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  • 1
    Online Resource
    Online Resource
    Corrigendum to: Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors
    CSIRO Publishing ; 2015
    In:  Australian Health Review Vol. 39, No. 1 ( 2015), p. 120-
    Details
    In: Australian Health Review, CSIRO Publishing, Vol. 39, No. 1 ( 2015), p. 120-
    Abstract: Objective To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors. Methods Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities. Results Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy. Conclusions Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events. What is known about the topic? Currently, the VPSRACS report on five QI. Previous research has shown associations between several of these indicators, but not all. What does this paper add? This paper examines associations between the five VPSRAC QI as well as other key demographic and health-related factors. Novel findings from regression analyses included an increased risk of falls associated with recommended body mass index and using gait aids, but no association between pressure ulcers and the Norton score. Regression models for other QI were limited by the small occurrences of the QI. However, significant associations were identified indicating that residents using a gait aid had a lower level of unplanned weight loss and residents with polypharmacy had higher unplanned weight loss. What are the implications for practitioners? This paper reinforces the value of collecting VPSRAC QI data to enable facilities to consider how these variables could impact on care quality and to proactively plan to reduce the risk of adverse events. Although QI data can be used to benchmark with other settings, this paper shows how QI data can be used to inform practice within a facility and help identify patient-related factors that may warrant further investigation.
    Type of Medium: Online Resource
    ISSN: 0156-5788
    URL: Article
    DOI: 10.1071/AH13184_CO
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2015
    detail.hit.zdb_id: 2082451-8
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  • 2
    Online Resource
    Online Resource
    Survival and critical care use among people with dementia in a large English cohort
    Oxford University Press (OUP) ; 2023
    In:  Age and Ageing Vol. 52, No. 9 ( 2023-09-01)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 52, No. 9 ( 2023-09-01)
    Abstract: Admitting people with dementia to critical care units may not always lead to a clear survival benefit. Critical care admissions of people with dementia vary across countries. Little is known about the use and trends of critical care admissions of people with dementia in England. Objective To investigate critical care use and survival among people with dementia in a large London catchment area. Methods A retrospective cohort study using data from dementia assessment services in south London, UK (2007–20) linked with national hospitalisation data to ascertain critical care admissions. Outcomes included age–sex-standardised critical care use and 1-year post-critical care admission survival by dementia severity (binary: mild versus moderate/severe). We used logistic regression and Kaplan–Meier survival plots for investigating 1-year survival following a critical care admission and linear regressions for time trends. Results Of 19,787 people diagnosed with dementia, 726 (3.7%) had ≥1 critical care admission at any time after receiving their dementia diagnosis. The overall 1-year survival of people with dementia, who had a CCA, was 47.5% (n = 345). Dementia severity was not associated with 1-year survival following a critical care admission (mild dementia versus moderate–severe dementia odds of 1-year mortality OR: 0.90, 95% CI [0.66–1.22]). Over the 12-year period from 2008 to 2019, overall critical care use decreased (β = −0.05; 95% CI = −0.01, −0.0003; P = 0.03), while critical care admissions occurring during the last year of life increased (β = 0.11, 95% CI = 0.01, 0.20, P = 0.03). Conclusions In this cohort, while critical care use among people with dementia declined overall, its use increased among those in their last year of life. Survival remains comparable to that observed in general older populations.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afad157
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2065766-3
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  • 3
    Online Resource
    Online Resource
    Empowering Better End‐of‐Life Dementia Care (EMBED‐Care): A mixed methods protocol to achieve integrated person‐centred care across settings
    Wiley ; 2020
    In:  International Journal of Geriatric Psychiatry Vol. 35, No. 8 ( 2020-08), p. 820-832
    Details
    In: International Journal of Geriatric Psychiatry, Wiley, Vol. 35, No. 8 ( 2020-08), p. 820-832
    Abstract: Globally, the number of people with dementia who have palliative care needs will increase fourfold over the next 40 years. The Empowering Better End‐of‐Life Dementia Care (EMBED‐Care) Programme aims to deliver a step change in care through a large sequential study, spanning multiple work streams. Methods We will use mixed methods across settings where people with dementia live and die: their own homes, care homes, and hospitals. Beginning with policy syntheses and reviews of interventions, we will develop a conceptual framework and underpinning theory of change. We will use linked data sets to explore current service use, care transitions, and inequalities and predict future need for end‐of‐life dementia care. Longitudinal cohort studies of people with dementia (including young onset and prion dementias) and their carers will describe care transitions, quality of life, symptoms, formal and informal care provision, and costs. Data will be synthesised, underpinned by the Knowledge‐to‐Action Implementation Framework, to design a novel complex intervention to support assessment, decision making, and communication between patients, carers, and inter‐professional teams. This will be feasibility and pilot tested in UK settings. Patient and public involvement and engagement, innovative work with artists, policymakers, and third sector organisations are embedded to drive impact. We will build research capacity and develop an international network for excellence in dementia palliative care. Conclusions EMBED‐Care will help us understand current and future need, develop novel cost‐effective care innovations, build research capacity, and promote international collaborations in research and practice to ensure people live and die well with dementia.
    Type of Medium: Online Resource
    ISSN: 0885-6230 , 1099-1166
    URL: Issue
    URL: Article
    DOI: 10.1002/gps.v35.8
    DOI: 10.1002/gps.5251
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1500455-7
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  • 4
    Online Resource
    Online Resource
    Fas-Deficient lpr Mice Are More Susceptible to Graft-Versus-Host Disease
    The American Association of Immunologists ; 2000
    In:  The Journal of Immunology Vol. 164, No. 1 ( 2000-01-01), p. 469-480
    Details
    In: The Journal of Immunology, The American Association of Immunologists, Vol. 164, No. 1 ( 2000-01-01), p. 469-480
    Abstract: The Fas/Fas ligand (FasL) pathway is involved in a variety of regulatory mechanisms that could be important for the development of graft-vs-host disease (GVHD) after bone marrow transplantation (BMT), such as cytolysis of target cells by cytotoxic T cells, regulation of inflammatory responses, peripheral deletion of autoimmune cells, costimulation of T cells, and activation-induced cell death. To further evaluate the role of Fas/FasL in the complex pathophysiology of GVHD, we used Fas-deficient B6.lpr mice as recipients in a MHC-matched minor histocompatibility Ag-mismatched murine model for GVHD after allogeneic BMT (C3H.SW→B6). We found a significantly higher morbidity and mortality from GVHD compared with control B6 recipients. In contrast, B6.lpr recipients had very little hepatic GVHD, although all other specific GVHD target organs (skin, intestines, and thymus) were more severely affected than in the control B6 recipients. B6.lpr recipients with GVHD demonstrated intact donor lymphoid engraftment and an increase in expansion of donor T cells and monocytes/macrophages compared with control B6 recipients. Serum levels of IFN-γ and TNF-α were higher in B6.lpr recipients than in control B6 recipients, and monocytes/macrophages in B6.lpr recipients appeared more sensitized. B6.lpr recipients had more residual peritoneal macrophages after BMT, and peritoneal macrophages from B6.lpr mice could induce a greater proliferative response from C3H.SW splenocytes. This study demonstrates that the expression of Fas in the recipient is required for GVHD of the liver, but shows unexpected consequences when host tissues lack the expression of Fas for the development of GVHD in other organs and systemic GVHD.
    Type of Medium: Online Resource
    ISSN: 0022-1767 , 1550-6606
    URL: Article
    DOI: 10.4049/jimmunol.164.1.469
    RVK:
    XA 54100
    RVK:
    XA 10000
    Language: English
    Publisher: The American Association of Immunologists
    Publication Date: 2000
    detail.hit.zdb_id: 1475085-5
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  • 5
    Online Resource
    Online Resource
    A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias – CORRIGENDUM
    Cambridge University Press (CUP) ; 2023
    In:  International Psychogeriatrics
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP)
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610223000406
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2147136-8
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  • 6
    Online Resource
    Online Resource
    A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias
    Cambridge University Press (CUP) ; 2023
    In:  International Psychogeriatrics
    Details
    In: International Psychogeriatrics, Cambridge University Press (CUP)
    Abstract: Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program. Design: Pre–post interventional mixed methods study. Setting: Online videoconference group program for carers across the UK held in 2021. Participants: Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators. Intervention: The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions. Measurements: We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2. Results: Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression. Conclusion: The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.
    Type of Medium: Online Resource
    ISSN: 1041-6102 , 1741-203X
    URL: Article
    DOI: 10.1017/S1041610223000236
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2147136-8
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  • 7
    Online Resource
    Online Resource
    Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors
    CSIRO Publishing ; 2014
    In:  Australian Health Review Vol. 38, No. 3 ( 2014), p. 325-
    Details
    In: Australian Health Review, CSIRO Publishing, Vol. 38, No. 3 ( 2014), p. 325-
    Abstract: Objective To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors. Methods Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities. Results Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy. Conclusions Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events. What is known about the topic? Currently, the VPSRACS report on five QI. Previous research has shown associa tions between several of these indicators, but not all. What does this paper add? This paper examines associations between the five VPSRAC QI as well as other key demographic and health-related factors. Novel findings from regression analyses included an increased risk of falls associated with recommended body mass index and using gait aids, but no association between pressure ulcers and the Norton score. Regression models for other QI were limited by the small occurrences of the QI. However, significant associations were identified indicating that residents using a gait aid had a lower level of unplanned weight loss and residents with polypharmacy had higher unplanned weight loss. What are the implications for practitioners? This paper reinforces the value of collecting VPSRAC QI data to enable facilities to consider how these variables could impact on care quality and to proactively plan to reduce the risk of adverse events. Although QI data can be used to benchmark with other settings, this paper shows how QI data can be used to inform practice within a facility and help identify patient-related factors that may warrant further investigation.
    Type of Medium: Online Resource
    ISSN: 0156-5788
    URL: Article
    DOI: 10.1071/AH13184
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2014
    detail.hit.zdb_id: 2082451-8
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  • 8
    Online Resource
    Online Resource
    Do interventions that include education on dementia progression improve knowledge, mental health and burden of family carers? A systematic review
    SAGE Publications ; 2020
    In:  Dementia Vol. 19, No. 8 ( 2020-11), p. 2555-2581
    Details
    In: Dementia, SAGE Publications, Vol. 19, No. 8 ( 2020-11), p. 2555-2581
    Abstract: The European Association of Palliative Care recommends that family carers need education on the progression of dementia. This systematic review aimed to explore whether interventions incorporating education regarding the progressive nature of dementia increased carers’ understanding of dementia and improved mental health and burden. Method MEDLINE, PsycINFO and CINAHL were searched to April 2018. Randomised controlled trials with samples of family carers of someone with dementia were eligible. Included interventions involved a component aimed to increase the carer’s understanding of the progression of dementia. Outcomes of interest included: knowledge of dementia, depression, burden and pre-death grief. Results Searches identified 3221 unique citations of which 11 studies were eligible for review. Interventions ranged from 4 to 16 sessions of which 1 to 3 sessions focused on the progression of dementia. Knowledge: Two studies evaluated carers’ knowledge of dementia. One found no difference between the trial arms immediately after the intervention or three months later. The second found a significant intervention effect at the end of the intervention but not at three-month follow-up. Depression: Seven studies evaluated intervention effects on depression. Meta-analysis of three trials showed significant differences in mean follow-up scores favouring intervention over control. The remaining four studies did not show differences in depression between intervention and control groups. Burden: Nine studies evaluated burden and were examined in two meta-analyses (mean scores at follow-up and mean change scores from baseline to follow-up), neither of which found a benefit for intervention over control. Using the grading of recommendations assessment, development and evaluation system, we judged the quality of evidence to be very low for depression and low for burden, knowledge and pre-death grief, reducing our confidence in any of the effect estimates. Conclusion The evidence was not sufficient to support or refute the effectiveness of education on progression of dementia on carers’ knowledge and mental health.
    Type of Medium: Online Resource
    ISSN: 1471-3012 , 1741-2684
    URL: Article
    DOI: 10.1177/1471301219831530
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2084045-7
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  • 9
    Online Resource
    Online Resource
    Experiences of end of life amongst family carers of people with advanced dementia: longitudinal cohort study with mixed methods
    Springer Science and Business Media LLC ; 2017
    In:  BMC Geriatrics Vol. 17, No. 1 ( 2017-12)
    Details
    In: BMC Geriatrics, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2017-12)
    Type of Medium: Online Resource
    ISSN: 1471-2318
    URL: Article
    DOI: 10.1186/s12877-017-0523-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2059865-8
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  • 10
    Online Resource
    Online Resource
    The impact of care recipient falls on caregivers
    CSIRO Publishing ; 2013
    In:  Australian Health Review Vol. 37, No. 2 ( 2013), p. 152-
    Details
    In: Australian Health Review, CSIRO Publishing, Vol. 37, No. 2 ( 2013), p. 152-
    Abstract: Objective. This study sought to explore the impact of care recipient falls on caregivers. Methods. Ninety-six community-dwelling caregiver−care recipient dyads participated in a 12-month prospective study. Falls and other accidents and service use were recorded. Dyads were assessed at baseline and after each fall. Assessment included the Zarit Burden Interview and a post-accident survey developed for the present study. Focus groups were then conducted to further explore the impact of falls on caregivers. Results. Fifty-four care recipients (56%) experienced falls within the 12 months of the study. There was a significant increase in caregiver burden after the first fall (Zarit Burden Interview score increased from 24.2 ± 14.2 to 27.6 ± 14.5, P  〈  0.01). Twenty-four percent of caregivers reported that they had altered their usual routine after the fall, mainly not wanting to leave the care recipient alone. However, there was no increase in the number of services used. Focus group discussions highlighted the need for constant vigilance of the care recipient, a lack of knowledge about support services and concerns related to utilising respite care. Conclusion. Falls among care recipients have a significant impact on carers, including an increased fear of falling, prompting the need for even closer vigilance. What is known about the topic? Falls are a significant problem for older people as one in three older people fall each year and injurious falls are the leading cause of injury-related hospitalisation in older people. In Australia falls cost the economy over $500 million per year. What does this paper add? This paper adds a unique perspective to the falls literature, that of the older person’s carer. Falls are a significant problem for community-dwelling carers of older people, contributing to carer burden and impeding the carer’s ability to undertake activities of daily living because of the perceived need for constant vigilance to prevent the person they care for from falling. What are the implications for practitioners? Practitioners should ensure that carers are aware of evidence-based falls-prevention practices and services, such as group and individual exercise programs, home modifications and podiatry, that might assist to prevent falls in the person they care for and therefore reduce the burden of care.
    Type of Medium: Online Resource
    ISSN: 0156-5788
    URL: Article
    DOI: 10.1071/AH12168
    Language: English
    Publisher: CSIRO Publishing
    Publication Date: 2013
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