: 1997
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Defence Health Foundation
View Funded ActivityStart Date: 2013
End Date: 2015
Funder: Australian Primary Health Care Research Institute, Australian National University
View Funded ActivityStart Date: 2013
End Date: 2015
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2013
Funder: University of Queensland
View Funded Activity