Allied health clinical supervision: An opportunity lost.

This study investigated clinical supervision with Allied Health professionals in a public health setting. Staff perceptions and experiences were explored through focus group discussions. Key themes identified that supervisees "tip-toe into complexity" by engaging in reflective practice for incremental personal and professional development. In contrast, supervisors identified that reflexivity was required for the opportunity to "develop at a deeper level". Offering a choice of supervisor and providing supervisor training enhanced supervision experiences. Challenges to effective supervision were identified. Competing priorities, inconsistent modes of delivery, major organisational change and the role of clinical supervision in line with professional development confounded the experiences. Health managers could improve the processes and outcomes by implementing consistency with approach, timing, documentation, language, and structure of Clinical Supervision.

Appropriate and acceptable health assessments for people experiencing homelessness.

BACKGROUND: Appropriate and acceptable recruitment strategies and assessment tools are essential to determine the health needs for people experiencing homelessness. Based on a systematic review and known feasible community-based health assessments for people who are not homeless, a set of health assessments were trialled with people experiencing homelessness. METHODS: Participants were recruited via support agencies. They completed a health risk assessment, demographic and self-report health questionnaires, and objective assessments across 17 domains of health. RESULTS: Fifty-three participants (43.3% female, mean age 49.1 years) consented and completed 83-96% of assessments. Consent was reversed for assessments of grip, foot sensation, body measures (11%), and walking (30%), and initially refused for stress, sleep, cognition (6%); balance, walk test (9%) and oral examination (11%). There was one adverse event. Most assessments were both appropriate and acceptable. Some required modification for the context of homelessness, in particular the K10 was over-familiar to participants resulting in memorised responses. Recruitment strategies and practices must increase trust and ensure participants feel safe. CONCLUSIONS: This set of health assessments are appropriate and acceptable for administration with people experiencing homelessness. Outcomes of these assessments are essential to inform public and primary health service priorities to improve the health of people experiencing homelessness.

Integrating community participation in the transition of older adults from hospital to home: a scoping review.

INTRODUCTION: Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?" MATERIALS AND METHODS: This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity. RESULTS: Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five studies reported interventions and four reported improved components of community participation. Numerous barriers to community participation were identified, with recommendations for future transition care services considered. CONCLUSION: There are considerable barriers to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life.IMPLICATIONS FOR REHABILITATIONCommunity participation is an important component of healthy ageing which health professionals should consider beyond discharge.Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults.Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities.

Balance provocation tests identify near falls in healthy community adults aged 40-75 years; an observational study.

BACKGROUND: Near falls, such as stumbles or slips without falling to the ground, are more common than falls and often lead to a fall. PURPOSE: The objective of this study was to investigate which balance tests differentiate near fallers from fallers and non-fallers. METHODS: This cross-sectional, observational study assessed balance in healthy community dwelling adults aged 40-75 years. Participants reported falls and near falls in the previous 6 months. Balance testing was completed in the local community for static (i.e. feet together and single-leg stance) and dynamic balance (i.e. tandem walk, Functional Movement Screen hurdle step and lunge). Between-group comparative analysis of pass-fail for each balance test was undertaken. RESULTS: Of 627 participants, there were 99 fallers (15.8%), 121 near fallers (19.3%) and 407 non-fallers (64.9%). Near fallers were twice as likely as non-fallers to fail single-leg stance eyes (OR 2.7, 95% CI 1.5-4.9), five tandem steps (OR 2.5, 95% CI 1.5-5.7), hurdle step (OR 2.9, 95% CI 1.4-5.8), and lunge (OR 2.5. 95% CI 1.5-4.1). The predictive capacity differentiates near fallers with a sensitivity of 73.3%. DISCUSSION: A new battery of tests assessing static and dynamic balance identifies near fallers in seemingly healthy, community dwelling middle- and young-older-aged adults.

Inertial Sensor Reliability and Validity for Static and Dynamic Balance in Healthy Adults: A Systematic Review.

Compared to laboratory equipment inertial sensors are inexpensive and portable, permitting the measurement of postural sway and balance to be conducted in any setting. This systematic review investigated the inter-sensor and test-retest reliability, and concurrent and discriminant validity to measure static and dynamic balance in healthy adults. Medline, PubMed, Embase, Scopus, CINAHL, and Web of Science were searched to January 2021. Nineteen studies met the inclusion criteria. Meta-analysis was possible for reliability studies only and it was found that inertial sensors are reliable to measure static standing eyes open. A synthesis of the included studies shows moderate to good reliability for dynamic balance. Concurrent validity is moderate for both static and dynamic balance. Sensors discriminate old from young adults by amplitude of mediolateral sway, gait velocity, step length, and turn speed. Fallers are discriminated from non-fallers by sensor measures during walking, stepping, and sit to stand. The accuracy of discrimination is unable to be determined conclusively. Using inertial sensors to measure postural sway in healthy adults provides real-time data collected in the natural environment and enables discrimination between fallers and non-fallers. The ability of inertial sensors to identify differences in postural sway components related to altered performance in clinical tests can inform targeted interventions for the prevention of falls and near falls.

Simulation and coaching to prevent aggressive events in aged care: A pilot study.

OBJECTIVES: Evaluation of simulation and coaching training to change the self-efficacy of aged care workers to prevent and manage workplace aggressive events. METHODS: Seventeen aged care workers from a community and residential aged care service provider completed education modules and two half-days of simulation using actors and real-life scenarios, with real-time coaching. Carer self-efficacy to identify, prevent and manage anxiety and aggression was measured before, following and six months after training. RESULTS: After training, participants reported significant improvements in preparedness to prevent and manage aggression, identify and manage triggers in their own behaviour, deflect and alter other triggers, and felt safer in the workplace. Six months after training, participants' self-efficacy remained above baseline for all measures and remained significantly improved for feeling safer in the workplace. CONCLUSION: This pilot study supports high-fidelity simulation and coaching to improve the self-efficacy of aged care workers to prevent and manage workplace aggressive events.

Older Adults' Experiences of Goals in Health: A Systematic Review and Metasynthesis.

Objective: To synthesize older adults' experiences and perceptions of goal setting and pursuit within health systems. Methods: Six databases were searched to May 2019 using a combination of MeSH and free text terms. Included papers were written in English and reported original qualitative research for participants aged 65 years and older. Participant quotes from the results sections of included studies were gathered for thematic analysis and synthesis. Results: Initial search yielded 9,845 articles, and 134 were identified for full-text review. Fifteen papers were included in the final synthesis. Two main themes were identified: enablers (intrinsic and extrinsic) and barriers (personal and system). Conclusion: Older adults' self-belief is the strongest enabler for goal activities, enhanced by a personalized coaching approach from health staff. Conversely, inconsistent goal terminology confuses patients and reduces engagement. Likewise, fatigue has profound physical and cognitive impact on patients' ability to engage and participate in goals.

Attaining and assessing the Australian interprofessional learning competencies.

Interprofessional collaboration is critical for optimal healthcare. Preparing for a collaborative, practice-ready workforce, the Interprofessional Learning Competencies (IPLCs) were adopted for accreditation of Australian entry-level health, nursing and medical tertiary training programs. In order to meet new accreditation standards, activities which facilitate and assess IPLC attainment must be identified. Interprofessional education programs have not evaluated student interprofessional learning activities using the Australian IPLCs. This project evaluates students' experiences of the IPLCs during 'Inspiring Health,' a community-based interprofessional placement, and determines whether reflections can effectively assess IPLC attainment. Forty-nine students from seven Flinders University health and social science programs completed written reflections about four self-selected IPLCs. The results indicated that students had opportunities to attain all the IPLCs. Their reflections were analyzed using thematic analysis. Three themes were identified: the processes by which students learned, the outcomes of their learning, and the factors that influenced their learning. Ultimately, these findings describe a beneficial community-based interprofessional learning activity for attainment of the Australian IPLCs and provide evidence that student reflections can be used to assess the Australian IPLCs.

Classification of Balance Assessment Technology: A Scoping Review of Systematic Reviews.

Accurate assessment of postural balance is necessary to identify and measure falls risk, inform clinical practice, determine efficacy of treatment and ultimately falls prevention. The aim of this scoping review was to identify gaps and inform practice, research and policy. There are a multitude of technologies available for assessing balance and no one that meets the requirements of every situation. Force plates had provided the gold standard technology for measuring centre of pressure variables as the cornerstone of balance assessment. Inertial measurements units are now considered as valid and reliable, however inertial sensors in smartphone require further refinement to measure with the same degree of accuracy. Fusion systems combine wearable and non-wearable technology in formal gait labs but also gaming. The flexibility provided choice of wearable, non-wearable and fusion systems meets most clinical and research requirements.

Opportunities for Technology-Assisted Healthy Ageing in a Local Government Context.

Current legislation aims to enable older Australians to age in place, and puts public healthcare within the remit of local governments. As Australia's population ages, local governments will need to explore new methods of service delivery in order to meet the increasing need for services that promote healthy ageing. Information technology (IT) may provide one such solution, however older Australian adults are reported to have low levels of technology use. In this simple descriptive qualitative study, focus groups with local government staff and community-dwelling older adults explored their perspectives regarding: a) IT solutions that councils could use to promote community-based healthy ageing, and (b) the enablers and challenges for adopting such solutions. Twenty-four adults participated in focus groups, and eleven of these adults also provided written data in response to visual prompts. Field notes were recorded by attending researchers. These three data sources were combined through narrative synthesis. Local government staff and community-dwellers alike perceived the utility of IT solutions in connecting community members, and connecting people to services (such as transport and providers of health information). While local government staff identified that IT solutions could provide benefits to the council when implemented in conjunction with existing services (e.g., to track data and identify information about community engagement and needs), community-dwellers placed stronger emphasis on adopting technology which had a clear purpose for its use. Due to limited digital literacy and some ambivalence towards embracing technology, IT solutions should be implemented with support to increase digital literacy, be widely advertised, and be centered in community needs. Personas have been generated and provided as possible case studies for technology adoption.

Do two measures of frailty identify the same people? An age-gender comparison.

RATIONALE, AIMS, AND OBJECTIVES: Most frailty assessments have been developed for people aged over 65 years. However, there is growing evidence that frailty is detectable in younger people. This paper tests the hypothesis that the Fried frailty phenotype and the CFS categories identify the same people in age-gender subgroups in community-dwelling 40 to 75-year-olds. METHOD: Participants were recruited via comprehensive community-sampling strategies. They self-reported frailty using the Clinical Frailty Scale (CFS), and frailty was also estimated using the Fried phenotype (self-reported unintended weight loss, exhaustion and low regular exercise; observed slow gait speed and poor grip strength). CFS and Fried scores were compared overall, and for age-gender subgroups (40-49 years, 50-59 years, 60-69 years, and 70-75 years). Spearman rho and differences in mean integer Fried scores were calculated across CFS categories using ANOVA. Correlations were determined between Fried categories of not-frail, pre-frail, and frail and ranked CFS categories, using ranked scores (tau-c) and Cochran-Mantel-Haenszel (C-M-H) tests. RESULTS: Of 656 participants (67% female; mean age 59.9 years, SD 10.6), Fried phenotype classified 59.2% not frail, 39.0% pre-frail, and 1.8% frail, with no gender or age differences. CFS data were missing for 25 participants, with N = 631 reporting categories of very well (24.6%), well (44.6%), managing well (21.9%), vulnerable (6.3%), mildly frail (0.5%), and moderately frail (0.2%). Overall, the mean Fried frailty scores increased incrementally and significantly across ranked CFS categories (P < .01), with weak linear correlation (rho = 0.09). There were variable correlations in age-gender groups, with the best correlation found for women aged 50 years or older, and men aged 60 to 69 years. CONCLUSION: Frailty assessments using the two assessments became more consistent, as age increased. Pre-frailty was identified by both assessments in all age-gender groups. The validity of self-reported CFS, and of pre-frailty criteria relevant to people younger than 65 years, needs investigation.

Contemporaneous patient and health professional views of patient-centred care: a systematic review.

OBJECTIVE: To understand the domains of agreement and disagreement, related to person-centred care, between the patient and healthcare professional during a shared episode of care. DESIGN: A systematic review following the PRISMA protocol searched PubMed (Medline), CINAHL, PsychInfo and Scopus using keywords for health professionals, patients and patient-centred care. A descriptive-interpretive method was used to identify domains described in the person-centred care framework. SETTING: Research conducted in all healthcare settings (inpatient, outpatient, community) were included. PARTICIPANTS: Research which presented the contemporaneous perspectives of a health professional and the person they were providing services to were included. INTERVENTION(S): Research regarding the delivery of any type of health service was included. MAIN OUTCOME MEASURE(S): The person-centred care framework which includes Structure, Process and Outcome as measures for implementing person-centred care was used to interpret and summarize the data. RESULTS: After title and abstract screening against inclusion and exclusion criteria, 15 of 1,406 studies were critically appraised. High levels of contemporaneous agreement were identified for easily accessible, supportive and accommodating environments, where information sharing occurred. Contemporaneous agreement occurred most often between patients and healthcare professionals in the importance of sharing information across all geographical settings, with greatest disagreement of patient involvement in the European and American hospital environments. CONCLUSIONS: Greater understanding of the context of information sharing and drivers for management preferences may support shared decision-making and increase satisfaction. More information regarding contemporaneous experiences of healthcare episodes is required to further inform patient-centred care practices and optimize health outcomes.

Health deficits in community dwelling adults aged 40 to 75 years.

BACKGROUND: Middle and older years are associated with age related health deficits but how early this begins and progresses is poorly understood. Better understanding is needed to address early decline and support healthier ageing outcomes. METHODS: Seemingly healthy, community dwelling adults aged 40 to 75 years were recruited via local council and business networks. They completed online surveys about sleep quality, distress and physical activity, and two hours of objective testing of physiologic and anthropometric measures, mobility, cognition, grip strength, foot sensation, dexterity and functional hearing. Analysis compared outcomes for age, gender, and age and gender groups with population norms for 21 health assessments. The total number of non-compliant tests for each participant was calculated by summing the number of non-compliant tests, and the frequency of these scores across the sample was reported. Gender and age effects were tested using ANOVA models. Combined age and gender categories were used for subsequent logistic regression modelling, with females aged 40-49 years being the default comparator. RESULTS: Of 561 participants (67% female; mean age 60 years (SD 10.3)), everyone had at least one deficit and median deficits was 5 (IQR 2). More than 50% of participants did not meet anthropometric and exercise norms, while 30 to 40% had reduced functional hearing and cognition. Overall, men performed worse and deficits increased with age particularly for physical activity, audiology, mobility, anthropometry, oximetry and foot sensation. Heart rate, body temperature and dyspnoea were the only variables where compliance was within 95% of expected values. Multiple areas of functional decline were found in people aged in their 40s and 50s. CONCLUSIONS: The health deficits identified are mostly mutable hence identification and interventions to address the multi-system functional decline in people as young as 40 has the capacity to ensure healthier ageing.

Feasibility of population screening tests to establish a healthy ageing trajectory.

OBJECTIVES: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40-75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. METHODS: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40-75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. RESULTS: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. CONCLUSION: This screening approach may provide new knowledge on healthy ageing in younger people.