Family carers of older adults

Discusses a piece by Professor Bob Knight (InPsych, December 2016)

Hector's dolphin movement patterns in response to height and direction of ocean swell

<p>A central question to any understanding of ecology is how animals use their habitat, and how habitat use is influenced by temporally changing features of the environment. Previous research on Hector's dolphins at Akaroa Harbour, New Zealand suggested that dolphins leave inshore, harbour environments during or after rough weather. To test this hypothesis, visual sightings (2000–2012) and acoustic detections (2007–2008) of Hector's dolphins in Akaroa Harbour were modelled to test for a relationship with swell height and swell direction. Sighting rates and acoustic detection rates in Akaroa Harbour were significantly lower on days after big swell events and in some linear models after swell events from the south. These results indicate that swell events influence Hector's dolphin movements in and around Akaroa Harbour. Possible reasons for this behaviour are diverse and need further investigation. However, this information can be used both to predict daily dolphin movement for conservation and research purposes, and to suggest how dolphins may react in future if extreme weather events are becoming frequent.</p

The effectiveness of chemical restraint in managing acute agitation and aggression: A systematic review of randomized controlled trials

One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast‐acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre‐hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base

Carers' experiences of accessing and navigating mental health care for older people in a rural area in Australia

© 2017, © 2015 Taylor & Francis. Objectives: Mental health care for older people is primarily delivered in the community and is largely dependent on informal carers. Mental health policy encourages partnerships between carers and service providers to facilitate service access, coordination and positive experience of care. However, carers often lack information and support from services, with the potential for carer burden, and negative impacts on their own health and capacity to fulfil caring tasks. This paper explores rural carers' experiences of accessing care from a range of services for older people with mental health problems. Method: The Pathways Interview Schedule was used to facilitate 9 in-depth care journey interviews with 11 carers of older people with a mental health problem. Interviews explored their journeys to and through mental health, aged care, primary care and social care services. Framework analysis was used to explore carers' experiences and perceptions of care with a focus on access enablers and barriers. Results: Carers had a significant role in navigating services and operationalising care for their relative. Enablers to accessing care included carer knowledge and workers actively involving carers in planning. Barriers included carer mental health literacy, consumer and carer readiness for services, and worker misinterpretation of confidentiality and privacy laws. Conclusion: Carers should be considered key partners in mental health care planning that crosses service sectors. For this to occur, changes are required at the worker level, including increased communication between mental health workers and carers, and the service level, involving training for staff in interpreting confidentiality and privacy policy

Accessing mental health services for older people in rural South Australia

Mental healthcare for older people is primarily delivered in the community with informal carers, usually family providing much of this. Older people often require input from a range of services across sectors

Regional responses to the challenge of delivering integrated care to older people with mental health problems in rural Australia

© 2017 Informa UK Limited, trading as Taylor & Francis Group Integrated care has been identified as means of managing the demands on the healthcare budget while improving access to and quality of services. It is particularly pertinent to rural health services, which face limited access to specialist and support services. This paper explores the capacity of three rural communities in South Australia to deliver integrated mental health support for older people. Methods: Thirty-one interviews were conducted with local health and social service providers from mental health, community health, general practice, residential aged care, private practice, NGOs and local government as part of a larger action research project on service integration. Results: Participants highlighted differences in service delivery between the communities related to size of the community and access to services. Three structural barriers to delivery of integrated care were identified. These are as follows: fragmentation of governmental responsibility, the current funding climate, and centralisation and standardisation of service delivery. Conclusion: We conclude that despite a focus upon integrated care in mental health policy, many features of current service delivery undermine the flexibility and informal relationships that typically underpin integration in rural communities. Objective

Carers' experiences accessing mental health care for older people in South Australia: Mapping the journey

Mental health care for older people is primarily delivered in the community and is largely dependent on input from informal carers. Australian mental health policy encourages partnerships between consumers, carers, and service providers to facilitate service access, coordination, and positive experience of care. In reality, however, carers often lack information and support from services and the consequences of care burden can impact on their own health and capacity to fulfil caring tasks. Older people with mental health problems often require input from a range of services across sectors, which can be challenging for consumers and their carers to navigate. Little is known about carers' experiences in obtaining appropriate care and support from such a broad range of services. This paper explores older people's journeys to and through mental health care from the carers' perspective. Nine in‐depth interviews were conducted with eleven rural carers of people with a mental health concern. Each journey was mapped to illustrate key points in the journey, people involved, key actions, carer experience, and suggested improvements. Two carer journeys are presented (one who successfully negotiated a care journey and one unsuccessful). Framework analysis was used to explore carers' perceptions of enablers and barriers to accessing care. Results highlighted the significant role carers had in navigating options and operationalizing care. Enablers included carer knowledge and roles and the presence of case reviews facilitating collaboration between services and with carers. Barriers included carer issues (mental health literacy), consumer issues (readiness for services), and worker issues (confidentiality). The results indicated that changes need to occur at the worker level (increased communication between mental health workers and carers) and service level (training for staff in interpreting confidentiality and privacy laws). It is concluded that to best manage the health and care of an older person, carers should be considered key partners by mental health nurses in care planning that crosses the service sectors

Testing a model of facilitated reflection on network feedback: A mixed method study on integration of rural mental healthcare services for older people

Objective: To test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people. Design: Participatory mixed methods case study evaluating the impact of a network management model using organisational network feedback (through social network analysis, key informant interviews and policy review). Intervention: A model of facilitated network reflection using network theory and methods. Setting: A rural community in South Australia. Participants: 32 staff from 24 services and 12 senior service managers from mental health, primary care and social care services. Results: Health and social care organisations identified that they operated in clustered self-managed networks within sectors, with no overarching purposive older people's mental healthcare network. The model of facilitated reflection revealed service goal and role conflicts. These discussions helped local services to identify as a network, and begin the problem-solving communication and referral links. A Governance Group assisted this process. Barriers to integrated servicing through a network included service funding tied to performance of direct care tasks and the lack of a clear lead network administration organisation. Conclusions: A model of facilitated reflection helped organisations to identify as a network, but revealed sensitivity about organisational roles and goals, which demonstrated that conflict should be expected. Networked servicing needed a neutral network administration organisation with cross-sectoral credibility, a mandate and the resources to monitor the network, to deal with conflict, negotiate commitment among the service managers, and provide opportunities for different sectors to meet and problem solve. This requires consistency and sustained intersectoral policies that include strategies and funding to facilitate and maintain health and social care networks in rural communities

Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: Protocol for a mixed methods case study

Introduction: An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. Methods and analysis: This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. Ethics, benefits and dissemination: Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group. © 2014, BMJ Publishing Group. All rights reserved

Longitudinal immune profiling reveals key myeloid signatures associated with COVID-19

COVID-19 pathogenesis is associated with an exaggerated immune response. However, the specific cellular mediators and inflammatory components driving diverse clinical disease outcomes remain poorly understood. We undertook longitudinal immune profiling on both whole blood and peripheral blood mononuclear cells of hospitalized patients during the peak of the COVID-19 pandemic in the United Kingdom. Here, we report key immune signatures present shortly after hospital admission that were associated with the severity of COVID-19. Immune signatures were related to shifts in neutrophil to T cell ratio, elevated serum IL-6, MCP-1, and IP-10 and modulation of CD14+ monocyte phenotype and function. Modified features of CD14+ monocytes included poor induction of the prostaglandin-producing enzyme, COX-2, and enhanced expression of the cell cycle marker Ki-67. Longitudinal analysis revealed reversion of some immune features back to the healthy median level in patients with a good eventual outcome. These findings identify previously unappreciated alterations in the innate immune compartment of patients with COVID-19 and lend support to the idea that therapeutic strategies targeting release of myeloid cells from bone marrow should be considered in this disease. Moreover, they demonstrate that features of an exaggerated immune response are present early after hospital admission, suggesting that immunomodulating therapies would be most beneficial at early time points