Ethics of Research with Older Australians

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CERHC Pilot Phase 2: Report to the Aged Care Quality and Safety Commission

The aim of the current project is to devise an appropriate set of questions for the development of consumer experience reports that can be published to support consumer decision-making about home- and community-based aged care services.</p

What factors influence nursing home use of hospital avoidance programs? An interview study

Aims: To understand why some nursing homes use hospital avoidance programs more frequently than others. Design: Two hospital avoidance programs, called residential-in-reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. Methods: Between 2014 and 2018, 127 semi-structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential-in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. Results: Nursing home reliance on residential-in-reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents.  Conclusion: The residential-in-reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential-in-reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. Impact: The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.</p

Sexuality, sexual health and older people: A systematic review of research on the knowledge and attitudes of health professionals

Objectives: Sexuality remains important to older people and should be recognised as an important part of their overall care. However, this appears to be poorly understood and addressed by many healthcare professionals. This systematic review reports on knowledge and attitudes of health professionals towards sexuality and sexual health of older people, including factors that impact knowledge and perceptions. Review methods and data sources: The review, conducted using Joanna Briggs Institute methods, included 23 studies of varied methodology published between January 2004 and January 2015. Results: Findings indicated that healthcare professionals often consider older people's sexuality as outside their scope of practice and there is lack of knowledge and confidence in this area. Cultural norms and taboos, length of time spent working with older people, familiarity with the older person, previous training and degree of exposure to people who are not heterosexual were all identified as factors that impact knowledge and attitude. Conclusions: Better role modelling and education are needed to improve knowledge and attitudes toward later life sexuality

Key components of system stewardship in Australia: A scoping review, Stage 1 and 2

In March 2021, the Final Report of the Australian Royal Commission into Aged Care Quality and Safety recommended that the Department of Health and Aged Care focus on stewardship of the aged care system and all its components. Funds were allocated in the 2021-22 Budget to strengthen the governance of aged care by creating a local network of department staff. The initial rollout, from 1 July 2021, involved establishing a regional presence in eight Primary Health Network (PHN) regions across Australia. Further funding was provided in the 2022-23 Budget to continue the regional stewardship approach.The Department of Health and Aged Care has recognised that implementing stewardship requires a continuous improvement approach and that a developmental evaluation would assist to achieve this goal. Clear Horizon was commissioned to undertake this evaluation, which included a literature review in its early stages. The focus of the literature review was on system stewardship:Stage 1: What is systems stewardship?Stage 2: Is a systems stewardship approach effective?▪ How is effectiveness defined?▪ What is the impact of systems stewardship on systems, staff, and clients?▪ What conditions are associated with successful implementation of systems stewardship?This first report (Stage 1) addressed the first of these questions. This report (Stage 2) incorporates evidence on questions relevant to the effectiveness of systems stewardship in more detail.</p

Pastoral Care in Aged Care Settings: Role and Challenges

This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral practitioners (n = 40) employed by a major Australian aged care provider. The survey covered the purpose of pastoral care, key tasks and resources, current and future challenges, and participants’ responses to challenges. The biggest issue was heavy demand on participants’ time, due to insufficient staff and demanding organisational procedures. A commonly mentioned challenge with future implications was increasing resident acuity. Respondents were dedicated and enthusiastic, despite heavy workloads and occasional difficulty working with care staff or management.</p

Organisational enablers and barriers to the recognition of sexuality in aged care: A systematic review

Aim: To identify organisational characteristics and practices that promote or inhibit the recognition of sexuality in the care of older people in health and aged care settings. Background: Sexuality in old age is poorly understood by health professionals and rarely addressed in care planning and delivery. Nurse managers are ideally placed to lead organisations in promoting a culture of acceptance that enables the expression of sexuality. Evaluation: A search for research/expert opinion papers published from January 2004 to February 2017 was undertaken. Two reviewers performed data extraction and appraisal of 34 included studies using Joanna Briggs Institute tools. The primarily qualitative research was analysed to identify 152 findings that were organised into 22 categories and combined into four syntheses. Key issue(s): An organisation's philosophies frame the way older people's sexuality is perceived. Cultivating a culture and environment of acceptance, engagement and knowledge and delivering care in a way that promotes opportunity for safe and private expression of sexuality are key enabling factors. Conclusion(s): Organisations and nurse leaders can support and facilitate older adults’ expression of their sexuality through the review and development of philosophies, policies, procedures, staff attitudes and knowledge and the creation of a conducive environment. Implications for Nursing Management: Nurse managers play a pivotal role in developing a sexuality-positive organisational ethos by ensuring policies, care practices, the environment and amenities are supportive of the expression of sexuality and by role modelling attitudes of respect and inclusivity

Let's talk about sex: older people's views on the recognition of sexuality and sexual health in the health-care setting.

Objective: To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals’ recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care. Review methods: The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health-care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible. Results: A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies – seven quantitative, eight qualitative and three opinion papers – met the inclusion criteria and were appraised. The importance of sexuality to well-being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health-care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings. Conclusions: Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health-care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment

Hanging on to Some Autonomy in Decisionmaking: How do Spouse Carers Support this?

In Australia, the majority of people with dementia live in the community with informal care provided by family, commonly a spouse. A diagnosis of dementia is a threat to one’s personhood and is often accompanied by perceptions of future dependency, which will involve the inability to carry out conventional roles and complete everyday tasks including making decisions. Being able to make decisions, however, is part of being a ‘person’ and it is through relationships that personhood is defined and constructed. In face-to-face interviews with seven couples (a carer and person with dementia dyad) and two spouse carers, this study explored why, and how, spouse carers support continued involvement in decision-making for people with dementia. The findings highlight the importance of loving and respectful relationships in the development of strategies to support continued decision-making for people with dementia

Research priorities in residential aged care services: A statewide survey

Objectives: To ascertain the research priorities of staff working in Victorian residential aged care services (RACS). Method: In October 2016, all 754 Victorian RACS were asked to list three most important research priorities in a confidential postal survey. Descriptive statistics and content analysis were used to analyse the data. Results: One hundred and sixty-two (21.5%) RACS participated. Research priorities, in order of importance, were grouped thematically as workforce issues, strategies to manage residents with dementia and funding to the sector. Staffing numbers and mix, particularly nurse-to-resident ratios, dominated workforce issues. The management of responsive behaviours was highlighted as a pressing clinical issue, and insufficient funding to the sector impacted on most issues reported. Conclusions: The research priorities identified were inter-related. Some were already well researched, suggesting RACS staff have little time and/or limited access to research evidence to inform the care and management of residents, possibly because of inadequate staffing and funding