Use of home care services by older Veterans and dependants in Melbourne, Australia, 2007-2016

LAY SUMMARY

Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analysed data from a Melbourne, Australia, home care organization’s electronic care records to explore the differences between clients supported by the Department of Veterans’ Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.

Loneliness in older age: What is it, why is it happening and what should we do about it in Australia?

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.

Co-creation of services to maintain independence and optimise well-being: Learnings from Australia's Older Women Living Alone (OWLA) project

For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of individuals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.

Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations

BACKGROUND

Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems.

OBJECTIVE

To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action.

DESIGN

Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study.

SETTING AND PARTICIPANTS

Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations.

INTERVENTIONS

Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care.

MAIN OUTCOME MEASURES

Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA.

RESULTS

The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples.

DISCUSSION AND CONCLUSIONS

The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.

Weight stigmatisation in antiobesity campaigns: The role of images

ISSUE ADDRESSED

Antiobesity campaigns may inadvertently stigmatise individuals with obesity via the use of images that portray negative obesity stereotypes. This study investigated the impact of images on weight stigma using mock antiobesity campaigns featuring different types of images.

METHODS

Participants (N = 240) were randomly assigned to one of four campaign conditions: stereotypical images, counter-stereotypical images, neutral images, or no images. All four conditions used the same nonstigmatising message text. Participants indicated their attitudes towards being in social situations (desired social distance) with the target featured in the images, or individuals with obesity (no images), rated the target or individuals with obesity on various traits, and indicated to what extent the campaign was motivating and stigmatising.

RESULTS

Analysis of variance revealed that the stereotypical images were rated as the most stigmatising and were also associated with higher negative and lower positive trait ratings of the target and more desired social distance from the target. Neutral images generally produced the least weight stigma.

CONCLUSION

It is important to consider the impact of antiobesity campaign images that depict common obesity stereotypes. Developing, testing and disseminating nonstigmatising campaigns is important to reduce stigma and better engage individuals with antiobesity public health messages. SO WHAT?: Weight stigma has negative consequences for physical and psychological health, which may undermine obesity intervention efforts. Stereotypical images that blame individuals for their weight reinforce obesity stigma and are likely to be in-effective in increasing healthier behaviour and reducing obesity. The development of effective antiobesity campaigns should be a public health priority.

The usefulness of the Brief Symptom Inventory in the neuropsychological evaluation of traumatic brain injury

Changes in the health care delivery system are forcing clinicians to use less timely and more cost efficient measures. In rehabilitation, more efficient measures of emotional-behavioural functioning are being administered to patients with traumatic brain injury (TBI), including the Brief Symptom Inventory (BSI), a 53 item short version of the Symptom Checklist-90 that assesses nine different dimensions of emotional-behavioural functioning. Because the BSI was developed for use with psychiatric populations, research of the measure with TBI populations is needed. The current study evaluated the utility of the BSI in a sample of 62 patients (34 male, 28 female, average age 35, average education 12 years) with TBI evaluated as outpatients at a midwestern rehabilitation hospital. Results indicated that: (1) subjects endorsed clinically elevated distress on seven of the nine subscales when compared to the normative sample; (2) the Obsessive-Compulsive (OC) subscale achieved the highest t-score (70.31); 3) the most frequent two-point profiles included the OC-Somatic (21%) and OC-Psychoticism (13%) subscales; and (3) the Global Symptom Index was significantly correlated with all nine subscales. It was concluded that caution must be used when administering the BSI to individuals with TBI due to a lack of a TBI standardization sample, the limited number of test items per subscale, and questionable labels for the different subscales (e.g. OC subscale items appear to be more reflective of TBI-related cognitive impairment than obsessive-compulsive traits).

Gene amplification on chromosome band 11q13 and oestrogen receptor status in breast cancer

We have analysed DNA from 183 primary breast cancers for amplification or rearrangement of a number of cellular proto-oncogenes, focusing primarily on a cluster of markers on the long arm of chromosome 11. Two of these oncogenes, INT2 and HST1, both of which encode members of the fibroblast growth factor family, are implicated in the generation of virally induced mammary tumours in mice. Here we confirm earlier reports that the q13 region of chromosome 11, in which these genes are tandemly linked, is modestly amplified in approximately 15% of primary human breast cancers. This amplification is confined, with one exception, to cases in which the oestrogen receptor (ER) levels are in excess of 20 fmol/mg protein (P = 0.001). However, DNA amplification does not usually result in detectable expression of either the INT2 or HST1 gene. The data imply that some other gene in the vicinity must contribute to the development of a subset of ER-positive tumours and that assessing the amplification of this region of DNA may be of value in defining a separate category of ER-positive tumour.

The locus of the polymorphic epithelial mucin (PEM) tumour antigen on chromosome 1q21 shows a high frequency of alteration in primary human breast tumours

Tumour and blood leukocyte DNAs from sporadic breast cancer patients were examined for chromosome 1 loss of heterozygosity using a probe for a polymorphic epithelial mucin, PEM, which is expressed in greater than 92% of breast carcinomas as well as in normal lactating breast tissue. Expression is detected by the monoclonal antibodies (MAbs) HMFG-1, -2 and SM-3 which react with epitopes in the 20 amino-acid repeat unit of the core protein. The PEM probe has been mapped to the chromosome band 1q21, a region that is often incriminated in chromosomal rearrangements in breast tumours. Loss of heterozygosity or alteration at the PEM locus was detected in 34% of the 70 informative patients examined. Twenty of the 24 individuals showed loss of an allele, whereas 4 showed gain of an additional allele or amplification of an existing allele. Twenty-eight percent of informative cases exhibited alterations at the MS32 locus, 1q42-43, and 20% had alterations at the short arm locus MS1 at 1p33-35. These findings identify the long arm of chromosome 1 and in particular the region around the PEM gene for localization of a gene whose loss or alteration may, in some tumours, contribute to the progression of disease in breast cancer patients.

A supervisory strategy to improve work performance for lower functioning retarded clients in a sheltered workshop

A multiple component strategy was investigated for aiding staff responsible for supervising production of lower functioning retarded clients on contract tasks in an institution-based sheltered workshop. The strategy was assessed in a combined multi-element, multiple baseline across groups design with a reversal component. Production performance increased during the production supervisory strategy with all 16 clients, with the range of increase varying from a few percentage points to 150% of baseline production. Both the clients and staff (responsible for conducting the research) preferred working under experimental conditions rather than under baseline conditions which approximated those found in "typical" sheltered workshops.

Accessory lobe of liver presenting through a congenital deficiency of anterior abdominal wall

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