Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling.

Purpose: Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes. Methods: Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables). Results: Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives. Conclusions: Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.

Objectif: selon les recherches, les physiothérapeutes ont des attitudes et croyances négatives à l'égard de l'obésité et des personnes obèses. Ils sont également soucieux de la santé et investis dans des comportements sains, y compris l'activité physique. Les chercheurs visaient à décrire la relation entre l'orientation vers la santé, l'orientation vers la forme physique et les attitudes vers l'obésité. Méthodologie: les physiothérapeutes (n = 187) et les étudiants en physiothérapie (n = 34) ont rempli un sondage en ligne (échelle d'orientation vers la santé, questionnaire multidimensionnel des relations entre le corps et soi, outil d'évaluation des attitudes envers l'obésité). Les chercheurs ont utilisé la modélisation des équations structurelles pour estimer les associations entre les attitudes envers l'obésité (variables dépendantes) et l'orientation vers la santé et la forme physique (variables indépendantes). Résultats: les participants ont obtenu un résultat élevé à l'égard de l'orientation vers la forme physique et vers la santé. Les chercheurs ont trouvé des associations positives vigoureuses entre l'orientation vers la forme physique et l'orientation vers la santé (p < 0,001). L'orientation vers la santé n'était pas associée de manière significative aux attitudes envers l'obésité (p = 0,075), mais un âge plus avancé était associé à des attitudes plus positives envers l'obésité (p < 0,01). Même si la plupart des participants reconnaissent que des facteurs hors du contrôle individuel contribuent au poids, bon nombre conviennent également avoir des points de vue négatifs normatifs. Conclusions: les physiothérapeutes sont fortement orientés vers la forme physique et la santé, ce qui peut sous-tendre des croyances à l'égard de la contrôlabilité du poids et contribuer à des attitudes négatives envers l'obésité et les personnes obèses. Il faudra réaliser des recherches plus approfondies auprès d'échantillons plus importants pour étudier les associations entre l'orientation vers la santé et les attitudes envers l'obésité de manière plus approfondie.

Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service.

BACKGROUND: Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. METHODS: This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. RESULTS: Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. CONCLUSION: This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.

Dementia care for people from culturally and linguistically diverse backgrounds: Qualitative secondary analysis of the Aged Care Australian Royal Commission data.

OBJECTIVE: Understanding the concerns and experiences of people living with dementia from culturally and linguistically diverse backgrounds is critical to ensure culturally appropriate care is delivered. This study aimed to describe the current experiences and concerns of older people from culturally and linguistically diverse backgrounds using the publicly available evidence from the Australian Royal Commission into Aged Care Quality and Safety. METHODS: This was a qualitative secondary analysis of the Australian Royal Commission into Aged Care Quality and Safety data to explore new and nuanced insights about care for culturally and linguistically diverse people living with dementia. Using the keywords to search the data corpus, we extracted a topic-specific data set focused on dementia care and cultural diversity. Thematic analysis was used to identify and describe the present practices and challenges. RESULTS: Our findings showed that the need for cultural connection for older people from culturally and linguistically diverse backgrounds increases as dementia progresses. Access to culture-specific food and music facilitated connection with their culture of origin. Many older people from culturally and linguistically diverse backgrounds with dementia reverted to their language of origin; however, the inability to communicate due to a lack of language support impacted their health and well-being, and care provision. CONCLUSIONS: Further work is needed to provide the necessary cultural experiences and language support to ensure comfort and equity in the provision of dementia care for Australians from migrant backgrounds.

Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety.

BACKGROUND: The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. METHODS: Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. RESULTS: Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family's fight for liberty. Triangulation across the data and academic literature supports the findings. CONCLUSION: Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a "first resort" care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.

Emergency department transfers from residential aged care: what can we learn from secondary qualitative analysis of Australian Royal Commission data?

OBJECTIVES: To use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care. DESIGN: The Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective. RESULTS: Three overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure. CONCLUSIONS: The results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step.

Working Hard and Pushing Through: A Thematic Analysis of Humanitarian Migrants' Experiences in the Australian Workforce.

Employment can play an important role for humanitarian migrants in their successful integration into a new country. For humanitarian migrants to Australia, there are no skill or language restrictions imposed on resettlement. Despite the benefits, humanitarian migrants often find themselves in low-status jobs and precarious working conditions. The present study examines perceptions of job quality and exposure to workforce psychosocial risk factors such as job strain, bullying, and discrimination. We conducted semi-structured in-depth interviews with 30 humanitarian migrants from South Sudan, Afghanistan, and Iraq. Thematic analysis of transcripts identified three overarching themes: Uncertainty and Insecurity, Working Hard and Pushing Through, and Positive Attitudes and Actions. Overall, our findings show that despite high levels of education and long-term residency in Australia, many of the participants struggled to find a safe and secure place in the workforce. While some spoke about their work in positive terms, their comments should not be taken as confirmation of a positive work environment. Humanitarian migrants face an uphill battle against oppressive working conditions and underemployment.

How Refugees Experience the Australian Workplace: A Comparative Mixed Methods Study.

There is a growing body of evidence indicating poorer working conditions for migrant workers, particularly refugees, compared with native-born workers. Our objectives were to compare exposure to workplace psychosocial stressors in working refugees with other migrant groups and Australian-born workers of Caucasian ancestry and to describe the working experience of refugees. Cross-sectional surveys collected information on the workplace stressors of job complexity, control, security, bullying, and racial discrimination from six migrant groups (n = 1062) and Caucasian Australians (n = 1051); semi-structured face-to-face interviews were used with currently employed refugees (n = 30). Content analysis examined the qualitative data. Compared to all other groups, working refugees were more likely to report experiencing racial discrimination in the workplace and to report exposure to more than three hazards. Content analysis indicated that working refugees are working below their capacity, in terms of hours and qualifications, and in jobs that were low status and lacked security. Despite challenging work conditions, participants reported adequate health and safety training and feeling a sense of pride in their work. These findings highlight the need for better support for refugees in negotiating the workplace once they find employment and the importance of employers providing an inclusive and equitable workplace.