Ian D Cameron

Supporting community‐dwelling older people with cognitive impairment to stay at home: A modelled cost analysis

Publisher: Wiley

Date: 07-2020

DOI: 10.1111/AJAG.12818

Abstract: To model the potential financial implications of Australian programs supporting cognitively impaired community‐dwelling older people. Markov cohort models of (a) an observational study of a residential dyadic training program for carers and people with dementia (GTSAH) and (b) a frailty intervention (FIT) in a cognitively impaired subgroup. Direct health and social welfare costs accrued over 5 years (2018 $AUD prices) were captured. GTSAH costs $3755, FIT costs $1834, and permanent residential aged care (P‐RAC) costs $237 per day. Modelling predicted costs break even in approximately 5 months for GTSAH and 7 months for FIT, after which these interventions saved funds. The primary driver of savings was the P‐RAC cost (discounted at 5%/annum), at $121 030 for GTSAH vs $231 193 for standard care and $47 857 with FIT vs $111 359 for standard care. Programs supporting cognitively impaired community‐dwelling older people could be financially beneficial further evaluation and implementation would be a worthwhile investment.

Stroke in Australia

Publisher: Wiley

Date: 28-08-2022

DOI: 10.5694/MJA2.51691

Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals’ views

Publisher: Informa UK Limited

Date: 23-07-2019

DOI: 10.1080/09638288.2019.1643418

Abstract: To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to in idual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.

Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation

Publisher: Korean Academy of Rehabilitation Medicine

Date: 31-12-2021

DOI: 10.5535/ARM.21034

Abstract: Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3 95% confidence interval, 5.02–21.16).Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Impact of pre‐surgery hospital transfer on time to surgery and 30‐day mortality for people with hip fractures

Publisher: AMPCo

Date: 11-05-2021

DOI: 10.5694/MJA2.51083

Quality and safety in residential aged care

Publisher: Wiley

Date: 22-03-2023

DOI: 10.1111/IMJ.16052

Abstract: In Australia, 243 000 in iduals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. To examine the validity of the QI programme indicators using explicit measure review criteria. The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine‐point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.

Factors influencing duration of compensation following road traffic crash injury in older vs younger adults

Publisher: Wiley

Date: 06-10-2020

DOI: 10.1111/AJAG.12830

HOW, WHY AND UNDER WHAT CIRCUMSTANCES DOES A QUALITY IMPROVEMENT COLLABORATIVE BUILD KNOWLEDGE AND SKILLS IN CLINICIANS WORKING WITH PEOPLE WITH DEMENTIA? A REALIST INFORMED PROCESS EVALUATION

Publisher: Cold Spring Harbor Laboratory

Date: 07-08-2020

DOI: 10.1101/2020.08.05.20169185

Abstract: In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the World Health Organisation to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few ex les in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested, and refined the program theory of a quality improvement collaborative. Data were collected pre-and post-intervention using surveys and interviews with participants (n=24). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Seven mechanisms were identified: motivation, accountability, identity, collective learning, credibility, and reflective practice. Each of these mechanisms operated differently according to context. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge and skills of clinicians to improve dementia care. A supportive setting and a credible, flexible, and collaborative process optimises quality improvement knowledge and skills in clinicians working with people with dementia. Australian and New Zealand Clinical Trials Registry 21 February 2018 (ACTRN 12618000268246)

Improved survival rates after hip fracture surgery in New South Wales, 2011–2018

Publisher: Wiley

Date: 27-02-2022

DOI: 10.5694/MJA2.51440

Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed, Physical Function, Strength and Balance, Body Composition, Energy and Protein, in Injured, Vulnerable Elderly: A Multisite Ran

Publisher: MDPI AG

Date: 13-09-2021

DOI: 10.3390/NU13093182

Abstract: It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an in idualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months in idualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the s le size achieved. Participants in the intervention group had greater increment in energy (235 kcal 95% CI, 95 to 375 p = 0.01) and protein intake (9.1 g 95% CI, 1.5 to 16.8 p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.

Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study

Publisher: Springer Science and Business Media LLC

Date: 25-06-2019

DOI: 10.1186/S12877-019-1187-Y

COVID ‐19: planning for the aftermath to manage the aftershocks

Publisher: AMPCo

Date: 29-06-2020

DOI: 10.5694/MJA2.50685

Linkage Projects - Grant ID: LP0669266

Start Date: 09-2006

End Date: 06-2010

Amount: $320,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP110200079

Start Date: 06-2012

End Date: 12-2016

Amount: $354,939.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP170100664

Start Date: 09-2018

End Date: 12-2022

Amount: $406,665.00

Funder: Australian Research Council