Challenges, solutions and future directions for public health innovations targeting dementia prevention for rural and remote populations

Currently, individuals living in rural and remote areas experience 1.4 times the total burden of chronic disease, including an 80% greater risk of late-life cognitive impairment and dementia, 2.5 times the number of preventable hospitalisations and a reduced life expectancy of up to 12 years compared to their metropolitan counterparts. Traditionally, health service planning and public health interventions have been largely built on the needs and characteristics of metropolitan populations. This disproportional focus can contribute to significant physical and cognitive health status disparities for rural and remote communities. This article focuses on existing challenges and strategies surrounding the cognitive health of rural and remote populations and provides short and long-term opportunities involving Australian public health policy and clinical practice to innovate dementia prevention for rural and remote communities

A Handheld Fine-Grained RFID Localization System with Complex-Controlled Polarization

There is much interest in fine-grained RFID localization systems. Existing systems for accurate localization typically require infrastructure, either in the form of extensive reference tags or many antennas (e.g., antenna arrays) to localize RFID tags within their radio range. Yet, there remains a need for fine-grained RFID localization solutions that are in a compact, portable, mobile form, that can be held by users as they walk around areas to map them, such as in retail stores, warehouses, or manufacturing plants. We present the design, implementation, and evaluation of POLAR, a portable handheld system for fine-grained RFID localization. Our design introduces two key innovations that enable robust, accurate, and real-time localization of RFID tags. The first is complex-controlled polarization (CCP), a mechanism for localizing RFIDs at all orientations through software-controlled polarization of two linearly polarized antennas. The second is joint tag discovery and localization (JTDL), a method for simultaneously localizing and reading tags with zero-overhead regardless of tag orientation. Building on these two techniques, we develop an end-to-end handheld system that addresses a number of practical challenges in self-interference, efficient inventorying, and self-localization. Our evaluation demonstrates that POLAR achieves a median accuracy of a few centimeters in each of the x/y/z dimensions in practical indoor environments

Morality or competence? The importance of affirming the appropriate dimension of self-integrity

Objectives: Two studies explored the relative efficacy of a morality-based versus a competence-based self-affirmation manipulation at increasing acceptance of personally relevant health-risk information. In accordance with prior theorising (e.g., Cohen & Sherman, 2014), it was hypothesized that the morality affirmation would be more effective than the competence affirmation in such contexts, as the former targets a different domain to that threatened by the health-risk information. Design: Both studies employed a cross-sectional experimental design. Methods: Participants were presented with a morality affirmation, competence affirmation or no affirmation control prior to reading a message about the risks of (a) not engaging in daily dental flossing (Study 1) and (b) red meat consumption (Study 2). Participants subsequently completed a number of measures assessing acceptance of the message. Results: In line with predictions, findings from both studies demonstrated that the morality affirmation precipitated greater acceptance of personally relevant health-risk information compared to the competence affirmation, as reflected in more positive attitudes (Studies 1 and 2) and intentions (Study 1). Study 2’s findings further suggested that the superior efficacy of the morality affirmation in health-related contexts could not simply be attributed to a general tendency for this affirmation to outperform the competence affirmation. Conclusions: The nature of the value affirmed may be a critical factor in determining the success of self-affirmation manipulations in health-related domains

3D Self-Localization of Drones using a Single Millimeter-Wave Anchor

We present the design, implementation, and evaluation of MiFly, a self-localization system for autonomous drones that works across indoor and outdoor environments, including low-visibility, dark, and GPS-denied settings. MiFly performs 6DoF self-localization by leveraging a single millimeter-wave (mmWave) anchor in its vicinity - even if that anchor is visually occluded. MmWave signals are used in radar and 5G systems and can operate in the dark and through occlusions. MiFly introduces a new mmWave anchor design and mounts light-weight high-resolution mmWave radars on a drone. By jointly designing the localization algorithms and the novel low-power mmWave anchor hardware (including its polarization and modulation), the drone is capable of high-speed 3D localization. Furthermore, by intelligently fusing the location estimates from its mmWave radars and its IMUs, it can accurately and robustly track its 6DoF trajectory. We implemented and evaluated MiFly on a DJI drone. We demonstrate a median localization error of 7cm and a 90th percentile less than 15cm, even when the anchor is fully occluded (visually) from the drone

A comprehensive overview of social network measures for older adults : a systematic review

Objectives: The size and type of older adults' social networks is associated with health, mental and social outcomes. Investigators within many disciplines are now measuring social networks, but it is not always clear what they are assessing, or which measures may best meet their objectives. To undertake a systematic review to identify (i) social network measures used for older adults, (ii) variety of social network dimensions and (iii) how measures have developed over time. Materials and Methods: The MEDLINE, EMBASE, CINAHL, PsycInfo and Cochrane Library databases were systematically searched to identify social network instruments, followed by categorization of the domains into quantitative, qualitative and alter domains. Results: A total of 229 studies and 21 social network measures were included, with 11 quantitative dimensions (e. g., size, frequency), 5 qualitative dimensions (e.g., support satisfaction, emotional bond) and 7 alter members (e. g., family, neighbours) of social networks identified. Measures commonly clustered on quantifiable network size (n = 19), availability of supportive networks (n = 14) and presence of family ties (n = 21). The period between 1985 and 1995 produced the greatest number of newly developed social network measures (n = 10) with a stronger focus on qualitative features. Discussion and Implications: This review provides researchers with an organized summary of measures and dimensions for consideration when appraising social connections in older adults. This can enable better study design through providing information that makes explicit inevitable trade-offs between survey length, comprehensiveness of dimension coverage, and utilization of the measure for researchers

Social interactions and quality of life of residents in aged care facilities : a multi-methods study

Background. The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents' interpersonal interactions and quality of life (QoL). Materials and methods. A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30-17:30 on weekdays. Observations included residents' actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed. Results. A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7-49.8), alone (47.9%, 95%CI 43.0-52.7) and being inactive (25.6%, 95%CI 22.5-28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9-22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0-23.0). Residents' interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9-35.7), residents' own room (26.7%, 95%CI 21.0-32.4) or the dining room (24.6%, 95%CI 18.9-30.2), and was most likely with another resident (54.8%, 95%CI 45.7-64.2). Quality of life scores were low (median = 0.68, IQR = 0.54-0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008). Discussion and conclusions. Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing

Quality of life measurement in community-based aged care : understanding variation between clients and between care service providers

Background: Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets. Methods: A retrospective sample of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients’ QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients’ electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets. Results: Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0– 1, SD = 0.15). After accounting for other factors, being older (p < 0.01), having lower-level care needs (p < 0.01), receiving services which met needs for assistance with activities of daily living (p < 0.01), and having higher levels of social participation (p < 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% (n = 4) had lower mean risk-adjusted QoL scores than expected (< 95% control limits) and 16% (n = 3) had higher mean scores than expected. Conclusion: Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support

Systematic review of 29 self-report instruments for assessing quality of life in older adults receiving aged care services

Background: Quality of life (QoL) outcomes are used to monitor quality of care for older adults accessing aged care services, yet it remains unclear which QoL instruments best meet older adults', providers' and policymakers' needs. This review aimed to (1) identify QoL instruments used in aged care and describe them in terms of QoL domains measured and logistical details; (2) summarise in which aged care settings the instruments have been used and (3) discuss factors to consider in deciding on the suitability of QoL instruments for use in aged care services. Design: Systematic review. Data sources: MEDLINE, EMBASE, PsycINFO, Cochrane Library and CINAHL from inception to 2021. Eligibility criteria: Instruments were included if they were designed for adults (>18 years), available in English, been applied in a peer-reviewed research study examining QoL outcomes in adults >65 years accessing aged care (including home/social care, residential/long-term care) and had reported psychometrics. Data extraction and synthesis: Two researchers independently reviewed the measures and extracted the data. Data synthesis was performed via narrative review of eligible instruments. Results: 292 articles reporting on 29 QoL instruments were included. Eight domains of QoL were addressed: physical health, mental health, emotional state, social connection, environment, autonomy and overall QoL. The period between 1990 and 2000 produced the greatest number of newly developed instruments. The EuroQoL-5 Dimensions (EQ-5D) and Short Form-series were used across multiple aged care contexts including home and residential care. More recent instruments (eg, ICEpop CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT)) tend to capture emotional sentiment towards personal circumstances and higher order care needs, in comparison with more established instruments (eg, EQ-5D) which are largely focused on health status. Conclusions: A comprehensive list of QoL instruments and their characteristics is provided to inform instrument choice for use in research or for care quality assurance in aged care settings, depending on needs and interests of users