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Bird K, Bohanna I, McDonald M, Wapau H, Blanco L, Cullen J, McLucas J, Forbes S, Vievers A, Wason A, Strivens E, Barker R. A good life for people living with disability: the story from Far North Queensland. Disabil Rehabil 2024; 46:1787-1795. [PMID: 37161860 DOI: 10.1080/09638288.2023.2205172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/14/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE People with disability in regional, rural and remote Australia have poorer service access compared to people from metropolitan areas. There is urgent need for reform. This study's aim was to explore the needs and aspirations of people with lived experience of disability in Far North Queensland (FNQ) to inform a new service framework. MATERIALS AND METHODS Twenty-five individuals with diverse experience of disability were engaged in semi-structured interviews. Participants were recruited from four sites that differed geographically, culturally, and socioeconomically. Using an inductive then deductive thematic approach to data analysis, statements of needs and aspirations were compiled and aligned with three pre-determined vision statements. RESULTS Needs and aspirations aligned well with the vision statements which were to: feel "included, connected, safe and supported"; have "opportunities to choose one's own life and follow one's hopes and dreams"; and have "access to culturally safe services close to home." To realise this vision in FNQ, support to navigate and coordinate services across sectors is essential. CONCLUSION People of FNQ of all abilities, need and aspire to experience "a good life" like their fellow Australians. Any new service model must focus on providing service navigation and co-ordination amid the complexities of service delivery in FNQ.
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Affiliation(s)
- Katrina Bird
- James Cook University, College of Healthcare Sciences, Cairns, QLD, Australia
| | - India Bohanna
- James Cook University, College of Healthcare Sciences, Cairns, QLD, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Hylda Wapau
- Torres and Cape Hospital and Health Service, Bamaga, QLD, Australia
| | - Leisyle Blanco
- James Cook University, College of Healthcare Sciences, Cairns, QLD, Australia
| | | | - Jan McLucas
- Former Senator and Co-Chair FNQ Connect Consumer Reference Group, QLD, Australia
| | - Sue Forbes
- Co-Chair FNQ Connect Consumer Reference Group, QLD, Australia
| | - Anita Vievers
- Centacare FNQ & Catholic Early Learning and Care, Cairns, QLD, Australia
| | - Alan Wason
- Mulungu Aboriginal Corporation Primary Health Care, Mareeba, QLD, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, Older Persons Sub-Acute and Rehabilitation, Cairns, QLD, Australia
| | - Ruth Barker
- James Cook University, College of Healthcare Sciences, Cairns, QLD, Australia
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Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Flicker L, Pachana NA, Kordick S, Strivens E. Validation of the Kimberley Cognitive Assessment (KICA-Cog) for Torres Strait Islander Peoples. Australas J Ageing 2024. [PMID: 38497228 DOI: 10.1111/ajag.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/13/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. METHODS Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. RESULTS A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. CONCLUSIONS The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.
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Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Queensland, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Sciences, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Kordick
- Faculty of Business, Justice & Behavioural Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
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Webb T, Meldrum K, Kilburn M, Wallace V, Russell S, Quigley R, Strivens E. Cultural, sociopolitical, environmental and built assets supporting health and well-being in Torres Strait Island communities: protocol for a scoping review. BMJ Open 2023; 13:e077229. [PMID: 38070909 PMCID: PMC10729014 DOI: 10.1136/bmjopen-2023-077229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Risks to an individual's health should be considered alongside the environmental, sociocultural and sociopolitical context(s) in which they live. Environmental mapping is an approach to identifying enablers and barriers to health within a community. The Indigenous Indicator Classification System (IICS) framework has been used to map the environment in Australian Indigenous communities. The IICS is a four-level nested hierarchical framework with subject groups including culture, sociopolitical and built at the top of the hierarchy and indicators at the bottom. The objective of this scoping review is to map the cultural, sociopolitical, environmental and built assets that support health and well-being that exist in each Torres Strait Island community. METHODS AND ANALYSIS This review will be conducted according the Joanna Briggs Institute (JBI) method for scoping reviews. It will include sources that identify cultural, sociopolitical, environmental and built assets that support health and well-being that exist in each Torres Strait Island community. Databases to be searched include: Informit; Scopus; Web of Science; HealthInfoNet, BioOne Complete and Green File. Sources of unpublished and grey literature will be located using Google and Google Scholar. Searches will be limited to the English language and literature published since January 2018 to ensure that the assets mapped reflect current conditions on each island. Data that answers the research question will be extracted from sources and recorded in an adaptation of the IICS. Quantitative analysis of the data will include summing each asset for individual islands and their associated clusters. Data will be presented graphically, diagrammatically, or in tabular form depending on what approach best conveys its meaning. ETHICS AND DISSEMINATION The Far North Queensland Human Research Ethics Committee (reference HREC/2022/QCH/88 155-1624) has approved this study. Dissemination of the review's findings will be led by Torres Strait Islander members of the research team through conferences and peer-reviewed publications.
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Affiliation(s)
- Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Melissa Kilburn
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
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Meldrum K, Wallace V, Webb T, Ridgway L, Quigley R, Strivens E, Russell S. Developing an appropriate depression and anxiety screening tool for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia: Protocol for a Delphi study. PLoS One 2023; 18:e0292162. [PMID: 38060486 PMCID: PMC10703283 DOI: 10.1371/journal.pone.0292162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023] Open
Abstract
Tools that screen for depression and anxiety developed using the Western biomedical paradigm are still used with First Nations peoples globally, despite calls for cross-cultural adaption. Recent work by the research team found that tools used to screen for depression and anxiety were not appropriate for use with Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area (NPA). of Australia. Consequently, the objective of this Delphi study is to gain consensus from an expert mental health panel to inform the development of an appropriate depression and anxiety screening tool(s). A Delphi study with Australian expert panellists will be used to reach consensus about whether an existing screening tool should be used or whether adaption or new tool development should take place. Three sequential rounds of anonymous online surveys will be used to reach consensus. The first round will seek consensus about the tool(s). Subsequent rounds will seek consensus on the development of the tool(s) identified in round one. Panellists will be identified using a combination of authorship of related publications, established national clinical or research profile in First Nations mental health, and/or by peer referral. Consensus will be reached when 75% of the panel agree. When agreement is not reached suggestions will be taken to the next round. If agreement is not achieved by the third round, the Steering Committee will make any outstanding decisions. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Torres Strait Islander members of the research team.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Lynne Ridgway
- North Coast Neuropsychology, East Ballina, New South Wales, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Hornby-Turner YC, Russell SG, Quigley R, Matthews V, Larkins S, Hayman N, Lakhan P, Flicker L, Smith K, McKeown D, Cadet-James D, Cass A, Garvey G, LoGiudice D, Miller G, Strivens E. Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol. Methods Protoc 2023; 6:103. [PMID: 37888035 PMCID: PMC10609630 DOI: 10.3390/mps6050103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.
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Affiliation(s)
- Yvonne C. Hornby-Turner
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Lismore, NSW 2145, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Metro South Hospital and Health Service, Inala, QLD 4077, Australia (P.L.)
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Crawley, WA 6009, Australia;
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, WA 6009, Australia
| | | | - Diane Cadet-James
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia;
| | - Gail Garvey
- School of Public Health, The University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dina LoGiudice
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3050, Australia
| | - Gavin Miller
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4878, Australia; (S.G.R.); (R.Q.); (E.S.)
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD 4870, Australia
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Meldrum K, Andersson E, Wallace V, Webb T, Quigley R, Strivens E, Russell S. Approaches to the development of new screening tools that assess distress in Indigenous peoples: A systematic mixed studies review. PLoS One 2023; 18:e0291141. [PMID: 37682832 PMCID: PMC10490875 DOI: 10.1371/journal.pone.0291141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023] Open
Abstract
This mixed studies review assessed the extent of the literature related to approaches used to develop new tools that screen for distress in Indigenous adults globally. It answered the research question: What qualitative and quantitative approaches are used to develop new screening tools that assess distress in Indigenous peoples globally? CINAHL, Embase, Emcare, Medline, PsychInfo and Scopus databases were systematically searched to identify relevant articles published between January 2000 and February 2023. Articles describing the development of a new screening tool for Indigenous peoples, globally, published in English since 2000 and constituted a full publication of primary research, met the inclusion criteria. Studies underwent quality appraisal using the Mixed-Methods Appraisal Tool. A sequential exploratory design guided data analysis. Synthesis occurred using a two-phase sequential method. Nineteen articles constituted the data set. Articles described the use of qualitative, quantitative, or mixed methods in approximately equal numbers. Overall, qualitative methods were used in early stages of tool development, with mixed and quantitative methods used to pilot and validate them. However, most studies did not follow the theoretical guidelines for tool development, and while validation studies took place in over half of the data set, none adequately assessed construct validity. Sixty percent of the articles were located using citation searches, which suggests database searches were ineffective. Valid tools that screen for distress in Indigenous populations support equitable access to health care. This review found that most screening tools were developed in Australia. However, additional evidence of their validity is needed in addition to a valid diagnostic tool that supports the determination of criterion validity. These needs present important future research opportunities.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | | | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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See RS, Thompson F, Russell S, Quigley R, Esterman A, Harriss LR, Hyde Z, Taylor S, Radford K, LoGiudice D, McDermott R, Livingston G, Strivens E. Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data. Lancet Public Health 2023; 8:e717-e725. [PMID: 37633680 DOI: 10.1016/s2468-2667(23)00146-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). METHODS We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. FINDINGS A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. INTERPRETATION Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. FUNDING Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.
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Affiliation(s)
- Rhiann Sue See
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia.
| | - Fintan Thompson
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia; Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia; University of South Australia, Adelaide, SA, Australia
| | - Sarah Russell
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia; College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia; College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | | | - Linton R Harriss
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia; Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
| | - Zoë Hyde
- Western Australian Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
| | - Sean Taylor
- Northern Territory Health, Top End, Northern Territory Government, Darwin, NT, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Randwick, NSW, Australia; School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Dina LoGiudice
- Department of Aged Care, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia; University of South Australia, Adelaide, SA, Australia
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, QLD, Australia; College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Erratum: Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions. Lancet Reg Health West Pac 2023; 37:100856. [PMID: 37693869 PMCID: PMC10485659 DOI: 10.1016/j.lanwpc.2023.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
[This corrects the article DOI: 10.1016/j.lanwpc.2023.100855.][This corrects the article DOI: 10.1016/j.lanwpc.2022.100532.].
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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Meldrum K, Andersson E, Webb T, Quigley R, Strivens E, Russell S. Screening depression and anxiety in Indigenous peoples: A global scoping review. Transcult Psychiatry 2023:13634615231187257. [PMID: 37490720 DOI: 10.1177/13634615231187257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Indigenous peoples' worldviews are intricately interconnected and interrelated with their communities and the environments in which they live. Their worldviews also manifest in a holistic view of health and well-being, which contrasts with those of the dominant western biomedical model. However, screening depression and/or anxiety in Indigenous peoples often occurs using standard western tools. Understandably, the cultural appropriateness of these tools has been questioned. The purpose of this scoping review was to map the literature that used any type of tool to screen depression or anxiety in Indigenous adults globally. A systematic scoping review method was used to search databases including, but not limited to, CINAHL, PubMed, Scopus and Google. Database-specific search terms associated with Indigenous peoples, depression and anxiety, and screening tools were used to identify literature. In addition, citation searches of related systematic reviews and relevant websites were conducted. The data set was limited to English language publications since database inception. Fifty-four publications met the review's inclusion criteria. Most studies were completed in community settings using standard western depression and anxiety screening tools. Thirty-three different tools were identified, with the Patient Health Questionnaire-9 being the most frequently used. The review's findings are concerning given repeated calls for culturally appropriate screening tools to be used with Indigenous peoples. Although there has been some work to cross-culturally adapt depression screening tools for specific Indigenous populations, clearly more clinicians and researchers need to be aware of, and use, culturally appropriate approaches to screening.
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Affiliation(s)
| | | | | | | | - Edward Strivens
- James Cook University
- Queensland Health, Cairns and Hinterland Hospital and Health Service
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Hamiduzzaman M, Kuot A, Greenhill J, Strivens E, Parajuli DR, Isaac V. Person-Centred, Culturally Appropriate Music Intervention to Improve Psychological Wellbeing of Residents with Advanced Dementia Living in Australian Rural Residential Aged Care Homes. Brain Sci 2023; 13:1103. [PMID: 37509033 PMCID: PMC10377712 DOI: 10.3390/brainsci13071103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
This quasi-experimental, nonrandomized intervention study reports the effect of person-centred, culturally appropriate music on psychological wellbeing of residents with advanced dementia in five rural residential aged care homes in Australia. Seventy-four residents attended in person-centred music sessions and culturally appropriate group sessions. Interest, response, initiation, involvement, enjoyment, and general reactions of the residents were assessed using the Music in Dementia Assessment Scale (MiDAS), and interviews and focus groups were conducted with aged care staff and musicians. The overall effect of person-centred sessions at two-time points were: during the intervention-351.2 (SD 93.5); and two-hours post intervention-315.1 (SD 98.5). The residents presented a moderate to high level of interest, response, initiation, involvement, and enjoyment during the session and at post-intervention. However, the MiDAS sub-categories' mean scores differed between the time-points: interest (t59 = 2.8, p = 0.001); response (t59 = 2.9, p = 0.005); initiation (t59 = 2.4, p = 0.019); and involvement (t59 = 2.8, p = 0.007), indicating a significant decline in the effect of person-centred music over time. Interestingly, during the period of time, most of the residents were observed with no exhibitions of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%), and with a presentation of relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data collected regarding culturally appropriate group music sessions were behavioural change, meaningful interaction, being initiative, increased participation, and contentment. The findings suggest that the integration of music into care plans may reduce the residents' agitation and improve their emotional wellbeing in rural aged care homes.
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Affiliation(s)
- Mohammad Hamiduzzaman
- University Centre for Rural Health, School of Health Sciences, The University of Sydney, Lismore 2480, Australia
| | - Abraham Kuot
- College of Medicine & Public Health, Flinders University, Adelaide 5001, Australia
| | - Jennene Greenhill
- Faculty of Health, Southern Cross University, Gold Coast 4225, Australia
| | - Edward Strivens
- Anton Breinl Research Centre, James Cook University, Older Persons Health Services, Cairns and Hinterland Hospital and Health Service, Cairns 4870, Australia
| | - Daya Ram Parajuli
- Department of Public Health, Torrens University, Adelaide 5000, Australia
| | - Vivian Isaac
- College of Medicine & Public Health, Flinders University, Adelaide 5001, Australia
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Thompson F, Russell S, Quigley R, Sagigi B, Miller G, Esterman A, Harriss LR, Taylor S, McDermott R, Strivens E. Dementia Risk Models in an Australian First Nations Population: Cross-Sectional Associations and Preparation for Follow-Up. J Alzheimers Dis Rep 2023; 7:543-555. [PMID: 37313487 PMCID: PMC10259055 DOI: 10.3233/adr-220093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/01/2023] [Indexed: 06/15/2023] Open
Abstract
Background Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia. Objective To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia. Methods A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi2. Results Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed. Conclusion Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Rachel Quigley
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | | | - Edward Strivens
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
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Strivens E, Stirling C. Following the aged care Royal Commission, have we finally found solutions or just created new problems? Australas J Ageing 2023; 42:275-277. [PMID: 37354005 DOI: 10.1111/ajag.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- Edward Strivens
- Older Persons Sub-Acute and Rehabilitation, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
- Healthy Ageing Research Team (HART), James Cook University, Cairns, Queensland, Australia
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Strivens E, Pachana NA. Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations. Clin Gerontol 2023; 46:240-252. [PMID: 35694996 DOI: 10.1080/07317115.2022.2086090] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults. METHODS A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region. RESULTS A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region. CONCLUSIONS Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait. CLINICAL IMPLICATIONS • Current mental health screening tools are not applicable for the Torres Strait• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities.
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Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Services, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, School of Medicine, University of Western Australia, Perth, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, Australia
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Meldrum K, Andersson E, Sagigi B, Webb T, Wapau C, Quigley R, Strivens E, Russell S. How Australian First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia describe and discuss social and emotional well-being: a qualitative study protocol. BMJ Open 2022; 12:e067052. [PMID: 36600438 PMCID: PMC9772669 DOI: 10.1136/bmjopen-2022-067052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Colonisation has, and continues to, negatively impact the mental well-being of Australia's First Nations peoples. However, the true magnitude of the impact is not known, partially because clinicians have low levels of confidence in using many existing screening tools with First Nations clients. In addition, many authors have critiqued the use of tools designed for Western populations with First Nations peoples, because their worldview of health and well-being is different. Therefore, the aim of the overarching study is to develop an appropriate mental well-being screening tool(s) for older adults (aged 45 and over) living in the Torres Strait that can be used across primary health and geriatric settings. This protocol describes the first phase designed to achieve the overarching aim-yarning about social and emotional well-being (inclusive of mental well-being) in First Nations peoples living in the Torres Strait and Northern Peninsula Area of Australia. METHOD AND ANALYSIS The study will be guided by decolonising and participatory action research methodologies. Yarning is an Australian First Nations relational method that relies on storytelling as a way of sharing knowledge. Yarning circles will be conducted with community members and health and aged care workers living on six different island communities of the Torres Strait. Participants will be recruited using purposive sampling. Thematic analysis of the data will be led by Torres Strait Islander members of the research team. ETHICS AND DISSEMINATION The Far North Queensland, Human Research Ethics Committee (HREC) (HREC/2021/QCH/73 638-1518) and James Cook University HREC (H8606) have approved this study. Dissemination of study findings will be led by Torres Strait members of the research team through conferences and peer-reviewed publications.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Ellaina Andersson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Betty Sagigi
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Torres and Cape Hospital and Health Service, Queensland Health, Thursday Island, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Chenoa Wapau
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Torres and Cape Hospital and Health Service, Queensland Health, Thursday Island, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Cairns and Hinterland Hospital and Health Service, Queensland Health, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Mann J, Devine S, Strivens E. Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care. Aust J Prim Health 2022; 28:469-473. [PMID: 35981911 DOI: 10.1071/py21236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Abstract
The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs.
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Affiliation(s)
- Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Sue Devine
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia
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Kinchin I, Kelley S, Meshcheriakova E, Viney R, Mann J, Thompson F, Strivens E. Cost-effectiveness of a community-based integrated care model compared with usual care for older adults with complex needs: a stepped-wedge cluster-randomised trial. Integ Health J 2022. [DOI: 10.1136/ihj-2022-000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ObjectiveTo assess the cost of implementation, delivery and cost-effectiveness (CE) of a flagship community-based integrated care model (OPEN ARCH) against the usual primary care.DesignA 9-month stepped-wedge cluster-randomised trial.Setting and participantsCommunity-dwelling older adults with chronic conditions and complex care needs were recruited from primary care (14 general practices) in Far North Queensland, Australia.MethodsCosts and outcomes were measured at 3-month windows from the healthcare system and patient’s out-of-pocket perspectives for the analysis. Outcomes included functional status (Functional Independence Measure (FIM)) and health-related quality of life (EQ-5D-3L and AQoL-8D). Bayesian CE analysis with 10 000 Monte Carlo simulations was performed using the BCEA package in R (V.3.6.1).ResultsThe OPEN ARCH model of care had an average cost of $A1354 per participant. The average age of participants was 81, and 55% of the cohort were men. Within-trial multilevel regression models adjusted for time, general practitioner cluster and baseline confounders showed no significant differences in costs, resource use or effect measures regardless of the analytical perspective. Probabilistic sensitivity analysis with 10 000 simulations showed that OPEN ARCH could be recommended over usual care for improving functional independence at a willing to pay above $A600 (US$440) per improvement of one point on the FIM Scale and for avoiding or reducing inpatient stay for any willingness-to-pay threshold up to $A50 000 (US$36 500).Conclusions and implicationsOPEN ARCH was associated with a favourable Bayesian CE profile in improving functional status and dependency levels, avoiding or reducing inpatient stay compared with usual primary care in the Australian context.Trial registration numberACTRN12617000198325.
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Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, Campbell S, Esterman A, Harriss LR, Miller G, Strivens E, McDermott R. Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: A cross sectional analysis using population attributable fractions. Lancet Reg Health West Pac 2022; 26:100532. [PMID: 35833207 PMCID: PMC9272378 DOI: 10.1016/j.lanwpc.2022.100532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable. Methods Data from two adult community health checks (2015-2018) were analyzed to determine the prevalence of 11 modifiable dementia risk factors among the First Nations residents of the Torres Strait and Northern Peninsula Area of FNQ. Population attributable fractions (PAF%) for dementia were calculated using age-standardized prevalence estimates derived from these health checks and relative risks obtained from previous meta-analyses in other populations. PAF% estimates were weighted for communality to account for overlap of risk factors. Findings Half (52·1%) of the dementia burden in this population may be attributed to 11 potentially modifiable risk factors. Hypertension (9·4%), diabetes mellitus (9·0%), obesity (8·0%), and smoking (5·3%) were the highest contributing risk factors. The contribution of depression (2·0%) and alcohol (0·3%) was lower than other global and national estimates. While the adjusted PAF% for social isolation was low based on the adult community health check data (1·6%), it was higher (4·2%) when official census data were analyzed. Interpretation These results suggest that a substantial proportion of dementia in FNQ First Nations peoples could potentially be prevented. Government investment in preventative health now is essential to reduce the future burden of dementia. Funding National Health and Medical Research Council (NHMRC, GNT1107140, GNT1191144, GNT1106175, GNT0631947).
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- University of South Australia, SA, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Sandy Campbell
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, Australia
| | | | - Linton R. Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
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Meldrum K, Andersson E, Wallace V, Webb T, Quigley R, Strivens E, Russell S. Approaches to the development of new mental well-being screening tools for Indigenous peoples: a systematic mixed studies review protocol. BMJ Open 2022; 12:e063710. [PMID: 35973708 PMCID: PMC9386234 DOI: 10.1136/bmjopen-2022-063710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Indigenous peoples' world views are intricately interrelated and interconnected with those of their communities and the environments where they live. Consequently, Indigenous peoples have a holistic view of their health, which contrasts with the dominant Western biomedical paradigm. However, the mental well-being of Indigenous peoples is predominately screened using tools developed using the Western paradigm that may not be culturally appropriate. The objective of this systematic mixed studies review (SMSR) is to assess the extent of the literature related to approaches used to develop new tools to screen the mental well-being of Indigenous adults. METHODS AND ANALYSIS This SMSR will be conducted in accordance with the method proposed by Pluye et al. It will include studies that describe the development of any type of tool or approach to screen for mental well-being in Indigenous adults, globally. Searches will be limited to the English language and literature published since January 2000. Databases to be searched include: CINAHL, Medline, PsycINFO, PubMed and Scopus. Only published studies will be included in the SMSR. Data that answers the research questions will be extracted from the literature and recorded on the associated data charting form. A sequential synthesis method will be used to analyse data from qualitative, quantitative and mixed-method studies. Data will be presented graphically, diagrammatically or in tabular form depending on what approach best conveys its meaning. ETHICS AND DISSEMINATION The SMSR will describe the approach to developing new tools for screening the mental well-being of Indigenous peoples across the globe. It will support researchers, clinicians and practitioners to consider both their approach to new tool development or, if they are using a previously developed tool, how reliable and valid it is for the population that they intend to use it with. Peer-reviewed publications will be used to disseminate SMSR findings.
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Affiliation(s)
- Kathryn Meldrum
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Ellaina Andersson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Valda Wallace
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Torres Webb
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
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Thompson F, Russell SG, Harriss LR, Esterman A, Taylor S, Quigley R, Strivens E, McDermott R. Using Health Check Data to Understand Risks for Dementia and Cognitive Impairment Among Torres Strait Islander and Aboriginal Peoples in Northern Queensland—A Data Linkage Study. Front Public Health 2022; 10:782373. [PMID: 35252085 PMCID: PMC8888447 DOI: 10.3389/fpubh.2022.782373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective High rates of dementia are evident in First Nations populations, and modifiable risk factors may be contributing to this increased risk. This study aimed to use a longitudinal dataset to gain insights into the long-term risk and protective factors for dementia and cognitive impairment not dementia (CIND) in a Torres Strait Islander and Aboriginal population in Far North Queensland, Australia. Study Design and Setting Probabilistic data linkage was used to combine baseline health check data obtained in 1998/2000 and 2006/2007 for 64 residents in remote communities with their results on a single dementia assessment 10–20 years later (2015–2018). The relationship between earlier measures and later CIND/dementia status was examined using generalized linear modeling with risk ratios (RRs). Due to the small sample size, bootstrapping was used to inform variable selection during multivariable modeling. Results One third of participants (n = 21, 32.8%) were diagnosed with dementia (n = 6) or CIND (n = 15) at follow-up. Secondary school or further education (RR = 0.38, 95% CI 0.19–0.76, p = 0.006) and adequate levels of self-reported physical activity (RR = 0.26, 95% CI 0.13–0.52, p < 0.001) were repeatedly selected in bootstrapping and showed some evidence of protection against later CIND/dementia in final multivariate models, although these had moderate collinearity. Vascular risk measures showed inconclusive or unexpected associations with later CIND/dementia risk. Conclusions The preliminary findings from this small study highlighted two potential protective factors for dementia that may be present in this population. A tentative risk profile for later CIND/dementia risk is suggested, although the small sample size limits the applicability of these findings.
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Affiliation(s)
- Fintan Thompson
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- *Correspondence: Fintan Thompson
| | - Sarah G. Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Linton R. Harriss
- College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Robyn McDermott
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Quigley R, Russell SG, Larkins S, Taylor S, Sagigi B, Strivens E, Redman-MacLaren M. Aging Well for Indigenous Peoples: A Scoping Review. Front Public Health 2022; 10:780898. [PMID: 35223727 PMCID: PMC8866315 DOI: 10.3389/fpubh.2022.780898] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
As life expectancy increases for Indigenous populations, so does the number of older adults with complex, chronic health conditions and age-related geriatric syndromes. Many of these conditions are associated with modifiable lifestyle factors that, if addressed, may improve the health and wellbeing of Indigenous peoples as they age. If models of healthy aging are to be promoted within health services, a clearer understanding of what aging well means for Indigenous peoples is needed. Indigenous peoples hold a holistic worldview of health and aging that likely differs from Western models. The aims of this review were to: investigate the literature that exists and where the gaps are, on aging well for Indigenous peoples; assess the quality of the existing literature on Indigenous aging; identify the domains of aging well for Indigenous peoples; and identify the enablers and barriers to aging well for Indigenous peoples. A systematic search of online databases, book chapters, gray literature, and websites identified 32 eligible publications on Indigenous aging. Reflexive thematic analysis identified four major themes on aging well: (1) achieving holistic health and wellbeing; (2) maintaining connections; (3) revealing resilience, humor, and a positive attitude; and (4) facing the challenges. Findings revealed that aging well is a holistic concept enabled by spiritual, physical, and mental wellbeing and where reliance on connections to person, place, and culture is central. Participants who demonstrated aging well took personal responsibility, adapted to change, took a positive attitude to life, and showed resilience. Conversely, barriers to aging well arose from the social determinants of health such as lack of access to housing, transport, and adequate nutrition. Furthermore, the impacts of colonization such as loss of language and culture and ongoing grief and trauma all challenged the ability to age well. Knowing what aging well means for Indigenous communities can facilitate health services to provide culturally appropriate and effective care.
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Affiliation(s)
- Rachel Quigley
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
- *Correspondence: Rachel Quigley
| | - Sarah G. Russell
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
| | - Sarah Larkins
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
| | - Sean Taylor
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Northern Territory Health, Darwin, NT, Australia
| | | | - Edward Strivens
- James Cook University, College of Medicine and Dentistry, Cairns, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
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Thompson F, Harriss LR, Russell S, Taylor S, Cysique LA, Strivens E, Maruff P, McDermott R. Using health check data to investigate cognitive function in Aboriginal and Torres Strait Islanders living with diabetes in the Torres Strait, Australia. Endocrinol Diabetes Metab 2021; 5:e00297. [PMID: 34559471 PMCID: PMC8754245 DOI: 10.1002/edm2.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 12/03/2022]
Abstract
Background Type 2 Diabetes (T2DM) has a subtle deleterious effect on cognition and imposes a higher lifetime risk of cognitive impairment and dementia. In populations where both T2DM and dementia are highly prevalent, understanding more about the early effects of T2DM on cognition may provide insights into the lifetime risks of this disease. Methods In 2016, 186 Australian Aboriginal and/or Torres Strait Islander residents of the Torres Strait (54% female, mean age =38.9 years, SD =15.9, range =15–74) participated in a community health check. The effect of diabetes (Type 1 or Type 2) on speed of thinking and working memory was assessed with the Cogstate Brief Battery (CBB) during the health check. Results One third of participants had diabetes (n = 56, 30.1%). After adjusting for age, education and previous iPad/Tablet experience, participants with diabetes had a small, yet significant reduction in accuracy on the One Back working memory task (β = −.076, p = .010, r2 = .042). The effect was most pronounced among participants with diabetes aged 20–49 years (n = 20), who also had evidence of poorer diabetes control (eg HbA1c% ≥6.5, 76.6%), relative to participants with diabetes aged 50 years and over (n = 31) (HbA1c% ≥6.5, 32.0%, p = .005). Conclusions Early and subtle decrements in working memory may be a potential complication of diabetes among Aboriginal and Torres Strait Islander residents of the Torres Strait. Several potentially influential variables were not captured in this study (eg medication and diabetes duration). Greater preventative health resources are required for this population, particularly given the emerging elevated dementia rates linked to chronic disease.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Qld, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Qld, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Qld, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Qld, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Lucette A Cysique
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Qld, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Qld, Australia
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Bohanna I, Harriss L, McDonald M, Cullen J, Strivens E, Bird K, Blanco L, Thompson F, Wapau H, Wason A, Barker R. A systematic review of disability, rehabilitation and lifestyle services in rural and remote Australia through the lens of the people-centred health care. Disabil Rehabil 2021; 44:6107-6118. [PMID: 34433373 DOI: 10.1080/09638288.2021.1962992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this systematic review was to identify models of community disability, rehabilitation and lifestyle service delivery in non-metropolitan areas of Australia, and to describe these models through an Integrated People-Centred Health Services (IPCHS) lens. MATERIALS AND METHODS We identified peer-reviewed studies published between 2000 and June 2021 that met the following criteria: described or evaluated a community service delivery model, intervention or program in regional, rural or remote Australia; provided for people with a disability or a potentially disabling health condition. A scoring rubric was developed covering the five IPCHS strategies. RESULTS Nineteen studies were included in the review. We identified a range of service delivery models providing support to people with a range of disabilities or conditions. We report evidence of the use of the IPCHS strategies in ways relevant to the local context. DISCUSSION Several strengths emerged, with many services tailored to individual need, and significant community engagement. Innovative rural service delivery approaches were also identified. Key areas requiring action included improved coordination or integration within and across professions and sectors. There was limited evidence of co-production of solutions or participatory governance. While people-centred approaches show promise to improve community-based services, large-scale fundamental change is required.IMPLICATIONS FOR REHABILITATIONCommunity-based disability and rehabilitation services in rural and remote Australia performed well at delivering tailored care and engaging in community consultation.These services must urgently implement strategies to enhance community ownership of solutions and participatory governance.Services must place a greater focus on explicit strategies to integrate and coordinate across services and professions, and to create an enabling environment, to deliver people-centred care.The World Health Organisation Integrated People-Centred Health Services framework provides an important roadmap to improving service delivery in rural and remote Australian communities.
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Affiliation(s)
- India Bohanna
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Linton Harriss
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Malcolm McDonald
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | | | - Edward Strivens
- Older Persons Sub-Acute and Rehabilitation, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Katrina Bird
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Leisyle Blanco
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - Fintan Thompson
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Hylda Wapau
- Torres and Cape Hospital and Health Service, Bamaga, Australia
| | - Alan Wason
- Mulungu Aboriginal Corporation Primary Health Care, Mareeba, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
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Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, Smith K, Pachana NA, Strivens E. Factors associated with the increased risk of dementia found in the Torres Strait. Australas J Ageing 2021; 41:88-96. [PMID: 34351674 DOI: 10.1111/ajag.12980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the specific risk factors for dementia in the Torres Strait. METHODS This research was conducted as part of a cross-sectional dementia prevalence study conducted in the Torres Strait. Participants underwent a comprehensive health assessment, where data on risk factors were collected, and a Geriatrician assessment, which was used to establish dementia diagnoses. RESULTS A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. Cerebrovascular disease, chronic kidney disease and older age were the most significant risk factors in this population. Once adjusted for age, cerebrovascular disease, chronic kidney disease, diabetes, low education and problems with mobility and incontinence were significantly associated with dementia. CONCLUSIONS Reducing dementia risk in the Torres Strait requires multifactorial interventions to address potentially modifiable risk factors with a particular focus on addressing the development of chronic midlife diseases.
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Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, QLD, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Sciences, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - Kate Smith
- University of Western Australia, Perth, WA, Australia
| | - Nancy A Pachana
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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Quigley R, Russell SG, Sagigi BR, Miller G, Strivens E. Community involvement to maximise research success in Torres Strait Islander populations: more than just ticking the boxes. Rural Remote Health 2021; 21:5957. [PMID: 34275323 DOI: 10.22605/rrh5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
CONTEXT Health research is important to effectively address the health disparities between Indigenous and non-Indigenous Australians. However, research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Justifiably then, people may be reticent to welcome researchers into their communities. Genuine commitment to community consultation, the fostering of partnerships and collaborative approaches maximise successful outcomes and research translation in these communities. ISSUE Despite guidelines existing to try to ensure the needs of Aboriginal and Torres Strait Islanders are met through any research involving them, non-Indigenous researchers may not be fully aware of the complexities involved in applying these guidelines. This article explores how a team of Indigenous and non-Indigenous researchers understood and applied the guidelines during a 3-year dementia prevalence study in the Torres Strait. Their reflections on the practicalities involved in conducting ethically sound and culturally appropriate research are discussed. LESSONS LEARNED Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just 'ticking the boxes' on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice.
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Affiliation(s)
- Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia; and Cairns & Hinterland Hospital & Health Service, Cairns, Qld 4870, Australia
| | - Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia; and Cairns & Hinterland Hospital & Health Service, Cairns, Qld 4870, Australia
| | - Betty R Sagigi
- Thursday Island Primary Health Care Centre, Thursday Island, Qld 4875, Australia
| | - Gavin Miller
- Older Person's Subacute and Rehabilitation Service, Cairns Hospital, Qld 4870, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Qld 4870, Australia; and Older Person's Subacute and Rehabilitation Service, Cairns Hospital, Qld 4870, Australia
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Mann J, Thompson F, McDermott R, Esterman A, Strivens E. Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial. BMC Health Serv Res 2021; 21:701. [PMID: 34271945 PMCID: PMC8285878 DOI: 10.1186/s12913-021-06668-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. METHODS The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered 'clusters' each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. RESULTS Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. CONCLUSIONS While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. TRIAL REGISTRATION The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104-1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p .
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Affiliation(s)
- Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld, 4870, Australia. .,College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld, 4811, Australia.
| | - Fintan Thompson
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld, 4811, Australia
| | - Robyn McDermott
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - A Esterman
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld, 4870, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Qld, 4811, Australia
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Isaac V, Kuot A, Hamiduzzaman M, Strivens E, Greenhill J. The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes. BMC Geriatr 2021; 21:193. [PMID: 33743597 PMCID: PMC7980426 DOI: 10.1186/s12877-021-02151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. METHODS A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. RESULTS Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. CONCLUSIONS The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458.
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Affiliation(s)
- Vivian Isaac
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia.
| | - Abraham Kuot
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Mohammad Hamiduzzaman
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
| | - Edward Strivens
- James Cook University & Clinical Director, Older Persons Health Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, 4870, Australia
| | - Jennene Greenhill
- Rural and Remote Health South Australia, College of Medicine and Public Health, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, SA, 5341, Australia
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Mann J, Quigley R, Harvey D, Tait M, Williams G, Strivens E. OPEN ARCH: integrated care at the primary-secondary interface for the community-dwelling older person with complex needs. Aust J Prim Health 2021; 26:104-108. [PMID: 32290951 DOI: 10.1071/py19184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022]
Abstract
Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary-secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.
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Affiliation(s)
- Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia; and Corresponding author.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Healthcare Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia
| | - Megan Tait
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia
| | - Gillian Williams
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, PO Box 6811, Cairns, Qld 4870, Australia
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Mann J, Thompson F, Quigley R, McDermott R, Devine S, Strivens E. Beyond multimorbidity: primary care and the older person with complex needs. Aust J Prim Health 2021; 27:194-201. [PMID: 33535025 DOI: 10.1071/py20125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study was to present the health and social characteristics of community-dwelling older people within the Cairns region who were identified by their GP as having complex care needs. This paper reports the subanalysis of baseline data from the Older Persons Enablement and Rehabilitation (OPEN ARCH) stepped wedge randomised controlled trial of an integrated model of care for community-dwelling older people. Data were analysed at the level of the participant and the level of the participant cluster (group of participants from the one GP). Median quality of life, as assessed by the EQ-5D, was higher for females than males (80 vs 70 respectively; P=0.05) and for people living alone than living with family (80 vs 60 respectively; P=0.0940). There was greater functional independence among non-Indigenous than Indigenous participants (median Functional Independence Measure scores of 122 vs 115 respectively; P=0.0937) and the incidence rate (95% confidence intervals) of presentation to the emergency department was sevenfold higher for Indigenous than non-Indigenous participants (11.47 (5.93-20.03) vs 1.65 (0.79-3.04) per 1000 person days respectively). Finally, 61.3% of participants required support to remain living in the community and 44% accessed allied health, with podiatry the most common intervention. The findings indicate that previous hospital utilisation is not a consistent indicator of complexity. Multimorbidity, cultural context and the living and caring situation are considered as matters of complexity, yet variation exists at the participant level.
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Affiliation(s)
- Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia; and Corresponding author.
| | - Fintan Thompson
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia
| | - Robyn McDermott
- Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Susan Devine
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia
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Quigley R, Russell SG, Sagigi B, Miller G, Strivens E. A framework of healthy ageing for the Torres Strait: A grassroots approach to dementia risk reduction. Alzheimers Dement 2020. [DOI: 10.1002/alz.039641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hughson J, Flicker L, Smith K, Bradley K, Belfrage M, Strivens E, Bessarab D, Atkinson D, Radford K, Russell SG, Quigley R, Allan W, Malay R, Sullivan K, Ducker B, LoGiudice D. Let’s CHAT – Dementia: Primary care model of care to optimise detection and management of dementia in Aboriginal and Torres Strait Islander older people: Determination of the risk factor profile in this population. Alzheimers Dement 2020. [DOI: 10.1002/alz.041319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Kate Smith
- The University of Western Australia Perth Australia
| | | | | | | | | | | | | | | | | | - Wendy Allan
- Neuroscience Research Australia Sydney Australia
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Strivens E, Russell SG, Quigley R, Sagigi B, Miller G. Dementia prevalence in Torres Strait communities. Alzheimers Dement 2020. [DOI: 10.1002/alz.039634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Russell SG, Quigley R, Sagigi B, Miller G, Strivens E. Collaborating with Australian Indigenous communities: A protocol to address the high rates of dementia found in aboriginal and Torres Strait Islander people. Alzheimers Dement 2020. [DOI: 10.1002/alz.037895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Edelman A, Grundy J, Larkins S, Topp SM, Atkinson D, Patel B, Strivens E, Moodley N, Whittaker M. Health service delivery and workforce in northern Australia: a scoping review. Rural Remote Health 2020; 20:6168. [PMID: 33245856 DOI: 10.22605/rrh6168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps. METHODS A scoping review design was adopted with searches incorporating both peer-reviewed and grey literature (eg strategy documents, annual reports and budgets). Grey literature was predominantly sourced from websites of key organisations in the three northern jurisdictions, with peer-reviewed literature sourced from electronic database searches and reference lists. Key articles and documents were also contributed by health sector experts. Findings were synthesised and reported narratively using the WHO health system 'building blocks' to categorise the data. RESULTS From the total of 324 documents and data sources included in the review following screening and eligibility assessment, 197 were peer-reviewed journal articles and 127 were grey literature. Numerous health sector actors across the north - comprising planning bodies, universities and training organisations, peak bodies and providers - deliver primary, secondary and tertiary healthcare and workforce education and training in highly diverse contexts of care. Despite many exemplar health service and workforce models in the north, this synthesis describes a highly fragmented sector with many and disjointed stakeholders and funding sources. While the many strengths of the northern health system include expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges. CONCLUSION Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery, workforce stability and evidence-based strengthening of community-led comprehensive primary health care. This requires intersectoral collaboration across many organisations and the three jurisdictions, drawing from previous collaborative experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia
| | - John Grundy
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace, Broome, WA 6725, Australia
| | - Bhavini Patel
- Top End Health Service, Northern Territory Department of Health, Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia; and Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia
| | - Nishila Moodley
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia
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Russell SG, Quigley R, Thompson F, Sagigi B, LoGiudice D, Smith K, Pachana N, Miller G, Strivens E. Prevalence of dementia in the Torres Strait. Australas J Ageing 2020; 40:e125-e132. [PMID: 33169520 DOI: 10.1111/ajag.12878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the prevalence of dementia and problems associated with ageing in the Torres Strait. METHODS The study was conducted across all 18 island and 5 mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland. Participants underwent a comprehensive health assessment and a Geriatrician assessment, which were used to establish consensus diagnoses. RESULTS A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. The prevalence of dementia in the sample was 14.2%, which was 2.87 times higher than the wider Australian population. CONCLUSION Torres Strait Islander peoples share the increased risk of dementia seen in Aboriginal Australians compared to the wider community. This highlights the need for interventions to address this increased dementia risk for Aboriginal and Torres Strait Islander communities.
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Affiliation(s)
- Sarah G Russell
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Betty Sagigi
- Queensland Health, Torres and Cape Hospital and Health Service, Thursday Island, Queensland, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kate Smith
- University of Western Australia, Crawley, Western Australia, Australia
| | - Nancy Pachana
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Gavin Miller
- Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Queensland Health, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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35
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Strivens E. Time for a new approach to funding residential aged care. Med J Aust 2020; 213:355-356. [DOI: 10.5694/mja2.50799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edward Strivens
- James Cook University Cairns QLD
- Cairns and Hinterland Hospital and Health ServiceCairnsQLD
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Johnston K, Preston R, Strivens E, Qaloewai S, Larkins S. Understandings of dementia in low and middle income countries and amongst indigenous peoples: a systematic review and qualitative meta-synthesis. Aging Ment Health 2020; 24:1183-1195. [PMID: 31074290 DOI: 10.1080/13607863.2019.1606891] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Dementia is a growing health priority, particularly in less resourced countries and amongst indigenous populations. Understanding cultural meanings ascribed to dementia is an important aspect of policy development and the provision of culturally congruent care and support for people with dementia, their families and the caring professions. This review investigates conceptualizations of dementia amongst indigenous peoples and populations living in low and middle income countries (LMIC), who experience limited diagnosis and formal care for dementia, and how these shape responses to dementia.Methods: A systematic search was conducted for qualitative studies, reported in English, that investigated the perceptions, attitudes or understandings of dementia in LMIC and amongst indigenous populations. A qualitative analysis and meta-synthesis was carried out.Findings: Nineteen articles were included in the review following quality assessment. Dementia was rarely conceptualized as a defined, pathological condition characterized by progressive cognitive decline. Rather, notions of dementia existed within conceptualizations of aging, mental illness, traditional cultural beliefs and the trauma of colonization. Responses to dementia were influenced and perpetuated by community and health providers, and cultural norms for caregiving.Conclusions: There is a need to understand conceptualizations of dementia from the perspective of all stakeholders within a setting, and the dynamic responses that exist between key stakeholders. Community knowledge systems could facilitate understanding about appropriate and acceptable health and community care responses to dementia, and approaches to stigma reduction. Inclusive discussions about dementia are essential if awareness campaigns are to improve the wellbeing of people with dementia and caregivers.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - Edward Strivens
- Sub-acute and Rehabilitation Services, Cairns and Hinterland Hospital Health Service, Cairns, Queensland, Australia
| | - Sefanaia Qaloewai
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
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Hamiduzzaman M, Kuot A, Greenhill J, Strivens E, Isaac V. Towards personalized care: Factors associated with the quality of life of residents with dementia in Australian rural aged care homes. PLoS One 2020; 15:e0233450. [PMID: 32437455 PMCID: PMC7241691 DOI: 10.1371/journal.pone.0233450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method ‘Harmony in the Bush’ dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.
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Affiliation(s)
- Mohammad Hamiduzzaman
- College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
| | - Abraham Kuot
- College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, Adelaide, South Australia, Australia
| | - Jennene Greenhill
- College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, Adelaide, South Australia, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Vivian Isaac
- College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, Adelaide, South Australia, Australia
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Bradley K, Smith R, Hughson JA, Atkinson D, Bessarab D, Flicker L, Radford K, Smith K, Strivens E, Thompson S, Blackberry I, LoGiudice D. Let's CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res 2020; 20:208. [PMID: 32164678 PMCID: PMC7069169 DOI: 10.1186/s12913-020-4985-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Documented rates of dementia and cognitive impairment not dementia (CIND) in older Aboriginal and Torres Strait Islander Peoples is 3-5 times higher than the rest of the population, and current evidence suggests this condition is under-diagnosed and under-managed in a clinical primary care setting. This study aims to implement and evaluate a culturally responsive best practice model of care to optimise the detection and management of people with cognitive impairment and/or dementia, and to improve the quality of life of carers and older Aboriginal and Torres Islander Peoples with cognitive impairment. METHODS/DESIGN The prospective study will use a stepped-wedge cluster randomised controlled trial design working with 12 Aboriginal Community Controlled Health Services (ACCHSs) across four states of Australia. Utilising a co-design approach, health system adaptations will be implemented including (i) development of a best practice guide for cognitive impairment and dementia in Aboriginal and Torres Strait Islander communities (ii) education programs for health professionals supported by local champions and (iii) development of decision support systems for local medical software. In addition, the study will utilise a knowledge translation framework, the Integrated Promoting Action on Research Implementation in Health Services (iPARIHS) Framework, to promote long-term sustainable practice change. Process evaluation will also be undertaken to measure the quality, fidelity and contextual influences on the outcomes of the implementation. The primary outcome measures will be rates of documentation of dementia and CIND, and evidence of improved management of dementia and CIND among older Indigenous peoples attending Aboriginal and Torres Strait Islander primary care services through health system changes. The secondary outcomes will be improvements to the quality of life of older Indigenous peoples with dementia and CIND, as well as that of their carers and families. DISCUSSION The Let's CHAT Dementia project will co-design, implement and evaluate a culturally responsive best practice model of care embedded within current Indigenous primary health care. The best practice model of care has the potential to optimise the timely detection (especially in the early stages) and improve the ongoing management of people with dementia or cognitive impairment. TRIAL REGISTRATION ACTRN12618001485224. Date of registration: 04 of September 2019.
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Affiliation(s)
- Kate Bradley
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Robyn Smith
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - Jo-anne Hughson
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
| | - David Atkinson
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Dawn Bessarab
- The University of Western Australia, M303, 35 Stirling Highway, Perth, 6009 Australia
| | - Leon Flicker
- The University of Western Australia, Rural Clinical School of Western Australia , PO Box 1377, Broome, 6725 Australia
| | - Kylie Radford
- Neuroscience Research Australia, 139 Barker Street, Sydney, NSW 2031 Australia
- The School of Medical Sciences, University of New South Wales, Sydney, NSW Australia
| | - Kate Smith
- University of Western Australia, 35 Stirling Highway, Perth, 6009 Australia
| | | | - Sandra Thompson
- The University of Western Australia, 167 Fitzgerald St, Geraldton, WA 6530 Australia
| | | | - Dina LoGiudice
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Royal Melbourne Hospital, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, Victoria 3052 Australia
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Amini H, Ong K, Strivens E. 63 Impact of an Orthogeriatric Service on Osteoporosis Management in HIP Fracture Patients. Age Ageing 2019. [DOI: 10.1093/ageing/afz164.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Osteoporosis which is now treatable is the major risk factor for hip fractures in the elderly. Having a hip fracture increases morbidity and mortality. Hip fractures are costly. Incidence increases with age.
Aims
To examine how introduction of an orthogeriatric service (OGS) improves osteoporosis management.
Method
A dedicated OGS was established in the orthopaedic unit in an Australian tertiary teaching hospital in July 2014. Retrospective analyses were undertaken to compare osteoporosis diagnosis and treatment rates in patients ≥ 65 years old presenting with minimal trauma hip fractures (MTHF) before and after the OGS was established.
Results
1. 108 MTHF (mean age 81 years) and 107 MTHF (mean age 82 years) were admitted in 2014 respectively before and after the OGS was established.
2. New osteoporosis diagnoses increased by 27%, new calcium &/or vitamin D prescription increased by 17% and new antiresorptive treatment increased by 30%, after the OGS was established.
3. The odds ratio for receiving a new diagnosis of osteoporosis post MTHF with the OGS compared to pre-OGS was 4.4 (2.1 – 9.0), p<0.0001.
4. The odds ratio for initiating new antiresorptive treatment post fractured NOF with OGS compared to pre-OGS was 6.2 (3.0 – 12.7), p<0.0001.
5. Rates of new diagnoses of osteoporosis and initiation of antiresorptive treatments with the OGS were not affected by age or gender.
Conclusion
1. Introduction of a dedicated OGS improved osteoporosis diagnoses and initiation of antiresorptive treatments.
2. Patients who received a new diagnosis of osteoporosis and/or started on antiresorptive treatment were also likely to be prescribed calcium and/or vitamin D supplements as well.
3. There did not appear to be any age or gender bias towards giving more new diagnoses of osteoporosis and/or more new antiresorptive treatments with a dedicated OGS.
4. These results may be useful for benchmarking and comparison purposes.
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Affiliation(s)
- Homaira Amini
- Geriatric Medicine, Princess Alexandra Hospital, Australia
| | - Kevin Ong
- General Medicine, Armadale Health Service, Australia
| | - Edward Strivens
- Older Persons, Subacute and Rehabilitation, Cairns and Hinterland Hospital and Health Service, Australia
- School of Medicine and Dentistry, James Cook University, Australia
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Russell S, Quigley R, Strivens E, Miller G, Norrie J, Craig D, Jordan J, Muller R. Validation of the Kimberley Indigenous Cognitive Assessment short form (KICA-screen) for telehealth. J Telemed Telecare 2019; 27:54-58. [PMID: 31284810 DOI: 10.1177/1357633x19860309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Studies show Aboriginal and Torres Strait Islander people are at increased risk of dementia. Whilst there have been several studies evaluating the use of telehealth for improving Aboriginal and Torres Strait Islander health outcomes, and studies validating telehealth dementia screening tools for the wider community, none have addressed the pressing need for culturally appropriate telehealth dementia screening for this at-risk population. The aim of the study was to examine the utility of using a culturally appropriate dementia screening tool (KICA-screen) in a telehealth setting. METHODS A prospective field trial was used to compare administration of the short version of the Kimberley Indigenous Cognitive Assessment (KICA-screen) face-to-face and via telehealth. A total of 33 medically stable Aboriginal and Torres Strait Islander inpatients/outpatients participated. The stability of the KICA-screen scores, administered face-to-face and via telehealth, for each participant was measured. RESULTS The two test delivery methods showed not only good correlation (Pearson's r = 0.851; p < 0.01) but good agreement (intraclass correlation coefficient = 0.85; p < 0.01). DISCUSSION Results of the assessment showed that KICA-screen can be reliably administered via videoconference and resulted in comparable scores to face-to-face testing in the majority of cases. The telehealth process was acceptable to participants, who were able to understand the process and complete the full screen remotely.
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Affiliation(s)
- Sarah Russell
- College of Medicine and Dentistry, James Cook University, Australia.,Cairns and Hinterland Hospital and Health Service, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Australia.,Cairns and Hinterland Hospital and Health Service, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Australia.,Cairns and Hinterland Hospital and Health Service, Australia
| | - Gavin Miller
- College of Medicine and Dentistry, James Cook University, Australia.,Cairns and Hinterland Hospital and Health Service, Australia
| | - Joan Norrie
- Cairns and Hinterland Hospital and Health Service, Australia
| | - Denise Craig
- Cairns and Hinterland Hospital and Health Service, Australia
| | - Jane Jordan
- Cairns and Hinterland Hospital and Health Service, Australia
| | - Reinhold Muller
- Centre for Chronic Disease Prevention, James Cook University, Australia
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Affiliation(s)
- Edward Strivens
- James Cook University School of Medicine and DentistryCairns Clinical School Cairns Queensland
- Cairns and Hinterland Hospital and Health Service Cairns Queensland
- Australian and New Zealand Society for Geriatric Medicine Cairns Queensland
| | - Christine Stirling
- School of Nursing, University of Tasmania Hobart Tasmania
- Australian Association of Gerontology Hobart Tasmania
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Kinchin I, Jacups S, Mann J, Quigley R, Harvey D, Doran CM, Strivens E. Efficacy and cost-effectiveness of a community-based model of care for older patients with complex needs: a study protocol for a multicentre randomised controlled trial using a stepped wedge cluster design. Trials 2018; 19:668. [PMID: 30514378 PMCID: PMC6280415 DOI: 10.1186/s13063-018-3038-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-dwelling older persons with complex care needs may deteriorate rapidly and require hospitalisation if they receive inadequate support for their conditions in the community. INTERVENTION A comprehensive, multidimensional geriatric assessment with care coordination was performed in a community setting-Older Persons ENablement And Rehabilitation for Complex Health conditions (OPEN ARCH). OBJECTIVES This study will assess the acceptability and determine the impact of the OPEN ARCH intervention on the health and quality of life outcomes, health and social services utilisation of older people with multiple chronic conditions and emerging complex care needs. An economic evaluation will determine whether OPEN ARCH is cost-effective when compared to the standard care. METHODS/DESIGN This multicentre randomised controlled trial uses a stepped wedge cluster design with repeated cross-sectional samples. General practitioners (GPs; n ≥ 10) will be randomised as 'clusters' at baseline using simple randomisation. Each GP cluster will recruit 10-12 participants. Data will be collected on each participant at 3-month intervals (- 3, 0, 3, 6 and 9 months). The primary outcome is health and social service utilisation as measured by Emergency Department presentations, hospital admissions, in-patient bed days, allied health and community support services. Secondary outcomes include functional status, quality of life and participants' satisfaction. Cost-effectiveness of the intervention will be assessed as the change to cost outcomes, including the cost of implementing the intervention and subsequent use of services, and the change to health benefits represented by quality adjusted life years. DISCUSSION The results will have direct implications for the design and wider implementation of this new model of care for community-dwelling older persons with complex care needs. Additionally, it will contribute to the evidence base on acceptability, efficacy and cost-effectiveness of the intervention for this high-risk group of older people. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000198325p . Registered on 6 February 2017.
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Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
- The Cairns Institute, James Cook University, Cairns, QLD Australia
| | - Susan Jacups
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
- The Cairns Institute, James Cook University, Cairns, QLD Australia
- Medical Services, Torres and Cape Hospital and Health Service, Cairns, QLD Australia
| | - Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- Division of Tropical Health and Medicine, James Cook University, Cairns, QLD Australia
| | - Christopher M. Doran
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD Australia
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Cham G, Davis N, Strivens E, Traves A, Manypeney G, Gunnarsson R. Factors correlating to the propensity of general practitioners to substitute borderline vitamin B12 deficiency. Scand J Prim Health Care 2018; 36:242-248. [PMID: 29933709 PMCID: PMC6381524 DOI: 10.1080/02813432.2018.1487522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to identify factors which correlate to the propensity of general practitioners (GPs) to prescribe supplementation for borderline vitamin B12 deficiency. DESIGN Cross-sectional surveys were distributed in person. SETTING Conferences held in Cairns, Palm Cove Beach, Mt Isa; educational meetings in Atherton; and meetings with individual general practices within the Cairns and Hinterland region. All located in Queensland, Australia. SUBJECTS 128 practicing GP specialists and registrars (practitioners in training). MAIN OUTCOME MEASURES Responses to the Likert scale statements with its five options scaling from 'strongly disagree' to 'strongly agree' were recoded to have binary outcomes for analysis. RESULTS A survey response rate of 89% was achieved. Participants who felt patient demands influence the management of borderline vitamin B12 deficiency were more likely to prescribe supplementation (OR 2.4, p = 0.037). Participants who perceived an overuse of vitamin B12 were less likely to prescribe B12 (OR 0.39, p = 0.019). Participants who often saw patients with vitamin B12 deficiency were less likely to request for the complementary biomarkers plasma methylmalonic acid or total homocysteine (OR 0.41, p = 0.045). CONCLUSIONS The identified disparity to prescribe vitamin B12 for borderline deficiency may be described as an attempt in the GP collective to seek a balance between being the patient's or the society's doctor. We propose that relevant authorities try to reduce this disparity by describing a management strategy for borderline vitamin B12 deficiency. Key points General practitioners hold different thresholds for commencing supplementation in cases of borderline vitamin B12 deficiency. Participants from Australia were asked to fill out a cross-sectional survey to explore factors which correlate with the propensity to prescribe in clinical practice. Our study identified that patient demands and a practitioner's perception of whether there is an overuse of vitamin B12 in the community influenced the propensity to treat for deficiency. The results give insight into reasons for initiating supplementation, and will help inform general practitioners on their current management.
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Affiliation(s)
- Grace Cham
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia;
- CONTACT Grace Cham Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia
| | - Nichola Davis
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia;
| | - Edward Strivens
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia;
- Older Persons and Subacute Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia;
| | - Aileen Traves
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia;
| | | | - Ronny Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Australia;
- Research and Development Unit, Primary Health Care and Dental Care, Southern Älvsborg County, Närhalsan, Västra Götaland Region, Sweden;
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Lowthian JA, Arendts G, Strivens E. Australian recommendations for the integration of emergency care for older people: Consensus Statement. Australas J Ageing 2018; 37:224-226. [PMID: 29732736 DOI: 10.1111/ajag.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Judy A Lowthian
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Glenn Arendts
- Department of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Edward Strivens
- Older Persons and Subacute Services, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. AUST HEALTH REV 2017; 41:144-150. [PMID: 27333204 DOI: 10.1071/ah16054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Affiliation(s)
- Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Michele Foster
- School of Social Work and Human Services, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
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Abstract
Purpose
Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues.
Design/methodology/approach
Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes.
Findings
The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs.
Originality/value
The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
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Affiliation(s)
- E. Strivens
- James Cook University, Cairns, Queensland, Australia,
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - S. Russell
- James Cook University, Cairns, Queensland, Australia,
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
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Abstract
Young onset dementia accounts for up to 1 in 10 dementia diagnoses. Those diagnosed face premature transition into the realm of aged care services and adjustment to an illness of ageing prior to age 65. To help elicit communication of the perceived psychosocial needs of this group, provide a platform to gain peer support and advocate for increased awareness, the Young Onset Dementia Support Group was established on the social networking site, Facebook™ . Followers post comments, read educational or otherwise interesting news feeds, share inspirational quotes and access others living with dementia worldwide. Facebook provides a means of rapid global reach in a way that allows people with dementia to increase their communications and potentially reduce isolation. This paper was authored by the page administrators. We aim to highlight the promising utility of a social network platform just entering its stride amongst health communication initiatives.
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Affiliation(s)
- Denise Craig
- FNQ ACAT and Memory Service, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Edward Strivens
- Older Persons and Subacute Services, Cairns and Hinterland Hospital and Health Service, Cairns.,James Cook University School of Medicine and Dentistry, Townsville, Queensland, Australia
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Russell S, Strivens E, LoGiudice D, Smith K, Helmes E, Flicker L. Ageing on Hammond Island: Is there cause for concern in the Torres Strait? Aust J Rural Health 2015; 24:342-343. [DOI: 10.1111/ajr.12178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sarah Russell
- Cairns and Hinterland Hospital and Health Service; Cairns Queensland Australia
- College of Medicine and Dentistry; James Cook University; Cairns Queensland Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service; Cairns Queensland Australia
- College of Medicine and Dentistry; James Cook University; Cairns Queensland Australia
| | - Dina LoGiudice
- Royal Park; Melbourne Health; Parkville Victoria Australia
| | - Kate Smith
- Western Australian Centre for Health and Ageing; University of Western Australia; Perth Western Australia Australia
| | - Edward Helmes
- Department of Psychology; James Cook University; Townsville Queensland Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing; University of Western Australia; Perth Western Australia Australia
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Affiliation(s)
- Kevin T Ong
- Older Persons, Sub-Acute and Rehabilitation Services, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Shirantha G Adikari
- Older Persons, Sub-Acute and Rehabilitation Services, Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - Edward Strivens
- Older Persons, Sub-Acute and Rehabilitation Services, Cairns and Hinterland Hospital and Health Service, Cairns, Australia James Cook University School of Medicine and Dentistry, James Cook University, Townsville, Australia
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