Recognition of dementia in the community is generally poor and individuals with dementia do not t... more Recognition of dementia in the community is generally poor and individuals with dementia do not tend to access appropriate treatment until the disorder is advanced. Using the Self Regulation Model, this study examined a range of socio-demographic, attitudinal, and psychological factors in order to better understand professional help-seeking by community-dwelling older adults. The sample comprised 205 healthy older adults (50 to 94 years) recruited from community groups and independent living residences. Participants completed measures of dementia-specific knowledge, prior contact with a person with dementia, self-perceptions of ageing, mental health help-seeking attitudes, illness perceptions and professional help-seeking intentions. Lower levels of dementia knowledge (r = -.17, p < .02) were associated with an increased tendency toward professional care-seeking. Older adults who hold a more positive sense of their physical self (r = .24, p < .001), cognitive self (r = .22, p = .003), and who evaluate themselves more positively in the context of social relationships (r = .28, p = < .0005) are more likely to seek professional care. A more positive inclination toward seeking mental health services (Help-Seeking propensity) r = .22, p < .002, and more openness regarding psychological issues (Psychological Openness) r = .17, p < .024 were both found to be positively related to the behavioural intention to seek help. Using multivariate analyses to control for socio-demographics, dementia familiarity, and ageing self-perception factors, the attitudes towards mental health help seeking were found to be the strongest predictor of care-seeking intention (beta = .20, p = 009), while having negative beliefs in the controllability of the illness through treatment, a cognitive dimension of the Self Regulation Model, was a weaker predictor (beta = .17, p = .03). Older adults' subjective ageing perceptions also predicted help-seeking intentions (beta = .17, p = .03). Reduced internalization of old age stereotypes related positively to adaptive help seeking responses. There is a need for greater attention to be paid to the impact of age-related stigma upon the path toward dementia care, both to increase understanding of normative ageing effects, and to implement strategies (e.g., anti-stigma programs) that will facilitate timely access to treatment.
Delirium is a common and serious condition which is often overlooked or misdiagnosed in older peo... more Delirium is a common and serious condition which is often overlooked or misdiagnosed in older people. In 2006, the first set of national clinical practice guidelines for the management of delirium in older people were developed. This paper provides an abbreviated version of the guideline document which includes recommendations for the detection of delirium (diagnosis and screening), assessment and prediction of risk factors for delirium, prevention of delirium and interventions to manage people with delirium. The guidelines reflect the available evidence base and highlight the limited high level research in delirium care, particularly in the areas of symptom management and screening for delirium.
International Journal of Older People Nursing, Aug 10, 2023
BackgroundCommunities of practice (CoPs) have the potential to help address the residential aged ... more BackgroundCommunities of practice (CoPs) have the potential to help address the residential aged care system's need for continuing education and quality improvement. CoPs have been used in healthcare to improve clinical practice; however, little is known about their application to the unique residential aged care context.ObjectivesThis rapid review of CoPs for residential aged care was conducted to summarise the features of CoPs, how they are developed and maintained, and assess their effectiveness.MethodsMEDLINE and CINAHL databases were searched for studies published from January 1991 to November 2022 about CoPs in residential aged care. Data were extracted regarding the CoPs' three key features of ‘domain’, ‘community’ and ‘practice’ as described by Wenger and colleagues. Kirkpatrick's four levels of evaluation (members' reactions, learning, behaviour and results) was used to examine studies on the effectiveness of CoPs. The Mixed Methods Appraisal Tool was used for quality appraisal.ResultsNineteen articles reported on 13 residential aged care CoPs. Most CoPs aimed to improve care quality (n = 9, 69%) while others aimed to educate members (n = 3, 23%). Membership was often multidisciplinary (n = 8, 62%), and interactions were in‐person (n = 6, 46%), online (n = 3, 23%) or both (n = 4, 31%). Some CoPs were developed with the aid of a planning group (n = 4, 31%) or as part of a larger collaborative (n = 4, 31%), and were maintained using a facilitator (n = 7, 54%) or adapted to member feedback (n = 2, 15%). Thirteen (81%) studies evaluated members' reactions, and three (24%) studies assessed members' behaviour. The heterogeneity of studies and levels of reporting made it difficult to synthesise findings.ConclusionsThis review revealed the variation in why, and how, CoPs have been used in residential aged care, which is consistent with previous reviews of CoPs in healthcare. While these findings can inform the development of CoPs in this context, further research is needed to understand how CoPs, including the membership makeup, delivery mode, facilitator type and frequency of meetings, impact quality of care.
Background Older people living in residential aged care facilities are at high risk of acquiring ... more Background Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. Methods Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities’ readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to bes...
Background People with dementia have unique palliative and end-of-life needs. However, access to ... more Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. Subjects & setting One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. Methods Randomisation was conducted at the level of the nursing home (cluster)....
Australia\u27s asylum seeker policies are not widely understood. They are complex, and have chang... more Australia\u27s asylum seeker policies are not widely understood. They are complex, and have changed many times, particularly since 2001. This chapter outlines Australia\u27s policies towards asylum seekers and refugees. First, it highlights the fundamental tenets of the Refugee Convention, which forms the basis of Australia\u27s obligations to refugees. It then explaines the different categories of intake, and the different procedures asylum seekers and refugees encounter to start a new life in Australia. We demonstrate that Australia\u27s policies are based on a distinction between two groups of people needing protection: \u27offshore\u27 refugees and \u27onshore\u27 asylum seekers. The different reception of these two groups by the Australian government could not be greater. The result is a system of two classes of refugees - a distinction that contravenes our international obligations
Additional file 1: Appendix 1. Characteristics and qPAD scores of staff who completed the follow-... more Additional file 1: Appendix 1. Characteristics and qPAD scores of staff who completed the follow-up survey (N=330)
Background: With increasing numbers of people living with dementia relying on family to care for ... more Background: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). Method: A mixed methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia.Results: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these 16 (80%) completed all eight sessions, two completed only three sessions, and two withdrew. Carers’ qualitative feedback indicated that the therapist in...
UNSTRUCTURED Background: Evaluation of appropriate methodologies for imputation of missing risk f... more UNSTRUCTURED Background: Evaluation of appropriate methodologies for imputation of missing risk factor or outcome data from electronic medical records (EMRs) is crucial but lacking for comparative effectiveness studies. Robust imputation of missing data relies on the understanding of the predictors of missingness in the risk factor data, especially in patients with chronic diseases. These two aspects have not been explored simultaneously to support methodological developments in clinical epidemiological studies with real-world data. Methods: Using disease-biomarker data (glycated haemoglobin, HbA1c) from large EMR database in patients with diabetes, exploratory analyses were conducted to ascertain the possible predictors of missingness. Three approaches based on multiple imputation (MI) technique, namely two-fold MI, MI by chained equations, and MI with Monte Carlo Markov Chain, were evaluated in terms of their robustness in imputing missing data. The value of using imputed data for...
Background Many people with advanced dementia live in residential aged care homes. Care home staf... more Background Many people with advanced dementia live in residential aged care homes. Care home staff need the knowledge and skills to provide high-quality end-of-life (EOL) dementia care. However, several studies have found EOL dementia care to be suboptimal, and care staff have reported they would benefit from training in palliative care and dementia. Simulation offers an immersive learning environment and has been shown to improve learners' knowledge and skills. However, there is little research on simulation training for residential care staff. This article presents the development and evaluation protocol of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) - a screen-based simulation training program on palliative dementia care, targeted at residential care staff. IMPETUS-D aims to improve the quality of palliative care provided to people living with dementia in residential care homes, including avoiding unnecessary transfers to hospital...
Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid ar... more Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid arthritis. (DOCX 14 kb)
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision,... more International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes used to identify joint surgery admissions and comorbidities. (DOCX 18 kb)
Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer pall... more Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the opportunity to learn in a realistic environment and fully interactive way. Objective The aim of this systematic review was to summarise and critically appraise controlled studies on simulation training in non-cancer palliative care for HCWs. Selection Medline, CINAHL, PubMed and Cochrane Library databases were searched using palliative care and simulation terms. Randomised controlled trials (RCTs), non-randomised RCTs and controlled before-and-after (CBA) studies were included. Two reviewers independently screened titles and abstracts and undertook full article review using predefined selection criteria. Studies that met the inclusion criteria had data extracted and risk of bias assessed using the Cochrane Effective Practice and Organisation of Care risk of bias ...
Recognition of dementia in the community is generally poor and individuals with dementia do not t... more Recognition of dementia in the community is generally poor and individuals with dementia do not tend to access appropriate treatment until the disorder is advanced. Using the Self Regulation Model, this study examined a range of socio-demographic, attitudinal, and psychological factors in order to better understand professional help-seeking by community-dwelling older adults. The sample comprised 205 healthy older adults (50 to 94 years) recruited from community groups and independent living residences. Participants completed measures of dementia-specific knowledge, prior contact with a person with dementia, self-perceptions of ageing, mental health help-seeking attitudes, illness perceptions and professional help-seeking intentions. Lower levels of dementia knowledge (r = -.17, p < .02) were associated with an increased tendency toward professional care-seeking. Older adults who hold a more positive sense of their physical self (r = .24, p < .001), cognitive self (r = .22, p = .003), and who evaluate themselves more positively in the context of social relationships (r = .28, p = < .0005) are more likely to seek professional care. A more positive inclination toward seeking mental health services (Help-Seeking propensity) r = .22, p < .002, and more openness regarding psychological issues (Psychological Openness) r = .17, p < .024 were both found to be positively related to the behavioural intention to seek help. Using multivariate analyses to control for socio-demographics, dementia familiarity, and ageing self-perception factors, the attitudes towards mental health help seeking were found to be the strongest predictor of care-seeking intention (beta = .20, p = 009), while having negative beliefs in the controllability of the illness through treatment, a cognitive dimension of the Self Regulation Model, was a weaker predictor (beta = .17, p = .03). Older adults' subjective ageing perceptions also predicted help-seeking intentions (beta = .17, p = .03). Reduced internalization of old age stereotypes related positively to adaptive help seeking responses. There is a need for greater attention to be paid to the impact of age-related stigma upon the path toward dementia care, both to increase understanding of normative ageing effects, and to implement strategies (e.g., anti-stigma programs) that will facilitate timely access to treatment.
Delirium is a common and serious condition which is often overlooked or misdiagnosed in older peo... more Delirium is a common and serious condition which is often overlooked or misdiagnosed in older people. In 2006, the first set of national clinical practice guidelines for the management of delirium in older people were developed. This paper provides an abbreviated version of the guideline document which includes recommendations for the detection of delirium (diagnosis and screening), assessment and prediction of risk factors for delirium, prevention of delirium and interventions to manage people with delirium. The guidelines reflect the available evidence base and highlight the limited high level research in delirium care, particularly in the areas of symptom management and screening for delirium.
International Journal of Older People Nursing, Aug 10, 2023
BackgroundCommunities of practice (CoPs) have the potential to help address the residential aged ... more BackgroundCommunities of practice (CoPs) have the potential to help address the residential aged care system's need for continuing education and quality improvement. CoPs have been used in healthcare to improve clinical practice; however, little is known about their application to the unique residential aged care context.ObjectivesThis rapid review of CoPs for residential aged care was conducted to summarise the features of CoPs, how they are developed and maintained, and assess their effectiveness.MethodsMEDLINE and CINAHL databases were searched for studies published from January 1991 to November 2022 about CoPs in residential aged care. Data were extracted regarding the CoPs' three key features of ‘domain’, ‘community’ and ‘practice’ as described by Wenger and colleagues. Kirkpatrick's four levels of evaluation (members' reactions, learning, behaviour and results) was used to examine studies on the effectiveness of CoPs. The Mixed Methods Appraisal Tool was used for quality appraisal.ResultsNineteen articles reported on 13 residential aged care CoPs. Most CoPs aimed to improve care quality (n = 9, 69%) while others aimed to educate members (n = 3, 23%). Membership was often multidisciplinary (n = 8, 62%), and interactions were in‐person (n = 6, 46%), online (n = 3, 23%) or both (n = 4, 31%). Some CoPs were developed with the aid of a planning group (n = 4, 31%) or as part of a larger collaborative (n = 4, 31%), and were maintained using a facilitator (n = 7, 54%) or adapted to member feedback (n = 2, 15%). Thirteen (81%) studies evaluated members' reactions, and three (24%) studies assessed members' behaviour. The heterogeneity of studies and levels of reporting made it difficult to synthesise findings.ConclusionsThis review revealed the variation in why, and how, CoPs have been used in residential aged care, which is consistent with previous reviews of CoPs in healthcare. While these findings can inform the development of CoPs in this context, further research is needed to understand how CoPs, including the membership makeup, delivery mode, facilitator type and frequency of meetings, impact quality of care.
Background Older people living in residential aged care facilities are at high risk of acquiring ... more Background Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. Methods Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities’ readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to bes...
Background People with dementia have unique palliative and end-of-life needs. However, access to ... more Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. Subjects & setting One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. Methods Randomisation was conducted at the level of the nursing home (cluster)....
Australia\u27s asylum seeker policies are not widely understood. They are complex, and have chang... more Australia\u27s asylum seeker policies are not widely understood. They are complex, and have changed many times, particularly since 2001. This chapter outlines Australia\u27s policies towards asylum seekers and refugees. First, it highlights the fundamental tenets of the Refugee Convention, which forms the basis of Australia\u27s obligations to refugees. It then explaines the different categories of intake, and the different procedures asylum seekers and refugees encounter to start a new life in Australia. We demonstrate that Australia\u27s policies are based on a distinction between two groups of people needing protection: \u27offshore\u27 refugees and \u27onshore\u27 asylum seekers. The different reception of these two groups by the Australian government could not be greater. The result is a system of two classes of refugees - a distinction that contravenes our international obligations
Additional file 1: Appendix 1. Characteristics and qPAD scores of staff who completed the follow-... more Additional file 1: Appendix 1. Characteristics and qPAD scores of staff who completed the follow-up survey (N=330)
Background: With increasing numbers of people living with dementia relying on family to care for ... more Background: With increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online). Method: A mixed methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia.Results: Twenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these 16 (80%) completed all eight sessions, two completed only three sessions, and two withdrew. Carers’ qualitative feedback indicated that the therapist in...
UNSTRUCTURED Background: Evaluation of appropriate methodologies for imputation of missing risk f... more UNSTRUCTURED Background: Evaluation of appropriate methodologies for imputation of missing risk factor or outcome data from electronic medical records (EMRs) is crucial but lacking for comparative effectiveness studies. Robust imputation of missing data relies on the understanding of the predictors of missingness in the risk factor data, especially in patients with chronic diseases. These two aspects have not been explored simultaneously to support methodological developments in clinical epidemiological studies with real-world data. Methods: Using disease-biomarker data (glycated haemoglobin, HbA1c) from large EMR database in patients with diabetes, exploratory analyses were conducted to ascertain the possible predictors of missingness. Three approaches based on multiple imputation (MI) technique, namely two-fold MI, MI by chained equations, and MI with Monte Carlo Markov Chain, were evaluated in terms of their robustness in imputing missing data. The value of using imputed data for...
Background Many people with advanced dementia live in residential aged care homes. Care home staf... more Background Many people with advanced dementia live in residential aged care homes. Care home staff need the knowledge and skills to provide high-quality end-of-life (EOL) dementia care. However, several studies have found EOL dementia care to be suboptimal, and care staff have reported they would benefit from training in palliative care and dementia. Simulation offers an immersive learning environment and has been shown to improve learners' knowledge and skills. However, there is little research on simulation training for residential care staff. This article presents the development and evaluation protocol of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) - a screen-based simulation training program on palliative dementia care, targeted at residential care staff. IMPETUS-D aims to improve the quality of palliative care provided to people living with dementia in residential care homes, including avoiding unnecessary transfers to hospital...
Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid ar... more Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid arthritis. (DOCX 14 kb)
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision,... more International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes used to identify joint surgery admissions and comorbidities. (DOCX 18 kb)
Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer pall... more Background The need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the opportunity to learn in a realistic environment and fully interactive way. Objective The aim of this systematic review was to summarise and critically appraise controlled studies on simulation training in non-cancer palliative care for HCWs. Selection Medline, CINAHL, PubMed and Cochrane Library databases were searched using palliative care and simulation terms. Randomised controlled trials (RCTs), non-randomised RCTs and controlled before-and-after (CBA) studies were included. Two reviewers independently screened titles and abstracts and undertook full article review using predefined selection criteria. Studies that met the inclusion criteria had data extracted and risk of bias assessed using the Cochrane Effective Practice and Organisation of Care risk of bias ...
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Papers by Joanne Tropea