Identifying age-friendly behaviours for bus driver age-awareness training.

BACKGROUND: Occupational therapists may be involved in advocating for age-friendly bus systems and training bus drivers in age-awareness. In order to develop evidence-based bus driver age-awareness training programs, the specific required bus driver behaviours should be explicated. PURPOSE: This study aims to define, clarify, and illustrate behaviours associated with bus driver friendliness and helpfulness. METHODS: Forty older people (aged 60 and over) in Queensland, Australia, completed a round trip bus journey and subsequent interview. Qualitative content analysis of participant observations with stimulated recall interviews was used to identify categories and themes around friendly and helpful bus drivers. FINDINGS: General professional behaviours included making older people feel safe, courtesy, friendliness, helpfulness and being aware of invisible disabilities and specific professional behaviours included giving time, pulling in close to the curb, communication, and information. IMPLICATIONS: The findings are incorporated into suggestions for a bus driver age-awareness training program.

The role of health professionals in health promotion: a case study of medical imaging technologists and alcohol.

This study aimed to determine the knowledge, attitudes and behaviour of medical imaging technologists (MITs) in Western Australia regarding alcohol. The WA population of 220 MIT members of the Australian Institute of Radiography was surveyed by mail in 2004. Specific questions were devised and piloted covering knowledge of alcohol, alcoholic content and drink size, and related personal behaviour. Responses were obtained from 91 MITs. Overall, they had a good knowledge of key facts related to alcohol. However, this did not always translate into appropriate attitudes and behaviour related to dealing with alcohol abuse. While statistically significant differences were not found according to sex, age group or location (metropolitan or rural), some trends were apparent. This study has found that MITs are not currently as equipped as they should be to be part of the health promotion model of education.

Vision self-management for older adults: a randomised controlled trial.

BACKGROUND/AIMS: Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. METHODS: A two-armed randomised controlled trial of older adults (n=77) with ARVL compared 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains. RESULTS: The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks' follow-up. CONCLUSION: Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.

Vision self-management for older adults: a pilot study.

PURPOSE: The aim of this study was to pilot test the vision self-management programme (VSM) a newly developed, 8-week self-management intervention. The programme is a structured, repeatable and theoretically derived programme for older adults with age-related vision loss (ARVL). METHOD: A pre-and post-test design was used, and involved 12 older adults with ARVL. The activity card sort, a measure of participation in life situations, was the primary outcome measure. Secondary outcome measures examining general health and vision specific domains were also used. RESULTS: Participants reported a statistically significant increase in participation in life situations immediately following the VSM programme. However, whilst an increase in such participation was still present at 12-week follow-up, this was no longer statistically significant. In addition, the participants demonstrated statistically significant gains in both general health and vision specific domains. Although these findings are exploratory they suggest that the VSM may have both short and longer term benefits for older adults living with ARVL. CONCLUSIONS: Overall findings indicate that the participation in the self-management programme resulted in improved participation and health outcomes and support the need for further study using more rigorous designs.

Residents' satisfaction with multi-purpose services.

AIM: To establish a system for measuring resident satisfaction in multi-purpose services, benchmarking and performance improvement. SETTING: Six multi-purpose services in rural New South Wales were involved in the project. DESIGN: Residents were surveyed and the results benchmarked. Benchmarking included a comparison of results along with an exploration of work processes across participating sites. This preceded quality improvement activities conducted by individual multi-purpose services. Resident surveys were repeated and staff and managers interviewed. OUTCOMES: Benchmarking was a useful method for identifying performance leaders and enabling the dissemination of better practice. The majority of staff members were comfortable with the PDSA (Plan, Do, Study, Act) quality improvement cycle to guide their improvement efforts. The ability of staff to complete quality improvement cycles was related to the management styles of their supervisors. Resident satisfaction was related to the understanding and confidence of staff. CONCLUSION: A resident satisfaction survey can provide the direction for effective quality improvement activities. Benchmarking results with other sites not only empowers staff members at those sites recognised as leaders, but can also stimulate dissemination of leading practice. Management styles which empower staff enhance their ability to implement quality improvement projects.

The benefit and burden of "ageing-in-place" in an aged care community.

Ageing-in-place is usually viewed as a positive approach to meeting the needs of the older person, supporting them to live independently, or with some assistance, for as long as possible. It implies that older people prefer to live in their own home, rather than in an institution or care centre. However, there is little in the literature about the implications of ageing-in-place for the individual or their carers, or the burden this can place on service providers and aged care communities. In an action research study that investigated the complexities and challenges of change in an aged care community in Western Australia, the implications of ageing-in-pace were apparent. The study revealed how residents expressed a desire to age-in-place and identified it as a critical element of quality of life and an important component of social connection. The findings also revealed the burden of ageing-in-place on carers, family and the organisation, and sufficient attention must also be paid to the wider impact on the individual, the family and carers.

General practitioners' experiences of managing patients with chronic leg ulceration.

OBJECTIVE: To understand general practitioners' experiences of managing patients with chronic leg ulceration, thus informing future strategies to improve leg ulcer care in general practice, Australia. DESIGN: Qualitative study using phenomenology and in-depth interviewing. PARTICIPANTS AND SETTING: Maximum variation sample of 12 GPs working in the Perth and Hills Division of General Practice between September and December 2004. MAIN OUTCOME MEASURE: Themes in participants' experiences of leg ulcer care. FINDINGS: Participants regarded leg ulcer management as an integral part of general practice. They expressed a desire to maintain their involvement, yet relied on nursing assistance. They perceived that ulcer care was usually straightforward and successful. Approaches to management appeared to differ significantly from that outlined in current guidelines. Instead, participants valued accessibility of care for the patient, awareness of patient context and regular review. Occasional problems with non-healing ulcers were experienced, and, in these situations, specialist opinion was appreciated. CONCLUSION: This study highlights fundamental differences between GP and specialist conceptualisation of leg ulcer care. For GPs, it identifies key areas of ulcer management that could be improved. For specialists, it suggests that widespread implementation of traditional guidelines may not be appropriate or acceptable. New approaches to leg ulcer management in general practice are likely to need a combination of education, human resources and practical support.

High-cost users of hospital beds in Western Australia: a population-based record linkage study.

OBJECTIVE: To describe how high-cost users of inpatient care in Western Australia differ from other users in age, health problems and resource use. DESIGN AND DATA SOURCES: Secondary analysis of hospital data and linked mortality data from the WA Data Linkage System for 2002, with cost data from the National Hospital Cost Data Collection (2001-02 financial year). OUTCOME MEASURES: Comparison of high-cost users and other users of inpatient care in terms of age, health profile (major diagnostic category) and resource use (annualised costs, separations and bed days). RESULTS: Older high-cost users (> or = 65 years) were not more expensive to treat than younger high-cost users (at the patient level), but were costlier as a group overall because of their disproportionate representation (n = 8466; 55.9%). Chronic stable and unstable conditions were a key feature of high-cost users, and included end stage renal disease, angina, depression and secondary malignant neoplasms. High-cost users accounted for 38% of both inpatient costs and inpatient days, and 26% of inpatient separations. CONCLUSION: Ageing of the population is associated with an increase in the proportion of high-cost users of inpatient care. High costs appear to be needs-driven. Constraining high-cost inpatient use requires more focus on preventing the onset and progression of chronic disease, and reducing surgical complications and injuries in vulnerable groups.

Improving mental health services in a local area -- an exploratory study.

The change in the focus of care for people with mental illness from hospital to community has been far from uniformly successful for a variety of reasons. A review of the development of mental health services suggests that the views of doctors and the responses of administrative systems are significant forces in shaping the development of services. This study explored the attitudes of general practitioners, psychiatrists and administrators, with a view to establishing areas of congruence in order to move towards an improved model of service delivery. Recommendations are made in the areas of primary care psychiatry, access, communication and education.

Factors influencing residents' satisfaction in residential aged care.

PURPOSE: The aim of this study was to identify the important factors influencing residents' satisfaction in residential aged care and to provide a better understanding of their interrelationships. DESIGN AND METHODS: A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency levels, and staff satisfaction. A stratified random sampling approach was utilized to select facilities. All residents satisfying the selection criteria (i.e., understand English, be sufficient cognitive competence, have a sufficient energy level to participate in the survey, and live in the facility for more than 4 weeks) and all care staff were invited to participate. A total of 996 residents and 895 staff from 62 facilities (36 hostels and 26 nursing homes) provided the required data. Structural equation modeling was used to examine the interrelationships among three sets of contributing factors, related to the facility, staff and residents, and resident satisfaction components, separately for nursing home and hostel residents. RESULTS: Overall fits of both nursing home and hostel models were satisfactory. This study has revealed that staff satisfaction plays a crucial and central role in determining resident satisfaction in nursing homes, whereas it has less impact in hostels. The provision of more care hours has only a small, yet positive, impact on resident satisfaction. Larger facility size has a negative impact on resident involvement. Older residents were found to be more satisfied with staff care. IMPLICATIONS: The results provide a comprehensive understanding of what influences resident satisfaction. By accounting for important factors identified by residents, a resident-focused care model can be developed and implemented, leading to better service for aged care residents.

Staff satisfaction and its components in residential aged care.

OBJECTIVE: The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care. DESIGN: A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components. SETTING: Seventy residential aged care facilities in Western Australia. STUDY PARTICIPANTS: The sample includes 610 nursing home and 373 hostel care staff. RESULTS: The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction. CONCLUSION: The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.

Measuring job satisfaction in residential aged care.

BACKGROUND: Staff satisfaction has received increasing recognition as an important factor influencing service quality and in particular the quality of residents' lives in residential aged care facilities, where staff typically have a long-term and close relationship with residents. Consequently, a valid and reliable instrument is required to assess staff satisfaction in this particular context. OBJECTIVE: This paper aims to assess the factor structure, reliability, and validity of the Measure of Job Satisfaction (MJS) instrument when used in residential aged care facilities. DESIGN: A cross-sectional survey design was used to collect the required information, and a stratified random sampling method was utilized to select facilities. Exploratory and confirmatory factor analyses were conducted to assess the factor structure of staff satisfaction via the MJS. SETTING: Both high and low care residential aged care facilities in Western Australia. STUDY PARTICIPANTS: Nine hundred and eighty-three staff (including the Director of Nursing, manager, registered nurses, enrolled nurses, nursing assistants, and therapists) in 70 residential aged care facilities. RESULTS: An acceptable five-factor (22-item) measurement model was derived. The Cronbach's alpha reliability levels range from 0.86 to 0.95. Convergent and discriminant validity are also satisfactory. CONCLUSION: This investigation has confirmed that a modified MJS is a reliable and valid instrument for assessing staff satisfaction in residential aged care settings.

Resident satisfaction and its components in residential aged care.

PURPOSE: The purpose of this study was to assess the direction and magnitude of the effects among the components of resident satisfaction in residential aged care and to examine if the relationships among satisfaction components vary according to facility type (i.e., nursing home and hostel). Briefly, a hostel is a low-care facility in which residents are more independent and receive personal but not nursing care. DESIGN AND METHODS: A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was used to select facilities. Structural equation modeling was used to examine relationships among satisfaction components in a sample of 394 nursing home and 752 hostel residents. RESULTS: The results indicate that satisfaction with staff care has a moderate and positive effect on all other aspects of resident satisfaction. The relationships among satisfaction components are different for nursing home and hostel residents. IMPLICATIONS: The findings lead to an improved understanding of the interrelationship among resident satisfaction components, which has important implications for improving quality outcomes (e.g., resident satisfaction) through appropriate intervention (e.g., enhancing staff care).