Everyday ethical decision-making, government healthcare spending and the age indifference principle : social ethical decision-making

This study evaluates the ethical decision-making frameworks utilised by a cross-section of 1240 Queenslanders aged between 18 and 101. Three research questions are addressed (1) Which of five normative ethical theories do the majority of Queenslanders apply in every day decision-making (2) Do Queenslanders expect these individual ethical frameworks to be consistent with the collective decision-making principles which drive government spending of the health dollar? (3) Are beliefs about individual and collective ethical-decision making moderated by age, gender and religiosity? Study results are discussed in terms of ethical theory, the practice of healthcare delivery and implications for Australia’s ageing population

Resilience, selective optimisation and compensation (SOC), and well-being in community dwelling older adults

Aim:The aim of this study is to investigate the relationship between resilience and subjective well-being in a sample of older Australians living independently in a regional community. The findings of previous research have been inferred upon older age groups, often without sufficient evidence to suggest validity or relevance. Of particular concern are the effects that both gender and previous life stressors may have on resilience in older adults. The question of how these might interact with ageing remains unanswered. This study explores the influence of gender and life stress on resilience for participants in the young-old, old-old, and oldest-old sub-groups. The relative contributions of resilience and the selective optimization with compensation model of ageing as predictors of subjective well-being in later life are also explored. Method:Convenience and snowball sampling methods were used to recruit 80 independent, community-dwelling participants aged 65 years and over. Demographic items including questions about positive and negative life events and the Connor-Davidson Resilience Scale, Satisfaction With Life Scale, the short version of the SOC Questionnaire and the Late-Life Function and Disability Instrument were interviewer-administered to all participants. Results:The psychometric properties of the Connor-Davidson Resilience Scale are presented and discussed in relation to an overall understanding of resilience and subjective well-being in later life. The effects of gender and life stress on resilience are presented for participants in the young-old, old-old, and oldest-old sub-groups. The relative contributions of resilience and the selective optimization with compensation model of ageing as predictors of subjective well-being in later life are also assessed.Conclusion:This study contributes to research on factors associated with resilience and well-being in Australia’s ageing population. The results are discussed in relation to understanding factors which lead to positive and successful ageing

Caring for residents with dementia beyond medication /

General practitioners provide most of the medical care for people with dementia who live in residential aged care facilities. Behavioural and psychological symptoms of dementia (BPSD) including psychosis, depression, agitation, aggression, and disinhibition, often occur. These affront the person’s dignity and well being and are often managed with psychotropic medications. Cholinesterase inhibitors are of no benefit in reducing these behaviours. Aims: This study evaluates the effectiveness of the ‘Spark of Life’ program, a social therapeutic, person-centred care program, which aims to improve memory, language, communication, social interaction, and behaviours. BPSD and associated variables were assessed as key outcome measures. Method: A small n case multiple baseline design was employed to assess the impact on behaviours, depression, pain, activity including falls, use of restraint, sleep, and requirements for antipsychotic, antidepressant and hypnotic medications. Data was obtained from people with dementia, their caregivers, and family members. Results: Continuous assessment of BPSD outcome measures over 8 months will be presented in graphical format for several residents with mild to moderate dementia. Related outcomes for carers and families will also be presented. Conclusions: The impact of this program on the wellbeing of residents may provide an effective non-pharmacological approach to the prevention and management of BPSD, enabling a reduction in the use of psychotropic medications

Effectiveness of the ‘Spark of Life’ dementia care program

Aim: The primary aim of this study is to evaluate the effectiveness of the ‘Spark of Life’ (SOL) program (a person-centered dementia care program) in improving outcomes for people with dementia and their carers. To date there has been no empirical research to evaluate the impact of this program on persons with dementia. The specific aims of the current study are to assess the effect of the SOL Program on: (1) Quality of life, satisfaction and person specific clinical outcomes for people with dementia (mild to moderate). (2) Caregiving satisfaction and approaches to dementia care for nurse caregivers. (3) Families’/Relatives' perceptions of care (satisfaction with care) and perceptions of the quality of life for their loved one with dementia. Method: The research design utilises multiple single-subject (small n) designs. The inclusion of multiple and heterogeneous study participants in which a complex intrasubject design is repeated increases the confidence that can be placed in inferences made about the intervention. The basic design is a time series for a single person(s) and a single outcome, with a single time of intervention. Results: Data analysis utilizes a combination of statistical and visual inspection methods. Continuous assessment (across 8-10 months) of outcome variables at baseline and post-intervention will be presented. Measurement outcomes include the Dementia Quality of Life Instrument (DQOL), Approaches to Dementia Questionnaire (ADQ), the Minnesota Job Satisfaction Questionnaire and the Quality of life in Alzheimer’s Disease (QOL-AD). Results for clinical outcome measures including behavioural and psychological symptoms of dementia, cognition, function and medications will also be presented. Conclusion: Optimizing outcomes for people with dementia is complex given the individual and idiosyncratic manifestations of the dementia syndrome. The current research makes a significant contribution by expanding the literature on outcomes research for people with dementia, their nursing home caregivers and families

The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons.

Objective: To compare the accuracy of the Rowland Universal DementiaAssessment Scale (RUDAS) and the Folstein Mini-mental State Examination (MMSE) for diagnosis of dementia in a multicultural cohort of elderly persons.Methods: A total of 129 community-dwelling persons were selected at randomfrom a database of referrals to an aged-care team. Subjects were stratifiedaccording to language background and cognitive diagnosis, and matched for ageand gender. The RUDAS and the MMSE were administered to each subjectin random order. Within several days, a geriatrician assessed each subject fordementia (DSM-IV criteria) and disease severity (Clinical Dementia RatingScale). All assessments were carried out independent and blind. The geriatricianalso administered the Modified Barthel Index and the Lawton InstrumentalActivities of Daily Living Scale, and screened all participants for non-cognitivedisorders that might affect instrument scores.Results: The area under the receiver operating characteristic curve (AUC) forthe RUDAS [0.92, 95% confidence interval (95%CI) 0.85–0.96] was similar tothe AUC for the MMSE (0.91, 95%CI 0.84–0.95). At the published cut-points(RUDAS < 23/30, MMSE < 25/30), the positive and negative likelihood ratiosfor the RUDAS were 19.4 and 0.2, and for theMMSE2.1 and 0.14, respectively.The MMSE, but not the RUDAS, scores were influenced by preferred language(p = 0.015), total years of education (p = 0.016) and gender (p = 0.044).Conclusions: The RUDAS is at least as accurate as the MMSE, and does notappear to be influenced by language, education or gender. The high positivelikelihood ratio for the RUDAS makes it particularly useful for ruling-in disease

The development, pilot and validation of a multicultural cognitive assessment scale

Australia is a multicultural society with an ageing population. Diseases such as dementia, which affect older age groups, are therefore becoming increasingly important health issues. Brief cognitive assessment instruments are used to screen older patients for dementia. Many of these instruments have been developed for use in English speaking populations and are not culture-fair or easily translated for use with non-English speakers. To ensure that people from all cultural backgrounds receive optimal health care, primary health care workers need a quick, reliable, and non-threatening dementia screening tool that is valid across cultures and easy to administer in a wide range of settings.This thesis explores the philosophical, scientific, and social antecedents of current approaches to measuring cognition. It argues that these have led to the treatment of culture as an intrinsic human attribute rather than one which describes variations in human experience. The consequences for approaches to the assessment of cognition in people from diverse cultural backgrounds are discussed and a model is presented to provide theoretical support for the development of a multicultural cognitive screening test for dementia.Following a literature review of brief cognitive screening instruments, clock drawing tests, and cross-cultural cognitive tests, two studies are presented. The first study tests the hypothesis that clock drawing is a useful multicultural screening instrument. There were no significant differences between six clock scoring methods for predicting dementia in a sample of 93 patients from non-English speaking backgrounds. While the Wolf-Klein clock scoring method produced the best trade-off between sensitivity (78%) and specificity (58%), this was insufficient to recommend clock drawing as a useful screening test for dementia in a multicultural population. The second study provides support for the hypothesis that a cognitive screening test with good predictive accuracy can be developed and used to screen for dementia in a multicultural population. This study reports the development, pilot, and validation stages of a multicultural cognitive test with excellent diagnostic accuracy (Area under the ROC curve = 0.95) and 89% sensitivity and 98% specificity for detecting dementia. This research has important implications for current clinical practice and the potential to improve public health for many Australians

The Rowland Universal Dementia Assessment Scale (RUDAS) : a multicultural cognitive assessment scale

Objective: To develop and validate a simple method for detecting dementia that is valid across cultures, portable and easily administered by primary health care clinicians. Design: Culture and Health Advisory Groups were used in Stage 1 to develop culturally fair cognitive items. In Stage 2, clinical testing of 42 items was conducted in a multicultural sample of consecutive new referrals to the geriatric medicine outpatient clinic at Liverpool Hospital, Sydney, Australia (n=166). In Stage 3, the predictive accuracy of items was assessed in a random sampleof community-dwelling elderly persons stratified by language background and cognitive diagnosis and matched for sex and age (n=90).Measurements: A research psychologist administered all cognitive items, using interpreters when needed. Each patient was comprehensively assessed by one of three geriatricians, who ordered relevant investigations, and implemented a standardized assessment of cognitive domains. The geriatricians also collected demographic information, and administered other functional and cognitivemeasures.DSM-IV criteria were used to assign cognitive diagnoses. Item validity and weights were assessed using frequency and logistic regression analyses. Receiver-operating characteristic (ROC) curve analysis was used to determine overall predictive accuracy of the RUDAS and the best cut-point for detecting cognitive impairment.Results: The 6-item RUDAS assesses multiple cognitive domains including memory, praxis, language, judgement, drawing and body orientation. It appears not to be affected by gender, years of education, differential performance factors and preferred language.The area under the ROCcurve for the RUDAS was 0.94. (95% CI 0.87–0.98). At a cut-point of 23 (maximum score of 30), sensitivityand specificity were 89% and 98%, respectively. Inter-rater (0.99) and test-retest (0.98) reliabilities were very high.Conclusions: The 6-item RUDAS is portable and tests multiple cognitivedomains. It is easily interpreted to other languages, and appears to be culturally fair. However, further validation is needed in other settings, and in longitudinal studies to determine its sensitivity to change in cognitive function over time