Publications by authors named "Yvonne Wells"

43 Publications

Caring self-efficacy of direct care workers in residential aged care settings: A mixed methods scoping review.

Geriatr Nurs 2021 Oct 11;42(6):1429-1445. Epub 2021 Oct 11.

Australian Institute for Primary Care & Ageing, La Trobe University, Bundoora, VIC, 3086, Australia; School of Health, Federation University Australia, Berwick, Victoria, Australia; Department of Non-communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh; Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.

The caring self-efficacy of direct care workers in residential aged care has been explored in the literature mostly as a predictor rather than the focus of interest. This scoping review aimed to provide an overview of the existing literature on aged care workers' caring self-efficacy and factors that influence it. A systematic search was performed in six electronic databases. All primary studies were included. A total of 41 studies met the inclusion criteria. Caring self-efficacy was most often described by aged care workers as their capacity to deal with difficult situations. The self-efficacy scores of direct care workers were high across studies. Self-efficacy was positively influenced by access to resources, relationships with residents and their families, the support of supervisors and co-workers, job satisfaction, and training opportunities, and negatively affected by work pressure and burnout. Findings indicate possible avenues for intervention to improve direct care workers' self-efficacy in aged care.
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http://dx.doi.org/10.1016/j.gerinurse.2021.09.014DOI Listing
October 2021

Self-efficacy of direct care workers providing care to older people in residential aged care settings: a scoping review protocol.

Syst Rev 2021 04 10;10(1):105. Epub 2021 Apr 10.

Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Australia.

Background: Self-efficacy is developed through a person's interaction with his/her physical and social environment. Self-efficacy in caring is an essential attribute of care workers to develop a positive attitude towards their clients, improve work performance, and enhance job satisfaction. Care workers' self-efficacy may vary according to the context in which the care is being provided. Aged care is a multidimensional and challenging setting, and characteristics of aged care services are different from those of acute care services. The objective of this review is to give an overview of the self-efficacy of residential aged care workers in caring for older people and factors influencing their self-efficacy.

Methods: The protocol for this review is based on the Joanna Briggs Institute Reviewer's Manual for Scoping Review. A systematic search of the literature on electronic databases MEDLINE, PsycINFO, CINAHL, AgeLine, SCOPUS, and ProQuest Dissertations and Theses Global will be carried out using predefined search terms to identify relevant studies. This review will include studies that examined the self-efficacy of direct care workers in caring for older people living in residential aged care facilities. All primary studies irrespective of the study design will be included. Studies conducted to develop measures or studies with informal care workers or students as study participants will not be considered. Two reviewers will independently conduct title and abstract screening, full-text screening, and data charting. A third reviewer will resolve discrepancies, while the final decision for conflicting studies will be made by consensus within the review team. Descriptive statistics will be utilized to analyze the quantitative findings, and the result will be presented in narrative form accompanied by tables and charts. Content analysis will be carried to analyze the qualitative findings and will be presented in narrative form supported by illustrative quotations.

Discussion: This study will be an important source of knowledge to policymakers and aged care providers to understand the self-efficacy of aged care workers to support and enhance their self-efficacy and thereby improve their caring behaviors towards their clients.

Scoping Review Registration: Joanna Briggs Institute Systematic Review Register with the title "A scoping review of factors influencing caring efficacy of direct care workers providing care to older people".
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http://dx.doi.org/10.1186/s13643-021-01655-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035725PMC
April 2021

What predicts consumer experience in residential aged care? An analysis of consumer experience report data.

Aust Health Rev 2021 Aug;45(4):485-490

Lincoln Centre for Research on Ageing, La Trobe University, Plenty Road and Kingsbury Drive, Bundoora, Vic. 3086, Australia. Email:

Objectives This study explored whether consumer experience report (CER) data from residential aged care services (RACSs) could be combined into a general factor and determined whether poor experience in RACSs could be predicted by known resident or home characteristics or sampling procedures. Methods CER data collected by structured interviews in 2018 and early 2019 were analysed using structural equation modelling and linear regression analysis. Results Data were available from 17194 interviews undertaken at 1159 RACSs. The 10 CER items loaded onto two independent factors. Bifactorial modelling indicated that items could be combined into a general factor. Controlling for state or territory, consumer experience was best predicted by home size: those in large facilities reported poorer experience than those in smaller facilities. Other significant negative predictors with small effect sizes included not being independently mobile, being male and not being randomly selected. Dementia did not predict total CER score. Conclusions The results of this study support the inclusion of people with dementia and exclusion of volunteer participants from published CERs. Further research is needed to explore why a relatively poor consumer experience is reported by people in larger homes, men and those with mobility issues. What is known about the topic? Poor experience in aged care is a persistent concern for government, individuals and aged care services. The recent Royal Commission into Aged Care Quality and Safety has identified systemic failure. Although many organisational features and processes have previously been identified as important in determining the quality of care, few studies have explored the characteristics that predict the consumer experience of residents in aged care. What does this paper add? This paper provides empirical evidence that several variables influence consumer experience in aged care, including facility size and resident sex and mobility. There is evidence that smaller facilities provide care that is perceived better by residents, and that men and people with mobility issues have worse experiences in aged care. There is a lack of clarity as to what other influences, such as facility ethos, facility location and staffing levels, may contribute to resident experience. Such clarity is important, because Australian aged care is currently facing comprehensive scrutiny, and governments are looking to ensure the safety and quality of aged care services. What are the implications for practitioners? Identifying and addressing inequities in aged care services and mitigating risks must be a priority in Australia to ensure aged care services provide safe and high-quality care. The results of this study challenge current funding structures that encourage the development of larger aged care homes, and instead suggest that better funding for smaller-sized facilities may be able to improve the experience of residents in aged care. The results also suggest that facilities and governments should attend to the experiences of specific groups, such as men and people with mobility issues.
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http://dx.doi.org/10.1071/AH20270DOI Listing
August 2021

Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis.

Int J Stroke 2021 Apr 12:17474930211006301. Epub 2021 Apr 12.

School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.

Background: Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation.

Aim: The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence.

Summary Of Review: Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria ( = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence ( = -3.40, 95% -4.46 to -2.34) and a medium effect when commenced >3 months after stroke ( = -0.67, 95% -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week ( = -2.32, 95% -2.96 to -1.68) and a small effect when administered five times a week ( = -0.44, 95% -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence.

Conclusions: Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.
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http://dx.doi.org/10.1177/17474930211006301DOI Listing
April 2021

Pastoral Care in Aged Care Settings: Role and Challenges.

J Relig Health 2021 Jun 25;60(3):2077-2091. Epub 2021 Feb 25.

Lincoln Centre for Research on Ageing, La Trobe University, Bundoora, Melbourne, VIC, 3086, Australia.

This mixed methods study explored challenges faced by pastoral care workers. A development phase preceded an on-line survey completed by chaplains and pastoral practitioners (n = 40) employed by a major Australian aged care provider. The survey covered the purpose of pastoral care, key tasks and resources, current and future challenges, and participants' responses to challenges. The biggest issue was heavy demand on participants' time, due to insufficient staff and demanding organisational procedures. A commonly mentioned challenge with future implications was increasing resident acuity. Respondents were dedicated and enthusiastic, despite heavy workloads and occasional difficulty working with care staff or management.
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http://dx.doi.org/10.1007/s10943-020-01172-8DOI Listing
June 2021

How well have senior Australians been coping in the COVID-19 pandemic?

Australas J Ageing 2020 12;39(4):386-388

Lincoln Centre for Research on Ageing, La Trobe University, Melbourne, Victoria, Australia.

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http://dx.doi.org/10.1111/ajag.12880DOI Listing
December 2020

Australasian Journal on Ageing Book Prize, 2019.

Authors:
Yvonne Wells

Australas J Ageing 2020 Mar;39(1)

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http://dx.doi.org/10.1111/ajag.12780DOI Listing
March 2020

Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: a systematic review.

Aging Ment Health 2021 02 9;25(2):187-205. Epub 2019 Nov 9.

Centre for Emotional Health, Department of Psychology, Macquaire University, Sydney, Australia.

Objectives: Cognitive behavioral therapy (CBT) for depression and anxiety for older adults living in residential aged care facilities (RACFs) needs to accommodate the care needs of residents and the circumstances of RACFs. This systematic review examines the delivery and content characteristics of these interventions, in relation to participant satisfaction, staff appraisal, uptake rate, attrition rate, and treatment effectiveness. Such a review could provide important information for the development of future CBT-based interventions.

Method: Studies that examined the application of CBT for depression or anxiety in RACFs were identified by systematically searching a number of relevant databases. Reference lists of all included studies were examined, and citation searches on the Web of Science were conducted. Two independent reviewers were involved in screening articles and in extracting data and assessing methodological quality of the selected studies.

Results: Across the 18 studies included in this review, the most common therapeutic strategy was pleasant activities scheduling. Studies varied on treatment duration (2-24 weeks), number of sessions (6-24), and length of sessions (10-120 min). Residents and staff members were satisfied with the CBT interventions. The average uptake rate was 72.9%. The average attrition rate was 19.9%. Statistically significant results were reported in 8 of the 12 randomized controlled trials (RCTs). In these eight RCTs, CBT was characterized by psychoeducation, behavioral activation, and problem-solving techniques; further, the therapists in six of these studies had training in psychology.

Conclusion: CBT interventions for depression and anxiety are acceptable to RACF residents and judged positively by staff members. Effective studies differed from non-effective studies on content and training characteristics, but not on other delivery features.
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http://dx.doi.org/10.1080/13607863.2019.1686457DOI Listing
February 2021

The change in quality of life for older Australians: A rural and urban comparison.

Aust J Rural Health 2019 Aug;27(4):322-327

College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.

Objective: To assess the quality of life of older Australians living in rural and urban communities over time.

Design: Panel survey conducted in 2012-2013 and 2014-2015.

Setting: Participants lived in metropolitan Melbourne (urban sample, N = 279), rural Victoria (N = 98) or Tasmania (N = 47).

Participants: All participants (N = 424) were clients of aged care providers or residents in retirement housing or residential care.

Main Outcome Measures: Quality of life.

Result: A repeated-measures analysis of variance showed a decrease in quality of life over time. There was no difference in change in quality of life over time by location of participants (urban vs rural). Multiple regression analysis showed that resilience predicted baseline quality of life in all three locations.

Conclusion: These findings generally did not support significant differences between geographic locations in trajectories of older adults' quality of life over time. Instead, individuals' resilience appears to be the strongest predictor of quality of life.
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http://dx.doi.org/10.1111/ajr.12553DOI Listing
August 2019

Development of a consumer experience reporting questionnaire for residential aged care homes in Australia.

Australas J Ageing 2019 Dec 23;38(4):267-273. Epub 2019 Apr 23.

Lincoln Centre for Research on Ageing, La Trobe University, Melbourne, Victoria, Australia.

Objective: To develop and pilot a short interview tool to be implemented by the Australian Aged Care Quality Agency (AACQA) in residential aged care, to inform prospective consumers about the quality of care and services received-the consumer experience report (CER).

Methods: Twenty-four questions addressing the four Aged Care Quality Standards were piloted with 140 residents and 48 representatives (including 27 resident-representative pairs). A method for approximating random selection was also trialled. Fifty-two residents were interviewed twice, one week apart, and each question's usability was rated by 11 surveyors and two interpreters. Selection criteria for questions included consumer preference, test-retest reliability, resident-representative agreement, usability and low missing data.

Results: Nineteen questions performed well on missing data, 16 on test-retest, 17 on resident-representative agreement and 12 on usability. Ten quantitative and two open-ended questions were selected.

Conclusions: The CER questions proved suitable to collect data systematically on consumer experience in residential aged care. AACQA (now the Aged Care Quality and Safety Commission) uses the CER interview to support their audit process, and aggregated results are published online.
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http://dx.doi.org/10.1111/ajag.12664DOI Listing
December 2019

Psychometric testing of the Older Patients in Acute Care Survey (OPACS) in Australian final year nursing students.

Nurs Open 2019 Apr 6;6(2):558-565. Epub 2019 Feb 6.

Australian Centre for Evidence Based Aged Care La Trobe University Melbourne Vic. Australia.

Aim: To assess the internal reliability and validity (content and criterion) of the Older Patients in Acute Care Survey (OPACS) as a measure of nurses' knowledge, attitudes and practices regarding care of older hospitalized patients in Australia.

Design: Cross-sectional survey.

Method: A convenience sample of final year nursing students at an Australian university in October 2014 completed the OPACS (191). Internal reliability was assessed using Cronbach's alpha, content validity using exploratory factor analysis and criterion validity using correlations between the OPACS and Palmore's Facts on Aging Quiz and the Caring Efficacy Scale.

Results: Despite good internal reliability on both OPACS subscales, exploratory factor analysis of the 36 items representing behaviours and the 50 items on knowledge and attitudes failed to load strongly on their corresponding factors. Analyses of criterion validity suggested the OPACS scales are measures of attitude.
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http://dx.doi.org/10.1002/nop2.238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419114PMC
April 2019

Quality and Safety in Aged Care Virtual Issue: What Australian research published in the Australasian Journal on Ageing tells us.

Australas J Ageing 2019 Mar;38(1):E1-E6

Lincoln Centre for Research on Ageing, La Trobe University, Melbourne, Victoria, Australia.

Objective: To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions.

Methods: Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality.

Results: Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care.

Conclusions: It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.
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http://dx.doi.org/10.1111/ajag.12638DOI Listing
March 2019

"I'm more aware now": perspectives from people with mild cognitive impairment (MCI), supporters and counsellors about the MAXCOG cognitive rehabilitation intervention.

Aging Ment Health 2020 06 10;24(6):965-970. Epub 2019 Feb 10.

School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

Cognitive Rehabilitation interventions have the potential to improve quality of life for people with MCI. We recently developed, trialled, and evaluated the use of the MAXCOG (Maximising Cognition) intervention-a very brief (four-session) face-to-face program focussing on individualised goals to improve function in daily life. Although the program assisted people reach their practical goals, we could not demonstrate broader changes to quality of life, mood, or carer burden. The aim of this study was to explore qualitatively the experiences of clients, supporters, and counsellors who participated. Fifteen clients, fourteen supporters, and three counsellors were interviewed using the Most Significant Change technique. Subsequently, thirty-five narrative accounts were transcribed and subjected to thematic analysis following Braun and Clarke's (2006) model. Key themes identified changes at two levels: specific changes (Putting strategies in place; and Doing it differently) and meta changes (More aware now; Facing up to life; and on top of anxiety and stress). Participants also mentioned supports and hindrances. The analysis provided a new perspective on the experiences of participants, supporters, and counsellors with the MAXCOG intervention, including identification of psychological changes that were not apparent from the quantitative analyses.
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http://dx.doi.org/10.1080/13607863.2019.1574712DOI Listing
June 2020

The relationship between workplace characteristics and work ability in residential aged care: What is the role of work-life interaction?

J Adv Nurs 2019 Jul 5;75(7):1427-1438. Epub 2019 Apr 5.

Centre for Ergonomics, Safety and Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.

Aims: To examine whether the work-life interface (through work-family conflict and overall work-life balance) moderates the relationship between work ability and workplace demands and resources.

Design: This study used a cross-sectional survey design to collect data from 426 employees working in residential aged care.

Methods: A paper-based questionnaire was distributed to all permanent and casual employees at eight aged care facilities in Melbourne, Australia, between June - September 2013. Moderation analyses were conducted using PROCESS v. 2.13 in SPSS v. 22.

Results/findings: As expected, workplace demands and resources directly influenced workers' work ability. In addition, moderate-to-high levels of work-family conflict and low-to-moderate levels of satisfaction with work-life balance combined interactively with particular workplace demands and resources (relationships with management, physical demands, and safety climate) to reduce work ability.

Conclusions: This study advances understanding of how work-life balance and work-life conflict can influence work ability levels and shows that addressing the work-life interface may be a legitimate means to improve work ability, potentially leading to continued workforce participation.

Impact: Staff retention in the residential aged care sector needs to be addressed. One possible means of achieving this is through improving work ability. This study expanded knowledge of how the work-life interface may influence work ability. The research demonstrated that relationships between work ability and particular workplace demands and resources were moderated by the work-life interface. This finding has implications for how human resources managers of residential aged care facilities may improve workforce retention-through facilitating employees to manage the work-life interface better.
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http://dx.doi.org/10.1111/jan.13914DOI Listing
July 2019

Long-term effects of a memory group intervention reported by older adults.

Neuropsychol Rehabil 2020 Jul 14;30(6):1044-1058. Epub 2018 Nov 14.

School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

The aim of this study was to examine older adults' experiences of change following a group memory intervention, the La Trobe and Caulfield Hospital (LaTCH) Memory Group programme. Semi-structured qualitative interviews were conducted with 30 individuals. Participants were healthy older adults and older adults with amnestic mild cognitive impairment (MCI) who had participated in the memory group five years previously. Transcripts were analysed for emergent themes in a workshop, using the Most Significant Change technique. The focus group derived four major themes relating to participants' experiences of change. Particularly noteworthy were themes describing a process of acceptance and normalising of memory difficulties in older age, as well as enhancement of coping and self-efficacy. The results highlight the importance of group support for older adults with and without objective memory impairment. Memory groups may use the group format to full advantage by (a) enhancing participants' experiences of universality to alleviate distress and promote coping, and (b) developing group norms to promote positive ageing, encompassing enhanced acceptance and self-efficacy.
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http://dx.doi.org/10.1080/09602011.2018.1544570DOI Listing
July 2020

Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review.

JMIR Res Protoc 2018 Jul 4;7(7):e164. Epub 2018 Jul 4.

Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.

Background: The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings.

Objective: The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings.

Methods: This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies.

Results: Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018.

Conclusions: In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed.

Trial Registration: PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54).

Registered Report Identifier: RR1-10.2196/9902.
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http://dx.doi.org/10.2196/resprot.9902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053602PMC
July 2018

Re-examination of the Family Law Detection of Overall Risk Screen (FL-DOORS): Establishing fitness for purpose.

Psychol Assess 2018 08 21;30(8):1121-1126. Epub 2018 May 21.

School of Psychology, Deakin University.

Conflicted parental separation is associated with escalating risks to wellbeing and safety for all family members. The Family Law DOORS (FL-DOORS, Detection Of Overall Risk Screen) is a three-part framework designed to assist frontline workers to identify, evaluate, and respond to these risks in separated families. The FL-DOORS system includes a 10-domain parent self-report screening measure, covering child and parent wellbeing, cultural and social risks, and safety risks experienced by and initiated by each parent. A first validation study of this screen was conducted with the first 660 separated parents to complete the measure at a frontline community agency, and found robust psychometric properties (McIntosh, Wells, & Lee, 2016). This paper presents a revalidation study of FL-DOORS screening measure with a new cohort of 5,429 separated parents, including 1,642 pairs. Our aim was to evaluate whether FL-DOORS was fit for the purpose of indicating a range of safety and wellbeing risks in separated families. We repeated internal scale reliability and concurrent and external criterion validity analyses. Original subscales were largely confirmed, and validity analyses were extended through a Multi-Trait Multi-Method (MTMM) approach. In this second larger cohort, the FL-DOORS screen was again found fit-for-purpose as an indicator of domestic violence and wellbeing risks in separated families. (PsycINFO Database Record
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http://dx.doi.org/10.1037/pas0000581DOI Listing
August 2018

Non-Pharmacological Approaches to Pain Management in Residential Aged Care: a Pre-Post-Test Study.

Clin Gerontol 2019 May-Jun;42(3):286-296. Epub 2017 Dec 14.

b Physiotherapy Department , Werribee Mercy Health , Melbourne , Australia.

Objectives: The project aimed to evaluate a pain management program (PMP) using non-pharmacological approaches at five residential aged care facilities (RACFs) in Australia.

Methods: The PMP involved a physiotherapist implementing four sessions per week of treatments (massage therapy, TENS, exercises and stretching, or combinations of these). Ninety-five participants were recruited (average age, 83 years; SD = 7.6; 38% men, 62% women; 56% with dementia). Sessions lasted approximately 10 minutes, and residents' levels of pain were recorded using a 5-point scale before and after each treatment. The intervention period for each participant was the first consecutive 8 weeks in which they received the intervention.

Results: Data analyses showed: (1) a small but statistically significant decrease in the number of as required (PRN) medications; and (2) a decrease in average pain ratings from pre-session to post-session from 2.4 (some to moderate pain) to 1.1 (a little pain). Notably, residents with dementia received lower pain ratings than those without.

Conclusions: Non-pharmacological approaches to pain in residential care settings are effective, especially when two or more are combined. Staff working in residential care settings should rely on best practice to recognise pain in residents with dementia.

Clinical Implications: Non-pharmacological interventions may be effective in reducing pain and reliance on PRN medications in residential care settings, especially when two or more are used. Staff working in residential aged care settings should be provided with training in pain assessment and management, with particular attention to residents with dementia.
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http://dx.doi.org/10.1080/07317115.2017.1399189DOI Listing
August 2020

Self-reported musculoskeletal disorder pain: The role of job hazards and work-life interaction.

Am J Ind Med 2018 02 9;61(2):130-139. Epub 2017 Nov 9.

Centre for Ergonomics, Safety and Health, School of Psychology and Public Health, La Trobe University, Victoria, Australia.

Background: Previous research identified an association between work-family conflict and musculoskeletal pain. This study explores how the work-life interface might affect pain experienced by residential aged care staff.

Methods: A cross-sectional survey of 426 employees in residential aged care was analyzed to assess the impacts of workplace hazards, work-family conflict, and work-life balance on self-reported musculoskeletal pain.

Results: Work-family conflict acts as a mediator of the relationships between workplace hazards and the total number of body regions at which musculoskeletal pain was experienced. Work-life balance only acts as a mediator for particular hazards and only if work-family conflict is not taken into account.

Conclusions: Addressing work-life interaction, and in particular work-family conflict, warrants further investigation as a legitimate means through which musculoskeletal disorder risk can be reduced. Policies and practices to improve work-life interaction and reduce work-family conflict should be considered as integral components of musculoskeletal disorder risk management strategies.
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http://dx.doi.org/10.1002/ajim.22793DOI Listing
February 2018

Effectiveness of the maximising cognition (MAXCOG) information resource for clients with mild cognitive impairment and their families.

Australas J Ageing 2018 Mar 3;37(1):E29-E32. Epub 2017 Nov 3.

Lincoln Centre for Research on Ageing, Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia.

Objective: To evaluate a new information resource developed for clients with mild cognitive impairment (MCI) or early dementia and their family supporters.

Methods: A controlled group trial was undertaken comparing 40 clients and family supporters who received 'service as usual' followed by 40 clients and family supporters who received 'service as usual' plus the new information resource. Telephone interviews comprising open questions, ratings and a quality-of-life questionnaire were undertaken two to four weeks after the client's final feedback session.

Results: The two groups (equivalent on sex, age and cognition) showed a similar pattern of responses regarding handout use and evaluation. However, family supporters in the group who received and read the new resource were better able to describe their use of cognitive management strategies.

Conclusion: Some family supporters appeared to benefit from using the new resource but people with MCI may require further face-to-face support to learn new strategies.
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http://dx.doi.org/10.1111/ajag.12479DOI Listing
March 2018

'Most significant change' and the maximising cognition (MAXCOG) intervention: The views of clients, supporters and counsellors.

Australas J Ageing 2017 Dec 13;36(4):324-326. Epub 2017 Oct 13.

Lincoln Centre for Research on Ageing, Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia.

Objectives: To explore the views of clients, supporters and counsellors about their experiences of the maximising cognition (MAXCOG) intervention.

Methods: The most significant change (MSC) method of analysis was used. Twenty-three narrative accounts of the MAXCOG intervention and the 'MSC' that occurred were obtained. A panel, including experts from Alzheimer's Australia, the MAXCOG research team and clinicians from memory clinics, conducted a workshop to discuss and categorise the accounts.

Results: Two subcategories of stories were identified: (i) An 'acceptance group' that focused on adjustment issues; and (ii) A 'goal achievement' group with a focus on goals and improvement in ability and confidence. These subcategories mapped closely to the original goals outlined for the MAXCOG intervention.

Conclusion: The MAXCOG intervention was successful in assisting people to work towards goals and adjust psychologically to difficulties.
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http://dx.doi.org/10.1111/ajag.12464DOI Listing
December 2017

MAXCOG-Maximizing Cognition: A Randomized Controlled Trial of the Efficacy of Goal-Oriented Cognitive Rehabilitation for People with Mild Cognitive Impairment and Early Alzheimer Disease.

Am J Geriatr Psychiatry 2017 Mar 16;25(3):258-269. Epub 2016 Nov 16.

Monash Ageing Research Centre, Monash University, and Monash Health, Melbourne, Australia.

Objectives: To review the efficacy of a home-based four-session individualized face-to-face cognitive rehabilitation (MAXCOG) intervention for clients with mild cognitive impairment (MCI) or early dementia and their close supporters.

Design: Randomized controlled trial comparing the intervention group (MAXCOG) with treatment as usual (control).

Participants: A total of 55 client-supporter dyads were enrolled in the study and 40 completed; 25 client-supporter dyads completed MAXCOG and 15 completed treatment as usual. Both MAXCOG and control groups included more MCI cases than dementia (22 versus 3 and 12 versus 3, respectively).

Intervention: Four weekly individual sessions of MAXCOG consisting of personalized interventions to address individually relevant goals, supported by the provision of the MAXCOG information resource.

Measures: The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure (COPM). Questionnaires assessing mood, illness adjustment, quality of life, and carer burden were also administered.

Results: The intervention group displayed significantly higher performance and satisfaction with primary goals on the COPM post-intervention than the control group, using a per-protocol analysis.

Conclusions: The MAXCOG intervention is effective in improving goal performance and satisfaction in clients with MCI and early dementia.
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http://dx.doi.org/10.1016/j.jagp.2016.11.008DOI Listing
March 2017

Development and validation of the Family Law DOORS.

Psychol Assess 2016 11 28;28(11):1516-1522. Epub 2016 Jan 28.

Relationships Australia.

When former spouses experience distress and dispute following separation, risks to well-being and to safety are heightened for all family members. Reliable family-wide risk screening is essential. The Family Law DOORS (Detection of Overall Risk Screen) is a 3-part screening framework to assist identification, evaluation, and response to safety and well-being risks in separated families. Uniquely, the Family Law DOORS screens for victimization and perpetration risks and appraises infant and child developmental risk. The Family Law DOORS self-report screening tool is the subject of this report. Internal scale reliability and concurrent and external criterion validity for the Family Law DOORS were estimated with a community sample of 660 separated parents, including 181 mother-father pairs. Overall psychometric properties are strong and demonstrate good potential for the Family Law DOORS to support early risk detection for separating families. (PsycINFO Database Record
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http://dx.doi.org/10.1037/pas0000277DOI Listing
November 2016

The Lived Experience of Providing Care and Support Services for Holocaust Survivors in Australia.

Qual Health Res 2017 Jun 14;27(7):1104-1114. Epub 2016 Sep 14.

1 La Trobe University, Melbourne, Australia.

Lack of awareness among paid carers of the possible late-life consequences of early-life periods of extreme and prolonged traumatization may have negative impacts on the experiences of trauma survivors in receiving care. An interpretive phenomenological approach was used to investigate the lived experience of paid carers in providing care for Jewish Holocaust survivors. In total, 70 carers participated in 10 focus group discussions. Credibility of the findings was ensured by methodological triangulation and peer debriefing. Three major themes emerged: (a) knowing about survivors' past helps me make sense of who they are, (b) the trauma adds an extra dimension to caregiving, and (c) caring for survivors has an emotional impact. Specific knowledge, attitudes, and skills for building positive care relationships with Holocaust survivors were identified. The findings offer a starting point for advancing knowledge about the care of older survivors from other refugee backgrounds.
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http://dx.doi.org/10.1177/1049732316667702DOI Listing
June 2017

Aged care managers' perceptions of staff preparedness for caring for older survivors of genocide and mass trauma in Australia: How prepared are aged care workers?

Australas J Ageing 2017 Mar 11;36(1):E20-E22. Epub 2016 Mar 11.

Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia.

Objective: To investigate aged care managers' perceptions of staff preparedness for working with older people who experienced genocide or mass trauma earlier in their lives (referred to in this paper as 'older survivors').

Methods: A survey of 60 aged care service managers was conducted (50% response rate). Trauma knowledge and skills scales with Cronbach's alpha scores of 0.74 and 0.90 respectively, were used. Scores across groups were compared using Student's t-tests.

Results: Three-quarters of the respondents reported that their agency had provided aged care services for older survivors. The majority of these managers perceived their staff to be moderately informed about trauma-related issues and half rated staff trauma-related skills positively. These ratings were positively associated with trauma-related staff training, service type and service location.

Conclusion: Results suggest that, overall, managers perceive a need to improve aged care staff's preparedness for providing care for older survivors.
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http://dx.doi.org/10.1111/ajag.12286DOI Listing
March 2017

Senior staff perspectives of a quality indicator program in public sector residential aged care services: a qualitative cross-sectional study in Victoria, Australia.

Aust Health Rev 2016 Feb;40(1):54-62

Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Vic. 3086, Australia. Email.

Objective: The aims of the present study were to describe the views of senior clinical and executive staff employed in public sector residential aged care services (RACS) about the benefits and limitations of using quality indicators (QIs) for improving care, and to identify any barriers or enablers to implementing the QI program.

Methods: A cross-sectional qualitative study using semistructured interviews and direct observation of key informants involved in the QI program was performed across 20 public sector RACS in Victoria, Australia. Participants included senior clinical, executive and front-line staff at the RACS. The main outcome measures were perceived benefits and the enablers or barriers to the implementation of a QI program.

Results: Most senior clinical and executive staff respondents reported substantive benefits to using the QIs and the QI program. A limited number of staff believed that the QI program failed to improve the quality of care and that the resource requirements outweighed the benefits of the program, resulting in disaffected staff.

Conclusions: The QIs and QI program acted as a foundation for improving standards of care when used at the front line or point of care. Senior executive engagement in the QI program was vital to successful implementation.
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http://dx.doi.org/10.1071/AH14197DOI Listing
February 2016

Health, lifestyle, and gender influences on aging well: an Australian longitudinal analysis to guide health promotion.

Front Public Health 2014 2;2:70. Epub 2014 Jul 2.

Australian Institute for Primary Care and Ageing, La Trobe University , Melbourne, VIC , Australia.

A primary societal goal for aging is enabling older people to continue to live well as long as possible. The evidence base around aging well ("healthy," "active," and "successful" aging) has been constructed mainly from academic and professional conceptualizations of mortality, morbidity, functioning, and psychological well-being with some attention to lay views. Our study aims to inform action on health promotion to achieve aging well as conceptualized by qualitative research identifying what older Australians themselves value most: continuing to live as long as possible in the community with independence in daily living, and good self-rated health and psychological well-being. Multivariate survival analyses from the Melbourne longitudinal studies on healthy aging program found that important threats to aging well for the total sample over a 12-year period were chronological age, multi-morbidity, low perceived social support, low nutritional score, and being under-weight. For men, threats to aging well were low strain, perceived inadequacy of social activity, and being a current smoker. For women, urinary incontinence, low physical activity and being under-weight were threats to aging well. The findings indicate that healthy lifestyles can assist aging well, and suggest the value of taking gender into account in health promotion strategies.
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http://dx.doi.org/10.3389/fpubh.2014.00070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078909PMC
July 2014

Developing a comprehensive approach to risk management of musculoskeletal disorders in non-nursing health care sector employees.

Appl Ergon 2014 Nov 3;45(6):1634-40. Epub 2014 Jul 3.

Lincoln Centre for Research on Ageing, La Trobe University, Bundoora, Vic, Australia.

This study of selected jobs in the health care sector explored a range of physical and psychosocial factors to identify those that most strongly predicted work-related musculoskeletal disorders (WMSD) risk. A self-report survey was used to collect data on physical and psychosocial risk factors from employees in three health care organisations in Victoria, Australia. Multivariate analyses demonstrated the importance of both psychosocial and physical hazards in predicting WMSD risk and provides evidence for risk management of WMSDs to incorporate a more comprehensive and integrated approach. Use of a risk management toolkit is recommended to address WMSD risk in the workplace.
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http://dx.doi.org/10.1016/j.apergo.2014.05.016DOI Listing
November 2014

Use of Quality Indicators in Nursing Homes in Victoria, Australia: A Cross-Sectional Descriptive Survey.

J Aging Health 2014 Aug 30;26(5):824-840. Epub 2014 Apr 30.

La Trobe University, Melbourne, Victoria, Australia.

Objective: This study aimed to characterize the use of mandated quality indicators (QIs) in public sector nursing homes by describing their adherence to established principles of measurement and whether nursing homes respond to QI data to improve care.

Method: Data were collected from a descriptive cross-sectional quantitative study using a confidential survey questionnaire distributed electronically to senior staff in all public sector nursing homes in Victoria, Australia.

Results: Staff from 113 of 196 facilities completed the survey (58%). Adherence to principles of measurement was suboptimal, with variation in applying QI definitions and infrequent random audits of data (n = 54, 48%). QI data triggered reviews of individual residents (62%-79%), staff practice (44%-65%), and systems of care (45%-55%). Most facilities (58%-75%) reported that beneficial changes in care occurred as a result of using QIs.

Discussion: QI performance data are positively received and used to improve care. Standardization of data collection, analysis, and reporting should strengthen the program's utility.
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http://dx.doi.org/10.1177/0898264314531619DOI Listing
August 2014

Relationship between frailty and discharge outcomes in subacute care.

Aust Health Rev 2014 Feb;38(1):25-9

Alfred Health, Alfred Hospital, Commercial Road, Prahran, Vic. 3181, Australia.

Aims: To determine whether level of frailty can predict length of stay, discharge destination, level of participation in physiotherapy, and degree of physical improvement with physiotherapy in older, subacute hospital patients.

Method: The Edmonton Frail Scale (EFS) was administered to 75 older people in a subacute hospital setting. Relationships between EFS score and a range of other measures, including participation in physiotherapy, Elderly Mobility Scale, discharge destination and length of stay, were examined.

Results: Level of frailty did not predict length of stay (rho=-0.13, P=0.24), discharge destination (t=-1.32, P=0.19), raw change on the Elderly Mobility Scale (rho=0.06, P=0.61) or rate of change on the Elderly Mobility Scale (r=-0.001, P=0.98). In addition, participants with a high level of frailty were more likely to achieve a satisfactory level of participation in physiotherapy sessions than those with low frailty (OR 1.43, P=0.02).

Conclusion: Level of frailty measured with the EFS was not a useful predictor of rehabilitation and discharge outcomes for older people in subacute care. These results do not support the routine use of the EFS to measure frailty in subacute care. WHAT IS KNOWN ABOUT THIS TOPIC? In a community-dwelling population, level of frailty has been found to predict poor outcomes from surgery, falls, fractures, disability, need for residential care and mortality. However, little is known about the impacts of frailty in a subacute setting, nor how frailty could best be measured in this setting. WHAT DOES THIS PAPER ADD? The use of the EFS as a predictive tool was not supported by the results of this exploratory study. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Alternative frailty measures may be more suitable than the EFS for patients in a subacute setting.
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http://dx.doi.org/10.1071/AH13067DOI Listing
February 2014
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