Decision making for people living with dementia by their carers at the end of life: a rapid scoping review.

BACKGROUND: There are an increasing number of people living with dementia, as well as an expectation that care decisions are made collaboratively with those with the disease entering the end stage and their families. This has increased the burden on family carers. AIM: To explore the evidence on the decisional support needs of informal carers of people with end-stage dementia. DESIGN: A rapid scoping review was undertaken of peer-reviewed publications between 2000 and 2016, which included all health-care settings and the person's own home. Six databases were searched (CINAHL, MEDLINE, EMBASE, BNI, PSYCHINFO, Web of Science) and all papers meeting the inclusion criteria were read. A thematic analysis was undertaken of the selected papers using a pragmatic approach based on how the papers addressed the research question. RESULTS: Sixty papers were individually appraised, with 40 being included in the review. Of these papers, 11 were literature reviews and 29 were primary studies. The themes identified were: the influential factors in carer decision making, the scope of carer decision making, the conflicts/problems in carer decision making, the resources carers need to make decisions and the impact of carer decision making. CONCLUSION: To date, the emphasis in dementia care has been on living well with dementia, but realistically there is a need to plan for a 'good death' that includes the person and their carers. There is a need to support people with dementia and their carers to make an advance care plan, while the person with dementia can take part in the decision-making process. This proactive intervention is likely to reduce carer decision burden at end of life and facilitate achievement of death in the person's preferred place, which is usually the home or care home.

REFUGEES IN NAURU.

A report alleging appalling abuse and neglect of refugees and asylum seekers living in detention on Nauru has recently been released based on Amnesty International and Human Rights Watch's investigations. The report detailed inhumane conditions, abuse and assault of detainees including neglect by locals and healthcare providers. The Department of Immigration has lashed out strongly refuting many of the claims in the report. Registered Nurse and citizen of Nauru Sue Barker also says the treatment of refugees and asylum seekers is very different to the one painted by the media. Sue has written to the ANMJ asking to give her account about the humane support refugees and asylum seekers are given by the locals on Nauru.

Addressing older people's mental health needs in the community setting.

It is estimated that more than one third of older people may experience problems with their mental health. While, in some of these cases, people will be able to self-manage with little or no support, individuals who are socially isolated or physically unwell may experience significant mental distress. Community nurses are ideally placed to identify mental health problems in patients who are housebound, and to make appropriate referrals. Yet many nurses report apprehension regarding a perceived lack of knowledge and skills in which to undertake an initial assessment. This article outlines the most common mental illnesses experienced by older people living in the community and provides guidance for community nurses on conducting an initial assessment to ensure that patients' holistic needs are met.

The experiences of older people who live with a long-term condition.

AIM: The aim of this study was to gain insight into the experiences of people aged 65 and older who have learned to live with a pre-existing long-term condition. METHOD: A qualitative approach and the principles of narrative research were used to learn as much as possible about the individuals' stories. A focus group of five men was interviewed and two women were interviewed as a pair. FINDINGS: Existing skills in condition management and interactions with professionals are transferable to new health needs that older people develop, but additional, age-related problems can affect management of long-term conditions. Progressive long-term conditions may become more difficult to manage with age, and it is difficult to distinguish between ageing processes and deterioration of pre-existing long-term conditions. Age-related social and financial changes and society's perception of older people may also present challenges to condition management. CONCLUSION: Nurses who care for older people should take into account the effects of the person's long-term condition and the ageing process when assessing their needs; understand that people may be reluctant to ask for practical assistance; explore existing support mechanisms that people have in place and their sustainability; and advocate with people to secure appropriate choices related to their health needs.

The tip of the iceberg: opportunistic screening for Chlamydia trachomatis in asymptomatic patients attending a young people's health clinic reveals a high prevalence--a pilot study.

OBJECTIVES: We implemented an opportunistic screening programme for Chlamydia trachomatis amongst patients presenting to a young peoples' health service in the city of Geelong, Australia, to define the prevalence of infection and to identify specific risk factors. METHODS: Over a 7-month period sexually active patients attending the young peoples' clinic were offered C. trachomatis screening by nucleic acid amplification test. There was 100% acceptance rate among those offered the test. Patient demographics, reason for presentation at the clinic and reported symptoms were documented by the clinicians and correlated with laboratory findings. RESULTS: 163 patients between the ages of 12-25 were tested, nine males and 154 females. The prevalence of chlamydia infection was 5.8% and was highest (16.0%) among patients presenting for the morning after pill. Inhibition of the nucleic acid amplification test occurred in 11.0% of urine samples. All patients with inhibited tests were asked to provide a repeat sample for retesting, but only 50% complied with this request. The majority of repeat samples (88.9%) had no inhibitors present and yielded a negative result. There was no correlation between symptoms and a positive chlamydia result. CONCLUSIONS: Chlamydia infection is common in young people engaging in unsafe sexual practice and cannot be predicted by the presence of symptoms. The high prevalence of infection in Geelong would make screening cost effective in this age group. Ongoing population screening of sexually active young people should be encouraged in community health centres. Inhibition of the nucleic acid amplification test was common but repeat testing of urine a few days later usually gave satisfactory results.