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Visvanathan R, Lange K, Selvam J, Dollard J, Boyle E, Jones K, Ingram K, Shibu P, Wilson A, Ranasinghe DC, Karnon J, Hill KD. Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial. Australas J Ageing 2024; 43:199-204. [PMID: 37861202 DOI: 10.1111/ajag.13245] [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] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). METHODS A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. RESULTS Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). CONCLUSIONS This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
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Affiliation(s)
- R Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - K Lange
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Selvam
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Dollard
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - E Boyle
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Jones
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - P Shibu
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
| | - A Wilson
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - D C Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - K D Hill
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Dollard J, Edwards J, Yadav L, Gaget V, Tivey D, Inacio MC, Maddern GJ, Visvanathan R. Economic and cost considerations of delivering and using mobile X-ray services in residential aged care facilities: A qualitative study. Australas J Ageing 2023; 42:710-719. [PMID: 37518833 PMCID: PMC10947139 DOI: 10.1111/ajag.13228] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To describe the economic and cost considerations of mobile X-ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. METHODS Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. RESULTS Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co-payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co-payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. CONCLUSIONS Mobile X-ray services providers charge residents an upfront co-payment for business viability, which can be a barrier to some residents wishing to access MXS.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Jane Edwards
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Lalit Yadav
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Virginie Gaget
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - David Tivey
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Allied Health and Human Movement, University of South Australia, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Dollard J, Edwards J, Yadav L, Gaget V, Tivey D, Maddern GJ, Visvanathan R. Mobile X-ray services in nursing homes as an enabler to healthcare-in-place for residents: informal carers' views. BMC Geriatr 2023; 23:458. [PMID: 37491218 PMCID: PMC10369836 DOI: 10.1186/s12877-023-04130-7] [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: 09/09/2022] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Informal carers (ICs) of residents living in nursing homes (NH) have a key role in the care of residents, including making decisions about and providing care. As radiology has a role in decision making about care, it is important to understand IC's perspectives about resident's use of mobile X-ray services (MXS). The aim was to explore the perspectives of ICs of residents living in nursing homes about the use of MXS. METHODS From November 2020 to February 2021, twenty ICs of residents living in four nursing homes in different areas of one Australian city participated. Their perspectives of MXS, including benefits and barriers, were explored in semi-structured interviews. Data were analysed using thematic analysis. RESULTS ICs were resident's children (80%) and spouses (20%). One resident had received a MXS. Four themes were developed: (1) a priority for resident well-being, where ICs were positive about using MXS, because residents could receive healthcare without transfer; (2) MXS could reduce carer burden; (3) economic considerations, where MXS could reduce health system burden but the MXS call-out fee could result in health inequities; and (4) pathways to translation, including the need to improve consumer awareness of MXS, ensure effective processes to using MXS,, consider nursing home staff levels to manage MXS and ICs expectations about quality and availability of MXS. CONCLUSIONS ICs consider MXS can benefit resident well-being by potentially reducing transfers to hospital or radiology facilities and advocated equitable access. ICs cautioned that the quality and safety of healthcare delivered in nursing homes should equal what they would receive in hospitals.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics and Training with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, South Australia, Australia.
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, South Australia, Australia.
| | - Jane Edwards
- Adelaide Geriatrics and Training with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Lalit Yadav
- Adelaide Geriatrics and Training with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Virginie Gaget
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide Surgical Specialties, University of Adelaide, Woodville South, South Australia, Australia
| | - David Tivey
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide Surgical Specialties, University of Adelaide, Woodville South, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide Surgical Specialties, University of Adelaide, Woodville South, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics and Training with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
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Pham CT, Visvanathan R, Strong M, Wilson ECF, Lange K, Dollard J, Ranasinghe D, Hill K, Wilson A, Karnon J. Cost-Effectiveness and Value of Information Analysis of an Ambient Intelligent Geriatric Management (AmbIGeM) System Compared to Usual Care to Prevent Falls in Older People in Hospitals. Appl Health Econ Health Policy 2023; 21:315-325. [PMID: 36494574 DOI: 10.1007/s40258-022-00773-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The Ambient Intelligent Geriatric Management (AmbIGeM) system combines wearable sensors with artificial intelligence to trigger alerts to hospital staff before a fall. A clinical trial found no effect across a heterogenous population, but reported a reduction in the injurious falls rate in a post hoc analysis of patients on Geriatric Evaluation Management Unit (GEMU) wards. Cost-effectiveness and Value of Information (VoI) analyses of the AmbIGeM system in GEMU wards was undertaken. METHODS An Australian health-care system perspective and 5-year time horizon were used for the cost-effectiveness analysis. Implementation costs, inpatient costs and falls data were collected. Injurious falls were defined as causing bruising, laceration, fracture, loss of consciousness, or if the patient reported persistent pain. To compare costs and outcomes, generalised linear regression models were used to adjust for baseline differences between the intervention and usual care groups. Bootstrapping was used to represent uncertainty. For the VoI analysis, 10,000 different sample sizes with randomly sampled values ranging from 1 to 50,000 were tested to estimate the optimal sample size of a new trial that maximised the Expected Net Benefits of Sampling. RESULTS An adjusted 0.036 fewer injurious falls (adjusted rate ratio of 0.56) and AUD$4554 lower costs were seen in the intervention group. However, uncertainty that the intervention is cost effective for the prevention of an injurious fall was present at all monetary values of this effectiveness outcome. A new trial with a sample of 4376 patients was estimated to maximise the Expected Net Benefit of Sampling, generating a net benefit of AUD$186,632 at a benefit-to-cost ratio of 1.1. CONCLUSIONS The benefits to cost ratio suggests that a new trial of the AmbIGeM system in GEMU wards may not be high-value compared to other potential trials, and that the system should be implemented. However, a broader analysis of options for preventing falls in GEMU is required to fully inform decision making. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN 12617000981325).
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Affiliation(s)
- Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia.
| | - Renuka Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Mark Strong
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Edward C F Wilson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kylie Lange
- Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Damith Ranasinghe
- The Auto-ID Lab, The School of Computer Science, University of Adelaide, Adelaide, SA, Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC, Australia
| | - Anne Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Jasper U, Visvanathan R, Dollard J, Yu S, Jadczak AD. Exploring the perspectives of clinicians on solutions to tackling physical inactivity and sedentary behaviour in older hospital patients. Health Promot J Austr 2023; 34:41-47. [PMID: 35714042 PMCID: PMC10084344 DOI: 10.1002/hpja.630] [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: 01/30/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Despite growing research on sedentary behaviour and physical activity among hospitalised older people, there is little evidence of effective intervention strategies. This study sought input from clinical staff from various health professions on strategies to increase physical activity and reduce sedentariness for hospitalised older people. METHODS A 60-minute focus group discussion involving two physiotherapists, two occupational therapists, one doctor, one nurse and one social worker was conducted. Participants were recruited from a subacute geriatric ward and an acute orthopaedic ward with an orthogeriatric service at a general hospital. Data were thematically analysed. RESULTS Six strategies to reduce sedentary behaviour and increase physical activity were identified: clear and positive communication for patients and family/carers; educating patients and family/carers; involving family/carers and volunteers; setting physical activity goals; utilising group activities and activities of daily living (ADL); and making the hospital environment activity-friendly. CONCLUSIONS This research has revealed novel strategies to increase physical activity and reduce sedentary behaviour in hospital. The next step is to design interventions for testing.
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Affiliation(s)
- Unyime Jasper
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Aged & Extended Care Services, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Solomon Yu
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Aged & Extended Care Services, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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Dollard J, Edwards J, Yadav L, Gaget V, Tivey D, Inacio M, Maddern G, Visvanathan R. Stakeholders' perspectives of mobile x-ray services in support of healthcare-in-place in residential aged care facilities: a qualitative study. BMC Geriatr 2022; 22:700. [PMID: 35999503 PMCID: PMC9400207 DOI: 10.1186/s12877-022-03162-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is interest in reducing avoidable emergency department presentations from residential aged care facilities (RACF). Mobile x-ray services may enable the delivery of healthcare in residential aged care facilities. Accordingly, the Australian Government in November 2019 introduced a Medicare Benefit Schedule rebate providing for a ‘call-out’ fee payable to radiology service providers. This study aims to understand stakeholder perspectives on the benefits of mobile x-ray services and the factors influencing their adoption by RACFs. Design, setting, participants Twenty-two semi-structured interviews were conducted between October 2020 and February 2021 with a range of stakeholders involved in healthcare delivery to residents: a) general practitioners; b) emergency department clinicians; c) paramedic clinicians; d) a hospital avoidance clinician; e) radiology clinicians and managers; and f) aged care clinicians and managers. Thematic analysis was conducted. Results Mobile x-ray services were considered valuable for RACF residents. Lack of timely general practitioner in-person assessment and referral, as well as staffing deficits in residential aged care facilities, reduces optimal use of mobile x-ray services and results in potentially unnecessary hospital transfers. Conclusions The use of mobile x-ray services, as a hospital avoidance strategy, depends on the capacity of RACFs to provide more complex healthcare-in-place. However, this requires greater access to general practitioners for in-person assessment and referral, adequate staffing numbers and appropriately skilled nursing staff within residential aged care facilities.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Jane Edwards
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Lalit Yadav
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Virginie Gaget
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - David Tivey
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, Australia.,Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,UniSA Allied Health and Human Movement, University of South Australia, Adelaide, SA, Australia
| | - Guy Maddern
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, SA, Australia.,Royal Australasian College of Surgeons, Adelaide, SA, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia. .,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia. .,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia.
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Dollard J, Edwards J, Yadav L, Gaget V, Tivey D, Inacio M, Maddern G, Visvanathan R. Residents' perspectives of mobile X-ray services in support of healthcare-in-place in residential aged care facilities: a qualitative study. BMC Geriatr 2022; 22:525. [PMID: 35752763 PMCID: PMC9233760 DOI: 10.1186/s12877-022-03212-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mobile X-ray services (MXS) could be used to investigate clinical issues in aged care residents within familiar surroundings, reducing transfers to and from emergency departments and enabling healthcare to be delivered in residential aged care facilities. There is however little research exploring consumer perspectives about such services. The objective of this research was to explore the perspectives and preferences of residents about the provision of MXS in residential aged care facilities, including their knowledge about the service, perceived benefits, and factors that require consideration for effective implementation. Methods A qualitative study design was used. The setting for the study included four residential aged care facilities of different sizes from different parts of a South Australian city. Purposive sampling was used to recruit participants. 16 residents participated in semi-structured interviews that were audio-recorded and transcribed verbatim. Data were inductively derived using thematic analysis. Results Participants had a mean age of 85 years, 56% were female, 25% had dementia and 25% had had a mobile X-ray in the last 12 months. Four themes were developed. Participants preferred mobile X-rays, provided as healthcare-in-place, to improve accessibility to them and minimize physical and psychological discomfort. Participants had expectations about the processes for receiving mobile X-rays. Costs of X-rays to people, family and society were a consideration. Decision making required residents be informed about mobile X-rays. Conclusions Residents have positive views of MXS as they can receive healthcare-in-place, with familiar people and surroundings. They emphasised that MXS delivered in residential aged care facilities need to be of equivalent quality to those found in other settings. Increased awareness of mobile X-ray services is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03212-2.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research With Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 37a Woodville Rd, Woodville South, South Australia, 5011, Australia. .,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, 37 Woodville Rd, Woodville South, South Australia, 5011, Australia.
| | - Jane Edwards
- Adelaide Geriatrics Training and Research With Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 37a Woodville Rd, Woodville South, South Australia, 5011, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, 37 Woodville Rd, Woodville South, South Australia, 5011, Australia
| | - Lalit Yadav
- Adelaide Geriatrics Training and Research With Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 37a Woodville Rd, Woodville South, South Australia, 5011, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, 37 Woodville Rd, Woodville South, South Australia, 5011, Australia
| | - Virginie Gaget
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - David Tivey
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.,Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,UniSA Allied Health and Human Movement, University of South Australia, Adelaide, South Australia, 5001, Australia
| | - Guy Maddern
- Surgical Specialties, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.,Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research With Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 37a Woodville Rd, Woodville South, South Australia, 5011, Australia.,Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, 37 Woodville Rd, Woodville South, South Australia, 5011, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
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Dollard J, Hill KD, Wilson A, Ranasinghe DC, Lange K, Jones K, Boyle EM, Zhou M, Ng N, Visvanathan R. Patient Acceptability of a Novel Technological Solution (Ambient Intelligent Geriatric Management System) to Prevent Falls in Geriatric and General Medicine Wards: A Mixed-Methods Study. Gerontology 2022; 68:1070-1080. [PMID: 35490669 PMCID: PMC9501724 DOI: 10.1159/000522657] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction As effective interventions to prevent inpatient falls are lacking, a novel technological intervention was trialed. The Ambient Intelligent Geriatric Management (AmbIGeM) system used wearable sensors that detected and alerted staff of patient movements requiring supervision. While the system did not reduce falls rate, it is important to evaluate the acceptability, usability, and safety of the AmbIGeM system, from the perspectives of patients and informal carers. Methods We conducted a mixed-methods study using semistructured interviews, a pre-survey and post-survey. The AmbIGeM clinical trial was conducted in two geriatric evaluation and management units and a general medical ward, in two Australian hospitals, and a subset of participants were recruited. Within 3 days of being admitted to the study wards and enrolling in the trial, 31 participants completed the pre-survey. Prior to discharge (post-intervention), 30 participants completed the post-survey and 27 participants were interviewed. Interview data were thematically analyzed and survey data were descriptively analyzed. Results Survey and interview participants had an average age of 83 (SD 9) years, 65% were female, and 41% were admitted with a fall. Participants considered the AmbIGeM system a good idea. Most but not all thought the singlet and sensor component as acceptable and comfortable, with no privacy concerns. Participants felt reassured with extra monitoring, although sometimes misunderstood the purpose of AmbIGeM as detecting patient falls. Participants' acceptability was strongly positive, with median 8+ (0–10 scale) on pre- and post-surveys. Discussion/Conclusion Patients' acceptability is important to optimize outcomes. Overall older patients considered the AmbIGeM system as acceptable, usable, and improving safety. The findings will be important to guide refinement of this and other similar technology developments.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- *Joanne Dollard,
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Damith C. Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Eileen Mary Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Mengqi Zhou
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicholas Ng
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged & Extended Care Services, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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9
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Visvanathan R, Ranasinghe DC, Lange K, Wilson A, Dollard J, Boyle E, Jones K, Chesser M, Ingram K, Hoskins S, Pham C, Karnon J, Hill KD. Effectiveness of the Wearable Sensor based Ambient Intelligent Geriatric Management System (AmbIGeM) in Preventing Falls in Older People in Hospitals. J Gerontol A Biol Sci Med Sci 2021; 77:155-163. [PMID: 34153102 PMCID: PMC8751806 DOI: 10.1093/gerona/glab174] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected. Methods A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325. Results A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34]; p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61]; p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14]; p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period. Conclusions The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards. Clinical Trials Registration Number: 12617000981325
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Affiliation(s)
- Renuka Visvanathan
- Aged & Extended Care Services and Basil Hetzel Institute, The Queen Elizabeth Hospital, Central Adelaide Local Health Network and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, Australia
| | | | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, SA, Australia.,School of Medicine, Flinders University of South Australia, Bedford Park, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Woodville South, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Michael Chesser
- School of Computer Science, University of Adelaide, Adelaide, SA, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Stephen Hoskins
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Clarabelle Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.,Rehabilitation, Ageing and Independent Living and mi(RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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10
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Arakawa Martins B, Jadczak AD, Dollard J, Barrie H, Mahajan N, Tam KL, Visvanathan R. Fifth-year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty before and after a geriatric medicine course. Australas J Ageing 2020; 39:e472-e477. [PMID: 32124560 DOI: 10.1111/ajag.12788] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the changes in fifth-year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty after a 4.5-week geriatric medicine course. METHODS Students' perceived importance and competence was assessed before and after the course using a 26-item Likert scale questionnaire with scores ranging from 1 to 6. RESULTS Students' perceptions of the importance of defining frailty (P = .01), explaining what frailty is (P = .03), advising on nutritional needs (P = .001) and exercise (P = .001) and prescribing an exercise program (P < .001) significantly improved after the course. Medical students' perceived competence in assessing, diagnosing and managing frailty was low to moderate precourse and increased significantly postcourse (2.3 [1.2] 4.9 [2.9], mean [IQR], P < .001) across all items. CONCLUSION An appropriate curriculum focusing on geriatric health conditions such as frailty can improve senior medical students' perceived importance and competence in assessing, diagnosing and managing frailty.
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Affiliation(s)
- Beatriz Arakawa Martins
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Helen Barrie
- National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,School of Social Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Neha Mahajan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Khai Loon Tam
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence on Frailty and Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
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11
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Jasper US, Yadav L, Jadczak AD, Yu S, Visvanathan R, Dollard J. Sedentary behaviour in hospitalised older people: a scoping review protocol. Syst Rev 2020; 9:36. [PMID: 32075689 PMCID: PMC7031934 DOI: 10.1186/s13643-020-01290-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/04/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Older adults spend up to 23 h daily sitting or lying while in hospital. Sedentary behaviour (SB) within a hospital setting is often associated with poor health outcomes including physical and cognitive decline, reduced quality of life and death as well as hospital readmissions. Conversely, replacing SB with mild to moderate levels of physical activity such as walking can significantly reduce hospital readmission risk by 30 days. Given the potentially harmful effects of SB in hospitalised older adults, it is vital to identify current literature by broadly exploring different aspects of SB among older people in hospital. The overall aim of this scoping review is to produce a literature map of current evidence on key domains of sedentary behaviour in hospitalised older people. METHOD A search for relevant publications will be undertaken in Pedro, MEDLINE Ovid, Cochrane, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, Embase, Ageline, Joanna Briggs Institute (JBI) and clinical trials registries. Publications in English and those where the author can provide the full text in English will be included. Studies conducted in hospitals (including in-patient rehabilitation facilities) or acute and subacute care settings and in people aged ≥ 65 will be included. A three-stage method will be used to identify relevant articles, consisting of database search using keywords, keywords and index words across all databases, and reference searching. Articles will be selected following screening of titles/abstracts succeeded by a full-text appraisal utilising a standardised selection form. Two independent reviewers will extract data using the standardised form that will be tested on two articles. A narrative summary will accompany results presented in tables and figures.
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Affiliation(s)
- Unyime S Jasper
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia. .,Basil Hetzel Institute for Translational Research, 37 Woodville Road, Woodville, Adelaide, 5011, Australia. .,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.
| | - Lalit Yadav
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Solomon Yu
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
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12
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Dollard J, Visvanathan R, Hill K, Ranasinghe D, Lange K, Jones K, Boyle E, Zhou A, Ng N, Wilson A. 123 Acceptability of the Ambient Intelligent Geriatric Management (AMBIGEM) System: A Technological Solution to Prevent in-Patient Falls. Age Ageing 2019. [DOI: 10.1093/ageing/afz164.123] [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: 11/14/2022] Open
Abstract
Abstract
AmbIGeM is a technological solution to prevent in-patient falls in patients aged >65. It has been evaluated in a 100-week stepped wedge pragmatic design in two geriatric evaluation and management (GEM) wards and a general medical ward in two Australian hospitals (Visvanathan, Ranasinghe, Wilson et al., Injury Prevention, 2017,0:1). Evaluation of acceptability of the AmbIGeM system from the perspectives of patients and staff who experienced it is reported here.
30 patients completed a 24-item survey, 27 patients were interviewed, 22 staff participated in 3 focus groups and 51 staff completed a 39-item survey. Survey data were descriptively analysed, and focus group and interview data were thematically analysed.
In patient surveys, patients were overall strongly positive, with means 8+ (on 11-point scale) on most items. In patient interviews, the AmbIGeM system was considered a good idea to prevent falls. Most patients thought the singlets comfortable and had no concerns for their privacy nor impact on normal activity. Patients and families felt reassured, although sometimes they misunderstood the purpose of AmbIGeM. In staff focus groups, staff perceived AmbIGeM beneficial in that it can detect and alert movement in patients who require supervision. In both GEM wards, AmbIGeM was considered particularly beneficial,practical and valuable to use on night shift. Factors such as perceived technical limitations (false and delayed alerts) and felt staff burden impacted on acceptability. In staff surveys, 56% agreed/strongly agreed that AmbIGeM has the capability to prevent falls while 16% disagreed/strongly disagreed, 62% thought AmbIGeM would be more user friendly if it was consistently accurate and 76% believed that AmbIGeM takes a moderate/lot of extra work.
Conclusion
AmbIGeM is largely acceptable to patients and requires further refinement for staff. Feedback is valuable to further refine the system.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Health & Medical, University of Adelaide, Australia
| | - Renuka Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Australia
| | - Keith Hill
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | | | - Kylie Lange
- Adelaide Medical School, University of Adelaide, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Eileen Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Australia
| | - Adele Zhou
- School of Medicine, Flinders University of South Australia, Australia
| | - Nicholas Ng
- School of Medicine, Flinders University of South Australia, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Health & Medical, University of Adelaide, Australia
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13
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Dollard J, Harvey G, Dent E, Trotta L, Williams N, Beilby J, Hoon E, Kitson A, Seiboth C, Karnon J. Older People Who Are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients' Pathways of Care. J Frailty Aging 2019; 7:193-195. [PMID: 30095151 DOI: 10.14283/10.14283/jfa.2018.12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/ admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.
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Affiliation(s)
- J Dollard
- Joanne Dollard, Basil Hetzel Institute, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville, SA 5011 Australia, T +618 8222 7349, F +618 8222 7872,
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14
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Harvey G, Dollard J, Marshall A, Mittinty MM. Creating the Right Sort of Ship to Achieve Integrated Care: A Response to Recent Commentaries. Int J Health Policy Manag 2019; 8:317-318. [PMID: 31204449 PMCID: PMC6571490 DOI: 10.15171/ijhpm.2019.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy Marshall
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
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15
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Cusack L, Wiechula R, Schultz T, Dollard J, Maben J. Anticipated advantages and disadvantages of a move to 100% single‐room hospital in Australia: A case study. J Nurs Manag 2019; 27:963-970. [DOI: 10.1111/jonm.12753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lynette Cusack
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Rick Wiechula
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Tim Schultz
- Adelaide Nursing School The University of Adelaide Adelaide South Australia Australia
| | - Joanne Dollard
- Adelaide Medical School The University of Adelaide Adelaide South Australia Australia
| | - Jill Maben
- Faculty of Health and Medical Sciences, School of Health Sciences University of Surrey Guildford UK
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16
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Khow KSF, Dollard J, Bray K, Smyth C, Chehade M, Theou O, Visvanathan R. A randomized controlled feasibility study to evaluate the effects of a goal-setting coaching intervention using feedback from an accelerometer on sedentary time in older people at risk of falls (SMART-MOVE): a study protocol. Pilot Feasibility Stud 2018; 4:173. [PMID: 30473871 PMCID: PMC6240173 DOI: 10.1186/s40814-018-0366-5] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background Sedentary behaviour and falls are important interrelated health issues in older people. One in three people aged 65 years and above fall at least once a year and sedentary behaviour has been identified as one of the risk factors for falls. Studies have shown that the duration of sedentary time increases with age. These dual problems need to be addressed effectively as the ageing population grows. Accelerometers enable accurate measurement of sedentary time. This study aims to establish the feasibility and effect of an individualized goal-setting health coaching intervention using feedback initially from an accelerometer and then pedometer over a period of 12 weeks (intervention) compared with providing a one-off advice through a brochure (control), on sedentary time in older people with a recent fall or at risk of one. Methods A single-blinded randomized controlled feasibility trial involving 80 community-dwelling people aged 65 years and above will be conducted with 40 randomized to the intervention and another 40 to control. Primary outcomes will be the feasibility of the intervention and change in total sedentary time at 12 and 24 weeks. Secondary outcomes include a change in fear of falling based on the falls efficacy scale, gait speed, self-reported sedentary time, the proportion of fallers and number of falls. Four focus groups (two from each arm) will be conducted at the end of the study to evaluate the feasibility and effectiveness of this intervention. Feasibility findings will be primarily descriptive. Mean group differences will be examined using independent samples t test for normally distributed data and nonparametric tests (Kruskal-Wallis and Mann-Whitney U) for non-normally distributed data. Differences in frequency of variables will be compared using chi-square test. Analysis of variance (ANOVA) will be used to test the post-intervention difference between the two groups at 12 and 24 weeks. Discussion The trial will address a key gap in evidence about sedentary behaviour and falls amongst older people and will evaluate the feasibility of an intervention that could be implemented within the primary health care settings. Trial registration Australian New Zealand Clinical Trials Registry 12617001186347, Registered 11 August 2017.
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Affiliation(s)
- Kareeann Sok-Fun Khow
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia Australia.,2Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, 61 Silkes Road Paradise, Adelaide, South Australia SA 5075 Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia Australia
| | - Joanne Dollard
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia Australia.,2Adelaide Geriatrics Training and Research with Aged Care (G-TRAC Centre), Discipline of Medicine, Adelaide Medical School, University of Adelaide, 61 Silkes Road Paradise, Adelaide, South Australia SA 5075 Australia
| | - Kathy Bray
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia Australia
| | - Carla Smyth
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia Australia
| | - Mellick Chehade
- 4Centre for Orthopaedic Trauma and Research, Royal Adelaide Hospital, The University of Adelaide, Adelaide, South Australia Australia
| | - Olga Theou
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia Australia.,5Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia Australia
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17
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Arakawa Martins B, Barrie H, Dollard J, Mahajan N, Visvanathan R. Older Adults' Perceptions of the Built Environment and Associations with Frailty: A Feasibility and Acceptability Study. J Frailty Aging 2018; 7:268-271. [PMID: 30298177 DOI: 10.14283/jfa.2018.23] [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: 11/11/2022]
Abstract
It is essential to evaluate frail older adults understanding and execution of survey tools to improve data quality and accurate representation in research. The study tested the feasibility and acceptability of a survey that assesses various measures of functional status in frail older people. The study evaluated: 1) recruitment rate; 2) time to complete questionnaires and difficulties encountered; and 3) acceptability by participants. Validated tools including: FRAIL Scale, EuroQoL 5D-5L, Charlson's Comorbidities Index, Baecke's Physical Activity Questionnaire, Life-Space Assessment, Katz and Lawton ADL and NEWS Walkability Scale were assessed. Twenty-five older patients (63% recruitment rate) of a post-acute restorative program (residential Transition Care Program) in Adelaide, South Australia were interviewed. Although not statistically different, time to complete the overall questionnaire differed between robust, pre-frail and frail participants. Overall, the survey was considered acceptable and feasible, with consideration with NEWS and Life-Space assessment regarding length, phrasing and layout.
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Affiliation(s)
- B Arakawa Martins
- Beatriz Arakawa Martins, The Basil Hetzel Institute and University of Adelaide 37, Woodville Road, Woodville South SA 5011, Australia, + 61 08 8222 7676
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18
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Jadczak AD, Dollard J, Mahajan N, Visvanathan R. The perspectives of pre-frail and frail older people on being advised about exercise: a qualitative study. Fam Pract 2018; 35:330-335. [PMID: 29145588 DOI: 10.1093/fampra/cmx108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Exercise is considered to be the most effective strategy to treat, prevent and delay frailty, a prevalent geriatric syndrome observed in clinical practice. Encouraging frail older people to take up exercise is crucial in the management of this condition. The study aimed to explore pre-frail and frail older peoples' perspectives in relation to being advised about exercise and their perceptions of the general practitioners' (GPs) role in promoting exercise for older people. METHODS Semi-structured interviews were conducted with 12 community-dwelling older (median age 83 years) participants screened pre-frail or frail using the FRAIL Screen. Their attitudes towards exercise, the advice received, their access to relevant information and their perceptions of the GP's role in promoting exercise were explored. Thematic analysis was conducted to analyse data. RESULTS The majority of participants had a positive attitude towards exercise, and many participants indicated a preference for being advised firstly by their GPs and then other healthcare professionals. Participants living in the community reported difficulties in accessing information on exercise and indicated that local governments and GP practices should promote exercise for older people more actively. Participants living in retirement villages, however, reported having access to relevant information and being encouraged to participate in exercise. CONCLUSION This research identified a gap in current practice, demonstrating that GPs, healthcare providers and local governments should promote exercise for older people more actively. Convincing health professionals to encourage regular exercise among their older patients would provide an opportunity to avoid and manage frailty in this population.
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Affiliation(s)
- Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Neha Mahajan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia.,Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
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Harvey G, Dollard J, Marshall A, Mittinty MM. Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future? Int J Health Policy Manag 2018; 7:290-293. [PMID: 29626395 PMCID: PMC5949218 DOI: 10.15171/ijhpm.2017.144] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022] Open
Abstract
Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairson the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.
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Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy Marshall
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Manasi Murthy Mittinty
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia.,Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
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Dollard J, Harvey G, Dent E, Trotta L, Williams N, Beilby J, Hoon E, Kitson A, Seiboth C, Karnon J. OLDER PEOPLE WHO ARE FREQUENT USERS OF ACUTE CARE: A SYMPTOM OF FRAGMENTED CARE? A CASE SERIES REPORT ON PATIENTS’ PATHWAYS OF CARE. J Frailty Aging 2018. [DOI: 10.14283/jfa.2018.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.
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Dent E, Hoon E, Karnon J, Kitson A, Dollard J, Newbury J, Harvey G, Gill T, Beilby J. Management of Musculoskeletal Conditions in Rural South Australia: A Randomised Controlled Trial. J Frailty Aging 2017; 6:212-215. [PMID: 29165539 DOI: 10.14283/jfa.2017.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/11/2022]
Abstract
With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component 'Self-management Plus' intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited; mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component 'Self-management Plus' intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention's feasibility in its current form.
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Affiliation(s)
- E Dent
- Elsa Dent, Centre for Research in Geriatric Medicine, School of Medicine The University of Queensland, Brisbane, Australia, Discipline of Public Health, School of Public Health The University of Adelaide, Adelaide, SA, 5005, Australia,
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Visvanathan R, Ranasinghe DC, Wilson A, Lange K, Dollard J, Boyle E, Karnon J, Raygan E, Maher S, Ingram K, Pazhvoor S, Hoskins S, Hill K. Effectiveness of an Ambient Intelligent Geriatric Management system (AmbIGeM) to prevent falls in older people in hospitals: protocol for the AmbIGeM stepped wedge pragmatic trial. Inj Prev 2017; 25:157-165. [DOI: 10.1136/injuryprev-2017-042507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/18/2017] [Accepted: 07/22/2017] [Indexed: 11/03/2022]
Abstract
BackgroundAlthough current best practice recommendations contribute to falls prevention in hospital, falls and injury rates remain high. There is a need to explore new interventions to reduce falls rates, especially in geriatric and general medical wards where older patients and those with cognitive impairment are managed.Design and methodsA three-cluster stepped wedge pragmatic trial, with an embedded qualitative process, of the Ambient Intelligent Geriatric Management (AmbIGeM) system (wearable sensor device to alert staff of patients undertaking at-risk activities), for preventing falls in older patients compared with standard care. The trial will occur on three acute/subacute wards in two hospitals in Adelaide and Perth, Australia.ParticipantsPatients aged >65 years admitted to study wards. A waiver (Perth) and opt-out of consent (Adelaide) was obtained for this study. Patients requiring palliative care will be excluded.OutcomesThe primary outcome is falls rate; secondary outcome measures are: (1) proportion of participants falling; (2) rate of injurious inpatient falls/1000 participant bed-days; (3) acceptability and safety of the interventions from patients and clinical staff perspectives; and (4) hospital costs, mortality and use of residential care to 3 months postdischarge.DiscussionThis study investigates a novel technological approach to preventing falls in hospitalised older people. We hypothesise that the AmbIGeM intervention will reduce falls and injury rates, with an economic benefit attributable to the intervention. If successful, the AmbIGeM system will be a useful addition to falls prevention in hospital wards with high proportions of older people and people with cognitive impairment.Trial registration numberAustralian and New Zealand Clinical Trial Registry: ACTRN 12617000981325; Pre-results.
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Jadczak A, Dollard J, Mahajan N, Visvanathan R. THE PERSPECTIVES OF OLDER PEOPLE AT- RISK OF FRAILTY ON BEING ADVISED ABOUT EXERCISE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5136] [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: 11/13/2022] Open
Affiliation(s)
- A.D. Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - J. Dollard
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - N. Mahajan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
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Dollard J, Smith J, R Thompson D, Stewart S. Broadening the Reach of Cardiac Rehabilitation to Rural and Remote Australia. Eur J Cardiovasc Nurs 2017; 3:27-42. [PMID: 15053886 DOI: 10.1016/j.ejcnurse.2003.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 10/27/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has an evidence base but traditional models may not readily apply to people living in rural and remote regions. AIM : To outline published comprehensive and non-hospital based CR models used for people discharged from hospital after a cardiac event that have potential relevance to those living in rural and remote areas in Australia. METHODS The PubMed database was searched using Medical subject headings (MeSH) terms and the key word 'cardiac rehabilitation' limited to clinical trials. Articles were retrieved if they included at least two components of CR and were not based in an outpatient setting. RESULTS No CR models specifically developed for rural and remote areas were identified. However, 14 studies were found that outlined 11 non-conventional comprehensive CR models. All provided CR in a home-based setting. Health professionals provided support via telephone contact or home visits, and via resources such as the Heart Manual. Reported outcomes from these CR programs varied: ranging from an increase in knowledge of risk factors, to improvements in physical activity, decreased risk factor profile, improved psychological and social functioning and reductions in health service costs and mortality. CONCLUSION Home-based, CR models have the most substantive evidence base and, therefore the greatest potential to be developed and made accessible to eligible people living in rural and remote areas.
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Affiliation(s)
- Joanne Dollard
- Spencer Gulf Rural Health School, University of South Autralia - Whyalla Campus, Nicolson Avenue, Whyalla Norrie, SA 5608, Australia.
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Walters L, Laurence CO, Dollard J, Elliott T, Eley DS. Exploring resilience in rural GP registrars--implications for training. BMC Med Educ 2015; 15:110. [PMID: 26134975 PMCID: PMC4487989 DOI: 10.1186/s12909-015-0399-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 06/19/2015] [Indexed: 05/16/2023]
Abstract
BACKGROUND Resilience can be defined as the ability to rebound from adversity and overcome difficult circumstances. General Practice (GP) registrars face many challenges in transitioning into general practice, and additional stressors and pressures apply for those choosing a career in rural practice. At this time of international rural generalist medical workforce shortages, it is important to focus on the needs of rural GP registrars and how to support them to become resilient health care providers. This study sought to explore GP registrars' perceptions of their resilience and strategies they used to maintain resilience in rural general practice. METHODS In this qualitative interpretive research, semi-structured interviews were recorded, transcribed and analysed using an inductive approach. Initial coding resulted in a coding framework which was refined using constant comparison and negative case analysis. Authors developed consensus around the final conceptual model. Eighteen GP registrars from: Australian College of Rural and Remote Medicine Independent Pathway, and three GP regional training programs with rural training posts. RESULTS Six main themes emerged from the data. Firstly, rural GP registrars described four dichotomous tensions they faced: clinical caution versus clinical courage; flexibility versus persistence; reflective practice versus task-focused practice; and personal connections versus professional commitment. Further themes included: personal skills for balance which facilitated resilience including optimistic attitude, self-reflection and metacognition; and finally GP registrars recognised the role of their supervisors in supporting and stretching them to enhance their clinical resilience. CONCLUSION Resilience is maintained as on a wobble board by balancing professional tensions within acceptable limits. These limits are unique to each individual, and may be expanded through personal growth and professional development as part of rural general practice training.
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Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, PO Box 3570, Mount Gambier, SA, Australia.
| | - Caroline O Laurence
- Discipline of General Practice, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Joanne Dollard
- Discipline of General Practice, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Taryn Elliott
- Adelaide to Outback GP Training Program, 183 Melbourne Street, North Adelaide, SA, 5006, Australia.
| | - Diann S Eley
- School of Medicine, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
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Abstract
BACKGROUND It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. OBJECTIVE To explore why older women do or do not seek GP help after a fall. METHODS A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥ 65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women's experience of falling and seeking GP help. Interviews were analysed using constant comparison. RESULTS Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs' time for trivial reasons and they believed they did not have timely access to their GP). CONCLUSIONS Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history.
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Dollard J, Barton C, Newbury J, Turnbull D. Older community-dwelling people's comparative optimism about falling: a population-based telephone survey. Australas J Ageing 2012; 32:34-40. [PMID: 23521732 DOI: 10.1111/j.1741-6612.2012.00597.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine whether older community-dwelling people underestimate their own perceived chance of falling compared with that of other older people (comparative optimism), and whether a history of falls is associated with comparative optimism. METHOD A sample of community-dwelling South Australians aged ≥65 years (n= 389) completed a computer-assisted telephone interview about their 12-month fall history, their perceived chance of falling and their rating of other older people's chance of falling. RESULTS Respondents were comparatively optimistic about their chance of falling (Z =-8.1, P < 0.001). Those who had fallen in the last 12 months had a lower comparative optimism score (Z =-3.0, P < 0.003). CONCLUSION As older people were comparatively optimistic about their likelihood of falling, they might not find fall prevention messages relevant. When older people present with a fall, clinicians could provide fall prevention information consistent with how older people present themselves.
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Affiliation(s)
- Joanne Dollard
- Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia.
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Adams M, Dollard J, Hollins J, Petkov J. Development of a questionnaire measuring student attitudes to working and living in rural areas
. Rural Remote Health 2005. [DOI: 10.22605/rrh327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Adams ME, Dollard J, Hollins J, Petkov J. Development of a questionnaire measuring student attitudes to working and living in rural areas. Rural Remote Health 2005; 5:327. [PMID: 15865474] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Student attachments in rural locations have been instigated, in part to foster positive attitudes to rural practice and encourage rural recruitment. Based on medical and allied health literature, it was hypothesised that students' attitudes to rural practice and rural life encompasses the following three dimensions: (1) community and social issues; (2) family and personal issues; and (3) professional issues. However, there are limited studies assessing attitudinal change before and after rural placement and no valid and reliable tools which examine change across all three dimensions. This article reports on the development, reliability and validity of such a tool to fill this gap in the rural health research literature. METHODS Students who undertook a rural placement in South Australia or a rural placement organised by the Mt Isa Centre for Rural and Remote Health in Queensland, Australia, during 2001 were invited to complete a pre- and post-placement questionnaire (n = 243). The response rate for the pre-placement questionnaire was 74.9% (n = 182) and 50.2% (n = 122) for the post-placement questionnaire. A literature review informed the content of the initial questionnaire, which consisted of a series of statements to which respondents were instructed to indicate how strongly they agreed or disagreed on a Likert scale of one to six. The assessment of validity and reliability of the questionnaire involved three main processes. Content validity was assessed by discussion and rating by academics and students, resulting in 18 questionnaire items. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach's alpha. RESULTS The Cronbach's alpha coefficient for the post-questionnaire was 0.68, acceptable for newly developed scales. Exploratory factor analysis and varimax rotation was conducted for pre- and post-placement (n = 110) questionnaires. The pre-placement questionnaire did not lend itself to logical interpretation, probably due to the diverse attitudes students may have pre-rural placement. However the factors on the post-placement questionnaire were interpretable. The Scree Plot indicated four factors, explaining 60.82% of the total variance. The factors were rotated using the normalised varimax rotation method. The factors extracted were: (1) friendliness and support in rural areas; (2) isolation and socialisation problems associated with living and working in rural areas; (3) enjoyable aspects of living in a rural area; and (4) opportunities that working in a rural area provides. CONCLUSIONS Analysis of the Student Attitudes to Rural Practice and Life Questionnaire provides evidence of validity. The study identified four factors associated with student attitudes to living and working in rural areas, which differ from those hypothesised. The main deviation was Factor 2, grouping all the negative aspects of isolation and socialisation in a rural area. The resulting factors provide a more integrated reflection of the rural experience, rather than the rigid categorisation of professional, social and personal issues. Reliability was found to be adequate. The questionnaire is able to measure student attitudes to rural practice and rural life, and may be used to evaluate the impact of rural placement on student attitudes.
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Affiliation(s)
- Maree E Adams
- Spencer Gulf Rural Health School, University of South Australia, Adelaide, South Australia, Australia.
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Taylor J, Wilkinson D, Blue I, Dollard J. Evidence-based rural general practice: barriers and solutions in South Australia. Rural Remote Health 2002. [DOI: 10.22605/rrh116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
Aboriginal Community Controlled Health Services face particular management issues as they adjust to the dominant Western paradigm of managerialism and the market model of health service provision. Their cultural orientation leads to distinctive organisational features which both advantage and disadvantages them in this environment. The holistic model of health used and community control enable the delivery of integrated, culturally appropriate health care. However, effective community control is difficult to achieve. Services may benefit from partnerships with collaborators such as hospitals, regional health services and university departments of rural health if the partnerships are based on mutual respect and ensure that community control is retained.
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Affiliation(s)
- J Taylor
- South Australian Centre for Rural and Remote Health, Adelaide University and University of South Australia
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Dollard J. A significant consideration in the etiology of periodontal disease. Contact Point 1970; 48:173-5. [PMID: 5266733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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White AM, Fichtenbaum L, Dollard J. An interactive behavior index and verbal content analysis. J Nerv Ment Dis 1968; 146:457-64. [PMID: 5677022 DOI: 10.1097/00005053-196806000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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White AM, Fichtenbaum L, Dollard J. A content measure of changes attributable to psychotherapy. Am J Orthopsychiatry 1966; 36:41-49. [PMID: 5904491 DOI: 10.1111/j.1939-0025.1966.tb02288.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Bird C, Miller NE, Dollard J. Social Learning and Imitation. The American Journal of Psychology 1942. [DOI: 10.2307/1417490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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