The abuse of older people is a largely unrecognised and under acknowledged social problem in Australia. My major objective in undertaking the work, which is represented by the original published articles that comprise the thesis, was to make a scholarly and practical contribution toward the minimisation of 'elder abuse. This objective was achieved with the development and implementation of a series of studies that articulated and ameliorated elder abuse in Australia.The thesis provides an erudite synthesis of these studies, which fall into four themes that illustrate the nature and scope of my theoretical and professional work in elder abuse. Much of the work was guided by a conceptual framework of ways of knowing in nursing, and was underpinned by the principles and practice of community development and participatory community-based action processes.The outcomes of these studies include work with three stakeholder groups: professionals who deal with elder abuse, older people who are victims or potential victims of abuse, and those who perpetrate abuse on an older person. The work, illustrated in the four themes, includesthe articulation of elder abuse issues with West Australian aged care workersthe development of elder abuse protocols, policy guidelines and ethical principles, to guide professional practice in abuse prevention and interventionthe design and implementation of participative community programs to empower older people, and their carers, to resist being abused or abusing and to assist perpetrators stop their abusethe amelioration of abuse of nursing home residents by staff.The thesis situates my conceptual and clinical effort within the wider corpus of Australian knowledge and practice on elder abuse and contributes to addressing the social problem of elder abuse within the context of Australian aged care.

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Yes / Over half a million people aged 65+ live in care homes (ONS 2011). Yet, sex, sexuality and intimacy and old people remain overlooked in social policy and professional practice (Hafford-Letchfield 2008). We explore narratives from a feasibility study based in Northwest England that consulted on the significance of researching sexuality and intimacy. We draw on narratives generated with two focus groups of professional carers (n = 16) and interviews with three residents, (two male and one female) and four female spouses (n = 7). All three types of stakeholders expressed concern about privacy and environmental impediments to intimacy (e.g. shortage of double rooms). However, distinct concerns were expressed by each group. Residents’ expressed scepticism that the topic was ‘too personal’, that old people were post-sexual or that sex/intimacy were part of range of needs and could be eclipsed by those relating to grand-parenting, avoiding isolation and personalization of care. Spouses emphasized the importance of intimacy over sex/sexuality as an indicator of the depth and longevity of a relationship but were concerned about unmet needs and loss of influence over their partners’ care. Obliged to meet a complex of legal, professional, ethical and interpersonal obligations, care staff articulated a need for guidance to help them support residents and their significant others. We conclude with practical recommendations that address barriers to enabling intimacy.

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Yes / This article aims to explore family perspectives on their involvement in the timely detection of changes in their relatives' health in UK nursing homes. Increasingly, policy attention is being paid to the need to reduce hospitalisations for conditions that, if detected and treated in time, could be managed in the community. We know that family continue to be involved in the care of their family members once they have moved into a nursing home. Little is known, however, about family involvement in the timely detection of changes in health in nursing home residents. This was a qualitative exploratory study with thematic analysis. A purposive sampling strategy was applied. 14 semi-structured one-to-one telephone interviews with family members of people living in 13 different UK nursing homes. Data were collected from November 2015 to March 2016. Families were involved in the timely detection of changes in health in three key ways: noticing signs of changes in health, informing care staff about what they noticed, and educating care staff about their family members' changes in health. Families suggested they could be supported to detect timely changes in health by developing effective working practices with care staff. Families can provide a special contribution to the process of timely detection in nursing homes. Their involvement needs to be negotiated, better supported, as well as given more legitimacy and structure within the nursing home. Families could provide much needed support to nursing home nurses, care assistants, and managers in timely detection of changes in health. This may be achieved through communication about their preferred involvement on a case-by-case basis as well as providing appropriate support or services. / NIH Research Programme Grant for Applied Research (RP-PG-0612-20010)

Yes / Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. Methods and analysis: Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). / UK NIHR grant number RP-PG-0612-20010.

M Family Medicine research report - Faculty of Health Sciences / Residents of old age homes are at increased risk for the complications of influenza. Studies in developed countries have consistently shown that influenza vaccination of old age home residents and staff can significantly decrease morbidity and mortality rates and that influenza vaccination is one of the most cost effective interventions possible in this population. No studies have been done on the cost benefit of using influenza vaccine in old age home residents in South Africa. The aim of this study was to evaluate the costs of treating influenza and influenza-like illnesses in old age home residents, and to compare the costs in people who had received the influenza vaccine to those who had not. The study population comprised 151 people residing in two old age homes in Johannesburg, namely Sandringham Gardens and Nazareth House. The study population was divided into two groups- those who received influenza vaccine and those who had not been vaccinated. The residents of Nazareth House who gave consent had all been vaccinated. The subjects at Sandringham Gardens were sub- divided into two groups, namely: “Residents” and “Frail care / wards” section. The general health of the “Frail care” people was poorer than that of the “residents”. Medical records were reviewed, and details of the number of doctor consultations, medication and physiotherapy prescribed, special investigations performed and hospital referrals related to influenza and influenza-like infections were recorded. The costs were then calculated using “medical aid rates”. There were no significant differences in the treatment costs, comparing those who had been vaccinated to those who had not been vaccinated. There are a number of possible explanations for this. These include, most importantly, a low to moderate epidemic activity of influenza in the season that the study was conducted. Other explanations are low patient numbers, the use of symptoms for diagnosis and the use of over the counter therapy. Despite the findings in the present study, the international literature supports the view that influenza vaccination is a cost-effective intervention in the older adult population, particularly those at higher risk. These findings have been implemented in the official guidelines of many countries, including the South African Adult Influenza Vaccination Guideline.

<p>Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. </p><p>Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. </p><p>In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00). </p>

Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00).