Benefits and Challenges of Assistance Dogs for Families of Children on the Autism Spectrum: Mothers' Perspectives.

Assistance dogs are a potential intervention for families of children on the autism spectrum to support participation. However, the lived experience of families with new assistance dogs has not previously been explored. This study described the expectations, benefits, and challenges of assistance dog ownership for families of children on the autism spectrum. Data were collected from four mothers through semi-structured interviews and photovoice prior to assistance dog placement and following 6 months of ownership. Findings indicated assistance dog ownership enhanced the child's self-regulation and socialization, and increased participation in daily routines. Having an assistance dog also enhanced participation in family outings and activities. Challenges included the adjustment period and the lack of public awareness of autism assistance dogs.

'At the End of the Day, It's Love': An Exploration of Relationships in Neurodiverse Couples.

Most autistic people report challenges in initiating and developing intimate, long-term relationships. We used a phenomenological approach to interview thirteen people who were in a neurodiverse intimate relationship (where one partner had a diagnosis of autism) in order to explore the challenges and facilitators both neurotypical and autistic partners experienced. Analysis revealed that ND relationships progressed along similar pathways as non-ND relationships. Facilitators included the strength-based roles that each partner took on and the genuine support and care for each other. Challenges were reported in communication, difficulties reading and interpreting emotions, and idiosyncratic characteristics of the autistic partner. Strategies that both partners used to cope with these challenges and their perspectives of relationship-support services are also presented.

Kinematic and perceptual responses in heavy lifting and pulling: Are there differences between males and females?

This study investigated kinematic and perceptual differences between the sexes in a heavy lifting and pulling task. A 20 kg box was lifted from floor to chest height, and a 70 kg mannequin pulled across 20m. The effect of height, mass and average grip strength on kinematics and perceived workload was examined in 42 (19 females, 23 males) healthy individuals. A univariate linear regression analysis found females lifted with greater lumbar extension compared to males (p < 0.001), and adopted more hip (p = 0.006) and knee flexion (p = 0.036) in the pulling task. Females reported a greater perceived workload in both tasks (p < 0.001). After the multivariable analysis, only grip strength remained significant for perceived workload in the lift (p = 0.04), and height for knee flexion in the pull (p = 0.009). This highlights that height and strength are important factors driving kinematics and perceived workload. Clinicians may consider these factors in heavy manual tasks, more so than sex.

Perspectives of older adults regarding barriers and enablers to engaging in fall prevention activities after hospital discharge.

Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6-month period post-discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6-month post-discharge using semi-structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.

Pet ownership and its influence on mental health in older adults.

Objectives: With aging, older adults are at risk of a decline in mental health as they experience significant life stressors that are specific to later life. It is thus important to explore the potential of suitable approaches that promote healthy aging, to address the mental health needs of older adults. Pet ownership has been found to be associated with positive mental health outcomes; however, there is limited research on the lived experience and meaning derived from pet ownership. The purpose of this study was to explore pet ownership in community-dwelling older adults and its influence on mental health.Methods: Semi-structured interviews were conducted with 14 community-dwelling older adults who were aged 65 and above and pet owners. Participants were interviewed individually on a single occasion about the meaning derived from the role of pet ownership and howthey perceived that their pet influenced their mental health.Results: Results were analysed using Colaizzi's phenomenological framework and four themes emerged from the interviews: pets provide (i) comfort and safety; (ii) social inclusion and participation; (iii) purposeful routine and structure; and (iv) a meaningful role.Conclusion: These findings suggest that the role of pet ownership may benefit community-dwelling older adults by providing companionship, giving a sense of purpose and meaning, reducing loneliness and increasing socialisation. These benefits may also increase resilience in older adults against mental health disorders, which may positively influence their mental health outcomes.

Understanding the Relationship Between Pet Ownership and Physical Activity Among Older Community-Dwelling Adults-A Mixed Methods Study.

Pet ownership is associated with increased levels of physical activity (PA) in older adults. Studies have mainly focused on the association between PA and dog walking; however, broader aspects of pet ownership may influence PA. The purpose of this study was to explore the association between pet ownership and incidental and purposeful PA using a mixed methods approach. Participants' (N = 15) PA was measured for 7 days using accelerometers and diaries. Semistructured interviews explored participants' perspectives regarding pet-related activities. Participants' mean (SD) daily step count was 14,204 (5,061) steps, and mean (SD) sedentary time per day was 8.76 (1.18) hr. Participants strongly concurred that their pets were an integral part of their daily lives. Incidental and purposeful PA resulted from participants undertaking pet care and socially interacting with their pets. Pets may interrupt sedentary behaviors by nudging older adults to engage in PA as part of their daily lived experience.

Linking knowledge and attitudes: Determining neurotypical knowledge about and attitudes towards autism.

"Why are neurotypicals so pig-ignorant about autism?" an autistic person wrote on the Curtin Autism Research Group's on-line portal as a response to a call for research questions. Co-produced with an autistic researcher, knowledge about and attitudes towards autism were analysed from 1,054 completed surveys, representing the Australian neurotypical adult population. The majority, 81.5% of participants had a high level of knowledge and 81.3% of participants had a strong positive attitude towards autism. Neither age, nor education level had an impact on attitudes. However, attitudes were influenced by knowledge about 'Societal Views and Ideas'; 'What it Could be Like to Have Autism'; and the demographic variables 'Knowing and having spent time around someone with autism'; and gender (women having more positive attitudes than men). Thus, targeted interventions, geared more towards men than women, to increase knowledge about autism could further improve attitudes and increase acceptance of the autistic community.

Evaluation of Tailored Falls Education on Older Adults' Behavior Following Hospitalization.

BACKGROUND: Older adults recently discharged from the hospital are known to be at risk of functional decline and falls. This study evaluated the effect of a tailored education program provided in the hospital on older adult engagement in fall prevention strategies within 6 months after hospital discharge. METHODS: A process evaluation of a randomized controlled trial that aimed to improve older adult fall prevention behaviors after hospital discharge. Participants (n = 390) were aged 60 years and older with good cognitive function (greater than 7 of 10 Abbreviated Mental Test Score), discharged home from three hospital rehabilitation wards in Perth, Australia. The primary outcomes were engagement in fall prevention strategies, including assistance with daily activities, home modifications, and exercise. Data were analyzed using generalized linear modeling. RESULTS: There were 76.4% (n = 292) of participants who completed the final interview (n = 149 intervention, n = 143 control). There were no significant differences between groups in engagement in fall prevention strategies, including receiving instrumental activity of daily living (IADL) assistance (adjusted odds ratio [AOR] = 1.3 [95% confidence interval {CI} = 0.7-2.1]; P = .3), completion of home modifications (AOR = 1.2 [95% CI = 0.7-1.9]; P = .4), and exercise (AOR = 1.3 [95% CI = 0.7-2.2]; P = .3). There was a high proportion of unmet ADL needs within both groups, and levels of participant dependency remained higher at 6 months compared to baseline levels at admission. The proportion of all participants who engaged in exercise following hospital discharge increased by 30%; however, the mean duration of exercise reduced from 3 hours per week at baseline to 1 hour per week at 6-month follow-up (SD = 1.12 hours per week). CONCLUSION: Tailored education did not increase older adult engagement in fall prevention strategies after hospital discharge compared to usual care. Further research is required to evaluate older adults' capacity to change their behaviors once they return home from hospital, which may enable a safer recovery of their independence. J Am Geriatr Soc 67:2274-2281, 2019.

Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: protocol for a process evaluation.

INTRODUCTION: Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. METHODS AND ANALYSES: This prospective observational cohort study is a process evaluation of a randomised controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring greater than 7/10 on the Abbreviated Mental Test Score. Participants are being discharged from hospital rehabilitation wards in Perth, Western Australia, and followed up for 6 months postdischarge. Primary outcome measures for the process evaluation are engagement in falls prevention strategies, including exercise, home modifications and receiving assistance with activities of daily living. Secondary outcomes will measure capability, motivation and opportunity to engage in falls prevention strategies, based on the constructs of the Capability Opportunity Motivation Behaviour system. Quantitative data are collected at baseline, then at 6 months postdischarge using structured phone interviews. Qualitative data are collected from a purposive sample of the cohort, using semistructured in-depth phone interviews. Quantitative data will be analysed using regression modelling and qualitative data will be analysed using interpretive phenomenological analysis. ETHICS AND DISSEMINATION: Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees.

Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis.

BACKGROUND: older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. METHODS: literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager®. RESULTS: sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). CONCLUSION: the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

Effectiveness of falls prevention interventions for older adults newly discharged from hospital: a systematic review protocol.

REVIEW OBJECTIVE: The objective of this review is to synthesize the best available evidence on the effectiveness of falls prevention interventions provided just prior or immediately after discharge from hospital on falls rates and falls injuries among older adults living in the community in the first 6 months after discharge from hospital.

Factors associated with negative co-parenting experiences in families of a child with autism spectrum disorder.

PURPOSE: The purpose of this study was to identify key factors associated with negative co-parenting experiences in parents raising a child with autism spectrum disorder. METHODS: Questionnaires were sent to families with one or more children with a diagnosis of autism spectrum disorder. Parents of 142 children with autism spectrum disorder indicated that the diagnosis had a very negative impact on their co-parent relationship. A multivariate logistic regression model was run to analyze the association of these experiences with various demographic, family and community factors. RESULTS: Three factors were associated with negative co-parenting relationships: (1) family stress due to the child's diagnosis, (2) effects of the diagnosis on parents' relationship with their other children and (3) distance travelled to the nearest medical facility. CONCLUSIONS: Findings highlight the need to further explore family dynamics, particularly the relationships between the co-parenting alliance, other family members and the extra-familial environment.

Exploring the experiences of people with the dual diagnosis of acquired brain injury and mental illness.

PRIMARY OBJECTIVE: People with the dual diagnosis of acquired brain injury and mental illness (ABI/MI) are vulnerable to a range of negative life experiences, which has received limited attention in the literature. The objective of the project described in this paper was to identify and describe these experiences in order to distinguish barriers and facilitators to successful rehabilitation and recovery. RESEARCH DESIGN: The project used qualitative methodologies. METHODS AND PROCEDURES: The 15 participants were eight people with ABI/MI, two family members and five support workers. Nineteen interviews were conducted. Analysis of these interviews produced a set of five key themes, with each theme elaborated by a set of descriptive issues. MAIN OUTCOMES AND RESULTS: The five themes were loss, personal development, occupation, family and services. The experiences of people with ABI/MI were strongly negative. They faced more barriers than facilitators to recovery. Current policies and practices were inadequate. CONCLUSIONS: Enhanced stakeholder collaboration and co-ordination and a more individualized, long-term perspective on the needs of people with ABI/MI are recommended to guide future policy and practice. Future research on quality-of-life, wellbeing, community inclusion and participation in ordinary life was recommended.