ORCID Profile
0000-0002-1018-6633
Current Organisation
University of Adelaide
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Publisher: Oxford University Press (OUP)
Date: 14-11-2018
Abstract: Exercise is considered to be the most effective strategy to treat, prevent and delay frailty, a prevalent geriatric syndrome observed in clinical practice. Encouraging frail older people to take up exercise is crucial in the management of this condition. The study aimed to explore pre-frail and frail older peoples' perspectives in relation to being advised about exercise and their perceptions of the general practitioners' (GPs) role in promoting exercise for older people. Semi-structured interviews were conducted with 12 community-dwelling older (median age 83 years) participants screened pre-frail or frail using the FRAIL Screen. Their attitudes towards exercise, the advice received, their access to relevant information and their perceptions of the GP's role in promoting exercise were explored. Thematic analysis was conducted to analyse data. The majority of participants had a positive attitude towards exercise, and many participants indicated a preference for being advised firstly by their GPs and then other healthcare professionals. Participants living in the community reported difficulties in accessing information on exercise and indicated that local governments and GP practices should promote exercise for older people more actively. Participants living in retirement villages, however, reported having access to relevant information and being encouraged to participate in exercise. This research identified a gap in current practice, demonstrating that GPs, healthcare providers and local governments should promote exercise for older people more actively. Convincing health professionals to encourage regular exercise among their older patients would provide an opportunity to avoid and manage frailty in this population.
Publisher: Wiley
Date: 02-03-2020
DOI: 10.1111/AJAG.12788
Publisher: Wiley
Date: 30-06-2022
DOI: 10.1002/HPJA.630
Abstract: Despite growing research on sedentary behaviour and physical activity among hospitalised older people, there is little evidence of effective intervention strategies. This study sought input from clinical staff from various health professions on strategies to increase physical activity and reduce sedentariness for hospitalised older people. A 60‐minute focus group discussion involving two physiotherapists, two occupational therapists, one doctor, one nurse and one social worker was conducted. Participants were recruited from a subacute geriatric ward and an acute orthopaedic ward with an orthogeriatric service at a general hospital. Data were thematically analysed. Six strategies to reduce sedentary behaviour and increase physical activity were identified: clear and positive communication for patients and family/carers educating patients and family/carers involving family/carers and volunteers setting physical activity goals utilising group activities and activities of daily living (ADL) and making the hospital environment activity‐friendly. This research has revealed novel strategies to increase physical activity and reduce sedentary behaviour in hospital. The next step is to design interventions for testing.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2022
DOI: 10.1038/S41467-022-30474-6
Abstract: One common cause of vision loss after retinal detachment surgery is the formation of proliferative and contractile fibrocellular membranes. This aberrant wound healing process is mediated by epithelial-mesenchymal transition (EMT) and hyper-proliferation of retinal pigment epithelial (RPE) cells. Current treatment relies primarily on surgical removal of these membranes. Here, we demonstrate that a bio-functional polymer by itself is able to prevent retinal scarring in an experimental rabbit model of proliferative vitreoretinopathy. This is mediated primarily via clathrin-dependent internalisation of polymeric micelles, downstream suppression of canonical EMT transcription factors, reduction of RPE cell hyper-proliferation and migration. Nuclear factor erythroid 2–related factor 2 signalling pathway was identified in a genome-wide transcriptomic profiling as a key sensor and effector. This study highlights the potential of using synthetic bio-functional polymer to modulate RPE cellular behaviour and offers a potential therapy for retinal scarring prevention.
Publisher: Oxford University Press (OUP)
Date: 21-06-2021
Abstract: The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected. A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325. A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34] p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61] p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14] p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period. The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards. Clinical Trials Registration Number: 12617000981325
Publisher: Maad Rayan Publishing Company
Date: 03-01-2018
Publisher: Proceedings of the National Academy of Sciences
Date: 20-06-2023
Abstract: Transplantation of stem cell–derived retinal pigment epithelial (RPE) cells is considered a viable therapeutic option for age-related macular degeneration (AMD). Several landmark Phase I/II clinical trials have demonstrated safety and tolerability of RPE transplants in AMD patients, albeit with limited efficacy. Currently, there is limited understanding of how the recipient retina regulates the survival, maturation, and fate specification of transplanted RPE cells. To address this, we transplanted stem cell–derived RPE into the subretinal space of immunocompetent rabbits for 1 mo and conducted single-cell RNA sequencing analyses on the explanted RPE monolayers, compared to their age-matched in vitro counterparts. We observed an unequivocal retention of RPE identity, and a trajectory-inferred survival of all in vitro RPE populations after transplantation. Furthermore, there was a unidirectional maturation toward the native adult human RPE state in all transplanted RPE, regardless of stem cell resource. Gene regulatory network analysis suggests that tripartite transcription factors ( FOS , JUND , and MAFF ) may be specifically activated in posttransplanted RPE cells, to regulate canonical RPE signature gene expression crucial for supporting host photoreceptor function, and to regulate prosurvival genes required for transplanted RPE’s adaptation to the host subretinal microenvironment. These findings shed insights into the transcriptional landscape of RPE cells after subretinal transplantation, with important implications for cell-based therapy for AMD.
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000522657
Abstract: b i Introduction: /i /b As effective interventions to prevent inpatient falls are lacking, a novel technological intervention was trialed. The Ambient Intelligent Geriatric Management (AmbIGeM) system used wearable sensors that detected and alerted staff of patient movements requiring supervision. While the system did not reduce falls rate, it is important to evaluate the acceptability, usability, and safety of the AmbIGeM system, from the perspectives of patients and informal carers. b i Methods: /i /b We conducted a mixed-methods study using semistructured interviews, a pre-survey and post-survey. The AmbIGeM clinical trial was conducted in two geriatric evaluation and management units and a general medical ward, in two Australian hospitals, and a subset of participants were recruited. Within 3 days of being admitted to the study wards and enrolling in the trial, 31 participants completed the pre-survey. Prior to discharge (post-intervention), 30 participants completed the post-survey and 27 participants were interviewed. Interview data were thematically analyzed and survey data were descriptively analyzed. b i Results: /i /b Survey and interview participants had an average age of 83 (SD 9) years, 65% were female, and 41% were admitted with a fall. Participants considered the AmbIGeM system a good idea. Most but not all thought the singlet and sensor component as acceptable and comfortable, with no privacy concerns. Participants felt reassured with extra monitoring, although sometimes misunderstood the purpose of AmbIGeM as detecting patient falls. Participants’ acceptability was strongly positive, with median 8+ (0–10 scale) on pre- and post-surveys. b i Discussion/Conclusion: /i /b Patients’ acceptability is important to optimize outcomes. Overall older patients considered the AmbIGeM system as acceptable, usable, and improving safety. The findings will be important to guide refinement of this and other similar technology developments.
Publisher: Maad Rayan Publishing Company
Date: 02-02-2019
Publisher: SERDI
Date: 2018
DOI: 10.14283/JFA.2018.23
Abstract: It is essential to evaluate frail older adults understanding and execution of survey tools to improve data quality and accurate representation in research. The study tested the feasibility and acceptability of a survey that assesses various measures of functional status in frail older people. The study evaluated: 1) recruitment rate 2) time to complete questionnaires and difficulties encountered and 3) acceptability by participants. Validated tools including: FRAIL Scale, EuroQoL 5D-5L, Charlson’s Comorbidities Index, Baecke’s Physical Activity Questionnaire, Life-Space Assessment, Katz and Lawton ADL and NEWS Walkability Scale were assessed. Twenty-five older patients (63% recruitment rate) of a post-acute restorative program (residential Transition Care Program) in Adelaide, South Australia were interviewed. Although not statistically different, time to complete the overall questionnaire differed between robust, pre-frail and frail participants. Overall, the survey was considered acceptable and feasible, with consideration with NEWS and Life-Space assessment regarding length, phrasing and layout.
Publisher: Wiley
Date: 18-05-2013
DOI: 10.1111/J.1741-6612.2012.00597.X
Abstract: To determine whether older community-dwelling people underestimate their own perceived chance of falling compared with that of other older people (comparative optimism), and whether a history of falls is associated with comparative optimism. A s le of community-dwelling South Australians aged ≥65 years (n= 389) completed a computer-assisted telephone interview about their 12-month fall history, their perceived chance of falling and their rating of other older people's chance of falling. Respondents were comparatively optimistic about their chance of falling (Z =-8.1, P < 0.001). Those who had fallen in the last 12 months had a lower comparative optimism score (Z =-3.0, P < 0.003). As older people were comparatively optimistic about their likelihood of falling, they might not find fall prevention messages relevant. When older people present with a fall, clinicians could provide fall prevention information consistent with how older people present themselves.
Publisher: CSIRO Publishing
Date: 2001
DOI: 10.1071/AH010125
Abstract: Aboriginal Community Controlled Health Services face particular management issues as they adjust to the dominantWestern paradigm of managerialism and the market model of health service provision. Their cultural orientation leadsto distinctive organisational features which both advantage and disadvantages them in this environment. The holisticmodel of health used and community control enable the delivery of integrated, culturally appropriate health care.However, effective community control is difficult to achieve. Services may benefit from partnerships with collaboratorssuch as hospitals, regional health services and university departments of rural health if the partnerships are based onmutual respect and ensure that community control is retained.
Publisher: Medknow
Date: 2023
Publisher: Springer Science and Business Media LLC
Date: 25-06-2022
DOI: 10.1186/S12877-022-03212-2
Abstract: Mobile X-ray services (MXS) could be used to investigate clinical issues in aged care residents within familiar surroundings, reducing transfers to and from emergency departments and enabling healthcare to be delivered in residential aged care facilities. There is however little research exploring consumer perspectives about such services. The objective of this research was to explore the perspectives and preferences of residents about the provision of MXS in residential aged care facilities, including their knowledge about the service, perceived benefits, and factors that require consideration for effective implementation. A qualitative study design was used. The setting for the study included four residential aged care facilities of different sizes from different parts of a South Australian city. Purposive s ling was used to recruit participants. 16 residents participated in semi-structured interviews that were audio-recorded and transcribed verbatim. Data were inductively derived using thematic analysis. Participants had a mean age of 85 years, 56% were female, 25% had dementia and 25% had had a mobile X-ray in the last 12 months. Four themes were developed. Participants preferred mobile X-rays, provided as healthcare-in-place, to improve accessibility to them and minimize physical and psychological discomfort. Participants had expectations about the processes for receiving mobile X-rays. Costs of X-rays to people, family and society were a consideration. Decision making required residents be informed about mobile X-rays. Residents have positive views of MXS as they can receive healthcare-in-place, with familiar people and surroundings. They emphasised that MXS delivered in residential aged care facilities need to be of equivalent quality to those found in other settings. Increased awareness of mobile X-ray services is required.
Publisher: SERDI
Date: 2017
DOI: 10.14283/JFA.2017.27
Abstract: With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component ‘Self-management Plus’ intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component ‘Self-management Plus’ intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention’s feasibility in its current form.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2015
Publisher: Wiley
Date: 30-07-2023
DOI: 10.1111/AJAG.13228
Abstract: To describe the economic and cost considerations of mobile X‐ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co‐payment to deliver MXS (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co‐payment, and equity concerns (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. Mobile X‐ray services providers charge residents an upfront co‐payment for business viability, which can be a barrier to some residents wishing to access MXS.
Publisher: MDPI AG
Date: 14-12-2020
Abstract: Background: Sedentary behaviour (SB) can delay hospitalised older adults’ recovery from acute illness and injuries. Currently, there is no synthesis of evidence on SB among hospitalised older people. This scoping review aimed to identify and map existing literature on key aspects of SB among hospitalised older adults, including the prevalence, measurement and intervention strategies for SB and sedentary behaviour bouts (SBBs) as well as healthcare professionals, patients and carers’ perspectives on interventions. Methods and analysis: Several electronic databases were searched between January 2001 and September 2020. The Joanna Briggs Institute (JBI) framework was used to conduct this scoping review. Results: Out of 1824 articles, 21 were included comprising 16 observational studies, 3 randomised controlled trials, 1 comparative study, and 1 phase-1 dose-response study. The s le size ranged from 13 to 393, with all 1435 participants community-dwelling before hospitalisation. Only two studies focused on measuring SB and SBBs as a primary outcome, with others (n = 19) reporting SB and SBB as a sub-set of physical activity (PA). Older adults spent an average of 86.5%/day (20.8 h) sedentary. Most studies (n = 15 out of 21) measured SB and SBB using objective tools. Conclusion: Hospitalised older people spent most of their waking hours sedentary. Studies explicitly focused on SB and SBB are lacking, and the perspectives of patients, carers and healthcare professionals are not clarified. Future hospital-based studies should focus on interventions to reduce SB and SBB, and the perspectives of healthcare professionals, patients and carers’ taken into account.
Publisher: Wiley
Date: 20-10-2023
DOI: 10.1111/AJAG.13245
Publisher: Oxford University Press (OUP)
Date: 04-2004
Publisher: Cambridge University Press (CUP)
Date: 2007
Publisher: Oxford University Press (OUP)
Date: 13-01-2014
Abstract: It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. To explore why older women do or do not seek GP help after a fall. A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥ 65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women's experience of falling and seeking GP help. Interviews were analysed using constant comparison. Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs' time for trivial reasons and they believed they did not have timely access to their GP). Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history.
Publisher: Wiley
Date: 07-03-2012
DOI: 10.1111/J.1365-2702.2011.03990.X
Abstract: Aim and objective. This study aimed to understand older people’s perceptions of their and other older peoples’ falls risk, to increase understanding of why older people might not believe falls are relevant to themselves. Background. One‐third of the people aged ≥65 years (older people) fall yearly. Many older people do not participate in falls prevention programmes because they purport they are not personally vulnerable. Design. A qualitative study was conducted, guided by the tenets of grounded theory. Method. Semi‐structured interviews were conducted with nine community‐dwelling older people living in metropolitan Adelaide, South Australia. The interview explored participant’s direct and indirect experience of falling, their perceived chance of falling in the next 12 months and that of others of the same age and sex to themselves and their reasons for this. Results. Participants carefully presented themselves as being ‘not the type who fall’, who they view negatively. They believed their or their friends past or future falls were (or could be) because of factors outside of their personal control or because they were not paying attention at that moment of falling, as opposed to being the type of person who falls. They used these explanations as strategies to maintain or protect their identity as being physically competent. Conclusions. Older people know that falling can be viewed negatively. Falling is a threat to their identity as the type of person who does not fall. This explanation is consistent with self‐presentation theory, where people use accounting strategies in social interaction to create a desired impression. Relevance to clinical practice. Falls prevention messages are likely to be rejected if the target group associate the message with a negative identity. These findings can assist nurses to understand older people’s reluctance to engage in falls prevention and can stimulate thinking regarding alternative engagement strategies.
Publisher: BMJ
Date: 19-08-2017
DOI: 10.1136/INJURYPREV-2017-042507
Abstract: Although current best practice recommendations contribute to falls prevention in hospital, falls and injury rates remain high. There is a need to explore new interventions to reduce falls rates, especially in geriatric and general medical wards where older patients and those with cognitive impairment are managed. A three-cluster stepped wedge pragmatic trial, with an embedded qualitative process, of the Ambient Intelligent Geriatric Management (AmbIGeM) system (wearable sensor device to alert staff of patients undertaking at-risk activities), for preventing falls in older patients compared with standard care. The trial will occur on three acute/subacute wards in two hospitals in Adelaide and Perth, Australia. Patients aged 65 years admitted to study wards. A waiver (Perth) and opt-out of consent (Adelaide) was obtained for this study. Patients requiring palliative care will be excluded. The primary outcome is falls rate secondary outcome measures are: (1) proportion of participants falling (2) rate of injurious inpatient falls/1000 participant bed-days (3) acceptability and safety of the interventions from patients and clinical staff perspectives and (4) hospital costs, mortality and use of residential care to 3 months postdischarge. This study investigates a novel technological approach to preventing falls in hospitalised older people. We hypothesise that the AmbIGeM intervention will reduce falls and injury rates, with an economic benefit attributable to the intervention. If successful, the AmbIGeM system will be a useful addition to falls prevention in hospital wards with high proportions of older people and people with cognitive impairment. Australian and New Zealand Clinical Trial Registry: ACTRN 12617000981325 Pre-results.
Publisher: Springer Science and Business Media LLC
Date: 17-11-2018
Publisher: Hindawi Limited
Date: 21-04-2019
DOI: 10.1111/JONM.12753
Abstract: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. Four constructs were derived: physical environment patient safety and comfort staff safety and importance of interaction. There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.
No related grants have been discovered for Joanne Dollard.