The health and relationship dynamics of late-life couples: a systematic review of the literature

Late-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data from both spouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States

The chaotic journey: Recovering from hip fracture in a nursing home

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/)

Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Quality in health care has tradi- tionally been determined based on clinical or health outcomes. However, these factors may not be the only aspects of health care that are important to patients. Within rehabilitation fac- tors related to the process of care, the way in which rehabilitation services are delivered, may also be important to patients when defining quality of care. Objective: The purpose of this study was to examine and compare the prefer- ences of older people receiving post-acute out- patient rehabilitation or residential intermediate (transition) care for alternative configurations of rehabilitation programs. Methods: A discrete choice experiment (DCE) was designed to elicit the preferences of older people for the design and delivery of post-acute rehabilitation pro- grams. The participants were older adults (≥65 years) receiving post-acute outpatient rehabili- tation or residential intermediate (transition) care in South Australia. Each participant was presented with a series of choice questions in- volving two hypothetical programs, the charac- teristics of which varied in every choice. Par- ticipants were then asked to select their pre- ferred program. Results: Despite marked differ- ences in case-mix and dependency levels, the preferences of the two groups were very similar, focusing on relationships and communication with health care professionals. Both groups demonstrated very strong preferences for the use of an electronic medical record and for re- ceiving information about their treatment and progress via a meeting with a specialist physi- cian and nurse. The outpatient rehabilitation group also exhibited a strong preference for a shared decision making model in relation to their future care needs. Conclusions: The find- ings highlight the commonality of preferences of older patients receiving post-acute services for the optimal configuration of rehabilitation ser- vices. Issues prioritised were service integration and access to senior medical and nursing staff. The study demonstrates the practicality and va- lidity of DCEs to determine older people’s pref- erences in defining quality of care. Keywords: DCE; Patient Preferences; Aged; Rehabilitation; Intermediate Care Facilitie

The social support and service needs of Australia’s ageing Greek migrants: a literature review.

This paper presents the results of a literature review undertaken to shape an emerging social research program on the service and support needs of Australia’s ageing Greek migrants. In late 2009 a narrative review was conducted of published and ‘grey’ literature to determine the scope of articles, with an emphasis on services and supports which help older people remain independent in the community. The search returned an extensive amount of international literature on ageing populations, but only a very small number of publications on the service use and needs of Australia’s older Greek population. Barriers to service use included low proficiency in English, lack of Greek-speaking service providers, low awareness of services available, and various cultural issues. The review also identified a lack of research carried out in the Greek language by researchers with a Greek background, which suggests that the views of older Greek migrants may be missing from much social research. We conclude that a sustained and culturally appropriate research effort conducted in the first language is needed and is essential if community-based services are to become more appropriate and accessible for the older members of Australia’s Greek communities

The social support and service needs of Australia’s ageing Greek migrants: a pilot project

This article explores the social support and service needs of Greek-speakers in Australia who migrated as young adults mostly in the 1940s and 1950s. The article reports the findings of a pilot research project initiated by the Modern Greek department at Flinders University in conjunction with social, health and ageing researchers. Focus groups and interviews were held in Adelaide and Darwin in 2010 with older Greek-speakers born in Greece and Cyprus; a survey of service organisations was also conducted. All older Greeks chose to be interviewed in Greek. They reported using a range of formal services, although some were confused about how to access services and lacked awareness of services. Interrupted primary education had resulted in low reading proficiency in Greek, while settlement experiences had contributed to low proficiency in reading, writing and speaking English. These were major barriers to accessing services with no Greek-speaking staff. In line with cultural expectations, a key support role was played by adult children, while some Greek-speaking GPs and MPs also mediated information and service access. Many older Greeks appear to be living independently in the community, but this is only possible because of high levels of informal support from close family. Those without children may therefore be more vulnerable to social isolation. The Modern Greek researchers who were integral members of the research team acted as ‘insiders’ who shared the culture and language of interviewees. Since all interviewees chose to be interviewed in Modern Greek, the ability to conduct interviews in Greek clearly enabled their participation, whereas they may have declined to participate had interviews only been available in English. At the same time, the non-Greek researchers provided a critical ‘outsider’ view which strengthened the data analysis and interpretation. We conclude that this project has demonstrated the important role that Modern Greek academics can play in research on social and health issues among the Greek diaspora

Cohort Profile: The Australian Longitudinal Study of Ageing (ALSA)

In response to the expressed need for more sophisticated and multidisciplinary data concerning ageing of the Australian population, the Australian Longitudinal Study of Ageing (ALSA) was established some two decades ago in Adelaide, South Australia. At Baseline in 1992, 2087 participants living in the community or in residential care (ranging in age from 65 to 103 years) were interviewed in their place of residence (1031 or 49% women), including 565 couples. By 2013, 12 Waves had been completed; both face-to-face and telephone personal interviews were conducted. Data collected included self-reports of demographic details, health, depression, morbid conditions, hospitalization, gross mobility, physical performance, activities of daily living, lifestyle activities, social resources, exercise, education and income. Objective performance data for physical and cognitive function were also collected. The ALSA data are held at the Flinders Centre for Ageing Studies, Flinders University. Procedures for data access, information on collaborations, publications and other details can be found at [http://flinders.edu.au/sabs/fcas/].Australian Research Council ARC (DP0879152 and 130100428; LP669272 and 100200413

The Benefits of a Life-first employment program for Indigenous Australian families: Implications for 'Closing the Gap'

This work is licensed under a Creative Commons Attribution 3.0 Australia License.There are significant and enduring inequities in education and employment outcomes between Indigenous and non-Indigenous Australians. In taking a ‘life-first’ approach to service provision the Building Family Opportunities Program (BFO) was able to successfully increase Indigenous Australians’ engagement with education and employment in South Australia. The evaluation of the BFO included quantitative administrative and survey data for 110 Indigenous families collected over a three year period, and qualitative data from interviews with 13 Indigenous jobseekers and focus groups with 24 case managers. Quantitative data revealed that similar proportions of Indigenous and non-Indigenous jobseekers achieved positive education/training and employment outcomes as a result of the program. Qualitative data were able to identify the strengths of this program as perceived by Indigenous families and case managers, including the practical and socio-emotional support offered to whole families, using a strengths-based, life-first approach. In the context of broader education and employment disadvantages experienced by Indigenous Australians, these results are significant and illustrate key lessons which can inform future policy and service delivery initiatives aiming to close the gap

The development and evaluation of a health promotion program for pregnant women aimed at addressing rates of caesarean section / Ruth Walker.

"May 2002"Includes bibliographical references (leaves 267-289)xvii, 290, [69] leaves : ill., plates ; 30 cm.Thesis (Ph.D.)--University of Adelaide, Depts. of Public Health and General Practice, 200

"It's because I'm known here" : older women's perceptions of health-supporting neighbourhood qualities in contrasting locations of metropolitan Adelaide : final report. 88p.

Final report prepared for the Department of Health. The objectives of the research project were to: – identify and understand the social and physical determinants of health-supporting neighbourhoods for older women – explore whether there is a difference in these determinants based on geographic location.Ruth Walke

Early rehabilitation management after stroke: What do stroke patients prefer?

Published version made available in accordance with Publisher Copyright. Accessed 10/03/2015.Background: Stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. It is unclear how acceptable these changes will be to stroke survivors, as little is known about which aspects of rehabilitation programmes are currently valued. Discrete choice experiments are a potential approach to assessing patient preferences, as they reveal the characteristics of programmes that are most important to consumers. METHODS: A discrete choice experiment was presented as a face-to-face interview to assess the priorities and preferences of stroke survivors (n = 50, mean age 72 years) for alternative rehabilitation service configurations. The discrete choice experiment was presented to the participants while they were on the stroke rehabilitation ward (approximately 3–4 weeks following stroke). RESULTS: Participants were highly focused on recovery and expressed strong preferences for therapy delivered one-to-one, but they did not favour very high intensity programmes (6 hours per day). While the attitudinal statements indicated high levels of agreement for programmes to incorporate the latest technology, the results from the discrete choice experiment indicated that participants were averse to computer-delivered therapy. CONCLUSION: Whilst rehabilitation therapy is highly valued, stroke survivors exhibited stronger preferences for low-intensity programmes and rest periods. High-intensity therapy protocols or approaches dependent on new technologies will require careful introduction to achieve uptake and acceptability