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Categories of Research Organisations Section 1: Categories of Research Organisations 1. Multidisciplinary Ageing Research Units 1.1 Centre for Ageing Studies Flinders University of South Australia Oliphant Building, Science Park BEDFORD PARK SA 5042 1.2 Centre for Applied Gerontology Bundoora Extended Care Centre 1231 Plenty Road BUNDOORA VIC 3083 1.3 Centre for Education and Research on Ageing Concord Hospital C25 CONCORD NSW 2139 1.4 Community Disability and Ageing Program Research Centre for Adaptation in Health and Illness University of Sydney SYDNEY NSW 2006 1.5 Healthy Ageing Unit Department of Social and Preventive Medicine University of Queensland Herston Road HERSTON QLD 4006 1.6 Lincoln Gerontology Centre Australian Institute for Primary Care La Trobe University BUNDOORA VIC 3083 1.7 National Ageing Research Institute University of Melbourne North West Hospital Poplar Road PARKVILLE VIC 3052 2. Medical Research Dentistry 2.1 AIHW Dental Statistics and Research Unit The University of Adelaide ADELAIDE SA 5005 Australian Ageing Research Directory 2000 1 Categories of Research Organisations 2.2 Dental Health Services Victoria 711 Elizabeth Street MELBOURNE VIC 3000 General Practice 2.3 Brisbane North Division of General Practice PO Box 845 LUTWYCHE QLD 4030 2.4 Department of Community Medicine and General Practice Monash University 867 Centre Road EAST BENTLEIGH VIC 3165 2.5 Department of General Practice University of Adelaide ADELAIDE SA 5005 2.6 Division of General Practice Central Sydney Area Health Service 37 Booth Street BALMAIN NSW 2041 2.7 DiNCQUMGP Divisions National Consortium for the Quality Use of Medicines in General Practice c/o Central Sydney Division of General Practice 37 Booth Street BALMAIN NSW 2041 2.8 General Practice Professorial Unit Faculty of Medicine University of Sydney Manly Hospital Darley Road MANLY NSW 2095 2.9 Northern Sydney Division of General Practice Room 30, Level 4 Vindin House Royal North Shore Hospital ST LEONARDS NSW 2065 Geriatric and Community Medicine 2.10 2 Aged Care Service Austin and Repatriation Medical Centre Banksia Street HEIDELBERG WEST VIC 3081 Australian Ageing Research Directory 2000 Categories of Research Organisations 2.11 Cognitive Neuropsychiatry Research and Academic Unit University of Melbourne PARKVILLE VIC 3052 2.12 Department of Geriatric and Rehabilitation Medicine Royal Adelaide Hospital Level 5 McEwin Building North Terrace ADELAIDE SA 5000 2.13 Department of Geriatric Medicine University of Western Australia Royal Perth Hospital Level 5, Ainslie House 48 Murray Street PERTH WA 6000 2.14 Eastern Regional Geriatric and Medical Rehabilitation Service 207-255 Hampstead Road NORTHFIELD SA 5085 2.15 General, Geriatric & Rehabilitation Medicine Central Sydney Area Health Service Balmain Hospital Booth Street BALMAIN NSW 2041 2.16 Geriatric Medicine Liverpool Hospital South Western Sydney Area Health Service PO Box 7103 LIVERPOOL BC NSW 1871 2.17 Rehabilitation and Aged Care Service Hornsby Ku-ring-gai Hospital Palmerston Road HORNSBY NSW 2077 2.18 Rehabilitation Studies Unit Department of Medicine University of Sydney PO Box 6 RYDE NSW 1680 Australian Ageing Research Directory 2000 3 Categories of Research Organisations Medicine 2.19 Brain Sciences Institute Swinburne University of Technology 400 Burwood Road HAWTHORN VIC 3122 2.20 Central West Parkinson’s Disease Research Group c/o Parkes Shire Council 2 Cecil Street PARKES NSW 2870 2.21 Centre for Epidemiology and Biostatistics University of Newcastle CALLAGHAN NSW 2308 2.22 Centre for Human Biology Department of Anatomy and Human Biology University of Western Australia NEDLANDS WA 6907 2.23 Centre for Magnetic Resonance University of Queensland HERSTON QLD 4006 2.24 Centre for Molecular Biology and Medicine Epworth Medical Centre 185-187 Hoddle Street RICHMOND VIC 3121 2.25 Clinical Cognitive Research Unit Austin and Repatriation Medical Centre Banksia Street HEIDELBERG WEST VIC 3081 2.26 Department of Biochemistry and Molecular Biology Monash University CLAYTON VIC 3800 2.27 Department of Epidemiology and Preventive Medicine Monash Medical School Monash University Alfred Hospital Commercial Road PRAHRAN VIC 3181 4 Australian Ageing Research Directory 2000 Categories of Research Organisations 2.28 Department of Medicine University of Adelaide The Queen Elizabeth Hospital 28 Woodville Road WOODVILLE SOUTH SA 5011 2.29 Department of Medicine Southern Clinical School University of Queensland Princess Alexandra Hospital Woolloongabba BRISBANE VIC 4102 2.30 Department of Nuclear Medicine The Queen Elizabeth Hospital 28 Woodville Road WOODVILLE SOUTH SA 5011 2.31 Department of Physiology University of Adelaide North Terrace ADELAIDE SA 5005 2.32 Department of Physiology Faculty of Medicine University of Melbourne PARKVILLE VIC 3052 2.33 Department of Rheumatology Royal North Shore Hospital ST LEONARDS NSW 2065 2.34 Discipline of Medicine University of Tasmania 43 Collins Street HOBART TAS 7000 2.35 Prince of Wales Medical Research Institute Prince of Wales Hospital Barker Street RANDWICK NSW 2031 2.36 Retinal Biology Laboratory Department of Anatomy & Histology University of Sydney SYDNEY NSW 2006 Australian Ageing Research Directory 2000 5 Categories of Research Organisations 2.37 School of Biomedical Sciences Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 2.38 School of Medical Education University of New South Wales SYDNEY NSW 2052 Optometry and Ophthalmology 2.39 Centre for Eye Research Australia University of Melbourne c/o Royal Victorian Eye and Ear Hospital Level 1, 32 Gisborne Street EAST MELBOURNE VIC 3002 2.40 Centre for Eye Research School of Optometry Queensland University of Technology Victoria Park Road KELVIN GROVE QLD 4059 2.41 National Vision Research Unit of Australia 386 Cardigan Street CARLTON VIC 3053 2.42 School of Applied Vision Sciences Cumberland Campus Building C42 University of Sydney SYDNEY NSW 2006 2.43 School of Optometry Queensland University of Technology Victoria Park Road KELVIN GROVE QLD 4059 2.44 School of Orthoptics La Trobe University BUNDOORA VIC 3083 Pharmacology 2.45 6 Department of Clinical Pharmacology St Vincent’s Hospital 41 Victoria Parade FITZROY VIC 3065 Australian Ageing Research Directory 2000 Categories of Research Organisations 2.46 Department of Pharmacy University of Sydney SYDNEY NSW 2006 2.47 Drug Research and Development Group Department of Medical Laboratory Science RMIT University PO Box 2476V MELBOURNE VIC 3001 2.48 Pharmaceutical Services Branch Public and Environmental Health Service Department of Human Services PO Box 6 RUNDLE MALL SA 5000 2.49 Quality Use of Medicine and Pharmacy Research Centre School of Pharmacy and Medical Sciences University of South Australia North Terrace ADELAIDE SA 5000 2.50 Tasmanian Quality Use of Medicines Group c/o School of Medicine University of Tasmania PO Box 252/34 HOBART TAS 7001 Psychiatry and Psychogeriatrics 2.51 Academic Department of Old Age Psychiatry Prince of Wales Hospital McNevin Dickson Building Avoca Street RANDWICK NSW 2031 2.52 Aged Care Services and Aged Psychiatry Services Caulfield General Medical Centre 260 Kooyong Road CAULFIELD VIC 3162 2.53 Aged Mental Health Research Group Monash University Kingston Centre Warrigal Road CHELTENHAM VIC 3192 Australian Ageing Research Directory 2000 7 Categories of Research Organisations 2.54 Centre for Mental Health Research Australian National University CANBERRA ACT 0200 2.55 Community and Mental Health Services Unit Australian Institute of Health and Welfare GPO Box 570 CANBERRA ACT 2601 2.56 Faculty of Psychiatry of Old Age Royal Australian and New Zealand College of Psychiatrists 309 La Trobe Street MELBOURNE VIC 3000 2.57 Mental Health Research Institute of Victoria Locked Bag No. 11 PARKVILLE VIC 3052 3. Health and Behavioural Sciences Allied Health 3.1 Centre for Allied Health Research University of South Australia City East Campus North Terrace ADELAIDE SA 5000 3.2 Centre for Evidence-based Physiotherapy School of Physiotherapy University of Sydney PO Box 170 LIDCOMBE NSW 1825 3.3 Communication Disability in Ageing Research Unit Department of Speech Pathology and Audiology University of Queensland BRISBANE QLD 4072 3.4 Department of Physiotherapy University of Queensland ST LUCIA QLD 4072 3.5 Dietitians Association of Australia Inc.(Victorian Branch) PO Box 229 Collins Street West MELBOURNE VIC 8007 8 Australian Ageing Research Directory 2000 Categories of Research Organisations 3.6 Physiotherapy Department Bankstown-Lidcombe Hospital South Western Sydney Area Health Service Eldridge Road BANKSTOWN NSW 2200 3.7 School of Communication Sciences and Disorders Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.8 School of Exercise and Sport Science Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.9 School of Occupational Therapy La Trobe University BUNDOORA VIC 3083 3.10 School of Occupational Therapy University of South Australia GPO Box 2471 ADELAIDE SA 5001 3.11 School of Physiotherapy Curtin University of Technology GPO Box U1987 PERTH WA 6845 3.12 School of Physiotherapy Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.13 School of Physiotherapy University of Melbourne Grattan Street PARKVILLE VIC 3052 Health 3.14 Aged Care Unit Australian Institute of Health and Welfare GPO Box 570 CANBERRA ACT 2601 Australian Ageing Research Directory 2000 9 Categories of Research Organisations 3.15 Aged Care Research and Evaluation Unit Department of Public Health University of Western Australia NEDLANDS WA 6907 3.16 Ballarat Health Services Base Hospital University of Melbourne PO Box 577 BALLARAT VIC 3353 3.17 Centre for Health Promotion Research School of Public Health Curtin University of Technology GPO Box U 1987 PERTH WA 6845 3.18 Centre for Rural and Regional Health University of Ballarat PO Box 663 BALLARAT VIC 3363 3.19 Centre for the Older Woman University of Queensland ST LUCIA QLD 4072 3.20 Centre for the Study of Health and Society The University of Melbourne Grattan Street PARKVILLE VIC 3052 3.21 Department of Health Policy and Management School of Public Health Curtin University of Technology GPO Box U1987 PERTH WA 6845 3.22 Department of Public Health and Community Medicine Faculty of Medicine University of Sydney SYDNEY NSW 2006 3.23 Disability Services Unit Australian Institute of Health and Welfare GPO Box 570 CANBERRA ACT 2601 10 Australian Ageing Research Directory 2000 Categories of Research Organisations 3.24 Division of Health Sciences University of South Australia North Terrace ADELAIDE SA 5000 3.25 Faculty Office Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.26 Faculty of Health Sciences La Trobe University BUNDOORA VIC 3083 3.27 Health Department of Western Australia 189 Royal Street EAST PERTH WA 6004 3.28 Health Issues Centre Level 11/300 Flinders Street MELBOURNE VIC 3000 3.29 Health Promotion Service South Eastern Sydney Area Health Service PO Box 430 KOGARAH NSW 2217 3.30 Healthy Ageing Research Unit Hornsby Ku-ring-gai Hospital Palmerston Road HORNSBY NSW 2077 3.31 Institute of Disability Studies Deakin University 221 Burwood Highway BURWOOD VIC 3125 3.32 Menzies Centre for Population Health Research University of Tasmania PO Box 252 HOBART TAS 7001 3.33 Mid North Coast Area Health Service Southern Sector York Street TAREE NSW 2430 Australian Ageing Research Directory 2000 11 Categories of Research Organisations 3.34 Monash University Centre for Rural Health Box 424 TRARALGON VIC 3844 3.35 Moreland Community Health Service 93 Bell Street COBURG VIC 3058 3.36 National Rural Health Alliance PO Box 280 DEAKIN WEST ACT 2600 3.37 Research Institute for Gender and Health The University of Newcastle CALLAGHAN NSW 2308 3.38 Rural Ageing and Lifestyle Group Charles Sturt University PO Box 789 ALBURY NSW 2640 3.39 School of Behavioural and Community Health Sciences Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.40 School of Community Health Charles Sturt University PO Box 789 ALBURY NSW 2640 3.41 School of Health University of New England ARMIDALE NSW 2351 3.42 School of Health and Human Performance Faculty of Arts, Health and Sciences Central Queensland University ROCKHAMPTON QLD 4072 3.43 School of Health and Human Services La Trobe University Edwards Road BENDIGO VIC 3552 12 Australian Ageing Research Directory 2000 Categories of Research Organisations 3.44 School of Health and Human Services University of Western Sydney PO Box 555 Macarthur Campus CAMPBELLTOWN NSW 2560 3.45 School of Health and Nursing University of Western Sydney Cnr Victoria Road and James Ruse Drive RYDALMERE NSW 2116 3.46 School of Health Sciences Deakin University 221 Burwood Highway BURWOOD VIC 3125 3.47 School of Occupation and Leisure Sciences Faculty of Health Sciences University of Sydney SYDNEY NSW 2006 3.48 School of Public Health La Trobe University BUNDOORA VIC 3083 3.49 Southern Cross Institute of Health Research Northern Rivers Area Health Service 31 Uralba Street LISMORE NSW 2480 3.50 Southern Downs District Health Services 56 Locke Street WARWICK QLD 4370 3.51 Tropical Health Program Australian Centre for International and Tropical Health and Nutrition University of Queensland HERSTON QLD 4006 Nursing 3.52 Australian Nursing Federation (Vic Branch) Box 12600 A’Beckett Street PO MELBOURNE VIC 8006 Australian Ageing Research Directory 2000 13 Categories of Research Organisations 3.53 Centre for Nursing Research School of Nursing Queensland University of Technology Victoria Park Road KELVIN GROVE QLD 4059 3.54 Centre for Nursing Research & Development School of Nursing Curtin University of Technology GPO Box U1987 PERTH WA 6845 3.55 Centre for Research into Nursing and Health Care School of Nursing & Midwifery University of South Australia City East Campus North Terrace ADELAIDE SA 5000 3.56 Department of Nursing and Public Health RMIT University Bundoora West Campus Plenty Road BUNDOORA VIC 3083 3.57 International Institute of Hospice Studies Flinders University of South Australia 700 Goodwood Road DAW PARK SA 5041 3.58 Nursing Department Faculty of Sciences University of Southern Queensland TOOWOOMBA QLD 4350 3.59 School of Nursing Deakin University 221 Burwood Highway BURWOOD VIC 3125 3.60 School of Nursing (NSW) Faculty of Health Sciences Australian Catholic University 40 Edward Street NORTH SYDNEY NSW 2059 14 Australian Ageing Research Directory 2000 Categories of Research Organisations 3.61 School of Nursing Faculty of Health Sciences University of Tasmania LAUNCESTON TAS 7250 3.62 School of Nursing and Health Studies Faculty of Arts, Health and Sciences Central Queensland University ROCKHAMPTON QLD 4702 3.63 School of Nursing and Public Health Edith Cowan University PERTH WA 6000 3.64 School of Postgraduate Nursing The University of Melbourne Level 1, 723 Swanston Street CARLTON VIC 3053 Psychology and Behavioural Sciences 3.65 Australian Psychological Society Ltd PO Box 126 CARLTON SOUTH VIC 3053 3.66 Department of Psychological Medicine University of Sydney SYDNEY NSW 2006 3.67 Department of Psychology Faculty of Arts Victoria University of Technology Ballarat Road FOOTSCRAY VIC 3011 3.68 Department of Psychology University of Adelaide North Terrace ADELAIDE SA 5005 3.69 Department of Psychology and Intellectual Disability Studies RMIT University City Campus GPO Box 2476V MELBOURNE VIC 3001 Australian Ageing Research Directory 2000 15 Categories of Research Organisations 3.70 Discipline of Behavioural Science School of Population Health Sciences University of Newcastle Locked Bag 10 WALLSEND NSW 2287 3.71 Human Motor Control Laboratory School of Psychology University of Tasmania GPO Box 252 HOBART TAS 7001 3.72 School of Psychology Curtin University of Technology GPO Box U1985 PERTH WA 6001 3.73 School of Psychology Edith Cowan University 100 Joondalup Drive JOONDALUP WA 6027 3.74 School of Psychology Flinders University of South Australia BEDFORD PARK SA 5042 3.75 School of Psychology University of New England ARMIDALE NSW 2351 3.76 School of Psychology University of New South Wales SYDNEY NSW 2052 3.77 School of Psychology University of South Australia St Bernards Road MAGILL SA 5072 4. Social Sciences Community Services and Social Welfare 4.1 16 Anglican Homes Inc. PO Box 63 COTTESLOE WA 6911 Australian Ageing Research Directory 2000 Categories of Research Organisations 4.2 Benevolent Society of NSW PO Box 171 PADDINGTON NSW 2021 4.3 Bentley Aged Care Service Bentley Health Service 18-56 Mills Street BENTLEY WA 6102 4.4 Carers Association of South Australia Inc. PO Box 410 UNLEY SA 5061 4.5 Carers Association Victoria Inc. 5th Floor, 130 Collins Street MELBOURNE VIC 3000 4.6 Carers NSW Level 5 93 York Street SYDNEY NSW 2000 4.7 Council on the Ageing Queensland Inc. PO Box 179 NUNDAH QLD 4012 4.8 Deaf Society of NSW Level 4 169 Macquarie Street PARRAMATTA NSW 2150 4.9 Eastern Domiciliary Care Service Hampstead Road NORTHFIELD SA 5085 4.10 Fronditha Care Inc. 94 Springs Road CLAYTON SOUTH VIC 3169 4.11 Helping Hand Aged Care Inc PO Box 65 NORTH ADELAIDE SA 5006 4.12 Hostel and Care Division (now disbanded) Home Care NSW PO Box 3004 PARRAMATTA NSW 2150 Australian Ageing Research Directory 2000 17 Categories of Research Organisations 4.13 Institute for the Service Professions Edith Cowan University Mount Lawley Campus MOUNT LAWLEY WA 6050 4.14 Julia Farr Services 103 Fisher Street FULLARTON SA 5063 4.15 NSW Committee on Ageing Ageing & Disability Department Level 13 83 Clarence Street SYDNEY NSW 2000 4.16 Office of Seniors Interests 4th Floor May Holman Centre 32 St George’s Terrace PERTH WA 6000 4.17 Parkes Aged Care Services Mid Western Area Health Service PO Box 103 PARKES NSW 2870 4.18 Silver Chain Nursing Association 6 Sundercombe Street OSBORNE PARK WA 6017 4.19 Southern Domiciliary Care 670 Marion Road PARK HOLME SA 5043 4.20 Western Domiciliary Care PO Box 129 WOODVILLE PARK SA 5011 4.21 West Australian Community Care Classification Project Steering Committee c/o Aged and Community Services WA Suite 3/59 Walters Drive OSBORNE PARK WA 6017 Demography, Population, Cultural and Religious Studies 4.22 18 Department of Archaeology and Anthropology Australian National University CANBERRA ACT 0200 Australian Ageing Research Directory 2000 Categories of Research Organisations 4.23 Centre for Community and Cross Cultural Studies School of Human Services Queensland University of Technology CARSELDENE QLD 4034 4.24 Population Studies Program Department of Sociology Faculty of Arts The Australian National University CANBERRA ACT 0200 4.25 Religious Studies Program School of Archeological and Historical Studies Faculty of Humanities and Social Sciences La Trobe University BUNDOORA 3083 4.26 School of International, Community and Cultural Studies Edith Cowan University Joondalup Campus JOONDALUP WA 6027 Law, Ethics, Criminology, Human Rights and Education 4.27 Aged Rights Advocacy Service 45 Flinders Street ADELAIDE, SA 5000 4.28 Australian Institute of Criminology GPO Box 2944 CANBERRA CITY ACT 2601 4.29 Centre for Curriculum and Professional Development School of Education Murdoch University South Street MURDOCH WA 6150 4.30 Human Rights and Equal Opportunity Commission GPO Box 5218 SYDNEY NSW 1042 Social Work, Social Policy and Social Research 4.31 Ageing and Long Term Care Practice Research Unit School of Social Work University of Melbourne MELBOURNE VIC 3010 Australian Ageing Research Directory 2000 19 Categories of Research Organisations 4.32 Centre for Social Science Research University of Central Queensland ROCKHAMPTON QLD 4702 4.33 De Bono Institute 4th Floor, 20 Queens Street MELBOURNE VIC 3000 4.34 Department of Social Work and Social Policy Faculty of Health Sciences La Trobe University BUNDOORA VIC 3083 4.35 Faculty of Human Development Victoria University of Technology PO Box 14428 MELBOURNE CITY MAIL CENTRE, VIC 8001 4.36 Faculty of Social Sciences Flinders University of South Australia BEDFORD PARK SA 5042 4.37 Impact Consulting Group Level 14, 114 William Street MELBOURNE VIC 3000 4.38 Kate Barnett & Associates Pty Ltd 56 Greenhill Road WAYVILLE SA 5034 4.39 National Key Centre for Social Applications of Geographical Information Systems University of Adelaide North Terrace ADELAIDE SA 5005 4.40 Positive Ageing Centre Cloisters Building 200 St George’s Terrace PERTH WA 6000 4.41 Positive Ageing Research Network Division of Social Sciences, Education and Humanities Murdoch University South Street MURDOCH WA 6150 20 Australian Ageing Research Directory 2000 Categories of Research Organisations 4.42 School of Humanities and Social Sciences Charles Sturt University Locked Bag 678 WAGGA WAGGA NSW 2678 4.43 School of Social Administration and Social Work Flinders University of South Australia GPO Box 2100 ADELAIDE SA 5001 4.44 School of Social Policy and Curriculum Studies Faculty of Education University of Sydney SYDNEY NSW 2006 4.45 School of Social Science and Planning RMIT University GPO Box 2476U MELBOURNE VIC 3001 4.46 School of Social Work University of New South Wales SYDNEY NSW 2052 4.47 School of Social Work and Social Policy University of Queensland BRISBANE QLD 4072 4.48 School of Social Work and Social Policy University of South Australia Magill Campus MAGILL SA 5072 4.49 School of Social Work and Social Policy University of Western Australia Stirling Highway NEDLANDS WA 6009 4.50 Social Policy Research Centre University of New South Wales SYDNEY NSW 2052 Australian Ageing Research Directory 2000 21 Categories of Research Organisations 5. Infrastructure Accident Research 5.1 Centre for Accident Research and Road Safety Queensland University of Technology Carseldine Campus Beams Road CARSELDINE QLD 4034 5.2 Monash University Accident Research Centre Monash University Wellington Road CLAYTON VIC 3168 5.3 Research & Analysis Unit WorkCover Corporation South Australia GPO Box 2668 ADELAIDE SA 5001 Architecture, Design and Housing 5.4 Australian Housing and Urban Research Institute Queensland University of Technology GPO Box 2434 BRISBANE QLD 4001 5.5 Australian Housing and Urban Research Institute University of Queensland ST LUCIA QLD 4092 5.6 School of Architecture, Interior and Industrial Design Queensland University of Technology GPO Box 2434 BRISBANE QLD 4001 5.7 School of Design Curtin University of Technology GPO Box U1987 PERTH WA 6845 Information, Telecommunications 5.8 22 Information and Telecommunications Needs Research Group School of Information Management and Systems Monash University Level 7, Sir John Monash Drive CAULFIELD EAST VIC 3145 Australian Ageing Research Directory 2000 Categories of Research Organisations Planning and Local Government 5.9 Municipal Association of Victoria Level 12, 60 Collins Street MELBOURNE VIC 3000 5.10 Research Unit Department of Infrastructure GPO Box 2797Y MELBOURNE VIC 3001 Recreation 5.11 Victorian Casino and Gaming Authority Level 5 35 Spring Street MELBOURNE VIC 3000 Australian Ageing Research Directory 2000 23 Multidisciplinary Ageing Research Units Section 2: Project Entries Multidisciplinary Ageing Research Units 1.1 Centre for Ageing Studies, Flinders University of South Australia 1 Title: Ageing and the economy in South Australia: Social capital and productive ageing Principal researchers: Dr R Ranzijn, Professor G Andrews, Ms J Harford, Associate Professor C Grbich, Professor M Luszcz Organisation: Centre for Ageing Studies, Flinders University of South Australia Status: Completed Funding: Office for the Ageing, South Australia, $80,000; University of South Australia, $3,000 Timetable: 1998 - 1999 Website: http://www.cas.flinders.edu.au/ Outline: The aim of this project was to evaluate the contributions of older South Australians to the economy and to balance this against the cost to society of maintaining them in health and comfort. There were three parts to the project: a literature review of national and international publications on productive ageing, a series of focus groups to gather qualitative data, and telephone interviews of 400 people in both metropolitan Adelaide (using participants in the Australian Longitudinal Study of Ageing) and regional areas. Two new instruments were developed to estimate the economic value of productive ageing. The results showed that the monetary value of productive ageing in South Australia is enormous and more than covers the costs of health care and social security. Keywords: Productive ageing, economics of ageing, mature age employment 2 Title: A longitudinal evaluation of cognitive and sensory function as predictors of attrition, mortality and cognitive impairment in the Australian Longitudinal Study of Ageing Principal researcher: Dr K Anstey Co-researchers: Professor M Luszcz, Ms L Giles, Professor G Andrews Organisation: Centre for Ageing Studies, Flinders University of South Australia Status: In progress Funding: Australian Association of Gerontology RM Gibson Award, $5,000 Website: http://www.cas.flinders.edu.au/ Outline: This study examines the effect of cognitive and sensory function on participation, drop-out and longevity in The Australian Longitudinal Study of Ageing (entry 4). It is evaluating the effect of these factors on partial completion of assessments and interviews so that sample bias in this large population study may be understood. This research is required to enable evaluation of the observations made from this large longitudinal study. Keywords: Longitudinal research methodology, cognitive impairment, sample attrition 24 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 3 Title: Evaluation of Adelaide GP Home Link project Principal researcher: Professor G Andrews Co-researcher: J Dunn Organisation: Centre for Ageing Studies, Flinders University of South Australia Status: Completed Funding: South Australian Health Commission, $12,000 Timetable: February 1998 - May 1998 Website: http://www.cas.flinders.edu.au/ Outline: GP Home Link was established as a pilot program designed to provide an alternative to referral of elderly persons to an emergency department of an acute care hospital thereby decreasing the rate of ‘unnecessary admissions’. The program was introduced in February 1997 as two linked projects, one in the eastern and the other in the northern suburbs of Adelaide. The projects are auspiced by Aged Care & Housing Group Incorporated (Eastern) and Helping Hand Aged Care Incorporated (Northern). The aim of the GP Home Link project is to avoid ‘unnecessary’ hospital admission for older persons by working closely with general practitioners to provide short-term intervention, coordinate care needs at home and provide services at no cost to the patient or the general practitioner. The evaluation was designed to examine and report on: (i) The effectiveness of the GP Home Link project in terms of the processes of establishment, management and service delivery; health outcomes and quality of life from a client/carer perspective; health outcomes from the GP/service provider perspective; the organisational outcomes of the project. (ii) The cost effectiveness and service outcomes of the project. (iii) The regional needs and differences and impact of these on project outcomes; gaps in services, and appropriateness of the project model in overcoming these gaps. (iv) The feasibility of the project continuing as a sustainable program. The evaluation was outcomes and process oriented and was informed by the key questions identified in the evaluation brief. Extensive consultation has been undertaken with key stakeholders in identifying and focussing on issues of importance. A variety of data gathering techniques were employed. The evaluation focussed on appropriateness, efficiency and effectiveness of the GP Home Link Program. Data collection techniques included: focus groups, face to face interviews, document analysis, existing data base, feedback forms and case studies. The evaluation demonstrated that the current GP Home Link Program clearly established the need and appropriateness of such a service in offering a viable alternative to referral by general practitioners of older persons in crisis circumstances to hospital emergency departments. The pilot GP Home Link projects were well conceived, have been efficiently and effectively implemented and provided a sound basis for further development of the concept. Keywords: Evaluation, effectiveness, services, pilot study, general practitioners 4 Title: The Australian longitudinal study of ageing Principal researcher: Professor G Andrews Co-researchers: Ms M Luszcz, Mr M Clark and others Organisation: Centre for Ageing Studies, Flinders University of South Australia Status: Current Funding: Australian Rotary Health Research Fund, $50,000; South Australian Health Commission, $76,900; US National Institute on Ageing, $967,521; South Australian Government, $50,000; Elderly Citizens Homes PL, $50,000 Timetable: 1992 - 2001 Website: http://www.cas.flinders.edu.au/ Australian Ageing Research Directory 2000 25 Multidisciplinary Ageing Research Units Outline: This study is a cross-disciplinary prospective study of adults aged 70 years and over. It is a population based bio-psycho-social and behavioural study of 2,087 older adults residing in the community and in residential care. It aims to gain understanding of how social, biomedical, and environmental factors are associated with age-related changes in the health and well-being of persons aged 70 years and older. Emphasis is given to the effects of social and economic factors on morbidity, disability, acute and long-term care service use, mortality and ‘successful’ aging. It analyses the complex relationships between individual and social factors and changes in health status, health care needs and service utilisation dimensions. The study sample was randomly generated from within the Adelaide Statistical Division using the State Electoral Database as the sampling frame. The sample was stratified by gender and the age groups 70-74, 75-79, 80-84, and 85 and over. Both community and institutional dwelling individuals were included in the list of specified persons. The baseline data collection for Australian Longitudinal Study of Ageing began in September 1992 and was completed in March 1993. Components of this wave included a comprehensive personal interview, conducted via Computer Assisted Personal Interview, a home-based assessment of physiological functions, self-completed questionnaires, and additional clinical studies. Personal interviews were carried out at this first wave for 2,087 participants, including 566 couples (that is, persons 70 years of age and over and their spouse, if 65 years and over). Clinical assessments were obtained for 1,620 of the participants. After an interval of one year from the initial interview, respondents were recontacted by telephone. In Wave 2, 1,779 participants were re-interviewed. The third wave, begun in September 1994, was a complete re-assessment, with face-to-face interviews, clinical assessments, self-completed questionnaires, and other clinical and laboratory studies were again carried out. A total of 1,679 interviews were carried out at Wave 3, and 1,423 clinical assessments were conducted. Data collection for the fourth wave, a short telephone interview similar to Wave 2 began in November 1995, and 1,504 interviews were completed. A fifth wave of telephone interviews was conducted during February 1998 resulting in 1,171 completed interviews. A sixth wave of comprehensive data collection commensurate with Waves 1 and 3 is planned to commence in October 2000. In addition to the primary data collection from respondents, ancillary data has been collected from secondary providers, including domiciliary care and rehabilitation services, Meals on Wheels, and the Royal District Nursing Society. Lists of study participants are compared bi-annually with the agencies' lists to determine the prevalence and incidence of receipt of services from these organisations. Extensive analyses utilising the longitudinal data will continue, and have been carried out in both Australia and the United States. Keywords: Population characteristics, health status, well-being 5 Title: United Nations project on development of a global research agenda on ageing for the 21st century Principal researcher: Professor G Andrews Organisations: Centre for Ageing Studies, Flinders University of South Australia; Office on Ageing, Department of Economic and Social Affairs, United Nations Headquarters, New York Status: In progress Funding: Novartis Foundation for Gerontology, $200,000; German Government, $100,000 Timetable: January 1999 - December 2001 Website: http://www.cas.flinders.edu.au/ Outline: The objective of the project is to develop a worldwide policy-related research agenda on ageing for the twenty-first century. The research agenda should increase understanding of critical policy-related aspects of ageing in order to improve quality of later life, reduce 26 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units inequalities and ensure the sustainability of societal and human development. It is based on recognition of the diversity in societies at different levels of demographic as well as social and economic development. The research agenda is intended to assist policy makers and others in their attempts to: (i) define policy goals; (ii) select priorities for policy interventions; (iii) identify measures for policy implementation; (iv) evaluate the impact of age specific and other policy measures, and (v) support capacity building. This joint project of the United Nations Programme on Ageing and the International Association of Gerontology began in 1997 at the Sixteenth Congress of the International Association of Gerontology in Adelaide. The first meeting of experts to start the process of elaboration of the Agenda was in February 1999. Later in 1999 the Government of Germany financially supported the project and a further meeting was held. A final meeting of experts is scheduled for December 2000. Following this a two day public meeting/scientific conference is to be convened at UN Headquarters during the first half of 2001, with participation of scientists relating to each priority area, as well as heads of international development agencies and relevant international foundations. The Research Agenda will introduced to the Member States of the United Nations and distributed to national governments and others around the globe. Keywords: Global, United Nations, research agenda 1.2 Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria 6 Title: Development of a plan for the North Eastern Aged Care catchment area for implementation of the Ministerial Task Force on Dementia Services Principal researchers: Dr J McCormack, Ms C Tenni, Ms J Slee, Dr S Lydall-Smith Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Department of Human Services, Victoria Outline: The project aims were to develop a plan, for the North Eastern Aged Care catchment area, to implement the recommendations made in the Report of the Ministerial Task Force on Dementia Services in Victoria. The project had two components, firstly to investigate the response of the catchment's service system to the recommendations and identify barriers to continuity of care for people with dementia. Secondly the project provides an evaluation of the Cognitive Assessment and Dementia and Management Service at Bundoora Extended Care Centre, which had been operating for just over a year. Material from a number of sources has been drawn together to provide information on the links between agencies providing services to people with dementia. This includes the development of a profile of the northern region with regard to the prevalence of dementia, a review of the range of services currently available to this group and measures taken to address the Task Force's recommendations. Consultation with clients of the Cognitive Assessment and Dementia and Management Service clinic has also been undertaken. Keywords: Planning, evaluation, dementia services, dementia management 7 Title: Domiciliary medication review Principal researchers: Dr M Woodward, Mr R Elliott, Ms B Gennari, Ms E Sealey Co-researchers: Professor M Roberts Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Quality Medication Care Group, University of Queensland Status: Ongoing Australian Ageing Research Directory 2000 27 Multidisciplinary Ageing Research Units Funding: Commonwealth Department of Health and Aged Care Outline: The Domiciliary Medication Review project is a randomised controlled trial designed to examine whether improved functioning of the primary health care team (general practitioner, community pharmacist, community-based nurse) can reduce medication misadventure due to polypharmacy and other risk factors for patients in their own homes. The aim of the project is to determine whether appropriate team-based primary medication care interventions, with the general practitioner as team leader, can improve outcomes for patients in the community. The intervention consists of a medical assessment by the patients’ general practitioner, a home visit from the general practitioner, pharmacist or nurse, and a medication review from the pharmacist. These activities are followed by a case-conference between the general practitioner and pharmacist, and development of a plan to address issues identified with the aim of optimising the patients’ medication regimen and minimising potential for medication misadventure. Across Victoria and Queensland, over 120 general practitioners have been recruited, with each general practitioner recruiting one or several patients. Keywords: Medication, randomised controlled trial, polypharmacy, intervention, general practitioner 8 Title: Evaluation of a life enhancement program for psychogeriatric residents Principal researchers: Dr S Lydall-Smith, Ms S Koch, Ms C Tenni Co-researchers: Ms L Eccleston, Ms C Gibbon, Ms T Bannister Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Department of Human Services, Victoria Outline: This project demonstrates a comprehensive model of care developed at the Merv Irvine 30-bed Aged Psychiatry Residential Service to offer residents the best possible living environment for their individual needs and circumstances. The Life Improvement and Functional Enhancement (LIFE) program aims to permeate and inform all care practices in the home. General aims were to evaluate the effectiveness of the program with specific reference to (i) resident care development (Study 1), (ii) the social environment of the home (Study 2), (iii) staff satisfaction and development (Study 3), and (iv) relatives (carers) satisfaction (Study 4). One of the most significant aspects of the evaluation was the emphasis placed on observing, evaluating and feeding back information into the program. The case studies demonstrate on an individual level how the aims of the Life Improvement and Functional Enhancement project have been reflected in care practices. The results of environmental assessments also indicated an improvement in resident independence and influence and a lessening of regimented care practices. The development and establishment of the staff education program was also found to be successful. Both the staff and relatives reported noticing positive changes in the home during the course of the project. Taken together these results appear to reflect the effective and successful development of the Life Improvement and Functional Enhancement program. Many lessons have been learned in relation to practical methods of implementing a model of care and the awareness of obstacles that may hinder the development of staff education. They include (i) that the support of management (at all levels) is essential to all proposed changes in facilities; (ii) the model of care should serve to inform all care practices; (iii) the model of care must be clearly articulated and communicated to all staff; (iv) the model of care must be clearly reinforced (modelled) by senior staff on each shift; (v) the aims of the model of care should also inform the preceptorship system. Certain obstacles to the development of a staff education strategy were identified, including the presence of institutional or “old school” nursing practices; a lack of flexibility of staff; a 28 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units task focused, top-down approach of working which inhibits staff initiating change themselves; and a possible belief amongst staff that their opinions will not impact on the running of the home. Feedback relating to their suggestions should be given quickly and publicly. The study also highlighted the clinical usefulness of completing standardised resident functioning assessments as a means of monitoring individual resident progress over time. Ideally an instrument designed to reflect the items of the Resident Classification Scale would be most useful for residential facilities, however such an instrument is yet to be developed. The PRGS used in this study was found to be relatively user friendly and effective in monitoring resident progress. The individual resident activity review form was also found to be a useful quality assurance exercise. Keywords: Psychogeriatric, residential care, life enhancement, staff education, resident functioning 9 Title: Malnutrition and screening efficacy in the community dwelling elderly referred to an Aged Care Assessment Service Principal researcher: Ms T Walker Co-researchers: Dr P Hunter, Ms S Race, Ms H Sheehan, Professor L Gray Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Outline: Malnutrition in the elderly is an important and largely unrecognised problem. It is associated with increased infections, falls, ulcers and decreased functional status with an overall increase in mortality. Overseas estimates of the prevalence of malnutrition in the community dwelling elderly vary between 2 percent to 82 percent, depending on the criteria used for establishing malnutrition. In Australia however, no studies have been done and the prevalence is largely unknown. Several screening tools have been recently developed for assessing malnutrition, but they have not yet been validated. The study aims were to determine the prevalence of malnutrition in the community dwelling elderly referred to an Aged Care Assessment Service and assess the validity of several screening tools by comparison with a number of objective measures of malnutrition. The nutritional status and risk factors of 100 community dwelling elderly referred to the Aged Care Assessment Service were assessed at a home visit. The prevalence of malnutrition was calculated from the anthropometric and biochemical measurements and compared to the screening tools administered. Establishing the prevalence of malnutrition in this way has implications for the assessment and management of the frail community dwelling elderly and will be the forerunner to intervention studies in this group. Keywords: Malnutrition, community dwelling elderly, prevalence, nutritional status, risk factors, screening tools 10 Title: National patient safety survey Principal researcher: Mr R Clark Co-researchers: Associate Professor D Jolley, Professor L Gray Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Ongoing Funding: National Health Priorities and Quality Branch, Commonwealth Department of Health and Aged Care grant Timetable: June 1999 - ongoing Outline: The project has three main aims: (i) to determine the prevalence of self reported adverse events within a representative population of Australians; (ii) to determine community Australian Ageing Research Directory 2000 29 Multidisciplinary Ageing Research Units awareness of and perceptions of risk associated with contact with the health care sector. Its objectives are (1) to survey a nationally representative sample of Australian adults regarding their experience of adverse events in the health care system; (2) to establish commonly held attitudes and beliefs of Australians as to the risk and conversely, safety of the health care system; and (3) to ascertain preferences of individuals regarding medical/health decision making. Data collection has been completed and data analysis is proceeding. Keywords: Self-reporting, adverse events, risk, health care system, attitudes 11 Title: North Eastern Coordinated Care Trial: Local evaluation Principal researchers: Professor L Gray, Dr G Hawthorne, Ms J Slee, Ms S Agius, Ms J Keller, Ms J Gilchrist Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Centre for Health Program Evaluation, University of Melbourne Status: Completed Funding: Acute and Coordinated Care Branch, Department of Health and Aged Care Outline: North Eastern Coordinated Care is auspiced by the North Western Health Care Network and the Trial management team is based at Bundoora Extended Care Centre. It commenced recruitment in December 1997. The target group was community dwelling older people with chronic health problems or disability, who used multiple community services or were at risk of repeated hospitalisations. In total, 1,056 people were recruited to the Trial, mainly by general practitioners who had agreed to participate in the Trial as Care Coordinators. Participants were then randomly assigned to either the intervention or control group and steps were taken to ensure that both groups were similar in terms of age, gender, disease group and non-English speaking background (stratification). Acute hospitals and community services in the Trial's catchment area commenced pooling funds from January 1999. Individualised care plans were developed for intervention clients, through a partnership arrangement between Care Coordinators and Service Coordinators, seconded from participating agencies. The central aim of the evaluation was to determine the effectiveness of the Trials: whether care coordination improves client health and well-being within existing resources. Other factors, which may impact on the Trials' success, were also examined. These include the care coordination function, characteristics of the clients group, Trial design and management, the extent of service substitution, and the size of the funds pool. The local evaluation of the North Eastern Coordinated Care Trial comprised quantitative and qualitative components. Quantitatively, the evaluation focuses on analysis of the intervention and control groups’ health outcomes (measured by service use, health status and quality of life), characteristics (age, diagnosis, dependency, level of social support etc.) and service use/cost. Qualitatively, the evaluation collated information (collected through in-depth interviews, focus groups and questionnaires) on Trial participants’ and service providers’ experiences of the Trial. Analysis conducted for the Interim Local Evaluation Report (January 1999) was based on data collected at recruitment, including demographic variables and health status and quality of life questionnaires. Service use, for two years prior to the Trial's commencement, was also analysed. No significant difference was found between the intervention and control groups in terms of the health status or quality of life measures at baseline. Nor was there any difference between the groups on demographic variables or service utilisation costs prior to the Trial. It would appear from this result that the stratified randomisation procedure was effective in the allocation of similar participants to each group. Since the Trial commenced, 251 of the 1,056 participants have exited (75% of exits were due to death or entry to residential care). This number consists of 131 intervention participants and 120 control 30 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units participants. No difference was found between the two groups on either the rate of exit or the reason for exiting from the Trial. Keywords: Coordinated Care, evaluation, care trials, fund pooling 12 Title: Parallel development of aged care and aged psychiatry services in North Eastern Aged Care Principal researchers: Ms C Tenni, Dr S Lydall-Smith, Ms J Slee, Dr J McCormack Co-researcher: Ms B Barron Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Department of Human Services, Victoria Outline: This project used an action research approach to develop an innovative model of practice and service delivery for newly co-located inpatient and community aged care and aged psychiatry services. The project provides a mechanism for the identification of issues relating to models of practice and service delivery, and documents how they have been addressed. In doing so, the project provides an opportunity for evaluation of the co-location process, and its strengths and weaknesses which will be of value to other services undergoing similar processes. Keywords: Model of care, aged care, aged psychiatry 13 Title: Post acute care program evaluation project Principal researchers: Professor L Gray, Dr G Hawthorne, Dr R Carter, Dr S Lambert, Ms L Wierzbowski Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Centre for Health Program Evaluation, University of Melbourne Status: Ongoing Funding: Victorian Department of Human Services Timetable: October 1998 - August 2000 Outline: Evaluation of the Victoria’s Post Acute Care (PAC) Program is being undertaken to (a) establish the cost effectiveness of the Program and (b) analyse the health and quality of life outcomes of patients who receive the Post Acute Care service. The methodology agreed to for the evaluation involves (i) analysis based on patient level data obtained from client questionnaires together with information retrieved from the Health Insurance Commission and hospital and community data bases; (ii) clients (patients) recruited through the means of a Randomised Controlled Trial. The Post Acute Care Program was established in 1995 to ensure the health outcomes of acute hospital patients were not compromised, and hospital readmission rates were not increased, by newly introduced changes to public sector funding arrangements in the health care industry. The program operates throughout urban and rural Victoria through sixteen individual Post Acute Care projects. These projects have, of necessity, a large degree of autonomy in order to accommodate the specific needs of the hospitals and communities where their clients are located. The major difference between the projects follows from (i) differences in operating models, which in turn determine the extent to which the Post Acute Care project will be integrated into their recruiting hospitals; (ii) differences in demand conditions arising from demographic characteristics of the client population, size and other structural features of the hospitals sites, and the nature of existing and developing hospital services that determine the requirements of the hospital site. Despite delays to beginning the study arising from the advent of a variety of ethical and practical issues, there has been solid progress made in this evaluation of a complex intervention. There Australian Ageing Research Directory 2000 31 Multidisciplinary Ageing Research Units were a number of ethical issues related to duty of care and the appropriateness of attempting to obtain informed consent from frail aged patients. The practical issues related to the potential for the randomised controlled trial to (a) impact negatively on the hospital and community networks established by the Post Acute Care projects, and (b) generate financial costs for the hospitals where recruiting would take place. Agreement to participate in the randomised controlled trial was obtained from four projects and their associated hospital sites. These were Inner and South Eastern PAC (Alfred), North Eastern PAC (Austin and Repatriation Medical Centre), Outer and Eastern PAC (Box Hill) and Peninsula PAC (Frankston). Development of the randomised controlled trial protocol was undertaken with due regard for the ethical and practical issues of concern to participants, the individual operating features of each of the Post Acute Care teams, and the integrity of the randomised controlled trial and the client information to be gathered. All information collected on patients recruited to the randomised controlled trial is being entered into the evaluation database. The data include one-month questionnaire interviews of Trial participants and their carers and administrative data retrieved from the Health Insurance Commission, Victorian Inpatient Minimum database and community agencies. Keywords: Post acute care, evaluation, randomised controlled trial, frail aged 14 Title: Post Acute Care Extension Study Principal researcher: Dr K Lim Co-researcher: Professor L Gray Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Ongoing Funding: National Health and Medical Research Council Public Health Scholarship Timetable: January 1999 - December 2000 Outline: The extended evaluation of the Post Acute Care study (entry 13) aims to look at the effects of post acute care on older patients (over 65 years of age). The study aims to test the hypothesis that Post Acute Care improves patient outcomes, in the form of improved quality of life and reduces hospital readmissions. To obtain more comprehensive data on Post Acute Care study and control patients, an extensive case note review of up to 700 medical records is being undertaken in the four hospitals; Box Hill, Austin and Repatriation Medical Centre, Alfred and Frankston hospitals. Keywords: Post acute care, patient outcomes, quality of life, hospital readmissions 15 Title: Prescribing indicators for elderly inpatients Principal researchers: Dr M Woodward, Mr R Elliott, Ms A Oborne Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Department of Human Services, Victoria Timetable: July 1998 - April 2000 Outline: This was a multi-centre study involving approximately 1,400 patients in nine hospitals around Victoria, over a period of 16 months. Indicators, which include measures of prescribing appropriateness, have been developed in the UK to assess prescribing for elderly hospital inpatients. Prescribing indicators are audit tools that enable detection of potentially inappropriate prescribing of medications, based on information readily available on inpatient medication charts and medical records. The indicators are objective, assess a range of therapeutic areas, are easy to use, and are based on published evidence in terms of clinical 32 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units outcome. Initial research, both in the UK and locally, has shown that use of the indicators can improve prescribing for elderly inpatients. The project aimed to adapt the prescribing indicators for Australian conditions and employ them to identify and reduce inappropriate prescribing for elderly inpatients in Victorian public hospitals. The project includes audits of prescribing practice at each hospital, followed by feedback at multidisciplinary, educational staff meetings. These are followed by repeat audits to measure changes in prescribing. In the longer term, the indicators will be useful for systematic monitoring and quality improvement in prescribing practices in acute and subacute hospitals caring for older people. A pilot study was completed at three hospitals in 1998, and during 1999 the project was extended to include six additional hospitals. The indicators were found to be easy and fast to use. They provided a useful tool for assessing appropriateness of prescribing for elderly hospital inpatients, and for monitoring changes in prescribing over time. The indicators could potentially be used to enable benchmarking of prescribing for elderly inpatients. Using the indicators, inappropriate prescribing for elderly hospital inpatients was identified, and audit and multidisciplinary feedback resulted in improved prescribing in the areas targeted. The improved prescribing resulting from this intervention was sustained for six months for two of the three areas targeted, indicating that multidisciplinary interventions of this type can induce sustained improvements in practice. Keywords: Hospital inpatients, prescribing indicators, prescribing practices, medication 16 Title: A double-blind placebo controlled study of RO 64-0796 (also known as GS4104) in the treatment of influenza infection in elderly adults Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Roche / Parexel, Protocol WV 15707 Timetable: May 1998 - September 1998 Outline: A double-blind placebo controlled study is being undertaken of RO 64-0796 (also known as GS4104) in the treatment of influenza infection in elderly adults. Keywords: Influenza, drug trial 17 Title: A double-blind, randomised, placebo controlled study of RO64-0796 (also known as GS4101) used in elderly subjects for the prevention of clinical influenza during the influenza season Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: Roche / Covance , Protocol WV 15708 Timetable: May 1998 - September 1998 Outline: A double-blind, randomised, placebo controlled study is being undertaken of RO640796 (also known as GS4101) used in elderly subjects for the prevention of clinical influenza during the influenza season. Keywords: Influenza, randomised controlled trial, drug trial Australian Ageing Research Directory 2000 33 Multidisciplinary Ageing Research Units 18 Title: A double-blind placebo controlled study of RO 64-0796 (also known as GS4104) in the treatment of influenza infection in elderly adults Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Ongoing Funding: Roche / Parexel, Protocol WV 15876 Timetable: May 1999 - ongoing Outline: This was a double-blind placebo controlled study of RO 64-0796 (also known as GS4104) in the treatment of influenza infection in elderly adults. Keywords: Influenza, drug trial 19 Title: A double-blind, stratified randomised, placebo controlled study of Ro 64-0796 in the treatment of influenza infection in elderly adults (WV15707C) Principal researcher: Dr M Woodward Co-researchers: Dr I A R Tan, Dr M R Bird, Ms E Sealey, Ms S Clements Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Roche Timetable: July 1998 - October 1998 Outline: This study aimed to investigate the clinical and antiviral efficacy, safety and tolerability of Ro 64-0796 (also known as GS4104) used to treat laboratory confirmed clinical influenza in elderly community dwelling adults. It also aimed to assess the impact of treatment of the acute disease on the use of medical and non-medical resources associated with influenza and its complications in this population. The study used a multicentred, doubleblind, stratified (flu vaccination status and history of chronic airways disease), randomised, placebo controlled design. Male or female patients aged 65 or older presenting with symptoms of influenza defined as fever over 37.5 plus one respiratory symptom and one constitutional symptom were enrolled in the study. Active medication (75mg dose) or placebo was administered for five days. Clinical laboratory tests (pathology and viral swabs) and vital signs were recorded at the screening assessment (day 1), and day 5 along with day 10 and 21 if indicated. A patient diary was used to record temperature, medication changes and symptoms between visits. The very low overall incidence of influenza in the study population prevented assessment of the efficacy of the drug, however the once daily dosing of the drug was well tolerated. Keywords: Influenza, geriatric, community dwelling elderly 20 Title: A double-blind, stratified, randomised, placebo controlled study of Ro 64-0796 in the treatment of influenza infection in elderly patients (WV15876B) Principal researcher: Dr M Woodward Co-researchers: Dr I A R Tan, Dr M R Bird, Ms E Sealey, Ms C L Scott Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Roche Timetable: March 1999 - October 1999 34 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Outline: This study aimed to investigate the clinical and antiviral efficacy, safety and tolerability of Ro 64-0796 (also known as GS4104) used to treat laboratory confirmed clinical influenza in elderly community dwelling adults. It also aimed to assess the impact of treatment of the acute disease on the use of medical and non-medical resources associated with influenza and its complications in this population. The study used a multicentred, doubleblind, stratified (flu vaccination status and history of chronic airways disease), randomised, placebo controlled design. Male or female patients aged 65 or older presenting with symptoms of influenza defined as fever over 37.5 plus one respiratory symptom and one constitutional symptom were enrolled in the study. Active medication (75mg dose) or placebo was administered for five days. Clinical laboratory tests (pathology and viral swabs) and vital signs were recorded at the screening assessment (day 1), and day 5 along with day 10 and 21 if indicated. A patient diary was used to record temperature, medication changes and symptoms between visits. Results of the study are still pending due to poor recruitment levels. Keywords: Influenza, geriatric, community dwelling elderly 21 Title: A multicentred double-blind, randomised, placebo controlled study of Ro 64-0796 used in elderly subjects for the prevention of clinical influenza during the influenza season Principal researcher: Dr M Woodward Co-researchers: Dr I A R Tan, Dr M R Bird, Ms E Sealey, Ms S Clements Organisations: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria; Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Roche Timetable: July 1998- October 1998 Outline: This study aimed to investigate (i) the efficacy, safety and tolerability of Ro 64-0796 (also known as GS4104) used to prevent laboratory confirmed clinical influenza in elderly occupants of residential homes; (ii) the benefit of seasonal prophylaxis against influenza in preventing lower respiratory tract infections and other complications of influenza. The study used a multicentred, double-blind, randomised, placebo controlled design in subjects who were residents of local hostel supported accommodation. Random allocation to six weeks of treatment with Ro 64-0796 or placebo occurred when influenza appeared in the community. Clinical laboratory tests (pathology and viral swabs) and vital signs were recorded at the screening assessment, at baseline, at any illness visit, at the week 3 and 6 visit and follow up (2 weeks after the final dose of study drug). A patient diary was used to record temperature, medication changes and symptoms between visits. The very low overall incidence of influenza in the study population prevented assessment of the prophylactic efficacy of the drug, however the once daily dosing of 75mg of the drug when administered for six weeks was shown to be well tolerated. The side effect profile remained similar to that observed in studies in young adults, including nausea, vomiting and possibly headache with diarrhoea, fatigue, pain and sore throat also noted in increased incidences than previous studies. The safety profile observed supports the potential use of this drug in the geriatric population. Keywords: Influenza, geriatric, hostels Australian Ageing Research Directory 2000 35 Multidisciplinary Ageing Research Units 22 Title: An open label, multicentre, extended evaluation of the safety & efficacy of E2020 in patients with Alzheimer's disease - continuation study (E2020-A044-305) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Completed Funding: EISAI, Protocol E2020-A044-305 Timetable: August 1995 - July 1998 Outline: An open label, multicentre, extended evaluation of the safety & efficacy of E2020 in patients with Alzheimer's disease - continuation study. Keywords: Alzheimer’s disease, dementia, drug trial 23 Title: A 24 week, multicentre, randomised double-blind placebo-controlled evaluation of the efficacy and safety of Donepezil Hydrochloride (E2020) in patients with dementia associated with cerebrovascular disease (E2020-A001-308) Co-researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Ongoing Funding: EISAI/Quintiles, Protocol E2020-A001-308 Timetable: June 1997 - ongoing Outline: A 24 week, multicentre, randomised double-blind placebo-controlled evaluation of the efficacy and safety of Donepezil Hydrochloride (E2020) in patients with dementia associated with cerebrovascular disease. Keywords: Dementia, cerebrovascular disease, randomised controlled trial, drug trial 24 Title: A 30 week, multicentre, open-label evaluation of Donepezil Hydrochloride (E2020) in patients with dementia associated with cerebrovascular disease (E2020-A001-309) Co-researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Status: Ongoing Funding: EISAI/Quintiles, Protocol E2020-A001-309 Timetable: CTN Phase III September 1998 - ongoing Outline: A 30 week, multicentre, open-label evaluation of Donepezil Hydrochloride (E2020) in patients with dementia associated with cerebrovascular disease. Keywords: Dementia, cerebrovascular disease, drug trial 25 Title: Double-blind, randomised, placebo-controlled comparative study of Celecoxib (SC-58635) for the inhibition of progression of Alzheimer’s disease (IQ5-97-02-001) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Victoria Funding: Searle / Parexel, Protocol IQ5-97-02-001 Timetable: CTN Phase III, June 1997 - ongoing Outline: Double-blind, randomised, placebo-controlled comparative study of Celecoxib (SC58635) for the inhibition of progression of Alzheimer’s disease. Keywords: Alzheimer’s disease, dementia, drug trial, randomised controlled trial 36 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 26 Title: Fixed dose study of efficacy and tolerability of SB 202026 in patients suffering from dementia of the probable Alzheimer’s type (202026-046) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Completed Funding: Smith Kline & Beecham, Protocol 202026-046 Timetable: March 1996 - May 1998 Outline: Fixed dose study of efficacy and tolerability of SB 202026 in patients suffering from dementia of the probable Alzheimer’s type. Keywords: Alzheimer’s disease, dementia, drug trial 27 Title: Long-term efficacy, safety and health care outcomes in patients receiving openlabel Lazabemide therapy Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Ongoing Funding: Roche & Worldwide Clinical Trials, Protocol No: PDL1015P 18 December 1997 (Roche - Protodigm) Timetable: CTN Phase III, December 1997 - ongoing Outline: Long-term efficacy, safety and health care outcomes in patients receiving open-label Lazabemide therapy. Keywords: Drug trial, 28 Title: Open-label evaluation of the long term efficacy of Celecoxib (SC-58635) in Alzheimer’s disease (IQ5-98-02-004) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Ongoing Funding: Searle / Parexel, Protocol IQ5-98-02-004 Timetable: CTN Phase III, September 1998 - ongoing Outline: Open-label evaluation of the long term efficacy of Celecoxib (SC-58635) in Alzheimer’s disease. Keywords: Alzheimer’s disease, dementia, drug trial 29 Title: Open-label multicentre clinical trial evaluating the safety and clinical effectiveness of Donepezil HCL (E2020) in patients with Alzheimer's disease (DON-NY-96-003-322) Co-researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Ongoing Funding: Pfizer, Protocol DON-NY-96-003-322 Timetable: June 1997 - ongoing Outline: Open-label multicentre clinical trial evaluating the safety and clinical effectiveness of Donepezil HCL (E2020) in patients with Alzheimer's disease. Keywords: Alzheimer’s disease, dementia, drug trial Australian Ageing Research Directory 2000 37 Multidisciplinary Ageing Research Units 30 Title: Six month double-blind extension followed by a long term open-label extension of the study RU35926/3006 with RY 35926/C1-979 (Milameline) 3 and 4mg/day in patients with Alzheimer’s disease (RU 35926/3007) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Completed Funding: Hoechst Marion Roussel, Protocol RU 35926/3007 Timetable: October 1996 - November 1997 Outline: Six month double-blind extension followed by a long term open-label extension of the study RU35926/3006 with RY 35926/C1-979 (Milameline) 3 and 4mg/day in patients with Alzheimer’s disease. Keywords: Alzheimer’s disease, dementia, drug trial 31 Title: Tailored/titration longitudinal Cognex (TLC) Trial Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Status: Ongoing Funding: Parke Davis Timetable: October 1994 - ongoing Outline: Tailored/titration longitudinal Cognex (TLC) Trial. Keywords: Drug trial 32 Title: The efficacy, safety and tolerability of Lazabemide (RO 19-6327 (versus placebo, administered for one year in patients with probable Alzheimer’s disease (Protocol PDL 1001 P) Principal researcher: M Woodward Organisation: Centre for Applied Gerontology, Bundoora Extended Care Centre, Vic Funding: Roche & Worldwide Clinical Trials, Protocol PDL 1001 P Timetable: CTN Phase III April 1997 - January 1999 Outline: The efficacy, safety and tolerability of Lazabemide (RO 19-6327 (versus placebo, administered for one year in patients with probable Alzheimer’s disease is being trialed. Keywords: Alzheimer’s disease, dementia, drug trial 1.3 Centre for Education and Research on Ageing, Concord Hospital, NSW 33 Title: A clinical trial of Adena in mild to moderate Alzheimer’s disease Principal researcher: Dr H Creasey Co-researcher: Ms J Groth Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Novartis Pharmaceuticals, $136,400 Timetable: 1995 - 2000 Website: www.cera.usyd.edu.au Outline: A group of 23 patients with mild to moderate Alzheimer’s disease commenced this 26 week double blind randomised controlled trial as part of an international multicentre study 38 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units in 1995. Adena is a cholinesterase inhibitor. After 6 months, all patients participated in the open label extension, allowing them to take the active drug in a dose that best suited the individual. Few side effects were reported and preliminary results indicate that the drug has potential benefit on cognition and activities of daily living. Six years later, 7 patients remain on the drug and although data collection ceases in May 2000, these patients will continue to receive the medication through the Special Access Scheme, until it becomes available in Australia. Keywords: Randomised controlled trial, Alzheimer’s disease, cholinesterase inhibitor 34 Title: Ageing rat colony: Melatonin secretion in food restricted rats Principal researcher: M MacGibbon Co-researcher: Dr A Everitt Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Timetable: 1996 - 1999 Website: www.cera.usyd.edu.au Outline: Both melatonin and food restriction have anti-ageing and disease preventing properties. The effects of food restriction on the normal age-related decline in total nocturnal melatonin secretion were measured. Food restriction had no effect on the level or the pattern of decline in secretion. However, it can be argued that the tissues of food restricted animals were exposed to higher concentrations of melatonin owing to their lower body weight compared with fully fed rats. Keywords: Food restriction, melatonin, rats, normal ageing 35 Title: Ageing rat colony: Secular increases in body size and life duration Principal researcher: Dr A Everitt Co-researcher: Dr F Seow Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Timetable: 1997 - 1999 Website: www.cera.usyd.edu.au Outline: In Western countries during the twentieth century, there has been a progressive increase in body height and weight in human populations, accompanied by a rise in life expectancy. Recent data analysis has revealed that rather similar changes were seen in conventional male Wistar rats studied between 1952 and 1990. Over this period there was a 25% increase in maximum body weight and a 10% gain in mean life duration. Keywords: Rats, body weight, normal ageing, life duration 36 Title: Anti-inflammatory drugs and Alzheimer’s disease (SOPS Stage 3) Principal researchers: Professor G A Broe, Dr D Grayson, Dr W Brooks, Dr H Creasey, Dr G Halliday Co-researchers: Associate Professor G Nicholson, Associate Professor R Martins, Dr J Kril, Associate Professor P Schofield Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: In progress Funding: Sir Zelman Cowen Universities’ Fund, $82,194 Timetable: 1996-97 - ongoing Australian Ageing Research Directory 2000 39 Multidisciplinary Ageing Research Units Website: www.cera.usyd.edu.au Outline: A number of epidemiological studies have found some evidence of a protective effect of anti-inflammatory drugs or aspirin against Alzheimer’s disease. This study further investigates this theory. Two research nurses visited people from the Sydney Older Persons Study (Stage 3) (entry 55), wrote down a complete list of their medications and requested a blood sample. The blood sample was used to determine possible genetic and biochemical factors which may play a part in the relationship between these drugs and Alzheimer’s disease. Early results were encouraging, showing a very strong negative cross-sectional association (people taking these drugs were less likely to have Alzheimer’s disease at that point in time). However, no longitudinal association was found. People without dementia who were taking these drugs at the beginning of the study, were just as likely to develop dementia or Alzheimer’s disease when examined three years later, as those not taking the drugs. A placebo-controlled trial may be necessary to settle this question definitively. One of the factors that may complicate studies like this is that different people have different genetic backgrounds, and these may influence how they respond to drugs like aspirin. Some of the key genes that may do this are currently being studied in the laboratory. Keywords: Anti-inflammatory drugs, Alzheimer’s disease, dementia 37 Title: Aricept for patients with mild to moderate Alzheimer’s disease Principal researcher: Dr H Creasey Co-researcher: Ms J Groth Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Funding: Pfizer P/L, $23,250 Timetable: 1997 - 1998 Website: www.cera.usyd.edu.au Outline: In 1997, CERA was given the opportunity of providing Aricept for five patients with mild to moderate Alzheimers Disease and to assess the effects of the drug. Aricept is a potent selective inhibitor of neural acetyl cholinesterase and has been approved for use in the USA, the United Kingdom and Australia. Two of the five patients are continuing on the drug which is now provided on the Special Access Scheme. Keywords: Randomised controlled trial, Alzheimer’s disease, cholinesterase inhibitor, Aricept 38 Title: Aricept for patients with mild to moderate dementia associated with cerebrovascular disease Principal researcher: Dr H Creasey Co-researcher: Dr W Brooks, Dr J Obeid, Mr O Piguet, Ms J Groth Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Eisai Inc, $100,000 Timetable: 1997 - 1999 Website: www.cera.usyd.edu.au Outline: This study is sponsored by Eisai Inc and conducted by Quintiles P/L. Although the result of clinical trials of Aricept for Alzheimers Disease is well documented, the effect on vascular dementia has not yet been assessed. This 26 week double blind randomised controlled multi centre trial commenced in 1997 and 12 patients have been enrolled. Currently 40 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units the project is seeking to enrol ten more patients. Following the six month blind trial, patients have continued to the open label extension and their progress is continuing to be monitored. Keywords: Randomised controlled trial, Alzheimer’s disease, cholinesterase inhibitor 39 Title: Ascertaining older people’s knowledge and acceptance of advance care directives Principal researchers: Ms S Wall, Mr C Shanley, Professor G A Broe Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Funding: Ageing and Disability Department, NSW, $10,080 Timetable: Mid 1998 - early 1999 Website: www.cera.usyd.edu.au Outline: Advance care directives set out the level and forms of treatment a person would want in the future in the event they are unable to communicate their wishes. Such a situation may occur if the person has a stroke, an accident or develops severe dementia. The written directive also provides for the person to nominate a proxy - someone who can make decisions on their behalf if they are not able to. The purpose of this project was to talk to older people directly about advance care directives rather than relying just on the views of concerned health care professionals. The study found that: advance care directives are not widely understood or used amongst older people; older people surveyed showed a high level of interest in advance care directives once they were explained; strong interest came from people without close personal or family relationships; targetting is most useful to “younger aged”. Keywords: Advance directives, proxies, living wills, guardianship 40 Title: Australian norms for older adults on the Boston Naming Test Principal researcher: J Millar Co-researchers: Dr D Grayson, Dr A Shores Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Funding: Ageing and Alzheimer’s Research Foundation, Department of Veterans’ Affairs (NDEMS) Website: www.cera.usyd.edu.au Outline: Neuropsychologists use normative data to determine whether an individual is impaired on a test compared with a “normal” reference group of a similar age and demographic background. Norms for many neuropsychological tests are scarce for adults over the age of 80 years. The aim of this study was to produce normative data for an elderly sample on the Boston Naming Test, which was designed to detect relatively mild word retrieval problems. In this test, participants are asked to name a series of pictures of common and less common objects. The Boston Naming Test was chosen because a common complaint of older adults is word-finding difficulty, and it has also been identified along with memory as one of the first signs of the very early stages of Alzheimer’s disease. 106 elderly individuals recruited from the Sydney Older Persons Study (entry 55) (age range 81-94 years) participated in this study. As performance on the Boston Naming Test was affected by level of education, normative data on the Test were provided separately for people with less than 10 years or more than 10 years education. The cultural properties of the Boston Naming Test were also examined. Several items in the test are specific to North American culture, and CERA is currently devising an abbreviated version of the test which should be more relevant for use with Australian populations. Analysis is also being undertaken of the types of errors made on Australian Ageing Research Directory 2000 41 Multidisciplinary Ageing Research Units the Boston Naming Test (e.g., visual versus semantic errors), to determine the effects of both age and very mild cognitive decline on naming ability. Keywords: Language, healthy ageing, neuropsychology 41 Title: Brain pathology in patients with neurodegenerative disorders Principal researchers: Dr J Kril, Professor G A Broe Co-researchers: Ms P Waley, Ms S Patel, Ms F Png Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW; Prince of Wales Medical Research Institute Status: Ongoing Funding: Medical Foundation of the University of Sydney, National Health and Medical Research Council (GMH) Timetable: 1997 - 2001 Website: www.cera.usyd.edu.au Outline: This project is investigating the pattern of pathology in a number of the rarer causes of dementia (eg. fronto-temporal dementia, diffuse Lewy body disease). These will then be compared with cases of Alzheimer’s disease in order to understand the mechanisms which cause cell death in dementia. Keywords: Dementia, neuropathology, non-Alzheimer dementia 42 Title: CERA’s role in NHMRC Network for Brain Research into Mental Disorders Principal researchers: Dr W Brooks, Professor G A Broe, Ms H Bennett, Dr H Creasey Co-researchers: Dr J Kril, Associate Professor G Halliday Organisation: Centre for Education and Research on Ageing, Concord Hospital NSW Status: Ongoing Funding: National Health and Medical Research Council, $40,000 per annum Timetable: 1993 - 2001 Website: www.cera.usyd.edu.au Outline: The NHMRC Network (formerly known as the Australian Neuroscience and Mental Illness Research Network) has been funded by the NHMRC from 1993-2001 to facilitate collaboration between researchers around Australia investigating the clinical diagnosis, neuroimaging, genetics and neuropathology of disorders such as dementia, schizophrenia and bipolar depressive disorder. The Network consists of four Consortia: CERA personnel are represented in the Diagnostic Assessment Consortium (Dr Helen Creasey, Ms Hayley Bennett, Dr William Brooks). During 1997-1999 Network activities have included recruitment and documentation of new families with hereditary dementias. Interstate field trips by Dr Brooks and Professor Broe have allowed research clinical assessments for affected members of these families in remote areas. Blood is collected for genetic studies at the Garvan Institute in Sydney (Associate Professor Peter Schofield, Dr John Kwok and Ms Prudence Stanford) and at the University of Western Australia (Associate Professor Ralph Martins). Autopsy diagnosis has also been arranged where possible and has been greatly helped by our close links with Dr Jillian Kril of CERA and Dr Glenda Halliday, NHMRC Senior Research Fellow at the Prince of Wales Medical Research Institute, who are funded independently of the Network. Collaboration between scientists in Sydney, Melbourne (Professor Colin Masters, Dr Catriona McLean and Ms Margaret Smith at the Department of Pathology, University of Melbourne), Perth (Associate Professor Ralph Martins), Adelaide and Brisbane, has meant that most of these families have now had their illness defined and diagnosed clinically, genetically and neuropathologically. These families are rare and very 42 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units important to the international research community. Because of the clearly genetic basis of their condition they contribute greatly to our understanding of the basic cellular processes involved in the development of Alzheimer’s disease and other dementias. This was recognised in 1999 by the award by the Department of Veterans’ Affairs of a three year project grant to Dr John Kwok, Associate Professor Peter Schofield and Dr William Brooks for 2000 - 2002 for further study of the genetic influences in these families. Keywords: Genetics, neuropathology, dementia, clinical diagnosis, Alzheimer’s disease, fronto-temporal dementia 43 Title: Characterisation of brain pathology in families with inherited dementia Principal researchers: Dr W Brooks, Dr J Kril, Associate Professor G Halliday Co-researchers: Associate Professor P Schofield, Dr J Kwok Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Core funding Timetable: 1997-2001 Website: www.cera.usyd.edu.au Outline: A small proportion of patients with dementia have an autosomal dominantly inherited disease. Although they are rare, these families provide valuable insights into the causes of dementia. Families with presenilin (PS-1) and tau (FTDP-17) mutations have been identified and their clinical phenotype and brain pathology are being characterised. Keywords: Dementia, genetics, neuropathology 44 Title: Correlates of brain atrophy in Alzheimer’s disease Principal researchers: Dr J Kril, Professor G A Broe Co-researcher: Ms S Patel, Ms F Png, Ms P Waley Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: University of Sydney Medical Foundation, $825,000 Timetable: 1997 - 2001 Website: www.cera.usyd.edu.au Outline: For nearly a hundred years, the pathological features of Alzheimer’s disease (plaques and tangles) have been recognised but, to date, no firm relationship has been found between the amount of pathology and the degree of impairment. It is believed to be the total amount of brain tissue damaged which is important in determining which functions will be affected in Alzheimer’s disease. This study will examine not only the number of plaques and tangles but also the amount of atrophy in order to determine a measure of total brain pathology in patients with Alzheimer’s disease. Keywords: Alzheimer’s disease, neuropathology, atrophy, dementia 45 Title: Elderly war veterans studies Principal researchers: Dr O Dent, Professor G A Broe, Dr D Grayson Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Completed Funding: Department of Veterans’ Affairs, $57,065 Australian Ageing Research Directory 2000 43 Multidisciplinary Ageing Research Units Timetable: 1998 Website: www.cera.usyd.edu.au Outline: In 1998, a series of seven occasional papers was presented to the Commonwealth Department of Veterans’ Affairs. These papers investigated a number of issues relating to the health and well-being of World War II veterans and war widows compared with elderly nonveteran community members, using data from the Sydney Older Persons Study (entry 55). Topics covered included the nature and structure of social support and social networks; use of, and satisfaction with, medical, allied health and community services; complementarity between informal support and community services; the influence of disease, social factors and participation in activities on quality of life. Keywords: Veterans’ health, social support, quality of life, service use 46 Title: Fronto-temporal dementia study Principal researcher: Mr B Casey Co-researchers: Professor G A Broe, Associate Professor M Fulham Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Nil Website: www.cera.usyd.edu.au Outline: Fronto-temporal dementia has a younger age at onset and distinct symptom profile from Alzheimer’s disease. This study combines neuropsychological measures and ratings of key symptoms such as apathy, disinhibition, and repetitive and stereotypic behaviours with functional neuroimaging (PET scans) to elucidate anatomical-behavioural relationships. Preliminary results provide support for models relating particular regions of the frontal lobe to specific functions. Keywords: Dementia, frontal lobe, temporal lobe, neuropsychology 47 Title: Genetic correlates of Alzheimer’s and non-Alzheimer’s dementias Principal researcher: Dr E Milward Co-researchers: Professor R Scott, Associate Professor R Martins, Associate Professor P Schofield, Dr J Kwok, Dr W Brooks, Ms B Kyngdon, Dr D Chan Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Continuing Funding: Ageing and Alzheimer’s Research Foundation Website: www.cera.usyd.edu.au Outline: Several genetic factors contributing to Alzheimer’s disease have now been determined, notably apolipoprotein E (apoE), amyloid precursor protein (APP) and the presenilins. This research is continuing to examine genetic factors with collaborators both within Australia and overseas. It is also assessing whether or not there are correlations between different genetic factors and various early onset dementias, as well as nonAlzheimer’s dementias. Keywords: Alzheimer’s disease, genetics 44 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 48 Title: Genetic factors influencing brain pathology Principal researchers: Dr C Shepherd, Dr J Kril Co-researchers: Professor GA Broe Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Sir Zelman Cowen Universities Fund Timetable: 2000 Website: www.cera.usyd.edu.au Outline: Recent evidence suggests that an individual’s genetic make-up may influence both their susceptibility to developing a neurodegenerative disease and the brain’s pathological response to that disease. This study is investigating the role of allelic variations in the major histocompatibility antigen (HLA) genes in Alzheimer’s disease. These genes code for proteins of importance in the inflammatory response and as brain inflammation is a significant component of Alzheimer-type pathology the research is seeking to establish if Alzheimer’s disease is associated with a particular HLA genotype. In addition, the amount of inflammatory pathology in the brain is being examined to determine if HLA genotype influences brain inflammation. Keywords: inflammation, medication, dementia, risk factors 49 Title: Magnetic resonance imaging correlates of “normal” brain ageing and age associated cognitive decline Principal researchers: Professor G A Broe, Dr H Creasey, Dr D Grayson, Dr S Gaden Co-researchers: Ms H Bennett, Ms T Lye, Mr O Piguet, Dr L Ridley Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: In progress Funding: National Health and Medical Research Council, $258,338; NSW Health Department Research Infrastructure Grant, Ageing and Alzheimer’s Research Foundation Timetable: 1997 - ongoing Website: www.cera.usyd.edu.au Outline: The hippocampus is a curved structure extending through the temporal lobes of the brain, and is intimately involved in the neural processing of memory. It is known to be one of the brain structures most vulnerable to degeneration in Alzheimer’s disease. A decline in memory functioning is also a common complaint among healthy individuals of advanced age, and this is thought to be associated with an age-related decrease in hippocampal volume. To investigate the association between “normal” ageing and hippocampal volume, 115 community-dwelling participants aged 81 years and over from the Sydney Older Persons Study (entry 55) were recruited. Each participant underwent magnetic resonance imaging scanning of the brain as well as neurological and neuropsychological assessment. Presently, whole brain volumes and hippocampal volumes are being measured, using a threedimensional technique on an advanced software program developed in the USA. The study aims to define magnetic resonance imaging correlates of “normal” brain ageing, with the specific purpose of investigating whether volumes of the hippocampus are selectively correlated with age-related memory performance. Keywords: Hippocampus, vascular changes, Alzheimer’s disease, memory Australian Ageing Research Directory 2000 45 Multidisciplinary Ageing Research Units 50 Title: Microvascular pathology in patients with late life depression Principal researchers: Dr C Peisah, Dr J Kril Co-researchers: Professor H Brodaty, Dr I Hickie Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: NSW Institute of Psychiatry Timetable: 1998 - 2000 Website: www.cera.usyd.edu.au Outline: It has been suggested that depression develops in elderly patients as a result of white matter damage in the frontal lobe. This study is determining the degree of white matter damage in elderly patients with and without depression to examine this hypothesis. Keywords: Depression, dementia, white matter disease 51 Title: Neuropsychology of ageing and cognition: Changes in executive functions Principal researchers: Mr O Piguet Co-researchers: Professor G A Broe, Dr D Grayson, Associate Professor R Tate Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: NSW Health Department Research Infrastructure Grant, Ageing and Alzheimer’s Research Foundation, Department of Veterans’ Affairs (NDEMS) Timetable: 1997 - ongoing Website: www.cera.usyd.edu.au Outline: Increasing variability in performance on tests of cognitive functions with ageing is well recognised. This study aims to provide a better understanding of the impact of age, environmental factors and illnesses on patterns of executive functions in older people. Executive functions include decision-making, planning, problem-solving and reasoning abilities, as well as higher-order memory and language functions. Participants in the study were recruited from the Sydney Older Persons Study (entry 55). They underwent extensive neurological and neuropsychological assessment, and were asked questions about their health and lifestyle. Analysis of the data is underway. Keywords: Cognition, executive functions, ageing, neuropsychology 52 Title: Protein changes correlating with neurodegeneration in Parkinson’s disease and dementia with Lewy bodies Principal researchers: Dr E Milward, Associate Professor G Halliday Co-researchers: Ms M Broe, Dr C Shepherd Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: National Health and Medical Research Council, Australian Brain Foundation Timetable: 1999 - 2001 Website: www.cera.usyd.edu.au Outline: The project aims to identify the protein and cellular components and clinical significance of hippocampal atrophy in Lewy body diseases. It is investigating protein changes and cell death in the brain in Parkinson’s disease. Keywords: Hippocampus, Lewy body, Parkinson’s disease, neurodegeneration, protein 46 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 53 Title: Subacute care study Principal researchers: Dr L Ahmad, Professor A Kramer Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: In progress Funding: Core funding Timetable: 1997 - 2000 Website: www.cera.usyd.edu.au Outline: This study is a follow-up of rehabilitation patients with hip fractures and strokes. The outcome data for the later time points (at 6, 9 and 12 months) are being analysed. Using the chart records of the acute stay, computed tomographic scan readings performed by the investigators and the outcome data of the stroke patients, predictors of clinical outcomes in terms of mortality, functional status, and place of discharge will be identified. Results of analyses relating to cost and outcomes at six months show that stroke patients receiving more intensive rehabilitation cost more, but were more likely to be discharged into the community. There was no difference in discharge outcome for hip fracture patients between different types of rehabilitation facilities. Keywords: Rehabilitation outcomes, hip fracture, stroke, subacute care 54 Title: Subcortical stroke study Principal researchers: Ms H Bennett, Dr A Corbett, Dr S Gaden Co-researcher: Professor G A Broe Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Nil Website: www.cera.usyd.edu.au Outline: This study explores the impact of small-vessel (subcortical) strokes on cognition, and their relationship to dementia. A group of 77 people who were radiologically identified as having subcortical infarction were examined four times over a six year period. At each point in time, they participated in neuropsychological, neurological and functional assessment, and underwent computed tomographic scanning. Predictors of outcome in terms of cognitive decline and incident dementia, functional decline, recurrent stroke and death are being examined. To date it has been found that early mild cognitive changes (as opposed to vascular risk factors, computed tomographic scan data, or neurological presentation) are the best predictors of incident dementia, and that a broader combination of these factors is predictive of functional decline. Keywords: Stroke, neuropsychology, dementia, small-vessel disease, computed tomographic scan 55 Title: Sydney older persons study Principal researchers: Professor G A Broe, Dr H Creasey, Dr D Grayson Co-researchers: Ms H Bennett, Dr L Waite, Dr W Brooks, Mr O Piguet, Ms E Sawley, Ms J Millar, Dr J Cullen, Ms D Edelbrock, Dr B O’Toole, Dr O Dent, Ms T Lye, Dr S Gaden, Dr L Ridley Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Australian Ageing Research Directory 2000 47 Multidisciplinary Ageing Research Units Funding: PH&RDC, National Health and Medical Research Council, Royal Freemasons’ Benevolent Institute, RADGAC, Department of Veterans’ Affairs, Ageing and Alzheimer’s Research Foundation, NSW Health Department Research Infrastructure Grant Timetable: 1991 - ongoing Website: www.cera.usyd.edu.au Outline: This study began in 1991 as the Sydney Older Veterans Health and Services Project investigating the health of 300 community dwelling veterans of World War II. The study was expanded to include a further 300 community (non-veteran) participants. Stage 1 (1991-1993) involved visiting people in their homes and conducting medical and neuropsychological assessments. Participants were also asked questions about their health and lifestyle, and often a spouse, relative or friend was interviewed to provide further information. These participants have been followed up every three years (Stage 2 was completed 1994 - 1996; Stage 4 1997 1999. Stage 3 was a separate blood collection phase. By asking the same questions at three year intervals, the research aimed to identify any functions that seem to either change or stay the same with advancing age. The research aims to identify factors which may predict “successful” versus “unsuccessful” ageing. It will also increase understanding of neurodegenerative disorders such as Alzheimer’s disease and Vascular dementia, by examining the role of environmental risk factors and protective factors in conjunction with genetic information gained from Sydney Older Persons Study Stage 3 (entry 56). A new development with regard to the Sydney Older Persons Study was the awarding of a research grant from National Health and Medical Research Council to investigate magnetic resonance imaging correlates of brain ageing. Many participants had an magnetic resonance imaging scan of the brain, which will facilitate investigation of individual structures within the brain, and identification of changes in brain tissue with advancing age, and with the onset and progression of neurodegenerative disease. Keywords: Cohort study, community survey, successful ageing, risk factors, neurodegenerative disease, dementia 56 Title: Systemic correlates of Alzheimer’s and non-Alzheimer’s dementias (SOPS Stage 3) Principal researchers: Dr E Milward, Professor G A Broe, Dr H Creasey Co-researchers: Ms B Kyngdon, Dr M Janu, Dr D Grayson, Dr W Brooks Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Ageing and Alzheimer’s Research Foundation, Alzheimer’s Association Australia; Sir Zelman Cowen Universities Fund Website: www.cera.usyd.edu.au Outline: Many studies suggest that there may be changes in the blood of patients who have Alzheimer’s disease or other dementias. Some of these changes may precipitate the disease process while others may result from the disease process. The research examined a range of blood factors that may be associated with Alzheimer’s disease or other dementias. A large number of Australian elderly (approximately 20%) are anaemic. Significant associations have been demonstrated between anaemia and vascular dementia but not between anaemia and Alzheimer’s disease. This association occurred in both genders, although most strongly in women (around 50% of all women with vascular dementia were anaemic by World Health Organization criteria). These preliminary results suggest that having anaemia may worsen the symptoms of dementia. Continuing analyses are being undertaken of other blood factors relating to anemia, such as vitamin B12, folate and iron. When their potential impact is known, control of these factors (along with other risk factors such as fat intake, obesity and 48 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units smoking) may be one way the symptoms of dementia can be lessened in some people, or perhaps its onset delayed or prevented. Keywords: Alzheimer’s disease, non-Alzheimer’s dementia, anaemia, systemic disease 57 Title: The contribution of small vessel disease to the development of dementia Principal researcher: Dr J Kril Co-researchers: Ms P Waley, Ms S Patel Organisation: Centre for Education and Research on Ageing, Concord Hospital, NSW Status: Ongoing Funding: Medical Foundation of the University of Sydney Timetable: 1997 - 2001 Website: www.cera.usyd.edu.au Outline: Small vessel disease is a rare cause of dementia when occurring in isolation. However, it has been suggested that small vessel disease is a significant contributor to the pathology of Alzheimer’s disease. This research is studying the architecture and density of the cerebral microvasculature in patients with small vessel disease, Alzheimer’s disease and both. In addition, the number of neurons in functionally specific brain regions are being quantified to determine if small vessel disease can cause neurodegeneration. Keywords: Dementia, capillaries, morphometry, brain perfusion 1.4 Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney 58 Title: Exploration of psychosocial issues for older people and their carers following discharge from a rehabilitation hospital Principal researcher: Professor L Gething Organisation: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney. Status: Completed Funding: Uniting Church Bequest Fund Timetable: 1999-2000 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: This project investigated physical, social and psychological experiences of patients discharged from in-patient treatment at the War Memorial Hospital in Waverley, Sydney and their carers. The project aimed to provide information for use in maximising patient outcomes following rehabilitation. It involved a multidisciplinary team that worked with the researchers and included a speech pathologist, general medical practitioner, social worker, gerontological nurse, occupational therapist and a physiotherapist. A questionnaire battery was administered through interview on three occasions. Thirty seven people participated in Interview One, 23 in Interview Two, and 20 in Interview Three. Eighteen people completed all three interviews. Respondents initially reported an objective quality of life comparable with other samples of older Australians, but this decreased significantly within the study group over the interview period. Subjective quality of life also was initially reported as similar to that found for a comparably-aged group, but decreased significantly one month following hospital discharge. The only functional measure found to be related to quality of life was confidence in carrying out daily activities. It was concluded that these findings highlight the importance of a holistic approach to assessing treatment outcomes which incorporates the views of clients as well as Australian Ageing Research Directory 2000 49 Multidisciplinary Ageing Research Units those of professionals. The report, which includes recommendations designed to maximise health management outcomes, is being used by the War Memorial Hospital to review its discharge planning processes. Keywords: Ageing, rehabilitation, consumer focus, health outcomes, multidisciplinary team 59 Title: International validation of the Reactions to Ageing Questionnaire Principal researcher: Professor L Gething Co-researchers: Dr K McKee, Dr L Olaf-Persson Organisations: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney; University of Sheffield, United Kingdom; Gothenberg University College of Health Sciences, Sweden Status: Current Funding: Community Disability and Ageing Program, University of Sydney Infrastructure Scheme Timetable: 1998-2000 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: International validation of the Reactions to Ageing Questionnaire involves researchers in Australia, the United Kingdom and Sweden. The Reactions to Ageing Questionnaire is being administered along with a battery of attitudinal measures including the Facts on Aging Quiz and Aging Semantic Differential. Results to date indicate a pattern of negative attitudes towards ageing (ageism) which extends across the three countries involved in the project. Results with the Facts on Aging Quiz and Aging Semantic Differential indicate that a range of negative features are attributed to older people which results in them being perceived as unsafe and unreliable as workers and drivers, and as being incompetent and dependent. Results with the Reactions to Ageing Questionnaire indicate that younger people anticipate their own ageing with considerable dread, but that this dread decreases with age. These attitudes emerged among health professionals and among members of the general population. Keywords: Attitudes, ageism 60 Title: Measurement of health professional attitudes towards ageing and older people Principal researcher: Professor L Gething Organisation: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney Status: Completed Funding: Australian Research Council Timetable: 1993 - 1995 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: This project explored community and health professional attitudes. It evaluated existing questionnaire measures of attitudes which were mainly derived from the United States and assessed their applicability for the Australian community. Results produced evidence that ageism occurred across a range of professional groups. Particular focus was placed on nurses working in different specialty areas. The most negative attitudes emerged for nurses working in acute care and in nursing homes. The project revealed a gap in the field of measurement of ageism. Preliminary steps were taken in the development of a questionnaire designed to address this gap. To that time, most attitudinal measures focused on perceptions of other older people or on perceived effects of ageing on others. Relatively little attention was paid to a person’s perceptions of his or her ageing or anticipation of what he or 50 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units she would be like in old age. The Reactions to Ageing Questionnaire was developed to assess how people feel about their own ageing (personal ageing). Keywords: Ageism, attitudes, health professionals, community 61 Title: Quality of life and Parkinson’s Disease Principal researcher: Ms J Middleton Co-researcher: Professor L Gething Organisation: Research Centre for Adaptation in Health and Illness, University of Sydney Status: Current Timetable: 1998 - 2001 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: This research project is exploring the needs of people with Parkinson’s Disease and their spouses at different stages as the condition progresses. Needs and symptoms vary greatly between individuals and between stages. Symptoms often are minor, but can result in falls and health crises that lead to major disabilities and subsequent lowered perceived quality of life. The aim of the project is to provide recommendations to enhance the efficiency of health services and supports so that health crises may be prevented. The study has two stages. In the first, a questionnaire is being distributed to 200 people with Parkinson’s Disease and their primary carers. Stage Two consists of focus group discussion of findings in order to develop recommendations for policy and practice. Keywords: Parkinson’s Disease, caregivers, quality of life 62 Title: Quality of life and service provision issues for people with a long standing disability who are ageing Principal researcher: Professor L Gething Organisation: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney. Status: Completed Funding: Community Disability and Ageing Program, NSW Ageing and Disability Department, Commonwealth Department of Health and Family Services Timetable: 1999 - 2000 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: A forum was held at the University of Sydney in 1998. It was attended by over eighty people and included people with disabilities, representatives of disability organisations and the State and Commonwealth governments, service providers and researchers. The session was teleconferenced in order to include the views of people with disabilities and service providers living in rural areas. A working party was conducted of consumers and representatives of peak and consumer disability organisations in order to develop recommendations. A draft report was prepared which contained outcomes of the first three components of the project. Feedback was then sought from consumers, peak and consumer disability and ageing organisations and government through oral and written submissions. This feedback was incorporated into the final report, entitled “We’re growing older too: Service provision and quality of life issues for people ageing with long standing disability”. Keywords: Ageing, disability, consumer consultation, quality of life, service provision Australian Ageing Research Directory 2000 51 Multidisciplinary Ageing Research Units 63 Title: Quality of life and well being issues for people ageing with traumatically acquired brain injury and spinal cord injury, and their unpaid carers Principal researcher: Professor L Gething Organisation: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney. Status: Current Funding: Motor Accidents Authority of NSW Timetable: 1997-2001 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: This project is exploring the quality of life and service provision issues for people with acquired brain injury, spinal cord injury and their carers. Organisations contributing to the project and represented on the steering committee are: The Australian Quadriplegic Association, Brain Injury Association of NSW, Carers NSW, the Paraplegic and Quadriplegic Association of NSW, Royal Rehabilitation Centre Ryde, and Royal North Shore Hospital. The following insurance companies also are involved on the steering committee: the Motor Accidents Authority of NSW, FAI Insurance, AMP, Sun Alliance, NRMA and MMI. The project involves questionnaire and interview data collection in metropolitan and rural NSW. It has two components. The first is a longitudinal study of people with brain and spinal cord injury and their carers in the two years after discharge from hospital. The second is a cross sectional study of quality of life and service provision for people ageing with these injuries. This component of the project involves data collection from people with disabilities, carers and a comparison group drawn from the general population. Preliminary results indicate that people with brain and spinal cord injury experience a greater range of health problems than those in the comparison group and that presence of disability impacts on quality of life for both the care recipient and caregiver. Keywords: Disability, quality of life, ageing, carers 64 Title: Use of goal attainment scaling with older people in the design and evaluation of health care Principal researcher: Professor L Gething Co-researchers: Ms A Kelly, Ms F Russell Organisation: Community Disability and Ageing Program, Research Centre for Adaptation in Health and Illness, University of Sydney; Central Sydney Area Health Service; War Memorial Hospital Status: Current Funding: National Health and Medical Research Council Timetable: 1998 - 2000 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: This project involves collaboration between the Community Disability and Ageing Program and health professionals working in the Central Sydney Area Health Centre and South Eastern Sydney Area Health Centre. The steering committee for the project involves nurses, occupational therapists, physiotherapists, a social worker and a speech pathologist. Agencies in which the project is taking place are War Memorial Hospital (average age of patients is 79 years) and the Concord Repatriation General Hospital (average age of patients is 67 years). This project is trialling the application of goal attainment scaling in a rehabilitation setting for people aged more than 50 years. Its design incorporates a control group, partial 52 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units intervention and complete intervention. People in the control group undergo existing rehabilitation regimens. In addition to existing regimes, those in the partial intervention group set goals in conjunction with a researcher but these goals are not used to guide rehabilitation planning. People in the complete intervention undergo each stage of setting goals and using them with the health professional team to design treatment and to assess treatment outcomes. Data collection for the control and partial intervention groups has been completed, whilst that for the complete intervention is due for completion in mid 2000. To date, goal attainment scaling has emerged as a useful adjunct to usual rehabilitation programs. It provides an effective method of incorporating client goals and needs into the planning process and has emerged as a useful method of facilitating communication between health professional groups involved in rehabilitation. Keywords: Ageing, consumer consultation, rehabilitation 65 Title: Volunteering to care: What makes a successful volunteer program Principal researchers: Ms R Melville, Ms E Priestly, Ms J Stone Organisation: Central Sydney Area Health Service and Research Centre for Adaptation in Health and Illness, University of Sydney Status: Completed Funding: Research Centre for Adaptation in Health and Illness Seeding Grant Scheme Timetable: 1998 - 1999 Website: http://www.usyd.edu.au/su/nrcahi/ Outline: The aim of this project was to conduct a survey of palliative care volunteer programs in Australia in order to provide information which could be used to guide decision making in regard to the value of these programs for professional nursing care. The project identified 40 volunteer palliative care programs throughout Australia. Program coordinators completed a telephone survey about the characteristics of clients, volunteers and the features of their organisation. Respondents also were asked about criteria used to assess the effectiveness of programs, including retention rates for volunteers, support structures within the program and the program’s ability to respond to the needs of clients within the community. Important factors underlying success included consistency of funding sources and a clearly articulated infrastructure. Local commitment to support systems also was important. Keywords: Volunteering, community care, palliative care 1.5 Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland 66 Title: A comparative study of the attitudes, needs and practices of Australian and UK employers towards the use of new technology by older workers. Implications for policy and practice Principal researcher: Dr M Steinberg Co-researchers: Dr P Taylor, Ms L Walley Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Australian Research Council, International Project Timetable: September 1998 - December 1998 Australian Ageing Research Directory 2000 53 Multidisciplinary Ageing Research Units Outline: The international study replicated the quantitative and qualitative investigation of Australian employers' attitudes and practices towards technology and the implications for older workers in the United Kingdom. Key informant interviews were conducted, as in Australia, building on Dr Taylor’s previous work with employers and his access to government and industry leaders. The Australian employer questionnaire was distributed to UK employers using the same methodology (certified mail, reply paid postal return, reminder letter sent and finally non respondents followed up by telephone). Employers were randomly sampled by representatives from the UK organisation Dunhill & Bradstreet. Keywords: Older workers, technological change, employers, ageing, attitudes, practices 67 Title: An exploration of decision-making around percutaneous endoscopic gastrostomy feeding for severely cognitively /neurologically impaired patients aged 65 plus Principal researchers: Dr M Steinberg, Ms C Cartwright, Associate Professor G Williams, Dr J Collie Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Ongoing Funding: Commonwealth Aged and Community Care Program, $15,000 Timetable: July 1999 - December 1999 Outline: Issues relating to the decision-making process with respect to the insertion, monitoring and withdrawal of percutaneous endoscopic gastrostomies, particularly in older people, were investigated. Key informant interviews and focus groups were conducted with relevant health, allied health, legal and ethics professionals, and with family members of older people who currently have a percutaneous endoscopic gastrostomy in situ. Issues identified were incorporated into questionnaires for a second study. Keywords: Percutaneous endoscopic gastrostomy feeding, older people, advanced dementia, decision-making 68 Title: A sustainable community-based falls prevention program Principal researchers: Dr M Steinberg, Ms N Peel Co-researcher: Ms C Cartwright Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Queensland Government Department of the Premier and Cabinet, $35,000 Timetable: May 1998 - December 1999 Outline: The aim of the study was to continue to monitor participants involved in a falls prevention intervention trial for a further year to assess the effectiveness and sustainability of interventions over a longer term. A secondary aim was to trial the awareness-raising and calendar monitoring component of the intervention on a group of frail older people. Results of the continued monitoring of participants from the intervention trial showed that reduced falls and injury rates obtained in the intervention program were sustained after the program ceased. The intervention program has the potential to capitalise on the older person’s motivation to improve their functioning and well-being and to be self-sustaining with life-long benefits. Use of available community resources increases the potential cost effectiveness of the interventions. Keywords: Falls prevention program trial, community-based older people, sustainability 54 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 69 Title: Attitudes and practices of employers and employees towards older workers in a climate of antidiscrimination Principal researchers: Dr M Steinberg, Professor K Donald, Professor J Najman Co-researcher: Ms G McChesney-Clark Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: University of Queensland Foundation Ltd, $40,000 Timetable: 1995 - 1996 Outline: The study aimed to examine the attitudes and practices of employers, employees and the general community with respect to older workers in a changing legislative context - the banning of compulsory retirement. 2,000 community members were randomly selected from the Brisbane Metropolitan electoral roll and surveyed using certified mail techniques. The Chief Executive Officers of 130 companies selected from the Register of Workplaces were hand delivered questionnaires (84% response rate). Results showed that perceptions of an older worker are very young for contemporary society; overt age discrimination in recruitment, access to training and other practices; indirect discrimination in attitudes and policies; and little knowledge of the legislation. The report and publications attracted considerable media and policy attention. Keywords: Older workers, discrimination, employer, employee, community attitudes, community practices 70 Title: Attitudes and practices of older Queenslanders towards technology Principal researcher: Dr M Steinberg Co-researcher: Ms L Walley Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Department of Public Works and Housing, Queensland, $10,000 Timetable: January 1998 - July 1998 Outline: This study examined the attitudes and practices towards technology of older Queenslanders. Five hundred questionnaires, developed for a previous community-wide study were distributed by mail to Queensland members of the National Seniors Association randomly sampled from membership lists (1% of memberships); 250 questionnaires were similarly distributed to members of the Council on the Ageing, Queensland (15% of membership). As the Australian Pensioners and Superannuants League does not have a Statewide database, the secretaries of all branches were requested to provide the names and addresses of 10% of their members (37 of the 90 branches responded - 41%), to whom questionnaires were distributed (n=305). Findings of the study indicated that the significant barriers, which prevent older Queenslanders using technology, are cost, access and equity, lack of adequate support, insufficient training and education provision, equipment design and jargon. Strategies for governments and organisations to help prevent or reduce the isolation or marginalisation of older people through a lack of access to information or services based on electronic delivery were recommended. Keywords: Older people, technological change, attitudes, practices Australian Ageing Research Directory 2000 55 Multidisciplinary Ageing Research Units 71 Title: Casemix: Quality care in a climate of reduced length of stay Principal researchers: Dr M Steinberg, Dr M Clark, Professor K Donald Co-researchers: Sister N Bischoff, Ms L Roberts, Ms R Wittmann Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: National Hospitals Quality Management Program, $75,000 Timetable: 1995 - 1997 Outline: This was the second phase of a three phase project. Admission and discharge policies were examined in all Queensland hospitals. The survey achieved a 93% response rate. More than half did not have formal discharge policies. Half did not have written admission policies. Even where such policies existed, some key staff were uninformed about them. Issues for patients, carers and health service providers impacting on quality of care as a result of reforms such as casemix and reduced length of stay were examined. 56 patient/carer dyads were interviewed separately in depth, including coping strategies. A patient satisfaction survey was also undertaken. 128 eligible patients were approached over 10 days, 114 of whom consented to participate; 90 were interviewed at follow-up by telephone two weeks post-discharge. The majority were: public patients, aged 35-64, female, married, Australian-born, low socioeconomic status. The length of stay was 2-5 days predominantly. Overall patients reported satisfaction in most areas examined (eg. 81% with the admission process, 86% with the care received). Pain was again an important issue, with 62% experiencing pain, which was severe or moderate for 82% of these. One important area was lack of information/ explanations. 63% had either not been told or not told enough about their daily routine: 11% never or only sometimes understood the doctors’ answers to their questions. Of the 53% receiving new medication in hospital, no explanation was given regarding side effects ( to 35%), even the purpose (to 19%). Of the 54% who had tests, 20% had no explanation of the reason for test/s and 41% had not received or understood the explanation of results. There were concerns about explanations regarding surgery, particularly about pain, fears and anxieties, with only 55% being fully satisfied with the information regarding surgery. The overall perspectives of carers and carees differed. On Carer Strain Index ratings, patients considerably underestimated the problems carers reported experiencing in areas of lifestyle adjustment eg. emotional adjustments, changes to personal plans’ and confinement, while patients overestimated the impact of demands on carers eg. time demands. The home visits were considered very beneficial. 70% of admissions were regarded by patients as emergency, which has implications for service planning and waiting list policies. 16% of patients and 27% of carers thought the length of stay too short. A substantial number of patients were discharged home with significant activities of daily living/independent activities of daily living difficulties, representing an impost for carers and problems for those without carers. Few hospital or community doctors considered activities of daily living and few referrals were made. Similarly, most of the post-discharge services arranged by the hospital were for medical services. Keywords: Quality, casemix, discharge, ageing, carers 72 Title: Community and health practitioner views on end-of-life decision-making in the Northern Territory Principal researchers: Ms C Cartwright, Dr G Robinson Co-researchers: Dr M Steinberg, Professor J Najman, Associate Professor G Williams, Professor W Tyler 56 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Northern Territory University Status: Completed Funding: Internal funding Timetable: 1996 - 1997 Outline: This was the fourth study in the end-of-life suite. It explored preferred options for decision-making in terminal care among Northern Territory doctors, nurses and community members, with emphasis on knowledge, beliefs and perceived barriers to implementation of such options. The objectives of the study were: (i) to identify and describe current knowledge and opinions of health professionals and community members towards planning for medical care in the end stages of life, through use of a range of options for extending patient selfdetermination in terminal care (including enduring power of attorney and advance directives, pain management and palliative care, physician-assisted suicide and euthanasia); (ii) to identify: barriers to such planning; areas of uncertainty which produce legal and medical ambiguities for professionals, patients and community members; and policies and protocols which exist in relation to terminal care; (iii) to identify concerns in relation to palliative care, including availability and the need for training of health professionals; (iv) to use this information to inform professional and public debate in Australia; and to assist policy makers and legislators. A 34 page questionnaire was mailed to over 700 health professionals (doctors and nurses) and over 1,000 community members in the Northern Territory. There was a 56% response rate from health professionals and a 50% response rate from the general community. There was strong support from both groups for the use of advance directives to record future treatment wishes and for the appointment of proxies to make health-care decisions for people who can no longer make such decisions themselves. Community members were less confident than health professionals that severe pain can be controlled in terminally ill people; all participants agreed that there is a need for palliative care to be more widely available and for more health professionals to have palliative care training. As the Rights of the Terminally Ill Act (1995) was in operation in the Northern Territory when the questionnaires were distributed, participants were asked to what extent they approved of the legislation, which allowed physician-assisted suicide and euthanasia. Community respondents strongly approved of the law, nurses were more in favour than against it and doctors were more likely to disapprove of the law. However, an analysis of the qualitative data indicated that many doctors were against the legislation but not necessarily against euthanasia, and community responses were enmeshed with issues of state’s rights. Keywords: End-of-life decision-making, advance directives, palliative care, euthanasia, physician-assisted suicide 73 Title: Continuity of care post-discharge: Pilot intervention Principal researchers: Dr M Steinberg, Sister N Bischoff Co-researchers: Dr E Ernst, Ms L Roberts, Ms R Wittmann Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Ipswich Hospital Status: Completed Funding: West Moreton Regional Health Authority, $25,000 Timetable: 1997 Outline: Phase three of a suite of studies developed, implemented and evaluated a pilot intervention to address information, referral and support needs of patients, carers and hospital and community staff highlighted in the earlier studies, based on the ACHS EQUIP Guide. Six Australian Ageing Research Directory 2000 57 Multidisciplinary Ageing Research Units main intervention strategies were developed: two patient/carer information booklets (Returning home and Healthy ageing); education on medications was provided by the hospital pharmacist; a staff resource manual; a discharge needs form; a wall referral chart for special services; a discharge check-list. The intervention was undertaken for four consecutive weeks in three acute wards. Eligible patients were approached consecutively, so that five were actively enrolled on each ward throughout the study. Of 54 patients approached, 6 declined and 12 were lost to follow-up. Patients and carers were assessed pre and 7-10 days post discharge. At the end of the pilot, key staff were interviewed, and focus groups were held. Patients were happy with the booklets and there was improved satisfaction with the amount and quality of information/ interaction provided. The big change was in medications, 86% being fully informed about the purpose and side effects of medications; however, pharmacy staff found it time consuming. Referrals to allied health staff did not increase. Community Liaison staff were very supportive. The booklets were popular with nursing staff. The discharge needs form was user friendly, but should be integrated into admission processes. The check-list was easy to use and useful. The wall chart and resource manual were less well used; staff had little awareness of them and they needed to be better placed in the ward. The pilot time was too short, but did show useful ways of approaching significant issues identified by patients, carers and service providers. Keywords: Discharge planning, patient information 74 Title: Early discharge and public health: Priorities and responsibilities across the hospital/community interface Principal researchers: Dr M Steinberg, Professor K Donald, Dr M Clarke Co-researcher: Sister N Bischoff Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: PHRDC, $60,000 Timetable: 1995 - 1996 Outline: Designed as a 3-phase study, this is Phase 1, an investigation of the perceived needs of patients and their carers following discharge home from general medical and surgical wards of a medium sized hospital with city and rural catchments. Measures included demographics, health status (diagnostic related groups, self-reported health, Nottingham Health Profile), activities of daily living, length of stay, readmissions to six months, interviewer ratings of social supports and physical environment, financial log. Carer’s assessment and health practitioner data were also obtained. A survey of nurses was also undertaken covering demographics, involvement in discharge planning, adequacy, knowledge of community resources etc. 119 patients were approached at discharge and 81 were interviewed. Of these, 71 were involved in the follow-up. 189 health practitioners participated, the majority (83%) being hospital based. The Nottingham Health Profile mean scores showed that, prior to discharge, energy and sleep were the most severe problems for patients (mean age 71.4 years and equal gender distribution), with energy and mobility the most severe at follow-up. Unresolved pain was a problem, particularly in orthopaedic patients, 80% of whom experienced problems with pain, with 40% still reporting constant pain at follow-up. Major problems became apparent in independent activities of daily living. At discharge the majority of patients required assistance with housework, shopping and transport, increasing further by follow-up. These were activities where carers reported particular difficulties in providing assistance, especially transport. Considerable readmissions occurred, 23% being readmitted within one month, 31% within three months and 42% within six months. By six months, half 58 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units of the readmitted patients had been readmitted at least twice. Few community staff were involved in discharge planning. The survey of nurses had a 59% response rate. Issues included involvement in discharge planning after hours, considerable gaps in knowledge of community resources and confidence in making referrals, and lack of involvement of doctors in discharge planning. Improved evaluation of outcomes and feedback were needed. Keywords: Assessment, hospital/community interface, discharge planning 75 Title: Falls prevention audit Principal researcher: Ms N Peel Co-researcher: Ms K Richards Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Queensland Government Department of Health, $15,000 Timetable: May 1999 - 31 July 1999 Outline: The aim of the research was to collate information about existing services, projects, and programs within Queensland, which contribute to reducing the risk of falls in older people. Exploration of the State’s existing falls interventions for older people will inform future strategic direction in falls prevention in the Queensland Public Health Services. Keywords: Audit, falls prevention services, older people 76 Title: Falls prevention: Home modification evaluation Principal researchers: Dr M Steinberg, Ms N Peel Co-researcher: Ms C Cartwright Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Queensland Government Department of Housing, $30,000 Timetable: January 1998 - December 1998 Outline: The aim of the study was to evaluate the role of home assessment and modifications in the prevention of falls. In a trial of falls prevention interventions, 252 members of the National Seniors Association were allocated to four groups and the groups randomly assigned to the interventions in an “add-on” process. All groups received education and awarenessraising, three groups the exercise intervention, two the home assessment and one the medical examination. Following cessation of the program, 195 agreed to be monitored for a further 12 months to determine sustainability of results. Comparative data showed that those who received in-home assessments were significantly more likely (p<.001) to take action regarding hazard removal than were other participants. Confidence and fear of falling showed beneficial improvements. The home assessment group had lower incidence rates of falls and injuries than the control group following the intervention program, but the differences were not significant. The twelve months’ monitoring following cessation of the program showed that these rates were further lowered with important implications for sustainability of the program. Keywords: Falls prevention, community-based older people, home safety, sustainability Australian Ageing Research Directory 2000 59 Multidisciplinary Ageing Research Units 77 Title: GP and patient knowledge, attitudes and congruence in end-of-life decisionmaking Principal researcher: Dr M Steinberg Co-researchers: Dr G Williams, Dr M Parker, Dr C Del Mar, Professor R Hoffenberg, Ms C Cartwright Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: General Practice Evaluation Programme, Commonwealth Department of Human Services and Health, $90,000 Timetable: February 1995 - April 1996 Outline: This was the second study in a suite of studies which explored preferred options for decision-making in terminal care. Participants in this study were general practitioners and patients they had seen in the previous twelve months. The emphasis of the study was on knowledge, beliefs and perceived barriers to implementation of such options. The objectives of the study were: (i) to identify and describe current knowledge and opinions of general practitioners and patients towards planning for medical care in the end stages of life, through use of a range of options for extending patient self-determination in terminal care (including enduring power of attorney and advance directives, do not resuscitate orders, and euthanasia); (ii) to identify barriers to such planning and areas of uncertainty which produce legal and medical ambiguities for general practitioners and patients; (iii) to use this information to inform professional and public debate in Australia; and to assist policy makers and legislators. A 40 page questionnaire was mailed to 287 general practitioners and a 32 page questionnaire was mailed to 581 patients who had attended some of the responding general practitioners in two areas of Queensland (Brisbane and Toowoomba). There was a 60% response rate from general practitioners and a 67% response rate from patients. There was strong support from both groups for the use of advance directives to record future treatment wishes and for the appointment of proxies to make health-care decisions for people who can no longer make such decisions themselves (although there was very poor support from general practitioners for such documents to be legally binding on health professionals). Patients were less confident than general practitioners that severe pain can be controlled in terminally ill people; all participants agreed that there is a need for palliative care to be more widely available and for more health professionals to have palliative care training. Patients were strongly in favour of changes to the law to allow the options of euthanasia and physician-assisted suicide; general practitioners were significantly more likely to say that the law should not be changed. Keywords: End-of-life decision-making, advance directives, palliative care, euthanasia, physician-assisted suicide 78 Title: Medical retirement in the Queensland Police Service Principal researcher: Dr M Steinberg Co-researchers: Professor K Donald, Associate Professor G M Williams, R Tyman Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: RADGAC, $106,000 Timetable: 1995 - 1996 60 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Outline: High rates of retirement had been occurring in the Queensland Police Service on medical grounds. The study examined and compared two groups of police officers who retired on medical grounds - those who returned to work and those who did not. 110 medical retirees were interviewed at length in their homes. The assessment included detailed history, demographics, employment history, health status and psychological measures including the SF-36, and examination of the Queensland Police Service medical records. Results have been used in workplace policies and practices, including selection, training and stress management. Contributing factors included lack of support, discrimination/harassment, traumatic events. Early warning signs were evident twelve years into their careers, including sleep disturbances, depressed mood and hypertension, followed over the next three years with declining health. Some 87% of the primary diagnoses associated with medical retirement were psychiatric including affective and stress-related disorders. The majority of conditions were rated as severe by consultants. Most retirees had undertaken some form of paid employment postretirement. Average scores on health measures post-retirement were good. Better selfmanagement as well as better improved human resource management practices were recommended by the retirees. Keywords: Medical retirement, workplace stressors, human resource management 79 Title: Multi-cultural research in ageing Principal researchers: Associate Professor G Williams, Ms C Cartwright, Dr M Steinberg Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Department of Premier and Cabinet, Multi Cultural Affairs Queensland, $25,000 Timetable: February 1999 - June 1999 Outline: This project investigated the needs of older Queenslanders from non-Englishspeaking backgrounds, whose major migration groups came to Australia in the 1940’s and 1950’s and whose country of origin is no longer a significant source of immigration to Australia. Three areas were chosen for investigation, to reflect location and targeted participants. These were: Brisbane (people from the Baltic States); Mt Isa (Finnish and Hungarian people) and Hervey Bay (Polish and Hungarian people). This allowed for comparison across locations, across cultural groups and within one cultural group in two locations. Key informant interviews and focus groups were held with members of the relevant communities and with health and other professionals in the three locations. Issues affecting the participants fell into three categories: (i) issues which are common to members of the older population in general, to which mainstream strategies should be applied (perhaps with refocussing or augmentation); (ii) issues which are specific to a particular group, for which ethno-specific strategies may be the optimal approach; (iii) issues which are location-specific, for which local strategies may need to be developed or applied. These included issues related to data collection, ageing in place, knowledge of and access to services, infrastructure, health services, and torture and trauma. Differences in location included: in Mt Isa younger people have moved away to the coastal areas or to the major cities and as older people die there are diminishing numbers remaining; in Hervey Bay the opposite problem is occurring, where many of the older people have come from other areas to retire in this seaside location and there are not always adequate services to meet their needs. Keywords: Older people, non-English-speaking, isolation, ethnic aged Australian Ageing Research Directory 2000 61 Multidisciplinary Ageing Research Units 80 Title: No Falls, No Fear! Preventing falls in older people project Principal researchers: Ms C Cartwright , Dr M Steinberg Co-researcher: Ms N Peel Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Queensland Health Promotion Council, Queensland Health, $218,617 Timetable: January 1996 - December 1997 Outline: This project used a multi-intervention strategy to try to prevent falls in older people, and to endeavour to determine the impact of multiple interventions on the rate of slips, trips and falls experienced by participants. Approximately 250 members of ten Brisbane-based branches of the National Seniors Organisation were linked by branch into four groups, with roughly 60 in each group. A base-line survey was done and the groups were then randomly assigned to receive from one to four interventions. The four interventions were: (i) education/awareness-raising; (ii) exercise; (iii) home assessment and modification; (iv) medical assessment, including medication check. One group received intervention (i), a second group received (i) and (ii), group three received (i), (ii) and (iii) and the final group received all four interventions. In addition, all participants kept a daily calendar, returning one page per month, on which they recorded details of any slip, trip or fall. Any notified event was followed up by the researchers with a phone call to the participant. The program demonstrated measurable health benefits in both the intermediate and longer term, and its success was gauged by the following evidence: (a) Multi-strand interventions were effective in reducing the risks of slips, trips and falls. The results show statistically significant reductions in the risk of slips and trips in interventions (ii), (iii) and (iv) compared with intervention (i) (the control), with evidence also for reduction in the risk of falling. (b) Intervention (iv), which included all four components of awareness-raising, exercise, home safety and medical assessment, had the greatest protective effect, reducing the risk of slips by 65 percent, trips by 71 percent and falls by 40 percent. This result surpasses the original goal of a 10 percent reduction in falls. Using resources available in the community, the program has the capacity to be self-sustaining and cost-effective. It also has the potential to capitalise on the motivation of older people to improve their functioning and quality of life. Keywords: Falls prevention, older people, awareness raising, exercise, home modification 81 Title: Older drivers and cognitive functioning: Experiences, perceptions and management needs Principal researcher: Dr M Steinberg Co-researchers: Ms N Peel, Ms C Cartwright, Associate Professor G M Williams Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: In progress Funding: Centre for Accident Research and Road Safety, Queensland, $61,000 Timetable: March 1999 - June 2000 Outline: The research aims to identify and assess transport needs and options for older people and identify issues for licensing of older drivers (including withdrawal of licences) and relationship to cognitive functioning. The study design uses both quantitative and qualitative methods, through literature search, liaison with key informants, questionnaires and in-depth interviews, to identify behaviours, needs and desired outcomes for the management of 62 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units transport of older people, particularly those with cognitive incapacity. The target population sample is 100 people 75 years and older, recruited through GP practices or Community Health Centres. Information from older people will be used to assist in the development of assessment and management strategies for the continuation, support, restriction, and withdrawal of driving privileges. Keywords: Older drivers, cognitive impairment, transport issues 82 Title: Patient self-determination in terminal care Principal researcher: Dr M Steinberg Co-researchers: Professor J Najman, Dr G Williams, Professor R Hoffenberg, Ms M Clarke, Ms C Cartwright Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Research and Development Grants Advisory Committee, Commonwealth Department of Human Services and Health, $120,000 Timetable: July 1994 - June 1996 Outline: The study explored preferred options for decision-making in terminal care among palliative and intensive care staff, general practitioners, directors of nursing in nursing homes, other health workers, older people, young people and the general community, with emphasis on knowledge, beliefs and perceived barriers to implementation of such options. The objectives of the study were: (i) to identify and describe current knowledge and opinions of health professionals and community members towards planning for medical care in the end stages of life, through use of a range of options for extending patient self-determination in terminal care (including enduring power of attorney and advance directives, do not resuscitate orders, and euthanasia); (ii) to identify barriers to such planning; areas of uncertainty which produce legal and medical ambiguities for professionals, patients and community members; and policies and protocols which exist in intensive care, palliative care and pain management units in relation to DNR codes, pain-management and patient self-determination; (iii) to use this information to inform professional and public debate in Australia; and to assist policy makers and legislators. A 40-page questionnaire was mailed to 1,300 health professionals (doctors and nurses) and 1,100 community members throughout Queensland. There was a 76% response rate from health professionals and a 53% response rate from the general community. There was strong support from both groups for the use of advance directives to record future treatment wishes and for the appointment of proxies to make health-care decisions for people who can no longer make such decisions themselves. Community members were less confident than health professionals that severe pain can be controlled in terminally ill people. All participants agreed that there is a need for palliative care to be more widely available and for more health professionals to have palliative care training. Community respondents were strongly in favour of changes to the law to allow the options of euthanasia and physician-assisted suicide; nurses were more evenly divided about this and doctors were more likely to say that the law should not be changed. An additional component of the study was an analysis of the responses of Directors of Nursing of all Queensland nursing homes. Keywords: End-of-life decision-making, advance directives, palliative care, euthanasia, physician-assisted suicide Australian Ageing Research Directory 2000 63 Multidisciplinary Ageing Research Units 83 Title: Patient self-determination in terminal care: Phase 2. Designing useful advance directives and proxies Principal researchers: Dr M Steinberg, Ms C Cartwright, Dr M Parker, Professor J Najman Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Research and Development Grants Advisory Committee, Commonwealth Department of Human Services and Health, $ 35,000 Timetable: May 1996 - April 1997 Outline: Studies undertaken by the research team demonstrated strong support from health professionals and community members for use of advance directives and proxy decisionmakers in terminal illness situations. Thirty-six advance directive/living will and/or proxy documents were collected from Australia and other countries. Using the best sections of those documents, material from our own research and paying attention to the relevant literature on why such documents are used or not used, four composite documents were developed. These were distributed to doctors, nurses, lawyers, ethicists, older people, young people and other stakeholders for assessment and comment. Assessment included ratings for simplicity, clarity, length, suitability for medical purposes, suitability for legal purposes and inclusion of appropriate safeguards. Following feedback the documents were refined, condensed to two and focus groups were then conducted with general practitioners, nurses and older people. Final amendments were made. The documents have since become the recommended forms in the Queensland Powers of Attorney Act (1998). Keywords: Advance directives, enduring power of attorney for health care, end-of-life decision-making 84 Title: Percutaneous endoscopic gastrostomy feeding for older people without decisionmaking capacity in Queensland nursing homes Principal researchers: Dr M Steinberg, Ms C Cartwright, Associate Professor G Williams Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Ongoing Funding: Queensland Public Trustee, $10,000 Timetable: September 1999 - June 2000 Outline: All aged-care facilities in Queensland were surveyed to identify policies, guidelines and/or practices relating to the insertion, monitoring and/or withdrawal of percutaneous endoscopic gastrostomies in patients with and without decision-making capacity. In addition, participants were asked what policies/guidelines existed for other life-sustaining medical treatment. 234 nursing homes responded to the survey. The data is currently being analysed but it appears that there are almost no written polices, and few verbal policies in relation to withdrawing or withholding life-sustaining medical treatment. Keywords: Life-sustaining medical treatment, percutaneous endoscopic gastrostomy feeding, advanced dementia, aged-care facilities 64 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 85 Title: Technological change: perceived or actual barriers to the employment of older workers? Implications for training and workplace practices Principal researcher: Dr M Steinberg Co-researchers: Professor J Najman, Professor K Donald Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: Australian Research Council, $101,000 Timetable: January 1997 - August 1998 Outline: Two studies were undertaken. The first study was one of 3,000 members of the community, selected at random from the Queensland electoral roll. The second study involved a survey of 500 Queensland employers selected at random from the Department of Employment Training and Industrial Relations Workplace Health and Safety Register. The studies were undertaken primarily to (i) collect data on the attitudes and practices of employers and community members towards technology and preferred learning modes; (ii) provide data on which interventions could be developed to increase the skills/adaptability with new technology for community members, employees and employers. Results showed highly significant age based differences in the use of everyday communication technologies (eg. PCs, email and Internet) by community members. Similar differences occurred in the use of computer technologies based on socio-economic groups. Significant differences were also found in access to the equipment at home and at work; and in attitudes of the respondents to computer use and preferred learning modes. Results indicated that access to equipment and training in the workplace was a major determinant of computer literacy. These issues are central to the changing nature of work and to policies regarding mature age unemployment and employment. Barriers which needed to be addressed include cost of equipment, access, support and appropriate skill training. Government, business and professional information and service providers need to ensure that older people (and other population groups) are not marginalised through lack of access to communication technologies or the skills to use such technologies. Keywords: Older workers, technological change, employers, ageing, attitudes, practices 86 Title: Technology skills and experience: Implications for the Queensland labour force Principal researcher: Dr M Steinberg Co-researchers: Ms L Walley, Dr D Warner Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Department of Employment Training and Industrial Relations, Queensland Status: Completed Funding: Department of Employment Training and Industrial Relations, Queensland Timetable: January 1999 - March 1999 Outline: This research investigates changing technology and work patterns; the implications of these changes for policy and practice; the provision of technology training and other assistance in technology in the labour market; and considerations for future policy and planning. The project drew on a previous study which examined the use of new technology by Queensland employers and members of the community. Following a literature review and analysis of Queensland labour market data, research was undertaken as to how employers can gain from encouraging employees to acquire and update knowledge and technology skills throughout their working lives. Possible strategies to overcome the problems facing Australian Ageing Research Directory 2000 65 Multidisciplinary Ageing Research Units unemployed Queenslanders (including the long term unemployed) who have no computer literacy were examined. Keywords: Employment, technological change, attitudes, practices 87 Title: The employment of older workers: Policies, programs and practices in Queensland Principal researcher: Dr M Steinberg Co-researchers: Professor J Mangan, Professor J Najman Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Queensland Chamber of Commerce and Industry Status: In progress Funding: Australia Research Council, SPIRT grant,$51,750 Timetable: January 2000 - January 2001 Outline: A collaborative research partnership between the University of Queensland, Queensland Government and Queensland Chamber of Commerce and Industry will investigate the ways in which employers respond to the challenges of an ageing workforce and will examine in detail the management of older workers. It responds to the growing proportions of older Australians in the workforce, who are mature-age (over 45), as well as the proportion of older workers caught in long-term unemployment or early retirement. Following preliminary work (literature review, key informant interviews and focus groups), a three step research plan is proposed: (i) employer survey; (ii) follow up interviews with employers covering policies, practices and economic implications; (iii) case studies of organisations. A key focus will be the economic cost of current attitudes, policies and practices to the employment and retention of older workers. Keywords: Mature age employment, employers, policy implications, older workers, ageing labour force, attitudes and practices 88 Title: The mature age labour force Principal researcher: Dr M Steinberg Co-researchers: Ms L Walley, Dr D Warner Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Department of Employment Training and Industrial Relations, Queensland Status: Completed Funding: Department of Employment Training and Industrial Relations, Queensland Timetable: September 1998 - March 1999 Outline: The purposes of the project were to: (i) provide an overview of changing demographic patterns and the implications of these changes for policy and practice; (ii) examine the position of mature age workers in the labour market; (iii) outline strategies for stimulating employment of mature age workers by providing practical examples of how different organisations have promoted the skills and capacities of their mature age workers; (iv) outline considerations for future policy and planning. The research involved an examination of statistical information derived from the Census of Population and Housing, Australian Bureau of Statistics publications (e.g. labour market surveys) and a literature review. The research covered the following topics: changes in the workplace and workforce participation, mature age (un)employment, costs of mature age unemployment; government labour market programs, public and private sector employment programs; industry and community training and awareness campaigns. 66 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Keywords: Mature age employment, employers, policy implications, older workers, ageing labour force, attitudes and practices 89 Title: Towards a research agenda for the health and well-being of older women Principal researcher: Dr M Steinberg Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland Status: Completed Funding: RADGAC, $4000 Timetable: 1994 Outline: Report of an Australia-wide expert group defining the research needs for strategic research funding, published by Australian Government Printing Service. Keywords: Older women, research, health, well-being 90 Title: Would legalising physician-assisted suicide and euthanasia mean more, or fewer, incidences of these options Principal researchers: Associate Professor G Williams, Dr M Steinberg, Ms C Cartwright, Professor J Najman Co-researcher: Dr G Hartel Organisation: Healthy Ageing Unit, Department of Social and Preventive Medicine, University of Queensland; Australian Centre for International and Tropical Health and Nutrition Status: Ongoing Funding: National Health and Medical Research Council, $200,000 Timetable: January 2000 - December 2001 Outline: Quantitative data from the Healthy Ageing Unit's previous studies found that the general community was supportive of legislation to allow euthanasia/physician-assisted suicide, nurses were divided (although still more in favour) and doctors were more likely not to favour such legislation. However, an analysis of some of the qualitative data indicated that attitudes to euthanasia and physician-assisted suicide are complex and may be driven by beliefs/values which could compromise patient care. This study includes a comprehensive analysis of the qualitative data from the previous studies, plus a detailed analysis of transcripts of key informant interviews and focus groups from this study, specifically targeted at understanding the “attitudes behind the attitudes” to euthanasia and physician-assisted suicide. Key informant interviews and focus groups have been conducted. Themes identified from these interviews/groups (and from the previous studies) have been incorporated into a questionnaire that is being distributed to approximately 1,000 each, doctors, nurses, social workers and general community members. Keywords: End-of-life decision-making, advance directives, palliative care, euthanasia, physician-assisted suicide 1.6 Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University 91 Title: Age discrimination in employment Principal researcher: Dr E Brooke Co-researcher: Ms L Rolland Australian Ageing Research Directory 2000 67 Multidisciplinary Ageing Research Units Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; JobsEast, Area Consultative Committee, Victoria Status: In progress Funding: Victorian, South Australian and Western Australian Equal Opportunity Commissions Timetable: August 1999 - late 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: This project aims to examine the extent and trend of utilisation of age discrimination legislation in employment by older people and barriers to its utilisation. It is being conducted in three states: Victoria, South Australia and Western Australia. The project also aims to identify negative perceptions held of older workers which may be linked with discriminatory workplace practices in recruitment, training, career development and exit policies. Consultations with stakeholders and focus groups with older workers and employers have been held in Victoria, South Australia and Western Australia. The outcomes of the research will lead to recommendations relating to strategies which combat age discrimination in employment. Keywords: Older workers, age discrimination, employment 92 Title: Aged Care Assessment Program costing study: The cost of assessment at service level Principal researcher: Dr F Charlton Co-researcher: Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: April 1998-June 1999 Website: http://aipc.latrobe.edu.au/lgc Outline: Very little information is available about the cost of assessing older people at the individual and agency level. This study gathered data on agency finances and amounts of time expended by all funded staff on the various tasks that either constitute an assessment or the running of an Aged Care Assessment Service. The development of a time log by the study team and the participating Aged Care Assessment Service resulted in a clear definition of the elements of a comprehensive assessment. The data collected from 9 Victorian Aged Care Assessment Services showed, for the first time, how Aged Care Assessment Service staff members distribute their time among tasks, where time is spent, and with whom it is spent. The teams distribute their time to assessment-related activities and agency-running activities in the proportions 72: 28 per cent, almost exactly mirroring the aggregate of Aged Care Assessment Service resource allocation. The financial information indicated how Aged Care Assessment Services allocate their available resources and the factors that influence this allocation. The size of the Aged Care Assessment Service is a major factor determining how resources are allocated with the smaller services generally having to allocate higher proportions of resources for overheads and correspondingly less to direct assessment activities. Estimates of unit costs were made recognising the limitations of the two alternative approaches used. Unit costs varied according to location with the cost of an assessment being higher in non-metropolitan areas. Keywords: Assessment teams, assessment costs, assessment processes 68 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 93 Title: Aged Care Assessment Service activity study Principal researchers: Ms H Russell Co-researchers: Dr Y Wells, Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Commissioned Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: April 2000 - November 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: This study aims to examine the full range of activities being undertaken by Aged Care Assessment Service (ACAS) teams and the variation between teams in the time spent on each activity in order to provide a basis for standardising practice where appropriate. The study will build on earlier work, the Cost of Assessment Study (entry 92), where the development of a time or activity log resulted in a clear definition of the elements of a comprehensive assessment. It is envisaged that the project will take place in two stages: Stage 1 will use focus groups and a survey of Aged Care Assessment Services to investigate the range of assessment practices and non-assessment activities across the different teams. Stage 2 involves the collection of quantitative data on the distribution of staff time in each of the Aged Care Assessment Service teams. More specifically, systematic data will be collected on how, in the different Aged Care Assessment Service teams, staff time is distributed across the range of activity categories defined in Stage 1. The methodology will involve Aged Care Assessment Service staff from all teams completing an activities diary for a one week period. A similar prospective methodology to that used in the 1999 study will be employed. Teamby-team variation in distribution of staff time across activities will be analysed in terms of number of assessments undertaken, team size (for example, in terms of equivalent full-time staffing), and other contextual variables. Minimum data set data will be used to see if client types differ across team and whether these differences are related to differences in time spent on assessment between teams. Keywords: Assessment, assessment processes, assessment costs, program evaluation 94 Title: Aged Care Assessment Service assessment study Principal researcher: Ms H Russell Co-researchers: Ms S Humphries, Dr Y Wells Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Commissioned Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Service Timetable: April 2000 - November 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: In the development of assessment models in the community health sector, it is important to be aware of what Aged Care Assessment Services do to undertake a comprehensive assessment. What do Aged Care Assessment Services do that sets them apart from other assessment services such those delivering HACC comprehensive assessments? Aged Care Assessment Service teams state that their restorative, comprehensive approach makes their assessment process different. Currently there is little evidence to substantiate or Australian Ageing Research Directory 2000 69 Multidisciplinary Ageing Research Units even describe what a comprehensive, multidisciplinary assessment entails. The study therefore aims to examine the elements or processes that make an assessment comprehensive and multidisciplinary and the extent to which a multidisciplinary approach facilitates restorative recommendations or actions for individual clients. The study design being developed includes a literature review, Aged Care Assessment Service consultation and agency survey and data collection related to individual client assessments. Keywords: Assessment, assessment processes, comprehensive assessment, service models 95 Title: Aged Care Assessment Service waiting time study Principal researchers: Dr B Crisp, Ms H Russell, Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Nearing completion Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: April 1999 - May 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: Although measures of how long older people wait for an Aged Care Assessment Service assessment are an important accountability measure for the Aged Care Assessment Program, these need to be better understood and measured on a consistent basis. This study sought to understand firstly, how should timeliness be defined, and secondly, what are the variations in team practice and client circumstances that influence the time that elapses between a referral and the subsequent assessment. A review of waiting time measurement in other services found no single way in which waiting times are reported by public sector agencies in Victoria. In all 18 Victorian Aged Care Assessment Services, assessors completed a one-page survey for each assessment conducted in a two-week period in July 1999. Data collected included client identification number, characteristics of the assessment (location, reason for referral, urgency at time of referral and whether or not this was a reassessment), client characteristics (age, sex, dementia status and cultural background). Information regarding timeliness of the service included the following dates: when the referral was received by the Aged Care Assessment Service, date of the first appointment for a face-to-face visit, and when the actual assessment meeting occurred. Data was also collected on factors which influenced the setting of appointments, and the assessor’s opinion as to the appropriateness of the waiting time. These details were obtained for 1,594 assessments including assessments in hospitals, in the community and in residential care. Keywords: Measurement, waiting times, assessment, performance indicators, program evaluation 96 Title: Aged Care Assessment Teams and general practitioners Principal researcher: Ms E Dickens Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Family Services Timetable: 1996 Website: http://aipc.latrobe.edu.au/lgc 70 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Outline: The interaction between Aged Care Assessment Team members and general practitioners is a key element of the process of assessment and care planning for older people who require formal support services or residential care. A cooperative working relationship between Aged Care Assessment Teams and general practitioners is most likely to achieve the best possible assessment outcomes for clients, leading to service provision that meets individual needs. This project, carried out in two stages, aimed to investigate the current state of Aged Care Assessment Team/general practitioner interactions and to produce evaluation options to promote better practice models of care. The methodology for the study involved interviews with all Victorian Aged Care Assessment Teams and some general practitioners about the nature of their relationship, the effectiveness of their current practices and their level of satisfaction with the services. A review of policy statements from the Council of Australian Governments, directions from the Commonwealth Guidelines for Aged Care Assessment Team services and recommendations from the 1995 review of Aged Care Assessment Team services in Victoria was conducted and other relevant research projects examined. A literature review also informed the suggestions for further research and strategies for change that were identified by this project. Strategies for improved practice included Aged Care Assessment Teams adopting strategies to explore the strengths and weaknesses of their current relationships with general practitioners, such as holding discussion groups with stakeholder groups, focus groups and individual interviews, and surveys. Secondly, interventions to improve interactions between Aged Care Assessment Teams and general practitioners could be designed and implemented, including formal reporting procedures, organised meetings and structured training packages, appointment of liaison personnel, and distribution of publicity material. Keywords: Assessment, assessment and general practitioners, general practitioners 97 Title: Assessment of older people: A review of recent international literature Principal researchers: Ms A Butler, Ms N Otis Co-researchers: Ms S Davidson, Ms E Dickens, Ms S Humphries, Ms H Russell Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: July 1997 - December 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: The Lincoln Gerontology Centre has been involved in monitoring and evaluating the Aged Care Assessment Program since its pilot phase in 1983/1984. This literature review was carried out in order to reflect on the Australian experience of assessment to date within a broader international context, with a view to encouraging an informed debate about the future role of assessment in Australia. The literature review covers five main areas: an international policy perspective, definitions, purposes and domains of assessment; the organisation of assessment; practice issues; clients in the assessment process. The summary and concluding chapter draws out three main themes: the tension between clinical/medical and social approaches to assessment; the difficulties of reconciling two of the main purposes of assessment, needs identification and resource allocation; and the debate about the extent to which assessment services should be independent of, or integrated with other services. Gaps in the literature are also identified. Keywords: Assessment, multidisciplinary assessment, literature review, older people, aged care system, client rights Australian Ageing Research Directory 2000 71 Multidisciplinary Ageing Research Units 98 Title: Better planning for resource allocation: Linkages services Principal researchers: Ms A Reynolds, Professor H Kendig Co-researchers: Dr F Charlton, Ms M Puckridge, Ms M Turner, Dr Y Wells Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Aged, Community and Mental Health Branch, Department of Human Services, Victoria Timetable: 1996 Website: http://aipc.latrobe.edu.au/lgc Outline: This study provided information on allocating resources for Linkages or Community Options projects in order to best meet the priority needs of people with more complex needs who live at home. A specialised case management service model was developed, with parameters for decision-making about the size and scope of Linkages (and other case management) services, as follows: (i) wherever possible, Linkages services should be provided in an integrated way with a range of other case management services; (ii) Linkages services (in combination with other case management services) should be large enough to employ skilled case managers, provide 24 hour coverage, develop effective administrative and financial systems, maximise financial purchasing resources, have close working relationships with other local service networks, and be able to negotiate effectively with other service providers and act as a strong and independent advocate for clients; (iii) size of case management services should ideally be no less than around 100 places. The key judgment for deciding on the appropriate scale and scope of services should always be made on the basis of achieving the best outcomes for consumers in the most cost-effective way. Flexibility in approach will always be needed to take into account the special circumstances of service provision in isolated rural areas, and the specific needs of particular target groups. Keywords: Resource allocation, community care, case management, complex needs 99 Title: Client rights: Experience of Aged Care Assessment Service practitioners Principal researcher: Ms S Kronk Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Family Services; Victorian Department of Human Services Timetable: March 1996 - October 1996 Website: http://aipc.latrobe.edu.au/lgc Outline: This study used data from in-depth interviews with Victorian Aged Care Assessment Service staff to investigate how practitioners were applying clients rights policies, and to explore methods used by Aged Care Assessment Service workers in attending to the rights of clients and others during the assessment process. Analysis of the interview data indicated that Aged Care Assessment Service staff approach the issue of rights from a more holistic, systems perspective than that laid down in the official Guidelines for Assessment Services. The right to self-determination was clearly described and understood by interviewees. Other important themes which emerged from the interviews were the complex, multi-faceted nature of many assessments; the difficulty in some cases of ensuring informed consent; the need at times to 72 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units balance the client’s right to self-determination with the practitioner’s duty of care; and the obstacles to client rights created by limited resource availability. Keywords: Client rights, informed consent, assessment 100 Title: Community care for older people with complex needs Principal researcher: Ms A Reynolds Co-researchers: Professor H Kendig, Ms E Dickens Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Special Initiatives Funding, Aged Care Services, Department of Human Services, Victoria Timetable: 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: This project aimed to provide a strategic review of the responsiveness of community care services to the complex needs of older people. The primary information source was extensive consultation with practitioners who are already leading innovative service approaches. The project drew heavily on the experience of Linkages and Community Aged Care Package projects, special aged care initiatives, and expert parts of mainstream services. Many of the issues concern joint effort and coordination across services. Effective services were found to begin with a focus on the needs, preferences and circumstances of each individual, and recognise that complexity for clients extends beyond physical limitations to also include medical and health complications, cognitive and behavioural problems, and social or emotional vulnerabilities such as social isolation. Service delivery which is effective for older people with complex needs can be implemented through a variety of organisations, and requires practice expertise, adequate resources, and cooperative service cultures. The support available through local service systems depends heavily on program management in setting directions and objectives for services, providing financial incentives, and monitoring quality. Keywords: Complex care, aged care, care coordination, care needs 101 Title: Enhancing employment opportunities for older workers Principal researchers: Dr E Brooke, Dr C Peterson, Associate Professor P Foreman Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; School of Public Health, La Trobe University; JobsEast; Victorian Equal Opportunity Commission Status: In progress Funding: Strategic Partnerships with Industry - Research and Training Scheme; JobsEast Timetable: January 2000 - 2003 Website: http://aipc.latrobe.edu.au/lgc Outline: This project aims to enhance employment opportunities for older workers aged 45 and over through implementing a demonstration project in organisations over three years. The project will implement and research innovative practices in recruitment, retention, training and exit policies. It will also examine barriers to their adoption such as age stereotypes. The demonstration project is to be conducted in four sites (which may be later extended). It will utilise both qualitative and quantitative methodology. The primary methodological approach to be employed is case study methodology. In the first year, several large data sets on older workers will be analysed and case study findings from international literature will be Australian Ageing Research Directory 2000 73 Multidisciplinary Ageing Research Units reviewed. Research instruments will be designed and qualitative and quantitative data collection commenced. The longitudinal research design over three years will be used to measure changes in practice and also to refine interventions in workplace practices. Keywords: Older workers, age discrimination 102 Title: Evaluation of ‘General Practice Integration in Linkages Case Management’ Project Principal researcher: Ms E Dickens Co-researchers: Dr F Charlton, Ms M Turner, Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Central Bayside Division of General Practice Timetable: 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: This was an independent evaluation of a project set up by the Central Bayside Division of General Practice to improve communication between General Practitioners and Linkages Case Managers in two Linkages programs in the Southern Melbourne Metropolitan Region. Findings suggested that the project did enhance general practitioner knowledge and understanding of case management, that it facilitated communication between General Practitioners and other community service providers and increased understanding between Case Managers and General Practitioners of each others’ roles in the care of people with high care needs who live in the community. The project highlighted some barriers to improving communication and cooperation between General Practitioners and Linkages Case Managers but also demonstrated some positive gains in the advancement of the principles of integrated health and community services to the target population. Keywords: Coordinated care, case management, integrated health services, general practitioner case management, general practitioner communication 103 Title: Evaluation of the Aged Care Assessment Program Principal researcher: Ms H Russell Co-researchers: Dr F Charlton, Dr Y Wells, Ms S Humphries, Ms J Collier Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Current Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: Ongoing Website: http://aipc.latrobe.edu.au/lgc Outline: The Lincoln Gerontology Centre is the designated state evaluation unit for Victoria for the Commonwealth/State Aged Care Assessment Program. The project involves collaboration with all 18 Aged Care Assessment Services across the state who routinely provide a standard minimum data set for each assessment conducted in a six month period. Approximately 25,000 assessments of older people are carried out in each period, with the minimum data set recording indicators of client status at assessment, socio-demographic factors, client flows through the Aged Care Assessment Services, and outcomes of the assessment process in terms of service recommendations. Each Service also provides a 74 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Narrative Report documenting contextual and process issues relating to the operation of that Service and impacts on assessment. A substantial report is prepared every six months for distribution to the Commonwealth and State and to individual Aged Care Assessment Services, to assist in service planning and development. The report uses a framework which examines the context, process, inputs and outcomes of Aged Care Assessment Service operations based on responses to minimum data set items and the Narrative Reports, on an aggregate basis. Team-by-team variations are examined, with individual team data being identified in a set of standard minimum data set tables. The data has shown a rapid expansion of the Aged Care Assessment Program since its inception and that the program does contribute to a shift in the balance of care between community-based and residential care. The data also monitors the timeliness of service delivery and special needs groups’ access to the program. While there has been a gradual ageing of the clientele over the life of the program, other socio-demographic and health status characteristics of the client group have remained fairly stable. Cross-tabulations of minimum data set variables are carried out to distinguish the characteristics of different groups of clients. This has shown, for example, that clients recommended for nursing home or high level care differ from hostel-recommended or low care clients in terms of socio-demographic characteristics (such as age and marital status), disability levels and living arrangements at assessment. In addition to regular minimum data set analysis, the evaluation project undertakes follow-up studies of particular client groups to examine outcomes beyond the limits of the minimum data set recommendation or to explore questions of interest to the Commonwealth and State. These projects are described individually. Keywords: Assessment, program evaluation, population characteristics, nursing homes, hostels, community care 104 Title: Evaluation of the Aged Care Assessment Program, National Minimum Data Set report Principal researcher: Dr F Charlton Organisations: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; NSW Evaluation Unit; Queensland Evaluation Unit; Data Management Unit SA; Aged Care Research and Evaluation Unit WA; Tasmanian Evaluation Unit; Business Information Management NT Funding: Commonwealth Department of Health and Aged Care Timetable: Ongoing Website: http://aipc.latrobe.edu.au/lgc Outline: The Aged Care Asssessment Program has been subject to ongoing evaluation on a state-by-state basis since its inception in 1984, under the program’s structure of individual state evaluation units. However, with the introduction of a uniform National Minimum Data Set in 1994, data is now aggreggated and analysed at a national level. Through a network of 121 multidisciplinary teams nationally, the program provides national coverage with an aim of ensuring that “frail older people gain access to available care services appropriate to their needs, and (improving) coordination of aged care services with other health and community services”. The national evaluation allows comparisons between states, and over time, with data being reported annually rather than six-monthly. The reports produced for the Commonwealth, States and state evalaution units include data on assessment rates, client characteristics, access for special needs groups and long-term care recommendations for a variety of residential care and community-based service options. Keywords: Assessment teams, program evaluation, population characteristics, nursing homes, hostels, community care Australian Ageing Research Directory 2000 75 Multidisciplinary Ageing Research Units 105 Title: Evaluation of the Department of Veterans Affairs HomeFront program Principal researcher: Associate Professor P Foreman Co-researcher: Mr I Gardner Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: In progress Funding: Department of Veterans Affairs Timetable: August 1999 - March 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: The HomeFront Program, which began in January 1999, is a national, preventative program aimed at reducing falls and accidents in the homes of veterans and war widows, and increasing the awareness and use of community support services among veterans and war widows. The study consists of a process evaluation of the implementation of HomeFront over its first year, and an impact evaluation of the effect on the incidence of falls and accidents, the use of community services among veterans and war widows, and the implications for the health and residential care costs to the Commonwealth. Keywords: Veterans, war widows, falls prevention, evaluation, community services, costs 106 Title: Evaluation of the Kingston Domiciliary Rehabilitation Program Principal researchers: Ms A Butler, Dr F Charlton Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Southern Health Care Network Timetable: April 1997 - April 1998 Website: http://aipc.latrobe.edu.au/lgc Outline: The Kingston Domiciliary Rehabilitation Program has been in operation since the beginning of 1996. It aims to provide older people who are patients within the Southern Health Care Network with an alternative to inpatient rehabilitation. The program encompasses four rehabilitation streams: orthopaedic, neurological, psychiatric, and other medical conditions. Services provided include case management, physiotherapy, occupational therapy, speech therapy, personal care and home nursing. The evaluation of the program encompasses a variety of methodologies and includes a literature review; a description analysis of the characteristics and outcome of all clients of the program for the period July 1996 to June 1997; a cost-effectiveness study comparing 250 clients of the program with a matched group of inpatient rehabilitation clients; a client and carer follow-up survey; and a qualitative analysis of the impact of the program on other stakeholders, including program staff, inpatient staff who refer clients to the program, outside agencies contracted to provide services, and agencies to which the program refers clients on discharge. Keywords: Rehabilitation, community care, community rehabilitation, program evaluation, geriatric medicine 107 Title: Evaluation of the Victorian Home Oxygen and Respiratory Support Group Principal researchers: Dr F Charlton, Ms H Russell Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University 76 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Status: Completed Funding: Commonwealth Department of Health and Family Services; Victorian Department of Human Services Timetable: 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: The prime tasks of this evaluation was to establish the cost effectiveness of the Victorian Home Oxygen and Respiratory Support Group as an example of a community-based primary model of support. The elements included in the evaluation framework were a description of the context in which the program operates, identification of the processes used for achieving the aims it the program, a description of both client and resource inputs to the program and the impact of those inputs, and the outcomes of the program. Detailed recommendations were made related to auspicing by Community Health Centres, the importance of professional involvement in self-help groups, access to allied health, and training for general practitioners. Recommendations were also made about transport needs, carer needs, access to computer facilities, adressing isolation and depression, training in group management and leadership, and planning a network of support groups. Keywords: Support groups, self-help, cost-effectiveness, chronic illness, respiratory illness, program evaluation 108 Title: Facilitating family involvement in a residential care setting Principal researchers: Ms H Russell, Associate Professor P Foreman Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Nearing completion Funding: Victorian Department of Human Services Timetable: May 1999 - April 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: The study was based on the recognition that ongoing caring relationships between family members and residents in residential care facilities are extremely important to residents’ quality of care and quality of life. The overall objective of the study was to examine ways in which these relationships can be maintained once an older person moves into residential care. The long-term aim of the study was to facilitate and enhance family participation in a residential care setting through changes to organisational policies and procedures. The study was undertaken in a 90 bed residential facility in Bundoora, a northern suburb of Melbourne. Specific study aims were (i) to identify the range and type of participation and involvement by families in the lives of older residents in an aged care unit; (ii) to understand the perceptions of family, staff, residents and management in relation to the role of the family in an aged care setting and to identify similarities and differences between the two groups in their perceptions; (iii) to identify the factors that facilitate or inhibit family participation in a residential care setting, and to identify ways in which family participation in a residential care setting can be enhanced; (iv) to develop a strategic plan for the care provider which identifies the key issues, objectives and specific strategies for enhancing family involvement. The methodology involved three key stages. Firstly, separate focus groups with each stakeholder group, families, staff management and residents. In the second, a survey of all families involved with the facility was conducted regarding current level of visiting, activities during visits and satisfaction with visiting. In the final stage, a strategic plan for family participation will be developed. Data from the focus groups indicate a common understanding of families’ experience of visiting. For example, staff demonstrated a sensitivity and awareness of the emotional turmoil associated with visiting, families’ need for Australian Ageing Research Directory 2000 77 Multidisciplinary Ageing Research Units support in the early period, for help in finding the right level of visiting and in facing the decline in their relatives’ condition. Reciprocal needs were also demonstrated between staff and families. Staff commented on the presence of families’ providing a more ‘normal’ and homely work environment. Families commented on conversation and communication with staff being the measure of a good visit. Unfamiliar staff, unfriendly staff were barriers to visiting. Results from the survey showed a high level of visiting by families and friends. Incorporating the focus group data, many areas were identified where there was a need for organisational change in order to provide increased support, communication and information to families. Family concerns were categorised into four areas and became the basis for the strategic plan: (i) communication: how can staff and families have better communication and better relationships; (ii) achieving the best quality of care and quality of life for residents; (iii) family/carer suport and encouragement; (iv) education and information. Keywords: Caregiving partnerships, residential aged care, family participation in care, carer stress, nursing home placement, quality improvement 109 Title: Follow-up of Aged Care Assessment Service recommendations for community care: A pilot study Principal researcher: Ms H Russell Co-researcher: Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: March 1998 - July 1999 Website: http://aipc.latrobe.edu.au/lgc Outline: Half of all clients assessed by Victorian Aged Care Assessment Services are recommended to remain living in the community. Previous studies aimed at better understanding this group of clients’ subsequent use of community services have been limited by methodological difficulties. This study aimed therefore to test a methodology, as well as investigating community service use, including the factors influencing the take-up of recommended services, and the waiting time for services. Previous service use and assessment recommendations were recorded for 30 consecutive community-recommended clients in four Victorian Aged Care Assessment Services. A staff member other than the original assessor followed each client at three weekly intervals for three months to determine the outcomes of the service recommendations. Some 35 different service types were recorded, with each client, on average having 5.4 services already in use and newly recommended. The most common recommendations were for restorative-type services such as rehabilitation, home aids and modifications, allied health and specialist medical and psychogeriatric assessment and treatment services. Respite, intensive care packages and personal alarms were also among the most frequently recommended services. Thirty-one per cent of services were in place or the intervention completed by three weeks, increasing to 44 per cent by 12 weeks. By 12 weeks 19 per cent of services had not been taken up for discretionary reasons (refused service, managing without or still considering). Keywords: Community services, assessment, community care 78 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 110 Title: Health and behavioural change in later life Principal researchers: Professor H Kendig, Dr C Browning, Ms D Osborne Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; Faculty of Health Sciences, University of Sydney; School of Public Health, La Trobe University Status: Ongoing Funding: Australian Research Council Small Grant, $38,000 (1994-1996) Timetable: January 1994 - December 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: This study examines the impact of life-long lifestyles on specific health-related behaviours in old age. The behaviours include physical activity, social activity, eating patterns, smoking, alcohol consumption, sleep patterns, visits to the doctor and use of medications. In 1994 a self-completion survey was conducted of 900 people from the Health Status of Older People Project (entry 113). The sample has been followed annually from 1994 and data on these variables is now being collected as part of the Health, Behaviours and Outcomes in Older People project (entry 112), a continuation of the Health Status of Older People project. The sample has shown a great deal of stability in health behaviours across the life-span. Many of the sample, however, have quit smoking and reduced levels of energetic activity. Keywords: Healthy ageing, older people, health-related behaviours, health attitudes 111 Title: Health and well-being impacts of retirement: A longitudinal study Principal Researchers: Associate Professor D de Vaus, Professor H Kendig, Dr Y Wells Co-researcher: Mr W Petralia Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; Faculty of Health Sciences, University of Sydney Status: In progress Funding: Victorian Health Promotion Foundation, $225,000 Timetable: January, 2000 - December 2002 Website: http://aipc.latrobe.edu.au/lgc Outline: The Health and Well-being Impacts of Retirement Study builds on the Healthy Retirement Project (entry 115), by examining the short-to-medium term outcomes of retirement. Since initial responses to such a major life transition as retirement may not persist, it is critical that our understanding extends beyond the initial phase. Rather than treating retirement as a single event, or as a uniform process affecting only the retiree, this prospective study will examine different types of retirees and retirement, stages of the retirement transition, and patterns of continuity and change. It will extend the understanding of the gender and employment diversity of retirement transitions, particularly the impacts of health, health behaviours, and family relationships in shaping a healthy retirement. The Health and Well-being Impacts of Retirement Study will provide practical input into intervention strategies designed to promote healthy retirement. It will evaluate the relative importance of personal, situational, and structural factors in shaping healthy outcomes. The study will inform health promotion strategies and the appropriateness of health education approaches relative to approaches that focus on situational and structural reform. The Healthy Retirement Project contacted 550 retirees twice before retirement and again soon after retirement. The new study will follow up the same individuals (and their spouses/partners) two and three years after retirement. Using the Healthy Retirement Project is a cost-effective means of providing access to a unique, diverse, difficult-to-recruit sample. This sample includes both women and Australian Ageing Research Directory 2000 79 Multidisciplinary Ageing Research Units men, part time and full time employees, blue and white collar workers, and employees from a wide range of industry sectors; both the retiree and his/her spouse or partner; and both voluntary retirees and people who have been made redundant. Since extensive pre-retirement and early-retirement data are available from the Healthy Retirement Project, excellent information about short and medium term outcomes will be available. Keywords: Retirement, health behaviours, adjustment, ageing, longitudinal studies, well-being 112 Title: Health, behaviours and outcomes in older people: A longitudinal study Principal researchers: Professor H Kendig, Dr C Browning, Professor B Lundgren-Lindquist, Professor M Morris, Ms D. Osborne Co-researcher: Dr Y Wells Organisations: Faculty of Health Sciences, La Trobe University; Schools of Public Health, Occupational Therapy, and Physiotherapy, La Trobe University; Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; Faculty of Health Sciences, University of Sydney Status: Ongoing Funding: National Health and Medical Research Council Project grant, $177,064 Timetable: January 1998 - December 2000 Website: http://sph.latrobe.edu.au Outline: The Health, Behaviours and Outcomes in Older People study is a continuation of the Health Status of Older People Project (entry 113). The baseline sample for this project was 1,000 people aged 65 and over living in the community in Melbourne, Australia in 1994. The two projects together provide a seven-year longitudinal sequence of data pertaining to the health and well being of older people living in the community. This study examines the influences of key health behaviours, and psychosocial and socio-economic factors on quality of life, functional capacities, use of health, community and residential services and survival in older people. This data will be used to inform healthy ageing policy and the design of programs to enhance health, independence and well being in older people. The strength of the study is its longitudinal design that allows an examination of the determinants and consequences of changes in the key variables. The data collection follows respondents as they move through the critical seventies age range where incidence of disability increases significantly. The findings presented to date include determinants of physical and social activity, health and well-being of caregivers, impacts of disability on well-being, health actions and social class, vision and functional capacities in older people, gender differences in depression, spirituality and health promotion, predictors of falls, the effect of urinary incontinence on quality of life and activity, health promoting actions of older people, use of community services by older people and chronic pain in older people. Keywords: Healthy ageing, older people, health-related behaviours, life transitions, psychological well-being, activity limitations 113 Title: Health status of older people project Principal researchers: Professor H Kendig, Professor R D Helme Co-researchers: Dr C Browning, Professor L Flicker, Ms K Teshuva Organisations: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; National Ageing Research Institute, University of Melbourne; School of Public Health, La Trobe University; Department of Medicine, University of Western Australia Status: Completed 80 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Funding: Victorian Health Promotion Foundation, $532,743 Timetable: January 1994 - December 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: The baseline sample for this project was 1,000 people aged 65 and over living in the community in Melbourne, Australia in 1994. The Health, Behaviours and Outcomes in Older People: A Longitudinal Study (entry 112) is a continuation of this project. This study examined the health status of older people living in the community. The broad findings are that older people in the community live relatively healthy lives and adapt to disability and life transitions. Published articles include health promotion and older people, the health of caregivers, sexuality in old age, the impact of disability on wellbeing and pain in older people. A number of research students have worked on the project on topics including social isolation in older men, predictors of changes in social activity, self-rated health, and service use. Keywords: Healthy ageing, older people, health status, health promotion 114 Title: Healthy retirement for Italians in Australia Principal researchers: Dr Y Wells, Mr W Petralia Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: In progress Funding: ARC Small Grants, $12,000 Timetable: January 2000 - October 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: The Healthy Retirement for Italians in Australia project is a unique study which will examine older Italian workers’ beliefs about retirement, and extent of retirement planning. Retirement is a major transition with the potential to impact on people’s health and well-being throughout the rest of their lives. Older migrants to Australia may have special needs as they approach the retirement transition. The Healthy Retirement for Italians in Australia Project will use the Italian language to gather information using qualitative and quantitative methodologies. The project will comprise two stages - focus groups and a cross-sectional survey. Recruitment will make use of the researchers' extensive contacts within the Italian community and will include advertisements, visits to Italian clubs and organisations, and contacts with industries which employ large proportions of older Italian men and women (for example, in businesses located in suburbs where large proportions of Italians live and work). Focus groups will provide qualitative information on Italian peoples’ experiences in approaching and adjusting to departure from full-time labour force. Results of the focus groups will inform development of the surveys and suggest approaches and content for interventions. There will be approximately 24 participants for this stage of the research. The cross-sectional survey will examine preparation (financial, mental, and social) for workforce departure; receptivity to ceasing work; involvement with family, leisure activities; health and health behaviours; and specific Italian cultural and linguistic factors. There will be approximately 100 participants for this stage of the research. The self-completion questionnaire used by the Healthy Retirement Project (entry 115) will be adopted, with additional questions that identify Italian cultural and linguistic factors. This self-completion questionnaire will be back-translated to ensure that there are no ambiguities in the translation. Analyses will examine (a) predictors of the major outcomes for the Italian sample. The literature indicates that likely predictors of retirement optimism, pessimism and planning in the pre-retirement population include: age, gender, level of education, occupation, job involvement, job status and ethic, income, health, leisure involvement, and company policies towards retirement, (b) differences between the Italian migrant sample (from Healthy Australian Ageing Research Directory 2000 81 Multidisciplinary Ageing Research Units Retirement for Italians in Australia project) and participants of the Healthy Retirement Project on the major outcomes and other indicators such as self-rated happiness, work ethic, work satisfaction, and level of boredom outside work hours, and (c) information on the degree that cultural and linguistic factors add to the predictions over and above significant factors for the Australian-born population. Such factors include: recency of arrival, English proficiency, proportion of family in Australia, socio-economic status compared with expectations prior to migration, satisfaction with life in Australia, and access to community services. Keywords: Italian, retirement, health, culture, language, qualitative, survey, cross-cultural 115 Title: Healthy retirement project Principal researchers: Associate Professor D de Vaus, Professor H Kendig, Dr Y Wells Co-researchers: Associate Professor S Quine, Mr W Petralia Organisations: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; Faculty of Health Sciences, University of Sydney; Council on the Ageing (Victoria) Status: Nearing completion Funding: Victorian Health Promotion Foundation, $373,000 Timetable: July 1997 - June 2000 Website: http://aipc.latrobe.edu.au/lgc Outline: The Healthy Retirement Project has three primary aims: (i) to identify the extent to which workers aged 50 years and over are prepared for retirement; (ii) to identify changes of health, health behaviours, and well-being during the retirement transition; and (iii) to identify factors associated with relatively more or less success in making these preparations and adjustments. Continuity theory is being applied to better understand how health-related activities and life satisfaction are influenced by personal resources as well as workplaces and social environments. Attention focuses on ways in which preparation and outcomes vary between workers in terms of gender, occupational status, and circumstances of retirement (forced, voluntary, health, income). Focus groups (Stage 1) identified experiences and key issues of people who had recently left the work force, or who were about to leave full-time paid work. While most participants had adjusted well to retirement, a minority still expressed strong feelings of grief and loss several years afterwards. A major factor in adjustment was whether their retirement was voluntary or forced. White-collar retirees were more concerned about financial issues than blue-collar retirees. Analyses are continuing, including the influence of gender and occupational status on retirement adjustment. A large cross-sectional survey (N=7,000; Stage 2) examined job satisfaction, retirement planning, and retirement expectations among employees aged 50 years and over. The sample includes men and women, blue and white-collar workers, and full-time and part-time employees across a broad range of sectors. Anxiety about retirement was greater among workers who were in older age brackets, without partners, and with low occupational status. Analyses are continuing. To identify the consequences of leaving the full-time paid workforce, a stratified sample (N=550; Stage 3) was surveyed on leaving the labour force and again six and twelve months afterwards; partners are also being recruited to the Project. The focus of this stage of the research is changes in health behaviours and well-being over the retirement transition. Data collection is ongoing for this stage of the Project. Preliminary findings have been distributed widely to employers and the public and applied by Council on the Ageing (Victoria) to develop programs for people leaving the full-time, paid workforce. Programs will be offered to industry partners. Keywords: Retirement, work satisfaction, retirement planning, expectations, job status, health behaviours, ageing, longitudinal studies 82 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 116 Title: Hostel or home? A study of Victorian Aged Care Assessment Team recommendations of hostel care plans Principal researchers: Dr F Charlton, Ms H Russell Co-researcher: Ms S Humphries Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, Latrobe University Status: Completed Funding: Commonwealth Department of Health and Family Services; Victorian Department of Human Services Timetable: 1995 - 1996 Website: http://aipc.latrobe.edu.au/lgc Outline: This two year study examined the factors that influence Aged Care Assessment Services to recommend that an older person enter a hostel rather than continuing to live in the community with additional services. The study took a grounded theory approach, exploring the issues firstly through open-ended field interviews with Aged Care Assessment Service workers, older people and hostel supervisors, followed by a sample survey of 532 Victorian Aged Care Assessment Service clients who were all assessed as being at hostel level of care in late 1995. Among the factors which were significantly more likely to predict a hostel recommendation than a recommendation to remain in the community were a number of psychosocial factors, in particular loss of motivation to continue living at home; having had an acute hospital episode; needing help with meals and housekeeping; family/carer issues, including family anxiety about their relative’s situation and inadequate informal support; and a history of not using community services prior to assessment. Regression analysis demonstrated the overall strength of the factor ‘loss of motivation’ in predicting a hostel care plan. Keywords: Assessment teams, hostels, community care, care planning 117 Title: Improving social networks study Principal researcher: Professor H Kendig Co-researchers: Mr I Gardner, Dr E Brooke, Ms E Ozanne Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Funding: Department of Veterans’ Affairs, $100,000 Status: Completed Timetable: 1996 - August 1998 Website: http://aipc.latrobe.edu.au/lgc Outline: The Australian Department of Veterans’ Affairs established the Improving Social Networks project within its mandate of promoting the health and well-being of veterans, carers and war widows. The Improving Social Networks initiative aims to enhance social networks and overcome social isolation among vulnerable people in the veteran community. International research literature documents the close inter-relationship between social participation, health and well-being. This study was commissioned to provide national research-based knowledge for developing effective interventions to ameliorate social isolation. It investigated veterans’ perceptions of their social activities and relationships, existing interventions and future strategies for action. Veteran sub-groups included World War II veterans and their carers, war widows and younger veterans, mainly Vietnam and Korean veterans. The research consisted of a quantitative component, based on a 1996 survey (n=1,607) and a qualitative component, consisting of in-depth interviews with veterans and Australian Ageing Research Directory 2000 83 Multidisciplinary Ageing Research Units focus groups with Ex-Service Organisations and service providers. Risk factors for social isolation were identified from the quantitative data for each of the sub-groups. These pathways to social isolation were confirmed by the in-depth interviews using a life history approach which explored veterans’ perspectives of their social relationships. Intervention strategies aimed at enhancing well-being through overcoming social isolation were recommended in four main areas: information, social support, health and transport. Keywords: Veterans, war widows, social networks, well-being 118 Title: Issues for the ethnic aged in Victoria: An overview Principal researcher: Ms H Russell Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Family Services; Victorian Department of Human Services Timetable: 1995 - 1996 Website: http://aipc.latrobe.edu.au/lgc Outline: During 1995/1996, three Victorian Aged Care Assessment Services received funding from the Commonwealth Department of Health and Family Services for pilot projects to explore ways of working more effectively with older people from non-English speaking backgrounds. The Lincoln Gerontology Centre supported the objectives of the project by developing a background paper reviewing available information on the needs and characteristics of the ethnic aged in Victoria. The paper also provides an overview of current issues in relation to aged care services for older Victorians born in non-English speaking countries and identifies key issues which need to be addressed by Aged Care Assessment Services and other service providers in order to best meet the needs of this important client group. Ethnic older people are clearly identified as having special needs compared to their Australian-born counterparts in communication, isolation, carer burden and mental health. The paper also demonstrates that there are wide variations between birthplace communities on most social and health characteristic measures, suggesting that any description of a group of people labelled as non-English speaking background must be interpreted cautiously. Keywords: Ethnic aged, aged care services, care needs 119 Title: National framework for comprehensive assessment in the HACC program Principal researchers: Dr F Charlton, Ms H Russell, Ms A Reynolds Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Aged Care Timetable: 1998 Website: http://aipc.latrobe.edu.au/lgc Outline: The need for a changed approach to assessment in the Health and Community Care (HACC) program was identified in two major reviews of the HACC program: Home But Not Alone (House of Representatives Standing Committee on Community Affairs, 1994); and Efficiency and Effectiveness Review of the Home and Community Care Program (Department of Health, Housing and Community Services, 1995). The National Framework for Comprehensive Assessment in HACC was developed using a process of national 84 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units consultations in each State and Territory with representatives of the major stakeholder groups: HACC officials, service providers and consumers groups. The framework describes a consumer-focused approach to assessment for people with complex, multiple or higher needs which is more comprehensive in scope than a service specific assessment. Keywords: Assessment, community care 120 Title: Nursing home follow-up study Principal researcher: Ms A Butler Co-researchers: Ms S Humphries, Ms M Puckridge, Ms M Turner Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Family Services; Victorian Department of Human Services Timetable: July 1996 - October 1997 Website: http://aipc.latrobe.edu.au/lgc Outline: This study investigated the length of time clients of Aged Care Assessment Services wait to enter nursing homes and factors influencing this time, where clients wait and the extent to which placement in a home of the client’s choice is achieved. Rates of cancellation and death while waiting were also examined. For a sub-sample of clients, information on reasons for waiting was obtained. While tracking of clients continued for one year, just over half (55.5 per cent) of the total study clientele were placed by 30 days after a nursing home recommendation was made. By six months, 97 per cent had entered. Some 20 per cent of nursing home applicants were not placed in a nursing home of their choice. The main factors influencing shorter waiting times appeared to be non-metropolitan locations, hospital assessments, and being aged over 80 years, while clients from non-English-speaking backgrounds waited longer. Keywords: Nursing homes, waiting times, residential care 121 Title: Promoting positive attitudes to ageing by health care service providers Principal researchers: Associate Professor Peter Foreman, Dr Y Wells, Mr W Petralia, Professor E Hamilton-Smith Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: In progress Funding: Victorian Department of Human Services Timetable: April 2000 - September 2000 Website: http://aipc.latrobe.edu.au.lgc Outline: This project is designed to explore how positive attitudes to ageing can best be promoted among health and welfare personnel who provide services to older Victorians. The major aims of the project are: (i) to examine current attitudes towards ageing within different groups of health and aged care service providers; (ii) to analyse how practices within health and aged care settings may reflect specific attitudes about older people, and (iii) to identify effective strategies and approaches than can promote more positive attitudes towards older people among service providers. It is envisaged that the project will shed light on the attitudes and practices of health and aged care providers with regard to older clients and provide a firm empirical foundation for the development of effective approaches to promote more positive Australian Ageing Research Directory 2000 85 Multidisciplinary Ageing Research Units attitudes among these service personnel. The project will use a range of information collection strategies including a comprehensive review of local and international writing and research; intensive consultations with older people and provider representatives; direct observation of interactions in residential settings, and systematic survey of samples of health and aged care service providers using Australian-developed questionnaires. Keywords: Health promotion, attitudes, older people, service providers, health professionals, aged care 122 Title: Residential respite care: An Aged Care Assessment Services perspective Principal researcher: Ms E Dickens Co-researcher: Ms N Otis Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Commonwealth Department of Health and Aged Care; Victorian Department of Human Services Timetable: March 1998 - October 1998 Website: http://aipc.latrobe.edu.au.lgc Outline: Respite has long been identified as a means of enabling carers to gain the 'breathing space' necessary for them to continue in their caring role. In recent years, policy makers have given increasing recognition to the role of respite care in maintaining the long-term viability of frail elderly in the community. This has been evident in growing resource allocations to both community-based and residential respite services, in increased usage and in the trialing of innovative models of delivery. This study provides a "snapshot" picture of the Victorian Residential Respite program from the Aged Care Assessment Service perspective. Aged Care Assessment Services form a unique interface between the health and community care systems guided by rules and the diverse needs of the individual. The specific aims of the study were to explore the Aged Care Assessment Services perceptions and understandings of respite care, to investigate the reasons for Aged Care Assessment Services recommendations for respite, to examine the uses of respite care and to identify barriers to the use of respite care. The study employed focus groups composed of selected Aged Care Assessment Service members from across Victoria. These interviews confirmed that Aged Care Assessment Services practices reflect agreement in principle with the official government definitions of respite care as providing a short-term break for carers. However, the complexity of client experiences and situations faced by Aged Care Assessment Service staff forces them in some cases to adopt a broader interpretation, such as where hospitals press for recommendations as a convalescent measure. Respite care is sometimes recommended as a last resort in situations where available services imperfectly align with individual need. Benefits other than those involving the physical and psychological health of the carer, or client living alone, include the provision of a transition step to permanent residential care, and the delaying of admission to permanent care. Two main barriers to the use of respite were identified: firstly, internal psychological and/or emotional reservations on the part of the carer/client. Aged Care Assessment Services suggested both early intervention and counselling and other forms of support could increase the acceptability of respite. At the time of the focus groups in early 1998 there was a strong sense in some groups that the critical role of counselling was being lost. A second barrier in bed availability was identified, with a need for coordination to match availability and need being as crucial as the allocation of sufficient bed numbers. Keywords: Residential respite, respite care, carers 86 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 123 Title: The economic benefits of maintaining a mature age workforce Principal researcher: Dr E Brooke Organisation: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University Status: Completed Funding: Positive Ageing Unit, Department of Human Services, Victoria Timetable: April 1999 - December 1999 Website: http://aipc.latrobe.edu.au.lgc Outline: This research project, commissioned by JobsEast Area Consultative Committee, examines the economic benefits to employers of maintaining a mature age workforce. The study tests the assumption that older workers cost more than younger workers to employers. The study design consisted of three stages: an analysis of Australian Bureau of Statistics data on older compared with younger workers; an analysis of human resource costs of recruitment and training, absenteeism and work injuries; and a cost benefit analysis of the comparative costs of older and younger workers. A national human resource benchmarking study was used to estimate these human resource costs. A focus group with recruitment consultants was also held to gather qualitative data on their perspectives of the cost and benefits of older workers. The findings reveal an overall benefit to employers due to the increased duration of older compared to younger workers. Older workers demonstrated comparatively lower human resource costs than younger workers, particularly in recruitment and training. The study also contains a literature review of uncosted benefits of older workers which showed that older workers can contribute benefits of maintaining corporate experience, filling skill shortages and reflecting the diversity of the customer base. Keywords: Older workers, ageing and employment 124 Title: The support needs of older people in high rise public housing Principal researchers: Dr E Brooke, Ms S Davidson, Professor H Kendig Organisations: Lincoln Gerontology Centre, Australian Institute for Primary Care, La Trobe University; Faculty of Health Sciences, University of Sydney Status: Completed Funding: Aged, Community, and Mental Health Division and the Office of Housing, Department of Human Services, Victoria Timetable: 1997 - 1998 Website: http://aipc.latrobe.edu.au.lgc Outline: The cornerstone of the study was the High Rise Public Housing survey of 109 older residents with low mobility who are living alone. The survey provided estimates for the broader population of vulnerable older people in thirteen older persons’ high rise public housing blocks in Melbourne. These high rise public tenants are likely to have suffered from the risks of low income, health and other personal disadvantages. People with low mobility in the Health Status of Older People (entry 113) survey provided a comparison group of other older people living elsewhere in Melbourne. In-depth interviews and focus groups provided further insights from the perspectives of the high rise public tenants and providers of housing and services. The findings show that older women living alone have capacities to build social networks and provide support within older persons’ high rise housing. High rise housing can enable opportunities for older people who live alone to increase social activity, for discrete monitoring by services and informal support. Keywords: Housing, social support, healthy ageing, community care Australian Ageing Research Directory 2000 87 Multidisciplinary Ageing Research Units 1.7 National Ageing Research Institute, University of Melbourne 125 Title: Age differences in post injury pain and tenderness Principal researcher: Dr Z Zheng Co-researchers: Associate Professor S Gibson, Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Timetable: January 1997 - 2000 Funding: University of Melbourne, $18,000 per annum Status: Current Website: www.nari.unimelb.edu.au Outline: The present project seeks to examine age differences in the severity and duration of post injury pain and tenderness. Using an experimental model of capsaicin-induced cutaneous injury, the research has shown that older persons take longer to first report the presence of pain, but the intensity of capsaicin pain and area of pain, remain similar regardless of age. The resolution of pain was also similar in young and older adults, although the tenderness surrounding the site of injury was maintained for a much longer period in adults of advanced age. These findings suggest some age differences in the plasticity of spinal cord neurons following an acute injury and in particular a reduced capacity to reverse sensitization processes once they have been initiated. Current research is examining whether the increased duration of tenderness is dependent on NMDA central nervous system mechanisms or peripheral mechanisms. In addition, temporal summation of noxious input as another test of spinal cord function is being investigated. Keywords: Pain, hyperalgesia, neurophysiology 126 Title: Age differences in psychological factors relevant to pain perception Principal researcher: Mr H Yong Co-researchers: Associate Professor S Gibson, Associate Professor D Horne Organisation: National Ageing Research Institute, University of Melbourne Timetable: 2000 - 2004 Status: Current Website: www.nari.unimelb.edu.au Outline: This research project aims to investigate the role of psychological factors in modulating pain perception in older people. Pain related beliefs and attitudes have been shown to shape how people respond to pain. Attitudes such as stoicism and cautiousness have been alluded to previously as particularly relevant to pain perception in older people. However, few studies have provided direct evidence for the role of these pain-related attitudes in accounting for the altered pain perception in older people. To date, a questionnaire has been developed as a direct measure of these two attitudes. Preliminary efforts on validation of the measure with a community-dwelling adult sample suggest that there is some evidence of validity and reliability. Further studies on the questionnaire will involve validating it on a pain clinic population and the use of sensory decision theory method to examine issues surrounding sensory deficit versus attitudinal bias as possible contributing factors to altered pain perception in older people. Keywords: Pain, stoicism, psychological attitudes, assessment 88 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 127 Title: Age related changes in pain perception, ways of coping with pain and the impact of pain on mood, activity and psychosocial function Principal researchers: Associate Professor S Gibson, Professor R D Helme Co-researchers: Mr M Gorman, Mr M Bradbeer, Ms M Chakour Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Timetable: Completed 1996 Website: www.nari.unimelb.edu.au Outline: Studies indicate that 40-80% of elderly people suffer from chronic pain, yet understanding of age related differences in pain perception, ways of coping with pain and the impact of chronic pain on mood, activity and psychosocial function is extremely limited. This study addressed these issues. Psychophysical methods was used to evaluate the nature and extent of age related changes in pain perception threshold in response to noxious thermal, mechanical and electrical stimulation of varying intensity and duration. Subjective ratings of the sensory and affective components of pain (sensation magnitude and unpleasantness) were monitored. To examine age related differences in peripheral pain mechanisms and central nervous system processes which might contribute to altered pain sensibility, a comparison of subjective reports under conditions of differential nerve fibre blockade and the intensity of noxious stimulation required for threshold activation of peripheral nociceptive mechanisms was made in subjects aged 20-100 years. Age related differences in subjective report and central nervous system processing, as indexed by cerebral nociceptive evoked responses, was also monitored at the intensity required for threshold activation of peripheral nociceptive mechanisms. The clinical pain experience in elderly adults suffering from chronic pain was documented using a comprehensive battery of psychometric questionnaires. Self reported levels of mood, activity, psychosocial function, the use and effectiveness of coping mechanisms and attitudes towards pain in subjects with chronic pain aged 20-100 years was compared. A better understanding of age related differences and similarities in the experience of pain will contribute towards more rational and adequate management of pain and suffering in the elderly, thereby improving quality of life for a significant number of elderly people. Keywords: Pain, nervous system, mental health, quality of life 128 Title: An analysis of research on preventing falls and falls injuries Principal researcher: Dr K Hill Co-researchers: Ms K Murray, Ms R Smith, Dr J Sims, Ms J Gough, Ms F Vrantsidis, Mr R Clark Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Injury Prevention, Department of Health and Aged Care Timetable: September 1999 - December 1999 Website: www.nari.unimelb.edu.au Outline: An extensive review of the international falls prevention literature to identify types of interventions which have been shown to effectively reduce falls and falls related injuries among older people. The review includes falls prevention programs in community, acute, and residential settings. Gaps in the research literature, and recommendations on future program development and research directions were identified. Keywords: Falls, falls prevention, hospital, community care, residential care, evidence based practice, literature review Australian Ageing Research Directory 2000 89 Multidisciplinary Ageing Research Units 129 Title: A role for reactive oxygen species and neuronal nitric oxide in delayed recovery of injured nerves with age Principal researcher: Associate Professor Z Khalil Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: In an animal model of neuropathic pain, Institute research demonstrated delayed recovery in aged rats as evidenced by prolonged maintenance of thermal hyperalgesia and reduction in microvascular blood flow in the area innervated by the injured nerve. The involvement of reactive oxygen species and neuronal nitric oxide in this delayed recovery was investigated. Young rats showed signs of recovery (reduction in thermal hyperalgesia and normalisation of peripheral microvascular blood flow) from the fifth week. No signs of recovery was observed in old rats for the eight weeks period. Reactive oxygen species activity was significantly higher in young injured nerves compared to Sham and was significantly greater in old injured nerves. Treatment with antioxidants and inhibitors of neuronal nitric oxide resulted in a significant alleviation in thermal hyperalgesia with improvement in the vascular responses from weeks five and six onwards. The results to date suggest that reactive oxygen species and neuronal nitric oxide contribute to delayed recovery of injured nerves in old rats and support the notion that the interaction of reactive oxygen species and neuronal nitric oxide to form peroxynitrite might contribute to delayed recovery. Keywords: Nerve injury, blood flow, microvasculature, pain 130 Title: Age-related changes in the mechanisms controlling local blood flow in rat skin microvasculature Principal researcher: Associate Professor Z Khalil Co-researcher: Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: National Health and Medical Research Council Website: www.nari.unimelb.edu.au Outline: The project tests the hypothesis that during maturation and ageing, there are changes in the mechanisms controlling blood flow in the microvasculature; changes which may explain the susceptibility of the aged population to a variety of vascular diseases, including atherosclerosis, thrombosis, coronary artery spasm, cerebral vasospasms, and skin ulcerations. Studies have concentrated on the interaction between the neuropeptide substance P and another sensory peptide, calcitonin gene-related peptide, and the effect of this interaction on modulating blood flow in the microvasculature. Neuropeptide substance P was found to be capable of sensitising a subsequent calcitonin gene-related peptide response while it desensitises an existing calcitonin gene-related peptide response. Recent experiments examined the mechanisms underlying these phenomenon, and preliminary data suggest that the sensitising effect appears to be mediated by endolethial mechanisms involving the release of endothelium derived relaxing factors. In contrast, the desensitising effect appears to be mediated by mechanisms controlling extracellular calcium. This study is of relevance to the control of local blood flow in different tissues, particularly the heart, where neuropeptide substance P and calcitonin gene-related peptide play an important role in the regulation of local coronary blood flow. Keywords: Vascular system, cardiovascular diseases, sensory peptides 90 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 131 Title: Barwon South West Personal Response System projects Principal researcher: Ms M Lindeman Co-researchers: Ms V Mayhew, Ms R Smith Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Barwon South West Region Timetable: 1998 Website: www.nari.unimelb.edu.au Outline: Building on the Barwon South West best practice in integrated service system development projects, this project entailed working with service providers to develop assessment protocols, principles to guide eligibility decisions, and systems to enhance the 24 hour service response in this large, rural health region. This linked with the introduction of the expanded Personal Alert Victoria program. Keywords: Personal response systems, assessment protocols, service development, after hours services 132 Title: Brain activity changes in healthy ageing and dementia Principal researcher: Professor R D Helme Co-researchers: Dr J Dunai, Associate Professor S Gibson, Ms A Kyriacou, Dr M Widagdo, Mr M Gorman Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: National Ageing Research Institute, University of Melbourne Timetable: 1990 - ongoing Website: www.nari.unimelb.edu.au Outline: QEEG and sensory and cognitive tasks used to detect and distinguish between brain activity changes associated with health ageing and dementia. Keywords: Dementia, encephalography 133 Title: Capacity assessment program Principal researcher: Dr P Darzins Organisation: National Ageing Research Institute, University of Melbourne Status: Current Funding: National Ageing Research Institute, University of Melbourne Timetable: Ongoing Website: www.nari.unimelb.edu.au Outline: The development and dissemination of an explicit standardised approach to the assessment of the capacity to make decisions in health care, personal care and finances. Keywords: Capacity assessment, decision making, ethics, medico-legal 134 Title: Community rehabilitation centres Principal researcher: Ms R Smith Co-researcher: Ms A Laffy Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Australian Ageing Research Directory 2000 91 Multidisciplinary Ageing Research Units Funding: Aged Community and Mental Health Division, Department of Human Services Timetable: 1996 - 1998 Website: www.nari.unimelb.edu.au Outline: A multi-part study involving development of clinical indicators for Community Rehabilitation Centres; mapping of service provision and development of planning guidelines for future service provision; a census of clients; and development of a generic brief for the facilities. Keywords: Community rehabilitation, performance indicators, service planning, service development 135 Title: Dementia care in the Vietnamese community Principal researcher: Dr L LoGiudice Co-researchers: Dr J Sims, Dr H Nguyen, Ms R Smith Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Western Metropolitan Region, Home and Community Care Timetable: 1999 Website: www.nari.unimelb.edu.au Outline: A study looking at the health and support services available for the families of those who have memory problems or dementia and who are of Vietnamese background. The aim is to promote quality in service provision via the development of enhanced access, culturally sensitive assessment and improved integration and coordination of care. Keywords: Dementia, cultural awareness, service planning, service development, community services, ethnic aged 136 Title: Developing a skin test for early diagnosis of Alzheimer’s disease and for monitoring effectiveness of treatment Principal researcher: Associate Professor Z Khalil Co-researcher: Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne. Status: Current Website: www.nari.unimelb.edu.au Outline: There is no single biological diagnostic test for Alzheimer's disease. The idea that the vascular effects of amyloid protein contribute to its neurotoxicity is now well accepted. There is evidence that the vascular actions of amyloid protein are similar in cerebral and skin microvasculature. Recent research has found that some patients with Alzheimer’s disease have abnormal skin vascular responses, and the Institute has obtained a provisional patent application for the use of a skin test for early diagnosis of Alzheimer’s disease (Patent No: PQ2881/99). It is now intended to examine the utility of this novel skin test. The research aims to calculate the test’s sensitivity and specificity within older populations and to determine the positive and negative predictive values of the skin test in different populations. If the test is sensitive it could be used for screening; if it is specific it would be useful for confirmation of suspected Alzheimer’s disease. In either case, it would aid the testing of treatments that can prevent Alzheimer’s disease. If the test is sensitive to change in clinical status it would help test treatments that can cure or improve the symptoms of Alzheimer’s disease. Keywords: Alzheimer's disease, skin vascular responses 92 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 137 Title: Development of best practice models for integrated aged and disability services in the Barwon and South West sub-regions of Victoria Principal researcher: Ms M Lindeman Co-researchers: Ms N Hunder, Ms R Smith, Ms L Costello, Dr A Howe Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: HACC Best Practice Initiative, Department of Human Services Timetable: 1998 Website: www.nari.unimelb.edu.au Outline: The HACC Best Practice initiatives aimed to facilitate an integrated service system among service providers. In these action research projects, the framework, supporting information and education was provided to regional services providers to enable the development of protocols and action plans which were relevant at the local level. This work was also used as a foundation by services involved in developing successful initiatives for primary care redevelopment programs. Keywords: primary care, rural health, service integration, action research, CIARR, client assessment, client targeting 138 Title: Differences in electrophysiological and behavioural measures of cognitive change between delirious and demented older people Principal researcher: Ms C Van Hintum Co-researchers: Dr J Dunai, Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: National Ageing Research Institute, University of Melbourne Timetable: Completion 2001 Website: www.nari.unimelb.edu.au Outline: This study will explore differences and changes in cognition, especially alertness, using electrophysiological, psychometric and reaction time measures. Keywords: Cognitive change, electrophysiological, behavioural 139 Title: Early prediction of falls risk in older people Principal researcher: Dr K Hill Organisation: National Ageing Research Institute, University of Melbourne Status: Current Timetable: January 1999 - December 2002 Website: www.nari.unimelb.edu.au Outline: Preliminary studies have investigated the utility of a series of dynamic force platform measures of balance in discriminating levels of balance performance between three groups – a group of healthy young, and a group of healthy old subjects, and a group of older people with mild increase in risk of falling. Results have indicated that centre of pressure measures during antero-posterior platform perturbation, with concurrent cognitive task, resulted in the greatest discrimination of performance between groups. A prospective study is now planned to evaluate the accuracy of these measures in accurate classification of falls risk in a group of older people with no overt balance and mobility dysfunction. Keywords: Falls, elderly, risk prediction Australian Ageing Research Directory 2000 93 Multidisciplinary Ageing Research Units 140 Title: Effects of ageing on sensory nerve function in rat skin Principal researcher: Associate Professor Z Khalil Co-researchers: Miss M Bassirat, Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: National Health and Medical Research Council Website: www.nari.unimelb.edu.au Outline: Age-related changes in pre-terminal activity of primary afferents involved in skin neurovascular function have been investigated. Changes in local skin blood flow were monitored using a laser Doppler flowmeter. Pre-terminal stimulation was achieved by electrical stimulation of the distal end of the sciatic nerve in three groups of young, old and neonatally pretreated capsaicin rats with 80% depletion of sensory nerves. Electrical stimulation of the sciatic nerve in young rats induced an increase in local blood flow within one minute, which was maintained during the stimulation period, while the capsaicin group and the old group showed a significantly increased latency and amplitude of the response. There was no difference in the vasodilator response to sensory nerve function with age. The study suggests that pre-nerve terminal function changes with ageing of the peripheral neurovascular apparatus. The similarity of the responses to electrical stimulation in capsaicin pretreated and old rats suggests that similar pre-terminal mechanisms operate in the two groups, namely a decrease in the number of sensory nerves present, and/or a decrease in their peptide content. The overall decrease in sensory nerve function observed may have important implications for wound healing and repair mechanisms and suggests that neural mechanisms must be considered in any explanation of reduced healing rates with age. Keywords: Sensory nerves, wound healing, blood flow 141 Title: Electroencephalographic studies of the neural substrates of melodic, harmonic and rhythmic elements in music cognition using EEG–Coherence Principal researcher: Dr B Barber Co-researchers: Professor R D Helme, Dr J Dunai Organisation: National Ageing Research Institute, University of Melbourne Status: Planned Funding: Funding application submitted Timetable: July 2000 - July 2002 Website: www.nari.unimelb.edu.au Outline: Previous studies at the Institute of music cognition, using electroencephalographic methods, yielded a number of results that encouraged further research. EEG-Coherence analysis, which provides information about the functional relationships between neocortical structures, revealed time-invariant, music-related interhemispheric and intrahemispheric cerebral links between cortical structures known to mediate auditory, motor, working memory and information retrieval processes. The studies in this proposal will continue to explore responses to complete musical structures and events, but they will also examine responses to specific substructural components to determine if changing patterns of involvement of neocortical structures can be linked to those musical substructures. If, as predicted, EEGCoherence measures are sufficiently sensitive to detect neural correlates of highly specific substructures of complete melodic, harmonic and rhythmic events, significant progress will be made towards the research goal of constructing an objective representation of music cognition. Such data will provide an invaluable tool with which to review theory and practice 94 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units in the education of musicians and will have applications in music therapy and the use of music in association with acute and sub-acute medical procedures. The identification of neural correlates of highly prescribed elements of musical structure will contribute to methodological refinements of current QEEG investigations of age-related cognitive impairment. Further, it is anticipated that results of this research will contribute to the ongoing development of a neurocognitive model for music by referencing the results to a neurologically plausible and comprehensive cognitive framework. Keywords: Music, cognition, electroencephalography 142 Title: Endogenous analgesic mechanisms in young and older persons Principal researcher: Mrs L Washington Co-researchers: Associate Professor S Gibson, Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Timetable: January 1999 - 2002 Funding: Helen Schutt Trust, $15, 000 Status: Current Website: www.nari.unimelb.edu.au Outline: The present project seeks to examine the efficacy of endogenous pain control (analgesic) systems in young and older adults. Repeated ice water immersion to pain tolerance levels was used to activate endogenous analgesia. A comparison of pain sensitivity before and after the ice water immersion revealed that both young and older adults could achieve a strong analgesic effect with electrical pain threshold increasing by more than 100%. However, the magnitude of the analgesic response was significantly less in older persons and this could potentially lead to more severe clinical pain states. Work is currently underway to identify the precise neurophysiologic mechanisms responsible for age differences in endogenous analgesia as well as possible variations in the duration of analgesia. These studies will include an investigation of the opioid dependent nature of analgesia as well as the site of action at a spinal cord or higher central nervous system site. Further research on pain modulation systems and age differences should provide a more comprehensive understanding of pain physiology and help improve treatment choices for the 50% of older adults who suffer from chronic pain conditions. Keywords: Pain, analgesia, neurophysiology, endogenous pain control 143 Title: Evaluation of a falls clinic for the elderly Principal researcher: Dr K Hill Co-researcher: Dr J Schwarz Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: Nil Website: www.nari.unimelb.edu.au Outline: This important resource for older people who fall has an extensive computerised data base which allows a variety of questions to be addressed. Keywords: Falls, elderly, assessment, evaluation Australian Ageing Research Directory 2000 95 Multidisciplinary Ageing Research Units 144 Title: Evaluation of consumer satisfaction with Community Care Packages Principal researchers: Ms R Smith, Ms M Nihill Organisation: National Ageing Research Institute, University of Melbourne Status: In progress Funding: Community Support Program, North Western Health Care Network Timetable: November 1999 - May 2000 Website: www.nari.unimelb.edu.au Outline: A qualitative study conducted for the Community Care Packages program of the North Western Health Care Network, is exploring client’s and carer’s experiences of care and their satisfaction with care using in-depth interviews. Input of staff of the program is also being sought through focus groups. Keywords: Consumer satisfaction, quality of care, health outcomes 145 Title: Evaluation of the factors that influence General Practitioners to use information technology to improve the practice of medicine Principal researcher: Ms G Banks Co-researchers: Dr D Beckett, Dr P Darzins Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: National Ageing Research Institute, University of Melbourne Timetable: 1999 - 2000 Website: www.nari.unimelb.edu.au Outline: Development and evaluation of a system that provides general practitioners and other health care practitioners with information about geriatric medicine issues via email. Keywords: Continuing Medical Education, information technology, health informatics, evidence based practice 146 Title: Evaluation of transcutaneous electrical nerve stimulation for the treatment of leg wounds in older people Principal researchers: Associate Professor Z Khalil, Dr P Darzins Co-researcher: Ms R Rimac Organisation: National Ageing Research Institute, University of Melbourne. Status: Current Website: www.nari.unimelb.edu.au Outline: The number of old people in Australia is increasing. The incidence and prevalence of leg wounds increases with age. In 1995, around 5% of older people reported they had illness related to ulcer in the two weeks preceding the survey. Leg wounds cost $450-$600 million per year in Australia. There is a clear need to improve wound management to save costs and to avert suffering. Institute research has shown that the age-associated delay in wound healing can be reduced by low frequency transcutaneous electrical nerve stimulation in animals and have elucidated the underlying physiology of such low frequency transcutaneous electrical nerve stimulation. Pilot data has shown marked benefit of low frequency transcutaneous electrical nerve stimulation in human leg wound healing. This project aims to test a novel treatment, low frequency transcutaneous electrical nerve stimulation, for chronic leg wounds. If low frequency transcutaneous electrical nerve stimulation can speed wound healing this could save much money and avert much suffering. The project also aims to test 96 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units whether low frequency transcutaneous electrical nerve stimulation can improve nerve function thus providing a possible therapy for peripheral neuropathy. This could ultimately help inhibit recurrence of ulceration, and could also decrease the pain of neuropathy. A noninvasive technique that can improve neuropathy and rates of wound healing, particularly in long-standing refractory cases, will provide enormous cost savings to the Australian health system and improve patient well-being. An examination of the efficacy of low frequency transcutaneous electrical nerve stimulation as an adjunct in the treatment of neuropathy and chronic leg wounds is a cost-effective means to explore the potential for sensory nerve manipulation to influence wound healing. Keywords: Leg ulcers, non-invasive electrical stimulation 147 Title: Falls trends in Australia Principal researcher: Dr K Hill Co-researchers: Ms B Gilsenan, Ms F Lentini, Dr N Kerse Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Victoria Timetable: 1998 - 1999 Website: www.nari.unimelb.edu.au Outline: This project involved two components: (i) investigating trends in falls incidence and prevalence through analysis of existing databases; (ii) development of an evidence based rating system for use in the evaluation of existing falls prevention programs. Over 130 falls prevention programs from across Australia have been investigated and a database of these programs established as a resource for government and service providers. Keywords: Health promotion, falls prevention 148 Title: Geriatric evaluation clinic database Principal researcher: Dr P Darzins Organisations: National Ageing Research Institute, University of Melbourne; Aged Care Program, North Western Health Care Network Status: Current Timetable: Ongoing Website: www.nari.unimelb.edu.au Outline: Development and testing of the utility of a FileMaker Pro database to manage outpatient medical records and to automatically generate letters to the referrers. Keywords: Filemaker Pro database, medical records 149 Title: Guidelines for assessment of relative priority for client need for personal alert services Principal researchers: Ms V Mayhew, Ms M Lindeman Co-researchers: Dr K Hill, Ms R Smith Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Aged Community and Mental Health Division, Department of Human Services Timetable: 1999 Website: www.nari.unimelb.edu.au Australian Ageing Research Directory 2000 97 Multidisciplinary Ageing Research Units Outline: The Victorian Personal Assistance Call Service (VICPACS) (now known as Personal Alert Victoria) is an integrated personal monitoring and response service for older people, or people with disabilities, living in their home and at risk of experiencing a critical event or episode. Guidelines were developed for assessment of relative priority of client use. A training program was subsequently developed and implemented in two large regions to assist with the implementation of this expanded service with new criteria for eligibility and access. Keywords: Assessment guidelines, service access, personal response systems, client need 150 Title: HACC targeting project Principal researcher: Dr A. Howe, Dr L Gray Co-researchers: Ms V Mayhew, Ms S Richardson, Ms M McKenna, Ms M Lindeman Organisations: National Ageing Research Institute, University of Melbourne; Centre for Applied Gerontology, Bundoora Extended Care Centre Status: Completed Funding: Department of Health and Family Services Timetable: 1996 - 1998 Website: www.nari.unimelb.edu.au Outline: This project involved a national survey of 400 HACC service providers, investigation of outcomes of different targeting strategies and analysis of data on more than 20,000 clients assessed by the Aged Care Assessment Service in Victoria and Western Australia. On the basis of the consultancy research findings, a draft framework for the development of guidelines for resource allocation has been prepared and distributed nationally. Community consultations on this framework were conducted. Three research reports were produced for consideration by the Department for incorporation into the HACC guidelines. Keywords: HACC, service targeting, service planning, resource allocation 151 Title: Handicap Assessment Resource Tool (HART) evaluation Principal researcher: Dr P Darzins Co-researchers: Ms R Smith, Dr R Clarnette, Ms J Taylor, Mr C Steel, Ms K Richter Organisations: National Ageing Research Institute, University of Melbourne; Aged Care Program, North Western Health Care Network Status: Current Timetable: Ongoing Website: www.nari.unimelb.edu.au Outline: The Handicap Assessment Resource Tool is now used for data collection regarding personal care handicap as a matter of routine at the Broadmeadows Health Service. The reliability and clinical utility of this approach will be established in different settings. Keywords: Handicap assessment, data collection, personal care handicap 152 Title: Home rehabilitation evaluation Principal researcher: Ms R Smith Co-researchers: Professor R D Helme, Dr S Gibson Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Rehabilitation Program, North Western Health Timetable: 1997- 1998 98 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Website: www.nari.unimelb.edu.au Outline: A project of North West Hospital Rehabilitation Program evaluating standard inpatient rehabilitation and home based service provision. This clinical research study aimed to compare the outcomes for clients/carers receiving home rehabilitation services with a group of clients/carers receiving usual inpatient care. It was a large scale study which involved a broad range of outcome measures, and interviews with both client and carer at three time points during the rehabilitation episode of care. Keywords: Home based rehabilitation, quality of care, outcomes 153 Title: Hospital services for older people Principal researcher: Professor R D Helme Co-researcher: Dr B Katz Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: Melbourne Extended Care and Rehabilitation Service Timetable: 1990 - ongoing Website: www.nari.unimelb.edu.au Outline: Studies of interventions and outcomes of an Aged Care Assessment Service in an acute teaching hospital environment. Keywords: Aged care, assessment services 154 Title: Improving outcomes for those with chronic pain Principal researchers: Professor R D Helme, Associate Professor S Gibson Co-researcher: Mr F Kung Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Victorian Health Promotion Foundation, $100,000 Timetable: 1996 - 1999 Website: www.nari.unimelb.edu.au Outline: The purpose of this project was to develop a validated survey questionnaire for measuring the perceived helpfulness and usage of pain management techniques in community dwelling older persons and to trial a new community based treatment program for chronic pain. Participants were free to choose the type of intervention approach (eg. self help, case management). The findings showed that the pain management strategies survey questionnaire was a reliable and valid tool for monitoring the use and helpfulness of a broad range of treatment options. The underlying conceptualisation of pain management approaches included self help remedies, medication/medical strategies and allied health/alternative methods for controlling pain. The use of a brief educational session was shown to improve the understanding of available treatment strategies for chronic pain and empowered participants to make informed and sensible choice regarding preferred treatment options. Older persons involved in the intervention program delivered via community health centres showed a significant reduction in self reported pain and improvement in mood, physical activity and perceived ability to cope with pain. The magnitude of change was much greater than a conventional treatment control group, was approximately equal to an intensive multidisciplinary pain management program and the post intervention improvements were maintained at a six month follow up. Keywords: Chronic pain, treatment, community care, coping Australian Ageing Research Directory 2000 99 Multidisciplinary Ageing Research Units 155 Title: Investigation of the mechanisms controlling microvascular blood flow with diabetes Principal researcher: Associate Professor Z Khalil Co-researcher: Miss M Bassirat Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: Diabetic vascular disease (diabetic angiopathy) can lead to renal failure, coronary heart disease and blindness. These complications have even more significant sequelae in our elderly population due to limited cardiovascular reserve. The prevention and treatment of diabetic micro and macro-angiopathy are therefore major health priorities. Hyperglycaemia plays a key role in damage to blood vessels. Basic research into the underlying mechanisms of this damage is likely to provide therapeutic insights, however, the complexity and number of factors that appear to be involved in diabetic angiopathy make this a considerable challenge. This research is investigating the progression of changes to blood vessels with time and the different factors that regulate blood flow in small vessels in diabetes. Changes with age in the microvascular control in diabetic vascular disease is a major area of interest. Keywords: Diabetes, blood flow, microvasculature 156 Title: Investigation of the mechanisms underlying chronic pain due to nerve injury Principal researcher: Associate Professor Z Khalil Organisation: National Ageing Research Institute, University of Melbourne Funding: National Health and Medical Research council Status: Completed Website: www.nari.unimelb.edu.au Outline: Human peripheral nerve injury is common and often complicated by three main problems: slow recovery, incomplete recovery and chronic pain. These problems are more pronounced with ageing and significantly contribute to the prevalence of chronic pain in the elderly. Studies suggest that the number of axons in the peripheral nerve as well as their capabilities to regenerate or reconnect following damage is reduced with ageing. Slow recovery after nerve injury with ageing could be related to changes in the nerve microenvironment, particularly the microcirculation, with the likelihood of a decrease in the availability of the local factors that may be vitally important in clinical recovery following peripheral nerve injury. This research is investigating the mechanisms underlying the reduction in blood flow to an injured nerve. Further studies in this area will help to explain the mechanisms which underlie the development of chronic pain due to nerve injury. Keywords: Chronic pain, nerve injury, ageing 157 Title: Investigation of the vascular activity of beta amyloid protein: Relevance to Alzheimer’s disease Principal researcher: Associate Professor Z Khalil Co-researcher: Miss H Poliviou Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: Alzheimer's disease is characterised by a progressive degeneration of brain cells 100 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units which continues without remission until death. Under the microscope, the disease is characterised by structures known as neurofibrillary tangles and amyloid plaques. The Institute’s most recent studies in this area revealed that the beta-amyloid protein, implicated in the pathology of Alzheimer's disease, interacts with endothelial cells to release endothelin. The significance of this finding is that it provides support to the growing belief in the possibility that vascular mechanisms could contribute to the pathology of Alzheimer's disease. Current investigations centre on age-related changes in the vascular activity of beta-amyloid fragments, some of which have been identified in blood vessels and body tissues. These studies could shed some light on the mechanisms underlying the toxic effects of beta-amyloid. Keywords: Beta-amyloid, microvasculature, Alzheimer's disease 158 Title: Linkages case management Principal researchers: Ms M Nihill, Ms R Smith Co-researchers: Ms S Richardson, Ms K Black Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Southern Metropolitan Region (via consortia of Linkages agencies) Timetable: 1997 - 1999 Website: www.nari.unimelb.edu.au Outline: A study to examine the health and well-being of Linkages clients and their carers and the service provider interactions in the Linkages system. There is a particular emphasis in this project on the use of acute care and general practice services by Linkages clients. Keywords: Case management, health outcomes, community care 159 Title: Measurement of disabilities in the elderly Principal researcher: Professor R D Helme Co-researchers: Associate Professor S Gibson, Mr T Corran Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Victorian Health Promotion Foundation, $60,000 Timetable: 1993 - 1996 Website: www.nari.unimelb.edu.au Outline: The aim is to develop better measures of disability in elderly patients suffering from problems with falls and balance, cognitive impairment, and pain and suffering. The reliability and validity of psychometric questionnaires and physiological measures are being examined for use in elderly populations. Psychometric questionnaires will be used to investigate measures of mood psychopathology, activity, pain, impact of ill health on psychosocial function, carer burden and stress, cognitive impairment, health beliefs, appraisals, and coping strategies. Bias against reporting of negative health consequences (depression) and in favour of reporting of positive attributes (levels of activity) will also be monitored. Physiological measures involve the potential use of quantitative EEG to monitor cognitive function, a force balance platform to index postural sway, an uptimer device to quantify activity levels, and the measurement of cerebral evoked potentials in response to painful stimulation. This should provide a comprehensive battery of reliable and valid measures as well as age appropriate normative values for an Australian sample, which includes the old old (individuals over 80 years). In addition, it is hoped that these measures will be useful in predicting those at risk of Australian Ageing Research Directory 2000 101 Multidisciplinary Ageing Research Units developing problems with balance, memory and pain during the later years, and assist in the evaluation of appropriate intervention strategies. Keywords: Falls, pain, cognition, testing, functional ability 160 Title: Mechanism of action of peptides that alleviate neuropathic pain Principal researchers: Associate Professor B Livett, Associate Professor Z Khalil Co-researchers: Ms V Pham, Ms N Satkunanathan Organisations: National Ageing Research Institute, University of Melbourne; Department of Biochemistry, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: Neuropathic pain is associated with a multiplicity of conditions that affect every member of the community particularly older adults. The common use of opiates to treat painful conditions like cancer and shingles is not always appropriate as side effects of morphine include nausea, constipation and depression, complicated by the fact that morphine and derivatives are addictive and produce tolerance requiring higher and higher doses to maintain the effects required. The recent discovery that pain can be controlled by non-opiate natural products from marine snails -cone shells- has led to the clinical use of these compounds, called conotoxins, in clinical trials (presently at stage III in the USA) for the treatment of intractible pain. The present study seeks to understand the process by which these conotoxins bring about pain relief and to investigate the possibility that combinational drug treatment with two or more conotoxins is more effective than with one compound alone. The research will also investigate whether the recovery from pain is better effected by use of combinations of these conotoxins. Since these conditions are experienced more in the aged, the research will investigate the effectiveness of these agents in preventing pain in adult and aged animal models of these disorders. These studies will contribute to more effective therapy for prevention of pain, with special benefit for the aged population. Keywords: Pain, conotoxins, pain relief 161 Title: Medical studies in people with dementia Principal researcher: Dr K Taubman Co-researchers: Professor R D Helme, Associate Professor D Ames, Dr M Yates, Ms A Kalogeropoulos, Dr D LoGiudice, Ms M Mastwyk, Ms R Cook, Dr R Shea, Dr E Seal, Mr R Moss Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: Pharmaceutical companies Timetable: 1995 - ongoing Website: www.nari.unimelb.edu.au Outline: Ongoing drug trials for dementia, a major cause of disability in the elderly. Keywords: Dementia, Alzheimer’s disease, drug trials 162 Title: Medication studies in influenza treatment Principal researcher: Mr M Bradbeer Co-researcher: Dr K Taubman Organisation: National Ageing Research Institute, University of Melbourne 102 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units Status: Ongoing Funding: Pharmaceutical company Timetable: May to October each year Website: www.nari.unimelb.edu.au Outline: To assess efficacy and safety of medications in treating influenza in (i) the elderly and (ii) those with chronic cardiac and pulmonary disorders. Keywords: Influenza, neuraminidase inhibitors 163 Title: Memory of pain and accuracy of pain recall in young and older persons Principal researcher: Mr G Dalton Co-researchers: Associate Professor S Gibson, Professor R D Helme, Dr K Niere Organisation: National Ageing Research Institute, University of Melbourne Timetable: 2000 - 2004 Status: Current Website: www.nari.unimelb.edu.au Outline: The aim of this project is to explore the accuracy of recall for pain stimuli across ages. An experimental pain model will be used as this allows a high degree of manipulation of the pain experience. Pain will be induced using an acid injection model due to the reported constant nature of the pain experience and chemical pain could be a common cause of persistent pain in the clinical setting. Accuracy of recall will be tested over various time periods: thirty minutes, two days, seven days. Recall for all aspects (sensory, spatial, affective, temporal and behavioural) of the pain experience will be undertaken. The different aspects of the process of memory (encoding, storage, retrieval) and the different systems of memory (sensory, working, declarative, implicit etc.) will be used as frameworks when testing accuracy of recall for pain experiences. Keywords: Pain, memory, assessment 164 Title: Mitochondria and ageing in Drosophila Melanogaster Principal researcher: Dr C Driver Co-researchers: Professor R Arking, Professor P Nagley Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: Mitochondrial failure is significant component in a number of age-related diseases such a Parkinsonism and Alzheimer’s diseases, and has been proposed by Linnane and others to be more widely involved in general ageing processes. To study this question further, several age-related phenomena are being assessed in strains of Drosophila that vary principally in the mitochondrial genome. These include: production of reactive oxygen species, longevity, failure of bioenergy, diurnal clock failure using molecular and behavioral techniques and deterioration of the alarm response. Segregation analysis indicates at two types of ageing-related phenomena that are related to mitochondrial function: production of reactive oxygen species and a second, unidentified process that produces functional loss in energy metabolism. This second process appears to be more important in age-related neurodegeneration. PCR analysis is in progress to determine how this second process is related to mitochondria DNA fragmentation with age. Agents have been identified that can reduce the impact of some of these changes. Keywords: Mitochondria, Drosophila, Alzheimer’s disease Australian Ageing Research Directory 2000 103 Multidisciplinary Ageing Research Units 165 Title: Modulation of peripheral inflammation by opioid-like peptides Principal researcher: Associate Professor Z Khalil Co-researchers: Professor F Nyberg, Mr D Wiktelius Organisations: National Ageing Research Institute, University of Melbourne; Department of Pharmaceutical Biosciences, Division of Biological Research on Drug Dependence, Uppsala University, Sweden Status: Current Website: www.nari.unimelb.edu.au Outline: Upon tissue injury, sensory nerves release neuropeptide transmitters, including Substance P, to mediate pain centrally and neurogenic inflammation peripherally. Substance P1-7 (SP1-7), a metabolite of Substance P is known to modulate nociception in the central nervous system and often has opposite effects from Substance P. The aim of this study is to examine the ability of SP1-7 to modulate the peripheral inflammatory response under different injury conditions. The current results suggest that SP1-7 may have important inhibitory actions on peripheral inflammation, similar to its antinociceptive role in the central nervous system. Further investigations are needed to examine age-related changes to the antinociceptive role of this opioid like peptide. Keywords: Inflammation, opioid-like peptides, pain relief 166 Title: National stocktake of falls and falls injury prevention Principal researcher: Dr K Hill Co-researchers: Ms R Smith, Mr R Clark, Ms J Nankervis, Ms F Vrantsidis Organisation: National Ageing Research Institute, University of Melbourne Status: In progress Funding: Injury Prevention, Department of Health and Aged Care Timetable: January 2000 - May 2000 Website: www.nari.unimelb.edu.au Outline: National survey of organisations involved in falls and falls injury prevention programs in community, hospital and residential care settings, investigating key issues associated with successful implementation, sustainability and transferability. Keywords: Falls, falls prevention, injury prevention, health program evaluation, health promotion 167 Title: Outcome measures in sub-acute care and rehabilitation Principal researchers: Ms R Smith, Dr P Darzins Co-researcher: Ms K Black Organisation: National Ageing Research Institute, University of Melbourne Status: In progress Funding: Sub-Acute Care, Department of Human Services, Victoria Timetable: 1999 - 2001 Website: www.nari.unimelb.edu.au Outline: This project will focus on identifying and reviewing outcome measures appropriate for use in rehabilitation and sub-acute aged care. The aim is to develop a framework for outcome measurement, identify gaps for ongoing research and contribute to the development of appropriate measures. Keywords: Outcome measurement, sub-acute care, rehabilitation, service monitoring 104 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 168 Title: Pain and hyperalgesia in elderly patients suffering from osteoarthritis of the hand Principal researcher: Dr M Farrell Co-researchers: Associate Professor S Gibson, Professor R D Helme, Professor J McMeeken Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Timetable: 1996 - 1999 Website: www.nari.unimelb.edu.au Outline: The pain experience of older patients with osteoarthritis of the hands was assessed using psychometric questionnaires and detailed psychophysical studies of pain sensitivity and tenderness in regions overlying the affected thumb joint. Psychometric results indicate three different sub-groups of patients with osteoarthritis: those with continuous pain, spontaneous incident pain and pain only upon repeated movement. Incident pain was not associated with any change in pain sensitivity, whereas patients with movement pain had lowered pain thresholds and tenderness at the base of thumb. Variance in the intensity of continuous joint pain was also associated with the extent of change cutaneous pain sensitivity and degree of tenderness. Manipulation of the intensity of movement pain, through self paced resisted thumb movement, led to an increase in cutaneous pain sensitivity which persisted well beyond the resolution of the pain associated with resisted movement. This increase in pain sensitivity was abolished by blockade of large myelinated A beta nerve fibres, thereby implicating mechanisms of central sensitization as a cause of altered pain sensitivity and tenderness. Overall, the present findings emphasise different sub-types of osteoarthritis with different underlying neurophysiological pain mechanisms. The development of future treatment for osteoarthritis pain may benefit from an approach that targets the specific sub-types of pain and the specific underlying mechanisms associated with such pain states. Keywords: Pain, peripheral nervous system, osteoarthritis 169 Title: Pain in cognitively impaired older persons Principal researcher: Associate Professor S Gibson Co-researchers: Professor R D Helme, Professor D Ames, Dr B Barber, Ms J Gracey Organisation: National Ageing Research Institute, University of Melbourne Status: Current Funding: National Health and Medical Research Council, $210,000 Timetable: January 1998 - December 2000 Website: www.nari.unimelb.edu.au Outline: The present project aims to examine pain perception and report on cognitively impaired older persons resident in an acute hospital setting, a nursing home setting or residing in the general community. Through a series of studies, the program seeks to use standard psychometric questionnaires in order to assess pain in demented older persons who retain oral communication skills. Barriers to routine psychometric assessment will be identified and a formal assessment of the reliability and validity of several types of pain assessment questionnaires will be undertaken in this population. In addition, the psychometric measures will be used to compare the impact of pain on self rated depression, anxiety and behavioural function as well as meaning of pain symptoms in adults with cognitive impairment and those without. Finally, delivery of an experimental pain stimulus and consequent recording of pain related cerebral evoked potentials will be used to evaluate the extent of any change in pain sensitivity and nociceptive processing in patients with diagnosed Alzheimer’s disease. These studies should provide important new insights into the role of cognitive factors in shaping the Australian Ageing Research Directory 2000 105 Multidisciplinary Ageing Research Units pain experience of older adults, help identify the most appropriate pain assessment methods for this population and improve understanding of any changes in nociceptive processing that occur in adults with cognitive impairment. Keywords: Cognitive impairment, pain, psychometric assessment 170 Title: Preferential neurogenic vascular responses of aged sensory nerves to low frequency electrical stimulation: Involvement of conotoxin-sensitive mechanisms Principal researcher: Associate Professor Z Khalil Co-researcher: Mr M Merhi Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: There is a decline in sensory nerve function with age that correlates with reduced neurogenic vascular responses and poor tissue repair. This study was designed to determine the experimental condition(s) under which the aged sensory nerve can produce adequate neurogenic vascular responses. The contribution of the sensory neuropeptides substance P, calcitonin-gene related peptide and the N-type voltage-operated calcium channel to these responses was examined. The results showed that old control rats exhibited a significant decrease in their vascular responses at high frequency electrical stimulation compared to young. In contrast, aged sensory nerves at low frequency electrical stimulation produced a vascular response equal to that of young control. The research provides evidence that there is a greater involvement of substance P and calcitonin-gene related peptide in the vascular responses obtained to high frequency electrical stimulation and low frequency electrical stimulation respectively and that N-type voltage operated calcium channels contribute to neurogenic vascular responses following low frequency electrical stimulation but not high frequency electrical stimulation. That the function of N-type voltage-operated calcium channels is preserved with age and that these channels play a large role in peptide release at low frequency electrical stimulation, might explain the preferential response of the aged sensory nerve to low frequency electrical stimulation. This phenomenon might be of clinical relevance considering that adequate neurogenic vascular responses are important for tissue repair following injury. Keywords: Sensory nerve activity, calcium channels 171 Title: Quantitative EEG in dementia diagnosis Principal researcher: Dr E Seal Co-researchers: Professor R D Helme, Dr J Pierson Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: National Health and Medical Research Council Timetable: Completed 2000 Website: www.nari.unimelb.edu.au Outline: Objective physiologic and psychometric measures to aid dementia diagnosis Keywords: Dementia, olfaction, EEG 106 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 172 Title: Recovery of balance and mobility in older stroke patients with severe physical dysfunction Principal researcher: Dr K Hill Co-researchers: Dr J Bernhardt, Ms S Law Organisations: National Ageing Research Institute, University of Melbourne; North Western Health Aged Care Program Status: Current Timetable: January 1998 - July 2001 Website: www.nari.unimelb.edu.au Outline: Stroke patients with severe physical dysfunction persisting at four weeks post stroke may not be considered suitable for rehabilitation. This project builds on some pilot work which identified that a small group of stroke patients with severe physical dysfunction at four weeks post stroke did achieve ongoing improvements in balance and mobility over the subsequent twelve weeks, and that nearly half achieved independent walking, and a similar proportion returned home. Performance will be measured on a range of balance and mobility measures for in-patients at a rehabilitation hospital, at four weeks post stroke, and then every two weeks until sixteen weeks post stroke. In addition, changes in dependence and final discharge destination will be investigated. Keywords: Cerebrovascular accident, equilibrium, functional recovery 173 Title: Rehabilitation consultancy service project: Barwon South West Region Principal researchers: Ms R Smith, Ms J Nankervis Co-researchers: Ms F Vrantsidis, Ms F Lentini Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: GP Association, Geelong Timetable: July 1999 - February 2000 Website: www.nari.unimelb.edu.au Outline: A blueprint to translate into practice the concept of a Regional Rehabilitation Consultancy Service at a regional level was developed following extensive consultations. Keywords: Service planning, service development, rural health, rehabilitation 174 Title: Rehabilitation services in Victoria Principal researchers: Ms R Smith, Ms F Vrantsidis Co-researchers: Ms T Seeleither, Ms F Lentini Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Aged, Community and Mental Health Timetable: 1999 - 2000 Website: www.nari.unimelb.edu.au Outline: Survey and service mapping of Victorian rehabilitation services. This data will be used by the Department of Human Services to inform state rehabilitation planning. Keywords: Service planning, service development, rehabilitation Australian Ageing Research Directory 2000 107 Multidisciplinary Ageing Research Units 175 Title: Role of bradykinin in inflammation Principal researcher: Associate Professor Z Khalil Co-researchers: Associate Professor S Brain, Mr T Cao Organisations: National Ageing Research Institute, University of Melbourne; Kings College London Status: Current Website: www.nari.unimelb.edu.au Outline: Bradykinin, an inflammatory mediator, plays an important role in modulating the inflammatory response following injury. The involvement of bradykinin receptor subtypes in the modulatory effects of bradykinin under different injury conditions has not been previously investigated. The current investigation is aimed at understanding the role of bradykinin in modulating inflammation under different injury conditions. Using established animal models, combined with specific bradykinin receptor antagonists, the data to date indicates that different receptor subtypes are involved in mediating bradykinin effects under different injury conditions. Changes in the involvement of these receptors with age is yet to be investigated. This information is clinically relevant as it could impact on treatment protocols used for different inflammatory conditions. Keywords: Injury, inflammation, bradykinin 176 Title: Role of oxidative damage in altering aged sensory nerve function: Implications for tissue repair in old age Principal researcher: Associate Professor Z Khalil Co-researcher: Ms B Khodr Organisation: National Ageing Research Institute, University of Melbourne Status: Current Website: www.nari.unimelb.edu.au Outline: Oxidative damage has been implicated in physiological ageing and a number of chronic neurodegenerative diseases associated with age. This damage is partly due to free radical reactions with fatty acid side chains of membrane phospholipids resulting in lipid peroxidation. Sensory nerves like other neuronal tissues are lipid rich and are major targets for oxidative damage. Possible damage to sensory neurones via this oxidative process (a primary “intrinsic” ageing process) could compromise their role in tissue repair (a secondary ageassociated pathological process). The role of oxidative damage in age-related functional deterioration of sensory nerves, with consequences for reduced inflammatory vascular responses and delayed tissue repair, has not been previously investigated. This project will provide new and novel data on the role of oxidative damage in age-related functional deterioration of sensory nerves (involved in tissue repair). The reduction in oxidative damage (via long term treatment with vitamin E) will be correlated with improvements in the physiological function of sensory nerves, thereby establishing clear relationships between oxidative damage and functional deterioration in this system (a primary “intrinsic” ageing process). The impact of oxidative damage on tissue repair (secondary age-associated pathological process) will be assessed using established animal models. This will provide important insights into possible new therapeutic interventions. In addition our novel findings that antioxidants could have some adverse effects necessitating the evaluation of the impact of antioxidant treatment in animal model systems. This will be of benefit for guiding the use of antioxidants in humans. The aim here is to minimise the long term effects of oxidative 108 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units damage on a primary “intrinsic” ageing process and reveal beneficial as well as undesirable side effects of antioxidant treatment on a secondary age- associated pathological process. Keywords: Oxidative damage, antioxidant treatment, adverse effects 177 Title: Senior Stats Principal researcher: Ms L Costello Co-researchers: Ms F Lentini, Ms R Smith Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Aged Community and Mental Health Division, Department of Human Services Timetable: 1998 Website: www.nari.unimelb.edu.au Outline: A project to review the utility and application of the Senior Stats software package, and to make recommendations about future program development. In addition, this project included review, analysis and write-up of the 1996-1997 HACC and Linkages data collections for Victoria. It also proposed a framework for estimation of the size of the HACC user population from available data. Keywords: Service statistics, information technology, HACC, data analysis 178 Title: Shifting cognitive task-set in healthy ageing Principal researcher: Dr J Dunai Co-researchers: Professor A Allport, Ms C MacBean, Professor J Tinder Organisation: National Ageing Research Institute, University of Melbourne Status: Current Funding: National Ageing Research Institute, University of Melbourne Timetable: Completion 2000 Website: www.nari.unimelb.edu.au Outline: A reaction time study of the ability of older individuals to switch attention between different cognitive activities. Keywords: Cognitive, healthy ageing 179 Title: Situational analysis of the veteran community Principal researcher: Dr M Farrell Co-researcher: Ms R Smith Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Veterans’ Affairs Timetable: November 1998 - February 1999 Website: www.nari.unimelb.edu.au Outline: This entailed a review and analysis of population data and veteran services. This data will be used for planning future residential care needs. This was a component of a larger project auspiced and managed by the Aged Care and Housing Group, Adelaide. Keywords: Demographics, service planning, residential care, veterans’ health Australian Ageing Research Directory 2000 109 Multidisciplinary Ageing Research Units 180 Title: Studies to improve sensory nerve function with age to accelerate tissue healing Principal researcher: Associate Professor Z Khalil Co-researcher: Mr M Merhi Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Website: www.nari.unimelb.edu.au Outline: With advanced age there is increased morbidity, in part because of a decreased capacity of individuals to maintain appropriate inflammatory and repair processes in the face of injury, infection, degenerative disease and cancer. It is well documented that acute inflammatory reactions of all kinds diminish with age, and that these reactions are an integral part of the wound healing process. Through previous research, an age-related decline in the function of sensory nerves which is associated with impaired tissue healing has been documented. The slow healing of skin wounds can have a major impact on the health and well being of older people, and on the services required to support them. This research investigated the possibility that non-invasive electrical stimulation can be used to activate the aged nerves, thus releasing neuropeptides with growth promoting effects which in turn accelerate the healing process. In this way, the potential exists for the deteriorating effect of age on sensory nerves to be minimised, and the process of healing damaged skin improved. Keywords: Sensory nerves, tissue healing, ageing 181 Title: Study of outcomes of planned learning for health care professionals: A systematic review Principal researcher: Ms J Gough Co-researchers: Dr P Darzins, Dr D Beckett Organisation: National Ageing Research Institute, University of Melbourne Status: Planned - Discussion at international research conference roundtable Funding: Application submitted Timetable: 2 - 3 year project Website: www.nari.unimelb.edu.au Outline: A review of the literature to identify best measures of outcomes of education for health care professionals. Keywords: Continuing professional education, outcome measures 182 Title: Specialist clinics Principal researchers: Dr M Farrell, Ms R Smith Co-researchers: Ms A Laffy, Ms F Lentini Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Aged Community and Mental Health Division, Department of Human Services, Victoria Timetable: 1998 - 1999 Website: www.nari.unimelb.edu.au Outline: This project had two parts: (i) development of program guidelines, clinical performance indicators and assessment guides for Pain Management and Falls and Mobility Clinics. This was achieved by working in conjunction with clinical experts; (ii) mapping existing services, considering the epidemiological, demographic, geographic and service 110 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units context factors, and proposing a plan for clinic development. This includes services such as Pain Management Clinics, Continence Clinics, CDAMS Clinics and Falls and Mobility Clinics. Keywords: Specialist multidisciplinary clinics, service planning, service development, service monitoring, performance indicators, assessment 183 Title: The examination of functional change in peripheral and central pain pathways in elderly patients suffering from chronic pain Principal researcher: Associate Professor S Gibson Co-researchers: Dr G Morris, Professor R D Helme, Mr M Farrell Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Sandoz Foundation for Gerontological Research, $10,000; Arthritis Foundation of Australia, $8,000 Timetable: 1990 - 1997 Website: www.nari.unimelb.edu.au Outline: An examination of peripheral nerve function, as indexed by axon reflex flare responses, and central pain processing using the nociceptive evoked response and changes in threshold to thermal and mechanical pain was undertaken in selected chronic pain patients. Two main groups of patients attending the North West Hospital multidisciplinary pain clinic were examined: those suffering from neuropathic mediated pain (post-herpetic neuralgia) and patients with nociceptor mediated pain (ie osteoarthritis). Patients with post-herpetic neuralgia suffering from allodynia (pain from a normally non-noxious stimulus) were demonstrated to exhibit significant impairments in peripheral nerve function. Conversely, patients with constant burning pain but no allodynia showed no change in peripheral nerve fibre function. Further, an examination of central nervous system processing, as indexed by the nociceptive evoked response, revealed that post-herpetic neuralgia patients with burning pain have increased central nervous system responses to a thermal pain stimulus, thereby emphasising a central pathophysiological component in this condition. Patients with allodynia showed no change in the nociceptive evoked response when compared with controls. These results suggest differing peripheral and central pathophysiological mechanisms in subgroups of patients with post-herpetic neuralgia, and may have important implications for the selection of appropriate treatment strategies. Responses to noxious mechanical stimulation were examined to further delineate the nociceptive mechanisms which contribute to post-herpetic neuralgia pain. Studies into the pathophysiology of osteoarthritis tested 100 subjects over two years, using a methodology similar to that of the post-herpetic neuralgia studies. This research provided insights into the pathophysiology of osteoarthritic pain and contributed to a better understanding of the similarities and differences between nociceptor type pain (osteoarthritis) and neuropathic (post-herpetic neuralgia) pain syndromes. Keywords: Pain, nervous system, osteoarthritis, neuralgia 184 Title: The presentation and assessment of people attending a memory clinic: Does cultural background make a difference? Principal researchers: Dr D LoGiudice, Dr A Hassett Co-researchers: Professor L Flicker, Associate Professor D Ames Organisation: National Ageing Research Institute, University of Melbourne Status: Current Funding: National Ageing Research Institute, University of Melbourne Australian Ageing Research Directory 2000 111 Multidisciplinary Ageing Research Units Timetable: 2000 - 2002 Website: www.nari.unimelb.edu.au Outline: In Australia, the proportion of elderly over 70 years of age of non-English speaking background is projected to reach 25% by 2001, many of whom will have dementia. Memory Clinic services are well established in Victoria, yet the potential difficulties associated with access and utilisation of these services by those of diverse cultural backgrounds have not been adequately addressed. This project addresses a number of issues pertinent in assessing the access and assessment of people and their families of non-English speaking background attending a memory clinic service. The study will compare the differences in presentation, assessment details, diagnoses and community service use between those of English speaking and non-English speaking backgrounds attending the Memory Clinic based at Melbourne Extended Care and Rehabilitation Service, Victoria. Evaluation of the validity of instruments currently being used in testing cognition will be undertaken in the non-English speaking background group to determine which aspects of the tools are most predictive for accurate diagnosis. This information will ultimately lead to determination of an appropriate cognitive instrument useful for assessment of this group of people. Finally, the effect of trans-migration on assessment of those with dementia can be determined by comparing data from a group of Italians who have migrated to Australia, with a group of Italians who have remained in their country of birth. This will assist in elucidating which factors, other than education, play a role in assessment of those with cognitive difficulties of non-English speaking background. Keywords: Dementia, memory clinic, non-English speaking background 185 Title: The relationship between subnormal serum vitamin B12 intake, and food B12 malabsorption in the elderly Principal researcher: Dr E Seal Co-researchers: Dr J Metz, Professor L Flicker Organisation: National Ageing Research Institute, University of Melbourne Status: Current Funding: Melbourne Extended Care and Rehabilitation Service Timetable: Complete 2000 Website: www.nari.unimelb.edu.au Outline: A randomised, double blind, placebo controlled study of oral vitamin B12 supplementation. Keywords: Vitamin B12, randomised controlled study 186 Title: The treatment of painful peripheral neuropathy due to diabetes Principal researcher: Dr K Taubman Co-researchers: Dr E Seal, Mr M Bradbeer Organisation: National Ageing Research Institute, University of Melbourne Status: Ongoing Funding: Pharmaceutical company Timetable: April 2000 - December 2000 Website: www.nari.unimelb.edu.au Outline: Double-blind randomised controlled trial which investigated the treatment of painful peripheral neuropathy due to diabetes. Keywords: Pain, peripheral neuropathy, diabetes 112 Australian Ageing Research Directory 2000 Multidisciplinary Ageing Research Units 187 Title: Training program for staff assessing client need for personal alert services Principal researchers: Ms J Nankervis, Ms M Lindeman Co-researchers: Dr K Hill, Ms M Nihill Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Department of Human Services, Eastern and Southern Metropolitan Regions Timetable: 1999 Website: www.nari.unimelb.edu.au Outline: A training program was developed for staff assessing client need for personal alert services. Keywords: Assessment guidelines, service access, personal response systems, training program 188 Title: Unplanned readmission of Post Acute Care Facilitation Unit clients Principal researcher: Ms R Smith Co-researcher: Ms A Laffy Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: Post Acute Care Facilitation Unit, North Western Health Timetable: 1998-1999 Website: www.nari.unimelb.edu.au Outline: This project aimed to explore factors which underpin unplanned readmission to hospital for post acute care clients and then to recommend strategies to reduce avoidable, unplanned readmissions. In depth case studies which include medical record review, interviews with hospital and community service providers, the client/carer and the post acute care staff are the central data source for the study. Keywords: Hospital care, post acute care, unplanned readmission, service evaluation, health outcomes, quality of care 189 Title: Use of home aids and appliances Principal researcher: Ms R Smith Co-researchers: Associate Professor S Quine, Ms J Anderson Organisation: National Ageing Research Institute, University of Melbourne Status: Completed Funding: HACC Service Development Grant Timetable: 1998 - 1999 Website: www.nari.unimelb.edu.au Outline: This involved an assessment of factors that affect the adoption of home aids and appliances. Keywords: Home assessment, equipment use, consumer satisfaction 190 Title: Well for Life Principal researchers: Ms R Smith, Ms A Bryce, Ms J Gough, Dr K Hill, Ms M Lindeman, Ms A Stewart Co-researchers: Ms B Gilsenan, Ms K Black Australian Ageing Research Directory 2000 113 Multidisciplinary Ageing Research Units Organisations: National Ageing Research Institute, University of Melbourne; Dietitians Association of Australia, Victorian branch Status: In progress Funding: Public Health and Development, Department of Human Services Timetable: 1999 - 2000 Website: www.nari.unimelb.edu.au Outline: The Well for Life project was designed to support the development of organisational practice and policy to enhance the social and physical health and well-being of the residents of aged care settings through improved nutrition and physical activity opportunities. This project focused on organised care settings for older people: Supported Residential Services and Aged Care Facilities (low and high care). Interventions and materials generated during the development phase (Phase 1) were further trialled and refined in the implementation phase (Phase II). The project incorporated an action research approach to foster and support workplace change. A range of project products will benefit residents, staff and management of these facilities. Keywords: Evidence based practice, quality of care, residential care, action research, nutrition, physical activity, workplace learning, workplace change 191 Title: Wound healing in aged animals: trophic action of peptides and growth factors Principal researcher: Associate Professor Z Khalil Co-researcher: Professor R D Helme Organisation: National Ageing Research Institute, University of Melbourne Funding: National Health and Medical Research Council Status: Completed Website: www.nari.unimelb.edu.au Outline: Ageing adversely affects wound healing rates and recent studies suggest that an intact nociceptor system of primary afferent nerves is important for successful skin repair. The major reason for delayed healing with age appears to be a prolonged lag phase between the injury and contraction of the wound. The fact that C-fibre function declines with age could partly account for poor healing qualities of the skin over the extremities in older people. An established thermal wound model is used to investigate the possible trophic action of specific peptides and growth factors, by injecting the drug at the site of injury and monitoring wound healing over time. The use of sensory peptides in promoting wound healing represents an adaptation of treatment to age-related change. Two groups of drugs, sensory peptides (SP, NKA and CGRP) and growth factors (LIF and NGF) are tested independently or together for their ability to promote healing in aged rats, and this is compared with a control aged group receiving saline injections. Results show that both SP and CGRP can enhance wound healing in aged rats, and that the use of these peptides in a specific sequence can further accelerate the rate of healing. Keywords: Biochemistry, wounds and injuries, peripheral nervous system 114 Australian Ageing Research Directory 2000 Medical Research Medical Research Dentistry 2.1 AIHW Dental Statistics and Research Unit, University of Adelaide 192 Title: The Adelaide dental study of nursing homes Principal researcher: Dr J Chalmers Co-researchers: Dr C Hodge, Mr K Carter, Professor A J Spencer, Dr J Fuss Organisations: AIHW Dental Statistics and Research Unit, University of Adelaide; Australian Dental Association (SA Branch) Status: Completed Funding: Baseline - Australian Dental Association (SA Branch) and AIHW Dental Statistics and Research Unit; One-year - Australian Dental Research Foundation, Australian Dental Association (SA Branch) and AIHW Dental Statistics and Research Unit Timetable: September 1997 - December 1999 Outline: The Adelaide Dental Study of Nursing Homes aimed to determine the prevalence and incidence of oral diseases in residents of seven randomly selected Adelaide nursing homes, and also to investigate the oral health status of existing versus new residents. Oral epidemiological dental inspections were completed for 224 residents at baseline and 186 residents at one-year. Weighted oral health data revealed that residents had a high prevalence and incidence of dental caries and other oral diseases/problems. Existing and new residents were found to have a similar oral health status. New residents were entering nursing homes with a compromised oral health status, which continued to rapidly decline during their institutionalisation. The study also mailed questionnaires to all practising Adelaide dentists and nursing home Directors of Nursing to quantify dental service provision in Adelaide nursing homes and to investigate the problems encountered with the organisation and provision of dental care for residents. Dental service provision for nursing homes was very low. The most frequent problems encountered reflected the inability of dental professionals to provide dental care on-site at nursing homes, resulting in the need to transport residents to dental practices. Dentists and Directors of Nursing also held some differing perceptions of problems. Directors of Nursing perceived resident-related cognitive and behavioural problems to be more frequently encountered. However, dentists perceived organisational-related problems such as a lack of suitable area for dentistry, increased time needed to provide dental treatment at nursing homes, and low priority given to dental care by nursing home staff, to be more frequently encountered. Keywords: Dental health, residential care, carers, dementia, nursing homes 193 Title: The oral health of community-dwelling older adults with dementia Principal researchers: Professor A J Spencer, Dr J Chalmers Co-researcher: Mr K Carter Organisation: AIHW Dental Statistics and Research Unit, University of Adelaide Status: In progress Funding: AIHW Dental Statistics and Research Unit, baseline funding; National Health and Medical Research Council, one-year and 2-year funding Australian Ageing Research Directory 2000 115 Medical Research Timetable: June 1998 - June 2001 Outline: The Oral Health of Community-Dwelling Older Adults with Dementia study aims to determine the prevalence and incidence of oral diseases in community-dwelling older adults with dementia, and to also determine risk profiles for these oral diseases. This longitudinal study uses a random sample from the list of carers who had contacted the Alzheimer’s Association of South Australia. Interviews and dental inspections are being conducted at baseline, 1-year and 2-years over a 8-month period with 115 dementia and comparison subjects. After consent is obtained, interviewers hold discussions with the person with dementia and any carers/family members to complete questionnaires. The questionnaire contains close-ended questions to collect information concerning the person’s oral hygiene practices and assistance required with oral hygiene, problems encountered providing oral care for the resident, time since, reason for, and treatment provided at last dental visit, smoking and alcohol consumption, medical history, current prescription and over-the-counter medications, chewing abilities, swallowing problems, carer burden, and educational and economic status. Assessment of functional status was conducted using the Katz, (1963) Index of Activities of Daily Living and the Lawton, (1969) Instrumental Activities of Daily Living scales. Following the completion of the dental inspection, a Mini Mental State Exam (MMSE, a Clock Drawing Test and a Global Deterioration Scale (GDS) is completed. Keywords: Dental health, community dwelling elderly, older adults, dementia 194 Title: The South Australian dental longitudinal study Principal researcher: Professor A J Spencer Co-researchers: Dr G Slade, Dr M Thomson, Dr J Chalmers, Mr K Carter, Dr K RobertsThomson Organisation: AIHW Dental Statistics and Research Unit, University of Adelaide Status: Baseline, 2-year and 5-year data collections completed. Grant proposal submitted for 10-year data collection in 2001. Funding: NIH, NHMRC Timetable: June 1991 - June 2002 Outline: This study aims to determine the prevalence and incidence of oral diseases in community-dwelling older adults residing in Adelaide and Mt Gambier. A stratified random sample of community-dwelling older adults was selected from the electoral database. Additional areas investigated in this longitudinal study have included the social impact of oral diseases, and the relationship between xerostomia (dry mouth), salivary gland hypofunction, medications and dental caries. Baseline oral epidemiological dental inspections were completed for 1,226 participants. At the most recent data collection at five-years, dentate participants from two-years and edentulous participants from baseline were interviewed and examined. The telephone interview was completed by 939 participants, with 709 of these (530 dentate and 179 edentulous) also having a clinical examination. Of those examined, 213 resided in Mt Gambier, the remainder resided in Adelaide. The Oral Health Impact Profile was completed by 792 participants. A dry-mouth questionnaire was completed by 639 of those examined, saliva samples were collected from 676 of those examined and a clock-drawing screening test of cognitive status was completed by 687 of the examined participants. This study has found the prevalence of edentulism (loss of all teeth) to be rapidly decreasing, with more older adults retaining some of their natural teeth. Older adults wearing dentures do have many denture-related problems and treatment needs. Coronal and root caries are significant oral health problems for these generally healthy and functionally independent older adults. Keywords: Dental health, community-dwelling elderly, older adults 116 Australian Ageing Research Directory 2000 Medical Research 2.2 Dental Health Services Victoria 195 Title: Evaluation of a community-based oral health promotion program for migrant older adults Principal researchers: Professor F A C Wright, Dr R Marino, Associate Professor V Minichiello, Associate Professor M Schofield Co-researchers: Associate Professor M V Morgan, Dr H Calache Organisations: Dental Health Services Victoria; School of Health, University of New England Status: Commenced Funding: Vic Health (Victorian Health Promotion Foundation) Timetable: February 2000 - December 2002 Website: www.dhsv.org.au Outline: This study aims to provide unique and comprehensive information on the oral health status, oral hygiene, oral health knowledge, attitudes and practices and patterns of use of oral health care services on non-English speaking background (Italian and Greek Australian) older adults. The study will also evaluate the impact of a community-based oral health promotion intervention on the oral health knowledge, attitudes and practices of Italian and Greek seniors in Melbourne. Keywords: Ethnic aged, dental health, education 196 Title: Improved oral health for older people: A strategic impact program Principal researchers: Dr D Cole, Dr P Dalgliesh, Dr W Evans, Associate Professor M V Morgan Co-researchers: Dr A Campain, Ms S Hudson, Professor C Wright Organisation: Dental Health Services Victoria; School of Dental Science, University of Melbourne Status: In progress Funding: ANZ Charitable trusts, $400,000; Department of Human Services, $100,000 Timetable: October 1998 - December 2000 Website: www.dhsv.org.au Outline: The principal aim is to establish a cost effective oral health maintenance program to improve the oral health and comfort of disadvantaged older persons, who reside in hostels, nursing homes or are homebound. The project addresses the problem of improving the dental status of the older community in a time of low funding and as increasing numbers are retaining their teeth. In addition, the disadvantaged have a backlog of care. The program works from the premise that prevention is better than cure. It presents and tests the comparative benefits of two innovative preventive approaches to providing a cost-effective program to achieving oral comfort and function for the older person. There is an increasing number of frail and dependent adults relying on the assistance of caregivers for personal support including oral hygiene practices. Lack of dental health knowledge and skills of caregivers creates a problem for access to dental care. Good dental health is particularly important for maintaining a healthy diet as pain on eating or difficulty with eating can lead to poor levels of nutrition. About half of older people (55 years plus) do not use dental services regularly and have had an extensive experience of dental decay. The program aims to (i) increase the capacity of individuals and caregivers to improve and maintain adequate oral health by developing and implementing a training program for them; (ii) introduce oral health training to aged care worker curriculums; (iii) implement fluoride programs; (iv) determine Australian Ageing Research Directory 2000 117 Medical Research the most effective way of reducing oral disease and improving comfort; (v) reducing risk factors for oral diseases; (vi) provide palliative dental care for at least 1,300 individuals to control pain and restore function; (vii) measure the improvement in comfort and oral health; (viii) improve access to dental care by removing financial, physical and other barriers to receiving care; (ix) identify the most cost effective of the programs to present to governments for the provision of ongoing funding and policy changes. The program combines best preventive clinical practices, minimal, but essential dental care of the older people in institutions and provision of knowledge, skills and tools to the individuals and caregivers. The entire sample of 1,300 persons aged 55 years and over will receive on an as needs basis palliative restorative dental care by a domiciliary dental team. Prosthetic services will be provided as required to dentate individuals. All edentulous patients will be referred for care if required through the normal public/private dental system. Those in the sample with natural teeth will be involved in the implementation of three programs: Program 1 involves nightly application by the individual or carer using a toothbrush with a low concentration neutral fluoride gel to the outside of the teeth where the teeth and gums meet. This also involves the development and trial, with Royal Melbourne Institute of Technology and STEP Group Training, of a learning module for caregivers. Program 2 involves a monthly professional fluoride application in a tray. Program 3 involves the control group. Keywords: Dental, oral health, older people, aged care, disadvantaged General Practice 2.3 Brisbane North Division of General Practice 197 Title: TEAMCare Health Coordinated Care Trial Principal researcher: Mr I Watts Co-researchers: Dr B Wenck, Mr M Page Organisation: Brisbane North Division of General Practice Status: Completed Funding: Tracking and design phase $1.3mill; Live/care coordination phase $1.4mill. Timetable: November 1996 - June 2000 Website address: www.bndgp.com.au Outline: The coordinated care trials aimed to develop and test different service delivery and funding arrangements, and to determine the extent to which the coordinated care model contributed to improved client outcomes, better delivery of services which are individually or collectively more responsive to clients’ assessed needs and more efficient ways of funding and delivering services. Coordinated Care Trials were expected to provide formal opportunities to (i) examine current processes; (ii) implement mechanisms for coordination of care; (iii) undertake clinical pathing and tracking within the community setting; (iv) identify and analyse unit costs within the context of community services; (v) assess the benefits of a coordinated care approach to the care of frail aged people with complex care needs The Trial utilised a geographic split to create intervention and control groups. Outcomes were measured through comparisons between these groups as well as longitudinal studies of the intervention group. External evaluations are being undertaken at both the local and national level. The eligibility criteria for participation in the Trial was: (i) people over 65 years of age (or 50 years if from an Aboriginal or Torres Strait Islander background) and (ii) who reside in the Brisbane North area (including the Pine Rivers Shire), and (iii) who have care needs which require the recurring use of four or more HACC services and (iv) who are able to 118 Australian Ageing Research Directory 2000 Medical Research understand the broad purpose of the Trial and the implications of their participation. People receiving health care services through a Community Aged Care Package or palliative care services are not eligible. Participants in the Intervention arm of the Trial had to reside within and have a general practitioner who practiced in the northern suburbs of Brisbane. Those in the Control arm predominantly resided within and had a general practitioner who practiced in the southern suburbs of Brisbane. The Trial developed a differential model of care coordination that resulted in participants being allocated into either of the High and Moderate Needs Groups. These classifications were continuously reviewed resulting in shifts between the groups for a number of participants. For participants in either group, their general practitioner was the Care Coordinator. Participants in the High Needs Group were also assigned a Service Coordinator, who were experienced community nurses employed by the Trial. The Service Coordinators completed standardised assessments of the participants as well as working with the general practitioner to facilitate appropriate levels of care and services (especially community-based care & services). The Trial also undertook a number of broad based (e.g. education, prevention etc) and individualised (purchase of services e.g. respite and equipment e.g. walking aids) programs, and implemented many strategies aimed at increasing linkages within the local health system (e.g. General practitioners received daily notifications of admissions to or discharges from hospital in regard to their patients). Keywords: Coordinated care, coordination, care planning, integration, general practice, Division of General Practice 2.4 Department of Community Medicine and General Practice, Monash University 198 Title: A study of Chinese attitudes to institutional care of the aged from a population of members of the Chung Wah Association, Western Australia Principal researcher: Dr Y F Chan Co-researcher: Professor L Piterman Organisation: Department of Community Medicine and General Practice, Monash University Status: Completed Timetable: 1996 - 1997 Outline: This study, conducted using a cross-sectional postal survey of 456 (56% response rate) members of the Chung Wah Association in Western Australia, explored Chinese attitudes to institutional care of their aged and identified factors which influenced these attitudes. The study found that 86% of the respondents agreed that the disabled elderly should be institutionalised. The 40-49 years age group contributed mainly to the respondents’ attitude to institutionalise the disabled elderly, while sex, education, occupation, country of origin, and length of residence in Australia made no significant contribution. Social reasons such as no family help and restricted family activities of the respondents, together with the health factors of the elderly had important effects on these attitudes. About 55% of respondents felt that their Chinese culture influenced their attitude. 21% of respondents agreed that the nondisabled elderly should be institutionalised. Respondents, if disabled, were more likely to institutionalise their disabled elderly and were also unlikely to live with their children on turning 60 years. The majority of respondents were in favour of government funding of institutions and care-givers of elderly. Keywords: Culture, aged care, institutionalisation, attitudes, ethnic aged Australian Ageing Research Directory 2000 119 Medical Research 199 Title: Depressive disorders in elderly Chinese patients attending primary health care centres in Macau. A comparison of general practitioners consultations and the results obtained using a depression screening scale Principal researcher: Dr C Canhota Co-researcher: Professor L Piterman Organisation: Department of Community Medicine and General Practice, Monash University Timetable: 1997 - 1998 Outline: According to the morbidity data of the Macau Primary Health Care Department, the diagnosis of depressive conditions in elderly patients is 0.06%, and the overall neurosis disorders count for 0.4% of diagnoses in the same age group. Are depressive disorders and other neuroses so uncommon or are doctors and their patients sharing and practising the same restrictive biomedical health model, giving no place for psychosocial complaints? An analytical cross-sectional study was done on a random systematic sample of elderly Chinese patients, who attended Community Health Centres for consultation. A questionnaire to identify the individual’s characteristics and the Hospital Anxiety and Depression Scale, previously adapted to a Chinese elderly population, were used. A checklist of 28 complaints/symptoms was used to evaluate the patient’s recent complaints and their motive for consultation. The recording of such complaints in the clinical records was also evaluated. The frequency of depression in Chinese elderly in this study was around 55%, as revealed by the Hospital Anxiety and Depression Scale questionnaire. The general practitioner’s diagnosis of depression was non- existent. The frequency of symptoms/complaints, especially of psychological complaints, was generally high, in the depressed elderly. These symptoms/complaints were not expressed spontaneously by the elderly but, when asked directly, they were shared with the medical professional. There was a statistically significant correlation between the occurrence of depression and age 75 years and over, or being female or being socially isolated. In this study, social class, type of living and economic dependency did not show a statistically significant relationship with depression. In conclusion, the frequency of depression in elderly attending the Health Centre is quite high and probably serves to compound the discomfort of other coexisting illnesses. Some possible causes for the high frequency of depression are suggested in this study. Using an available scale for detection of depression can alert the general practitioner to the possibility of being in presence of an elderly with psychological distress. Efforts must be made to enhance the knowledge, skills and attitudes of the medical professional towards psychological problems. Keywords: Depression, general practice, screening, ethnic aged 200 Title: The efficacy of an education/exercise program in a group of elderly people with musculoskeletal pain Principal researcher: Dr K Wilkie Co-researcher: Dr I Chenoweth Organisation: Department of Community Medicine and General Practice, Monash University Timetable: September 1996 - March 1998 Outline: The aim of this study was to develop and evaluate a program of primarily nonpharmacologic interventions specifically designed for the treatment of osteoarthritis in general practice in Australia. A psycho-social educative intervention was developed combining many elements including exercise, patient education, alternative treatments and social support. This was an experimental study and patients were assessed over a four month period. The program is easily reproducible for general practitioners and modifiable to other chronic illnesses 120 Australian Ageing Research Directory 2000 Medical Research commonly encountered in general practice and provides a useful framework on which to base interventions in general practice. Keywords: Elderly, exercise, musculoskeletal pain, osteoarthritis, general practice 2.5 Department of General Practice, University of Adelaide 201 Title: Randomised controlled trial of 75+ health assessment Principal researcher: Dr J Newbury Co-researcher: Professor J Marley Organisation: Department of General Practice, University of Adelaide Status: Nearing completion Funding: Department of Health and Aged Care, General Practice Evaluation Program Timetable: February 1998 - May 2000 Website: http://www.helth.adelaide.edu.au/gp/ http://som.flinders.edu.au/FUSA/GPNIS/ Outline: The research aimed to (i) conduct a randomised controlled trial of 75+ Health Assessment using an assessment instrument designed in a pilot study (GPEP 334); (ii) evaluate the 75+ Health Assessment’s ability to uncover problems; (iii) evaluate the general practitioners’ ability to coordinate care of problems revealed. The randomised controlled trial was based in the Adelaide Western Division of General Practice. One hundred patients were recruited from six general practices. Control patients completed a Short Form 36 (SF-36) at enrolment and were then left to usual care. Intervention patients had a 75+ Health Assessment and a SF-36 at enrolment and their nominated general practitioner received a report of their 75+ Health Assessment. No interval reminders of problems revealed were delivered to general practitioners of the intervention patients. Both groups were visited twelve months later and had a 75+ Health Assessment and a SF-36. Final visits were completed in February 2000. The SF-36 was used to measure quality of life and to compare control and intervention group. Data are currently being analysed. Preliminary analysis includes five deaths in the control group and one in the intervention group (p=0.20). Medicare item numbers for 75+ Health Assessments were introduced on 1 November 1999. Implementation of this initiative is proceeding with Divisional support. The results of this randomised controlled trial of 75+ Health Assessment will guide evaluation of this aspect of aged care. Keywords: Health assessment, preventive home visits, randomised controlled trial 2.6 Division of General Practice, Central Sydney Area Health Service 202 Title: Advance health care directives Principal researchers: Professor M Mira, Dr L Hindmarsh Co-researcher: Ms C Raynes-Greenow Organisation: Division of General Practice, Central Sydney Area Health Service Status: In progress Funding: Commonwealth Government Timetable: Three year project Outline: An Advance Health Care Directive is a written statement that contains a person’s wishes regarding their future health care. This directive is used to inform health care professionals, family and carers of these decisions if the person is unable to make their own Australian Ageing Research Directory 2000 121 Medical Research decisions known due to illness or dementia. The key concept behind Advance Health Care Directives is the patient autonomy over personal health care. Advance Health Care Directives allow a person to make decisions about her/his future quality of life. A pilot was conducted in the Area Health Service during 1998 and 1999. It trialled the use of Advance Health Care Directives in general practice. The results of the pilot suggest that an Advance Health Care Directives program is feasible in the general practice setting. Currently, the program is being designed to be more NSW specific, and there are plans to implement the program on a wider scale within Central Sydney. The original program comes from extensive research in nursing homes and hospital settings in Canada, where Advance Health Care Directives are well supported and extensively used. Keywords: Directive, living wills, future health, choice, patient autonomy 2.7 DiNCQUMGP Divisions National Consortium for the Quality Use of Medicines in General Practice 203 Title: DiNCQUMGP – Polypharmacy in the elderly program Principal researchers: Dr P Bolton, Dr D Steed, Dr A Kwong, Dr M Surveyor, Ms J Tasker Organisation: DiNCQUM National Consortium comprising Central Sydney Division of General Practice; Central Coast Division of General Practice, NSW; Fremantle Division of General Practice, WA; Osborne Division of General Practice, WA; The Pharmaceutical Alliance Status: Completed Funding: Divisions of General Practice; Merck Sharpe and Dohme; The Pharmaceutical Alliance; Department of Health and Family Services Timetable: May 1998 - December 1999 Outline: Polypharmacy, the prescribing of multiple medications for a patient, is common in older people and accounts for significant morbidity and mortality in the aged. The program aims to promote, support and maintain rational prescribing among general practitioners and to encourage quality use of medicines as part of day-to-day practice. The program involved general practitioners from four Divisions of General Practice volunteering for participation. They enrolled up to twelve of their patients for medication review. Patients met specific criteria: people aged 65 and over who used five or more prescribed medications, living at home or in aged care residential facilities other than nursing homes, and not clients of the Department of Veteran Affairs. Before recruitment of patients, participating general practitioners attended two Continuing Medical Education (CME) accredited workshop evenings where they received information about prescribing for the elderly with a focus on cardiovascular and psychotropic medications, as well as information about how to conduct medication reviews. General practitioners received a copy of the Australian Medicines Handbook as a resource to help them in the medication review process. General practitioners conducted an initial medication review and recorded data about the patient’s medications and the reasons for prescribing these. Patients were asked to complete the health assessment SF36 form at the time of the medication review. The medication review and patient completion of the SF-36 were repeated 6-9 months later (the second review) to reassess patients and encourage maintenance by general practitioners and patients of behaviour changes in respect of changes made at the initial review and to assess the extent of this change. In all, sixty-two general practitioner volunteers from four divisions recruited 694 patients to participate in the program and 466 patients underwent both medication reviews. The median age of participants was 74 years, range 61-98, interquartile range (IQR) 70-79. There were 232 (33.5%) men and 122 Australian Ageing Research Directory 2000 Medical Research 461 (66.5%) women who participated in the study. Results showed a statistically significant decrease in the number of medications and the dose of benzodiazepines and an increase in the number of SSRI antidepressants following medication review using both linear modelling and paired techniques. There was also a reduction in the number of benzodiazepines using paired techniques which was not seen using linear modelling techniques. There was a trend to a reduction in tricyclic antidepressant prescriptions seen using paired techniques. Keywords: Medication review, collaboration, elderly, consumer, general practitioner 2.8 General Practice Professorial Unit, University of Sydney 204 Title: Coordinated and continuing care: Factors in the transition from hospital to residence Principal researcher: Professor D Saltman Organisation: General Practice Professorial Unit, University of Sydney, Manly Hospital Status: Completed Funding: General Practice Evaluation Program Timetable: January 1996 - July 1997 Outline: This research aimed to (i) determine the relationship between functional status and continuity of care over time; (ii) assess the validity and psychometric properties of an Australian functional status instrument; (iii) describe functional status over time; (iv) assess the feasibility of establishing international, national and local collaborative research efforts and databases in the topic area of functional status. Keywords: Functional status, continuity of care 205 Title: GP and specialist costs, utilisation and functional status in elderly patients Principal researcher: Professor D Saltman Co-researcher: Ms M Ahern Organisation: General Practice Professorial Unit, University of Sydney, Manly Hospital Status: Commissioned Funding: General Practice Evaluation Program Timetable: May 2000 - May 2001 Outline: The project seeks to conduct a secondary analysis of the Manly Hospital Cohort Study data. This study is an unique opportunity to link individual hospital casemix, Medicare and functional status data. Keywords: Functional status, health status 206 Title: Patient and provider feedback project Principal researcher: Professor D Saltman Co-researcher: Dr M Harris Organisation: General Practice Professorial Unit, University of Sydney, Manly Hospital Status: Completed Funding: General Practice Evaluation Program Timetable: April 1997 - December 1998 Outline: The study was the second phase of the Manly Hospital Cohort Study. During the first stage, it was found that participants were interested in receiving feedback about their health and functioning and their use of health services. The second stage developed a study in Australian Ageing Research Directory 2000 123 Medical Research which functional status and health care utilisation information was fed back to participants of the cohort. The project was unique in that patients in Australia have not had access to this type of information about themselves. It was also unique as it examined the relationship between functional status and health service utilisation in this group of elderly patients recruited from the hospital. Keywords: Health status, functional status 2.9 Northern Sydney Division of General Practice 207 Title: Greenwich Hospital home-based rehabilitation project Principal researchers: Mr M Burke, Ms L Anderson Organisation: Northern Sydney Division of General Practice Status: Completed Timetable: May 1997 - June 1999 Outline: After two and half years of involvement in the establishment and operating of the Greenwich Hospital home-based rehabilitation service, the Division’s financial sponsorship of the project ceased on 30 June 1999. Between May 1997 and April 1999, 62 local general practitioners attended 102 home-based patients. General practitioner involvement with a specialist rehabilitation team has been an essential feature contributing to the success of this project. Home-based rehabilitation was found to be a satisfactory alternative to inpatient hospital care. Functional outcomes for home based rehabilitation are equivalent to traditional inpatient rehabilitation care. Home-based rehabilitation is safe with adverse events equivalent to inpatient hospital rehabilitation. The service was well received by patients and carers with a high level of satisfaction of the service. General practitioners who had managed home-based patients endorsed the service. The delivery of home-based rehabilitation model of care is an efficient use of health resources in selected patient groups. The benefits may be more marked for patients referred directly to home-based rehabilitation from the acute setting although this would require more detailed study with a larger sample size. Participating general practitioners, health providers and consumers have made recommendations for improved service delivery. From 1 July 1999, the Northern Area Health Service has agreed to continue the home-based rehabilitation program as a part of the rehabilitation services available through Greenwich Hospital. General practitioners will continue to be invited to participate in the service by contributing to pre-discharge planning through a faxed general practitioner consultation sheet and by visiting home-based patients once they are in their own homes. Keywords: Rehabilitation, home-based rehabilitation, general practitioners Geriatric and Community Medicine 2.10 Aged Care Service, Austin and Repatriation Medical Centre 208 Title: Multicentre study assessing clinical safety and efficacy of PAI-2 applied topically to venous leg ulcers Principal researcher: Dr M Woodward Co-researcher: Dr I Tan Organisation: Aged Care Service, Austin and Repatriation Medical Centre 124 Australian Ageing Research Directory 2000 Medical Research Status: In progress Funding: Biotech Australia Timetable: Commenced May 1999 Outline: This is a double-blind, randomised, parallel group, multicentre study assessing the clinical safety and efficacy of Plasminogen Activator Inhibitor Type 2 (PAI-2) gel in the treatment of venous leg ulcers. 132 participants aged 18 years and over with diagnosed venous leg ulcers are treated with topical application of PAI-2 gel or a matching placebo gel. This treatment is in addition to standard compression therapy. Participants receive treatment either in the outpatient clinic or their own homes for twelve weeks. For a further three months, participants are assessed monthly to determine the long term efficacy and safety of the study medication. Compression therapy is maintained during this period. Clinical assessments are made throughout the three month treatment phase and the follow-up phase. These include measurement of healing using tracings of the ulcer and planimetry, photographic evidence, assessment of PAI-2 levels in plasma and haematology and biochemistry. Keywords: Venous leg ulcers, plasminogen activator inhibitor 209 Title: Prevalence, bother and quality of life effects of lower urinary tract symptoms after stroke and in normal controls Principal researcher: Dr M R Bird Co-researchers: Professor G Donnan, Dr A Thrift, Dr D Fonda Organisations: Aged Care Services, Austin and Repatriation Medical Centre; National Stroke Research Unit Status: In progress Funding: National Continence Management Strategy, $70,000 Timetable: 1999 - 2001 Outline: The aims of this study are: (i) to determine differences in the prevalence of lower urinary tract symptoms including frequency, nocturia and urinary incontinence between a prospective community based stroke census and age and sex-matched neighbourhood controls; (ii) to measure the impact of urinary symptoms using newly developed ‘bother’ scores and condition specific quality of life measures in both groups; (iii) to determine the use of continence services in the management of bothersome lower urinary tract symptoms in both groups. Keywords: Stroke, incontinence 2.11 Cognitive Neuropsychiatry Research and Academic Unit, University of Melbourne 210 Title: Progressive changes in brain structure and function in patients with schizophrenia-like illnesses developing for the first time after the age of 60 years. The nature of progressive brain changes in first episode, late-onset psychosis Principal researchers: Associate Professor C Pantelis, Dr A Hassett Co-researchers: Associate Professor D Ames, Professor T Barnes, Dr J Buchanan, Associate Professor E Chiu, Dr P Desmond, Dr R Knafele, Associate Professor P Maruff, Professor C Masters, Ms J E M Riffkin, Dr C Ritchie, Ms A Scholes, Ms D Smith, Dr D Velakoulis Organisations: Cognitive Neuropsychiatry Research and Academic Unit, University of Melbourne; School of Psychological Science, La Trobe University; Sunshine Aged Persons’ Mental Health Unit; Broadmeadows Aged Persons’ Mental Health Unit; Department of Australian Ageing Research Directory 2000 125 Medical Research Psychiatry, Frankston Hospital; St George’s Health Service; Department of Pathology, University of Melbourne; Mental Health Research Institute of Victoria Status: Planned Funding: Department of Human Services Timetable: June 2000 - June 2005 Outline: Few investigations have involved the examination of patients with schizophrenialike psychosis developing for the first time after the age of 60 years. Furthermore, the classification of these disorders is controversial and not well defined. Evidence suggests that psychoses of old age may be differentiated into at least two types: (i) a psychotic illness that is similar to schizophrenia, which has a non-progressive course and is similar to early-onset schizophrenia; (ii) a late-onset delusional disorder where cognitive impairment is more generalised and there appears to be an overlap with disorders of old age, such as dementing illness, in which there is progressive deterioration. To date there have been few adequate studies which have investigated the psychoses of old age from the neuropsychological and structural imaging perspective to assess whether or not they can be differentiated in this way. The ability to diminish these disorders will have important implications for management and treatment as well as adding to the body of knowledge and understanding of these illnesses in the elderly. The purposes of this longitudinal study are to examine the radiological and neuropsychological features at the onset of the psychotic illness that develops for the first time in later life, and to determine how these features change over time. In addition, the study will investigate whether neurobiological (neuroimaging and neuropsychological) indices at baseline and follow-up discriminate between late-onset schizophrenia and late-onset delusional disorder, and relate these changes to clinical phenomenology. The study will also attempt to determine whether these late-onset schizophrenia and late-onset delusional disorder can be differentiated based upon differences in ApoE genotype. Finally, the study aims to identify social and personality factors in patients with first episode late-onset psychosis and also to discriminate between patients with late-onset psychosis, the non-psychotic elderly and younger persons with schizophrenia. Keywords: Late-onset, psychosis, schizophrenia, delusional disorder, dementia, ApoE genotype 2.12 Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital 211 Title: A private hospital multidisciplinary geriatric assessment unit Principal researchers: J Faunt, R Penhall, J Siggins Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Ongoing Outline: This project aims to describe prospectively the population of patients admitted to the geriatric assessment group in comparison to another group of like hospitalised patients and detail the function of the unit. The project outcomes will be patient, family and local doctor satisfaction; improved assessment and management; shorter length of stays; better discharge outcomes; savings. Keywords: Geriatric assessment unit, private hospital, hospital population 212 Title: Hypertension in the Very Elderly Trial (HYVET) Collaborating Centre Principal researcher: Dr R Penhall 126 Australian Ageing Research Directory 2000 Medical Research Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Planned Outline: This project will aim to detect a significant difference in stroke events between placebo and active treatment in hypertensive patients aged 80 years or over. It will provide experimental data on the benefits of treatment of high blood pressure in the very old in primary and secondary prevention of fatal and nonfatal strokes. Keywords: Hypertension, stroke events, high blood pressure 213 Title: Prevalence of sleep disordered breathing and the effect of continuous positive airway pressure treatment of sleep disordered breathing on cognitive functioning, quality of life and recovery following stroke Principal researchers: R Antic, P Thompson, Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Pilot phase Outline: This is an after study, during the acute phase in the Stroke Unit of patients with the potential for rehabilitation, to determine sleep disordered breathing using a portable monitoring system. Half of those so diagnosed will receive nasal continuous positive airway pressure for four weeks during rehabilitation. The expected project outcomes are (i) validation of the portable monitoring system; (ii) determination of the natural history of upper airways dysfunction in stroke patients exhibiting abnormalities during the initial diagnostic study; (iii) clarification of the level of acceptance of continuous airways pressure by stroke patients with rehabilitation potential and its impact on outcome. Keywords: Stroke, sleep, sleep disordered breathing, airway pressure treatment 214 Title: Preventing falls in the elderly: Is head-up bed tilt effective? Principal researchers: J Faunt, A Tonkin, Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Planned Outline: This study aims to establish the usefulness of head-up bed tilt in the prevention of falls in a group of semi-independent elderly volunteers. It will provide confirmation of the effectiveness and tolerability of modified head up bed tilt in the management of orthostatic intolerance and prevention of falls, and result in fewer falls so less injuries, less deaths and reduced aged care costs. Keywords: Falls, falls prevention, head-up bed tilt 215 Title: Principles for best medical practice around decision making Principal researcher: Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: In progress Outline: This study aims to establish guidelines to facilitate best practice in the care of older persons. The outcomes will be awareness of responsibilities and legislative requirements, appropriate documentation and improved assessment and care. Keywords: Best practice, assessment Australian Ageing Research Directory 2000 127 Medical Research 216 Title: Report on the operation of a hospital based geriatric rehabilitation unit Principal researchers: K Buchiw, P Stewart, T McDonald, Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Ongoing Outline: This project aims to describe a focus on rehabilitation of older people after an acute illness. The expected outcomes are patient improvement clinically and functionally to enable a population with previous limited access to rehabilitation to return to community living. Keywords: Rehabilitation, geriatric rehabilitation unit, acute illness 217 Title: Stroke rehabilitation database Principal researcher: Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Ongoing Outline: The project entails the collection of relevant data from all admissions to a stroke rehabilitation unit over a five year period. The collected data will be used to further understand the process of rehabilitation after a stroke. Keywords: Stroke, Stroke rehabilitation 218 Title: The community view of health status and outcomes after hospital care Principal researchers: Dr R Penhall, P Drysdale Organisation: Department of Geriatric And Rehabilitation Medicine, Royal Adelaide Hospital Status: Completed Aim: This study aims to use the SF36 Health Status Assessment Tool clinically to assess the patient's perspective of health status after hospital inpatient care over a twelve month period. The outcomes were (i) the collection of normative data on perceived health status and outcomes in both geriatric and general medical patients; (ii) determination of factors that may influence the perception patients have about their health status and outcome in an ambulatory setting; (iii) understanding of the usage and sensitivity to change of the SF36 in this setting. Keywords: Health status, assessment tool, post-discharge outcomes 219 Title: Treatment of Alzheimer's disease Principal researchers: R Prowse, Dr R Penhall Organisation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: Ongoing Outline: This project involves participation in clinical trials of drug treatment options for Alzheimer's disease. The outcome will be clarification of effective treatment options and treatment protocols for the assessment and management of Alzheimer's disease. Keywords: Alzheimer’s disease, dementia, drug trials 128 Australian Ageing Research Directory 2000 Medical Research 2.13 Department of Geriatric Medicine, University of Western Australia, Royal Perth Hospital 220 Title: An intervention trial to prevent cognitive impairment and depression in older men Principal researcher: Professor L Flicker Co-researchers: Associate Professor O Almeida, Mr P Norman, Dr R Clarnette, Associate Professor K Jamrozik, Associate R Martins Organisation: Department of Geriatric Medicine, University of Western Australia, Royal Perth Hospital Status: Ongoing Funding: Small bequests, $10,000 Timetable: June 2000 - June 2003 Outline: A gradual decline in the thinking processes, dementia and depression are major issues for older people. There is already some evidence that elevated homocysteine levels may be contributing to these problems. This project seeks to evaluate an inexpensive and simple vitamin supplement which may provide a highly cost effective method of preventing cognitive decline, dementia and depression in older people. This research will also allow the evaluation of biological and genetic risk that may also impact on these problems. Keywords: Cognitive impairment, dementia, depression, homocysteine 221 Title: Attitudes towards life sustaining treatments of older patients following disabling stroke Principal researcher: Dr L K Bowker Co-researchers: Professor L Flicker, Dr S Maher, Dr S Henderson Organisation: Department of Geriatric Medicine, University of Western Australia, Royal Perth Hospital; School of Nursing, Curtin University of Technology Status: In progress Funding: Nil Timetable: October 1999 - December 2000 Outline: This study aims to explore patient involvement in decisions about life sustaining treatments such as cardio-pulmonary resuscitation after a disabling stroke. Patients are recruited from the Royal Perth Hospital following a stroke and are interviewed once within the first two weeks of stroke (whilst still in hospital) and once following discharge home, (between three and six months following their stroke). Exclusions are age under 50, abbreviated mental test score under 7, severe dysphasia, decreased conscious level or psychological distress such that the staff felt it inappropriate to approach the patient. A semi quantitative interview incorporating education about techniques and success of cardiopulmonary resuscitation is used to obtain patients’ opinions. Barthel Index, Geriatric Depression Scale, quality of life estimates and a competency test specific to advanced directives are also collected. The follow up interview contains identical information and a small subsection of patients at follow-up also undergo an in-depth qualitative exploration of their views. Quantitative data will be analysed to look for variables which predict patients’ preferences for cardio-pulmonary resuscitation and data will also be compared with a previous study done by the same author in the United Kingdom to look for intercontinental differences. Qualitative data will be transcribed and will undergo thematic analysis. 45 patients with a mean age of 70 have been interviewed in hospital. 37 (82%) of them wanted resuscitation for themselves in their current states, 7 (15%) refused cardio-pulmonary Australian Ageing Research Directory 2000 129 Medical Research resuscitation and one was unsure). 4 out of 45 of the patients changed their minds following education about cardio-pulmonary resuscitation, all becoming more negative about the procedure. In the event of a further stroke, 30 (67%) of them would accept artificial feeding techniques. 30 (67%) of the patients scored above the thresholds of competency on their competency test with 15 (33%) being judged incompetent to complete an advanced directive. Keywords: Cardiopulmonary resuscitation, living wills, advance directives, elderly, stroke 222 Title: Does vitamin D prevent hip fractures in institutionalised Australian women Principal researcher: Professor L Flicker Co-researchers: Dr S Scherer, Dr M Stein, Dr C Nowson, Associate Professor J Hopper, Associate Professor J Wark Organisations: Department of Geriatric Medicine, University of Western Australia, Royal Perth Hospital; Department of Medicine, University of Melbourne; Department of General Practice and Public Health, University of Melbourne; School of Health Sciences, Deakin University; Royal Freemasons Homes, Melbourne Status: Completed Funding: National Health and Medical Research Council, Victorian Health Promotion Foundation Timetable: 1996-2002 Outline: Vitamin D deficiency is a common and easily reversible nutritional problem in older people in residential care. Publication of benefits from vitamin D and calcium supplementation in older women in residential care in France has made the evaluation of population based interventions in Australia a priority. The general aim is to evaluate a simple, cost effective and immediately available intervention, vitamin D supplementation, in the prevention of osteoporotic fractures, especially hip fracture. The specific targeted population will be the high risk population of elderly female nursing home and hostel residents. This study will address whether it is justified to treat all women in these settings with vitamin D supplementation or alternatively to screen and supplement those women with demonstrable vitamin D deficiency. Keywords: Vitamin D, fractures, older women, residential care, nutrition, osteoporosis 223 Title: Non-invasive predictors of back pain/disabilities Principal researcher: Associate Professor K Singer Co-researchers: Professor L Flicker, Dr R Price, Dr K Metcalf, Dr S Song Organisations: Department of Geriatric Medicine, University of Western Australia, Royal Perth Hospital; Neuromuscular Research Department, University of Western Australia Status: In progress Funding: Nil Timetable: December 1999 - June 2000 Outline: This is a pilot study set up to investigate the rule of a novel photographic back shape analysis technique called rastostereography. It is well known that back pain and associated disability are poorly correlated to severity of common diseases such as osteoporosis and osteoarthritis as measured by conventional and often expensive imaging techniques. This study uses a novel, non-invasive measurement technique called rastostereography which is correlated with results from pain and disability questionnaires as well as standard imaging. The aim is to recruit approximately twenty subjects with osteoporosis, degenerative joint disease and no specific disease. Subjects will then complete pain and disability questionnaires (SF36, Beck Depression Inventory, McGill Pain Index, and Roland and Morris Back 130 Australian Ageing Research Directory 2000 Medical Research Disability Questionnaire). They will also undergo conventional imaging (lateral thoracolumbar X-rays, densitometry (DXA) and MRI) as well as biochemical markers of bone disease. Rastostereography accurately documents back shape using computer analysis of digital photographs to produce three-dimensional images as well as comparable parameters such as angle of maximum kyphosis. Once all results are available, the plan is to use a cluster analysis and multiple regression analysis to statistically compare all available data and help to define a role for rastostereography. Rastostereography may be a useful method of predicting back pain and disability in older people. Keywords: Osteoporosis, osteoarthritis, rastostereography, bone densitometry, back pain 2.14 Eastern Regional Geriatric and Medical Rehabilitation Service 224 Title: Classifying carers within the funding equation: The development of a carer assessment tool and classification system Principal researcher: Ms D Rembicki Co-researchers: Mr A Quire, Ms J Harford, Dr R Penhall Organisations: Eastern Regional Geriatric and Medical Rehabilitation Service; Southern Domiciliary Care and Rehabilitation Service; Department of Public Health, University of Adelaide Status: In progress Funding: Department of Human Services, as agent for the Office for the Ageing, $80,000 Timetable: March 2000 - September 2001 Outline: This study is directed to the further development of a carer assessment and classification system which aids in recording carer profiles, the identification of unmet need, the impact of care giving and classification of resource needs. The aims of the project are to: (i) Develop a carer assessment tool that will be applicable across a variety of caregiving and service delivery settings. It is envisaged that it will have value not only in a variety of community settings, but also in the acute care sector. (ii) Develop a greater understanding of the current proportion of client services directed to carers and to be able to inform policy makers and funders. (iii) Develop an indicator of resource usage that would be able to inform an output based funding model. (iv) Create a formal recognition of the carer role. This project intends to build on the work of Kilner (1996). It is intended that the proposed tool will be able to measure and record carer profiles, the impact of caregiving, identifying unmet needs, as well as classification for resourcing needs. It offers carers the opportunity to undergo a comprehensive needs assessment. It will allow for the examination of specific areas such as the relationship between carer stress, carer health status, quality of life, relinquishment and the services accessed. It will also allow for carer issues identified through the assessment process to be incorporated into a comprehensive care plan. To achieve the above objectives, a multifaceted approach will be utilised. The instrument will be piloted on approximately 40 carers of the clients of Eastern Domiciliary Care Service to establish the appropriateness of the instrument and time for assessment. After any refinement, the instrument will be pilotted on 300 carers of the clients of Eastern Domiciliary Care Service and Adelaide Hills Community Health Service to establish the acceptability of the instrument by carers, clients, and service providers. Carers of the clients of the above services will be offered a carer assessment as appropriate. This method is based on the process which has been established in the United Kingdom. All participants will be volunteers. Keywords: Carer assessment tool, carer and caregiving, services, service provision, assessment, classification, health, quality of life, instrument Australian Ageing Research Directory 2000 131 Medical Research 2.15 General, Geriatric & Rehabilitation Medicine, Central Sydney Area Health Service, Balmain Hospital 225 Title: The effectiveness and appropriate intensity of progressive resistance training required to treat clinical depression in the elderly: A randomised controlled trial Principal Researcher: Dr N Singh Co-researcher: Professor M F Singh Organisation: General, Geriatric & Rehabilitation Medicine, Central Sydney Area Health Service, Balmain Hospital Funding: General, Geriatric & Rehabilitation Medicine, Central Sydney Area Health Service. $100,000 Timetable: April 1998 - April 1999 Outline: The effectiveness of progressive resistance training exercise in the treatment of depression was explored and compared to standard care in this randomised controlled trial. Community dwelling subjects aged 60 years and over, who scored 14 or higher on the Geriatric Depression Scale and who were assessed by a psychiatrist to meet DSMIV criteria for major or minor depression or dysthymia were eligible to be randomised to one of three groups: high intensity training (training intensity = 80% of one repetition maximum), low intensity training (training at 20% 1RM) or standard care of their General Practitioner (GP control). Patients were excluded if they were on antidepressants, seeing a psychiatrist or had medical contraindications to exercise. Blinded outcome assessments were completed at eight weeks by a psychiatrist. The primary depression outcomes included the Hamilton Rating Scale for Depression and the Geriatric Depression Scale. Those in the exercise groups trained three times a week and completed three sets of eight repetitions. Each week all participants were asked a series of questions to determine adverse events and changes in circumstances. The hypothesis of the study was that High Intensity Training is more effective in the treatment of depression in older people than Low Intensity Training and standard General Practitioner care. There were no significant differences in any baseline characteristics between the groups. There was a significant effect of group assignment on changes in self and therapist rated depression scores. The Geriatric Depression Scale in the High Intensity Training group was reduced by 65% versus Low Intensity Training 36% versus GP control 15%. The Hamilton Rating Scale for Depression was reduced by 60% in the High Intensity Training group, 28% in Low Intensity Training group and 11% in the GP control. The preliminary analysis of the results of this study suggest that progressive resistance training is an effective treatment for clinical depression but only if performed at high intensity. Keywords: Progressive resistance weight training, depression, exercise, randomised controlled trial 2.16 Geriatric Medicine, Liverpool Hospital, South Western Sydney Area Health Service 226 Title: Aged Care Assessment Team falls reduction trial Principal researcher: Dr D Basic Organisation: Geriatric Medicine, Liverpool Hospital, South Western Sydney Area Health Service; Lidcombe-Bankstown Aged Care Assessment Team; Penrith Aged Care Assessment Team 132 Australian Ageing Research Directory 2000 Medical Research Status: Pilot study completed 1999 Funding: Research and Development Grants Committee, $50,000 Timetable: Data entry nearing completion Outline: Multicentre trial aimed at the reduction of falls in the frail elderly. Keywords: Falls, falls reduction, multicentre trial, frail elderly, physical therapy, environmental therapy, behavioural therapy 227 Title: Development and validation of a multi-cultural-mini-mental-state examination instrument Principal researcher: Dr J Rowland Co-researchers: Dr D Basic, Dr D Conforti, Professor H Dickson, Ms J Storey Organisation: Geriatric Medicine, Liverpool Hospital, South Western Sydney Area Health Service Status: In progress Funding: NSW Health Department, $134,000 Timetable: Completion early 2002 Outline: Development and validation of a multi-cultural-mini-mental-state examination instrument. Keywords: Multi-cultural mini-mental-state examination instrument, dementia assessment, clock drawing 228 Title: Randomised study of the effectiveness of an aged care liaison nurse in the emergency department in reducing adverse outcomes Principal researcher: Dr D Basic Co-researcher: Dr D Conforti, Dr J Rowland, Professor H Dickson, Ms K Coady Organisation: Geriatric Medicine, Liverpool Hospital, South Western Sydney Area Health Service Status: In progress Funding: Nil Outline: Randomised study of the effectiveness of an aged care liaison nurse in the emergency department in reducing adverse outcomes. Keywords: Aged care liaison nurse, emergency department, functional assessment, premorbid function, hospital admission 2.17 Rehabilitation and Aged Care Service, Hornsby Ku-ring-gai Hospital 229 Title: Effectiveness of external hip protectors in preventing hip fracture Principal researchers: I D Cameron, R G Cumming, S E Kurrle, S Quine, G Salkeld, T Finnegan Organisation: Rehabilitation and Aged Care Service, Hornsby Ku-ring-gai Hospital Status: Nearing completion Funding: National Health and Medical Research Council; Hornsby Ku-ring-gai Hospital Timetable: May 1996 - December 2000 Outline: This study is investigating the effectiveness of external hip protectors in preventing hip fractures in high risk older women who are living at home in the community. Follow-up of the six hundred women participants is close to complete. Findings from the study, to date, Australian Ageing Research Directory 2000 133 Medical Research are that hip protector use is associated with a reduction in fear of falling, that the health utility of a hip fracture causing loss of independence and admission to a nursing home is equivalent to death and that hip fractures can rarely occur while wearing hip protectors. Keywords: Hip protectors, fracture prevention, falls, adherence, fear of falling, quality of life 230 Title: External hip protectors: effectiveness in very high risk older people Principal researchers: I D Cameron, R G Cumming, S E Kurrle, S Quine, G Salkeld Organisation: Rehabilitation and Aged Care Service, Hornsby Ku-ring-gai Hospital Status: Nearing completion Funding: Northern Sydney Area Health Service Timetable: September 1996 - May 2000 Outline: This study seeks to establish the effectiveness of external hip protectors in older people at very high risk of hip fracture who are living in residential aged care facilities. One hundred and seventy four participants were randomised to use of external hip protectors, or not, and have been followed for eighteen months. It has been difficult to secure high adherence due to aged care facility staff availability and commitment, intercurrent illness of the participants and difficulty wearing the hip protectors at night. Keywords: Hip protectors, fracture prevention, falls, adherence 231 Title: Rehabilitation for nursing home residents after hip fracture Principal researchers: C Uy, I D Cameron, S E Kurrle Organisation: Rehabilitation and Aged Care Service, Hornsby Ku-ring-gai Hospital Status: In progress Funding: Northern Sydney Area Health Service Timetable: September 1999 - December 2000 Outline: This randomised trial is investigating the effectiveness of an evidence based treatment program, including inpatient rehabilitation for people who were living in a nursing home and were ambulant and then had a hip fracture. Keywords: Proximal femoral fracture, rehabilitation, nursing home, falls 2.18 Rehabilitation Studies Unit, Department of Medicine, University of Sydney 232 Title: Effectiveness of oral nutritional supplementation in undernourished older women with hip and other fractures Principal researchers: I D Cameron, C Hankins, S E Kurrle Organisation: Rehabilitation Studies Unit, Department of Medicine, University of Sydney Status: In progress Funding: Department of Medicine University of Sydney, $15,000 Timetable: March 2000 - December 2000 Outline: A randomised trial is being conducted that investigates the effectiveness of oral nutritional supplementation in older women with hip and other fractures. Participants who fulfil a definition of undernutrition and are offered a drink that is a protein and energy supplement for forty days (or usual care) after their injury. The major outcomes to be assessed are mobility, activities of daily living function and nutritional status. People who live in the community and residential aged care facilities will participate. Keywords: Proximal femoral fracture, undernutrition, rehabilitation, falls, osteoporosis 134 Australian Ageing Research Directory 2000 Medical Research 233 Title: Frailty interventions trial in elderly subjects Principal researchers: I D Cameron, A Moseley, C Anderson, N Latham, S E Kurrle Organisation: Rehabilitation Studies Unit, Department of Medicine, University of Sydney Status: Commissioned Funding: Application pending Timetable: June 2000 - December 2001 Outline: This study called FITNESS is a randomised controlled trial that investigates the effectiveness of two simple, inexpensive and widely applicable interventions, exercise and Vitamin D. The aims are to improve muscle strength and physical functioning, and thereby prevent falls and dependency, in frail older people. Two Australian centres will be participating in this multicentre international trial. Keywords: Falls, progressive resistive exercise, vitamin D, disability, osteoporosis Medicine 2.19 Brain Sciences Institute, Swinburne University of Technology 234 Title: Effects of Phosphatydlserine, Ginkgo biloba and other nutritional products in age-related memory decline: An electrophysiological, biochemical and behavioral study Principal researchers: Dr P J Nathan, Professor R B Silberstein Co-researchers: Dr L Vitetta, Ms L Curran, Ms E Ricketts Organisation: Brain Sciences Institute, Swinburne University of Technology Status: Planned Funding: Blackmore’s Ltd Timetable: June 2000 - June 2002 Website: http://www.scan.swin.edu.au/ Outline: Age-related memory impairments have been linked to deficits in cholinergic function, and increase in free-radical damage. Recent evidence suggests that Phosphatidylserine, a phospholipid widely distributed in the brain can modulate cholinergic function, while Ginkgo biloba, folate and vitamins have been shown to have anti oxidant properties. The present study aims to examine the efficacy of Phosphatidylserine, and a new Blackmore’s product, AD formula containing Ginkgo biloba, folate and vitamins on memory processes in elderly subjects over a three month period. Subjects will be randomly allocated to a placebo, phosphatydylserine or AD formula group in double blind placebo-controlled design. Subjects will undergo: (i) electrophysiological testing using a technique called steady state probe topography while performing various memory tasks, and (ii) other psychological cognitive testing before and after treatment. Blood samples will also be collected before and after treatment to examine changes in biological markers of cholinergic dysfunction and freeradical damage. Keywords: Memory, phosphatidylserine, gingko biloba, folate, vitamins, electrophysiology, biochemistry Australian Ageing Research Directory 2000 135 Medical Research 2.20 Central West Parkinson’s Disease Research Group, NSW 235 Title: Assessment of health service needs of people with Parkinson's Disease and their carers in the central west of NSW Principal researchers: Dr J Selby, Mr J Scoble, Mr R Wilson, Ms V Shaw, Dr S Hammond, Dr M Dunne Organisation: Central West Parkinson's Disease Research Group, NSW Status: Completed Funding: $14,910 Timetable: Completed Outline: The project aimed to assess health needs of people with Parkinson's Disease and their carers in the Central West of NSW. Funding was for completion of data collection and analysis of a larger project. The final report details the analysis and recommendations on service provision for this geographically diverse area of NSW. Keywords: Parkinson’s disease, carers, rural health 2.21 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle 236 Title: Depression among older Australian veterans and war widows Principal researcher: Dr J Byles Co-researchers: Associate Professor N Higginbotham, Mr B Goodger, Ms M Tavener et al. Organisation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Status: Completed Funding: Department of Veterans Affairs Preventive Care Trial Timetable: 1996 - 2000 Website: www.health.newcastle.edu.au/disciplines/cceb/pctrial/home.html Outline: This study developed and evaluated a brief measure of depression for use within a population of older Australian war veterans and their widows. Derived from the Geriatric Depression Scale, the 12-item GDS-veterans is designed to include items that most closely represent the thoughts and feelings of older veterans in relation to their war-related experiences. The scale was administered to 1,620 veterans and widows concurrent with the Medical Outcomes Study 36-item health related quality of life measure (MOS SF-36). Of those surveyed, 13.5% indicated that they often or always worry about things that happened during the war, indicating that this item tapped an important dimension for many of the veteran population. Scores on the GDS-veterans were strongly correlated with the mental health sub-scale (-0.72) and the mental component summary score (-0.68) of the MOS SF-36 health related quality of life measure. Keywords: Depression, aged, war veterans, scale development 237 Title: Factors associated with injurious falls among older Australian women Principal researcher: Dr J Byles Co-researchers: Ms L Mackenzie, Dr G Mishra Organisation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Status: In progress Funding: Commonwealth Department of Health and Aged Care 136 Australian Ageing Research Directory 2000 Medical Research Timetable: 1996 - ongoing Website: http://u2.newcastle.edi.au/wha Outline: This research describes factors associated with falls resulting in serious injury among women in Australia aged 70-75 years. Stage 1 involved analysis of cross-sectional data from 12,900 community-dwelling women participating in the Australian Longitudinal Study on Women’s Health baseline postal survey, to identify the proportion reporting a fall with serious injury and factors associated with these serious falls. Six hundred and fifty-five women (4.9%) reported a fall with serious injury within the twelve months before the survey. On multivariate analysis, four variables were significantly associated with these reports of serious falls. Physical health summary scores were negatively associated with the odds of having had a serious fall (OR: 0.95; 95% CI:0.94-0.96). A greater number of life events (OR: 1.32; 95% CI: 1.24-1.4); higher scores on the ‘feeling dejected’ subscale of an elder abuse scale (OR: 1.96; 95% CI: 1.45-2.65) and medications for nerves (OR: 1.4; 1.09-1.92) were positively associated with reporting a fall with serious injury. These results highlight the need to consider the wider contexts of women’s health and other circumstances both in terms of falls prevention and in assisting people to recover from a fall-related injury. In Stage 2, the temporal relationship between these factors and injurious falls is being investigated longitudinally. Keywords: Falls, injury 238 Title: Factors predicting the risk of falls, stumbles and accidents amongst older people living in their own homes Principal researcher: Ms L Mackenzie Co-researchers: Dr J Byles, Associate Professor N Higginbotham, Dr K D’Este Organisation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Status: Completed Funding: Department of Veteran’s Affairs Preventive Care Trial; National Health and Medical Research Council Scholarship Timetable: 1996 - 2000 Website: www.health.newcastle.edu.au/disciplines/cceb/pctrial/home.html Outline: The aim of this research is to develop and validate a brief screening instrument to assess home safety. The instrument was developed through empirical and consensus methods and is being validated as part of a prospective randomised controlled trial of health assessments (Department of Veteran’s Affairs, Preventive Care Trial (entry 240). In addition, an inter-rater reliability study was undertaken using occupational therapists and occupational therapy assistants and good to excellent reliability was established. The trial has also involved detailed sub-studies to: (i) validate self-report of falls and related events; (ii) assess the predictive validity of the HOME FAST tool for identifying falls risk; (iii) assess the utility of the HOME FAST tool in enabling home modification; (iv) assess the effectiveness of home modification and other risk factor modification in reducing the risk of falls and injury among people aged 70 years and older. Keywords: Home safety, falls, injury, screening tool, occupational therapists 239 Title: Needs of men with prostate cancer Principal researcher: Ms J Duke Co-researchers: Dr J Byles, Dr C Treloar, Dr K D’Este Organisation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Status: Completed Australian Ageing Research Directory 2000 137 Medical Research Funding: University of Newcastle, $10,000 Timetable: 1996 - 2000 Website: www.health.newcastle.edu.au/disciplines/cceb Outline: The aim of this research is to describe the needs of men who have been diagnosed with prostate cancer. The first stage of the research involved the development and validation of an instrument to measure unmet needs for help across a broad spectrum of life domains. The instrument was developed through in-depth interviews and focus group discussions, and psychometrically validated. The second stage of the study involves a twelve month follow-up study to identify the prevalence of need, and those areas of need that remain unchanged. Keywords: Prostate cancer, needs 240 Title: Preventive care trial for elderly veterans and war widows Principal researcher: Professor R Heller Co-researchers: Dr J Byles, Associate Professor N Higginbotham, Professor K Nair, Dr J Butler, Associate Professor C Jackson Organisations: Centre for Clinical Epidemiology & Biostatistics, University of Newcastle; Centre for General Practice, University of Queensland; National Centre for Epidemiology and Population Health, Australian National University Status: In progress Funding: Commonwealth of Australia Department of Veterans’ Affairs, $1.6 million Timetable: June 1996 - August 2001 Website: http://www.health.newcastle.edu.au/disciplines/cceb/pctrial/home/html Outline: The trial is a three-year randomised controlled study of preventive care health assessments, conducted by specially trained health professionals in the homes of consenting veterans and war widows. The trial is the first of its kind in Australia, and aims to show that regular home based preventive care of elderly people, incorporating education, advice and referral to health and community services can improve health outcomes and quality of life. Participants are veterans and war widows are aged over 70 years of age, resident in 10 randomly selected areas throughout New South Wales and Queensland and are Gold Card holders with the Department of Veterans’ Affairs. After a baseline telephone survey, participants were allocated at random into either a control (to continue to receive usual care) or intervention group (to receive either one or two home health assessments per year). Working within existing community models for care (Divisions of General Practice, Aged Care Assessment Teams and Community Options) community based health professionals carry out regular visits to the homes of intervention group participants to conduct a semistructured face-to-face interview. Interview questions are taken from a checklist developed for the trial, and include issues such as activities of daily living, cognitive functioning, social interaction and satisfaction, quality of life, medication use, nutritional status and home safety. Health concerns are negotiated between the health professional and participant and a computer generated report sent to their nominated local medical officer. Three months after the visit, each person is followed up by the health professional to further discuss referral progress or any additional concerns. The main outcomes being assessed are hospital and residential care admissions, the use of health and community services, mortality, general health status and quality of life and accident and falls prevention. Keywords: Veteran, randomised controlled trial, preventive care, checklist 138 Australian Ageing Research Directory 2000 Medical Research 241 Title: Social support and the Australian elderly Principal researcher: Mr B Goodger Co-researchers: Dr J Byles, Dr G Mishra, Associate Professor N Higginbotham Organisation: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Status: Completed Funding: National Health and Medical Research Council Scholarship Timeline: 1996 - 2000 Website: www.health.newcastle.edu.au/disciplines/cceb/pctrial/home.html Outline: The initial phase of this research involved validation of a brief measure of social support designed for older people: The Duke’s Social Support Index. As a first step, the concurrent validity of the measure was assessed against the Interview Schedule for Social Interaction and test-retest reliability was determined. Further validation was provided through in-depth interviews with those at the highest and lowest scoring ends of the scale, and contrasting the experiences and values of social support for these people. The third component of the project involved a longitudinal study of women aged 70-75 years as part of the Australian Longitudinal Study on Women’s Health. This study allowed the distribution and correlation of social support scores to be determined, and assessed the changes in social support and health-related quality of life over time. The final phase is a randomised controlled trial (Department of Veterans Affairs Preventive Care Trial, entry 240) which includes social support as a key component of the intervention. Keywords: Social support, health, quality of life 2.22 Centre for Human Biology, Department of Anatomy and Human Biology, University of Western Australia 242 Title: Development of new animal models of Alzheimer’s Disease Principal researcher: Associate Professor A R Harvey Co-researchers: Associate Professor R Martins, Dr T Robertson Organisation: Centre for Human Biology, Department of Anatomy and Human Biology, University of Western Australia; Department of Surgery, University of Western Australia; Department of Pathology, University of Western Australia Status: Ongoing Funding: National Health and Medical Research Council, ARC (SPIRT) Outline: Use of transplantation methods and transgenic mouse lines to study the influence of glial cell, particularly astrocytic, reactivity on pathological changes typical of Alzheimer’s Disease. Keywords: Alzheimer’s Disease, astrocytes, glia, amyloid, apolipoprotein E, presenilins, transplants, cerebral cortex 243 Title: Regeneration in ageing skeletal muscle Principal researcher: Professor M D Grounds, Professor J K McGeachie Organisation: Centre for Human Biology, Department of Anatomy and Human Biology, University of Western Australia Status: Nearing completion Funding: Nil Timetable: Ongoing Australian Ageing Research Directory 2000 139 Medical Research Outline: Old age is associated with a progressive loss of muscle mass and a decrease in force and power. This is due to atrophy of individual myofibres as a result of denervation, combined with a loss and change in contractile properties of motor units in muscle. These striking age-related changes in innervation should have little impact on the initial regenerative response of injured aged skeletal muscle, as the early events of regeneration are unaffected by innervation. The research has confirmed that muscle can regenerate well in old hosts, and that the muscle precursor cells (myoblasts) retain an excellent capacity for proliferation and fusion even in very old animals, although this response may be slightly delayed. The research hypothesis is that the early events related to the inflammatory cell response and angiogenesis will be delayed in muscles regenerating in old hosts. All aspects of the repair process related to the age of the muscle graft and of the host environment are being investigated using crosstransplantation experiments, and histological analysis of muscle grafts sampled at various times during the first week after transplantation. The angiogenic stimulus produced by young and old skeletal muscle is also being investigated using corneal micropocket assays. Keywords: Skeletal muscle repair, myogenesis, angiogenesis, inflammation, ageing 2.23 Centre for Magnetic Resonance, University of Queensland 244 Title: The development and validation of a composite brain template using magnetic resonance imaging to aid in the differential diagnosis of common dementias in patients with memory complaints following neuropsychological evaluation Principal researchers: Professor D Doddrell, Dr J Chalk, Dr S Rose, Mr G de Zubicaray, Mr A Janke Organisations: Centre for Magnetic Resonance, University of Queensland; Department of Medicine, University of Queensland, Princess Alexandra Hospital Status: Planned Funding: SmithKline Beecham (UK), $1,400,000 Timetable: June 2000 - 2003 Outline: The study aims to develop generalized 3D magnetic resonance imaging models of the brain for various common dementias, namely Alzheimer’s disease, frontotemporal dementia, Lewy body disease and vascular dementia using information provided from history, examination and neuropsychological information. The aim is for recruitment of at least 20 patients into each group. Keywords: Dementia, magnetic resonance imaging, Alzheimer’s disease, frontotemporal dementia, vascular dementia, Lewy body disease 2.24 Centre for Molecular Biology and Medicine, Epworth Medical Centre 245 Title: Confocal microscopy investigations of metabolic changes with age Principal researchers: Dr N Yarovaya, Professor A W Linnane, Dr L Kramarova Co-researcher: Ms J Borg Organisation: Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: In progress Funding: Australian Tea Tree Oil Research Institute, $500,000 Timetable: July 1997 - June 2000 Website: www.cmbm.com.au 140 Australian Ageing Research Directory 2000 Medical Research Outline: Loss of muscle mass and associated motor dysfunction is a leading cause of frailty and disability in the elderly. Skeletal muscle is primarily composed of long-lived, high oxygen-consuming post-mitotic cells, a feature that is shared with other critical organs such as brain and heart. These organs demonstrate an age-associated loss of cellular bioenergy capacity which is postulated to contribute to the various age-associated pathologies. The Centre has developed several different histochemical and immunohistochemical procedures for the evaluation of bioenergy parameters in muscle tissue using confocal laser scanning microscopy. This strategy provides the capability for the microscope’s high resolution images to be studied using sophisticated computer analysis. As an example, investigations involving human and rat skeletal muscle have been using the confocal microscope to determine the level of measurable cytochrome oxidase activity (an exemplifier of mitochondrial bioenergy capacity) in single muscle fibres. A functional loss of cytochrome oxidase activity, a key component of mitochondrial respiration, has been observed in muscle tissues from ageing individuals. Most significantly, this loss in bioenergetic capacity appears to be generally correlated with the mitochondrial DNA changes. As skeletal muscles are complex structures made up of several intermixed fibre types that vary in their energy profiles, a more in-depth analysis is required to distinguish the age-associated decrease in mitochondrial bioenergy capacity (cytochrome oxidase activity) from changes such as glycolysis. Keywords: Confocal microscopy, mitochondrial DNA, age associated pathologies, cytochrome oxidase activity, cellular bioenergy 246 Title: DNA Microarray analysis of ageing muscle Principal researchers: Dr G Kopsidas, Professor A W Linnane, Dr C Zhang, Dr S Kovalenko Co-researchers: Dr M Schena, Ms P Papakostopoulos Organisation: Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: Ongoing Funding: Australian Tea Tree Oil Research Institute, $300,000 Timetable: July 1999 - June 2000 Website: www.cmbm.com.au Outline: DNA microarrays are an exciting new technology that can potentially screen thousands of genes known and unknown, to provide a comprehensive image of the activities of the genes as they regulate changes within the body. The Centre has recently begun to utilise this technology and has installed the appropriate instrumentation, as well as establishing an important collaboration with Dr Mark Schena, a pioneer in the creation of DNA microarrays. The Centre’s laboratory has been investigating age-associated changes in ageing post-mitotic tissues in humans and the relationship of these changes to the age-associated loss of cellular bioenergy. The studies of the ageing process will be advanced by utilising both commercially available microarrays, and microarrays that have been manufactured at the Centre, to examine the molecular events associated with ageing and bioenergy decline in humans. This will be accomplished by defining the transcriptional response to the ageing process in various human tissues and cell lines, in particular human skeletal muscle. This research has implications for using therapies to assist the normal ageing community to maintain their general energy function, health and lifestyle. Keywords: DNA microarrays, age associated changes, cellular bioenergy, ageing process Australian Ageing Research Directory 2000 141 Medical Research 247 Title: Investigation of the changes in mitochondrial DNA with age Principal researchers: Professor A W Linnane, Dr S Kovalenko, Dr G Kopsidas, Dr G Bronnikov, Dr M Islam, Dr V Rotaru, Dr C Zhang Co-researchers: Ms A Caragounis, Ms C Gange, Ms R Weston Organisation: Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: Ongoing Funding: Various sources Timetable: 1989 - continuing Website: www.cmbm.com.au Outline: In 1989, the research group proposed that the mutation in mitochondrial DNA played a major role in the human ageing process. According to the proposal, the accumulation with age of spontaneous random mitochondrial DNA mutations hinders the synthesis of the mitochondrially encoded components of the oxidative phosphorylation system and hence affects the cell’s ability to produce bioenergy in the form of ATP. The loss in bioenergy capacity was postulated to lead to many of the consequences of the ageing process and could impact on conditions as diverse as those affecting brain functions (eg. Parkinson’s Disease), skeletal muscle (frailty) and cardiac muscle (non-ischaemic cardiomyopathy). Many studies in the Centre’s laboratory and others have firmly established that the proposed increase in mitochondrial DNA mutations does indeed occur with age. An ongoing project utilising an advanced modification of the Polymerase Chain Reaction (PCR) called extra-long or “XLPCR”, is being used to elucidate age-related changes in mitochondrial DNA in rat and human tissues. These studies should embrace the use of XL-PCR at various tissue sample sizes encompassing bulk tissue samples in the order of 5mg down to analysis that involves a single cell of predetermined bioenergetic status. The single cells are obtained by firstly staining a histological tissue section of rat and human tissue for cytochrome-c-oxidase (used as an exemplifier for the bioenergy status of a cell) followed by micro-dissection and XL-PCR of selected single cells. Keywords: Mitochondrial DNA, human ageing, mitochondrial DNA mutation, polymerase chain reaction, oxidative phosphorylation 248 Title: Proteomic investigation of age-associated changes in protein levels Principal researchers: Dr P Lewandowski, Professor A W Linnane Co-researchers: Ms V Kanellakis, Mr H Eastwood Organisation: Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: In progress Funding: Centre for Molecular Biology and Medicine, $200,000 Timetable: July 1999 - December 2000 Website: www.cmbm.com.au Outline: Several lines of evidence support the view that the bioenergetic function of the mitochondria in post-mitotic tissue deteriorates during normal ageing. Skeletal muscle is one such tissue that undergoes age-related fibre loss and atrophy and an age-associated rise in the number of cytochrome c oxidase (a major component of the oxidative phosphorylation pathway) deficient muscle fibres. In general, the ageing process is thought to involve a change in expression of less than 2% of the total human cellular gene complement and is unlikely to be due to large, global alterations in gene activity. The latest developments in two dimensional gel electrophoresis potentially enables an examination of all proteins produced by a cell/tissue. Several thousand proteins can be displayed on each gel and by the judicious 142 Australian Ageing Research Directory 2000 Medical Research use of an appropriate pH range for electro-focusing, the total proteins of a cell can be potentially displayed by way of a number of two dimensional gels per sample. It is now possible to determine the molecular weight of the displayed protein spots and determine their amino acid sequences using mass spectroscopy. The Centre has developed a program on the use of the proteomic technology to study the total cellular protein pool from tissues of young and aged subjects in order to identify age-associated changes. Keywords: Proteomics, mitochondria, gel electrophoresis, protein spots, amino acid sequences 249 Title: The assessment of coenzyme Q10 treatment of hip replacement patients Principal researchers: Professor A W Linnane, Dr G Bronnikov, Dr S Kovalenko, Dr G Kopsidas Co-researchers: Dr M Richardson, Ms E Sakabetis, Ms K Vasilopoulos, Mr H Eastwood, Ms V Kanellakis, Ms A Caragounis, Ms C Gange, Ms J Borg, Ms R Weston, Dr M Islam, Dr N Yarovaya, Dr L Kramarova, Dr V Rotaru, Dr P Lewandowski Organisation: Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: In progress Funding: Australian Tea Tree Oil Research Institute, $500,000 Timetable: July 1999 - June 2000 Website: www.cmbm.com.au Outline: A clinical trial is being carried out on patients undergoing elective hip replacement surgery to establish whether Coenzyme Q10 improves muscle function in the elderly, and whether recovery from the surgery is also improved. Each patient is being interviewed for placement into the trial at their initial consultation with their surgeon, and those that consent will become part of the trial without any disruption to their normal scheduled surgery. Participants will be asked to take Coenzyme Q10 at doses of 200 mg/day, or an identical placebo that does not contain the coenzyme, for 12-14 weeks. The trial is double blind so that neither the researcher nor the patients know who is receiving Coenzyme Q10 during the study. Patients will be required to undergo physiotherapy and clinical assessments. A single slice Computerised Tomography scan through the thigh (quadriceps) muscles prior to the supplementation with Coenzyme Q10, prior to surgery, and about two months after surgery will be done. Small blood samples are required on four occasions. The first three collections will be with blood tests routinely taken for surgery. The fourth requires a separate collection. Additionally, during the hip replacement procedure, a thigh muscle biopsy will be taken from tissue normally discarded during surgery. Keywords: Clinical trial, hip replacement surgery, coenzyme Q10, muscle function, muscle biopsy 2.25 Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre 250 Title: A clinical trial to determine the efficacy and safety of 6, 12, 24 and 36 mg tid and 36 mg bid Talsaclidine (free base) for 12 weeks in a double-blind, randomised, placebocontrolled parallel group comparison in patients with mild to moderate dementia of Alzheimer type Principal researcher: Dr M Woodward Co-researchers: Dr J Merory, Dr D G Darby, Dr M R Bird, Dr I A R Tan, Mr B A Field, Mrs A J Woodward, Ms C L Scott, Ms E M Sealey Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Australian Ageing Research Directory 2000 143 Medical Research Status: In progress Funding: Boehringer Ingelheim Timetable: January 1999 - September 1999 Outline: This is an international, multicentre, Phase IIB clinical trial of the muscarinic M1agonist Talsaclidine. It looked at the dose-response relationship of symptomatic therapy plus safety and tolerability. The primary variable is the ADAS-cog (+extension), with secondary variables being MMS, BEHAVE-AD, HAMD 17 item scale, IADL, Living status, and ADCS-CGIC. Keywords: Alzheimer’s disease, dementia, muscarinic agonist, talsaclidine, efficacy, safety 251 Title: A multicentre, randomised, double-blind, placebo-controlled, dose-ranging study to evaluate once daily doses of AIT-082 over 24 weeks in patients with probable Alzheimer’s disease of mild to moderate severity (082-99-006) Principal researcher: Dr M Woodward Co-researchers: Dr J R Merory, Dr M R Bird, Dr I A R Tan, Mr B A Field, Ms E Sealey, Ms M Hoffman, Ms C L Scott Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Planned Funding: NeoTherapeutics Inc. Timetable: Commencing May 2000 Outline: This is an international, multicentre, Phase IIB, randomised, double blind, placebo controlled clinical trial of this drug, which has demonstrated memory enhancing and neurotrophic properties in pre-clinical studies. The primary objective is to assess the efficacy of the medication administered once daily for 24 weeks in probable Alzheimer’s disease of mild to moderate severity. The secondary objectives are to evaluate the safety characteristics and to assess the pharmacokinetic activity. Assessments will include ADAS-cog, MMSE, ADCS-CGIC, NPI, NPI-D and DAD. Keywords: Alzheimer’s disease, dementia, efficacy, safety, neurotrophin 252 Title: A multicentre, randomised, double-blind, placebo-controlled evaluation of the safety and efficacy of Donepezil HCl (Aricept, E2020) in patients with moderate to moderately severe Alzheimer’s disease (DON-NY-96-002-324) Principal researcher: Dr D G Darby Co-researchers: Dr M Woodward, Dr J R Merory, Dr M R Bird, Dr I A R Tan, Mr B A Field, Ms C L Scott, Mrs A J Woodward Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Eisai Inc./Pfizer Ltd Timetable: January 1998 - December 1998 Outline: This is an international, multicentre, Phase IIIB clinical trial to evaluate the safety and efficacy of Donepezil HCl (Aricept, E2020), versus placebo in patients with moderate to moderately severe Alzheimer’s disease. The secondary objectives of this study are to assess patients’ behaviour and the impact of Donepezil on patient and caregiver health, care resource utilisation, and caregiver work productivity. The primary efficacy measure was the Clinician’s Interview-Based Impression of Change plus Caregiver’s Diary (CIBIC+CD). The secondary efficacy measures included the MPI, Caregiver Diary, FRS, DAD, SIB, S-MMSE, IADL+PSMS to measure cognition behaviour and daily function of the patient. The modified 144 Australian Ageing Research Directory 2000 Medical Research CSS and HQOL(SF-36) were used to measure physical and psychological well-being of the caregiver. The CAUST (Outcomes Research Questionnaire) was used to measure patient and caregiver healthcare resource utilisation and caregiver work productivity. Keywords: Donepezil HCl, Alzheimer’s disease, dementia, acetylcholinesterase inhibitor, efficacy, safety 253 Title: A multicentre, randomised, double-blind placebo controlled study of three fixed doses of Aripiprazole in the treatment of institutionalised patients with psychosis associated with dementia of the Alzheimer’s Type (Protocol CN 138-004) Principal researcher: Dr M Woodward Co-researchers: Dr I A R Tan, Dr M R Bird, Ms E Sealey, Ms C L Scott, Ms M Hoffman Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Commissioned Funding: Bristol-Myers Squibb Timetable: May 2000 - May 2002 Outline: This phase III study has the primary aim to compare the efficacy of three fixed doses of Aripiprazole and placebo using the Neuropsychiatry Inventory-Nursing Home (NPI-NH) Scale. Other objectives include comparison of the safety and tolerability of Aripiprazole and to compare the effects on a number of other psychiatric measurements (eg. agitation, depression, mental status). A total of 500 subjects aged between 55 and 90 will be enrolled worldwide, with participants displaying delusions or hallucinations which have been present for greater than one month secondary to Alzheimer’s disease. All participants must reside in a nursing home or supported residential living facility and must be capable of moving around with a walking aid or self propelled wheelchair. During the ten week acute phase, patients are assigned to one of four treatment arms – receiving either 2mg, 5mg, 10mg or placebo. After week 7 this dose may be unblinded if the patients condition is the same or worse. Upon completion of the ten weeks, the patient may then proceed onto the open label extension which will continue for a further 42 weeks with assessments. To assess efficacy the NPI-NH and the Clinical Global Impression (CGI) will be used. Other secondary parameters are also being used in this study including the Mini Mental Status Examination, Cohen-Mansfield Agitation Inventory, Cornell Depression Rating and BPRS. Keywords: Alzheimer’s disease, delusions, hallucinations, nursing home, supported residential, atypical antipsychotic 254 Title: An open label, multicentre, clinical trial evaluating the safety and clinical effectiveness of Donepezil HCl (Aricept, E2020) in patients with Alzheimer’s disease Amendment II (DON-NY-96-003-322) followed by an open label, multicentre clinical trial evaluating the safety and clinical effectiveness of Donepezil HCl(Aricept, E2020) in patients with Alzheimer’s disease - Amendment II (DON-NY-96-003-322 Amendment II) Principal researcher: Dr J R Merory Co-researchers: Dr M Woodward, Dr D G Darby, Dr M R Bird, Dr I A R Tan, Mr B A Field, Ms C L Scott, Ms A J Woodward Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Pfizer Pty Ltd Timetable: August 1997 - February 1999 Australian Ageing Research Directory 2000 145 Medical Research Outline: This is an international, multicentre, phase 111B clinical trial over twelve weeks. Efficacy will be assessed by cognitive/behavioural testing using the MMSE, IADL, SF-36, plus a weekly caregiver diary assessing subject engagement and motivation weekly. Keywords: Donepezil HCl, Alzheimer’s disease, dementia, acetylcholinesterase inhibitor, efficacy, safety 255 Title: A 24 week, multicenter, randomised, double-blind, placebo-controlled evaluation of the efficacy and safety of Donepezil hydrochloride (E2020) in patients with dementia associated with cerebrovascular disease (E2020-A001-308); followed by a 66 week open label evaluation of Donepezil in patients with dementia associated with cerebrovascular disease (E2020-A001-309) Principal researcher: Dr J R Merory Co-researchers: Dr M Woodward, Dr DG Darby, Dr I A R Tan, Dr M R Bird, Mr B A Field, Ms E Sealey, Ms C L Scott Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Ongoing Funding: Eisai Inc Timetable: November 1997- ongoing Outline: The objectives of this study are to evaluate the efficacy and safety of Donepezil HCL (E2020), a central cholinesterase inhibitor on cognitive and global functions in patients with dementia associated with cerebrovascular disease. This is a multicentred phase III study with 450 patients to be enrolled over 40 sites. Participants will be randomised to either the 5mg, 10mg or placebo treatment arm for 24 weeks. They may then choose to continue with the 66 week open label phase. Parameters will be measured prior to, during and at the end of the study. Physical examinations and clinical laboratory tests, will assess safety. Primary efficacy are being measured by neuropsychological tests including Alzheimer’s Disease Assessment Scale (cognitive subscale), Clinicians Interview Based Assessment of Change (CIBIC-Plus). The CDR-SB, Mini-Mental State Examination and the Alzheimer’s Disease Functional Assessment and Change Scale (ADFACS) will measure secondary efficacy. Keywords: Cerebrovascular disease, dementia, donepezil, cholinesterase inhibitor, stroke 256 Title: A 30 week, multicentre, randomised, double-blind, placebo-controlled evaluation of the safety and efficacy of Donepezil HCl (Aricept,E2020) in patients with Alzheimer’s disease ( E2020-A044-304) followed by an open label, multicentre, extended evaluation of the safety and efficacy of Donepezil HCl (Aricept,E2020) in patients with Alzheimer’s disease continuation study (E2020-A044-305) Principal researcher: Dr J R Merory Co-researchers: Dr M Woodward, Dr D G Darby, Mr B A Field, Mrs M Hoffman Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Completed Funding: Eisai Inc. Timetable: October 1994 - June 1998 Outline: This is an international, multicentre, clinical trial and the objectives of this study were to evaluate the safety and efficacy of two dose levels of Donepezil HCl (Aricept, E2020), in patients with Alzheimer’s disease. The test drug was administered in a doubleblind manner once daily for 24 consecutive weeks followed by a six week single-blind placebo washout. The study objectives were met by measuring efficacy, cognitive test 146 Australian Ageing Research Directory 2000 Medical Research performance (ADAS-cog), global evaluation (clinician’s interview-based impression-plus version CIBIC-Plus) and functional evaluations of Interview for Deterioration in Daily functioning activities in Dementia (IDDD), Quality Of Life (QOL) and some of the boxes of the Clinical Dementia Rating Scale (CDR-SB). Results showed Donepezil to be well tolerated and to improve cognition and global function in patients with mild to moderately severe Alzheimer’s disease. Significant improvements in cognitive and global function were observed as evaluated by ADAS-cog and CIBIC-Plus. In both the 5 and 10 mg per day Donepezil groups compared with placebo. Treatment-associated changes were also observed in functional skills as shown by improved scores on the CDR-SB and the complex tasks component of the IDDD. A dose-response effect was evident, with the 10 mg per day Donepezil group demonstrating greater benefits in all outcome measures than the 5 mg per day group. No clinically significant laboratory test abnormalities were produced. Keywords: Donepezil HCl, Alzheimer’s disease, dementia, acetylcholinesterase inhibitor, efficacy, safety 257 Title: Double-blind, randomised, placebo controlled, comparative study of Celecoxib (SC-58635) for the inhibition of progression of Alzheimer’s disease (IQ5-97-02-001) followed by clinical protocol for open label evaluation of the long-term efficacy and safety of Celecoxib (SC-58635) in Alzheimer’s disease (IQ5-98-02-004) Principal researcher: Dr M Woodward Co-researchers: Dr J Merory, Dr D G Darby, Dr M R Bird, Dr I A R Tan, Mr B A Field, Ms A J Woodward, Ms C L Scott, Ms E Sealey Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Terminated Funding: G.D.Searle & Co Timetable: July 1997 - December 1999 Outline: This was a Phase III, international, clinical trial of the selective inhibitor Cycloxygenase 2(COX-2). This anti-inflammatory drug with its lack of COX-1 inhibitory activity showed relatively little problems with safety, however on analysis, there was a lack of efficacy, based on the results of psychometric analysis of cognitive functioning (ADAS-cog) and the CIBIC rating scale, and the trial was terminated. Keywords: Alzheimer’s disease, dementia, efficacy, safety, monoaminoxidase B inhibitor 258 Title: Risperidone in the treatment of behavioural and psychological signs and symptoms in dementia (BPSSD): a multicentre, double-blind, placebo controlled parallel group trial (RIS-AUS-5) Principal researcher: Dr M Woodward Co-researchers: Dr I A R Tan, Dr M R Bird, Ms E M Sealey, Ms K Prentice, Ms C.L Scott Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre; Centre for Applied Gerontology, Bundoora Extended Care Centre Status: Ongoing Funding: Janssen-Cilag Timetable: March 1998 - ongoing Outline: This phase III study aims to compare the efficacy of Risperidone versus placebo in treating the behavioural and psychological signs and symptoms of dementia (BPSSD), specifically aggression, delusions and hallucinations, and evaluate the safety and tolerability in the nursing home population. Other outcome criteria will evaluate nursing burden and Australian Ageing Research Directory 2000 147 Medical Research health care resource use for patients with manifestations of BPSSD who are treated with Risperidone or placebo during the 12 week trial period. The study is being conducted in Australia and New Zealand, and aims to recruit a total of 342 patients with Alzheimer’s disease, vascular or mixed dementia. The primary efficacy parameter used for this study is the Cohen Mansfield Agitation Inventory (CMAI, disruptive form). Pathology in Alzheimer’s Disease Rating Scale (BEHAVE AD), Single instrument for Classifying Nursing Home and Hostel Residents (SCI), Functional Assessment Staging (FAST), Clinical Global Impression (CGI), and the Mini Mental Status Examination (MMSE) are to be secondary parameters. Keywords: Alzheimer’s disease, dementia, vascular dementia, nursing homes, risperidone, behavioural, psychological, delusions, hallucinations, atypical antipsychotic 259 Title: Screening of cognitive function using a novel computerised battery Principal researcher: Dr D G Darby Co-researchers: Dr M Woodward, Dr J R Merory, Dr M Hopwood, Mr B A Field, Dr I A R Tan Ms T Wardill, Mrs M Hoffman Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Planned Timetable: Commencing May 2000 Outline: Screening tests for patients with difficulties with thinking, concentration and memory are of potential use in all age groups. One reason is that illness affecting these abilities is very common, and includes depression, anxiety, drug abuse, head injury, or aging-related memory problems such as dementia. With new and effective therapies now available for many of these conditions, new ways of diagnosing them before they are severe are required. Using computers to do the tests is now possible, and offers several advantages such as being able to time accurately, screen many people and be used in remote locations. Such tests must be ‘standardized’ in people shown to be thinking normally and tested to see if they give different results in people with medical disorders which impair thinking. This study uses a new computer test to detect differences in thinking abilities. It uses pictures of playing cards presented in different ways to assess alertness, memory and aspects of concentration. Speed of response, errors and other aspects of performance are also measured. Keywords: Cognitive function, dementia, screening tests 260 Title: Study of the efficacy and tolerance of RU 35926/C1-979 (Milameline), 3 and 4 mg per day in patients with Alzheimer’s disease. A 26 week, double-blind, placebo-controlled, multicentre study. (RU35926/3006 -979-107) followed by a six month, double-blind extension, followed by a long term, open label extension of the study RU35926/3006 with RU35926/C1979 (Milameline) 3 and 4 mg per day, in patients with Alzheimer’s disease (RU35926/3007) Principal researcher: Dr M Woodward Co-researchers: Dr J R Merory, Dr M R Bird, Dr D G Darby, Mr B A Field Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Terminated Funding: Hoechst Marion Roussel Timetable: April 1996 - November 1997 Outline: This was a Phase III study of the efficacy of the muscarinic agonist Milameline. In terms of the safety results, the cholinergically mediated adverse advents expected with this drug were found. The results showed no significant differences between placebo and treatment groups for ADAS-cog or CIBIC. The trial was terminated due to lack of efficacy in the double-blind study. Keywords: Alzheimer’s disease, dementia, muscarinic agonist, efficacy, safety 148 Australian Ageing Research Directory 2000 Medical Research 261 Title: The efficacy, safety and tolerability of Lazabemide (Ro-19-6327) versus placebo, administered for one year in patients with probable Alzheimer’s disease (PDL 1001P) followed by long-term efficacy, safety and health care outcomes in patients receiving open label Lazabemide therapy (PDL 1015P) Principal researcher: Dr M Woodward Co-researchers: Dr J Merory, Dr D G Darby, Dr M R Bird, Dr I A R Tan, Mr B A Field, Ms A J Woodward, Ms C L Scott, Ms E Sealey Organisation: Clinical Cognitive Research Unit, Austin and Repatriation Medical Centre Status: Terminated Funding: Hoffmann-LaRoche/Protodigm Ltd Timetable: April 1997 - November 1999 Outline: This is an international, multicentre, phase 111, double blind clinical trial looking at efficacy, safety and tolerability of Lazabemide versus placebo. Lazabemide is a substance that inhibits the enzyme monoaminoxidase B (MAO-B). Monoamines are known to play a role in cognitive function and are reduced in Alzheimer’s disease. Preliminary results indicated efficacy, but the trial was stopped due to safety concerns reflected by some serious adverse advents reported. Keywords: Alzheimer’s disease, dementia, efficacy, safety, monoaminoxidase B inhibitor 2.26 Department of Biochemistry and Molecular Biology, Monash University 262 Title: Age-associated human mitochondrial DNA mutations Principal researchers: Professor P Nagley, Dr C Zhang Co-researcher: Professor A W Linnane Organisations: Centre for Molecular Biology and Medicine, Epworth Medical Centre; Department of Biochemistry and Molecular Biology, Monash University Status: Completed Funding: National Health and Medical Research Council, $300,000 Timetable: 1995 - 1997 Website: http://www.med.monash.edu.au/biochem/nagley.htm Outline: This study focussed on age-associated molecular changes in mitochondria, the energy-producing component of living cells. The decline in energy-production in tissues of humans, with advancing years, is linked to the loss of respiratory function in mitochondria within the cells. This project involved a detailed study of damage to the specific loops of DNA in mitochondria, whose genetic information is essential for the correct development of the energy-producing system of mitochondria. Specific methods were developed for the quantitative analysis of both deletions (gaps) or point mutations at particular locations in the human mitochondrial DNA, using the polymerase chain reaction. The study found that in many human tissues mutations in mitochondrial DNA occur randomly in ageing. Deletions accumulate with age, while point mutations show a much weaker correlation with age. The distribution of mutations was found to occur in a mosaic pattern, such that a different population of mutations is present in adjacent regions of the same tissue. It was proposed that mitochondrial DNA mutations arise early in development and are continuously generated in many body tissues throughout the whole of life. The accumulation of mitochondrial DNA mutations during ageing is suggested to play a role in age-associated disease, previously affecting major organs such as heart and brain. Keywords: Cells, tissues, DNA, energy production, mitochondria, molecular biology, mutations Australian Ageing Research Directory 2000 149 Medical Research 263 Title: Factors involved in age-associated functional loss in rat neurons Principal researcher: Professor P Nagley Co-researcher: Dr Z Khalil Organisation: Department of Biochemistry and Molecular Biology, Monash University Status: In progress Funding: External funding being sought Timetable: 1997 - ongoing Outline: This project utilises an animal model system of ageing, involving laboratory rats. The system faithfully reflects age-associated loss of pain perception and reduced efficiency of wound healing in humans. The project investigates the progressive loss of function with age in the neurons, cells of the nervous system. The proposition being tested is that oxidative stress is responsible for the defects in the nerve system as the animals age, by use of rats systematically fed with antioxidants. The source of oxidative stress is the oxygen breathed in from the air; the damage is manifested in many tissues of the body. One point of focus of oxygen-induced damage occurs through the accumulation of chemical changes in the compartment of the cell (known as mitochondria) responsible for oxygen consumption and release of energy from food. The chemical damage to mitochondria occurs both to the proteins and to the DNA of this cell compartment. The project concentrates on mitochondria as one of the likely prime factors in the functional decline of nerves during ageing. Aspects of mitochondrial damage being studied include mitochondrial DNA, membrane organisation, and energy production. It is also investigating the well-established observation that recovery of nerves from damage is much less efficient in the elderly than in young individuals. Using the rat system, the potential role of the mitochondria in this impaired recovery process is being studied. The results of research on the rat model system will provide new important insights into the ageing process in humans, and will provide evaluation of the use of longterm antioxidant treatment. Keywords: DNA, energy production, mitochondria, molecular biology, mutations, nerve function, pain perception, wound healing 2.27 Department of Epidemiology and Preventive Medicine, Monash University 264 Title: Effective discharge performance indicator project Principal researcher: Dr J Ibrahim Co-researchers: Ms M Buick, Dr J Majoor, Dr K Ogden, Professor J J McNeil Organisation: Health Services Research Unit, Department of Epidemiology and Preventive Medicine, Monash University Status: In progress Funding: Department of Human Services, Victoria Timetable: March 2000 - July 2000 Website: http://www.med.monash.edu.au/epidemiology/index.html Outline: This project aims to develop effective discharge performance indicators, which will be used to measure performance of hospitals, sub-acute services and Multi Purpose Services in relation to discharge on a statewide basis. The objectives of the consultancy are (i) to design performance indicators, (ii) to consider how the different hospitals in Victoria could be grouped to use comparative information, (iii) to consider how the performance indicators can be applied to improve patient care. The research methods to be used in this consultancy include a systematic review of the published literature, extensive consultation with recognised experts, peak organisations and the key stakeholders. Specific fieldwork will investigate and 150 Australian Ageing Research Directory 2000 Medical Research consider (i) the feasibility of collecting the data elements required for the performance indicators, (ii) the most appropriate model for the classification of hospitals into similar groupings. Keywords: Performance measures, discharge planning 265 Title: Melbourne atherosclerosis and vitamin E trial Principal researcher: Professor J J McNeil Co-researchers: Associate Professor B P McGrath, Dr P Branley, L Shiel, J Snaddon Organisations: Department of Epidemiology and Preventive Medicine, Monash University; Department of Vascular Medicine, Monash Medical Centre Status: In progress Funding: National Health and Medical Research Council project grant 1994-1999 Timetable: 1994 - 2000 Website: http://www.med.monash.edu.au/epidemiology/prevmed/mavet.htm Outline: The Melbourne Atherosclerosis and Vitamin E Trial (MAVET) is a double-blind placebo controlled randomised trial of Vitamin E (500 i.u./day) established to determine if Vitamin E will retard the progression of atheroma in smokers. Atherosclerosis occurs due to accumulation of cholesterol-laden material in walls of arteries, leading to narrowing and a restriction of blood flow. Recent studies have suggested that the more rapid progress of atherosclerosis in smokers may result from oxidation of the cholesterol particles in blood. Some vitamins, including Vitamin E, are natural antioxidants and can protect cholesterol particles from oxidation. Some epidemiological studies in humans suggest that Vitamin E may slow the progress of atherosclerosis. This study is therefore measuring the effect of Vitamin E on the rate of progression of the disease. Beginning in 1994, 409 volunteers with a mean age of 64 years, were recruited to join the study. Half of the participants receive 500 i.u. of Vitamin E daily and the other half receive a capsule identical in appearance containing a placebo. The study is conducted in a double-blind manner where neither the participants nor the research team know who is taking Vitamin E or placebo. The code for this information is held by an external body until the end of the study. Each participant attends the study centre initially on a semi-annual and thereafter an annual basis. At each visit an ultrasound is performed on the carotid arteries (neck arteries). The images from the ultrasound are digitized and are also analysed for changes in artery wall thickness. Keywords: Vitamin E, atherosclerosis, clinical trial, cardiovascular disease prevention 266 Title: Prevention of cataract and age-related macular degeneration with Vitamin E in the elderly Principal researchers: Professor J McNeil, Professor H Taylor Co-researchers: Associate Professor C McCarty, Dr L Robman, Ms G Tikellis, Dr K Ogden Organisations: Department of Epidemiology and Preventive Medicine, Monash University; Centre for Eye Research Australia, University of Melbourne Status: Nearing completion Funding: National Health and Medical Research Council Timetable: 1995 - 2000 Website: www.med.monash.edu.au/epidemiology Outline: Cataract is one of the leading causes of blindness in the world today, and in the Western world more than 40% of people over 75 years suffer from senile cataract. Age related macular degeneration is responsible for the majority of new cases of visual impairment in the Western world, and is a condition for which treatment options are limited. There is a growing Australian Ageing Research Directory 2000 151 Medical Research body of evidence suggesting a role for antioxidant therapy to prevent the progression of these conditions. This study aims to determine the effect of Vitamin E supplementation (500 i.u. daily) in preventing incidence and/or progession or promoting regression of nuclear and cortical cataracts, and preventing incidence and/or progression of age related macular degeneration over a four year period. The study is randomised, placebo controlled, doubleblinded trial. 1,200 participants between 55-80 years of age, with little or no cataract and not taking anticoagulant or steroidal medication were identified from within a community setting in suburban Melbourne. Participants were interviewed and examined at baseline and annually for four years. Photography of the lens and macula was performed following dilation to a minimum pupil size of 6.5mm. The lens was photographed using the Nike EAS-1000 Anterior Eye Segment Analysis camera linked to a personal computer with optical disc drive for digital analysis and image storage. Stereo photography of the macula was performed using the Nike 3-DX funds camera, and grading of macular characteristics carried out according to the International Classification and Grading System for Age-related Maculopathy and Agerelated Macular Degeneration. All data has been collected, and data analysis will commence in April 2000. Keywords: Cataract, macular degeneration, antioxidant, Vitamin E, randomised controlled trial 267 Title: Stroke prevention and intervention program Principal researcher: Professor J J McNeil Co-researchers: Dr P Talman, Dr H Stephenson, Dr C Chapman, Dr S Killalea Organisations: Department of Epidemiology and Preventive Medicine, Monash University; Department of Neurosciences, Monash Medical Centre Status: In progress Funding: ANZ Charitable Trust Timetable: 1998 - 2000 Outline: Stroke accounts for approximately 10% of all deaths in Australia and is largely a disease of the elderly. The research team has developed a computer-based decision support tool to assist general practitioners in the management of risk factors for stroke, such as smoking, hypertension, carotid stenosis and atrial fibrillation. The process involved the development of a paper version of the decision logic, which was developed by an expert panel and evaluated with members of two Divisions of General Practice. This paper version was transformed into a knowledge base consisting of a flowchart with direct references to an accompanying HTML document. The system minimises data entry by intelligently prompting for clinical data only when required, and improves guideline compliance by processing this data into patient-specific recommendations. This program’s potential uses include education of practitioners and patients, practice and prescription audit, and improved clinical outcomes due to greater adherence to best practice guidelines. Further evaluation of the software in a general practice setting is underway. Keywords: Stroke, risk factors, information technology 2.28 Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, South Australia 268 Title: Zinc absorption and zinc status in patients with Alzheimer’s disease, asthma or rheumatoid arthritis Principal researchers: Dr R N Ratnaike, A G Milton 152 Australian Ageing Research Directory 2000 Medical Research Co-researchers: Dr K Boundy, E Goble, Professor R E Ruffin, Dr K Pile, Dr P Pannell, Dr P D Zalewski Organisation: Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, South Australia Status: Commissioned Funding: Presently being sourced Timetable: May 2000 - December 2001 Outline: Decreased plasma Zn concentrations are reported in Alzheimer’s disease, asthma, and rheumatoid arthritis. The research will investigate the zinc status and small bowel absorption of zinc in patients with these conditions, and matched controls. The second part of the study is to measure the plasma response to a standard oral zinc dose to determine if there is a defect in the absorption and transport of zinc in the small intestine. Zinc is essential for growth, development, and tissue repair. A large number of the body’s metalloenzymes and zinc finger transcription factors are zinc dependent: some are activated by zinc, but most require zinc for their synthesis, e.g. alkaline phosphatase, carbonic anhydrase, glutamate dehydrogenase and alcohol dehydrogenase. Zinc is also required for the synthesis of DNA and RNA. Research has demonstrated that zinc has a role in the prevention of apoptosis. The level of labile zinc in healthy cells is inversely correlated to the capacity of the cells to undergo apoptotic DNA fragmentation in culture. It appears that a reduction in Zn below a certain threshold level induces apoptosis. Apoptosis is greatly enhanced in tissues of Zndeficient animals and in isolated cells cultured in Zn-depleted medium, or in the presence of membrane-permeable Zn chelators. Zinc inhibits apoptotic DNA fragmentation by blocking the responsible endonuclease activity. Information on the zinc status and absorption of Zn is pertinent because the diet that is predominant in Australia, Canada and the US is known to be zinc deficient. This suggests that the increased incidence of these diseases in the west may be linked to zinc status. Poor absorption of zinc could be a contributing factor in these illnesses. Keywords: Zinc, Alzheimer’s disease, asthma, rheumatoid arthritis 2.29 Department of Medicine, University of Queensland, Princess Alexandra Hospital 269 Title: Coronary artery disease in the elderly Principal researcher: Professor T Marwick Organisation: Department of Medicine, Princess Alexandra Hospital, Southern Clinical School, University of Queensland Status: Ongoing Funding: National Health and Medical Research Council Timetable: Current Outline: Development of new non-invasive testing protocols for the diagnosis and evaluation of coronary artery disease, particularly involving myocardial tissue Doppler. Assessment of myocardial viability following infarction using stress echocardiography. Detection of vessel patency after infarction using contrast echocardiography. Keywords: Coronary artery disease, viable myocardium, elderly 270 Title: Growth hormone insulin-like growth factor I and IGF-binding proteins in acute exercise Principal researchers: Associate Professor R C Cuneo, Ms J D Wallace Australian Ageing Research Directory 2000 153 Medical Research Organisation: Department of Medicine, Southern Clinical School, Princess Alexandra Hospital, University of Queensland Status: In progress Funding: National Health and Medical Research Council, Project Grant, $340,000 Timetable: January 2000 - December 2002 Outline: Insulin-like growth factor I (IGF-I) and related serum binding proteins (IGF-BPs) have pivotal roles in the maintenance of normal health and regulation of growth in differentiated function of a wide range of tissues. IGF-I declines dramatically with apparently normal ageing. The reason is partly related to the reduction in serum growth hormone concentrations with age. This study aims to examine the effect of acute physical activity on the immediate changes in IGF-I and related IGF-binding proteins. Preliminary data suggests that acute exercise contributes to rapid fluxes in IGF-I and IGF-binding proteins in and out of peripheral circulation. This study aims to examine the effect of differences in basal growth hormone concentrations, by studying normal and growth hormone deficient subjects, the latter with and without GH treatment on these processors. A greater understanding of the normal exercise physiology will permit health care strategies which may benefit ageing individuals and those in other catabolic states. Keywords: Growth hormone, IGF-I, IGF-binding proteins, exercise, liver 271 Title: Growth hormone production, physical activity and ageing Principal researchers: Associate Professor R C Cuneo, Ms J D Wallace Organisation: Department of Medicine, Southern Clinical School, Princess Alexandra Hospital, University of Queensland Status: In progress Funding: Eli Lilley Research Grant, $11,000 Timetable: 1993 - 2001 Outline: Growth hormone production declines dramatically in apparently normal ageing. The reasons for this decline are unknown but the research hypothesis is that alterations in physical activity, either acutely or chronically, contribute to this decline. This project aims to study habitually active elderly males (mostly veteran runners) and examine their 24 hour growth secretory profile on two occasions, one with and the other without high levels of physical activity performed during the day. Subjects are housed in a temperature-controlled metabolic unit and have venous samples taken for growth hormone assay at 20 minute intervals for 24 hours. Prescription was designed to mimic the type of activity individuals normally undertook. Preliminary findings suggest that some veteran athletes actually produce growth hormone profiles that are indistinguishable from individuals in their 20’s. The potential conclusions from this study are that while growth hormone is an essential part of maintenance of normal adult body composition, physical activity and numerous other important physiological actions, high levels of habitual physical activity may promote and maintain optimal health in the elderly. Keywords: Ageing, exercise, growth hormone, insulin-like growth factor I, sleep 272 Title: Medications and the elderly Principal researcher: Professor M Roberts Organisation: Department of Medicine, Princess Alexandra Hospital, Southern Clinical School, University of Queensland Status: Ongoing Funding: Various sources 154 Australian Ageing Research Directory 2000 Medical Research Outline: Medications and the elderly. Keywords: Medication, elderly 273 Title: Paget's disease in the elderly Principal researcher: Dr J Shaw Organisation: Department of Medicine, Princess Alexandra Hospital, Southern Clinical School, University of Queensland Status: Ongoing Funding: National Health and Medical Research Council Outline: Paget’s disease of bone is a common metabolic bone condition characterised by bone pain, deformity, pathological fracture and an increased incidence of osteosarcoma. Genetic factors play a role in the pathogenesis of Paget’s disease of bone, with penetrance influenced by increasing age, but the molecular basis remains largely unknown. Pedigree studies have identified two susceptibility loci for Paget’s disease of bone mapped to chromosome 6p21.3 (PBD1) and 18q21.1-22(PDB2). A large pedigree of over 250 individuals, with 49 affected by Paget’s disease of bone have been identified. The disease is inherited as an autosomal dominant trait in this pedigree with high penetrance by the sixth decade. Linkage analysis has excluded linkage between Paget’s disease in this pedigree and the PDB1 and PDB2 loci. These data confirm the genetic heterogeneity of Paget’s disease of bone. A microsatellite genome-wide scan has been undertaken to identify a novel susceptibility locus for Paget’s diseases of bone, and this will be followed by positional cloning in region(s) of positive linkage to identify the causative gene(s). Keywords: Paget's disease, ageing 274 Title: Parkinson's disease and ageing Principal researcher: Professor M Roberts Organisation: Department of Medicine, Princess Alexandra Hospital, Southern Clinical School, University of Queensland Status: Ongoing Funding: Various sources Outline: Parkinson’s disease and ageing Keywords: Parkinson's disease, ageing 275 Title: Type 2 diabetes and ageing Principal researcher: Dr J Shaw Organisation: Department of Medicine, Princess Alexandra Hospital, Southern Clinical School, University of Queensland Status: Ongoing Funding: National Health and Medical Research Council Outline: Type 2 (non-insulin dependent) diabetes mellitus affects approximately 4% of the Australian population, with prevalence rates up to six times higher in indigenous Australian communities and in subjects of Pacific Islander descent. Type 2 diabetes is a major public health problem because of its association with complications including blindness, renal impairment, neuropathy, heart disease and peripheral vascular disease. Type 2 diabetes has a strong genetic component, with penetrance influenced by age and obesity. Pedigree studies are being coordinated in a number of indigenous Australian communities and in pedigrees of Australian Ageing Research Directory 2000 155 Medical Research Pacific Islander descent, with the aim being to identify the genetic basis for Type 2 diabetes in these families. The clinical relevance of this research includes the development of preclinical screening strategies for Type 2 diabetes, improved understanding of the pathophysiology of Type 2 diabetes, and the eventual development of novel therapeutic approaches to the condition. Keywords: Diabetes type 2, ageing 2.30 Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia 276 Title: An I-123 iododexetimide (IDEX) SPECT study of acetycholine neuroreceptors in the medial temporal lobe in Alzheimer’s disease Principal researchers: Dr K Boundy, Dr P Roselt, Dr A Katsifis Co-researchers: Dr L Barden, Ms E Goble, Dr R Casse, Dr M Kitchener Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: In progress Funding: TQEH Research Foundation, Nuclear Medicine and Neurology Trust Funds Timetable: 2000 - 2001 Outline: With the advent of drugs that appear to slow or even halt the progress of Alzheimer’s disease, there is great interest in the earliest possible detection of the disease. Preliminary studies at The Queen Elizabeth Hospital have demonstrated that SPECT scanning of the muscarinic cholinergic receptor label, I-123 iododexetimide is very sensitive to the effects of early Alzheimer’s disease. A strong deficit in iododexetimide activity in the posterior cingulate cortex and a lesser deficit in the medial temporal lobe was detected. This research aims to increase the sensitivity to effects in the temporal lobes in order to enhance our ability to detect early Alzheimer’s disease. Both early and late scanning is being performed and the advanced image processing techniques of SPECT scatter subtraction, coregistration of SPECT to MR, transformation to a standard anatomical space, and statistical parametric mapping are then applied. Keywords: Alzheimer’s Disease, iododexetimide, SPECT, cholinergic receptors 277 Title: An open-label, multicentre, follow-up trial to assess the long-term safety and tolerability of oral talsaclidine 24mg tid in patients with mild to moderate dementia of Alzheimer type Principal researcher: Dr K Boundy Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: Open label extension stage Funding: Boehringer Ingelheim, TQEH Dementia Research Fund Timetable: 1999 - December 2000 Outline: Talsaclidine is a muscarinic agonist which exhibits high selectivity for post synaptic M1 receptors linked to a full intrinsic activity and very stable pharmocokinetics profile. Furthermore, it is also able to modify amyloid precursor protein -secretion in a positive manner. Clinical studies with single doses of talsaclidine fumarate have confirmed the drugs action as a cholinergic agent. There was no cause for concern about safety, in subsequent studies with 1.5-48 mg Talsaclidine tid (free base) in young healthy volunteers, with a 156 Australian Ageing Research Directory 2000 Medical Research treatment duration of two weeks and with doses up to 36 mg tid (free base) with a treatment duration of four weeks in patients with Alzheimer’s disease. Keywords: Alzheimer's disease, talsaclidine, muscarinic agonist, amyloid precursor protein 278 Title: An open label study to evaluate tolerability of increasing dosages of SDZ ENA 713 in patients with probable Alzheimer’s disease. Protocol No ENAB 355-E-00 Principal researchers: Dr K Boundy, Dr L Barden Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: Open label extension stage Funding: Novartis Pharmaceuticals, TQEH Dementia Research Fund Timetable: 1996 - May 2000 Outline: SDZ ENA 713 (Exelon/Rivastigmine) is a brain selective, pseudo-irreversible acetylcholinesterase inhibitor of the carbamate type. It is intended for use in patients with mild to moderate Alzheimer's disease. In Alzheimer’s disease, degeneration of cholinergic neurons results in reduced levels of acetylcholine in the synapse. This loss of cholinergic function correlates with the cognitive deficits characteristic of Alzheimer’s disease. By inhibiting acetylcholinesterase, the resulting elevation in acetylcholine levels is believed to be responsible for the clinical improvement in patients treated with Exelon. The effectiveness of Exelon has been demonstrated by the results of worldwide clinical studies. Taken together these studies show that Exelon, compared with placebo, produces significant improvement in the major domains of cognition, global functioning, activities of daily living and on the severity of the patients disease. Keywords: Alzheimer's disease, Exelon, acetylcholinesterase, acetylcholine, cognition 279 Title: Long term safety and efficacy of Galantamine in the treatment of Alzheimer’s disease Principal researchers: Dr K Boundy, Dr L Barden Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: Open label extension stage Funding: Janssen Cilag, TQEH Dementia Research Fund Timetable: 1998 - December 2000 Outline: Galantamine, is a natural cholinesterase inhibitor from snowdrop and daffodil bulbs. Consistent results in all Phase 2 and 3 trials demonstrate the sustained efficacy and safety of Galantamine in the treatment of patients with mild to moderate Alzheimer’s disease. Galantamine treated patients in all placebo controlled phase 3 trials improved, while those taking placebo deteriorated. These results were both statistically significant and clinically meaningful, and were seen in both the main efficacy analysis and the responder analysis. Furthermore, evidence from long-term, albeit open-label studies demonstrate that the benefit on cognition was maintained over 12 months of Galantamine treatment. Keywords: Alzheimer's disease, Galantamine, natural cholinesterase inhibitor, cognition Australian Ageing Research Directory 2000 157 Medical Research 280 Title: Multicentre, randomised, double-blind placebo controlled dose ranging Phase III study to evaluate once daily doses of AIT-082 over 24 weeks in patients with probable Alzheimer's disease of mild to moderate severity Principal researchers: Dr K Boundy K, Dr L Barden Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: In progress Funding: Cromedica, TQEH Dementia Research Fund, North Western Adelaide Health Service Timetable: 2000 - 2001 Outline: AIT-082 is a purine derivative that is being tested in mild to moderate Alzheimer’s disease. It is orally active and crosses the blood brain barrier and has no toxic metabolites. This drug may restore memory deficits through a mechanism involving carbon monoxide and guanylate cyclase. A previous three month trial of this drug, in Canada, South Africa and Australia has, on interim analysis, demonstrated ‘safety and positive effects’ on memory. Keywords: Alzheimer's disease, neotrofin, memory 281 Title: Pre and post Aricept SPECT scanning to observe the clinical, neurophysical and cerebral blood flow effects of Donepezil in mild Alzheimer’s disease Principal researchers: Dr K Boundy, Dr L Barden, Dr M Kitchener, Ms E Goble Organisation: Department of Nuclear Medicine, The Queen Elizabeth Hospital, South Australia Status: In progress Funding: Dementia Research Trust, Pfizer Pharmaceuticals Timetable: 2000 - 2001 Outline: Donepezil (Aricept) has been shown clinically to benefit cognitive function, shortterm memory and activities of daily living. This study aims to investigate the mechanisms of these effects by measuring regional cerebral bloodflow using HMPAO SPECT imaging before and after a course of Aricept. Comparison of these images over a population of subjects will yield details of the effect of the drug on bloodflow in different structures of the brain. Advanced processing techniques including SPECT to SPECT and SPECT to MRI coregistration of 3D images, transformation to a standard anatomical space, and statistical parametric mapping will be applied to the data. Keywords: Alzheimer’s disease, Aricept, Donepezil, SPECT 2.31 Department of Physiology, University of Adelaide 282 Title: Induction of reorganisation in the human brain Principal researchers: Dr M Ridding, Dr T Miles, Professor P Thompson Co-researcher: Dr D McKay Organisation: Department of Physiology, University of Adelaide Status: In progress Funding: Australian Research Council, $55,000 per annum Timetable: 1999 - 2001 Outline: The research proposes to induce long-term (ie. lasting several hours) changes in the organisation of the sensory cortex of human subjects. These will be measured using high- 158 Australian Ageing Research Directory 2000 Medical Research resolution electroencephalography and observation of the nature and duration of these changes over a time course of hours or possibly days. The human brain has long thought to be basically “hard-wired”, ie. its neutral circuits are laid down fully by about the age of puberty, then remain essentially unchanged throughout life. This idea has been reinforced by observations that people who have strokes, for example, can undergo only limited recovery of function. However, it is clear that the neural circuits can be modified during, for example, memory or the learning of a new motor skill. While this constitutes indirect evidence that circuits are modified, it has not hitherto been possible to demonstrate changes in neural connectivity in the human brain directly. Recent work in the Department has shown that short-term changes (lasting up to an hour or so) can be induced in the motor cortex of the brain by prolonged nerve stimulation. The research has produced compelling evidence that longer-term changes (lasting for several hours) can be induced by combining peripheral nerve stimulation with brain stimulation. What is even more interesting is that the changes do not occur immediately, but build up over several hours following the cessation of the stimulation. This observation strongly suggests that stimulation algorithm is inducing the expression of a protein in synapses in neurones of the human cortex. This observation has no precedent in human neuroscience. While confirmation will require invasive animal experiments, the matter is of intense interest in human neuroscience. It is now proposed to extend the study of sensory modification to the sensory cortex of the human brain. Cortical reorganisation is relevant to phenomena such as motor skill acquisition and the many other functions of the cortex, including speech and even reasoning. It is also likely to be important in various aspects of the rehabilitation of damaged or dysfunctional brains, although the latter lies outside the scope of the present application. Keywords: Cortex, human, reorganisation, plasticity 2.32 Department of Physiology, University of Melbourne 283 Title: Mechanisms of age-related changes in skeletal muscle structure and function; Improving muscle function in the elderly Principal researcher: Dr G S Lynch Organisation: Department of Physiology, University of Melbourne Status: In progress Funding: Australian Research Council, The Rebecca L Cooper Medical Research Foundation, $133,000 Timetable: January 1999 – December 2001 Website address: http://www.physiol.unimelb.edu.au Outline: As we get older, the size and strength of our muscles decrease significantly, factors that dramatically impact upon the quality of life. Muscle weakness is a major health problem throughout the world, although few recognise its impact on their lives and well being until it is too late to prevent these deleterious age-related changes. Muscle wasting or atrophy with aging is termed “sarcopenia”, and this loss of muscle tissue impacts upon the ability to exercise and thus accelerates osteoporosis, setting up a vicious cycle of increasing disability and impaired mobility. Muscle weakness contributes to the increased incidence of fall-related fractures in the elderly and similar age-related losses in muscle strength and endurance are responsible for the inability to perform even simple activities required for daily living, such as those required for personal hygiene and feeding. The aim of this research is to investigate the underlying mechanisms of the age-related changes in skeletal muscle and to devise strategies that can ameliorate muscle wasting in old age. Restoring or increasing muscle tissue to previous or higher levels will improve muscle function. The relative efficacy of intervention Australian Ageing Research Directory 2000 159 Medical Research strategies, such as administration of insulin-like growth factor-I (IGF-I), from the examination of physiological and biochemical parameters following treatment of aged rats, is determined. As for old compared with young humans, aged rats exhibit muscle wasting and weakness compared with young rats. Strategies that improve muscle size and strength in rats have the potential for similar improving these parameters in elderly humans. If successful, the impact of these intervention strategies would be far-reaching and would mean an immediate improvement in the quality of life for the elderly. Keywords: Muscle wasting, sarcopenia, exercise, strength training, growth factors 2.33 Department of Rheumatology, Royal North Shore Hospital, NSW 284 Title: Fracture risk epidemiology in the elderly Principal researchers: P Sambrook, L March, I D Cameron, R Cumming, S Lord Organisation: Department of Rheumatology, Royal North Shore Hospital Status: In progress Funding: National Health and Medical Research Council Timetable: March 1999 - December 2001 Outline: This study is investigating predictors of falls and fractures in nursing and hostel residents. A large cohort is being enrolled who have baseline assessment of bone characteristics (by quantitative ultrasound of the heel), physiological function (including strength, reaction time, vision and cognitive function), vitamin D, comorbid illnesses, medications and care environment. Falls, fractures and vital status are monitored. Keywords: Falls, osteoporosis, proximal femoral fracture, muscle strength, vitamin D, vision, cognitive function 2.34 Discipline of Medicine, University of Tasmania 285 Title: Correlation between functional and electrophysiological recovery in acute ischemic stroke Principal researchers: Dr D Dunbabin, Professor D Kilpatrick Organisation: Discipline of Medicine, University of Tasmania Status: Completed Outline: There is still controversy about the prognostic value of motor evoked potential in the assessment of hemiplegia. The aims of this study are to determine the relationship between functional and electrophysiological recovery and thus the value of motor evoked potential as a prognostic indicator of clinical outcome in acute ischemic stroke. Seventeen healthy subjects and 38 stroke patients were included in the study. Functional recovery was assessed with the Modified Canadian Neurological Scale, the Barthel Activities of Daily Living Index and the Rankin scale. Transcranial magnetic stimulation was used to determine the change in central motor conduction time. Stroke outcome was assessed at the end of two weeks. One-way ANOVA with post hoc comparisons using Scheffé procedure as well as t tests were used to assess the significance of the results. The data showed that there is a close relationship between clinical and electrophysiological improvement and that motor evoked potentials are a useful prognostic indicator of clinical outcome. Keywords: Electrophysiology, prognosis, ischemic stroke, stroke, stroke outcome 160 Australian Ageing Research Directory 2000 Medical Research 286 Title: Effects of spontaneous recanalization on functional and electrophysiological recovery in acute ischemic stroke Principal researchers: Dr D Dunbabin, Professor D Kilpatrick Organisation: Discipline of Medicine, University of Tasmania Status: Completed Outline: Transcranial Doppler ultrasound studies have shown that spontaneous recanalization results in a better clinical improvement after the onset of stroke. However, its effect on electrophysiological recovery is still unknown. The aim of this study was to determine the effects of spontaneous recanalization on the change in central motor conduction time in acute ischemic stroke. Seventeen healthy subjects and 38 consecutive patients with a first acute ischemic stroke involving the middle cerebral artery territory were included. Transcranial Doppler ultrasound was used to detect spontaneous recanalization. Transcranial magnetic stimulation was used to determine the change in central motor conduction time on days 1 and 14. Spontaneous recanalization was observed in 62% of patients: 24% before 24 hours and 38% after this period. No recanalization was observed in 14 patients. The central motor conduction time improved in 87% of the patient who had recanalized before 24 hours and 62% in the recanalized after 24 hours group. In contrast, it improved in only 17% of the patients in the non-recanalized group. These data show that spontaneous recanalization results in a better recovery of the central motor pathway leading to a better central motor conduction time improvement in acute ischemic stroke. Keywords: Electrophysiology, reperfusion, stroke, ischemic stroke, stroke outcome 2.35 Prince of Wales Medical Research Institute 287 Title: Adoption and adherence to physical activity in older people Principal researchers: Dr S Lord, Ms J Corcoran Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: NSW Health Physical Activity Demonstration Grant, $40,545 Website: www.powmri.unsw.edu.au Outline: The study aim was to determine psychological, physiological, health and lifestyle factors associated with adoption and adherence to physical activity in older people living in retirement villages and hostels. The study design was a prospective population study involving 300 participants. The outcome was understanding of major factors associated with adoption and adherence to physical activity in older people, strategies for maximising compliance to exercise interventions. Keywords: Exercise adherence, exercise adoption, falls prevention, aged 288 Title: An exercise intervention program for preventing falls in elderly persons Principal researchers: Dr S Lord, Ms B Matters, Ms J Corcoran, Ms A Howland Organisation: Prince of Wales Medical Research Institute Status: In progress Funding: National Health and Medical Research Council Project Grant, $173,841; MBF, $35,000 Timetable: June 1999 - December 2000 Website: www.powmri.unsw.edu.au Australian Ageing Research Directory 2000 161 Medical Research Outline: The study aims to determine whether structured group exercise can improve strength, balance and coordination and reduce falls and falls-injuries in older people living in retirement villages and hostels. The expected outcome of the study is improved physiological functioning and fewer falls in exercise groups, and a model for implementing as community/institutional falls prevention strategy. The study design is a cluster randomised controlled trial, with 600 participants engaged in an exercise program of 12 months’ duration. Keywords: Falls, aged, exercise, balance, strength 289 Title: An evaluation of whether cataract surgery improves memory performance and reduces falls risk Principal researchers: Dr K Anstey, Dr S Lord, Associate Professor P Mitchell, Dr M Hennessy Organisation: Prince of Wales Medical Research Institute Status: Ongoing Funding: National Health and Medical Research Council, $100,000 Timetable: 2000 - 2001 Website: www.powmri.unsw.edu.au Outline: The aim of this study is to evaluate whether improved vision after cataract surgery has benefits for cognitive performance and falls risk. A randomised controlled trial is being conducted at Prince of Wales Hospital, Westmead Hospital and St George Hospital. A cognitive and falls risk assessment is administered pre and post surgery on adults aged 65 and older with no other serious eye disease. Keywords: Cataract, memory, vision, falls 290 Title: Determinants of choice reaction time stepping in older people Principal researchers: Dr S Lord, B Matters, J Corcoran Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: National Health and Medical Research Council Project Grant, $173,84; MBF, $35,000 Timetable: 1996 - 1998 Website: http://www.powmri.unsw.edu.au Outline: The study was to determine whether choice reaction time stepping (a measure of the motor task required to avoid a fall) is associated with lower limb strength, sensation, vestibular function, vision and sway. It was a cross-sectional study of 600 men and women aged 70+ from retirement villages and hostels. The outcome of the study was increased understanding of human balance and falls, protective strategies, and insights into which physiological domains require priority interventions. Keywords: Falls, reaction time, stepping, aged, risk factors 291 Title: Determinants of lateral stability in older people Principal researchers: Dr S Lord, Ms B Matters Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: Vincent Fairfax Family Foundation, $50,000 Website: www.powmri.unsw.edu.au 162 Australian Ageing Research Directory 2000 Medical Research Outline: The study aim was to determine whether lateral stability (important for avoiding injurious falls to the side or rear) is associated with lower limb strength, sensation, vestibular function, vision and sway. Cross-sectional study of 160 community-dwelling men and women aged 70 years and over was undertaken. The outcome was increased understanding of human balance and falls, protective strategies, and insight into which physiological domains require priority interventions. Keywords: Lateral stability, falls, balance, risk factors, aged 292 Title: Effect of exercise for improving functioning post-hip-fracture Principal researchers: Dr S Lord, Ms C Sherrington Organisation: Prince of Wales Medical Research Institute Status: In progress Funding: APA Scholarship Timetable: Completion July 2000 Website: www.powmri.unsw.edu.au Outline: The study aim is to determine whether two exercise rehabilitation programs can improve functioning in older persons who have suffered a hip fracture (such persons are at increased risk of suffering a second one). Two randomised controlled trials, one in a rehabilitation setting, and one following, are being undertaken with 80 and 120 subjects respectively. The expected outcome is exercise models for maximising physiological functioning in older persons who have suffered a hip fracture. Keywords: Exercise, hip fracture, balance, strength, falls risk, aged 293 Title: Falls in older people: tailored strategies for prevention Principal researchers: Dr S Lord, B Matters, Dr P Williams Organisation: Prince of Wales Medical Research Institute Status: Ongoing Funding: National Health and Medical Research Council Project Grant, $329,509; MBF Health Research Award, $136,781 Timetable: Completion December 2001 Website: www.powmri.unsw.edu.au Outline: The study aim is to determine whether tailored interventions aimed at improving or compensating for impairments in the following physiological domains: strength, balance, speed and coordination, vision, peripheral sensation and visual field dependence - can reduce the rate of falling in older community-dwelling people. A randomised controlled trial is being conducted, involving 600 participants in minimal and extensive interventions for a twelve months duration. A full cost-effectiveness study is planned for this project. Keywords: Falls prevention, targeted programs, exercise, vision, falls risk, aged 294 Title: Is immediate blood pressure drop on rising a risk factor for falls in older people? Principal researchers: Dr S Lord, E Heitterachi Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: National Health and Medical Research Council Website: www.powmri.unsw.edu.au Australian Ageing Research Directory 2000 163 Medical Research Outline: The research aimed to determine whether instantaneous blood pressure drop on rising from a prone position predicts falls in older people while in hospital. A prospective hospital study was undertaken with 80 participants. The outcome was increased understanding of the role of postural hypotension in falls (new methodology used for more accurate measurement of blood pressure change). Keywords: Postural hypotension, falls, dizziness, risk factors, aged 295 Title: Predictors of cognitive ageing Principal researcher: Dr K Anstey Co-researchers: Professor M Luszcz, Dr S Lord Organisation: Prince of Wales Medical Research Institute; Flinders University of South Australia Status: Ongoing Funding: National Health and Medical Research Council, Australian Clinical Research Fellowship, $200,000; Clive and Vera Ramaciotti Foundation, $5,000; Flinders Medical Centre, $5,000; Australian Research Council, $15,000 Timetable: 1998 - 2001 Website: http://www.powmri.unsw.edu.au Outline: The main part of this research programme examines sensorimotor and health predictors of normal cognitive ageing. Data is being analysed from the Australian Longitudinal Study of Ageing, the Randwick Falls and Fractures Study and other studies. Both cross-sectional and longitudinal approaches are being used. Factors that predict both the maintenance and decline in cognitive abilities are being identified and compared between studies. Normative data on neuropsychological tests in very old adults are being collated. Keywords: Cognitive ageing, vision, hearing, health, longitudinal research methodology, predictors 296 Title: Risk factors for falls in acute hospital Principal researchers: Dr S Lord, R Salgado Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: School Community Medicine, University of New South Wales; National Health and Medical Research Council, $5,000 Website: www.powmri.unsw.edu.au Outline: The study aimed to determine whether a simple screening test involving assessments of confusion, mobility, psychoactive drug use and stroke can predict falls in older people while in hospital. A prospective hospital study involving 88 participants was undertaken. The outcome was increased understanding of causative factors for falls in hospital for subsequent intervention trials. Keywords: Falls, hospitals, mental status, drug use, stroke, mobility limitations, risk factors, aged 297 Title: Risk factors for falls in women with established osteoporosis Principal researcher: Dr S Lord Organisation: Prince of Wales Medical Research Institute Status: Completed 164 Australian Ageing Research Directory 2000 Medical Research Funding: Eli Lilly, $46,000 Website: www.powmri.unsw.edu.au Outline: The research set out to determine whether women with osteoporosis (BMD <2SD young normal) also have increased risks of falling due to reduced strength and stability. A prospective population study of 334 community dwelling post-menopausal women was undertaken. The study period was 24 months. The study outcome is improved knowledge of risk factors for falls in high risk of injury group. Keywords: Osteoporosis, balance, strength, reaction time, falls risk 298 Title: Risk factors for fractures in community-dwelling women Principal researcher: Dr S Lord Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: National Health and Medical Research Council; Sandoz Website: www.powmri.unsw.edu.au Outline: This study set out to determine whether a range of physiological measures plus bone density can increase the prediction of fractures over BMD alone. The study design was a prospective population study of 341 community dwelling women aged 65 years plus, with a study period of 5 years duration. The study resulted in improved knowledge of risk factors for fractures in community-dwelling women which is important for designing appropriate interventions. Keywords: Fractures, osteoporosis, balance, strength, reaction time, falls risk 299 Title: Shoe characteristics and balance in older women Principal researchers: Dr S Lord, G Bashford Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: National Health and Medical Research Council Website: www.powmri.unsw.edu.au Outline: The study aimed to determine whether shoe collar height and sole density is associated with balance in older women. The study design was a randomised crossover trial with 42 participants. The outcome was improved understanding of important shoe characteristics for development of safe shoes. Keywords: Shoes, balance, falls, risk factors, aged 300 Title: The effect of age-related and environmentally manipulated visual factors on processing speed and associative memory in mid to late adulthood Principal researcher: Dr K Anstey Co-researchers: Associate Professor S Andrews, Associate Professor S Dain Organisation: Prince of Wales Medical Research Institute Status: Ongoing Funding: Australian Research Council, $4000 Timetable: One year duration Website: http://www.powmri.unsw.edu.au Outline: This study evaluates the effect of visual factors on cognitive processing in old age. The hypothesis of the study is that age-related changes in visual function may influence the Australian Ageing Research Directory 2000 165 Medical Research speed and efficiency with which older adults process information. This is a correlational study involving adults aged 60 and older. Keywords: Cognitive aging, memory, vision, contrast sensitivity 301 Title: The effect of water exercise on physical, psychological and social factors in older people Principal researchers: Dr S Lord, Ms M Thomas, Dr D Chan, Ms L Harren, Ms A Collings Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: Ageing and Disability Department, NSW, $19,900 Timetable: Completed Website: www.powmri.unsw.edu.au Outline: The project looked at whether a water exercise program could provide benefits for older people particularly in assessing whether or not the program improved physical skills, pain levels, anxiety and depression, life satisfaction and social isolation. It sought to determine whether water exercise can improve strength, balance and coordination and improve psychological and social well-being in older community-dwelling women. A controlled trial with 240 participants undertook an exercise program of 22 weeks duration. The outcome was improved physiological and psychosocial functioning in exercise groups, model for implementing as community/institutional falls prevention strategy. Keywords: Physical activity, healthy ageing, older people, water exercise, balance, strength, psychological and social well-being, aged 302 Title: The role of vestibular impairment in instability and falls in older people Principal researchers: Dr S Lord, A Howland Organisation: Prince of Wales Medical Research Institute Status: In progress Funding: National Health and Medical Research Council, $520,616 Timetable: Completion December 2002 Website: www.powmri.unsw.edu.au Outline: The research is aiming to determine whether two new tests of vestibular function: a test of vestibulo-ocular stability and a test of vestibular postural functioning - are associated with instability and falls in older people. Prospective population studies of 200 community dwelling men and women aged 70 years and over are being used, with a follow-up period of 12 months. The expected outcome is improved knowledge of vestibular risk factors for falls for use in tailored intervention programs. Keywords: Vestibular function, balance, falls risk, aged 303 Title: Visual risk factors for falls in elderly persons Principal researchers: Dr S Lord, Ms B Matters Organisation: Prince of Wales Medical Research Institute Status: Completed Funding: Vincent Fairfax Family Foundation, $50,000 Website: www.powmri.unsw.edu.au Outline: This study aimed to determine whether impaired or reduced depth perception, visual field, stereopsis, edge contrast sensitivity and bifocal spectacles are associated with falls in 166 Australian Ageing Research Directory 2000 Medical Research older people. It was a prospective population study of 160 community dwelling men and women aged 70 years and over. The follow-up period was of twelve months duration. The outcome was improved knowledge of visual risk factors for falls for use in tailored intervention programs. Keywords: Falls, vision, aged, risk factors 2.36 Retinal Biology Laboratory, Department of Anatomy & Histology, University of Sydney 304 Title: Microvascular and immune response in the retinae of aged rats Principal researcher: Dr T Chan-Ling Co-researchers: Ms S Hughes, Dr P Hu, Dr Y Morcos Organisation: Retinal Biology Laboratory, Department of Anatomy & Histology, University of Sydney Status: In progress Funding: Rebecca Cooper Foundation for Medical Research Timetable: October 1999 - December 2005 Outline: The research aims to (i) characterise the glial, microvascular and inflammatory responses of the central nervous system to ageing; (ii) determine whether breakdown of the blood-brain barrier accompanies ageing of the central nervous system. The microvasculature of the central nervous system undergoes structural and functional changes during normal ageing. Preliminary studies in a rat model of ageing have shown that breakdown of the bloodretinal barrier occurs during ageing of the central nervous system. The research will entail a comprehensive analysis of the cellular and microvascular changes associated with ageing in retinal whole-mount preparations with the use of immunohistochemistry with cell specific markers, intravascular tracers to assess barrier properties, and TUNEL to detect apoptotic cells. The research aims to determine the earliest cellular and microvascular changes associated with normal ageing of the central nervous system. Recent studies on the pathogenesis of autoimmune conditions have demonstrated the sensitivity of the retinal whole-mount technique in detecting small numbers of infiltrating inflammatory cells and mild breakdown of the blood-brain barrier. Given that advanced age is an important risk factor for vascular dementia, characterisation of such early age-related changes in the central nervous system may facilitate diagnosis and intervention prior to the onset of dementia. Keywords: Retinal biology, angiogenesis, neuroimmunology, vascular dementia 2.37 School of Biomedical Sciences, University of Sydney 305 Title: An investigation of the response to tendon stimulation in essential tremor Principal researcher: Dr J Burne Organisation: School of Biomedical Sciences, Faculty of Health Sciences, University of Sydney Status: Completed Funding: University Research Grant, $11,000 Timetable: January 1999 - December 1999 Outline: Essential tremor occurs in hereditary and sporadic forms, but diagnosis is based on clinical criteria since no definitive pathological or neurophysiological abnormality has been Australian Ageing Research Directory 2000 167 Medical Research found. The research involved the development of a technique to study reflexes following electrical stimulation of upper limb muscle tendons and subsequently found this response to be abnormal in tremulous Parkinson's disease. A further study of essential tremor using the same technique also disclosed a significant neurophysiological abnormality. The technique will thus provide a useful tool to study the pathophysiology of essential tremor and a potential means of objectively diagnosing the main variants that present clinically. Keywords: Parkinson's disease, essential tremor, clinical diagnosis 306 Title: The effect of voluntary muscle contraction on Parkinsonian and essential tremor Principal researcher: Dr J Burne Organisation: School of Biomedical Sciences, Faculty of Health Sciences, University of Sydney Status: Completed Funding: Cumberland Research Grant, $5,500 Timetable: January 1998 - December 1998 Outline: Gross and disabling upper limb muscle tremor contributes greatly to disability in Parkinson's disease and essential tremor. Existing criteria do not reliably distinguish between the two forms of tremor diagnostically, and their pathophysiology is not well understood. The investigator quantified the response of both tremors to loading of wrist muscles using a computer-controlled torque motor. Essential tremor amplitude (as represented by spectral peak amplitude) was found to reliably increase in a linear manner with added load, while the response of Parkinsonian tremor was more complex and non-linear. This differential response to load can provide a useful diagnostic indicator and points to basic differences in pathophysiology. Keywords: Parkinson's disease, essential tremor, clinical diagnosis 2.38 School of Medical Education, University of New South Wales 307 Title: Promoting the health and quality of life of residents of retirement villages Principal researcher: Dr J E Ritchie Co-researchers: Ms B Hill, Ms B Squires, Ms F Trede Organisation: School of Medical Education, University of New South Wales Status: Completed Funding: Ageing and Disability Department, NSW, $20,342 Timetable: November 1997 - September 1998 Outline: A participatory action research project was undertaken with residents of three retirement villages. The purpose of the research was to empower older people to raise issues of concern regarding their health and well being, to act on priority issues, to strengthen village support networks and to build supportive environments for health within these settings. A case study approach was utilised where each village community was invited to work together with the researcher over a period of some months to explore the most appropriate ways to attain these goals. The process was recorded in an ethnographic manner through documentation of field observations and taping and transcription of both formal and informal interviews and village meetings. Eight major themes emerged from residents’ discussions over issues of concern. These included social interaction and support, physical environment, personal health concerns, safety, resources, activities and interests, financial pressures and management issues. Each village set up a working group which reviewed these concerns and 168 Australian Ageing Research Directory 2000 Medical Research nominated priority areas on which they could act. Once action was determined, the researcher acted in a liaising role to take the residents’ ideas and opinions to management in order that steps could be taken to reduce the factors causing problems for residents. Special effort was made to create a more supportive environment following the wishes of residents. Finally, each village group was invited to choose a method, such as an ongoing health committee, with the particular aim of sustaining the process initiated by the project into the future. Outcomes of the project include demonstrated cooperative actions to improve health and quality of life and an enhanced sense of community reported by residents. The participatory nature of the research where the researcher worked “with” residents rather than “on” them has resulted in documentation of a concrete planning, action and reflection cycle with the explicit and active involvement of residents. Keywords: Healthy ageing, participatory action research, supportive environment for health, empowerment, retirement villages Optometry and Ophthalmology 2.39 Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne 308 Title: Cardiovascular health and age-related maculopathy study Principal researcher: Associate Professor C McCarty Co-researchers: Dr R Guymer, Professor J J McNeil, Associate Professor B McGrath, Dr L Robman Organisations: Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne; Department of Epidemiology and Preventive Medicine, Monash University Status: Commenced Funding: National Health and Medical Research Council, $758,570 Timetable: January 2000 - December 2002 Outline: The project is a prospective study which aims to describe the risk factors for progression of age-related maculopathy in a population-based cohort. Specific aims of the study are to: (i) quantify annual progression rates of age-related maculopathy in a populationbased cohort of adults with identified age-related maculopathy; (ii) assess the relationship of cardiovascular risk factors to the progression of age-related maculopathy; (iii) evaluate other potential risk factors for the progression of age-related maculopathy. Prior to this study, the population-based Visual Impairment Project, funded by the National Health and Medical Research Council and Victorian Health Promotion Foundation, identified 687 people with age-related maculopathy among a random sample of 5,000 Victorians aged 40 years and older. These people will be recruited to participate in the current study. Examination involves clinical eye examination, stereo photography of the macular area followed by grading of the photos, carotid artery scan, blood draw (for cholesterol and glucose testing, as well as future genetic testing), blood pressure and anthropological measurements. The information collected from the participants includes health history, family history of eye diseases, use of medications, detailed ocular sunlight exposure and visual function questionnaires, dietary intake information, quality of life and cognitive function. The cohort of participants will be examined annually. Three studies have previously assessed the association between agerelated maculopathy and cardiovascular diseases. The Rotterdam Study (Netherlands) found an association of age-related maculopathy prevalence with atherosclerosis. The Beaver Dam Eye Study (Wisconsin) and Blue Mountains Eye Study (Australia) examined serum blood Australian Ageing Research Directory 2000 169 Medical Research lipid levels and their association with age-related maculopathy, however no examination of the carotid arteries was performed. This current study is the first to investigate the progression of age-related maculopathy features in relation to the progression of cardiovascular disease. It will also be the first study to quantify the annual progression rate of age-related maculopathy in a population-based study. The study is located at the Caulfield General Medical Centre, Caulfield, Victoria. Keywords: Age-related maculopathy, progression, cardiovascular risk factors, public health 309 Title: Vision screening of older people Principal researchers: Dr J Keeffe, Associate Professor C McCarty Organisation: Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne Status: Completed Funding: Department of Human Services, $160,000 Timetable: 1998 - 1999 Outline: This project aimed to detect people with vision impairment in Aged Care Assessment Centres for referral for appropriate eye care. All consenting patients admitted to three aged care centres during two six-month test periods had their vision assessed. Two centres were in the major country centres of Bendigo and Ballarat and the other centre was in Bundoora, in metropolitan Melbourne. The visual acuity test used was based on the directional E test developed for the World Health Organisation Low Vision Kit. Symbols to test visual acuity at 6/12 were added. The test was modified for use at three metres due to available space in patients’ rooms. It is suggested that 6/12 is a relevant functional indictor of vision as it is the vision required to obtain an Australian driving licence. Visual acuity tests were obtained for 687 out of 735 (93%) people. Those unable to respond to a visual test had severe communications problems due to cognitive or memory impairment, behavioural problems or inattention due to illness. Of those with completed test results, 41% had impaired vision and only 30% of those were receiving eye care. The remaining 70% were referred to ophthalmologists (45%), optometrists (36%) and 20% to low vision services. It is expected that some of the people referred to ophthalmologists will subsequently be referred to low vision services. This simple vision test can assess the vision of most older people despite cognitive, physical or sensory impairments that can hinder the response to regular vision tests. A significant proportion of people in aged care centres with poor vision needed to be referred for eye care or rehabilitation because of their poor vision. Keywords: Vision impairment, low vision, eye care, rehabilitation, vision screening, service utilisation 310 Title: Visual impairment project Principal researchers: Professor H Taylor, Associate Professor C McCarty Organisation: Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne Status: Data collection completed Funding: National Health and Medical Research Council; Victorian Health Promotion Foundation; Ansell Ophthalmology Foundation; Dorothy Edols Estate; Jack Brockhoff Foundation Timetable: 1992 - 2000 170 Australian Ageing Research Directory 2000 Medical Research Outline: The aim of this study is to determine the distribution and determinants of eye disease in older Victorians. It also aims to establish the impact of eye disease on visual function and activities of daily living as well as the need for, access to and barriers to eye care service utilisation. More than 5,000 people who were aged 40 years and older and living in urban and rural Victoria and Melbourne nursing homes participated in the study. Data collected included interview data regarding demographic characteristics and personal medical history. Surviving urban members of the baseline study were re-examined five years later to determine the incidence of eye disease in this population. Estimates derived from this study indicate that about 398,000 Australians over the age of 40 have vision below the legal limit for driving. About 212,000 people would have significant improvement in their vision with correctly prescribed spectacles. Approximately 63,000 Australian have legal blindness. The leading cause of blindness in older Australians is age related macular degeneration (17,000 people) followed by glaucoma (10,000 people). Un-operated cataract accounts for an estimated 5,000 cases of blindness, primarily among residents of aged care facilities. The number of new cases of vision impairment increased sharply with age. Over a five year period 22% of people over the age of eighty years will develop vision impairment. Keywords: Vision impairment, prevalence, risk factors, service utilisation 2.40 Centre for Eye Research, School of Optometry, Queensland University of Technology 311 Title: Repeatability and intercorrelations of standard vision tests as a function of age Principal researcher: Associate Professor J Lovie-Kitchin Co-researcher: Professor B Brown Organisation: Centre for Eye Research, School of Optometry, Queensland University of Technology Status: Completed Funding: Internal Timetable: March 1997 - December 1999 Outline: This study assessed repeatability and intercorrelations of five standard vision tests in subjects with normal vision. Seventy-eight subjects (aged 21-68 years) completed five measurements each of high and low contrast visual acuity, near visual acuity and contrast sensitivity (Pelli-Robson chart). Except for correlations between high and low contrast visual acuity (r=0.78), intercorrelations between tests were low to moderate (r<0.5). For each measure, variability for the group was about one line on the chart (one triplet for the PelliRobson chart) and the minimum variability for an individual subject was about one third of this. On average, 1-2 lines can be expected to be lost over the normal lifespan on each test. Variability in responses did not increase significantly with age for any test. The research concluded that the criterion for judging change on commonly used clinical vision tests is about one line for subjects over a wide age range. Keywords: Visual acuity, high contrast, low contrast, contrast sensitivity, clinical tests, ageing 312 Title: The effect of orientation and mobility training on vision and mobility performance in visually impaired adults Principal researchers: Ms G Soong, Associate Professor J Lovie-Kitchin Co-researcher: Professor B Brown Australian Ageing Research Directory 2000 171 Medical Research Organisation: Centre for Eye Research, School of Optometry, Queensland University of Technology Status: Nearing completion Funding: Internal Timetable: March 1996 - May 2000 Outline: A number of previous studies have shown that the size of the visual field and contrast sensitivity are the most important visual functions determining how well visually impaired subjects travel in their environment. However, most of these studies have not screened their subjects for mobility training. This study examined the effect of orientation and mobility training on vision and mobility performance of visually impaired adults. Vision and mobility performance of two groups of visually impaired subjects with various ocular diseases were assessed: the experimental group who received mobility training and the control group with no previous mobility training who were not referred for training. Visual performances were measured binocularly as high and low contrast visual acuities, letter and edge contrast sensitivities and kinetic visual fields. The subjects’ mobility performance was measured on an indoor mobility course: (i) walking efficiency was assessed as percentage preferred walking speed; (ii) safety performance was assessed as errors made during travel on the course. Vision and mobility performances were measured before training and approximately four weeks after completion of training for the experimental group, whilst the control group was assessed at two visits approximately five weeks apart. Self-reported mobility performance was examined by a questionnaire administered to each group at both visits and again six months after the second visit. Walking efficiency of the experimental group improved with practice immediately following orientation and mobility training but the improvement was no greater than that due to practice. There was no improvement in safety performance either due to practice or training immediately after orientation and mobility training. Self-reported mobility performance did not improve immediately after orientation and mobility training but improved six months after training. Stepwise multiple regression analyses showed that for the combined experimental and control groups, low contrast visual acuity and inferior remaining visual field were the best predictors of percentage preferred walking speed and error score respectively. Percentage preferred walking speed began to significantly deteriorate when low contrast visual acuity was 6/150 or worse whilst error score particularly declined when inferior remaining visual field was 45 degrees radius or less (between the field extent of 225 and 315 degrees). This study concluded that mobility performance of visually impaired adults improves following orientation and mobility training, but immediately after training this is due to familiarity with the course. Further research needs to be conducted to determine the improvement in mobility performance over a longer period of time following training. Tentative criteria for orientation and mobility training referral are recommended: low contrast visual acuity 6/150 or worse and/or inferior remaining binocular visual field of 45 degrees or less. However, further research is needed to ascertain if these criteria are applicable to other visually impaired groups. Keywords: Vision, visual impairment, mobility, adult 313 Title: Vision and mobility performance in patients with central and peripheral field loss Principal researchers: Ms S Hassan, Associate Professor J Lovie-Kitchin, Dr R Woods Organisation: Centre for Eye Research, School of Optometry, Queensland University of Technology Status: Nearing completion Funding: Internal Timetable: March 1996 - June 2000 172 Australian Ageing Research Directory 2000 Medical Research Outline: The orientation and mobility performance of subjects with contrasting types of visual field loss has received relatively little attention in the literature. Previous studies have assessed the mobility performance of either a heterogeneous group of low vision subjects with mixed ocular diseases or a homogenous group of subjects with a particular eye disease, the most common being retinitis pigmentosa. There have been few attempts to investigate both the performance and vision determinants of orientation and mobility in subjects with central visual field loss. Nor have the similarities and differences in mobility performance and its relationship with vision between subjects with central and peripheral visual field loss been established. The first experiment in this study evaluated the vision and mobility performance of subjects with central visual field loss, modelled by age-related macular degeneration, against subjects with normal vision of similar ages. The central visual field loss subjects had no more difficulty with orientation and mobility than normally sighted subjects of similar age. This was true in both the efficiency (speed) and safety (errors) aspects of mobility performance. This study also showed, for the first time, that subjects with binocular central visual field loss had significantly greater difficulty with mobility than normally sighted subjects of similar age. The presence and/or size of the binocular central visual field loss was the best predictor of mobility performance in elderly subjects with or without central visual field loss. In the second experiment, the vision and mobility performance of subjects with peripheral visual field loss, modeled by retinitis pigmentosa, against normally sighted subjects of similar age was investigated. The peripheral visual field loss subjects had significantly impaired mobility compared to age-matched normal-vision subjects. This was evident in both the efficiency (speed) and safety (errors) aspects of mobility performance. Residual visual field measures related to the central 100 radius visual field zone emerged as significant predictors of mobility performance in subjects with peripheral visual field loss and normal vision. The peripheral visual field loss subjects walked significantly slower and made more errors than the central visual field loss subjects. Obstacles of low illuminance and inferiorly and superiorly placed were problematic to only the peripheral visual field loss subjects. Another aim of this study was to develop and assess the effectiveness of visual field scoring based on cortical magnification. Despite the fact that these methods of visual field scoring emphasise the central visual field, which was shown to be a significant predictor of mobility performance, these methods did not emerge as better predictors of mobility performance than scoring methods based on conventional visual field measures. This may be a consequence of the equations used and measurement errors associated with kinetic perimetry. Keywords: Vision, visual impairment, visual fields, perimetry, mobility, adult 2.41 National Vision Research Institute of Australia, Victoria 314 Title: Growth and ageing of the eye lens Principal researcher: Professor R C Augusteyn Co-researcher: Dr A Stevens Organisation: National Vision Research Institute of Australia Status: Ongoing Funding: National Vision Research Institute internal funds Timetable: 1975 - open-ended completion Website address: http://www.optometry.unimelb.edu.au/nvri/nvri.html Outline: This programme aims to understand the processes involved in lens growth and the changes due to ageing of lens constituents. In particular, it aims to discover the causes of the age-related disorders of vision associated with the lens such as cataract and presbyopia. Australian Ageing Research Directory 2000 173 Medical Research Topics currently under investigation include crystallin modification, lens compression, ageing changes in protein contents in different species, steroid effects and metabolic activities in the lens. Keywords: Lens, growth, ageing, refraction, differentiation, crystallins, metabolism, cataract, presbyopia 315 Title: The role of TIMP3 in macular degeneration Principal researcher: Dr M J Tymms Co-researcher: Professor R C Augusteyn Organisation: National Vision Research Institute of Australia Status: Ongoing Funding: National Health and Medical Research Council Timetable: 1999 - 2001 Website: http://www.optometry.unimelb.edu.au/nvri/nvri.html Outline: Age-related macular degeneration is a major cause of blindness in the ageing population. A rare inherited human condition, Sorsby fundus dystrophy shows striking similarities with age-related macular degeneration and is caused by mutation in the TIMP3 gene. To aid in the study of the biological mechanisms underlying age-related macular degeneration and therapeutic intervention, a mouse model for Sorsby fundus dystrophy is being developed. Other studies are examining how the TIMP3 gene is regulated as the level of TIMP3 protein is elevated in age-related macular degeneration. Keywords: Ageing, retina, blindness, macular degeneration 2.42 School of Applied Vision Sciences, Faculty of Health Sciences, University of Sydney 316 Title: Safe driving for an ageing population: Interventions for age-based vision changes Principal researchers: Ms N Jolly, Mr N Moss Organisation: School of Applied Vision Sciences, Faculty of Health Sciences, University of Sydney Status: In progress Funding: NSW Ageing and Disability Department, $9,808 Timetable: 1999 - June 2000 Outline: A number of visual problems occur with ageing, including decreased visual acuity (ability to see clearly and accurately), decreased constrast sensitivity (ability to see variations between levels of light and shade), and changes to visual fields (ability to see peripherally). Poor visual acuity leads to difficulty in identifying information that assists in driving, for example, seeing lines on the road, traffic signs and even traffic lights. Similarly, decreased contrast sensitivity leads to difficulty in night driving, and in other poor illumination situations including dappled lighting, wet weather, dusk and driving in car-parking stations. When visual fields decrease, people have problems identifying objects on the road, including other cars. Research shows that the people are often unaware of any visual problems they may have, and that the methods they employ to deal with these problems do not adequately compensate for the loss. This leads to unsafe driving. This study will assess the visual losses in a normal aged population, their impact on driving and develop practical interventions to compensate for these deficits. These techniques can then be applied to a wider community, and will lead to increased independence, well-being and health, in mobility, and psychological factors. The project is directed at the implementation of interventions to assist safe driving 174 Australian Ageing Research Directory 2000 Medical Research practice and evaluation of outcomes, which can then be used to (i) influence future planning and development of policies for safe driving for the aged; (ii) develop strategies that will enable the aged to fully participate as members of the community; (iii) determine methods to maintain physical independence for the aged; (iv) highlight issues and interventions that will provide access and support to the aged to maintain independence by ensuring continued safe mobility; (v) inform about vision standards for aged drivers as set out by the Road Traffic Authority. Keywords: Older drivers, mobility, visual impairment, vision, acuity, driving, independence, mobility 2.43 School of Optometry, Queensland University of Technology 317 Title: Age, visibility and road safety under daytime and night-time conditions Principal researcher: Associate Professor J M Wood Co-researchers: Professor R Troutbeck, Mr K Jones, Mr M King Organisation: School of Optometry, Queensland University of Technology Status: Current Funding: ARC SPIRT Scheme, $162,000 Timetable: April 2000 - 2003 Outline: Older drivers have fatal crash rates comparable to, or higher than, young drivers, and are usually at fault in fatal crashes. A major contributor to their crash risk is deteriorating vision, which exacerbates age-related limitations on judgement, decision making and other cognitive skills. This project will use innovative driving measurement techniques to identify the visibility problems that older drivers have within the road system and develop modifications to the road environment which act to increase visibility and hence road safety for older drivers. These changes will be implemented into national road environment standards and other older driver safety programs nationally. Keywords: Elderly drivers, visibility, vision, night-time driving, road signs 2.44 School of Orthoptics, La Trobe University 318 Title: Changes in eye movement control as indicators of cognitive changes in ageing Principal Researchers: Associate Professor L Abel, Ms J Douglas Organisation: School of Orthoptics, La Trobe University; School of Human Communication Sciences, La Trobe University Status: Nearing completion Funding: Australian Research Council Small Grant, $12,000 Timetable: March 1997 - May 2000 Outline: Many aged people remain mentally alert and active, while others suffer dementing illnesses causing great disability, with very serious burdens consequently being placed on their families and society at large. This project examined in detail normal young and elderly subjects performance on batteries of volitional fast eye movement and neuropsychological tasks selected to draw upon similar brain regions. Preliminary data found wide performance variation in older subjects on the eye movement tasks and in several instances performance on the two types of tests was correlated. Future goals are to subsequently conduct studies over several years to see whether these inexpensive and readily performed tasks could serve as early predictors of subsequent cognitive decline, permitting earlier intervention. The research hypotheses were (i) that age-related differences would be found in performance in both testing Australian Ageing Research Directory 2000 175 Medical Research domains; (ii) that performance on saccadic eye movement and cognitive tests selected to draw upon resources in the frontal lobes of the brain would be correlated; (iii) that subgroups of poor performers on the eye movement tests would exist. The following saccadic tasks were selected, all requiring internal control of either saccadic initiation or suppression: (a) antisaccade task: looking in the opposite direction from where a target appeared, (b) remembered saccade task: after a delay, looking at the location where a flash of light had occurred, (c) predictable saccade task: refixating lights at ±15 deg as they were alternately illuminated every sec and (d) self-paced saccade task: looking back and forth between the ±15 deg lights as fast as possible. Cognitive tests included the Wisconsin Card Sorting Test, the Trail-making Test Part B and the Stroop Test. The study was conducted on 26 young and 14 elderly subjects. Elderly subjects’ performance on all but the predictable task was poorer as a group than that of the young subjects, although on all tasks some elderly subjects’ performance fell within the range of the young. Deficits were qualitatively similar to those previously found between healthy elderly subjects and patients with Alzheimer’s disease. As anticipated, a range of significant correlations were found between the saccadic and cognitive measures. On virtually all the saccadic eye movement measures, standard deviations for the elderly subjects were significantly larger than for the young, and examination of the data did suggest the existence of subgroups of poor-performing old subjects in several instances. Study results indicated that not only simple, reflexive saccades but also those refixations depending upon more complex internal processing tend to decline with age, but not in everyone, with some performing at young levels. These performance declines are paralleled by similar changes in performance on standard tests of frontal lobe function, suggesting that the eye movement and cognitive tasks do indeed draw upon similar resources. The diversity of responses in the older group suggested that further study would be appropriate to see whether a battery of such tests would be useful in identifying individuals at risk for or in the early stages of Alzheimer’s disease. Keywords: Ageing, cognition, eye movements, neuropsychology 319 Title: The effect of eccentric viewing in conjunction with magnification on the visual function of persons with age-related macular degeneration Principal researchers: Ms M Curavic, Dr K Fitzmaurice Organisation: School of Orthoptics, La Trobe University; Vision Australia Foundation Status: Initial one year pilot study in progress Funding: Not applicable Timetable: March 2000 - November 2000 Outline: Age-related macular degeneration is the leading cause of blindness for people aged over 65 and it affects the quality of vision and the field of vision. The centre of the field of vision is the area affected by age-related macular degeneration which is the area used for fine detailed tasks such as reading, seeing faces and driving. Consequently the impact of agerelated macular degeneration on daily function and independence can be devastating. The impact of age-related macular degeneration can be ameliorated with appropriate rehabilitation. The most commonly used form of rehabilitation is magnification. Although this is beneficial, there are some limitations such as a decreased field of view. The peripheral vision in patients with age-related macular degeneration is usually preserved and individuals affected by the disease can learn to use their remaining vision for reading and activities of daily living. The use of remaining peripheral vision is known as eccentric viewing. The use of eccentric viewing as a rehabilitation technique is still controversial and has not been as strongly established clinically as the use of magnification. The aim of this project is to 176 Australian Ageing Research Directory 2000 Medical Research determine if the use of eccentric viewing in conjunction with magnifiers will improve the visual efficiency and functional ability of persons with age-related macular degeneration. The study will comprise a pre/post test design with two cohorts of subjects, group 1 who will be prescribed appropriate magnifying aids and group 2 who will receive appropriate magnifying aids and undertake eccentric viewing training. Subjects will be diagnosed with age-related macular degeneration, be 60 plus years of age and be classified as legally blind. Group 1 will receive standard rehabilitation management, which is the prescription of appropriate magnification and instructions in the use of the magnifier. Group 2 will also receive prescribed magnification and instruction in its use as well as eccentric viewing training. Baseline near visual acuity will be measured with and without magnification and visual function will be assessed using the Melbourne Low Vision Activities of Daily Living (ADL) Index. Visual field will be assessed using a Bjerrum tangent screen. Both groups will be given their magnifiers to take home. Subjects in group 2 will undergo a program of eccentric viewing training using EccVue a computer generated training program. Training will be limited to 24 one hour sessions. Participants in group 1 will be contacted weekly for a “chat” and to check on progress with the magnifier. At the conclusion of a twelve week period, participants from both groups will undergo a post test of near visual acuity and assessment with the Melbourne Low Vision Activities of Daily Living Index. The study will be conducted at the Vision Australia Foundation, Low Vision Clinic. Keywords: Macular degeneration, eccentric viewing, magnification, low vision, vision rehabilitation Pharmacology 2.45 Department of Clinical Pharmacology, St Vincent’s Hospital 320 Title: Clinical and pharmacological studies of nonsteroidal anti-inflammatory drugs in Alzheimer’s disease Principal researchers: Dr S Scharf, Dr F Vajda, Professor N Chritophidis Co-researcher: Ms P Angelis Organisation: Department of Clinical Pharmacology, St Vincent’s Hospital Status: Completed Funding: National Health and Medical Research Council; internal funding Timetable: 1996 - 1998 Outline: This series of studies aimed to (i) investigate the relationship between inflammatory markers and Alzheimer’s disease and (ii) determine the efficacy and safety of an nonsteroidal anti-inflammatory drugs in combination with a gastro-protective agent in this disease. Serum was obtained from 41 volunteers with Alzheimer’s disease and 32 matched controls. Serum levels of interleukin 6 and its soluble receptor were compared in the two groups using ELISA. A double blind placebo controlled trial of the combination diclofenac/misoprostol was conducted with the 41 participants over 25 weeks. Keywords: Alzheimer’s disease, inflammation, anti-inflammatory Australian Ageing Research Directory 2000 177 Medical Research 2.46 Department of Pharmacy, University of Sydney 321 Title: A comparative study of two collaborative models for the provision of domiciliary based medication review Principal researchers: T Chen, R Hurst Co-researchers: A Bennett, C Smith, S Johnsen Organisation: Department of Pharmacy, University of Sydney; St George Division of General Practice Status: Completed Funding: Commonwealth Department of Health and Aged Care, $430,000 Timetable: June 1999 - April 2000 Outline: The project aims to establish a sustainable, cost effective and transportable mechanism for the delivery of domiciliary based medication review services for ambulatory patients. The study involves intensive collaboration and communication between general practitioners and pharmacists through a variety of face-to-face meetings: training programmes for both pharmacists and general practitioners in the delivery of domiciliary medication review and the development and trialing of guidelines for both general practitioners and pharmacists in the medication review process. Two models are evaluated and compared. Model 1 involves the provision of GP-initiated, pharmacist-conducted medication reviews. Model 2 involves GP clinical audit of patients suitable for medication review in conjunction with a GP-initiated, pharmacist-conducted medication review. 46 general practitioners, 82 pharmacists, and 382 patients were recruited to the study. All general practitioners in clinical audit arm undertook training in the clinical audit process including the pharmacological principles which underpin the process. A medication review training manual and ten hour process-based program for pharmacists was developed. Pharmacists interviewed 318 patients and conducted 381 medication reviews. Each general practitioner spent approximately 2 to 3 hours in case conferencing meetings with pharmacists. Keywords: Domiciliary medication review, clinical audit, pharmacists, general practitioners 322 Title: Cost analysis of medication regimen reviews performed by community pharmacists for ambulatory patients through liaison with local general medical practitioners Principal researchers: Dr I Krass, Ms C Smith Organisation: Department of Pharmacy, University of Sydney; Sutherland Division of General Practice Status: Completed Funding: Department of Health and Family Services Timetable: Completed February 1999 Outline: This project aimed to establish a protocol for the identification of ambulatory patients by general practitioners for referral to community pharmacy for medication regimen review and to evaluate the cost savings and health outcomes associated with this activity. It represents an extension of earlier research (entry 321) which developed an intervention strategy to increase professional contact between pharmacists and general practitioners using medication regimen review as a focus. In this project, a total of 315 patients were identified by 35 general practitioners in the Sutherland Shire of which 275 completed the medication review cycle. The economic evaluation focussed on estimating the cost saved by the health care system as a result of changes to the patient’s regimen. A total of 2,220 medications were 178 Australian Ageing Research Directory 2000 Medical Research prescribed, representing a mean of 8 per patient. In all, 869 changes to therapy were observed at the three month follow up: 47% drug ceased, 17% dose reduced, 11% does increased, and 15% drug changed. The economic evaluation fundamentally addressed the question of whether professional payment for medication regimen review could be offset by reduced medication costs and reduced utilisation of health care resources. The study provides a good indication that medication regimen review provided by appropriately trained community pharmacists in collaboration with general practitioners leads to positive clinical benefits for a substantial number of patients. There is also good indication that it can reduce health care costs substantially, especially given that medication costs savings alone covered the costs of fees for the medication regimen review. Although the extent of other health care costs avoided is less clear, these results are encouraging. Keywords: Medication review, pharmacists, general practitioners, economic evaluation 2.47 Drug Research and Laboratory, Department of Medical Laboratory Science, RMIT University 323 Title: Age-related adrenoceptor signal switching and its relevance to drug modification of vascular tone Principal researchers: Mr H Majewski, Ms A van der Zypp Co-researchers: Ms S Rajanayagam, Ms H Teede, Ms M Dobos Organisation: Drug Research and Development Group, Department of Medical Laboratory Science, RMIT University Status: In progress Funding: National Heart Foundation, 1999-$50,000; 2000-$50,000; 2001-$65,000 (sought); 2002-$70,000 (sought) Website: http://www.bh.rmit.edu.au/ Timetable: 1999 - 2000. Funding being sought to continue in 2001 and 2002. Outline: It is proposed that b-adrenoceptor vasorelaxation involves multiple signal transduction pathways, one mediated by activation of smooth muscle adenylate cyclase and the other involving the release of nitric oxide and other vasoactive mediators from the vascular endothelium. Whilst some of these pathways have been previously described in the literature there was considerable dispute with a number of contradictory studies. This research resolved these discrepancies by proposing that there is a b-adrenoceptor “signal switching” as blood vessels age from an endothelium independent action in blood vessels from young animals through to a pronounced endothelium effect in old animals. The initial part of this study has now been concluded and published (van der Zypp et al., 2000). One of the striking observations was that this age-dependent signal switching did not involve changes in endothelial nitric oxide relaxation. There is now evidence that the signal switch involves arachidonic acid and specifically cyclo-oxygenase-2 (COX-2). Aspirin and indomethacin potentiate b-adrenoceptor vasorelaxation and decrease a1-adrenoceptor mediated vasoconstriction in old but not young blood vessels of rats. The COX-2 inhibitor NS-398 markedly decreased phenylephrine constriction only in old blood vessels. Three basic studies are planned to follow up this discovery: (i) pharmacological and biochemical studies of a and b-adrenoceptor signalling in blood vessels of rats of different ages with specific focus on arachidonic acid and COX-2; (ii) pharmacological studies of rat microvasculature to determine whether effects in aorta are also observed at this level with respect to agedependent signal switching; (iii) pharmacological and biochemical studies in human microvessels obtained to determine the role of age and COX-2 in responses to a and badrenoceptor agonists. It is postulated that some of the cardioprotection afforded by drugs Australian Ageing Research Directory 2000 179 Medical Research such as aspirin in the elderly may include beneficial effects through alterations in these signalling pathways. COX-2 inhibitors whilst they do not have anti-aggregatory properties in isolated platelets may also turn out to have cardiovascular protective properties by inhibiting vasoconstrictor mechanisms and potentiating vasodilator mechanisms. Keywords: Ageing, cardiovascular system, blood vessels, arachidonic acid, vascular endothelium 2.48 Pharmaceutical Services Branch, Public and Environmental Health Service, Department of Human Services, South Australia 324 Title: The development and evaluation of strategies for the non-drug management of insomnia Principal researchers: Mr W Dollman, Ms T LeBlanc, Ms L Stevens Organisation: Pharmaceutical Services Branch, Public and Environmental Health Service, Department of Human Services, South Australia Status: Nearing completion Outline: This work has been conducted by the Branch's Quality Use of Medicines Program, and has involved the production of an Insomnia Management Kit to be used in a collaborative fashion by the doctor, the patient and the pharmacist. The kit has been trialled in the Southern Fleurieu Peninsula region of South Australia, and the evaluation will be concluded in June 2000. Keywords: Benzodiazepines, quality use of medicines, prescribing, insomnia 325 Title: Achieving quality use of medicines in community and residential care settings Principal researchers: Mr W Dollman, Ms T LeBlanc, Ms L Stevens Organisation: Pharmaceutical Services Branch, Public and Environmental Health Service, Department of Human Services, South Australia Status: Nearing completion Outline: This program has again focused on the Southern Fleurieu Peninsula region, discussing Quality Use of Medicines principles with respect to the prescribing of medications in general practice and in the local nursing homes. The evaluation will include an examination of the impact on the prescribing of the benzodiazepine class of drugs. Keywords: Benzodiazepines, quality use of medicines, residential care, prescribing 2.49 Quality Use of Medicine and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia 326 Title: Factors influencing implementation of quality use of medicines in aged care facilities Principal researcher: Associate Professor Andrew Gilbert Co-researchers: Professor J Cheek, Ms A Ballantyne, Dr R Penhall, Professor L Sansom Organisation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia; Centre for Research into Nursing and Health Care, University of South Australia; School of Nursing; University of South Australia; 180 Australian Ageing Research Directory 2000 Medical Research School of Pharmacy and Medical Sciences, University of South Australia; Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital Status: In progress Funding: Department of Health and Aged Care, $232,146 Timetable: August 1999 - July 2001 Outline: This study proposes to investigate the barriers in residential aged care facilities to the implementation of the best practice models for quality use of medicines in aged care facilities and other related activities which have been shown in controlled studies to be effective in improving the quality use of medicines. The study has three aims: (i) Working within a multidisciplinary framework, it will identify and describe factors that influence the implementation of best practice with respect to the quality use of medication in residential aged care facilities. (ii) Develop strategies to address the identified factors and to facilitate the uptake of existing best practice guidelines, including the Australian Pharmaceutical Advisory Council guidelines for aged care facilities. (iii) Make recommendations at the policy, structural, organisational, and individual level which will support the use of the strategies. This multi-method, descriptive/exploratory study will be conducted in a representative sample of residential aged care facilities in South Australia. The project comprises three stages, each directly pertaining to the aims of the study. Stage One is designed to identify factors that influence the implementation of best practice by collecting different perspectives from individual practitioners, organisations and key players in these facilities. Stage Two involves the development of a range of strategies that might be used to address the factors identified in stage one. This will be achieved by running a series of focus groups made up of managers, residents and staff at the aged care facilities, as well as visiting service providers and carers. Stage Three develops the recommendations for changes at the policy, structural, organisational and individual level which will support the use of the developed strategies. Keywords: Quality use of medicines, aged care facilities, residential care facilities, medication 327 Title: Quality use of medicines in the community implementation trial Principal researchers: Associate Professor A Gilbert, Dr J Beilby Co-researcher: Ms K Mott Organisation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia Status: Completed Funding: Department of Health and Aged Care, $471,270 Timetable: April 1999 - March 2000 Outline: This project was funded to provide 1,000 medication management services in South Australia over a twelve month period. The aim of the trial was to determine whether a model of collaborative medication management services was potentially sustainable, acceptable to all stakeholders, produced positive health outcomes and could be administratively simple and cost effective. 119 general practitioners and 64 pharmacists have provided medication management services to 1,001 patients as part of this trial, across six Divisions of General Practice in South Australia. The collaborative medication management model used in this trial, has been successful in: (i) engaging general practitioners and pharmacists in the process; (ii) identifying and providing the service to people in the community at risk of medication misadventure; (iii) resolving medication management problems in those people; (iv) producing savings to the health system; (v) developing an administratively simple model and a level of remuneration that is acceptable to all participants. The evaluation found that the criteria used by the general practitioners and pharmacists were successful in identifying Australian Ageing Research Directory 2000 181 Medical Research people at risk of medication misadventure. Over 90% of people who received the service had one or more medication related problems. The average number of problems per person was 3.0. Consumers wished the service to continue as it provided needed support to them in their use of medication. The model and the level of remuneration were acceptable to general practitioners and pharmacists. There was a net saving to the health system of $120 per person after costs were accounted for. The majority of patients in the trial were over 70 years of age, took an average of 9.3 medications, had an average of 5.7 medical conditions, and had an average of 3 medication related problems identified. The Quality Use of Medicines in the Community Implementation trial successfully trialed a sustainable, acceptable and effective model of collaborative medication management through general practitioners and pharmacists supported by Divisions of General Practice. Keywords: Quality use of medicines, medication management, models of practice 328 Title: The community pharmacy model practices project Principal researcher: Associate Professor A Gilbert Co-researchers: Mr P Hocking, Dr M Angley, Miss S Edgecombe, Mr G March, Mr N Quintrell Organisation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia Status: Completed Funding: Department of Health and Aged Care, $668,385 Timetable: June 1996 - September 1997 Outline: There is a public health problem of morbidity and mortality due to drug misadventure. Part of the cause of this problem is people having difficulties in managing their medications appropriately. There is a need for some health professional to identify and solve medication-related problems, and to provide follow-up services to ensure people are managing their medications. The project aimed to: (i) develop a practice-based model of medication management in a range of community pharmacies, which would evaluate the effectiveness of pharmacists' interventions; (ii) resolve medication-related health problems, describe consumer and health professional perceptions and valuing of such a service; (iii) assess the cost-effectiveness of the model. The development of the models utilised action research methodology. The research team, the pharmacists, consumers, professional organisations and the government worked together to define the critical components of the professional activity and to formulate protocols for service delivery and standards that were acceptable to all parties. Having drafted these, mechanisms for implementation, documentation and patient follow-up procedures were negotiated. An auditing and feedback procedure was established. Eleven South Australian community pharmacies (nine metropolitan and two country) pharmacies were initially selected for inclusion into the project after a call for registration of interest. A series of workshops were held to develop the models which were defined under the following criteria; aims, patient target criteria, re-engineering, patient care process, documentation, process standards and audit mechanism. Evaluation of the project was three-pronged: (I) Consumer evaluation: Two of the following evaluation tools were selected and undertaken at each pharmacy: written questionnaires, telephone interviews, focus groups, case studies, face-to-face interviews. (2) Practice evaluation: pharmacist time spent in providing the service, problems presented by patients, actions taken by pharmacists in addressing patient problems, and outcomes of those pharmacists actions were recorded. (3) Health economic evaluation: Fixed costs relating to pharmacy infrastructure and variable costs covering client and non-client specific variables were determined from records kept by participating pharmacists. Cost savings were estimated using 182 Australian Ageing Research Directory 2000 Medical Research a technique developed by Caleo et al (1996). Each patient interaction where pharmacists acted to solve medication-related problems was documented by the pharmacist. The project successfully demonstrated that pharmacists can work effectively within new models of practice and achieve positive health outcomes for their patients. Pharmacists in the project were able to establish effective liaison with consumers and key health practitioners. The project demonstrated a genuine community need, that pharmacists are best placed to meet that need. The pharmacists identified a large number of unresolved medication and related health problems in their customers and were able to provide advice and treatment that led to resolution of the vast majority of these problems. Even within the brief time frame of this study, there was a surplus of benefits over costs to society in reduced medication use and medical costs avoided. The health and quality of life of many elderly and chronically ill people can be substantially improved through the adoption of this model of practice. Keywords: Models of practice, medication management, quality use of medicines, pharmacists 2.50 Tasmanian Quality Use of Medicines Group 329 Title: Adverse drug events as a cause of admission in patients 75 and over at the Royal Hobart Hospital Principal researcher: Dr J H Vial Co-researchers: M Chan, Dr F Nicklason Organisation: Tasmanian Quality Use of Medicines Group comprising School of Medicine, University of Tasmania; Royal Hobart Hospital Status: Completed Outline: Prospective review of 240 consecutive unplanned admissions of patients 75 years and over to general medical units of the Royal Hobart Hospital over eight weeks to determine the contribution to unplanned admissions of adverse drug events, their nature and their preventability. Approximately thirty percent of admissions were due to adverse drug events. Over half of these were due to adverse drug reactions. Falls and postural hypotension, delirium and heart failure were the most common adverse rug event presentations. Half were preventable. It was estimated that the cost of preventable adverse drug event admissions to the Royal Hobart Hospital of patients 75 years and over was approximately $1million per year. Keywords: Adverse drug events, falls, postural hypotension, delirium 330 Title: Anti-thrombotic prophylaxis in atrial fibrillation Principal researchers: Associate Professor G Peterson, Dr J H Vial Co-researchers: S Y Ang, S Jackson, R Daud, M Evenhuis Organisation: Tasmanian Quality Use of Medicines Group comprising School of Medicine, University of Tasmania; School of Pharmacy, University of Tasmania; Royal Hobart Hospital Status: Nearing completion Funding: RHH Research Foundation, $10,000; Clifford Craig Foundation, $2,000 Outline: These studies were performed to assess use of thrombosis prophylaxis in atrial fibrillation against current guidelines and to assess the risks and benefits of warfarin prophylaxis as it is used in clinical practice. The initial retrospective review of 226 consecutive patients with non rheumatic, chronic or paroxysmal atrial fibrillation in patients admitted to the Royal Hobart Hospital revealed under-utilisation of thrombosis prophylaxis, but also a rate of bleeding complications in warfarin treated patients which was substantially Australian Ageing Research Directory 2000 183 Medical Research above those observed in the clinical trials. As a result of this, the investigators have gone on to perform a larger, mainly prospective study of 474 consecutive patients to further assess thrombosis prophylaxis use and the risks and benefits of treatment. Keywords: Atrial fibrillation, thrombosis prophylaxis, warfarin Psychiatry and Psychogeriatrics 2.51 Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick 331 Title: A case-controlled study of nursing home residents referred for treatment of vocally disruptive behaviour Principal researchers: B Draper, J Snowdon, S Meares, J Turner, P Gonski, H McIntosh, B McMinn, G Luscombe, D Draper, L Latham, E Abbott Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: School of Community Medicine, University of New South Wales, $6,000 Timetable: 1996 - 1997 Outline: The aim of this study was to identify factors associated with vocally disruptive behaviour in nursing home patients referred to aged care services for treatment, using a casecontrol methodology. Characteristics of the vocally disruptive behaviour, reasons for referral, perceived causal factors and psychotropic use were noted. Twenty-five subjects and controls were examined with the Screaming Behaviour Mapping Instrument, the Cornell Scale for Depression in Dementia, the Dementia Behavior Disturbance Scale, and measures of cognition, functional capacity, social activities and emotional reactions of nursing staff. Vocally disruptive behaviour was associated with other disturbed behaviours, depression, anxiety, severe dementia, functional impairment, communication difficulties, use of psychotropic medication, social isolation, and emotional distress in the nursing staff. Reasons for referral may relate more to the stress experienced by nursing home staff in managing vocally disruptive behaviour, than specific attributes of the vocally disruptive behaviour itself. Keywords: Nursing home residents, vocally disruptive behaviour, case controlled study, assessment tool 332 Title: A case-controlled study of nursing home residents referred for treatment of vocally disruptive behaviour: Treatment outcomes Principal researchers: B Draper, J Snowdon, S Meares, J Turner, P Gonski, H McIntosh, B McMinn, G Luscombe, D Draper, L Latham, E Abbott Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: School of Community Medicine, University of New South Wales, $6,000 Timetable: 1996 - ongoing Outline: Research on intervention strategies for vocally disruptive behaviour is limited. There have been many case reports and several audits of treatments used in clinical practice but few systematised studies. Further analyses will report an audit of management strategies 184 Australian Ageing Research Directory 2000 Medical Research currently utilised by services. Three month outcome data were collected and the efficacy of various treatment strategies assessed. Keywords: Nursing home residents, vocally disruptive behaviour, management strategies, treatment outcomes 333 Title: A longitudinal study of cognitive impairment and dementia in stroke patients Principal researchers: P Sachdev, H Brodaty, D Gillies Co-researchers: M Valenzuela, D Monk, R Schwartz, R Shnier, W Haindl, A Walker, D Hadzi-Pavlovic Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: National Health and Medical Research Council, $90,516 (1997), $93,487 (1998), $64,961 (1999), $283,968 (2000-2002); Vincent Fairfax Family Foundation, $75,000 Timetable: 1997 - 2002 Outline: The study aim is to identify risk factors for dementia in patients who have had a stroke. A group of patients are followed for fifteen months after their admission for stroke as well as a group of volunteer healthy controls. All subjects have had a clinical, neurological, neuropsychological and neuroimaging assessments with magnetic resonance imaging, including functional and perfusion magnetic resonance imaging. The study commenced in March 1997 and by the end of 1999 a total of 200 stroke patients, and 68 controls had received a baseline assessment. Keywords: Stroke patients, longitudinal study, cognitive impairment, dementia, magnetic resonance imaging 334 Title: A new efficient way of detecting dementia in general practice Principal researchers: D Pond, H Brodaty, F Huppert, G Luscombe Co-researchers: N Kemp, L Harding Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: General Practice Evaluation Program, $99,520 Timetable: 1999 Outline: The study aimed (i) to test a new screening instrument for dementia (the GPCOG) developed for use in general practice; (ii) to assess its performance validity and reliability against the CAMDEX interview, used as a gold standard, and another screening instrument (the AMTS); (iii) to examine its acceptability to general practitioners and patients. The GPCOG was administered by 83 general practitioners to 385 patients and 227 informants. Patients were then reassessed more fully by a psychologist. Patients diagnosed with dementia scored less on all sections of the GPCOG compared to those without dementia. Eight-seven per cent of general practitioners felt that the GPCOG was practical to use in general practice, and 75% of patients were reassured by the testing. Keywords: Screening tool, dementia, general practice, general practitioners Australian Ageing Research Directory 2000 185 Medical Research 335 Title: A 1-3 year prospective follow-up study of electroconvulsive therapy outcome in older depressed patients Principal researchers: H Brodaty, I Hickie, C Mason Co-researchers: L Prenter, D Monk, D Berle Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: This was a naturalistic, prospective, 1-3 year follow-up study of 81 consecutive inpatients (from eight Sydney hospitals) with a primary diagnosis of major depression who were prescribed electroconvulsive therapy. It examined three questions relating to outcome, side effects and attitudes. Electroconvulsive therapy was found to be effective in reducing symptoms and improving function. These benefits were similar for patients younger than 65 years, those aged 65-74 years and those aged 75 years or more. So called side effects of electroconvulsive therapy proved to be mostly symptoms of the depression itself and were no more prevalent in the elderly. At 2 year follow-up, dementia was more common in the very old than at long-term follow-up, perhaps reflecting the link between late-onset depression and dementia underpinned by cerebrovascular disease. Finally, the study found that patient attitudes and expectations before treatment were not related to improvement after electroconvulsive therapy. Psychiatrists' expectations of improvement were more accurate. There was no association between what patients thought and what psychiatrists expected. Keywords: Electroconvulsive therapy, depression, older depressed, dementia 336 Title: An intervention programme for carers of dysphasic stroke patients - a controlled study Principal researchers: B Draper, G Bowring, P Conroy, P Servaes, C Poulos, F Ehrlich Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Discontinued Funding: Nil Timetable: 1996-1998 Outline: In this controlled intervention study for carers of dysphasic stroke patients, an intervention involving education, communication skills training and stress management coupled with the development of a support group was to be assessed. The project, which commenced in October 1996, was to run for at least four years; however it was discontinued after two years. Keywords: Carers, dysphasic stroke, education 337 Title: An investigation of suicidal and other life threatening behaviours in nursing home residents Principal researchers: B Draper, H Brodaty Co-researchers: D Saab, V Richards Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed 186 Australian Ageing Research Directory 2000 Medical Research Funding: National Action Plan for Dementia Care, $210,000 Timetable: 1996-1998 Outline: The study aimed to document the prevalence of life-threatening behaviours, suicidal ideation and depressive symptoms in nursing home residents and to determine whether lifethreatening behaviours are associated with suicidal ideation or depression. A survey was undertaken of 635 residents of 11 eastern Sydney nursing homes using the Even Briefer Assessment Scale for Depression (EBAS-DEP), Life-Threatening Behaviours Scale (LTBS) and suicidal ideation item from the Hamilton Rating Scale for Depression. Chart diagnoses and demographic data were obtained. In the previous two weeks on the LTBS, 30.9% had refused to eat/drink, 18.2% refused to take medication, 17.3% alienated staff/provoked rejection, 11.7% exposed themselves to hazards, 5.7% expressed suicidal ideas and 2.4% cut themselves with a sharp object. Four factors were found on the LTBS – unco-operativeness, risk taking, passive self-harm and self-injury. None of these factors were found to have a significant relationship with depressive symptoms or suicidal ideation. There was a strong correlation between the presence of suicidal ideation and depressive symptoms on the EBASDEP (r = 0.66, p = 0.00). Life-threatening behaviours were associated with dementia, were more common in younger residents and varied significantly between nursing homes. It was concluded that direct and indirect life-threatening behaviours are common in nursing home residents. Keywords: Life-threatening behaviours, suicidal ideation, depression, nursing home residents, assessment scales 338 Title: A psychogeriatric outreach service to nursing homes in Sydney Principal researchers: B Draper, S Meares, H McIntosh Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The study aimed to describe nursing home referrals to a multidisciplinary psychogeriatric outreach team. Retrospective case note audit was undertaken of all nursing home referrals to a psychogeriatric outreach service in Sydney during 1996. Of 106 referrals (mean age 76.9 years) from 22 nursing homes, 101 (95%) were assessed in the home. Behavioural problems were identified in 87 referrals (82%), usually being associated with chronic organic brain syndromes including dementia (n=75, 86%). Aggressive behaviours (45%), agitation (32%), unco-operativeness (17%), and screaming (16%) were the most frequently identified problems. Depression was diagnosed in 33 referrals (31%), often comorbid with dementia (n=16). Multiple diagnoses were present in 58 (55%) referrals. The most frequent treatment recommendations related to the use of nursing interventions (73%), psychotropic medication (70%), behavioural problems (29%), and family involvement (29%). Admission to the acute psychogeriatric ward occurred in 18 cases (17%). The study concluded that psychogeriatric services should provide adequately staffed outreach teams to nursing homes. Keywords: Nursing homes, psychogeriatric outreach, audit Australian Ageing Research Directory 2000 187 Medical Research 339 Title: Coping with depression: A family affair - the long-term effects on children and spouses of living with a person with depression Principal researchers: C Peisah, H Brodaty, K Anstey Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The overall aim of the study was to examine the long-term effects on family members of living with a person with depression. Major depression is often, though not always, accompanied by family and marital dysfunction and adverse psychological and psychiatric morbidity for offspring. The determinants of morbidity are not understood well, and the effects of variables such as type, severity, chronicity, recurrence of depression and duration of follow-up on family outcome have not been studied systematically. The study compared the psychiatric status and relationships of children and spouses of patients with depression and those admitted for surgical procedures 25 years ago. The offspring of depressed patients had greater frequency of clinician-rated lifetime and current psychiatric diagnoses and affective disorder compared with controls. The spouses of probands resembled those of other groups on most measures. The study concluded that family outcome and family characteristics may be useful external validators of depressive subtypes. The families of neurotically depressed probands appear to fare worse in terms of relationships and outcome for offspring. Keywords: Depression, coping, long term effects, children, family outcome 340 Title: Focussed active caregiver therapy: A randomised, prospective, controlled intervention study of caregiver plus drug therapy vs drug therapy alone for Alzheimer’s disease Principal researchers: H Brodaty, B Draper, M Mittleman, A Burns, P Sachdev, K Berman, N Kemp, A Leimena Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: Pfizer International (unrestricted grant), $230,000 Timetable: 1999 -2001 Outline: The study aims to determine whether caregiver intervention plus drug therapy for Alzheimer's disease is superior to drug therapy alone. 150 couples, people with Alzheimer’s disease and their spouses, are being randomised to receive Donepezil plus information to the caregiver or Donepezil plus counselling and other services to the caregiver. The year-long international trial is taking place in New York, Manchester and Sydney. Anticipated outcomes include improvement in the quality of life of patients and caregivers, less caregiver depression and a delay in the nursing home admission for the patient. Keywords: Caregiver therapy, drug therapy, Alzheimer’s disease, randomised controlled trial, donepezil, counselling 341 Title: Idiopathic calcification of the basal ganglia Principal researchers: H Brodaty, P Mitchell Co-researchers: G Luscombe, J Kwok, P Schofield, R Mackenzie 188 Australian Ageing Research Directory 2000 Medical Research Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: This project investigated a large family (10 first generation, 21 second generation) with idiopathic calcification of the basal ganglia discovered after two members were referred for assessment of dementia. Attempts were made to perform clinical (psychiatric and neurological), neuropsychological, radiological and laboratory assessments for all members of the first, second and third generations. The syndrome of idiopathic calcification of the basal ganglia is manifested by bilateral calcification, neurological disturbances and psychiatric abnormalities that include dementia, schizophrenia-like psychoses and mood disturbances. These manifestations were found to be independent of each other. With the exception of an association between apolipoprotein E4 and dementia, known genetic markers of dementia have so far not been linked to any of the other manifestations of idiopathic calcification of the basal ganglia. Keywords: Idiopathic calcification, basal ganglia, dementia, assessment 342 Title: Longitudinal controlled study of psychological stress in carers of stroke patients Principal researchers: H Brodaty, B Draper, G Luscombe, P Sachdev Co-researchers: M Valenzuela, M Jones, J Kinch , D Monk, A Withall Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: National Health and Medical Research Council, $90,516 (1997), $93,487 (1998), $64,961 (1999), $283,968 (2000); Vincent Fairfax Family Foundation, $75,000 Timetable: Commenced 1997 Outline: Previous studies of carers of persons with stroke have established that they do experience psychological distress and burden. However, the factors mediating such impacts or stresses of caregiving have not been clearly delineated. It is important to determine predictors of stress in carers in order to identify factors amenable to intervention and carers vulnerable to breakdown. A longitudinal design is particularly valuable in this area of research as the dynamics of caring for someone with a chronic or long-term illness, such as a vascular dementia, change over time. This study is linked to the longitudinal follow-up of admissions to Prince of Wales and St. George Hospital Stroke Units which is investigating risk factors for post-stroke dementia. The aims are (i) to follow a group of primary carers over a fifteen month period starting from admission of the "patients" to the Stroke Unit and a group of informants of controls for a twelve month period, (ii) to determine (a) the levels of stress in carers of stroke patients compared with informants of matched controls, (b) whether factors can be identified to predict stress in this sample, and (c) the longitudinal course of any such stress. Keywords: Carers, stroke patients, psychological stress 343 Title: Longitudinal study of depression Principal researchers: H Brodaty, G Luscombe, C Peisah, K Anstey, G Andrews Co-researchers: D Monk, L Prenter, K Berman Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Australian Ageing Research Directory 2000 189 Medical Research Status: Completed Funding: Nil Timetable: 1999 Outline: The study aim was to examine the long-term outcomes of depression by comparing outcomes of patients who had been admitted to hospital for depression or for gall bladder or appendix operations between 1966 and 1972. It found that depression was a recurrent, chronic condition with only 12.2% remaining well over the 25 years. The suicide rate was highest in the first two years after admission. A major theme of the research has been the link between depression and dementia. In general, cognitive function was found to be unaffected by having had depression but, for a proportion of patients there was a significantly higher risk of vascular dementia. Keywords: Depression, longitudinal study, dementia, cognitive function, vascular dementia 344 Title: Long-term outcome of late onset schizophrenia Principal researchers: H Brodaty, P Sachdev Co-researchers: D Monk, L Prenter Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: A follow-up of subjects with late-onset schizophrenia and healthy controls, who were recruited in 1992-1994, is investigating the hypothesis that subjects with late-onset schizophrenia are at increased risk of developing dementia. Several papers on the crosssectioned data examining clinical, neurological, neuropsychological, neuroimaging and EEG data have been published. Keywords: Late-onset schizophrenia, schizophrenia, dementia, outcome 345 Title: Magnetic resonance imaging and long-term outcome in depression Principal researchers: E Scott, I Hickie, H Brodaty, K Wilhelm Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: Nil Outline: A previous study conducted by the Department demonstrated, in a cohort of 39 older patients with severe depression, that subcortical white matter changes on magnetic resonance imaging predict an impaired response to standard antidepressant therapies. This study was initially extended to examine the clinical outcome of patients after fourteen months (range 6 months - two years). Of the 37 patients re-assessed, 12 (32%) were living in institutional care. Although no patient clearly met DSM-III-R criteria for a dementia, 10 were rated as having ‘probable’ dementia syndromes. The original selection criteria for scanning highlighted vascular risk factors. Consequently, the dementias that evolved were mainly vascular. Age and subcortical white matter changes were the strongest predictors of poor longitudinal course. When the follow-up was extended to five years, 16/37 (43%) patients had developed a dementia syndrome. This study has now been extended to 80 subjects. Most of those available have now been re-scanned and clinically assessed two to five years after initial presentation. Of those patients who have been rescanned none has demonstrated 190 Australian Ageing Research Directory 2000 Medical Research improvement and some exhibit progression in subcortical white matter change. Quantitative analysis of the MRI scans is underway. Keywords: Magnetic resonance imaging, depression, antidepressant therapy, dementia, longterm outcome 346 Title: Models of management of depression and psychosis in nursing home residents with dementia: a randomised controlled trial Principal researchers: H Brodaty, B Draper Co-researchers: D Lie, H Paton, K Martin, F Cameron, D Monk, D Saab, V Richards Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: National Action Plan for Dementia Care, $210,000 Timetable: 1996 - 1998 Outline: The study aim was to compare different models of management of depression and psychosis in residents with dementia in nursing home. Three models of management were compared: (i) usual care - by the general practitioner and nursing home; (ii) consultative model - the general practitioner was given information on the assessment and a recommended management plan after a thorough psychogeriatric assessment; (iii) intensive psychogeriatric management - the management plan devised prior to randomisation is undertaken by the psychogeriatric team alongside the general practitioner, families and nursing home staff. Outcome success was gauged by the reduction in depressive/psychotic symptoms, greater participation in activities, and reduction in stress levels of carers. Keywords: Depression, psychosis, dementia, management models, nursing home residents, general practitioners 347 Title: Prediction of falls in an acute old age psychiatry unit Principal researchers: B Draper, H McIntosh, G Busetto Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: Nil Timetable: 1999 Outline: Falls are a major cause of morbidity in an acute old age psychiatry unit. Existing falls screening instruments fail to adequately predict patients at risk of falling in this environment as they mainly focus on older people in community or general medical settings. This project devised a Falls Screen based on a retrospective audit of falls in the old age psychiatry unit. The Falls Screen has now been prospectively used in over 150 admissions. The project aims to validate the Falls Screen and identify strategies to reduce falls in the ward. Keywords: Falls, falls prediction, old age psychiatry unit 348 Title: Prevalence of depression, psychosis and behavioural disturbances in nursing homes Principal researchers: H Brodaty, B Draper Co-researchers: D Saab, D Lie, V Richards, H Paton, K Martin, D Monk Australian Ageing Research Directory 2000 191 Medical Research Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: National Action Plan for Dementia Care, $210,000 Timetable: 1996 - 1998 Outline: The study aim was to ascertain the level of behavioural and psychological symptoms in nursing home residents. Nursing staff were surveyed about each of 647 residents living in 11 nursing homes. Over 90 per cent of residents were found to have some level of behavioural or psychiatric disturbance: 80 per cent with activity disturbance or aggression, 55 per cent with psychotic symptoms and, depending on the threshold chosen, 42 per cent with depressed mood. Older and more severely demented residents had higher behavioural and psychological symptoms of dementia rates as did those residing in larger nursing homes. Behavioural disturbances were frequently associated with psychosis and/or depression. Keywords: Depression, psychosis, behavioural disturbances, nursing home residents, prevalence 349 Title: Psychiatrists’ attitudes towards ageing Principal researchers: B Draper, L Gething, J Fethney, S Winfield Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The objective was to explore whether there is a relationship between the effects of gender, age and perceptions of personal health on psychiatrists' reactions to personal ageing. To determine the effects of psychiatrists' reactions to personal ageing upon their approach to clinical practice, retirement planning and post-retirement activities. The method implemented was postal survey design. Respondents were Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand. Of 1,086 eligible subjects, 529 participated. The main outcome measures were: Reactions to Ageing Questionnaire (RAQ); self-rated health; location and type of psychiatric practice; the perceived benefits and drawbacks of age on psychiatric practice and case selection; and retirement plans. Positive attitudes towards personal ageing were found to be significantly associated with old age, males and good or excellent self-rated health. Negative attitudes were associated with working in universities and anticipated retirement due to poor health. Field of practice, anticipated post-retirement activities and approach to clinical practice were not found to have a significant effect on attitudes towards personal ageing. It was concluded that the effects of life experiences on psychiatrists' attitudes towards personal ageing were complex. Attitudes towards personal ageing had little impact on psychiatric practice. Keywords: Psychiatrists, attitudes, ageing 350 Title: Psychological aspects of holocaust survival Principal researchers: C Joffe, H Brodaty, F Ehrlich Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Henry H Roth Charitable Foundation, $4,000 192 Australian Ageing Research Directory 2000 Medical Research Timetable: 1999 Outline: A detailed demographic questionnaire was sent to 2,800 older Jewish individuals living in Sydney. From the sample of 814 respondents, 100 holocaust survivors, 50 refugees and 50 Australian/English born individuals were randomly chosen for in-depth interviews using standardised scales to measure psychological morbidity, psychiatric symptoms, physical health, cognitive function, social and marital function and symptoms of post traumatic stress disorder. About 40% of the holocaust survivors met DSM IV criteria for Post Traumatic Stress Disorder, compared to 16% of the refugees and 4% of the Australian/English born elders. Survivors also had high levels of psychiatric morbidity, 67% reporting trouble with “nerves or depression”, compared with approximately one-third of the refugee and the ‘control’ groups. Twenty-nine percent of holocaust survivors rated their current psychological health as bad to poor, compare to six and two percent of the refugees and controls respectively. There were no significant differences in self-rated physical health. Keywords: Psychological health, trauma, post traumatic stress disorder 351 Title: Stress in carers of the elderly attending a Sydney family medical practice Principal researchers: C Payda, B Draper, G Luscombe, F Ehrlich, J Maharaj Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: Carers have been identified in many studies as being particularly vulnerable to psychological morbidity. This study aimed to examine stress in carers of the elderly who attended a solo family medical practice in Sydney, using the General Health Questionnaire (GHQ) as a measure of psychological morbidity. Eighty-seven carers were compared with 102 non-caregiving controls. No significant difference was found in GHQ scores, reflecting the high level of stress in this family practice sample (mean GHQ = 4.7, SD = 6.2). Psychological morbidity in carers was associated with the provision of assistance with Instrumental Activities of Daily Living such as shopping, cooking and finances. This suggests that because carers often encounter specific challenges which may be amenable to interventions, general practitioners should familiarise themselves with these issues, determine the caregiving status of their patients and provide information about community services to carers. Keywords: Carer stress, assessment tool, psychological morbidity, general practitioners 352 Title: The effectiveness of old age psychiatry services Principal researcher: B Draper Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The objective was to review evaluation strategies and outcomes of acute service delivery in old age psychiatry. All controlled trials, prospective and retrospective audits, and surveys of the outcomes of service delivery in old age psychiatry located in acute hospitals and community settings were revised. Service delivery by medical, adult psychiatry and consultation/liaison services were included. With the exception of outreach services to Australian Ageing Research Directory 2000 193 Medical Research nursing homes, long term institutional care was excluded. Controlled trials, audits and surveys were each found to provide important data in the evaluation of service delivery. There was better quality evidence to support the effectiveness of components of old age psychiatry services than other services. The majority of studies indicated that old age psychiatry services have positive acute treatment outcomes, particularly with depression. There was insufficient evidence to determine which processes of care were associated with better outcomes. Pluralistic evaluations indicate that carers often have unmet needs and were not as positive about outcomes. There were no controlled comparisons of service delivery provided by other services. Medical services may be effective in treating behavioural disturbances related to dementia and delirium, but there was little evidence of effectiveness with depression. Audits of adult psychiatry inpatient services with specialist old age psychiatry staff have demonstrated positive outcomes. Controlled trials and audits indicate that old age psychiatry services are effective. Further pluralistic evaluations and comparisons with other services are required. Keywords: Old age psychiatry services, effectiveness, outcomes, controlled trials, audits 353 Title: The effects of physical health upon the outcome of admission to an acute psychogeriatrics ward Principal researchers: B Draper, G Luscombe Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The study objectives were to quantify the physical health of admissions to an acute psychogeriatric unit and to determine whether measures of physical health predict psychiatric outcome at discharge and mortality at twelve months. The study entailed a prospective audit of psychogeriatric unit admissions over twelve months using the Physical Health Schema (PHS) to quantify physical health. There were 88 admissions categorised into four principal psychiatric diagnostic groups - major depression (46), dementia (20), delirium (7) and ‘other’ diagnoses (15). The mean number of organ systems affected by physical illness was 3.9 per admission (SD 1.5, range 1-8), which did not differ between psychiatric diagnostic groups. Neurological disorders were the most severe and disabling conditions, with gastrointestinal and musculoskeletal disorders the other main acute conditions, and cardiovascular and sensory disorders the other main chronic conditions. Patients rated, on global outcome as recovered or improved, had fewer chronic organ systems affected by physical illness than patients whose outcomes unchanged or worse outcomes (Model 2 = 8.01, df = 1, p = 0.005) and ADL score (Model 2 = 6.33, df = 1, p = 0.012). Mortality 12 months after discharge was predicted by PHS acute illness scores (Model 2 = 7.94, df = 1, p < 0.005) and ADL score (Model 2 = 6.43, df = 1, p < 0.05). The study concluded that acute psychogeriatric units are best co-located near geriatric medical wards in general hospitals due to high rates of physical illness. Keywords: Acute psychogeriatric unit, admission, physical health outcomes 354 Title: The influence of age upon clinical psychiatric practice Principal researchers: B Draper, G Luscombe Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick 194 Australian Ageing Research Directory 2000 Medical Research Status: Completed Funding: Nil Timetable: 1999 Outline: The objective was to determine the effects of age upon the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists. A postal survey of Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand was undertaken. Main outcome measures were age; location and type of psychiatric practice; hours of work; attitudes about reaccreditation; changes in work practices over the career; and the perceived benefits and drawbacks of age on psychiatric practice and case selection. Of 1,086 eligible subjects, 629 participated. Mean age of the sample was 52.7 years (SD 13.5). Those psychiatrists favouring reaccreditation were younger. Psychiatrists practising psychotherapy, forensic psychiatry or general psychiatry; working in psychiatric hospitals and private practice were more likely to be older. Older psychiatrists worked shorter hours. There was largely no association between case selection and age. Psychiatrists reporting increased credibility and respect as a benefit of their current age upon their psychiatric practice were older, as were those identifying fatigue and an inability to keep up-to-date as a drawback of age. Psychiatrists reporting a lack of credibility and respect were younger, as were those who reported increased enthusiasm and optimism. The study concluded that age is associated with benefits and drawbacks to the practice of psychiatry and this may be reflected in the different practice profiles of older and younger psychiatrists. Keywords: Psychiatric practice, age, influence 355 Title: The influence of experience upon clinical psychiatric practice Principal researchers: B Draper, G Luscombe, S Winfield Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The study objective was to determine the effects of experience upon the practice, roles, status and attitudes of psychiatrists within the Royal Australian and New Zealand College of Psychiatrists. A postal survey was undertaken of Fellows of the Royal Australian and New Zealand College of Psychiatrists resident in Australia or New Zealand. Main outcome measures were years of psychiatric experience; higher medical qualifications; location and type of psychiatric practice; attitudes about senior psychiatrists and mentorship; changes in work practices over the career; and the perceived benefits and drawbacks of experience on psychiatric practice and case selection. Of 1,086 eligible subjects, 629 participated. Over 96% of respondents, particularly the younger and less experienced, believed that senior psychiatrists have wisdom to offer to junior colleagues. This wisdom principally related to mentorship/supervision. Increased respect and tolerance of patients as a benefit of experience was more likely to be reported by respondents who were more experienced. Respondents more confident about treating younger patients and treating functional psychoses were more likely to be less experienced, as were those reluctant to take on psychotherapy cases. Those respondents reluctant to take on dangerous or acting out patients were more experienced. Field of psychiatric practice significantly influenced case selection. The study concluded that senior psychiatrists have accumulated wisdom through experience that is sought by junior colleagues via mentorship. The study recommended that Australian Ageing Research Directory 2000 195 Medical Research the Royal Australian and New Zealand College of Psychiatrists should specifically address the needs of early career and senior psychiatrists. Keywords: Psychiatric practice, influence, experience, mentors 356 Title: The measurement of stress levels in nursing home staff and family carers of dementia patients Principal researchers: H Brodaty, B Draper Co-researchers: F Cameron, H Paton, D Lie Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: National Action Plan for Dementia Care, $210,000 Timetable: 1996 - 1998 Outline: The study measured the stress levels in both nursing home staff and family carers of dementia patients. (i) Nursing home staff: Several studies indicate that there tends to be high stress levels amongst nursing home staff. They are often caring for residents who are experiencing a combination of dementia, psychiatric problems and associated behavioural problems. The “Models of management of depression and psychosis in nursing homes” project (entry 346) provided an opportunity to measure the impact on the staff of interventions for nursing home residents by the research team. More specifically, before and after the project, staff were asked about their knowledge and attitudes when working with those with dementia. Job satisfaction was examined. (ii) Family carers: Results of some studies indicate that placement of relatives with dementia in nursing homes may resolve some problems that are stressful for family carers. However it may also create a new set of stressors for family members, including cultural pressures from submitting to nursing home placement, financial burden, and poor interaction with staff. As part of the previous project, family carers were asked during assessment and at completion of the project about problems they may be experiencing and possible effects of these on their health. Keywords: Dementia patients, stress levels, nursing home staff, family carers 357 Title: Treatment of vocally disruptive behaviour of multifactorial aetiology Principal researchers: S Meares, B Draper Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: School of Community Medicine, University of New South Wales, $6,000 Timetable: 1996 - 1997 Outline: The objective was to describe the treatment of vocally disruptive behaviour of multifactorial aetiology. Three case reports of multifactorial vocally disruptive behaviour successfully treated by a multidisciplinary psychogeriatric outreach team. A biopsychosocial assessment is required to identify the different aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. It was concluded that successful interventions require the combination of multiple biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of vocally disruptive behaviour as a reasonable outcome. Keywords: Vocally disruptive behaviour, treatment, multifactorial, intervention 196 Australian Ageing Research Directory 2000 Medical Research 358 Title: Use of psychotropics in nursing homes Principal researchers: B Draper, H Brodaty Co-researchers: V Richards, D Lie Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Continuing Funding: National Action Plan for Dementia Care, $210,000 (1996-1998) Timetable: 1996 - ongoing Outline: Concerns are frequently expressed about the use of psychotropic medication in nursing homes. The sample comprised 647 residents (mean age 82.3 years) from 11 eastern Sydney nursing homes. Overall, 333 residents (51.5%) were prescribed a regular psychotropic, which increased to 381 residents (58.9%) when ‘as required’ prescription was included. Antipsychotics were regularly prescribed in 21.4% of residents, antidepressants in 19.8%, sedative/hypnotics in 23.1%, anxiolytics in 8.5% and anticonvulsants in 9.7%. When regular and 'as required' psychotropics are considered, 22.9% of residents were taking more than one psychotropic. In those prescribed antidepressants, 45% were taking tricyclics and 41% SSRIs. Only 32 (28.3%) residents on antidepressants had a chart diagnosis of depression. On the EBAS-DEP, 69.2% with significant levels of depressive symptoms were not on antidepressants, though 53.8% of residents on antidepressants also had significant levels of depressive symptoms. The mean daily dosage of antipsychotic medication prescribed (in chlorpromazine equivalents) was 73.0 mg. Keywords: Psychotropic medication, nursing homes, antidepressants 359 Title: Work stress and satisfaction Principal researchers: B Draper, G Luscombe, C Doutney Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1997 - 1999 Outline: 1997 saw the start of the consolidation of the psychiatric units of the Eastern Sector Mental Health Service onto the Prince of Wales campus. With the potential of this process to pose a number of challenges to staff members, the study aim was to find out more about what it was like for staff to work in their units before the move, in terms of job satisfaction and work stress, and then over the following 6 months in the consolidated units. Staff in all of the Eastern Sector inpatient units and community teams were asked to fill out survey questionnaires, on three occasions - before the move, then three and six months after. Eightyseven baseline surveys were received and 75 'six month' surveys. Unfortunately the data collected at three months had to be abandoned because of problems with distribution and collection of surveys. Keywords: Work stress, work satisfaction, relocation 360 Title: A 30-week, multicentre, randomised, double-blind, placebo-controlled evaluation followed by an open label, extended evaluation of the safety and efficacy of E2020 in patients with Alzheimer’s disease Principal researchers: H Brodaty, B Draper, K Berman, L Prenter, S Sharah Australian Ageing Research Directory 2000 197 Medical Research Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Nil Timetable: 1999 Outline: The Academic Department for Old Age Psychiatry was one of seven Australian centres involved in an international trial of E2020 (Donepezil, Aricept) - an acetylcholinesterase inhibitor for the treatment of Alzheimer’s disease. Six otherwise healthy patients (and their carers) with mild to moderate Alzheimer’s disease were enrolled in the initial 30-week, randomised, double-blind placebo-controlled trial. All subjects had completed this initial trial by October 1996 and were subsequently enrolled in a first and then a second extension study. Donepezil (E2020) was found to be associated with modest improvements in cognitive and global function, and activities of daily living. Keywords: Drug trial, Alzheimer’s disease, randomised controlled trial, donepezil 361 Title: An open-label extension evaluation of the safety and efficacy of donepezil hydrochloride (E2020) in patients with Alzheimer’s disease Principal researchers: H Brodaty, B Draper, Berman K, Prenter L, Sharah S Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Eisai and Pfizer Timetable: 1999 Outline: E2020 (donepezil, Aricept) is an acetyl-cholinesterase inhibitor reported to improve cognitive function by preventing the breakdown of acetylcholine in the brain. Patients completing the initial 30 week, randomised, placebo controlled double-blind trial in October 1996, were enrolled in the extension study. The extension study was terminated in May 1998, by Pfizer, when Aricept (donepezil/E2020) was approved by the TGA for use by doctors under the Special Access Scheme in Australia. All patients completing the trial to this time were transferred to the Aricept Maintenance Program, whereby they could continue receiving Aricept (free of charge) from Pfizer. Keywords: Drug trial, Alzheimer’s disease, randomised controlled trial, donepezil 362 Title: A double-blind randomised placebo controlled comparative study of Celecoxib (SC-58635) for the inhibition of progression of Alzheimer’s disease and open-label extension Principal researchers: H Brodaty, P Sachdev, K Fell, K Berman, S Sharah, D Berle Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Completed Funding: Searle and Co. Timetable: 1999 Outline: The Academic Department for Old Age Psychiatry is one of three centres in Australia, involved in an international multi-centre trial of Celecoxib, a cox-2 inhibitor, nonsteroidal anti-inflammatory drug. Celecoxib is an effective anti-inflammatory agent, but has fewer side effects than other anti-inflammatories. There is evidence of brain inflammation in some patients with Alzheimer’s disease, and so it was hoped that Celecoxib would help 198 Australian Ageing Research Directory 2000 Medical Research patients with Alzheimer’s disease. Preliminary results indicate that Celecoxib was no better than placebo in preventing decline. Keywords: Drug trial, Alzheimer’s disease, randomised controlled trial, Celecoxib 363 Title: Risperidone in the treatment of behavioural and psychological signs and symptoms in dementia (BPSSD): A multicentre, double-blind, placebo controlled, parallel group trial, and an open-label extension phase Principal researchers: H Brodaty, K Berman, B Draper, E Burgess Organisation: Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick Status: Double-blind phase completed. Open-label phase continuing. Funding: Janssen-Cilag Timetable: Ongoing Outline: Approximately 90 per cent of nursing home patients show some form of behavioural disturbance. Current treatment options for these problems are limited, and novel psychotropic agents have become the treatment of choice. Risperidone, a novel antipsychotic with fewer side effects than traditional antipsychotic medications, has been reported to be helpful in the treatment of behavioural disturbances in patients with dementia. 310 nursing home patients with dementia and behavioural disturbances were randomly assigned to receive risperidone or placebo for 12 weeks. At this site 24 patients were screened and 21 enrolled in the study. All patients were visited on a frequent and regular basis and were assessed for change in their behavioural problems and possible side-effects. Fourteen patients completed the double-blind phase and, all except for one, proceeded to the open label phase. Data from this study are currently being analysed. Keywords: Drug trial, dementia, behavioural disturbance, Risperidone, nursing home patients 2.52 Aged Care Services and Aged Psychiatry Services, Caulfield General Medical Centre, Victoria 364 Title: An open-label, multicentre, follow-up trial to assess the long-term safety and tolerability of oral administration of talsaclidine in patients with mild to moderate dementia of Alzheimer’s type Principal researchers: Dr S Scharf, Dr K Hall, Professor E Storey, Associate Professor D Fonda Co-researchers: Dr W Gee, Dr D Kirby Organisation: Aged Care Services and Aged Psychiatry Services, Caulfield General Medical Centre Status: In progress Funding: Boehringer Ingelheim Timetable: 1999 - 2002 Outline: This is a multi-centre open label extension study of the long term safety of talsaclidine in patients with Alzheimer’s disease. Keywords: Alzheimer’s disease, drug therapy, muscarinic agonist Australian Ageing Research Directory 2000 199 Medical Research 365 Title: A novel education strategy for staff in residential care facilities Principal researcher: Associate Professor D Fonda Co-researchers: Ms J Verbeeck, Professor C Torrence, Ms B Hughes Organisation: Aged Care Services, Caulfield General Medical Centre Status: Commissioned Funding: Internal Timetable: Commence May 2000 Outline: It is well recognised that optimal continence management is not provided in hostels, supported residential services and nursing homes. Part of this project is looking at a new approach built around case studies and short information sessions which is hoped to be far more informative and accessible to personal care assistants, together with support from the senior management of these facilities. The project will be conducted over a ten week period and will be evaluated for both effectiveness and its ongoing applicability for other residential facilities. Keywords: Incontinence, carers, education 366 Title: Developing ‘critical pathways’ for the frail elderly Principal researcher: Associate Professor D Fonda Co-researcher: Ms L Willinck Organisation: Aged Care Services, Caulfield General Medical Centre Status: Completed Funding: Department of Human Services, Victoria, $120,000 Timetable: 1996 - 1999 Outline: A quality improvement project was conducted to improve the management of frail elderly patients on a 40 bed Aged Care Unit. Critical pathways and clinical practice guidelines are tools used to manage patients with specific diagnoses. Because the frail elderly population frequently suffer from multiple medical conditions, these tools were adapted to meet the needs of such patients regardless of their primary diagnosis. The traditional critical pathway was modified into a user friendly team meeting pathway. This tool is used during multidisciplinary patient discussions. It facilitates identification of critical ‘at risk’ patient functions, promotes streamlined documentation of patient status and treatment and identifies potential barriers to discharge. The clinical practice guidelines were adapted which contained assessment and management guidelines supported by current references. Data was collected on three occasions (baseline, one and two years post implementation) from sixty consecutive patient discharges and surveys of thirty staff and thirty carers which demonstrated the following quantitative improvements: reduction in average length of stay from 21 to 16 days; increase in carer satisfaction with service from 77% to 87%; increase in staff satisfaction with service from 70% to 73%. The project has also resulted in numerous qualitative improvements including improved consistency of assessment and documentation processes and staff demonstrated unanimous preference for the new method of conducting team meetings. Keywords: Clinical pathways, practice guidelines, frail elderly 200 Australian Ageing Research Directory 2000 Medical Research 367 Title: Efficacy and safety of talsaclidine for 12 weeks in a double blind, randomised, placebo controlled parallel group comparison in patients with mild to moderate dementia of Alzheimer’s type Principal researchers: Dr S Scharf, Dr K Hall, Professor E Storey, Associate Professor D Fonda Co-researchers: Dr W Gee, Dr D Kirby Organisation: Aged Care Services and Aged Psychiatry Services, Caulfield General Medical Centre Status: Completed Funding: Boehringer Ingelheim Timetable: 1998 - 1999 Outline: This centre was a study site as part of a multi-centre phase IIb/III study of a novel muscarinic receptor agonist in patient’s with mild to moderate Alzheimer’s disease. Results are pending. Keywords: Alzheimer’s disease, drug therapy, muscarinic agonist 368 Title: Evaluating and validating a multi-centre continence assessment tool Principal researcher: Associate Professor D Fonda Co-researchers: Dr M Bird, Dr M Murray, Ms A Khera, Ms J Verbeeck, Professor C Torrence Organisation: Aged Care Services, Caulfield General Medical Centre Status: Commissioned Funding: Internal Timetable: Commence May 2000 Outline: Through a collaborative approach, a minimum data-set and continence assessment tool was developed in eleven continence clinics around Victoria during 1998-1999. A software package was developed to support this. This project is to validate the various assessment tools that have been developed as part of this process between health professional groups, within clinics and between clinics. Compliance with the assessment tool will also be assessed. A second phase of the project will then look at the actual outcome data from a number of these centres in order to provide the first comprehensive multi-centre data in this country. Keywords: Incontinence, outcome measures, education, assessment tool 369 Title: New screening tool for carers and patients suffering with incontinence Principal researcher: Associate Professor D Fonda Co-researchers: Ms J Verbeeck, Ms B Hughes, Professor C Torrence Organisation: Aged Care Services, Caulfield General Medical Centre Status: Commissioned Funding: Internal Timetable: Commence May 2000 Outline: Most screening documents and tools on incontinence use standardised questions seeking specific information from patients or their carers regarding incontinence. Researchers at the Centre have developed an alternate tool in the form of an open questionnaire and rating scale that allows the patient or carer to both define their problems and its magnitude. The tool can then be repeated at the completion of the treatment period. This project will attempt to Australian Ageing Research Directory 2000 201 Medical Research validate the tool’s intra rater reliability and compare it to more standardised questionnaires. If successful, it will serve as a most useful normal approach to data gathering that can be used within and across clinical settings. Keywords: Incontinence, carers, outcome measures 370 Title: Prediction and prevention of falls in an aged care hospital unit Principal researchers: Dr S Scharf, Dr W Gee, Dr C Fong, Associate Professor D Fonda Co-researcher: Mr D Fowler Organisation: Aged Care Services, Caulfield General Medical Centre Status: In progress Funding: Internal Timetable: 1999 - 2000 Outline: Falls are a significant cause of morbidity and mortality in older hospitalised patients. Most falls prevention programs have been community based however there is less information about successful prevention programs in hospital. The aims are: (1) to validate a falls risk assessment tool in hospitalised elderly patients in an Australian setting and (2) to reduce the rate of falls in older patients with a prevention program. This is a prospective intervention study in a 30 bed aged care hospital ward. A previously reported hospital falls risk assessment tool (STRATIFY) was applied to 56 consecutive admissions who were then documented as high risk or low risk of falls and the rates of falls in the two groups were compared. A four week prospective audit of falls was performed prior to and following application of the risk assessment tool together with a multidisciplinary falls prevention program. Initial results of this pilot study suggest that patients at high risk of falls in hospital can be identified and that the rate of falls can be reduced. Keywords: Falls, old age, hospital 371 Title: The Bridging Project – Phase 1: Evaluation of prevalence of psychiatric comorbidity in an acute hospital Principal researcher: Associate Professor D Fonda Co-researchers: Dr K Hall, Ms S Thambipillai Organisation: Aged Care Services and Aged Psychiatry Services, Caulfield General Medical Centre Status: Completed Funding: Department of Human Services, Victoria, $60,000 Timetable: 1998 - 1999 Outline: Psychiatric co-morbidity is an increasingly common problem amongst older patients admitted acutely to hospital. Their recognition and management is usually sub-optimal in acute hospitals that are not geared to deal with these problems. In 1998, Phase I of ‘The Bridging Project’ investigated the management of psychiatric co-morbidity in a 29 bed acute medical aged care unit. Retrospective data was collected from an audit of 100 consecutive discharged patient’s medical records. The same questions were then asked prospectively of 100 admissions to the same unit. The following information was obtained from the 200 consecutive patients in July and August 1998: patients with a known psychiatric history 18%; patients with diagnoses with dementia 37%; patients diagnosed with delirium 16%; patients diagnosed with depression 20%; patients presenting with disruptive behaviour 45%; patients on psychotropic medication including sedation 62%; average length of stay for all patients 17 days; average length of stay for all patients with psychiatric co-morbidity 23 days. Numerous patient, staff, carer and organisation-wide issues were identified during Phase I of the study. 202 Australian Ageing Research Directory 2000 Medical Research These include: ward design inappropriate for this client group; lack of activities; high level of family stress and concern about taking patient home; high level of staff stress and absenteeism; limited staff expertise in management such patients in setting of other acute problems; increase length of stay; increased rate of workers compensation. Keywords: Acute care, dementia, psychiatric co-morbidity 372 Title: The Bridging Project: Phase 2 Implementation of strategy to improve care of patients with psychiatric co-morbidity Principal researcher: Associate Professor D Fonda Co-researchers: Professor C Torrence, Mr I Gardner, Ms E Fitzgerald, Ms A Bruce Organisation: Aged Care Services and Aged Psychiatry Services, Caulfield General Medical Centre Status: In progress Funding: Department of Human Services, Victoria, $200,000 Timetable: July 1999 - ongoing Outline: The Bridging Project Phase 2, aims to implement strategies to address the various problems identified in the Phase 1 project with the ultimate objective of improved care for patients, reduced stress for carers and staff and reduced length of stay and improved efficiency for the hospital. If this model is successful, it should have widespread applicability. Keywords: Acute care, dementia, psychiatric co-morbidity 373 Title: Use of tele-medicine to manage incontinence in isolated settings Principal researcher: Associate Professor D Fonda Co-researchers: Ms A Khera, Professor C Torrence Organisation: Aged Care Services, Caulfield General Medical Centre Status: Commissioned Funding: Internal Timetable: Commence May 2000 Outline: Both patients and health professionals in isolated settings are often disadvantaged when it comes to assessing and managing incontinence. This project is looking at both qualitative and quantitative valuation on a teleconferencing approach to supporting such practitioners. The project includes other forms of support including phone, E-mail and written information as well as periodic visits. It is hoped to be able to define a viable model together with a cost projection to help set up funded services utilizing existing continence services. Keywords: Incontinence, teleconferencing, isolated settings 2.53 Aged Mental Health Research Group, Monash University 374 Title: Acute hospital use by the elderly Principal researcher: Dr R Rosewarne Co-researcher: Ms A Bruce Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Department of Health and Community Services, Victoria $15,000 Timetable: Jan 1997 - November 1997 Australian Ageing Research Directory 2000 203 Medical Research Outline: Hospital Accident and Emergency Departments play a major role in the assessment and management of older people presenting with acute medical needs. This project provided a comprehensive description of the number, prevalence and characteristics of older people using these resources. Baseline information was collected from three hospitals in the Southern Health Care Network for the outcomes for clients 70 years of age and over. Retrospective analysis of acute hospital assessment services was undertaken for inpatient and outpatient data for people (70 plus age group) presenting to Accident and Emergency Departments or entering the hospital system via direct hospital admission. Data sources were the medical records databases for the three hospitals. Keywords: Acute care, assessment, usage 375 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: A review of the available literature on residential care of people with dementia and challenging behaviour Principal researchers: Dr C Doyle, Dr R Rosewarne Co-researchers: Ms J Opie, A Bruce, Ms S Ward, J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: The purpose of the literature review was to provide background information about dementia, challenging behaviour and best practice, and to summarise international and Australian literature on the care needs of people with dementia and challenging behaviour who live in residential facilities. The following main sections of the literature were targeted: (i) current definitions of dementia, challenging behaviour and best practice; (ii) assessment and diagnosis issues, which are important because the perception and prevalence of challenging behaviour is partly dependent on the method of assessment and diagnosis; (iii) descriptions of the residential care structures used internationally and in Australia to support people with dementia and behavioural problems; (iv) descriptions of best practice approaches for people with dementia and challenging behaviour used internationally and in Australia. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 376 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: Main report Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: This report provided a condensed reference for reports in the Dementia and Challenging Behaviour Series. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 204 Australian Ageing Research Directory 2000 Medical Research 377 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: Residential dementia care: Environments, care practices, staffing and philosophy: Working paper no. 3 Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: This paper describes the environments and care practices adopted in Commonwealthfunded hostels and nursing homes for people with dementia and challenging behaviour. It also provides guidance on the current views on best practice for residential dementia care. A total of 294 aged care residential facilities provided data via a questionnaire. In addition, project staff visited a total of 18 hostels and 24 nursing homes distributed across all Australian states. The key discussion areas in this report were design for dementia, general practitioner and specialist support services, care planning and dementia management plans, dealing with problem behaviours, use of restraints, pain management, general health monitoring, activity or dementia programs, involvement of relatives in resident care, staff selection and education, staff training and direct care management models. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 378 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: Resident profile survey: Working paper no. 1 Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 199 Outline: The purpose of this research is to provide information that will lead to an improvement in the quality of Commonwealth-funded residential services for people with dementia and challenging behaviour. Stage one of the research focused on: (i) description of the types of residential facilities used for dementia care in Australia; (ii) profile of the characteristics of people with dementia and challenging behaviour living in these facilities; (iii) an estimate of the Australia-wide prevalence of challenging behaviour in the different hostel and nursing home environments. The paper also presents the results of an analysis examining the appropriateness of the funding instruments used for the assessment of residents with challenging behaviour in hostels and nursing homes. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care Australian Ageing Research Directory 2000 205 Medical Research 379 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: Commonwealth and state service systems: Working paper no. 4 Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: This report described the elements of the current service systems, and identified approaches that would improve the relationships between these elements, particularly across sectoral boundaries and levels of government. A number of services are involved in the provision of assessment, care and support - at home and in acute and extended care settings for older people. Effective management of these service relationships and responsibilities is essential if older people are to be provided with appropriate care options and supports in an efficient and timely manner. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 380 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: The cost of residential care: Report of the financial study Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: The costing survey found that: (i) On average, dementia-specific hostel and nursing home accommodation returned an operating deficit of approximately $6 to $7 per resident per day. (ii) Personnel costs, in particular direct care staffing costs, were the major contributor to overall expenditure. (iii) Dementia-specific accommodation devoted a greater percentage of total costs to care staff than mainstream accommodation. (iv) Resident behaviour profiles and dependency scores are related to care staff hours and costs per resident per fortnight and to total expenditure per resident per day. (v) The more impaired or difficult the residents were, the more likely the facility was to incur an overall operating deficit. (vi) The existence of a documented behaviour management plan for residents with dementia was associated with a reduction in staff care hours and costs. The information gleaned through this survey suggests that the difference between facilities making a profit and those making a loss was not always determined by the number of direct care staff hours. Some facilities have more direct care hours than average and are making a profit while others have less and are in deficit. Organisations providing residential care need professional management and organisational skills in order to produce profitable outcomes. While this is desirable in all levels of care, it appears to be particularly true for dementia-specific accommodation. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 206 Australian Ageing Research Directory 2000 Medical Research 381 Title: Care needs of people with dementia and challenging behaviour living in residential facilities: Summary report Principal researcher: Dr R Rosewarne Co-researchers: Ms J Opie, Ms A Bruce, Ms S Ward, Dr C Doyle, Mr J Sach Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Health & Family Services, $300,000 for research series Timetable: June 1995 - March 1997 Outline: This is a summary report of the Dementia and Challenging Behaviour report series. Keywords: Dementia, challenging behaviour, quality of care, care practices, dementia care, residential care 382 Title: Consumer outcomes for psychogeriatric care Principal researcher: Dr R Rosewarne Co-researcher: Ms S Ward Organisation: Aged Mental Health Research Group, Monash University Status: Current Funding: Department of Human Services, Victoria, Innovative Practice Grants Initiative, $114,894 Timetable: November 1998 - July 2000 Outline: Consumer satisfaction surveys traditionally employ a methodology that uses generic questionnaires that fail to address matters of concern to individual patients and carers. The aim of this project was to construct an alternative valid scale for assessing individual client/carer-rated clinical outcomes for clients and carers receiving services from an aged mental health service, in particular people with dementia and other psychiatric diagnoses. The study sampled clients and carers across several sites in Victoria. A multi-dimensional approach was undertaken with clients, carers and service providers being asked to identify up to five important problem areas for (i) the client and (ii) the carer, and to rate the impact of those problems. They are then asked what were the anticipated (or actual) service outcomes. This was done within two weeks of the client entering the system and again eight weeks later. This approach becomes embedded in the clinical process, and encourages a co-operative interaction as it focuses clinicians on the consumer’s needs. Measurements taken include demographics, service intervention checklist, clinical care goals and outcomes scale, HoNOS65+, Mental Health Inventory, and a Global Outcomes Question. Keywords: Clinical care goals, aged mental health, clients, carers, service providers 383 Title: Difficult behaviours in elderly GP patients with dementia Principal researchers: Professor D O’Connor, Dr R Rosewarne Co-researcher: Ms S Ward Organisation: Aged Mental Health Research Group, Monash University Status: Ongoing Funding: Department of Human Services, Victoria, $187,388 Timetable: March 1997 - December 1999 Outline: This study aimed to (i) measure the frequency and severity of behavioural symptoms in people with dementia living in the community and (ii) determine carers’ responses to such Australian Ageing Research Directory 2000 207 Medical Research behaviours. These results will be used to identify successful strategies applied by carers in the community. A survey was conducted of persons with dementia identified in a previous study of 30 elderly GP patients and 20 referrals from aged psychiatry services. Carers came from the South-eastern Melbourne metropolitan area and were interviewed in their homes. The strategies identified by carers were categorised using a simple typology based on work by Harvath (1994) and Dodds (1994). Research tools included the Mini-Mental State Examination, Abbreviated Canberra Interview for the Elderly and The Manchester & Oxford University Scale for the Psychopathological Assessment of Dementia (MOUSEPAD). The main behaviours of concern were sleep (52%), verbal (28%), walking (22%) and other (30%). Carers tended to use more passive interventions, the most frequently reported interventions were ignoring (24.1%), diversion (12.2%), verbal reprimand (11.3%), reality orientation (10.3%) and manipulating the environment (8.7%). General practitioners were identified as the most frequently used community service for community carers. Keywords: Dementia, behaviour, community, family carers 384 Title: Evaluation of psychogeriatric consultancies to nursing home residents with behavioural problems and dementia Principal researcher: Professor D O’Connor Co-researchers: Dr C Doyle, Ms J Opie Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Commonwealth Department of Human Services, RADGAC, $161,755 Timetable: 1995 - 1998 Outline: This study tested the premise that planned specialist consultancies, which applied individually tailored psychosocial, nursing, and medical interventions, would reduce the frequency and severity of behavioural symptoms in dementia. The design included a four week trial for two residents in each facility with a one-month follow-up assessment. Residents from each facility were randomly assigned to Group A (delayed intervention in week 3) or Group B (intervention in week 2). The sample size was 99 residents in 45 nursing homes in the south-eastern Melbourne metropolitan area. The behaviour(s) of concern had to be moderately disruptive at least several times a day, as assessed by the Cohen Mansfield Agitation Inventory (CMAI). A diagnosis of dementia was assessed using Mini-Mental-StateExamination (MMSE) and resident’s records; depression was assessed using the short Geriatric Depression Scale (GDS), and interviews with senior nursing staff, relatives and care staff were conducted to collect medical, social and behavioural histories. Behaviours were rated (1) by the care staff using a modified Behavioural Assessment Graphical System (BAGS) (IRR=0.83), and (2) by systematic observations (IRR=0.99). ANOVA results for the BAGS data showed that all behaviour types (verbal disruption, physical aggression, restlessness, socially/sexually inappropriate) significantly declined over the 4-week pre-post intervention period. During the controlled trial, verbal disruption and socially or sexually inappropriate behaviours significantly declined for both Group A and Group B. Keywords: Dementia, behaviour, nursing home, planned consultancy, individual interventions 385 Title: Residential care staff counselling in nursing homes in the ACT Principal researchers: Ms S Ward, Ms J Opie Organisation: Aged Mental Health Research Group, Monash University Status: Completed 208 Australian Ageing Research Directory 2000 Medical Research Funding: Department of Health & Family Services, Canberra, $7,116 Timetable: July 1995 - June 1996 Outline: An external evaluation was conducted of the Residential Care Staff Counselling Project which (i) provided education and support in basic counselling and referral for staff in residential facilities caring for people with dementia and (ii) provided further counselling to unpaid carers. The project targeted seven nursing homes from the ACT and Queanbeyan area. The aims of the external evaluation were to (1) describe the project; (2) review formative evaluation undertaken by the project worker; (3) evaluate outcomes for care staff in (a) reduced hours spent by nursing home staff on counseling relatives, (b) lowering of staff stress levels, and (c) relief of emotional pressure for the family carers. The General Health Questionnaire was distributed to care staff and unpaid carers, and interviews were conducted with both groups. The methodology of the external evaluation was that of a product or impact evaluation of the project on the target audience i.e. the staff and family carers. Although the project team were kept informed, they were not actively involved in any internal evaluation as this was the responsibility of the Dementia Care Counsellor/Educator. The internal evaluation was not able to demonstrate whether increased knowledge and skills had been transferred into actual care practices because of the reliance on self-report. The external evaluation found that the two outcomes indicators for staff were not significantly met during the trial period, but there was a positive decrease for both of these indicators. Although the project targeted all levels of residential direct care staff, the feedback from participants appeared to demonstrate that senior nursing staff were more likely to be approached by family carers on more sensitive issues especially if they had concerns about the nursing or medical care of their relative. It would have been more appropriate to have targeted senior staff specifically rather than all staff. Due to a poor response rate from the family carers it was not possible to demonstrate a measured change in the relatives’ stress levels. Keywords: Counselling, dementia, carers, nursing homes 386 Title: Wandering and dementia in Victoria Principal researcher: Dr R Rosewarne Co-researcher: Ms A Bruce Organisation: Aged Mental Health Research Group, Monash University Status: Completed Funding: Department of Human Services, Victoria, $15,000 Timetable: March 1997 - March 1998 Outline: The aim of the study was to provide information on the extent of wandering and disorientation in public places by older persons with dementia or memory loss. A number of different sources were used to ascertain the prevalence of problem wandering. Reports from taxi companies, hospital emergency departments, public transport staff and shopping centre records were used to give an indication of the likely size of the problem from the community perspective. Further empirical data was examined from a research project examining a large sample of community dwelling elderly and another focusing in residential aged care facilities. The study provided a number of recommendations focusing on the identification requirements for wanderers, responsibilities for residential care providers, community awareness needs and the roles of police and emergency service workers. Keywords: Dementia, wandering Australian Ageing Research Directory 2000 209 Medical Research 2.54 Centre for Mental Health Research, Australian National University 387 Title: Epidemiology of dementia and depression in late life Principal researchers: Professor A S Henderson, Professor A F Corm Organisation: Centre for Mental Health Research, Australian National University Status: Largely completed Funding: NHMRC, Australia Rotary Health Research Fund Timetable: 1980 to present Website address: http://www.anu.edu.au/perc/ Outline: This was an epidemiological study of dementia and depression in late life. Keywords: Dementia, Alzheimer’s disease, depression, elderly, late life, risk factors 388 Title: The Canberra/Queanbeyan longitudinal study of ageing Principal researchers: Professor A F Jorm, Professor A S Henderson, Dr H Christensen, Ms A E Korten Co-researchers: Associate Professor A Mackinnon, Ms P A Jacomb Organisation: Centre for Mental Health Research, Australian National University Status: Three waves of data have been undertaken (1991, 1994, 1998) and a fourth wave is planned for 2002. Funding: National Health and Medical Research Council Timetable: Completion 2002 Website: [email protected] Outline: This study, which commenced in 1991, was designed to examine the incidence and prevalence of dementia, cognitive decline and depression in an elderly population and to examine risk and protective factors for these conditions. Over the last eight years, the above researchers have addressed a number of areas of ageing, including the prevalence and incidence of dementia, depression and cognitive decline in the elderly, the validity of diagnostic categories, the assessment of dementia (PAS scales), the relationship between selfreports of memory decline and objective tests, predictors of successful aging, risk factors for mortality, psychological well being of carers of those with dementia, the relationship between physical and cognitive tests longitudinally, education, mental activity and blood pressure as predictors of cognitive change. The relationship between genetic markers, such as APOE genotype and cognitive decline has also been examined. Keywords: Longitudinal study, cognitive ageing, dementia, depression, old age, cognitive tests, mortality, successful ageing, risk factors, genetics 389 Title: The PATH (Personality and Total Health) Through Life Project Principal researchers: Professor A F Jorm, Dr H Christensen, Dr B Rodgers Co-researchers: Ms P A Jacomb, Mrs A E Korten, Ms T Caldwell, Ms K Maxwell, Dr S Esteal, Dr K Baghurst, Dr J Bryan, Professor P Sachdev Organisation: Centre for Mental Health Research, Australian National University Status: In progress Funding: Australian Rotary Health Research Fund, Australian Brewers’ Foundation, National Health and Medical Research Council, Australian National University Timetable: Commenced 1999, due for completion 2021, duration 23 years Website: http://www.anu.edu.au/perc/pathways.htm 210 Australian Ageing Research Directory 2000 Medical Research Outline: The PATH Through Life Project is a longitudinal study of an adult community sample which investigates the causes of three classes of common mental health problems: (i) anxiety and depression, (ii) alcohol and other substance abuse, and (iii) cognitive functioning and dementia. The project investigates four broad themes which are relevant to each of these mental health problems: ageing vs cohort effects, risk factors, molecular genetic associations, and co-morbidity of mental health problems. Participants are being sampled from the electoral rolls for Canberra and Queanbeyan. The sample covers three age groups: 20-24 years, 40-44 years and 60-64 years, with at least 2,000 participants in each age group. A cross-sectional survey is being carried from 1999-2001, with the 20-24 age group interviewed in 1999, the 40-44 age group in 2000 and the 60-64 age group in 2001. These cohorts will be followed up at 4-yearly intervals for a total of 20 years, so that the study gives both cross-sectional and longitudinal assessments over the same age span. The study is collecting data on the following classes of variables: sociodemographic characteristics, anxiety, depression, substance abuse, cognitive function, well-being, physical health, health habits, use of health services, personality, coping, early life psychological risk factors, current psychosocial risk factors, nutrition, DNA. For the 40-44 and 60-64 age groups, it is also planned to obtain magnetic resonance imaging scans on large sub-samples. Keywords: Depression, anxiety, dementia, cognitive impairment, alcohol, substance abuse, risk factors 2.55 Community and Mental Health Services Unit, Australian Institute of Health and Welfare 390 Title: Older people and mental health (Stage 2) Principal researchers: Ms J Shaw, Ms L Moon Co-researchers: Ms R Cameron, Mr D Braddock, Mr B Grant Organisation: Community and Mental Health Services Unit, Australian Institute of Health and Welfare Status: Ongoing Funding: Office of the Aged, Department of Health and Aged Care Timetable: 1997 - 2000 Website: http//www.aihw.gov.au Outline: The project is a scoping study on mental health service delivery for older Australians. Key components of the study are: (i) Examination of existing national datasets to determine data availability relevant to mental health services for older people. (ii) Analysis of existing data sources to provide information about utilisation of mental health services by older people. This analysis includes results on the demographic characteristics of older people accessing services, diagnostic information about this group, and information on the types of treatment provided. Contextual information on the prevalence of mental health disorders in this age group is also included. (iii) Discussion on the gaps and deficiencies in the available data. This discussion is to include suggestions on potential improvements that could be made in the national data on health services for older people. Keywords: Older people, mental health, mental health services, mental health disorders. Australian Ageing Research Directory 2000 211 Medical Research 2.56 Faculty of Psychiatry of Old Age, Royal Australian and New Zealand College of Psychiatrists 391 Title: A review of provision of psychiatric services for older people in Australia provided by psychiatrists Principal researcher: Dr G Halliday Organisation: Faculty of Psychiatry of Old Age, Royal Australian and New Zealand College of Psychiatrists Status: In progress Funding: Faculty funds Timetable: Commenced 1999, to be repeated annually. Outline: Details of services provided by psychiatrist members of the Faculty to older people in Australia are being collated in order to compare data with information obtained in a previous survey. Sex, age, distribution within Australia, and type of service provided have been reviewed. Keywords: Survey, psychiatrists, old age, Australia, services 212 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Health and Behavioural Sciences Allied Health 3.1 Centre for Allied Health Research, University of South Australia 392 Title: Identification and examination of strategies used by ill elderly to maintain independent living Principal researcher: Dr K Grimmer Co-researchers: To be appointed Organisation: Centre for Allied Health Research, University of South Australia Status: In progress Funding: Primary Health Care Initiatives Program, Department of Human Services, as agent for the Office of the Ageing, $91,565 Timetable: 12 months Outline: The project is concerned to identify and examine strategies and community supports that enable ill elderly people to successfully return to, and maintain independent community living. The objective is to identify the strategies and supports that successfully assist recently ill elderly people (aged 65 and over) to return to, and maintain independent community living. Successful independent community living is defined as the ability of the elderly to be safe and participate in the activities they wish, while living in their own homes. This project will follow up patients who return, or not, to successful community living after an event of hospitalisation, and describe the strategies and supports used by them. The areas in which lack of supports may result in unplanned (or early) use of residential care services, or additional burdens placed on patient and carers to maintain independent community living status will be identified. All elderly patients admitted to the medical and surgical wards of the Lyell McEwin Health Service, the Whyalla Hospital and Health Services and Port Augusta Hospital during the months of August and September 1999 will be invited to participate in the study. Sufficient numbers of patients are discharged from these sites within the time frames of the enrolment period of the study to support the proposed study sample. Invitation will be under the auspices of the Director of Nursing in each site, indicating the commitment of the hospital to the patient’s welfare. This strategy was reported by Stevenson et al 1997, Czarn et al 1992 and was employed by the applicants with success in the recently completed study. The first 50 patients from the metropolitan and the first 25 patients in the two rural locations to agree to participate will be enrolled as the study sample. These people will agree to be followed each month over the next year by questionnaire, telephone interview, and in a subset of 20% of the sample, by personal interview. The patient sample will be heterogeneous, in that it will comprise a range of diagnosis related groups and will include patients with and without carers. This allows for stratification by diagnosis related group, by carer presence and by rural or metropolitan location. Keywords: Identification, strategies, ill elderly, independent living, maintenance, activities of daily living Australian Ageing Research Directory 2000 213 Health and Behavioural Sciences 3.2 Centre for Evidence-Based Physiotherapy, School of Physiotherapy, University of Sydney 393 Title: Physiotherapy Evidence Database (PEDro) Principal researchers: Dr A M Moseley, Ms C Sherrington, Dr R D Herbert, Dr C Maher Organisation: Centre for Evidence-Based Physiotherapy, School of Physiotherapy, University of Sydney Status: Ongoing Funding: Australian Physiotherapy Association, $37,399; NSW Physiotherapist's Registration Board, $9,560 Timetable: Commenced May 1998 - completed stage 1 October 1999 Website: http://ptwww.cchs.usyd.edu.au/pedro Outline: Physiotherapists face a number of impediments to the use of an evidence-based approach to clinical decision-making. These include poor access to relevant, high quality trials; insufficient skills to evaluate the methodological quality of clinical trials; the fact that there are very few systematic reviews of the effectiveness of physiotherapy interventions. This project aims to develop and maintain an Internet-based resource to facilitate the implementation of evidence-based physiotherapy. The Physiotherapy Evidence Database (PEDro) is the world’s first Internet-based database of clinical trials in physiotherapy. It is a free, searchable database of all randomised controlled trials and systematic reviews relevant to physiotherapy. PEDro was officially launched on 30 September 1999 at the University of Sydney. PEDro is designed to give physiotherapists rapid access to research evaluating the effectiveness of physiotherapy interventions. Physiotherapists can visit the website and use powerful, user-friendly search strategies to identify trials. The database contains systematic reviews and quality-assessed randomised controlled trials relevant to physiotherapy. Users can access bibliographic details, author abstracts and ratings of methodological quality on the database. Search results are ranked according to methodological quality to allow quick access to the best quality trials available. In February 2000, PEDro contained 2,165 records - 1,892 randomised controlled trials and 273 systematic reviews. 80% of the randomised controlled trials were rated for quality using the PEDro scale. 320 ratings were confirmed by a second and, if necessary, a third rater. Copyright permission to reproduce author abstracts was available for just under half of the records. Physiotherapists (and other users) from all over the world are using the PEDro database. Since the launch, there has been an average of approximately 100 visitors to the PEDro web-site every day. The focus of stage 2 is on rating trials in languages other than English, completing the double and triple ratings, and identifying more trials. Keywords: Physiotherapy, evidence-based practice, systematic review, randomised controlled trial 3.3 Communication Disability in Ageing Research Unit, Department of Speech Pathology and Audiology, University of Queensland 394 Title: Multichannel compression amplification in hearing aids: Optimizing speech perception Principal researchers: Dr L Hickson, Mr N Thyer Organisation: Communication Disability in Ageing Research Unit, Department of Speech Pathology and Audiology, University of Queensland 214 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Status: Completed Funding: National Health and Medical Research Council, $85,000 Timetable: March 1997 - March 1999 Outline: The overall aim of this project was to determine the most appropriate settings for compression hearing aids to provide the best possible speech perception for older people with hearing impairment. The aim of Phase 1 was to determine compression characteristics (compression ratio and crossover frequency) for a two channel hearing aid which best preserve the acoustic properties of the speech signal. Speech stimuli were recorded through a hearing aid that allowed for the selection of either linear amplification, single channel compression or two-channel compression. A total of 26 recordings were made of 24 speech syllables. The recorded speech material was subsequently acoustically analysed to determine the following parameters: Consonant-Vowel ratio, Envelope Difference Index, amplitude differences at various temporal points in each consonant. This extensive acoustic data collection and analysis phase was completed in January 1998 and the compression characteristics of the hearing aid necessary for Phase 2 of the research were determined. The aim of Phase 2 was to investigate the relationship between the acoustic changes identified in Phase 1 and the speech perception performance of people with varying degrees of sensorineural hearing loss of cochlear origin. Ninety-three subjects aged 60 to 80 years with acquired bilateral sloping sensorineural hearing impairment (mild to moderately severe) have been assessed. Participants were recruited from the chief investigators’ existing database of older people with hearing impairment and from referrals by audiologists at Australian Hearing. Each assessment session took approximately four hours and consisted of pure-tone audiometry; impedance audiometry; loudness growth in 1/2 octave bands testing; a temporal resolution test; a frequency resolution test and speech perception testing (with stimuli recorded through the hearing aid in Phase 1). The analysis of data from Phase 2 is complete and indicates that the primary hypothesis of the research has been supported: it is possible to predict speech perception performance with compression by examining the acoustic characteristics of the processed speech signal. These findings have considerable significance for the use of compression in hearing aids. Keywords: Hearing aids, compression amplification, speech perception 395 Title: The effect of communication on the quality of life of healthy older adults and older adults with aphasia Principal researcher: Ms M N Cruice Co-researchers: Dr L Worrall, Dr L Hickson Organisation: Communication Disability in Ageing Research Unit, Department of Speech Pathology and Audiology, University of Queensland Status: In progress Funding: Australian Postgraduate Award, Walter and Eliza Hall Travelling Scholarship 1999 Timetable: January 1998 – June 2001 Website: http://www.uq.edu.au/spaa/cdaru/index.html Outline: Although effective communication is deemed crucial for quality of life, there is little understanding of the relationship between the two concepts. Within the field of speech pathology, the paucity of both information and quality of life assessment tools is cause for concern, as quality of life becomes increasingly important in communication rehabilitation. Employing the health-disease continuum approach, two population groups have been chosen for investigation. The impact of communication on quality of life is well illustrated by people with specific communication disabilities, such as aphasia. Aphasia is the language-based communication disability, that can result from a stroke. To differing degrees, it affects Australian Ageing Research Directory 2000 215 Health and Behavioural Sciences comprehension and expression in both verbal and written modes. Healthy older adults encounter communication difficulties too, albeit comparatively more mild than in aphasia, as part of the normal ageing process. These two groups are acknowledged as having communication disabilities which differ in cause, type, severity and range. Through interview and assessments from the fields of speech pathology and quality of life, this research endeavours to (i) provide clarification of the relationship between communication and quality of life; and (ii) evaluate the use and suitability of existing quality of life assessment tools, and the proxy respondent technique, in both groups. It is also hoped that there will be implications within the field of gerontology, by creating an awareness of the importance of communication to ageing and quality of life, and possibly creating a role for speech-language pathologists in communication health promotion in an ageing society. Within Brisbane and surrounding areas, approximately 30 adults with aphasia and 100 healthy ageing adults, and their respective significant others, will participate in interviews of between four and eight hours’ duration. Participants complete well-being and health-related quality of life assessments, as well as assessments and checklists relating to language, hearing, vision, communication and social activities. The research uses the conceptual framework of the International Classification of Impairment, Activity and Participation (ICIDH-2), evaluating the three levels (I, A, and P) in conjunction with quality of life. Correlational and multiple regression statistics are being used to analyse data. Keywords: Quality of life, healthy ageing, aphasia, communication, disability, assessment 396 Title: The efficacy of a communication program for older people with hearing impairment Principal researchers: Dr L Hickson, Dr L Worrall Organisation: Communication Disability in Ageing Research Unit, Department of Speech Pathology and Audiology, University of Queensland Status: Planned Funding: Application submitted for funding to NHMRC Timetable: Planned to commence January 2001. 3 year project Outline: Sixty percent of people over the age of 60 years have hearing loss that adversely affects their ability to communicate. Hearing difficulties are associated with social isolation, depression and reduced quality of life. Thus, hearing impairment in older people is a major public health issue. The current focus on hearing aids as the only form of treatment is inappropriate and/or inadequate for between 60% to 85% of older people with hearing impairment. The overall aim of this project is to evaluate the efficacy of a new approach in aural rehabilitation for older people with hearing impairment: the Active Communication Education (ACE) program. The program is designed as an alternative for, or a supplement to, hearing aid fitting. The specific hypotheses to be tested are (i) there will be significant improvements in measured hearing disability, handicap, quality of life and communication ability for participants who complete the ACE program; (ii) the measured hearing disability, handicap, quality of life and communication ability will be better for participants who complete the ACE program than for a control group who complete a placebo program; (iii) if there are improvements in measured hearing disability, handicap, quality of life and communication ability following ACE, these will be maintained at six months follow-up; (iv) factors such as age, gender, hearing loss, extent of social contact, hearing aid use, and attitudes to hearing impairment will effect participant response to the ACE program. The ACE program has been developed to assist older people with hearing impairment to regain and maintain their communication skills. Various group communication programs have been 216 Australian Ageing Research Directory 2000 Health and Behavioural Sciences used with older people in the past but these have been poorly evaluated. Studies had small subject numbers and methodological limitations. In addition, previous programs have been largely didactic and impairment-based, and recent advances in educational gerontology and theories of disablement indicate the need for an experiential interactive program that targets everyday communication. ACE is designed for use with groups of older people (and their significant others). The program, facilitated by an audiologist or speech pathologist, runs for two hours per week over five weeks. It is therefore a simple inexpensive program grounded in current theories of communication disability and ageing. A total of 200 participants are required for this study, however an additional 20% will be recruited initially to account for sample attrition. Participants must be over 60 years of age and have a mild to moderate hearing impairment. Participants will be recruited from Senior Citizen centres, retirement villages, neighbourhood centres, church agencies and clubs. Following a baseline assessment, participants will be randomly allocated to either an immediate or a deferred treatment group. Participants will be tested pre-and post-intervention as well as six months post-intervention. A series of self-report measures of hearing disability and handicap, communicative function and health-related quality of life will be administered face-to-face at each test session. Keywords: Hearing impairment, communication, education, aural rehabilitation 3.4 Department of Physiotherapy, University of Queensland 397 Title: A comparative study of falls prevention programs in the community Principal researchers: Ms J C Nitz, Ms N Low Choy, Mr R Bronk, Mr G Kerr Organisations: Department of Physiotherapy, University of Queensland; School of Exercise Science and Sports Management, Southern Cross University, Lismore; School of Human Movement Studies, Queensland University of Technology Status: Planned Funding: National Health and Medical Research Council funding being sought Timetable: Anticipated 2001 Outline: The aim of this study is to undertake controlled intervention trials in the community that target separate groups that comprise: (1) robust community dwelling adults over 65 years of age who are able to ambulate two kilometres or more and have no night ambulation problems; (2) frail community dwelling adults over 65 years of age who can ambulate up to 100 meters with or without a walking aide, who have no history of falling but might have night ambulation problems; (3) frail community dwelling adults over 65 years of age who are able to ambulate any distance and who have fallen. There will be five interventions evaluated including: (i) falls education program; (ii) strengthening program; (iii) strengthening and flexibility program; (iv) balance strategy training plus a strengthening and flexibility program; (v) balance strategy and training plus strength and flexibility training individually tailored to postural stability and balance assessment. These data will allow comparison of the efficacy in reducing incidence of falls of different intervention programs, and secondly, allow comparison of specifically designed physiotherapy intervention programs to generic education or exercise programs. Subjects will be recruited via the injury prevention research program. A falls diary will be used to record falls during the course of the study. Physical evaluation of the postural stability and balance of each subject will be conducted on admission to a falls prevention program (education, physiotherapy or generic exercise program) and at intervals over 18 months. Keywords: Falls, postural stability, falls education, physiotherapy exercise, exercise Australian Ageing Research Directory 2000 217 Health and Behavioural Sciences 398 Title: An evaluation of sitting position on oxygen saturation in the frail elderly Principal researchers: Ms J C Nitz, Ms M Steer Organisation: Department of Physiotherapy, University of Queensland Status: Planned Timetable: Commence May 2000 Outline: The aim of this study is to demonstrate the effect of a very reclined seating posture on the oxygen saturation, blood pressure and pulse rate when compared to upright sitting posture in the very frail aged person. The very reclined sitting position is commonly used as a safe sitting position for frail aged who are unable to maintain the upright position without restraint and for those who might try to stand up without assistance and are at risk of falling. Subjects included in the study will be considered very frail, unable to mobilise and living in a nursing home but are able to give informed consent. Baseline measurements of SaO2, blood pressure and pulse rate will be taken after the resident has been in the reclined position for 15 minutes and then at 15 minute intervals until four sets of measurements are taken. The reclined position is defined as 750 or greater recline. After one hour, the chair will be positioned in the upright (defined as between 00 and 250 of recline) and the regime of measurement repeated until four sets of measurements are obtained. These datasets will be obtained on three separate occasions. Recommendations on the use of the very reclined sitting position with respect to the consequences of oxygen saturation decline in the frail elderly will be made on examination of the study results. Keywords: Frail aged, oxygen saturation, sitting posture 399 Title: A survey of the need for physiotherapy intervention in a cohort of post-polio sufferers in Queensland: Is ageing the issue? Principal researchers: Ms N Low Choy, Ms M Lynch Organisation: Department of Physiotherapy, University of Queensland Status: Nearing completion Funding: Dorothy Hopkins Award, Australian Physiotherapy Association, $1,500 Timetable: January 1999 - October 2000 Outline: This study was designed to clarify the nature and extent of the new health problems being reported by persons as they age with a prior history of poliomyelitis. The survey was confined to Queensland and was designed to: (i) obtain demographic information; (ii) define types of problems, frequency and severity of post-polio symptoms being experienced; (iii) examine the impact of post-polio symptoms on activities of daily living, lifestyle and employment, examine factors associated with the development of post-polio symptoms in order to determine risk indicators for late onset polio symptoms; and (iv) develop the implications for the physiotherapy practice. A survey methodology using a self administered questionnaire as the measurement instrument was employed. The instrument gathered information related to demographics, history of the initial polio presentation, including the frequency and severity of symptoms, new post-polio symptoms (type, frequency and duration of symptoms), as well as the assessment of impact on activities of daily living, employment and lifestyle and the use of aids and assistive devices. The results are currently being collated in preparation for a discussion that will develop the implications for the physiotherapy profession. Keywords: Post-polio, post-polio symptoms, poliomyelitis, survey, activities of daily living 218 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 400 Title: Balance ability across the mature adult life span as identified by clinical and laboratory measures Principal researchers: Professor S K Khoo, Ms J C Nitz, Ms N L Low Choy, Ms R C Isles Organisations: Department of Physiotherapy, University of Queensland; Research Centre for the Older Woman, Queensland Health Status: Planned Timetable: Data collection to commence late 2000 Outline: The proposed study forms part of a comprehensive program that will evaluate the ageing woman from climacteric to death, incorporating gynaecological, physical evaluation of lumbar stability, osteoporosis level, neuropsychiatric, cardiovascular and urological examination. The aims of the study are to: (i) evaluate the ability of mature women to maintain postural control and balance in static and dynamic situations in relation to age; (ii) identify any ‘biomarker’ that indicates decline in neuro-motor integration of visual, vestibular, somatosensory and motor control of postural stability that is not clinically evident but is apparent on laboratory measurement; (iii) allow correlation of postural stability and balance ability to osteoporosis level as an indicator for likelihood of a fall with a consequent fracture; (iv) allow correlation of overall postural stability to segmental stability and urinary continence; (v) provide a realistic lower age limit for instigation of falls prevention programs with expected long-term effects on postural stability and balance. Currently available reliable and valid methods of measurement will be utilised to collect data describing postural control, balance, mobility and functional strength. Subjects will be obtained from the electoral role in the northern Brisbane area, and will comprise normal adult women over 40 years of age (no upper age limit) Subjects will be in age cohorts of 5 years age ranges. All cohorts will require a minimum of 100 subjects in each for statistical power. Keywords: Ageing, postural stability, balance, women 401 Title: Normative data across the adult life span for the Timed Up and Go Test Principal researchers: Ms N Low Choy, Mr G Morrison, Ms T Comans Organisations: Department of Physiotherapy, University of Queensland; Department of Physiotherapy, Queen Elizabeth 11 Hospital, Queensland Status: Current Funding: Charles and Sylvia Vertel Foundation, $13,000 administered by the Stroke Association of Australia Timetable: January 1999 - July 2000 Outline: A study to determine normative data for the Timed Up and Go Test across the adult life span so that the measures could be reliably used to: (i) establish targets for clients who have neuro-motor impairments; (ii) monitor performance; (iii) provide motivation; (iv) assist in the achievement of improved outcomes of care; (iv) aid return to previous level of function; (v) assist in early discharge from hospital, thus reducing the cost of institutional care. The effect of age and gender on performance on the test was evaluated. One hundred and eighty subjects were tested. Thirty subjects were admitted to six, ten year age categories. Subjects were healthy ambulant community dwelling adults who were able to complete a 10 metre walk as a screening test. The design of the project enabled inter-tester and intra-tester reliability to be determined with no significant difference between the testers being determined. This finding means that different physiotherapists can use the test with confidence in the rehabilitation setting. The results obtained have enabled the researchers to develop a normal values chart. An upper and lower performance limit for each age group has Australian Ageing Research Directory 2000 219 Health and Behavioural Sciences been developed which reflects a 95% confidence of values falling within 1.96 standard deviations from the mean for each age category. The information will be available for physiotherapists to use internationally as a base for comparison with specific disorders affecting the adult. Keywords: Balance, gait, standing, walking, functional assessment, quantitative measure of function 402 Title: Postural adaptations of persons with tetraplegia who use manual wheelchairs Principal researchers: Ms J C Nitz , Ms D Amsters Organisation: Department of Physiotherapy, University of Queensland; Spinal Injuries Unit, Princess Alexandra Hospital, Queensland Status: In progress Funding: Princess Alexandra Hospital Research & Development Foundation Grant, $7,930 Timetable: Completion November 2000 Outline: The aims of the study are to: (i) establish how sitting posture of persons with tetraplegia from traumatic spinal cord injury differ from that of able bodied persons, (ii) determine if sitting postures of persons with tetraplegia change with increasing age and/or time since injury. Five subject groups are being studied, four groups with tetraplegia and one comprising normal subjects. The tetraplegic groups comprise subjects 50 years and over with an injury of less than five years duration, 50 years and over with injury for more than 15 years, younger than 40 years of age with an injury duration of less than five years and younger than 40 years of age with an injury more than 15 years duration. A minimum of 15 subjects in each tetraplegic group will be tested. A standard adjustable testing wheelchair will be manufactured so that different patient size can be accommodated and used for all subject measurements. Measurements include pelvic tilt, resting spinal curvature, forward head position and passive lumbar extension. The effect of age on the sitting position and the effect of ageing with tetraplegia will be evaluated through correlative and comparative analyses. Keywords: Ageing, tetraplegia, seated wheelchair posture 3.5 Dietitians Association of Australian Inc. (Victorian Branch) 403 Title: Identifying and assisting home based adults who are nutritionally at risk Principal researcher: Dr B Wood Co-researchers: Ms S Race, Ms J Bacon, Ms A Stewart Organisation: Dietitians Association of Australia Inc. (Victorian Branch) Status: Completed Funding: Victorian Department of Human Services, Aged Care Division, Home and Community Care Timetable: 1996 - 1999 Outline: This project has successfully used action orientated research methods to develop a number of resources which support the identification of, and provision of assistance to home based frail elderly people and younger people with disability who are nutritionally at risk. The main aim was to enable Home and Community Care (HACC) Services to identify when a person is at nutritional risk and to solve problems by offering effective support, or by referring the person to a specialist who can provide expert assistance on food and nutrition issues. Specific objectives were to (i) improve awareness and information about nutritional risk factors and food and nutrition issues for the HACC target group; (ii) improve assessment processes used by HACC service providers such that the methods are sensitive to identifying 220 Australian Ageing Research Directory 2000 Health and Behavioural Sciences those at nutritional risk and planning better-targeted intervention; (iii) provide information on current resources available, and appropriate actions and referral systems to enable service providers to access specialist support and expertise on food and nutrition issues for their clients. The project target group was HACC service providers, the home based frail elderly client, younger adults with disability, and regional and local dietitians. Initial work concentrated on the development of resources for the home based frail elderly, and statewide training of assessment officers in the use of these resources. The development of Nutritional Risk Screening in home-based adult clients with disability has also been completed, together with those for the financially disadvantaged in alternative housing. This has enabled integration of all resources across the HACC target group. The project outcomes are (1) Nutritional Risk Screening and Monitoring outline, a tool is used in conjunction with any assessment form, particularly the universal client referral form (CIARR). (2) A Resource Manual for Assessment Officers. This comprehensive manual provides an outline of nutritional risk screening as part of general needs assessment, nutrition and health issues, dietary principles and problems, many options for simple intervention, and ways in which dietitians can assist home care clients and Services. It includes eleven case studies, quality improvement, and references and resources. (3) A Training Manual for Dietitians who undertake the training of Community Workers in Nutritional Risk Screening. Based on the Resource Manual, this material includes an outline of the training sessions and copies of 120 model overhead slides. (4) The client booklet - Good food and health for older people who want to help themselves - includes some practical suggestions for assisting clients to prevent problems and to solve some of their simple problems. (5) “Train the trainer” programs have been provided for dietitians in every Victorian health region, and statewide training has begun for assessment officers. Similar work and outcomes has been conducted in another Project for Carers in the Grampians Health Region. Keywords: Assessment, home based adults, elderly, adults with disability, nutritional risk, intervention, community workers, dietitians 3.6 Physiotherapy Department, Bankstown-Lidcombe Hospital, South Western Sydney Area Health Service 404 Title: Functional outcomes and fall risk following hip fracture: two randomised trials of exercise intervention Principal researchers: Ms C Sherrington, Mr S Lord, Mr R Herbert Co-researchers: Mr P Pamphlett, Ms P Jensen Organisations: Physiotherapy Department, Bankstown-Lidcombe Hospital, South Western Sydney Area Health Service; Prince of Wales Medical Research Institute Status: In progress Funding: Australian Postgraduate Award; HRFSSW, $7,408; Arthritis Foundation, $7,500 Timetable: Completion August 2000 Outline: This study aims to investigate the effects of different exercise programs on functional status and fall risk among older people after hip fracture. It involves two randomised trials. One study investigates the effect of two different muscle strengthening strategies among 80 people undergoing in-patient rehabilitation at the Bankstown-Lidcombe Hospital. The other investigates the effects of two different individualised supervised home exercise programs among 120 older people who have been in-patients at the BankstownLidcombe, Liverpool, War Memorial, Greenwich and Hunters Hill (Private) Hospitals with recent fall-related hip fractures. A control group is undergoing the usual intervention. Keywords: Hip fracture, exercise, physiotherapy Australian Ageing Research Directory 2000 221 Health and Behavioural Sciences 405 Title: Randomised controlled trial to evaluate exercise classes for elderly people with movement difficulties Principal researchers: Ms C Sherrington, Ms J Jacka, Ms G Ho, Ms J Nugent, Ms L Gale Organisation: Physiotherapy Department, Bankstown-Lidcombe Hospital, South Western Sydney Area Health Service Status: In progress Funding: NSW APA research grant Timetable: February 2000 - ongoing Outline: This project aims to evaluate the feasibility and effectiveness of a new five-week group exercise program designed to improve the physical abilities of individuals with a physical disability. Participants are not able to attend community exercise groups and are not currently receiving other rehabilitation services. The objectives are to compare measures of physical ability (strength, balance and endurance) in two groups of participants: those who attend the first program of classes and those who are waiting to attend the same program over the following five weeks. Group assignment is by concealed randomisation. Keywords: Exercise, physiotherapy, strength, balance, endurance 406 Title: Some characteristics of shoulder use during the day in healthy people over the age of 60 years Principal researcher: Mr K Schurr Co-researcher: Dr L Ada Organisation: School of Physiotherapy, University of Sydney, Physiotherapy Department, Bankstown- Lidcombe Hospital Status: Completed Funding: Nil Timetable: Completed March 2000 Outline: Twenty-one people over the age of 60 years were observed in this study to investigate the frequency and duration of lengthening of the shoulder internal rotator, adductor and extensor muscles during the day. In addition, the duration of occasions where the weight of the arm was unsupported were recorded. The purpose of collecting this information was to (i) establish the stimuli required to maintain the length of the shoulder internal rotator, adductor and extensor muscles; (ii) to determine to what extent the shoulder muscles surrounding the glenohumeral joint are required to support the weight of the arm during daily use. The key results of the study were: (1) The shoulder internal rotator, adductor and extensor muscles are lengthened for a median of 1% of the waking day. This brief period of time was found to be related to the passive range of motion into external rotation and flexion. (2) The arm is allowed to hang unsupported for 4% of the day. The weight of the arm is supported either by external means (for example a table) or by muscles during movement for the rest of the time. The study concluded that after stroke people need to have the shoulder internal rotator, adductor and extensor muscles lengthened for at least 14 minutes as part of their rehabilitation to prevent contracture of those muscles. Care needs to be taken to ensure that people after stroke whose shoulder muscles are paralysed need to have the weight of their shoulders supported at all times to prevent subluxation of the glenohumeral joint. Keywords: Physiotherapy, shoulder, muscle length, subluxation, stroke 222 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 407 Title: Task specific training compared with resistance training to improve performance of standing up and lower limb strength in the frail elderly Principal researchers: Ms L Gale, Ms G Ho, Mr K Schurr, Ms C Sherrington, Mr P Pamphlett Co-researcher: Mr R Herbert Organisation: Physiotherapy Department, Bankstown-Lidcombe Hospital, South Western Sydney Area Health Service Status: In progress Funding: Physiotherapy Research Foundation seeding grant, $5,000; HRFSSW Equipment Grant, $2,000; NSW APA Research Grant, $1,562; NSW APA Research Grant, $1,000 Timetable: Ongoing Outline: A group of physiotherapists working in the area of in-patient rehabilitation at Bankstown-Lidcombe Hospital has developed a task specific strength training regime aimed to improve performance of standing up and lower limb strength in the elderly. This approach is now being compared to more traditional open chain resistance exercises in a randomised controlled trial among elderly in-patients who have difficulty standing up. This project is being conducted as a randomised trial where subjects are randomised to one of two treatment groups. Participants are those who are over sixty years of age and who are unable to stand up from a 35cm stool. Those excluded include persons who would be unable to perform either of the exercise protocols or those who have a degenerative condition. There will be 100 subjects included to determine the difference in the effect between a closed chain and an open chain exercise protocol on participants’ performance. Participants’ performance is measured before randomisation and on completion of two weeks of the protocol by a blind measurer. Measures used to evaluate the effect include measures of muscle strength, a functional mobility scale, measures of walking parameters and velocity and percentage of time spent in single support. Keywords: Strength training, exercise, physiotherapy 3.7 School of Communication Sciences and Disorders, Faculty of Health Sciences, University of Sydney 408 Title: Communication in people with traumatic brain injury Principal researcher: Dr L Togher Organisation: School of Communication Sciences and Disorders, Faculty of Health Sciences, University of Sydney Status: In progress Funding: University of Sydney U2000 Postdoctoral Fellowship, $158,329 Timetable: 1999 - 2001 Outline: This study aims to investigate the communication of people with a severe traumatic brain injury. It aims to: (i) identify communication behaviours which may penalise people with severe traumatic brain injury resulting in loss of friends and social isolation; (ii) establish measures to describe these aberrant behaviours; (iii) identify the relationship between poor psychosocial outcomes and communication; and (iv) trial a training program to rehabilitate communication in people with severe traumatic brain injury and so improve psychosocial outcomes. This study proposes to extend previous research, which has identified specific communication behaviours in people with traumatic brain injury with a range of communication partners including mothers, police, bus timetable service providers, and health Australian Ageing Research Directory 2000 223 Health and Behavioural Sciences professionals in different communication settings including community education programs and interviews, using a variety of approaches. Keywords: Traumatic brain injury, disability, rehabilitation, social isolation 409 Title: Training police as communication partners of people with traumatic brain injury Principal researchers: Professor C Code, Dr S McDonald, Dr L Togher Organisation: School of Communication Sciences & Disorders, Faculty of Health Sciences, University of Sydney; Department of Psychology, University of New South Wales Status: Completed Funding: National Health and Medical Research Council, $37,469 Timetable: January 1998 - December 1998 Outline: Research by the Brain Damage and Communication Research Group, University of Sydney, has identified specific conversational behaviours in a range of communication partners of people with traumatic brain injury. These include mothers, police, bus timetable information service providers and health professionals, with the most striking results being seen with the police interactions. The effect of this was to produce inappropriate and inefficient interactions which significantly impeded the purpose of communication, the exchange of information. This had major significance given that 90% of traumatic brain injury patients come into contact with the police because of the cause and nature of their injury (ie. motor vehicle accidents, assaults). Based on these findings, a training program (ie. Communicating: Police interactions with people who have brain injury) was undertaken with the NSW Police Service to investigate the hypothesis that training communication partners in the community would result in significant improvement in their interactions with people with traumatic brain injury during routine service enquiries. Results indicated that police officers were able to modify their communication behaviours to enable the people with traumatic brain injury to communicate more effectively and appropriately. The success of this training program was based on a combination of knowledge about how to communicate with people with a disability and the structure of interactions common in everyday policing (e.g., service encounters, interviewing); skills training which involved practising strategies in a small group format, and experience, including face-to-face practice with people with traumatic brain injury. It is suggested that this type of training would be beneficial to police recruits and operational police. Further study is required regarding the current needs of operational police in dealing with people with disability, particularly those who present with a communication or behavioural disorder. Keywords: Traumatic brain injury, disability, professional training, police service 3.8 School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney 410 Title: A randomised controlled trial to reduce insulin resistance in the obese elderly Type 2 diabetic Principal researcher: Professor M Fiatarone Singh Organisation: A Health and Ageing Research Program by School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney Status: In progress Funding: Novo Nordisk, $15,000 Timetable: January 2000 - December 2000 224 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: The value of tight regulation of blood sugar in type 2 (adult onset) diabetics has been convincingly demonstrated in recent years, however, the clinical management of the obese elderly patient with this disease is often complicated by increasing insulin resistance and resultant multiple drug therapy, as well as many other co-existing health conditions that impede compliance and reduce quality of life. Progressive resistance training or weightlifting exercise, has been shown to improve glucose control mechanisms in healthy, obese and glucose-intolerant individuals. In addition, it is associated with increased total energy expenditure in physical activity in healthy and frail older adults and relief of anxiety, depression and insomnia in patients with clinical depression, and reduced cortisol responses to acute physiological stress. This constellation of effects related to glucose homeostasis, body composition, energy expenditure and stress, along with its greater feasibility in this population than aerobic exercise because of concomitant obesity, cardiovascular and arthritic disease, provide the rationale for the investigation of the benefits of progressive resistance training in the clinical management of older diabetics. This study will test the hypothesis that: (i) the addition of progressive resistance training (weight lifting exercise) to the usual care of obese elderly patients with type 2 diabetes for twelve months will result in improved control of blood sugar due to increased sensitivity to insulin, compared to controls receiving usual care; (ii) the improvements in glucose homeostasis and insulin action will be independently related to both reductions in abdominal fat tissue and increases in muscle mass in the experimental group; (iii) patients in the experimental group will have a significant improvement in psychological profile and health-related quality of life compared to controls. Type 2 diabetes comprises the largest group of older diabetics, and the morbidity and health care expenditures associated with this condition are substantial. This treatment regimen, if successful, would improve physiological and psychological function and body composition, as well as glucose homeostasis in these patients. It offers a distinct departure from lifestyle recommendations which are primarily negative in nature, such as dietary restriction, achieving a more favourable energy balance and reduced fat mass through enhanced metabolic rate and activity levels, at the same time counteracting age and disease-related muscle wasting. In contrast to aerobic training recommendations, which are often frustrating or impossible to implement in obese elders due to osteoarthritis, peripheral vascular disease, lung disease and cardiac ischaemia, resistance training has been shown to be safe and well-accepted in these and other complex patient populations. Keywords: Progressive resistance training, diabetes, obesity, quality of life 411 Title: Effects of strength training on mobility and activities of daily living after hip fracture Principal researchers: Associate Professor M Thompson, Dr G Bennett, Dr L Barnsley, Mr T Gwinn Organisations: A Health and Ageing Research Program between School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney; Geriatric and Rehabilitation Medicine, Nepean Hospital; Department of Rheumatology, Faculty of Medicine, University of Sydney Status: In progress Funding: National Health and Medical Research Council, $120,540 Timetable: 1998 - 2000 Outline: After a hip fracture an elderly person's mobility (ability to walk, rise from a chair, climb stairs) is often drastically and permanently impaired. This results in reduced ability to perform self-care activities such as accessing transport, purchasing groceries, preparing meals, Australian Ageing Research Directory 2000 225 Health and Behavioural Sciences etc. As a result, quality of life is reduced and there is a high risk of nursing home admission. Physical impairment following hip fracture is partially related to weakness of the leg muscles. The aim of this project is to determine if increases in lower extremity muscle strength produce increases in mobility, and the capacity to perform weight bearing activities of daily living among elderly persons who have experienced age related hip fracture. In order to achieve this, the objective of the project is to compare the outcomes of long-term high resistance training to those of control subjects who perform low intensity activities, in a randomised clinical trial. The project follows on from previous research the group has undertaken to demonstrate significant improvements in strength and mobility in healthy elderly women following a high resistance training program. Initial descriptive data has been collected on elderly hip fracture patients at Nepean and Concord Hospitals while the high resistance training intervention is focused on recruiting patients from Concord Hospital. Keywords: Hip fracture, mobility, exercise 412 Title: Manual support fixture design in high risk environments Principal researchers: Dr R Smith, Dr A Bowen-James Organisations: A Health and Ageing Research Program between School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney; School of Occupation and Leisure Sciences, Faculty of Health Sciences; A & M Henry P/L (industry partner) Status: In progress Funding: ARC SPIRT Australian Postgraduate Award (Industry), $62,592 Timetable: 1998 - 2000 Outline: Manual support fixtures can take the form of railings, strap hangers, banisters, grabrails and handles. These fixtures serve the functions of safety, assistance in balance, load support, and propulsion for people in a wide variety of situations such as transport, industrial and domestic environments. The particular focus of this study is improving the independence and mobility of the frail aged in high-risk areas such as the bathroom. The project has already characterised the anti-slip performance of a range of metal and plastic grabrails and now the performance of able-bodied and impaired aged subjects executing the sit-stand-sit movement will be measured with the grabrail placed in a variety of different positions. The outcomes of the project will be information for objective and industry-compatible guidelines for the design and effective placement of grabrails. Keywords: Safety, built environment, independence, mobility 413 Title: The relationship between nutritional status and functional outcome following hip fracture in the elderly Principal researcher: Ms R Orr, Associate Professor M Thompson Organisation: School of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney Status: Completed Funding: Cumberland Research Grant $9,960 Timetable: January 1997 - December 1999 Outline: Hip fracture in the elderly is a serious medical, social and economic problem. It is well documented that many of the older population suffer from poor nutrition, which can also have severe medical consequences. It is proposed that under-nutrition is a strong determinant of poor functional recovery and disability following hip fracture in the elderly population. This project aimed to establish whether measures of poor nutritional status can significantly 226 Australian Ageing Research Directory 2000 Health and Behavioural Sciences predict measures of disability, and if so, does poor nutrition contribute more to the disability than any other known factor. The relationships between nutritional status and functional disability were followed for the course of one year, specifically at 3, 6 and 12 months. The researchers made a number of nutritional measures, functional performance measures. As many other variables can predict outcome, the key co-predictors identified from the literature were measured. The researchers attempted to establish the relative contribution of nutrition and co-predictor outcomes to functional capacity after hip fracture. Keywords: Hip fracture, disability, rehabilitation, nutrition 414 Title: The role of sarcopenia and undernutrition in disability after hip fracture Principal researcher: Professor M Fiatarone Singh Organisation: A Health and Ageing Research Program by School of Exercise and Sport Science, Faculty of Health Sciences, University Sydney Status: In progress Funding: National Health and Medical Research Council, $308,171 Timetable: 2000 - 2002 Outline: Hip fracture is one of the most costly and devastating medical events which can befall an elderly individual, and is expected to affect 40,000 Australians per year by the year 2040. It often results in permanent loss of walking abilities and independence, as well as a severely diminished quality of life. Although hip fracture has been thought of as a problem primarily related to osteoporosis (age-related loss of bone), it is now increasingly clear that other factors such as muscle wasting and weakness, gait and balance problems, and poor dietary intake are also risk factors for this condition. Although surgical techniques have advanced to the point that most operations to repair hip fracture are now successful, the rehabilitation outcomes are disappointingly poor, compared to other orthopaedic injuries. This is because recovery after hip fracture is in fact not primarily related to the bone disease itself, but to inadequate muscle bulk and strength. It is likely that already frail patients with a new hip fracture will experience further muscle wasting over time, because of their very low levels of physical activity, inadequate rehabilitation efforts, poor nutritional intake, depression, social isolation, and impaired memory in some cases. If this theory is correct, the investigator will be able to prove that disability after hip fracture is closely related to muscle mass, and many common clinical problems contribute to this underlying mechanism of dysfunction. The investigator will test these ideas by following patients who have had a hip fracture for twelve months, with periodic detailed assessment of psychological, physical and nutritional status. This new information may then be used to develop better clinical practice models for the specific assessment and treatment of muscle wasting and poor diet in patients with hip fracture, in order to improve functional independence and quality of life for these individuals. Keywords: Hip fracture, rehabilitation, muscle wasting, nutrition 3.9 School of Occupational Therapy, La Trobe University 415 Title: Use and meaning of motorised scooters to older persons living in rural Victoria Principal researcher: Professor B Lundgren-Lindquist Co-researcher: Ms E Esdale Organisation: School of Occupational Therapy, La Trobe University Status: Ongoing Timetable: September 1999 - December 2000 Australian Ageing Research Directory 2000 227 Health and Behavioural Sciences Funding: Strathbogie Shire Council, $5000; VicRoads, $5,000 Outline: Motorised scooters are becoming popular amongst the older population. Frequently older people are purchasing scooters when they have stopped driving or have lost their motor vehicle driving licences. Driving loss or reduced mobility can diminish an individual’s freedom and independence to participate in a range of activities. Motorised scooters possess many of the proposed attributes to support independence and healthy active ageing. Motorised scooters have the potential to prevent social isolation and provide control and autonomy over individual’s personal and social environment. However, there is little specific research on motorised scooters as an alternative mode of transport for older people and their impact on maintaining individuals active and healthy. The objectives of the study are to: (i) independently assess both the safety adequacy of scooters being used in the town and the operational capabilities and training of current scooter operators; (ii) begin to understand older persons and others experience of scooters, the place and meaning of scooters in their daily life. Individual semi-structured interviews have been completed with six residents who operate scooters in the areas of Euroa, Nagambie and Shepparton. Each of the six interviewees had been assessed using a battery of short tests to assess their mental, physical and sensory abilities. A survey of 45 users of scooters in the region was also being undertaken. Most users reported that their engagement in social and physical activity had increased with the purchase of a scooter, and this was integral to their daily life. Keywords: Older people, transport, activity, successful ageing, independence 3.10 School of Occupational Therapy, University of South Australia 416 Title: Action towards the recognition of sexual minorities in gerontology in Australia Principal researcher: Ms J Harris Organisation: School of Occupational Therapy, University of South Australia Status: In progress Funding: Postgraduate Research Scholarship, University of South Australia Outline: This study examines the process of change through activism which could lead to the recognition of sexual minority issues in gerontology in Australia. It examines the question of the nature of action required to reverse the current invisible status of gay, lesbian, bisexual, transgender and intersexed people in gerontology research, education, policy development and service intervention. This invisibility is evident in the absence of sexual minority issues in current gerontology literature, education and research in Australia. It contrasts significantly with the situation in overseas contexts. The research investigates the process of change which occurred in one site (the State of California) in the United States around this question during the past two decades. It draws upon these data in order to examine implications for change in the local context. The study takes place within the context of social movement theory, assessing the application of constructs within this theoretical framework to the prospects for change in the Australian context. Interviews, questionnaires, archival documents, gay and lesbian media and cultural products are the primary data sources. Keywords: Gay, lesbian, bisexual, transgender, intersexed, activism, social movements, homophobia 228 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 417 Title: An investigation into the similarities and differences between anticipatory grief and post-death grief for a sample of older South Australians Principal researcher: Ms K A Sloan Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Funding: Not applicable Timetable: January 1999 - December 1999 Outline: The purpose of this paper is to present the findings of a study designed to examine the similarities and differences between the symptoms of grief throughout the terminal illness of a partner (anticipatory grief) and the symptoms of grief experienced after the death of a partner (post-death grief). Participants were obtained from a database of names held at Daw House Hospice in South Australia. Results indicated that a majority of symptoms associated with both anticipatory grief and post-death grief were statistically similar as measured by the Grief Experience Inventory. Furthermore, people experiencing anticipatory grief displayed a more intense level of symptoms on the Grief Experience Inventory for the sub scales of anger, somatization, physical symptoms, loss of vigour and other atypical responses. Possible explanations for such results are the combination of other stressors in every day life as well as coping with the terminal illness of a partner. Keywords: Anticipatory grief, post-death grief, grief, terminal illness 418 Title: A study to examine the relationship between the Executive Interview and the Assessment of Motor and Process Skills on a small sample of older people identified as ‘at risk’ in their own home Principal researcher: Ms J L McWha Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Outline: The purpose of this pilot study was to determine if any relationship exists between the two assessments Executive Interview and the Assessment of Motor and Process Skills (AMPS). Despite their limitations, great reliance tends to be placed on bedside testing on mental status using tests of cognition and executive cognitive function such as the Executive Interview to predict functional performance. The Assessment of Motor and Process Skills is an observational assessment of functional ability which evaluates the effects of cognitive impairment and disability. The scores of a small sample of older people using these measures were examined. Pearsons correlation coefficient was calculated and no correlation was found. It is likely that this result supports other research findings that the two distinct aspects of executive cognitive function and functional performance should be assessed separately. Keywords: Executive cognitive function, activities of daily living, assessment 419 Title: Cultural and language barriers to using residential aged care facilities: Important issues for Vietnamese elderly people in South Australia Principal researcher: Mr T Van Nguyen Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Australian Ageing Research Directory 2000 229 Health and Behavioural Sciences Timetable: January 1999 - November 1999 Outline: This small scale exploratory qualitative research study investigated how Vietnamese elderly people in South Australia perceived the use of residential aged care facilities. A focus group involving a semi-structured interview was conducted with eight Vietnamese elderly people. Three primary themes emerged from the data: barriers to using residential aged care facilities, the importance of cooperation with nursing staff, and the aspirations of the Vietnamese elderly group. Vietnamese elderly people are under-represented in residential aged care facilities. A number of Vietnamese elderly people are in a sad plight due to cultural and language barriers to using these facilities. This study suggests the need for further research to investigate the appropriateness of current policies and practices in residential aged care, and to develop policy which brings social justice to all Australians. Keywords: Focus group, cultural attitudes, residential care, Vietnamese elderly, ethnic aged 420 Title: “How wet their eyes are when they’re talking to me”: Professional challenges in the rationing of in-home respite - a South Australian example Principal researcher: Ms P Smith Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: January 1997 - November 1997 Outline: This research paper summarises an exploratory project designed to clarify the factors service providers take into account when making decisions about the allocation of inhome respite to HACC eligible clients. The project centres on a small sample of South Australian local government agencies. Factors which were found to be prominent in making judgments of eligibility and allocation included level of carer stress, intensity of caring, adequacy of respite hours, and access to regional funding. The research demonstrates the complex and sensitive nature of the continuum of assessment, prioritisation and resource allocation. It also suggests that this process was made more problematic by ambiguity of HACC criteria and guidelines, the inadequate funds to meet clients needs, and regional funding inequities. Service provider stress was an expected theme that also impacted on respite provision decision making. The study argues that HACC criteria and guidelines need to be clarified and made more explicit and that the distribution of HACC funds to agencies be made more regionally equitable. Keywords: HACC, respite care, in-home respite, carers, carer stress 421 Title: Interpersonal communication between Alzheimer’s dementia effected elderly and their family caregivers Principal researcher: Ms J A Glonek Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Outline: The small scale phenomenological study describes the lived experience of unaffiliated daughters who care for their mothers with late phase Alzheimer’s dementia, in the home environment. The clusters and themes which emerged from the analysis of the transcribed interviews revealed that communication was an accurate indicator of the dynamics of the mother/daughter relationship during the disease course even at an advanced stage of cognitive and linguistic impairments. Their communication was seen as advantageous in ensuring the prolonged maintenance of personal identity, mother role and autonomy of the 230 Australian Ageing Research Directory 2000 Health and Behavioural Sciences care recipients. Paradoxically, specific features of the compromised language use of the mothers were found to be detrimental to the well being of the caregiving daughters. The findings of the study suggested that elaborate communication preserved the centrality of the mother/daughter relationship. The familiar connectedness excluded the notion of role reversal and extended the period of mainstream living for the mothers. Keywords: Mother/daughter relationship, language code, preservation of status, dementia, Alzheimer’s disease, carers 422 Title: Issues of drug compliance for older Vietnamese people Principal researcher: Mr H D Pham Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: January 1999 - November 1999 Outline: Non-drug compliance in older people poses a serious problem in relation to quality of life as well as cost. This study aims to identify factors which prevent older Vietnamese people (aged 65 and over) from strictly following their doctor’s instruction when taking medications. An ethnographic research design using participant observation and open-ended interview was used to explore the nature of non-drug compliance as experienced by older Vietnamese people. Detailed interviews were completed on a sample of three older Vietnamese people. Interviews were audiotaped and these recordings were then transcribed verbatim and analysed by the researcher. Findings indicate that lay beliefs about illness, its causes and its treatments are likely to be influenced by the individual’s culture and hence also by their ethnic group. These beliefs in turn are likely culprits of non-drug compliance for this group. Keywords: Drug compliance, cultural beliefs, Vietnamese elderly, ethnic aged 423 Title: The experience of a small sample of adult children following placement of a parent in a residential aged care facility - high level of care Principal researcher: Ms B Pawelski Co-researcher: Ms S Gilbert-Hunt Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: January 1999 - November 1999 Outline: This research explores the experience of a small sample of adult children following placement of a parent in a residential aged care facility – high level of care. A qualitative phenomenological approach was chosen for this study to identify the essence of this experience from the participant’s perspective. Data were collected via in-depth interviews with three adult children and analysed using Colaizzi’s methodology. Five major themes were developed from common experiences of such a situation: (i) shared decision making; (ii) children’s expectation of care; (iii) parent’s reaction to new environment; (iv) new opportunities; (v) coming to terms. The study concluded that support in the decision making process prior to admission to residential aged care facility and time for adaptation and adjustment to new environment indicates that the post placement experience of adult children was easier to cope with and overall a positive one. However, acknowledgment that residential aged care facility is the last place before death, made the children continue to feel guilty. This raised the question of whether they had done enough for their parent. Keywords: Residential care, placement, post placement experience Australian Ageing Research Directory 2000 231 Health and Behavioural Sciences 424 Title: The impact of temporality in Alzheimer’s dementia: an existential philosophical interpretation Principal researcher: Ms J A Glonek Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: Completion June 2000 Outline: A fundamental research study based on philosophical enquiry and interpretations explored the role of space and time in human functioning, impaired functioning as is the case in some psychiatric states and in the gradual non-functioning of Alzheimer’s dementia. The research investigated temporality aspects in cognition and in the existentially important domains of personal identity and interactions with the world, that is, with objects, others and the self. The findings indicated a relationship between the global dimension of time and space and the global functioning deterioration in the dementing disease. Distortions of time and space were proportionate to the degree and severity of the progressive disease. The major impact of temporality in the person with Alzheimer’s dementia was considered to be associated with the misrepresentation of the present, the suppression of cognitive processing and the de-construction of the personal self. Keywords: Temporality, existential functioning, Alzheimer’s disease, dementia 425 Title: The lived experience of hip fracture recovery: A phenomenological study of two elderly women Principal researcher: Ms C Butt Co-researcher: Dr E May Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: March 1998 - December 1998 Outline: The aim of this study was to describe how elderly persons experience recovery from hip fracture. Phenomenology methodology was applied to gain a rich description of the experiences of regaining activities or occupations and what factors impacted upon that recovery process. A further purpose of this study was to describe how elderly persons reestablish themselves in valued occupational roles. Two female participants, aged 71 years were interviewed using a semi-structured interview technique. Data analysis using Colaizzi’s method of analysis as a framework induced seven emergent themes describing experiences of occupational recovery and return of occupational roles. These were being supported, choosing to limit certain occupations, modifying involvement, maintaining autonomy, predicting occupational recovery, anxiety over recovery and I feel older when I limp. Six emergent themes were induced in response to participants’ experience of factors which influenced the recovery process, namely previous life skills, secondary health issues, cautiousness, support, who would have thought and understanding recovery. The results of this study highlight issues worthy of further investigation particularly in the area of long term follow-up, patient understanding of the recovery process and fear of increased risk of further falls. Keywords: Hip fracture, occupation, recovery 426 Title: The views of older clients on falls rehabilitation Principal researcher: Ms A Sheppeard Co-researcher: Ms S Gilbert-Hunt 232 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Organisation: School of Occupational Therapy, University of South Australia Status: Completed Timetable: January 1998 - November 1998 Outline: The object of this small interpretive study was to explore the day-to-day mobility experience of older community dwelling people who had a history of falls. In-depth interviews were conducted with six participants who had taken part in rehabilitative physiotherapy programmes to improve their walking and balance. Data was analysed using phenomenological methodology based on Colaizzi’s six procedural steps. Four main themes emerged which emphasised the impact of falls on participants’ mobility confidence and examined the methods they used to regain their functional mobility an independent life-style. The study found that there is a need for physiotherapists to assess clients in a holistic manner and involve them in planning realistic goals for rehabilitation. It also identified the necessity of providing an adequate follow up service to maintain clients' functional mobility and prevent a reduction of their independence and personal control of their life style. Keywords: Falls rehabilitation, falls, mobility, physiotherapy 3.11 School of Physiotherapy, Curtin University of Technology 427 Title: Functional adaptation to exercise in elderly subjects Principal researcher: Ms A Brown Co-researcher: Professor J Cole Organisation: School of Physiotherapy, Curtin University, Western Australia Status: In progress Funding: Australian Postgraduate Award, School of Physiotherapy, Curtin University Timetable: 1998 - October 2000 Outline: The study investigates the role of exercise in the alleviation and/or prevention of functional disability in elderly subjects aged 75 years and older. Elderly subjects were assessed on a number of physical, functional, psychological and quality of life variables for a six month baseline period before random allocation to intervention group. The intervention period lasted for sixteen weeks and subjects participated in enhanced levels of physical activity, social activity or acted as controls. Following completion of intervention, subjects were assessed and followed for a further twelve months. In addition, falls experienced by subjects were monitored. Keywords: Exercise, function, disability, falls, socialisation 3.12 School of Physiotherapy, Faculty of Health Sciences, University of Sydney 428 Title: Application of a dynamical systems analysis to stair walking in subjects with knee osteoarthritis Principal researcher: Associate Professor J Crosbie Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney (Health and Ageing Research Program) Status: In progress Funding: Cumberland Research Grant, $6,666 Timetable: June 2000 - June 2001 Australian Ageing Research Directory 2000 233 Health and Behavioural Sciences Outline: Symptomatic osteoarthritis of the knee is an extremely common condition, occurring in approximately 6.1% of adults aged 30 and over. The prevalence increases with age, radiographic evidence of knee osteoarthritis being found in 44% of people aged over 80 years. The ageing of the population will result in an exponential growth in the global burden of pain, physical disability and dependence. Osteoarthritis of the knee is significantly disabling and can impair many activities of daily living. Indeed, osteoarthritis of the knee has been shown to account for the highest percentage of disability in walking, stair climbing and housekeeping in a comparative analysis of ten medical conditions. Osteoarthritis primarily affects the articular cartilage of the involved joint and as yet no treatment is available which can reverse the disease process. Consequently, current treatment is aimed at decreasing symptoms and maintaining function. The study proposed is the first of a series in which, ultimately, the effects of physiotherapy and other interventions will be evaluated. As a first phase in this process, it is necessary to identify the changes in movement exhibited by patients with osteoarthritis affecting the knee during stair ascent and descent. In comparison with the conventional "biomechanical" approach, in which peak joint movements and joint range alone are described and analysed, this protocol will investigate the synchronies of joint movements and the coordination of joint movements during the tasks, comparing healthy agematched subjects to patients with osteoarthritis. As a further aspect of the investigation, a cohort of young, healthy subjects will be analysed performing the tasks. This will allow exploration of age-related changes in the task performance, an investigation not previously reported. Keywords: Osteoarthritis, physiotherapy, disability 429 Title: A randomised controlled trial of the efficacy of a protocol to train sitting balance early after stroke Principal researcher: Dr C Dean Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney (Health and Ageing Research Program) Status: In progress Funding: Physiotherapy Research Foundation, $4,928 Timetable: January 2000 - December 2000 Outline: Poor sitting balance is a common problem after stroke. This study aims to test a protocol aimed at improving sitting balance early after stroke. The protocol has been shown to be effective with individuals a long time after stroke. This study will provide information that may, in the future, improve rehabilitation outcomes for patients early after stroke. Keywords: Stroke, rehabilitation, physiotherapy 430 Title: Changes in stroke patients' abilities to stand up and to walk after discharge from rehabilitation Principal researchers: Ms V Fowler, Dr R Adams Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney (Health and Ageing Research Program) Status: In progress Funding: Physiotherapy Research Foundation, $4,920 Timetable: January 2000 - December 2000 Outline: Stroke is the largest cause of long-term disability in Australia. While it is generally agreed that individuals benefit from some form of structured rehabilitation, these benefits are not always maintained after discharge. To date, there has been little research effort directed 234 Australian Ageing Research Directory 2000 Health and Behavioural Sciences toward determining factors predicting whether or not individuals continue to improve or even maintain the physical skills gained in rehabilitation after discharge. Identification of factors which predict long-term outcome and are amenable to intervention will enable better focus in discharge planning and follow-up services and should improve the long-term outcome of stroke rehabilitation. The aims of this study are (i) to determine the extent to which individuals maintain their abilities to perform sit-to-stand and walking during the first two months after discharge from physiotherapy rehabilitation following stroke, and (ii) to identify factors which may predict or underlie any changes and which are amenable to intervention. These factors will be manipulated in future studies aimed at helping individuals better maintain their functional skills after discharge. Keywords: Stroke, rehabilitation, physiotherapy 431 Title: Does current rehabilitative practice improve cardiovascular fitness and lower limb strength after stroke? Principal researchers: Dr S Kilbreath, Associate Professor G Davis, Dr B Zeman Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney; Rehabilitation Research Centre, Faculty of Health Sciences; Royal Rehabilitation Centre, Ryde Status: Completed Funding: Australian Brain Foundation, $7,400 Timetable: January 1999 - December 1999 Outline: Within the rehabilitation process, physiotherapy treatment endeavours to maximise the stroke patient's ability to perform daily functional tasks such as walking and stairway ascent. Indeed, various studies have established that the majority of patients regain the ability to walk by the time they are discharged from physiotherapy, but with much higher energy expenditure than prior to their stroke. However, the ability to transfer these regained skills into community life is questionable. One of the major factors which contributes to the inability to achieve true community-based ambulation is likely to be due to reduced cardiorespiratory fitness and lower limb muscle strength. To what extent current rehabilitation practices impact on patients' fitness is not known. Thus, the purpose of this study is to determine whether the current rehabilitation practices which result in improved walking also result in improvement in cardiovascular fitness and lower limb strength. Patients are assessed within six weeks of their stroke (when they achieve a Motor Assessment Score of 2 for walking) and six weeks later. Specific measurements include (i) assessment of cardiovascular fitness using a specially designed cycle ergometer to assess maximal and submaximal effort, (ii) lower limb strength derived from force applied to pedals of a specially developed bicycle, and (iii) variables of gait including velocity and cadence. Findings from this study will determine whether current rehabilitation practices are sufficient to reverse the poor cardiovascular fitness associated with this group of patients. Keywords: Stroke, rehabilitation, physiotherapy, cardiovascular fitness 432 Title: Effects of muscle contraction on proprioceptive function and postural stability in young and elderly subjects Principal researchers: Dr K Refshauge, Dr R Fitzpatrick Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney; Prince of Wales Medical Research Institute Status: Completed Funding: Physiotherapy Research Foundation, $4,940 Australian Ageing Research Directory 2000 235 Health and Behavioural Sciences Timetable: January 1999 - December 1999 Outline: The broad aim of this study is to investigate the reasons for falling and instability in older people. In young and elderly subjects, the investigators are examining the effects of different levels of muscle contraction and strength on subjects' ability to detect movements imposed at the ankle. This will be correlated with subjects' stability when standing. These experiments address fundamental questions of human neurophysiology concerning how much is known about body movement and position, and the mechanisms of postural stability. There are also direct implications for improving physiotherapy management of the elderly population. The benefit of these studies includes the potential to predict those subjects who are likely to fall. Falls in the elderly population cost $10 billion annually in Australia and an effective strategy to prevent falls is needed. Keywords: Falls, neurophysiology, prevention 433 Title: Is there a causal relationship between spasticity and muscle contracture following stroke? Principal researches: Associate Professor N O'Dwyer , Dr L Ada, Professor P Neilson Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney; School of Electrical Engineering and Telecommunications, University of New South Wales Status: Completed Funding: National Health and Medical Research Council, $142,469 Timetable: 1997 - 1999 Outline: Stroke is the largest cause of disability in Australia, with 200,000 people enduring the medical or socioeconomic sequelae at any time. This project charted important aspects of the recovery of movement control during the first twelve months following stroke by making detailed measurements of muscle length, reflexes and strength. By identifying the relations between these characteristics, the researchers enhanced understanding of recovery following stroke and contributed important information to the rehabilitation of this condition. Keywords: Stroke, rehabilitation, disability 434 Title: Muscle activation associated with loss of dexterity following stroke Principal researchers: Ms C Canning, Dr L Ada, Associate Professor N O'Dwyer Organisation: School of Physiotherapy, Faculty of Health Sciences, University of Sydney Status: Completed Funding: Physiotherapy Research Foundation, $4,993 Timetable: January 1998 - December 1998 Outline: This study aimed to characterise the abnormalities of muscle activation underlying low dexterity after stroke. A broad definition of dexterity has been adopted, where loss of dexterity refers to an inability to coordinate muscle activity in the performance of a motor task. Electromyogram of biceps brachii and triceps brachii were monitored from 16 people after stroke and 10 neurologically-normal controls as they performed a tracking task requiring coordinated elbow flexion and extension. Weakness could not interfere with performance, since the task was designed to require minimal strength. Stroke subjects were assigned to a low or high dexterity group based on their performance. Spatio-temporal aspects of biceps and triceps electromyogram were analysed. Low dexterity performance after stroke was characterised by excessive biceps muscle activation and decreased coupling of muscle activation to target motion. The investigators ruled out weakness, slowness of muscle activation, excessive co-contraction and spasticity as causes of these abnormalities. Therefore, the loss of dexterity after stroke can be seen as a specific negative impairment which can exist 236 Australian Ageing Research Directory 2000 Health and Behavioural Sciences independently of other motor impairments and reflects loss of skill in generating spatial and temporal muscle activation patterns which confirm with environmental demands. Keywords: Stroke, dexterity, motor impairment, physiotherapy 3.13 School of Physiotherapy, University of Melbourne 435 Title: A clinical trial on the efficacy of Coenzyme Q10 in ameliorating muscle bioenergy deficiency in aged patients undergoing hip replacement surgery Principal researchers: A W Linnane, J McMeeken, M Galea, B Black, S Kovalenko, G Bronnikov, M Richardson Organisations: School of Physiotherapy, University of Melbourne; Centre for Molecular Biology and Medicine, Epworth Medical Centre Status: In progress Funding: Centre for Molecular Biology and Medicine, $62,000 Timetable: 2 years Outline: A clinical trial will be carried out on patients undergoing elective hip replacement surgery to establish whether Coenzyme Q10 supplementation improves muscle function in the elderly, and whether this results in a significant improvement in recovery of muscle strength after major surgery. Patients undergoing total hip arthroplasites will be given coenzyme Q10 oral supplements over a period of one month prior to surgery and subsequently for two months following surgery. Physiotherapy assessments computer tomography, and medical (clinical) assessments will be used to determine the efficacy of Coenzyme Q10 supplementation in improving muscle strength prior to surgery and recovery following surgery. Blood samples will be collected prior to commencement of Coenzyme Q10 therapy, at the time of surgery and two months after surgery to measure the level of Coenzyme Q10 in the blood and to assay for a number of biological markers of the bioenergy status of the individual. At the time of surgery, a muscle tissue sample will be obtained which will also be assayed for a number of bioenergy parameters. These blood and tissue tests are to establish the effect of Coenzyme Q10 supplementation on the bioenergetic status of the individual (with the aim of developing of a bioenergy diagnostic). Keywords: Hip replacement, co-enzyme Q10, muscle function 436 Title: Age related differences in development of hyperalgesia Principal researcher: Z Zheng, S J Gibson, Z Khalil, R D Helme, J M McMeeken Organisation: School of Physiotherapy, University of Melbourne Status: In progress Funding: Overseas Postgraduate Research Scholarship, Department of Employment, Education and Training; Melbourne Research Scholarship, University of Melbourne and the National Health Medical Research Council of Australia ($105,000) Timeframe: 3 years Outline: The world is ageing. As estimated by the United Nations, the world population reached six billion in October 1999. Approximately 580 million are people over 60 years old and this number will increase to 1000 million by year 2020 (1998 WHO). Australia is one of most aged countries (European countries are 15-20 years older). In 1997 12% of the population was aged 65 and over, which is three times greater than in 1921 (ABS database). With an increasingly aged population, age-related diseases become more prevalent. The Australian Ageing Research Directory 2000 237 Health and Behavioural Sciences incidence of chronic pain associated with advancing age is from 25% to 70% in people over 65 years old and 8% to 37% in people between 25 to 34 years old. Age may not only affect the magnitude, but also the temporal properties of acute pain. These age-related changes would alter the role of acute pain as a warning signal, and potentially delay and mislead diagnosis and treatment. Thus the overall aim of the current study was to investigate agerelated differences in experimental hyperalgesia. Capsaicin, a chilli pepper solution, was topically applied to induce experimental hyperalgesia in pain free human volunteers. Two steps were involved in achieving the aim: the first was to examine the possible age differences in capsaicin-induced hyperalgesia, and the second was to test some possible contributing factors to the differences. Keywords: Capsaicin, hyperalgesia, pain 437 Title: Balance and mobility changes following Vitamin D intervention in elderly institutionalised patients Principal researchers: K L Bennell, L Flicker, J Wark, C Nowson, E Brown Organisation: School of Physiotherapy, University of Melbourne Status: In progress Funding: Part of a larger project called ‘A vitamin D intervention study in elderly institutionalised females’ funded by National Health and Medical Research Council, $319,620 over three years from 1996 to 1998 Timetable: 1997 - 2000 Outline: Osteoporosis is a current and increasingly large-scale public health problem. Despite significant recent improvements in the ability to detect and quantify, prevent and treat osteoporosis and thus reduce fracture risk, the general penetration of these advances into the residential care sector has to date been poor. More than one third of the nation’s hip fractures will occur among the 130,000 residents within care facilities. Vitamin D deficiency, resulting partly from a number of age-related changes and exacerbated by some care environments, is prevalent among these residents and may be one of the modifiable risk factors for the disease. Several studies have found a decline in fracture rates associated with Vitamin D and calcium intervention. However, few studies have looked at the role Vitamin D may play in bone quality, muscle strength, mobility and balance in older people in residential care. The aim of this study was to assess the mobility effects of Vitamin D in calcium replete female residents in long-term care facilities. This will be achieved through collection and analysis of data obtained as part of the greater Hip Fracture Prevention Project of the Royal Melbourne Hospital and University of Melbourne. 164 hostel residents, aged 83.5+6.9 years have participated in the muscle strength, mobility and balance sub-study to date. Subjects whose baseline serum 25-hydroxycholecalciferol levels are 25-90 nmol/l are randomised into one of two treatment groups: calcium 600 mg/day + placebo or calcium 600 mg/day + 10,000 IU/week Vitamin D2. Subjects are assessed at baseline, 6 months and 12 months using the test measures: quadriceps strength, body sway, step test, functional reach, time ‘up and go’ and timed 6 meter walk. Results analysed to date have found no significant changes from baseline at 6 or 12 months in any of the mobility, strength or balance measures between the Vitamin D or placebo groups. However, there was a decrease over time in these measures indicating deterioration with ageing. Keywords: Osteoporosis, bone quality, muscle strength, Vitamin D 238 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 438 Title: Efficacy of a physiotherapy treatment for knee joint osteoarthritis: A randomised, double-blind controlled trial Principal researchers: K L Bennell, K Crossley Organisation: School of Physiotherapy, University of Melbourne Status: In progress Funding: National Health and Medical Research Council, $152,000 Timeframe: February 2000 - February 2002 Outline: Osteoarthritis is a prevalent chronic joint disease causing pain, stiffness and functional disability. Apart from the considerable financial costs, osteoarthritis causes loss of quality of life. Hence, effective conservative treatment for osteoarthritis is necessary. Although patients with osteoarthritis often receive physiotherapy treatment, evidence of its efficacy must be provided through rigorous scientific trials before it can become evidencebased practice. As knee osteoarthritis is chronic and essentially incurable, a well designed physiotherapy program should aim to decrease the pain and dysfunction arising from the disease process and promote self-management. This research entails testing a physiotherapy program which concentrates on improving the motor control of the quadriceps during functional activities. The treatment program also incorporates strategies that may directly or indirectly reduce the load on the knee. Educating the patient about the disease process, how to avoid aggravating activities and how to control pain is important for self-management. This physiotherapy treatment is designed to become a long-term self-management program and hence patients are taught the skills needed to achieve this aim. The project will also evaluate whether any benefits seen with physiotherapy can be adequately maintained with a home program and to what degree patients comply with this program. Keywords: Knee, osteoarthritis, rehabilitation 439 Title: Muscle strength and oxygen consumption in patients following total hip replacement surgery Principal researchers: K Reardon, M Galea, L Denehy, I L Bygott, T Allen Organisations: School of Physiotherapy, University of Melbourne; Physiotherapy Department, St Vincent’s Hospital Status: Completed Funding: Nil Timetable: 18 months Outline: The extent of muscle wasting and weakness pre and post-operatively was assessed with muscle ultrasound and isokinetic testing of the quadriceps and hamstrings in patients undergoing elective total hip replacement for osteoarthritis. Oxygen consumption was also measured during a standard test on an exercise bike. Functional changes in mobility were examined using the Timed Up and Go test. Subjects had significant wasting of quadriceps on the affected side pre-operatively, which gradually improved over a 5-month period postoperatively. Although subjects made functional improvements postoperatively as measured by the Timed Up and Go test, there was a significant reduction of quadriceps strength which did not improve markedly over the five month observation period. Keywords: Hip replacement, surgery, quadriceps strength, muscle wasting Australian Ageing Research Directory 2000 239 Health and Behavioural Sciences 440 Title: Muscle strengthening following stroke Principal researchers: J McMeeken, I Story Organisation: School of Physiotherapy, University of Melbourne Status: Preparation for publication Funding: The Alfred Group of Hospitals Research Trust, $20,000 Timetable: 1998 - 2000 Outline: Brain injury or stroke frequently results in many impairments which may be associated with disability. These include muscle weakness, spasticity, high fatiguability, loss of fine movement and disturbance of a number of reflex phenomena. The rehabilitation focus in many therapy settings gives little attention to muscle strength despite its strong demonstrated relationship to function in patients who have had a stroke. Current randomised controlled, double blind studies address the capacity to strengthen affected muscles following stroke; determine whether there were any subsequent differences in passive resistance to stretch and effects on functional capacity. Keywords: Stroke, spasticity, muscle strength 441 Title: Prediction of gait velocity in stroke patients Principal researchers: P A Goldie, T A Matyas, G J Kinsella, M P Galea, O M Evans, T M Bach Organisations: School of Physiotherapy, University of Melbourne; School of Physiotherapy, La Trobe University Status: Completed Funding: Commonwealth Services Research and Development Grant, $90,626 Timetable: 3 years Outline: The research set out to quantify prediction of gait velocity in ambulatory stroke patients during rehabilitation. It entailed a single group of 42 patients in an inpatient rehabilitation setting being tested at the beginning of rehabilitation (Test 1) and eight weeks later (Test 2). Participants were patients who had had a unilateral first stroke, who gave informed consent, and were able to walk 10 meters. The measures used were (i) independent variables: gait velocity at Test 1, age, time from stroke to Test 1, side of lesion, neglect; (ii) dependent variables: gait velocity at Test 2, gait velocity change. The correlation between initial gait velocity and gait velocity outcome at Test 2 was of moderate strength (r2 = .62, p<.05). However, even at its lowest, the standard error of prediction for an individual patient was 9.4 m/min, with 95% confidence intervals extending over a range of 36.8 m/min. Age was a weak predictor of gait velocity at Test 2 (r2 = -.10, p<.05). Gait velocity change was poorly predicted. The only significant correlations were initial gait velocity (r2 = .10, p<.05) and age (r2 = .10, p<.05). Whilst the prediction of gait velocity at Test 2 was of moderate strength on a group basis, the error surrounding predicted values of gait velocity for a single patient was relatively high, indicating that this simple approach was imprecise on an individual basis. The prediction of gait velocity change was poor. A wide range of change scores was possible for patients, irrespective of their gait velocity score on admission to rehabilitation. Keywords: Stroke, gait, rehabilitation 442 Title: Task-related training of upper limb function following stroke Principal researchers: M P Galea, K J Miller Organisation: School of Physiotherapy, University of Melbourne 240 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Status: In progress Funding: Melbourne Career Establishment Grant, L E W Grant Timetable: One year with possible extension Outline: The hand is the principal means by which the individual interacts with objects and the environment. Consequently the loss of the use of a hand as a result of brain damage following stroke can be devastating. Unfortunately most reports of upper limb function after stroke indicate that recovery is poor, with relatively few patients regaining useful function. This project entails a randomised, controlled multi-centre clinical trial of a program specifically directed towards training of the affected arm in acute stroke patients. It is hypothesised that such a program will result in functional outcomes for the affected upper limb that are superior to those of traditional rehabilitation. A comprehensive range of clinical and laboratory tests of motor and sensory function will be used as well as quantifying the use of the limb with a behaviour map. Until the results of this study are known, an evidence-based approach to the treatment of upper limb function following stroke cannot be implemented. The specific aims of the project are to (i) investigate the efficacy of an intensive task-related training program directed towards treatment of the affected upper limb in the early period following stroke; (ii) identify clinical factors that predict success (or lack of success) after such a training program. Keywords: Upper limb function, stroke, hand, multi-centre clinical trial 443 Title: Upper limb movement and function after stroke Principal researchers: B Champion, M Galea, A Winter Organisation: School of Physiotherapy, University of Melbourne Status: Completed Funding: Alfred Hospital Small Grant Timeframe: 2 years Outline: The aims of this study were to provide a profile of upper limb recovery in a nonsurgical stroke population, and to examine the relationship between the ability to move the arm and the ability to perform a functional task. The records of 153 subjects were audited for upper limb Motor Assessment Scale (MAS) subscores, the Functional Independence Measure (FIM) subscore for Upper Body Dressing, and the total Functional Independence Measure score at admission and discharge from rehabilitation. Significant improvement occurred for all outcome measures. There was no relationship between the Motor Assessment Scale scores and the functional task of Upper Body Dressing. The results emphasise the importance of using outcome measures which assess both impairment and disability and indicate that substantial improvements in upper limb function are possible after stroke. Keywords: Upper limb function, stroke Health 3.14 Aged Care Unit, Australian Institute of Health and Welfare 444 Title: Community aged care packages: A comparative profile of patterns of client characteristics and patterns of service use Principal researchers: Dr D Gibson, Ms S Mathur Co-researcher: Ms A Evans Organisation: Aged Care Unit, Australian Institute of Health and Welfare Australian Ageing Research Directory 2000 241 Health and Behavioural Sciences Status: Completed Funding: Commonwealth Department of Health and Family Services Timetable: July 1996 - June 1997 Website: http://www.aihw.gov.au Outline: This report describes and analyses, in a comparative framework, the data generated by the Community Aged Care Packages Survey undertaken in 1996. Client profiles and patterns of service use are examined for community options, community care packages and hostels. Keywords: Community care, hostels, service delivery, brokerage 445 Title: HACC service standards consumer appraisal data development project Principal researcher: Dr A Jenkins Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: In progress Funding: Commonwealth, State and Territory HACC Officials Timetable: Commenced August 1998. Completion of project is contingent on data to be collected from the implementation of HACC Service Standards Instrument in the participating States and Territories. Completion date to be negotiated. Website: http://www.aihw.gov.au Outline: This project is concerned with the development of tools and methods for collecting consumer appraisals of agency performance against the HACC National Service Standards. It is undertaken at the request of the HACC Officials Standards Working Group. It represents a continuation of the Institute’s assistance to this group in implementing quality assurance initiatives in the Home and Community Care Program. Previously the Institute assisted in the development and refinement of an Instrument to measure agency compliance with the HACC National Service Standards based on agency reports of service provision practices. The Consumer Appraisal Data Development Project follows this by addressing the important contribution that consumer appraisals can make in the assessment of quality in HACC agencies. The first stage of this project involved investigating and reporting on work that has already occurred in the area. This review of the current literature canvassed consumer involvement in the appraisal of a range of health and welfare services. The aim of this review was to examine the best methods for obtaining consumer feedback, particularly from consumers represented by the HACC target group: the frail elderly, young disabled and carers. It also examined special issues in obtaining consumer feedback that arise for people from diverse cultural backgrounds, indigenous people, the financially disadvantaged and people with dementia and their carers. Following this literature review, a field trial is being conducted to test strategies for obtaining consumer input into the HACC quality assessment process. The aim of this field-testing is to produce a refined tool to gather consumer views of service quality in their particular HACC agency. A further aim is to investigate methods for using this tool. These methods will be assessed according to three criteria: (i) the capacity of the tool to stand alone as an accurate indicator of agency service quality; (ii) the usefulness of the method in informing assessors about the quality of the service provided by an agency; and (iii) the viability of the method according to such criteria as cost, timeliness, practicality, acceptability to clients, and usefulness to service providers. Keywords: Consumer survey, quality assessment, survey methodology 242 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 446 Title: Ethnicity projections project Principal researchers: Dr P Braun, Ms C Benham, Dr D Gibson Co-researcher: Ms M Bui Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Ongoing Funding: Department of Health and Aged Care Timetable: February 2000 - December 2000 Website: http//www.aihw.gov.au Outline: The overall goal is to gain a comprehensive understanding of the changing face of the ethnic mix in older age groups in Australia through to 2026 under specified projection assumptions. Principal data sources for the project come from the Australian Bureau of Statistics in terms of quinquennial projections from 1996 to 2026, covering gender and age groupings from aged 65 years onward. Three main files are involved. Firstly, age projections by country of birth for Australian residents at Statistical Local Area (1996) level. The other two corresponding data sources are one including religion and birthplace and the other including language and birthplace. The latter two files are also projected at Statistical Local Area level. These files may be linked to a smaller file holding Commonwealth planning regions and Geographic regions (RRMA) using the Statistical Local Area (1996) field. The abundance of information will allow a wide variety of analysis and reporting. Research will include examination of current profile and distribution, size, proportion to the total population, complexity of the population, age and sex profiles, distributions in terms of geographic type and planning regions. A second tier will examine trend in terms of size, profile and distribution. In conjunction with this analysis, which will be both statistical and descriptive, the intention is to produce a comprehensive attachment of statistics presenting data at a lower level to maximise use of the available data. Keywords: Country of birth, age group, State, planning region, metropolitan, rural, sex, year, religion, language 447 Title: Expected length of stay in nursing homes and hostels over a lifetime in Australia Principal researcher: Mr Z Liu Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Timetable: 1998 - October 1999 Website: http://www.aihw.gov.au Outline: A life-table model is developed to estimate the lengths of stay in nursing homes and hostels over a lifetime. These estimates can be used to calculate the lifetime costs of residential aged care to the Commonwealth government and individuals. The expected lengths of stay in nursing homes and hostels are estimated at various ages by sex. The results are compared with the life expectancy of the general population and the life expectancy of the population with severe or profound disability. The paper fills a gap in the knowledge of residential aged care services in Australia. Keywords: Life table, length of stay, nursing homes, hostels Australian Ageing Research Directory 2000 243 Health and Behavioural Sciences 448 Title: Older Australia at a glance (2nd edition) Principal researchers: Dr D Gibson, Ms C Benham, Ms L Racic Co-researchers: Dr C Choi, Mr G Davis, Mr J Goss, Ms J Hargreaves, Ms B Holmes, Professor H Kendig, Ms S Mathur, Dr C Mathers, Ms D Osborne, Professor R Rosewarne, Mr R Webb, Mr D Wilson, staff of the Department of Health and Aged Care, the Department of Family and Community Services and the Department of Treasury Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Funding: Office of Older Australians, Department of Health and Aged Care. Timetable: 1998 - November 1999. Website: http://www.aihw.gov.au Outline: This collection of fact sheets covers a wide range of issues pertaining to ageing in Australia in a succinct and summary fashion. Each fact sheet was compiled by an expert in the field, and includes references for further reading. Topics covered include retirement, the Age Pension, superannuation, housing, healthy ageing, nursing homes, hostels, community care, assessment, health differentials, dementia, disability, hospitalisation, self-assessed health status, carers, informal care, indigenous people, people from culturally and linguistically diverse backgrounds, volunteers and expenditure. Keywords: Retirement, superannuation, healthy ageing, nursing homes, hostels, community care, assessment, health differentials, dementia, disability, hospitalisation, self-assessed health status, expenditure 449 Title: Older overseas born Australians Principal researchers: Dr D Gibson, Ms C Benham Co-researchers: Dr D Rowland, Ms B Holmes Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Funding: Department of Immigration and Multi-cultural Affairs Timetable: November 1999 - February 2000 Website: http//www.aihw.gov.au Outline: This report examines the social and economic circumstances of overseas born Australians aged over 55 years. The analysis uses English Proficiency Country Groups, a classification of birthplace developed by the Department of Immigration and Multicultural Affairs to capture not only language proficiency but also the cultural diversity of immigrants to Australia. The older overseas born population will undergo rapid change over the next few decades, increasing in both absolute and relative terms, but also undergoing change in the internal age structure towards an increase in the oldest age groups, as well as ongoing change in the ethnic composition of the population. The report provides a demographic profile of the older overseas born population and discusses the history of immigration to Australia, setting the context for the changes which will occur. Current social and economic characteristics of the older overseas born are examined and their impact on each of the population groups as the population ages. Family status, English proficiency, education and qualifications, labour force participation, income, housing, pensions, retirement, superannuation, and health status and service use are considered. Keywords: Immigration, overseas born, demography, English proficiency, labour force participation, income, housing, pensions, superannuation, health status, aged care services 244 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 450 Title: Older women: past, present and future Principal researcher: Dr D Gibson Co-researchers: Ms C Benham, Ms E Gray Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Funding: Office of the Status of Women Timetable: February 1999 - October 1999 Website: http://www.aihw.gov.au Outline: This project was commissioned by the Office of the Status of Women for inclusion in their report Women in Australia 1999. It explores the life circumstances of four different cohorts of women born over the first half of this century, from 1905 to 1950. The chapter explores the particular social and economic environment prevalent over the lives of these women, and the way in which these circumstances have impacted on them in old age. Fertility, marriage patterns, life expectancy, paid workforce participation, superannuation and health status are amongst the variables examined. The four cohorts chosen range from those now in very advanced old age (the 1905 cohort) to those who are yet to enter old age (the 1950 cohort). Keywords: Older women, cohort, lifecycle, labour force participation, paid work 451 Title: Refinement of the quality measures Instrument for the HACC national service standards Principal researchers: Dr A Jenkins, Dr D Gibson Co-researcher: Ms E Butkus Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Funding: Commonwealth, State and Territory HACC Officials Timetable: June 1996 - October 1997 Website: http://www.aihw.gov.au Outline: This project was concerned with the development of an instrument to measure how Home and Community Care (HACC) organisations meet the national service standards. The service standards were developed on the basis of extensive consultations in 1989, and released by the relevant Commonwealth State and Territory ministers in 1991. The instrument was developed for use in monitoring the quality of service provided by HACC agencies from the perspective of agencies themselves as well as government departments. The final version of the instrument was approved for implementation by HACC Officials from July 1999. The project included the preliminary testing of an instrument to measure client feedback on agency performance. Keywords: Quality, appraisal, services, community, monitoring 452 Title: Residential aged care statistics Principal researchers: Mr Z Liu, Dr P Braun Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Ongoing Timetable: An annual publication released in June/July each year Website: http://www.aihw.gov.au Australian Ageing Research Directory 2000 245 Health and Behavioural Sciences Outline: This project involves the production of an annual publication containing a detailed set of statistics on residential aged care. Each publication contains information on population and residential aged care service capacity, residents and their characteristics, admissions and separations, new residents and their characteristics, and resident dependency. The first publication in the series, Nursing Homes in Australia 1995–96, was completed in 1997. The most recent publication, Residential Aged Care Facilities 1998–99 is scheduled for completion in June 2000. The reports are a joint publication of the Australian Institute of Health and Welfare and the Department of Health and Aged Care. Keywords: Residential, aged care services, nursing homes, hostels 453 Title: Spatial equity in the distribution of aged care services Principal researchers: Dr D Gibson, Dr P Braun Co-researcher: Mr Z Liu Organisation: Aged Care Unit, Australian Institute of Health and Welfare Status: Completed Timetable: October 1999 - March 2000 Website: http://www.aihw.gov.au Outline: Geographic characteristics and social conditions in rural and remote areas often mean greater difficulty and costs in terms of providing aged care services. This, in turn, inevitably causes concern over spatial equity in the distribution of aged care services. This paper aims to address the spatial equity issue by analysing aged care services (both residential and community-based aged care services) by four geographic categories: capital cities, other metropolitan areas, rural areas and remote areas. Nursing home type patients are included in the analysis where possible in order to get a more complete picture of available resources. Keywords: Geographic, spatial, equity, residential care, community care, rural, remote 3.15 Aged Care Research and Evaluation Unit, Department of Public Health, University of Western Australia 454 Title: Development of a single instrument for the classification of nursing home and hostel residents Principal researcher: Dr C Rhys-Hearn Co-researchers: Mr E Lindsay-Smith, Mr R Parsons, Dr H Vu, Mr D Matsakidis, Mr C Benson, Mr P Hewitt, Professor S McCarthy, Dr G Lewin Organisations: Aged Care Research and Evaluation Unit, Department of Public Health, University of Western Australia. Biostatistical Consulting Services, University of Western Australia; NSW Aged Care Assessment Program Evaluation Unit, Westmead Hospital; Queensland Aged Care Evaluation Unit, Princess Alexandra Hospital; Silver Chain Nursing Association, Western Australia Status: Completed Funding: Commonwealth Department of Health and Family Services $247,775 Timetable: November 1996 - May 1997 Outline: The aim was to design a single instrument for the classification of nursing home and hostel residents. The project involved a consultation process including all sectors of the residential care industry, the development and trial of a draft instrument which was piloted in three states and finally a main study on a large number of residents. Nursing homes and hostels, both in the pilot and the main study phase, were stratified by state or territory, 246 Australian Ageing Research Directory 2000 Health and Behavioural Sciences location (metropolitan, rural or remote) and size. The final sample of approximately 20,000 residents was checked to ensure representativeness in terms of Resident Classification Instrument (RCI) and Personal Care Assessment Instrument (PCAI) categories, dementiaspecific homes and homes caring for culturally and linguistically different background residents. Homes catering mainly for Aboriginal and Torres Strait Islander residents were included as a separate sample in the main study. A total of 429 hostels and nursing homes completed the study resulting in 18,610 completed forms. Several statistical approaches were tested to select weights for the regression analyses. The model used, calibrated the question which rated care needs relative to other residents and which was costed on a separate study conducted by a different consultant. As a result, a Single Classification Instrument (SCI) was designed containing 22 questions. Following the main study, a validation study was undertaken to test the final version of the SCI, which was slightly changed from the original instrument. The validation process involved 2,208 residents and produced the same results as the main study instrument. Keywords: Single Classification Instrument, Resident Classification Scale, residential care, nursing homes, hostels 455 Title: National psychogeriatric unit evaluation study Principal researchers: Mr E Lindsay-Smith, Mr C Benson, Mr D Matsakidis, Professor D Ames, Professor S McCarthy Organisations: Allied Health and Community Consulting Services, Brisbane, Queensland; NSW Aged Care Assessment Program Evaluation Unit, Westmead Hospital; Aged Care Research and Evaluation Unit, Department of Public Health, University of Western Australia; Department of Psychiatry, Royal Melbourne Hospital; Queensland Aged Care Evaluation Unit, Princess Alexandra Hospital Status: Completed Funding: Commonwealth Department of Health and Family Services Timetable: October 1997 - January 1998 Outline: Psychogeriatric Units were established by the Commonwealth Government in all Australian States and the Northern Territory with the aim of raising the quality of care for older people with dementia and challenging behaviours through access to staff with psychiatric, psychological and geriatric experience, to provide expert diagnosis, assessment, advice and support to older people, nursing homes, hostels and Aged Care Assessment Teams. The evaluation study concentrated on three issues: (i) to determine the appropriateness of the service delivery model in meeting the objectives of the initiative; (ii) to evaluate the effectiveness of each psychogeriatric unit; and (iii) to determine the extent to which quality of life had improved for unit clients. Data were collected through surveys of service providers/ carers of community clients and interviews of psychogeriatric unit staff or other related bodies. The findings were very positive in that, although each psychogeriatric unit had developed in a different way, they were all highly regarded by residential aged care facilities’ staff, general practitioners and professional carers as well as community carers. Their interventions had a high rate of improvement in behaviour of residents (77%) and community clients (79%), mostly with lasting effects at least three months after intervention and prevented admission to psychiatric facilities in almost 50% of cases of community clients. The main recommendations were to continue funding for psychogeriatric units, increase the number of psychogeriatric units to cover areas lacking existing services, develop closer links between psychogeriatric units and Aged Care Assessment Teams and provide a formal telephone Help Line. Keywords: Psychogeriatric unit, aged care Australian Ageing Research Directory 2000 247 Health and Behavioural Sciences 3.16 Ballarat Health Services Base Hospital, University of Melbourne 456 Title: Prevalence and sociodemographic determinants of cardiovascular risk in a rural area Principal researchers: Professor H G Peach, Ms N Bath Organisation: Ballarat Health Services Base Hospital, University of Melbourne Status: Completed Funding: National Health and Medical Research Council Timetable: Completed 1998 Outline: The study hypothesis was that age, gender, education and employment are determinants of cardiovascular risk in rural areas. A cross-sectional survey was undertaken of 338 adults randomly selected from Ballarat's electoral rolls. Height, weight, blood pressure and fasting lipids were measured. The data were analysed using logistic and multiple regression analyses. Increasing age was found to be associated with hypertension, high plasma cholesterol, overweight/obesity, high plasma triglyceride levels and plasma fibrinogen. Men were more likely to be overweight/obese and have a high plasma triglyceride than women. Not having completed high school was associated with hypertension, high plasma cholesterol and triglyceride levels and physical inactivity. Smoking was associated with employment and being in a non-professional/managerial occupation. The study concluded that health promotion initiatives in rural areas should take account of the needs of older people and the other population subgroups. Keywords: Cardiovascular, rural, mortality 3.17 Centre for Health Promotion Research, School of Public Health, Curtin University of Technology 457 Title: Healthy seniors Principal researchers: Dr P Howat, Ms H Iredell, Dr D Cross, Ms A Nedwetzky, Mr G Gratton, Ms J Collins, Dr R James, Ms H Close Organisations: Centre for Health Promotion Research, School of Public Health, Curtin University of Technology; Department of Veterans’ Affairs; Bunbury Health Service; Office of Seniors’ Interests Funding: Curtin University; additional funding being sought from the WA Health Promotion Foundation Timetable: July 1999 - January 2001 Outline: The current proportion of the population over the age of 60 years (seniors) is expected to increase from the current 14% to 22% within the next 25 years. Health promotion aimed at improving the quality of life, including health status for seniors is, therefore, likely to attain increasing importance. Seniors are over-represented for many health problems that increase in prevalence in relation to increased age. These include mental health problems such as depression and suicide, which are predicted to attain an even greater importance to seniors in future years. Social isolation that was identified through the literature and in a preliminary research project appears to be a major factor relevant to these health problems. It appears that social isolation can be partly remedied by strategies that develop social support. Improving social support of seniors, it is purported, is likely to contribute to their health status and quality of life. However, there have been few reported interventions aimed at improving 248 Australian Ageing Research Directory 2000 Health and Behavioural Sciences social support, with scant evidence of rigorous and appropriate evaluations of any programs incorporating social support strategies. Hence there is need for research that will identify strategies that provide social support for seniors, and for a study that evaluates their effectiveness. This formative research project will comprise four stages: Stage 1 involves an extensive literature and program review; Stage 2 will consist of interviews with representatives of organisations that cater for seniors’ social needs; Stage 3 involves a Delphi study with relevant experts to identify successful strategies for promoting social support; Stage 4 involves consultation with the target group, via nominal group interviews. This stage will refine the recommended intervention strategies. It is expected that the results of the study will provide the basis for the development of a proposal for a large-scale intervention program. Keywords: Healthy ageing, seniors, social support, health promotion 458 Title: Stepping out Safely Program Principal researchers: Dr P Howat, Ms H Iredell, Dr D Cross, Dr R James , Ms T Shaw , Dr M Stevenson, Ms I O’Ferrall, Ms N Bennett, Mr F Winkler Organisations: Centre for Health Promotion Research, School of Public Health, Curtin University of Technology; Bunbury Health Service; Injury Control Program, Health Department of Western Australia; Main Roads of Western Australia; The Public & Community Health Unit, Inner City Health Service Funding: The WA Health Promotion Foundation, Bunbury Health Service, other program partners, $400,000 plus Timetable: September 1999 - November 2002 Outline: People in the age group over 60 years (seniors) are increasing as a proportion of the total population in Australia. Hence they will become an increasingly important target group for health promotion interventions including traffic safety. The cost of pedestrian injuries for Western Australia is estimated at over $65million per year. Seniors are over represented, accounting for between 30% and 40% of all pedestrian deaths in Western Australia. Their fatality rate of 3.9/100,000 is one of the highest in the developed world. Despite substantial declines in traffic injury rates throughout Australia in recent years, there has been a significant increase in injuries to senior pedestrians in Western Australia. In 1996, 20 senior pedestrians died and more than 80 required treatment for serious injuries. Based on this priority health problem, an intervention, The Stepping Out Safely Program has been planned for a two and half year period. The program will involve two different approaches to disseminating the program messages – use of community nurses in a rural city in Western Australia; and use of other health professionals in two Perth Local Government Areas. A combination of other strategies will also be used in the intervention areas, including mass media, mail outs, individual contacts and environmental changes. This project will test a model that can be ultimately adapted for Statewide implementation. Strategies to ensure the sustainability are built into the project. The program will be evaluated using process and impact measures. The program builds on the results of formative research, funded by a Healthway ‘starter’ grant and Main Roads of Western Australia. It therefore utilises significant resources that have already been devoted to planning, which is a cost saving for the proposed program. It is a collaborative program planned jointly by a range of players, and its development has involved considerable consultation with all major stakeholders. Keywords: Healthy ageing, Seniors, pedestrian safety, health promotion, injury control Australian Ageing Research Directory 2000 249 Health and Behavioural Sciences 3.18 Centre for Rural and Regional Health, University of Ballarat 459 Title: Ageing in focus: reconnecting communities into the 21st century Principal researchers: K L Brown, H Hayes, M Pope, K Walsh Co-researchers: J Smith, D Bauer Organisations: Centre for Rural and Regional Health, University of Ballarat; Ballarat Health Services, Queen Elizabeth Centre; Human Mind and Body program, Museum Victoria Status: Ongoing Funding: Positive Well-being for Older Persons Grant Scheme, $40,000 Website: http://www/ballarat.edu.au/rural/health Outline: The project was aimed at initiating and investigating dialogue and activity between two groups of people who, at first glance, would seem to be poles apart: older people and the young. The project involved one regional primary school and older people living within the community. Participants were actively involved in a range of collaborative activities within the school environment. The study aimed to (i) determine young persons’ perceptions of ageing; (ii) elicit older persons’ perceptions of what it is like to be young in the twentieth century, and (iii) examine both young persons and older persons’ views and attitudes towards the potential for a positive and shared experience of intergenerational activities. Focus groups were conducted with the younger and older people and teachers participating in the project. There were four classes of grade five and six students, five teachers and approximately 20 participants from community organisations involved in the project. Keywords: Education, intergenerational, community connections 3.19 Centre for the Older Woman, University of Queensland 460 Title: A longitudinal study of healthy and unhealthy ageing in women Principal researcher: Professor S K Khoo Co-researchers: Dr S O’Neill, Ms R McIntosh Organisations: Centre for the Older Woman, University of Queensland; Royal Women’s Hospital, Brisbane Status: Planned Funding: RWH Foundation, $300,000; industry, $450,000; private, $400,000 Timetable: May 2000 - 2005 Outline: This is a longitudinal study of healthy and unhealthy ageing in women with assessment of areas of change. Keywords: Longitudinal study, ageing, women 3.20 Centre for the Study of Health and Society, University of Melbourne 461 Title: Living old: Then and now travelling exhibition Principal researchers: Ms S Feldman, Dr M Guillemin Co-researchers: Ms C Hunter, Ms L Bladin Organisations: Centre for the Study of Health and Society, University of Melbourne; Medical History Museum, University of Melbourne Status: Completed and currently travelling 250 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Funding: Positive Wellbeing for Older People Grant, Department of Human Services and VicHealth, $40 000 Timetable: Commenced January 1999 - completed May 1999; currently travelling Outline: This is research that documents a historical record of ‘living’ old and demonstrates the social, cultural, technological and medical responses to ageing. The research is presented as a travelling exhibition of life in old age. In particular, the exhibition emphasises the different notions of living - older people participating, responding, and contributing at various times and stages. The exhibition identifies the many and varied ways this happens - ways which are structured and given meaning in a context in which culture, economy and society and bodily capacity are intermingled. The project aims to challenge current negative stereotypes of old age as a time of degeneration by using representations of older people living actively over different historical periods. The exhibition opened at the Medical History Museum at the University of Melbourne in May, 1999. Since then it has travelled to various urban and regional sites. In this way, it seeks to forge links between academic institutions and government and community agencies, while simultaneously increasing awareness of health and well being in old age. Keywords: Ageing, historical, exhibition 3.21 Department of Health Policy and Management, School of Public Health, Curtin University of Technology 462 Title: Ageism and the attitudes of nurses towards older people Principal researcher: W Meng Co-researcher: Professor D Boldy Organisation: Department of Health Policy and Management, School of Public Health, Curtin University of Technology Status: Completed Outline: This project involves a literature review covering ageism, professional attitudes and the role of health professional, specifically nurses. Keywords: Ageism, nurses 463 Title: A review of the Extended Aged Care at Home Packages Principal researcher: Ms S Yew Co-researchers: Professor D Boldy, Ms L Grenade Organisation: Department of Health Policy and Management, School of Public Health, Curtin University of Technology Status: In progress Funding: Commonwealth Government Timetable: Completed 2000 Outline: A review of the Uniting Church Homes Rowethorpe Extended Aged Care Home program (REACH) is being undertaken as a pilot study. Through this program, care equivalent to nursing home care is provided to elderly people living in the community. The study involved an extensive review of literature and documentation as well as a small-scale survey of key stakeholders namely the program manager, care staff and care recipients, including informal carers. From the client perspective, the REACH program appeared to be achieving its aim of high quality care and affordability and levels of satisfaction were high. Australian Ageing Research Directory 2000 251 Health and Behavioural Sciences However, the review also highlighted a number of broader level issues, which may require attention, in particular funding, standards assessment and inter-agency involvement and cooperation. Keywords: Community care, home-based care 464 Title: Factors influencing residents’ satisfaction in residential aged care facilities Principal researcher: S Chou Co-researchers: Professor D Boldy, Ms L Grenade Organisation: Department of Health Policy and Management, School of Public Health, Curtin University of Technology Status: In progress Timetable: Complete late 2000 Outline: The research involved: (i) determining the factor structure of a resident satisfaction scale and assessing reliability and validity of the scale; (ii) exploring the direction and magnitude of the effect among the satisfaction components; (iii) construction and testing of hypothesised model linking resident satisfaction (total and components) in aged care facilities to factors related to staff (eg. satisfaction, professional development), residents (dependency, age) and the facility (location). Data collected has covered both nursing homes (30 nursing homes, 395 residents, 610 staff) and hostels (41 hostels, 754 residents, 37 staff) using both quantitative and qualitative approaches. Resident satisfaction has been measured using both the self-completed questionnaire approach of the project “Seeking the Residents’ View of Aged Care Facilities”. Modelling has involved multiple regression and structure equation modelling techniques. Keywords: Aged care facilities, resident satisfaction 465 Title: Residential options for people with disabilities who are ageing Principal researcher: Ms M Harper Co-researcher: Professor B Boldy Organisation: Department of Health Policy and Management, School of Public Health, Curtin University of Technology Status: In progress Timetable: Completion 2000 Outline: The overall aim is to explore the specialised residential service needs of people with long standing disabilities who are ageing, in order to develop one or more models that are likely to achieve acceptance to key stakeholders. The project will mainly consist of an extensive literature review, followed by a number of (two or three) focus group meetings with small numbers of clients and key carers. In addition, consultations with relevant state and commonwealth bodies will be held. Keywords: Residential care, housing, disability, ageing satisfaction 466 Title: Seeking the resident view in aged care facilities Principal researchers: Professor D Boldy, Ms L Grenade Organisation: Department of Health Policy And Management, School of Public Health, Curtin University of Technology Status: Completed Funding: $250,900 over three years Timetable: Completed 1988 252 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: This project involved the development of a manual for use by managers and administrators of aged care facilities as a means of exploring the views and concerns of residents. It comprises interview schedules and self complete questionnaires covering respectively residents and their representative. It also includes advice on sampling, interviewers and interview techniques, data recording and analysis, report writing, feedback and follow-up. Instruments were developed and tested for validity and reliability in a sample of 41 facilities and with a sample of 47 residents and representatives throughout Australia. While originally developed for use as an internal monitoring tool, the manual has directed relevance to the new national accreditation process. Keywords: Residential aged care facilities, residential input, consumer views 3.22 Department of Public Health and Community Medicine, Faculty of Medicine, University of Sydney 467 Title: For older women by older women. Autonomy and legitimization of older women through social action. An ethnographic study of the Older Women’s Network Principal researcher: P Reynolds Organisation: Department of Public Health and Community Medicine, Faculty of Medicine, University of Sydney Status: Completed Funding: Nil Timetable: December 1998 - March 2000 Outline: The proportion of the population aged 65 years or more is increasing in Australia. Of these, 56.5% are women. There are concerns about the rising number of health problems and the rising costs of health care in this older population. Governments, therefore, are seeking ways to maintain health and wellness, such that older people may live better longer. Increasingly, the determinants of health, such as income security, housing and social support networks are being taken into account when planning health programs and policies. In particular, social action groups are being recognised as useful resources for health and wellbeing. One such group is the Older Women’s Network which has grown to become a voice for older women in shaping government policy. An ethnographic study was selected, using methods of observer-participation and a focus group, in order to identify the benefits of membership of the Older Women’s Network. It was anticipated that this might assist health professionals and others in developing policy and programs that effectively improve the health and wellbeing of older women. Two major concepts, namely ‘autonomy’ and ‘legitimization’ emerged from a five-step process of data analysis which reflected the complexities of ways in which older women strive to legitimize their role in society as fully participating individuals, in control of their own destinies. The overall impression of the culture of the Older Women’s Network was that membership is beneficial in many ways, with one significant benefit relating to the notion of ‘feeling useful’. There was also evidence, however, that the Older Women’s Network is facing certain challenges when working with outside agencies for example. It was revealed that, while members welcomed the opportunity for the network to influence social policy, they nevertheless perceived such partnerships as a threat to the Older Women’s Network’s autonomy. In order for the Older Women’s Network to adapt to its growth and development such that benefits of membership could be optimised, four strategies for change were identified. These were: recognising the need for change; enlargement of skills base for members; operational change and increasing collaboration with other agencies. Strategies that might improve opportunities for healthy outcomes for older women were also identified. These were: to increase the amount of research into wellness Australian Ageing Research Directory 2000 253 Health and Behavioural Sciences practices of older women; examine positive health indicators of the wellness of older women; develop gender-sensitive health promotion programs; research the notion of ‘feeling’ useful’ in relation to health and wellness. Keywords: Older women, social action, autonomy, legitimisation, ethnography, wellness 468 Title: Randomised trial of home assessment and modification for prevention of falls in older people Principal researcher: Associate Professor R G Cumming Co-researchers: Ms M Thomas, Mr G Salkeld, Dr G Szonyi Organisation: Department of Public Health and Community Medicine, Faculty of Medicine, University of Sydney Status: Completed Funding: National Health and Medical Research Council, $180,000 Timetable: May 1995 - February 1998 Outline: A randomised controlled trial was done to determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls. 530 subjects (mean age 77 years) were recruited, usually just prior to discharge from selected hospital wards. The intervention was a home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications. The primary study outcome was falls, ascertained over a twelve month follow-up period using a monthly falls calendar. Thirty six percent of subjects in the intervention group had at least one fall during follow-up, compared to 45% of controls (P = 0.050). The intervention was only effective among subjects (n = 206) who reported having had one or more falls during the year prior to recruitment into the study: in this group, the relative risk of at least one fall during follow-up was 0.64 (95% confidence interval, 0.50-0.83). Similar results were obtained when falls data were analysed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a twelve month follow-up visit. The study concluded that home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be due to home modifications alone. Home visits by occupational therapists may also lead to changes in behaviour that enable older people to live more safely in both the home and external environment. Keywords: Accidental falls, clinical trial, home modifications, occupational therapy 3.23 Disability Services Unit, Australian Institute of Health and Welfare 469 Title: Ageing and disability project Principal researcher: X Wen Co-researchers: Ms R Madden, Ms N Fortune Organisation: Disability Services Unit, Australian Institute of Health and Welfare Status: In progress Funding: Disability Administrators Timetable: Completion August 2000 Website: http//www.aihw.gov.au Outline: This project is designed to provide information to assist disability support service providers and senior policy makers faced with questions such as: (i) What are the ageing trends of people with a disability and the types of assistance needed at various ages? (ii) Can 254 Australian Ageing Research Directory 2000 Health and Behavioural Sciences we usefully distinguish between disability clients and aged care clients, with respect to their need for services? When is a person’s requirement for assistance a result of ageing rather than the onset of disability at an earlier age, and does any such distinction have implications for the nature of services provided? (iii) What are trends in informal care? How might these trends interact with population factors to affect demand for disability services into the future? (iv) What inferences can be made about future needs for support services? The study is being conducted in three stages: (i) a literature review, (ii) an analysis of Australian population implications, (iii) an analysis of support service implications. Keywords: Disability, ageing, disability support services, need, informal care 3.24 Division of Health Sciences, University of South Australia 470 Title: Exploring alteration of medication dose forms in residential aged-care facilities Principal researchers: Professor R Nation, Professor J Cheek Co-researchers: Associate Professor A Gilbert, Ms A Ballantyne Organisation: School of Pharmacy and Medical Sciences and Centre for Research into Nursing and Health Care, Division of Health Sciences, University of South Australia Status: In progress Funding: Pharmaceutical Education Program (PEP), $133,969 Timetable: October 1999 - March 2001 Website: http://www.unisa.edu.au/CRNHC/ or http://www.qummap.health.gov.au Outline: This study examines nursing and care-worker practice of altering solid oral formulations (crushing of tablets, opening of capsules) as an aid to administration of medications to residents in high level and low level aged-care facilities. The specific aims of the study are: (i) to determine the incidence and reasons for the practice and of the methods employed for altering and administering the altered form of the drug, the potential direct and indirect effects of the practice for resident well being and care, and potential alternatives to the practice; (ii) to develop guidelines for best practice in relation to the alteration of dose form prior to the administration of medications to this group of residents guided by an understanding of the reasons behind current staff practice, practical considerations, pharmaceutical issues and resident care and safety; (iii) to inform the development of educational programs for all those involved in the administration of medications in residential aged-care facilities, such as nurses, care workers, pharmacists, doctors and allied health professionals in relation to the practice of altering dose form prior to medication administration. The study is descriptive and exploratory. The purposive sample of residential aged care facilities in South Australia is formed by region and by classification of facility. It is a multi-method study in which each method collectively helps to build an account and understanding of the practice of altering solid oral drug formulations prior to administration in aged care facilities. The project comprises three phases. Phase one involves non-participant observations in which there are regular periods of comprehensive observation of staff preparing and administering medications. Phase two comprises in-depth interviews with two purposively selected care providers from each facility to probe aspects of the practices observed in Phase one. Qualitative thematic analysis of interview and observation data then aims to identify recurrent patterns and summative themes that are fed into Phase three. An expert panel of experienced clinical and research pharmacists is also convened in order to carry out a comprehensive pharmaceutical analysis to determine both the pharmaceutical implications and possible outcomes for residents associated with those manipulations. Phase three follows analysis and comparison of the multiple data sources of Phases one and two. In Phase three, a participatory action model is used to engage key stakeholders (eg. care Australian Ageing Research Directory 2000 255 Health and Behavioural Sciences providers, medical practitioners, pharmacists, residents) in discussion of the data and the search for practical solutions to issues uncovered in the research and to develop a position paper. A workshop will then be conducted with representatives of the key stakeholder groups to further refine the discussion document into a draft set of guidelines. These draft guidelines are then pilot tested in the participating facilities and further refined. The iterative process of drafting and testing guidelines continues until a consensus is reached. The acceptability of the guidelines to the staff and other key stakeholders within the residential aged-care facilities will be evaluated by an experienced, independent external consultant. Keywords: Alteration of medication, residential aged care, therapeutic guidelines, prescribing, medication 3.25 Faculty Office, Faculty of Health Sciences, University of Sydney 471 Title: Australian ageing research project Principal researchers: Professor H Kendig, Professor G Andrews, Dr C Browning, Associate Professor S Quine, Ms A Parsons Organisations: A Health and Ageing Research Program between Faculty Office, Faculty of Health Sciences, University of Sydney; Centre for Ageing Studies, Flinders University; Department of Public Health, La Trobe University; Department of Public Health & Community Medicine, Faculty of Medicine, University of Sydney Status: In progress Funding: Commonwealth Department of Health and Aged Care, $29,542 Timetable: February 2000 - June 2000 Outline: The Commonwealth and state governments have recognised the need for a national review of research on healthy ageing to determine the future direction and carriage of research on this topic. The project involves reviewing both current and planned research into healthy ageing to ascertain the existing position, possible future directions and the present and future players. The task is multi-faceted. It includes both a review of existing data and the collection and analysis of views of researchers, policy makers, non government organisations and consumers. The methods involve completion of a web-based questionnaire by researchers, face to face and telephone interviews with policy makers in each state, and consultative meetings with groups consisting of researchers, policy makers, non government organisations and consumers within each state. This is a new approach to recognising both the positive aspects of ageing and the importance of involving and responding to the different players in the research process. Keywords: Research policy, consumers, healthy ageing 472 Title: Global health expectancy research among older populations Principal researchers: Professor H Kendig, Associate Professor S Quine, Dr Z Hossain, Ms A Parsons Organisations: A Health and Ageing Research Program between Faculty Office, Faculty of Health Sciences, University of Sydney; School of Behavioural and Community Health Sciences, Faculty of Health Sciences; Department of Public Health and Community Medicine, Faculty of Medicine Status: In progress 256 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Funding: World Health Organisation Kobe Centre for Health Development, Japan, consultancy $49,180 Timetable: February 2000 - June 2000 Outline: The main aim of this project is to provide information useful for the development of health policies for older people in countries around the Asia/Pacific Rim, with a strong emphasis on urban areas in developing countries. The information collected will contribute to the development of sensitive population indicators and determinants of healthy ageing, and provide an early warning related to the risk of morbidity, disability and premature mortality. The World Health Organisation Kobe Centre has recognised the need to develop a comprehensive database on healthy ageing in the region. This project will significantly contribute to the development of an information base through a review of published and unpublished literature, and a survey of international researchers to locate relevant large scale surveys (greater than 1,000 persons) conducted in the region. This project will also enable the identification of gaps in the existing data, by topic and by country, which can then be addressed. Keywords: Policy, aged population, database, developing countries 473 Title: Health and Ageing Research Program Principal researchers: Professor H Kendig, Professor M Fiatarone Singh, Associate Professor S Quine Organisations: Faculty Office, Faculty of Health Sciences, University of Sydney; School of Exercise and Sport Science, Faculty of Health Sciences; Department of Public Health and Community Medicine, Faculty of Medicine Status: Ongoing Funding: University Research Infrastructure Block Grant; $133,333; Faculty funding, $66,666 Timetable: 1999 - 2000 Outline: The Health and Ageing Research Program (HARP) at the University of Sydney was founded in 1999 to foster the multi-disciplinary exploration of broad biomedical, clinical, psychosocial and service/policy topics of relevance to healthy ageing. The ultimate goal of the collaborative work is to improve both the quality of life of individuals as they age, as well as to increase societal awareness and support for the needs of older people. Keywords: Physical aspects of ageing, social aspects of ageing, health, healthy ageing, independence, quality of life 474 Title: The older people's health survey Principal researchers: Professor H Kendig, Associate Professor S Quine, Ms M Barns Organisation: A Health and Ageing Research Program between Faculty Office, Faculty of Health Sciences, University of Sydney; Department of Public Health and Community Medicine, Faculty of Medicine Status: In progress Funding: NSW Department of Health, $32,450 Timetable: 1999 - 2000 Outline: The NSW Department of Health in its Healthy Ageing Framework 1998-2003 emphasised the importance of improving the opportunities for all older people to remain as independent and healthy as possible and able to participate in community life. The Older People's Health Survey was designed with input from an expert steering committee and a technical advisory committee. The questionnaire covered priority topics including: Australian Ageing Research Directory 2000 257 Health and Behavioural Sciences independence, contributions to the community, physical and mental health, physical and social environmental influences on health, life-style and use of health and community services. The questionnaire is being administered by telephone to 8,500 people over the age of 65 years living in NSW (500 in each of the 17 Area Health Services). The results will provide a basis for evaluating current Department of Health strategies and will be used to develop new programs to improve the health and well-being of older people across the State. Keywords: Independence, lifestyle, physical health, mental health, survey 3.26 Health Department of Western Australia 475 Title: Research into oral health for disadvantaged groups in the community Principal researcher: Ms L Slack-Smith Organisation: Health Department of Western Australia, Office of the Chief Medical Officer Status: In progress Funding: Health Department of Western Australia, $255,000 Timetable: March 1999 - February 2001 Outline: This research has a number of components relating to oral health in disadvantaged groups. One aspect relates to the research to investigate and identify issues and concerns regarding oral health and dental service access in older persons living in Perth Metropolitan Area. This group has been previously identified as being at risk of poor oral health outcomes. The study will determine factors identified by residents as limiting utilisation or access to services and other oral health issues. Four community discussion groups (focus groups) will be conducted to determine perceived oral health needs for the participants. The study will (i) identify concerns for selected groups of older people regarding oral health; (ii) determine reasons why older people do or do not attend dental services, (iii) determine the role of support people in access to dental health care. Such qualitative research will identify issues of importance while assisting in the quantitative investigation of service needs. It will also provide a substantial basis for future research. Keywords: Oral health, dental health, disadvantaged, quality, older persons 476 Title: The 1995 Western Australian health survey: A profile of the health of Western Australians aged 50 years and over Principal researchers: Mr R Milligan, Ms A Daly Organisation: Health Department of Western Australia Status: Completed Funding: Health Department of Western Australia Timetable: April 1995 - December 1996 Outline: In 1995, as part of the Western Australian Health Survey, over 1,840 adults aged fifty and above were interviewed by telephone. The report presents statewide age specific and age standardised prevalences of self-reported health conditions, risk factors, health service utilisation and health status. The information is presented in tables and graphs for males, females and all persons. An appendix of locality specific prevalences is included. Keywords: Health conditions, health status, risk factors 258 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 3.27 Health Issues Centre, Victoria 477 Title: Health at any age: A framework for health promotion with older people in the Western Metropolitan Region Principal researchers: Ms H Hayes, Mr P Butler, Ms M Carter Organisations: Health Issues Centre; Centre for Development & Innovation in Health, Australian Institute of Primary Care, La Trobe University Status: Completed Funding: Department of Human Services, Western Metropolitan Region with funding through the Aged Care Special Initiatives Program, $20,000 Timetable: 1997 - 1998 Website: www.vicnet.net.au/~hissues http://aipc.latrobe.edu.au Outline: This project aimed to explore health promotion for the growing elderly population, a group identified by the Western Metropolitan Region as a priority group because of their high level of need, the cost of meeting their needs, and the rapidly rising numbers of people living to an advanced age. It was carried out with guidance and enthusiastic input from a reference group drawing on a broad range of community agencies in Melbourne’s multicultural western suburbs. The project adopted the approach that health is both a personal and a community resource. A key focus of the strategies detailed in the project report was on the prevention of frailty as well as how health promotion can be undertaken with people who are already frail, especially frail older people. The concept of a positive health orientation is the essence of the philosophy and recommendations in the report. The methodology employed several qualitative techniques. Searching HEAPS national database revealed a wealth of resources and programs. A literature review identified key reports and projects that influenced the project framework. This background informed the consultation phase of the project in which diverse organisations and individuals addressed three key questions in an open ended discussion format: (i) the perceived needs of the target group; (ii) what strategies might maintain or improve their condition/circumstances; (iii) what strategies might help prevent people from becoming frail as they age. A workshop served to further develop strategies, as well as to highlight several innovative approaches. The project report documents each phase of the project and provides a detailed implementation plan. Keywords: Healthy ageing, health promotion, frail elderly 3.28 Health Promotion Service, South Eastern Sydney Area Health Service 478 Title: Engaging older people from non-English speaking backgrounds and the frail aged in physical activity Principal researchers: Ms B Stickney, Ms H Pinnock, Ms O Vilishanskaye Organisation: Health Promotion Service, South Eastern Sydney Area Health Service Status: In progress Funding: Ageing and Disability Department, NSW, $9,713 Timetable: Completion June 2000 Outline: This project looks at a current program for older men and women to identify reasons for success and lack of success of the strategies used to encourage continued participation in the program. Information collected will be used to build models for good practice in Australian Ageing Research Directory 2000 259 Health and Behavioural Sciences enhancing and maintaining non-English speaking background and frail aged participation in healthy ageing activities. Keywords: Frail aged, non-English speaking background, physical activity, ethnic aged 3.29 Healthy Ageing Research Unit, Hornsby Ku-ring-gai Hospital 479 Title: Depression in the older person intervention project Principal researcher: Dr R H Llewellyn-Jones Co-researchers: C Heal, H Smithers, C McMahon Organisation: Healthy Ageing Research Unit, Hornsby Ku-ring-gai Hospital Status: In progress Funding: Second National Mental Health Plan, $162,000 Timetable: January 2000 - January 2002 Outline: This project will implement and evaluate a multifaceted shared care intervention for late life depression in three hostels for the aged as well as implementing elements of the intervention in rural New South Wales. Implementation will be in collaboration with the local psychogeriatric services. The intervention will provide training to residential care staff and general practitioners to enhance their skills in the assessment and management of depression; health education programs to the residential population to destigmatise depression and promote active self help practices; and health promotion programs to reduce depression by decreasing social isolation, increasing activity levels and improving functional independence. An education program on late life depression will also be provided for rural clinicians and other carers. The project will evaluate clinical outcomes as well as recording the lessons learned during the implementation process. It is anticipated that there will be approximately 60 subjects in each of the hostels. Outcomes will be evaluated by pooling data from the hostels. The effects of the interventions on clinical outcome will be evaluated using a pre-post design, examining effects on depression outcome (Geriatric Depression Scale score), activity levels, functional status as well as staff and general practitioner knowledge levels. Other factors having a possible effect on these outcome measures will be controlled for by using multiple linear regression analysis. In addition, the process of implementing the interventions will be evaluated throughout by collecting data on staff attendances at education, levels of care staff satisfaction and barriers to implementation. Keywords: Depression, aged, residential facility, combined modality therapy 480 Title: Challenging behaviours in dementia: A controlled trial of psychosocial approaches Principal researchers: Dr M Bird, Dr R H Llewellyn-Jones Co-researchers: H Smithers, J Cohen, A E Korten Organisation: Healthy Ageing Research Unit, Hornsby Ku-ring-gai Hospital Status: Completed Funding: Commonwealth Department of Health and Family Services, $287,040 Timetable: May 1996 - November 1998 Outline: This project describes an innovative primarily psychosocial approach to challenging behaviours in dementia, in which management was tailored to the unique characteristics of each case. The project evaluated this approach against usual care which commonly consists almost exclusively of pharmacological interventions. The study was a referral based nonrandomised controlled trial using repeated measures design. Referrals were accepted both for patients still living in the community and patients in residential care, though only the latter 260 Australian Ageing Research Directory 2000 Health and Behavioural Sciences were used for the comparison with usual services. Small numbers precluded a valid between group comparison for community residents. The experimental group consisted of patients referred to the psychogeriatric/geriatric services of Hornsby Ku-ring-gai Hospital, Sydney. They received tailored, predominantly psychosocial, interventions. Cases were assessed and case managed by a registered nurse and/or clinical psychologist both skilled in dementia care. A psychogeriatrician assisted in the minority of cases where medication formed part of the intervention. The control group consisted of subjects referred to the psychogeriatric/geriatric services of Royal North Shore and Ryde Hospitals, Sydney. They received the more usual, almost entirely pharmacological, way of approaching these problems. They were assessed and managed by their usual community psychogeriatric teams, with the psychogeriatrician and/or psychiatric registrar handling the overwhelming bulk of cases. Measures were taken for all subjects and their carers (family members or nursing staff) at baseline and two and five months later. The key outcome instruments assessed the precise nature and level of behavioural disturbance, level of carer distress associated with the behaviour, carer perception of behaviour change, carer coping levels, and attitude to the patient. Psychotropic medication use was also assessed. The results show, very clearly, that a novel psychosocial approach in which medication was used mainly as an occasional adjunct was at least as effective as the usual primarily pharmacological approach, and was more effective on some key carer parameters. This is the first study ever to show this. The overall success rate in the experimental group was about 75% in reducing the challenging behaviour and/or reducing carer distress associated with the behaviour so that it was no longer perceived as challenging. In the comparison control group, carers reported an equal amount of behaviour change at follow-up, and a similar reduction of distress associated with the behaviour. However, nursing staff in the Hornsby sample reported significantly greater capacity to cope with the patient overall, and there was a greater movement away from pejorative attitudes towards the patient. Because of the unprecedented ageing of the Australian population and concomitant dramatic rise in the rate of dementia, challenging behaviours in dementia will increasingly present to carers and health services. The results of this study present a very strong case for more research to refine and develop the innovative techniques used, and evaluate how they can be made more widely available. The important results of this study are currently being prepared for publication and further data analysis is being conducted. Keywords: Dementia, psychosocial intervention, challenging behaviours, reducing drug use 3.30 Institute of Disability Studies, Deakin University 481 Title: Telecommunication needs of aged Australians Principal researcher: Ms J Owens Co-researcher: Ms G Lamb Organisation: Institute of Disability Studies, Deakin University Status: Commissioned Funding: Department of Communications, Information Technology and the Arts Timetable: March 2000 - December 2000 Website: http://www.hbs.deakin.edu.au/ids Outline: People currently aged 65 and over have lived through an age of tele-communication advances that have impacted on their employment, leisure, financial, and social activities. The development of a range of ‘real time’ and ‘delayed time’ telecommunications equipment has given consumers increased choice over when, how, and where they would like to communicate. For some consumers, however, this choice is not a reality. Aged persons are Australian Ageing Research Directory 2000 261 Health and Behavioural Sciences particularly vulnerable to changes in economic status, health, and social conditions which may affect their telecommunication choices. They may experience equipment access difficulties due to acquired conditions which affect their physical, dexterity, and sensory skills, thus affecting their ability to communicate how, when, and where they would like. Does the advancement of age and life changes in the areas of employment, leisure, health/physical status, cognition, and support impact on attitudes toward technology and the use of telecommunications equipment for the over-65s? Previous research in the area of telecommunications equipment and service needs of particular populations (e.g. people with sensory and communication impairments) has indicated that users and potential users of telecommunication equipment and services can have quite specific needs and requirements. The introduction of innovative technologies such as optical fibres, satellites, and cellular phones has enabled personal communication that is not restricted by time or location. These technologies serve as conduits through which an expanding proportion of information is accessed as well as offering increased participation in modern life. Are aged Australians benefiting from the telecommunications technologies that are available? The aim of this project is to determine the telecommunication equipment and service use and needs of aged individuals in the state of Victoria. Aged consumers will be approached through local councils, Senior Citizen clubs, Universities of the Third Age, retirement villages in the metropolitan and country areas of Victoria, and through on-line sources. 100 participants will be randomly selected from the total number of respondents. Letters inviting participation will be mailed or emailed to executive officers/coordinators of the above facilities. Flyers inviting participation will be distributed or posted in the facilities. Following selection of the 100 participants, letters will be sent to all respondents informing them whether they have been selected to participate in the project. A questionnaire will be designed for completion through a telephone interview or on-line. The questionnaire will contain open-ended and multiple forced-choice questions. Qualitative and quantitative data will be collected through the telephone interview or completion of the on-line questionnaire. Qualitative methods using inductive techniques and N-VIVO software will be used to analyse open-ended questions. Quantitative data will be analysed using SPSS and descriptive statistics. Keywords: Telecommunications, aged care, communication, telephone, facsimile, email, Internet, devices, services 3.31 Menzies Centre for Population Health Research, University of Tasmania 482 Title: A Tasmanian study of the role of genetics and environment in osteoarthritis of the hand Principal researcher: Dr G Jones Co-researchers: Dr M Sale, Dr H Cooley Organisation: Menzies Centre for Population Health Research, University of Tasmania Status: Ongoing Funding: Exgenix and Arthritis Foundation of Australia Timetable: 1998 - ongoing Outline: Osteoarthritis is a disease of unknown aetiology that results in deterioration of the structure and function of articular cartilage and may also be associated with growth of new bone around the affected joint. Twin studies have implicated a substantial genetic contribution to osteoarthritis, particularly of the hand. No genes have been identified, although a number of candidates have been suggested in association, and animal studies and two small family studies have suggested linkage to 2q. Osteoarthritis causes joint pain and stiffness and can lead to considerable disability, particularly when larger, weight-bearing joints such as the hips 262 Australian Ageing Research Directory 2000 Health and Behavioural Sciences and knees are involved and these are often linked with osteoarthritis of the hand. Indeed, osteoarthritis is the leading cause of disability in western society. There is no cure for osteoarthritis and current treatment is palliative or involves joint replacement, which is very costly. Identification of susceptibility or severity genes in osteoarthritis might lead to a better understanding of the biochemical basis of osteoarthritis, which may translate to rational therapeutic strategies. It might also lead to preventive strategies in at-risk individuals. Since late 1998, the research team has been collecting extensive phenotypic data on familial osteoarthritis of the hand in Tasmania. Subjects have been recruited from the practice databases of the three rheumatologists who provide a statewide service. The study targets persons with a positive family history defined as at least one living family member with osteoarthritis of the hand using strict criteria for definition. Clinical data collection, phenotypic assessment and DNA extraction has been completed for a total of 550 subjects from 100 families as well as 70 controls. Of these, 206 (37%) are affected by osteoarthritis of the hand and some families span three generations. All subjects have a standard AP hand Xray, a hand photograph, venipuncture, hand WOMAC as well as assessment of important environmental factors (anthropometrics, hormonal status, physical activity and smoking). It is proposed to check 2q initially. However, given the extensive nature of the dataset, it is intended to proceed with a genome wide screen regardless of the 2q result to demonstrate if linkage is present at other sites as this condition is likely to be polygenic. Further research will be guided by the initial results. Keywords: Epidemiology, osteoarthritis, genetics 483 Title: Fracture incidence in Southern Tasmania: A population based study Principal researcher: Dr G Jones Co-researcher: Dr H Cooley Organisation: Menzies Centre for Population Health Research, University of Tasmania Status: Ongoing Funding: Merck Sharp and Dohme, National Health and Medical Research Council Timetable: June 1997 - ongoing Outline: Symptomatic fractures are a significant problem in terms of both morbidity and financial cost. Marked variation in both total and site-specific fracture incidence has been documented internationally but there is limited within country data. This prospective population based study documented the incidence of all symptomatic fractures occurring from 1 July 1997 to 30 June 1999 in adults 50 years and over resident in Southern Tasmania (total population over the age of 50 years, 64,688). Fractures were ascertained by reviewing reports from all the radiology providers within the area. To date, there is compelling evidence that fracture incidence is different between different geographic sites within the same country, which has important implications for health planning. In addition, the combination of high residual fracture risk and short life expectancy in elderly subjects suggests fracture prevention will be most effective in later life. Keywords: Epidemiology, fracture, lifetime fracture risk, osteoporosis 3.32 Mid North Coast Area Health Service, Southern Sector, NSW 484 Title: That older people deserve more respect Principal researchers: Ms B Jordan, Mr S McMurtry Organisation: Mid North Coast Area Health Service, Southern Sector Australian Ageing Research Directory 2000 263 Health and Behavioural Sciences Status: Completed Funding: Mid North Coast Area Health Service, Southern Sector Timetable: November 1998 - May 2000 Outline: This study aimed firstly to explore the attitudes of teenagers towards older people in the community, then to measure any swing in attitudes following a range of interventions. To do this, 176 year nine students were surveyed in November 1998, prior to the start of the International Year of the Older Person. A number of exercises were undertaken with this group of young people, among which was an essay competition, the title of which was “ That older people deserve more respect”. This could be argued in either the positive or the negative. This was the first of a number of interventions aimed at introducing the concept of respect to this group of students. As a control group, a further 71 students of the same age at a high school some 50 kilometres distant were surveyed. There was no further contact with this group until the exit survey some twelve months later. As this study focussed on attitudinal factors, the surveys allowed plenty of room for comment by the students. On a light note, the research may have discovered a landmark statement on ageing. In response to the question, When do you become old?”, one young man answered “When your teeth fall out, your hair turns grey and you think the wall is your friend”. Keywords: Ageing, attitudes, teenage attitudes 3.33 Monash University Centre for Rural Health 485 Title: Rural and remote area aged care: An international annotated bibliography Principal researcher: Ms A Robinson Co-researchers: Associate Professor E Duffy, Professor R Strasser, Ms P Buckley Organisation: Monash University Centre for Rural Health Status: Completed Funding: Australian Health Ministers' Advisory Council; Monash University Timetable: 1998 Website: http://www.med.monash.edu.au/crh/ Outline: The bibliography provides an international coverage of the published literature obtained from journal articles. There are 443 entries derived from 220 articles. More than 5,000 citations were searched on MEDLINE, CINAHL, SOCIOFILE, APAIS and PSYCINFO from 1980 to 1996. The search focused on the keywords 'aged' and 'elderly' combined with 'rural', 'remote' and 'isolated'. More than 590 articles were identified and 443 articles from 220 journals are included in the bibliography, and now kept at the Centre for Rural Health, and available through the Literature Information Service for Rural and Remote Health (LISARRH) service managed by the Centre, and accessible through its website. Approximately 60% of the articles focus on general health status of elderly people, and health care delivery to them. Areas of specific health issues and problems, including mental health and nutrition, make up the other 40%. As a specific health issue, the cardiovascular and circulatory system has had the most studies. Approximately 80% of the articles are the result of academic and service based research. Most of these are in America. One of the largest is the ongoing Iowa 65+ Rural Health Study, on which a number of smaller studies are based. Others are from throughout the world, including Dubbo in Australia. The Bibliography is designed to be a reference manual for health practitioners in rural and remote areas, researchers interested in the health status of aged people and others concerned with the welfare of aged people. Keywords: Aged, elderly, rural, remote, isolated, health, bibliography 264 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 3.34 Moreland Community Health Service, Victoria 486 Title: Safe citizens pilot project Principal researcher: Ms T Smith Organisation: Moreland Community Health Service Status: Completed Funding: Victims Referral and Assistance Service, Department of Justice, $100,000 Timetable: January 1998 - October 1998 Outline: This project researches and pilots a program model to address the effect of crime and the fear of crime on older persons. The project was developed in consultation with various Aged Care service providers in the City of Moreland and with 600 older persons who participated in workshops conducted during the project, as well as members of peak agencies representing older persons. The project created a strong demand throughout Victoria for both resource material produced and for workshops developed by the project for older people and for workers. One of the major achievements of the project was its success in involving people and agencies representing older people from linguistically and culturally diverse backgrounds in the consultative and implementation processes. Three separate resources were produced in the course of the project. These included a comprehensive resource manual for workers engaged in providing services to older persons which were used to support workshops and seminars developed and delivered by the project team. During the consultative process, the issue of elder abuse was identified, and in response to this issue an Intervention Order brochure was developed and produced. The third resource produced was a Safe Citizens booklet with a focus on helping older people to live safe and active lives. The booklet was produced in eight community languages. Keywords: Safety, crime, fear of crime, elder abuse, intervention order, linguistically and culturally diverse 487 Title: Safe citizens project Principal researcher: Mr N Button Organisation: Moreland Community Health Service Status: Completed Funding: Victims Referral and Assistance Service, Department of Justice, $96,300 Timetable: April 1999 - October 1999 Outline: To coincide with the International Year of Older Persons in 1999, funding was provided to extend the pilot Safe Citizens project (entry 486). The project primarily focused on crime and the perception of crime among older people. The resource materials were reprinted and the project was extended on a statewide basis. Workshops have been held around Greater Melbourne and across regional Victoria. Over 30,000 copies of the Safe Citizens Booklet have been requested and distributed. Recipients include aged care services, ethnic peak bodies and senior clubs, community and neighbourhood houses, community health centres, local government, general practitioners and 5,400 Victorian members of the Australian Council of the Aged. The project concentrated on emphasising the rights of older persons in a way which will enable them to feel safe in their homes, communities and lifestyle choices. Keywords: Safety, crime, ethnic aged, lifestyle, elder abuse Australian Ageing Research Directory 2000 265 Health and Behavioural Sciences 3.35 Research Institute for Gender and Health, University of Newcastle 488 Title: Sleep disturbance and sleeping medication use among older women in Australia Principal researcher: Dr J Byles Co-researchers: Dr M Harris, Ms G Mishra, Professor K Nair Organisation: Research Institute for Gender and Health, University of Newcastle; Centre for Clinical Epidemiology & Biostatistics, University of Newcastle Status: In progress Funding: Commonwealth Department of Health and Aged Care, Pharmaceuticals Education Program, $54,750 Timetable: 1999 - 2000 Website: http://u2.newcastle.edi.au/wha Outline: In Stage 1, a cross sectional survey of Australian women aged 70–75 years was undertaken to estimate the proportion of older women who report sleeping difficulties and/or use sleeping medication, and to identify associated factors. These women were participants in the Australian Longitudinal Study on Women's Health (entry 489) randomly selected from the Australian Medicare database. 12,624 women aged 70-75 years provided data for this analysis (32% of eligible sample). Of these women, 50% (n=6042) reported sleeping difficulty never or rarely, 33% (n=3979) sometimes, and, 17% (n=2011) often. Approximately 18% (n=2287) of women reported to use sleeping medication within the previous four weeks. Women reporting sleeping difficulty sometimes were over five times more likely to be taking sleeping medications than women who reported to never or rarely experience difficulties (p=<0.0001); while women reporting difficulty sleeping often were over 15 times more likely to be using sleeping medications (p=<0.0001). Mean scores for sub scales of the Medical Outcomes Study SF-36 health-related quality of life measure were significantly lower for women reporting sleeping difficulty and women using sleeping medication (p=<0.001). Similarly, there was an inverse relationship between the SF-36 physical and mental health summary scores and difficulty sleeping or sleeping medication use. This analysis shows that selfreported sleeping difficulty is significantly related to reduced quality of life, suggesting sleeping difficulty is not a benign issue. Stage 2 involved in-depth interviews with women who experience difficulty sleeping and who do and do not use sleeping medications. Stage 3 will involve longitudinal analysis of health outcomes (quality of life, falls, health care use) associated with sleeping difficulty and medication use. Stage 4 is a workshop designed to allow women with sleeping difficulty to incorporate the findings of the first three stages of the research to develop their own health promotion strategy that meets their needs and circumstances. Keywords: Sleep, medication, health promotion 489 Title: The Australian longitudinal study on women’s health Principal researcher: Professor A Dobson Co-researchers: Dr J Byles, Professor C Lee, Professor W Brown, Associate Professor M Schofield, Dr L Bryson et al. Organisation: Research Institute for Gender and Health, University of Newcastle Status: In progress Funding: Commonwealth Department of Health and Aged Care, $8 million Timetable: 1996 - 2003 Website: http://u2.newcastle.edi.au/wha 266 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: The aim of the Australian Longitudinal Study on Women's Health is to explore the physical, psychological, social and environmental factors that affect the health of women in Australia. There are several cohorts including one of women aged 70-75 years at baseline in 1996. The women were randomly selected from the Health Insurance Commission database, with deliberate over-representation of women from rural and remote areas. A total of 12,624 women completed the baseline questionnaire (response rate 40%), and over 90% of these women completed the first full follow-up survey in 1999. The baseline data provided a clear picture of positive ageing among older women in Australia despite the increasing number of physical, emotional and social difficulties that confront them. Analysis of follow-up data is in progress and will concentrate on the change in health-related quality of life associated with personal characteristics (eg. exercise, nutrition, optimism and hardiness), health service use, social support and participation, and community factors (eg. neighbourhood satisfaction and rurality). A number of sub-studies are nested within the main project and are reported separately. Keywords: Women’s health, healthy ageing, health services, rural health 490 Title: The health and social needs of older Australian women as widows Principal researcher: Dr J Byles Co-researchers: Ms S Feldman, Dr G Mishra Organisation: Research Institute for Gender and Health, The University of Newcastle; Alma Unit for Women and Ageing, Faculty of Human Development, Victoria University of Technology Status: In progress Funding: Commonwealth Department of Health and Aged Care Timetable: 1996 - 2000 Website: http://u2.newcastle.edi.au/wha Outline: This set of sub-studies of the Australian Longitudinal Study on Women's Health (entry 489) were designed to explore and understand the changing needs of women following the death of their partner. Stage 1 involved analysis of the baseline (cross-sectional data) from a population survey of 12,624 women aged 70-75 years and revealed specific needs for the 4,106 women who had been widowed. Women widowed in the past 12 months had the lowest self-rated health, scored significantly lower than married women on all 8 sub-scales of the SF-36, and were more likely to report they were stressed about their health. They also had particular physical and mental health needs as well as financial and practical needs relating to managing on their income. In Stage 2, the qualitative and quantitative data provided by the women were analysed to describe how women re-establish themselves as single women. The data highlighted the importance of health care providers and other community services in assisting women through this transition, as well as the need to maintain social contact and community participation. In Stage 3, 250 women whose husbands had died within the previous three years were re-surveyed to identify and quantify the immediate health and social needs following their husband's death. While most widows still lived alone (n=186, 80.5%) and in their own homes (n=198, 81.5%), almost one-fifth of women had moved house since being widowed for financial or social reasons. Most women described themselves as coping, some better than others. The women reported high prevalence of need for legal services, assistance with financial matters, and home maintenance. Nearly all women had contacted a general practitioner since the death of their husband. Many had received some form of assistance for their bereavement from their general practitioner, mostly in the form of understanding, support and information. A high percentage (34.5%) said they had received medication to assist their bereavement, and 35% had taken medication to help them sleep or Australian Ageing Research Directory 2000 267 Health and Behavioural Sciences “for their nerves” within the four weeks prior to survey. Generally, the women felt they had maintained or increased their level of social contact and participation in activities since becoming widowed. Stage 4, which is underway, is a longitudinal analysis of the factors affecting health related quality of life for women widowed between surveys in 1996 (baseline) and 1999 (follow-up). Keywords: Widows, survey, bereavement support 3.36 Rural Ageing and Lifestyle Group, Charles Sturt University 491 Title: Building healthy communities: Extending lifestyle programs for rural older adults through volunteers Principal Researchers: Dr B Neumayer, Ms C Wilson-Lord Organisation: Rural Ageing and Lifestyle Group, Charles Sturt University Status: Ongoing Funding: Commonwealth Grant, $68,000 (1998-99); New South Wales International Year of Older Persons Grant, $10,000 (1999-00) Timetable: August 1998 - ongoing. Outline: The initial research hypothesis for this project was stating a need for more organised assistance for older adults living in rural areas to develop and run healthy lifestyle programs in their local communities. The study design was based upon ongoing action research. The subjects were older adults living in rural/regional Australia in various rural communities in southern New South Wales and Northeastern Victoria. Stage 1 of the project was to consult with older adults living in rural/regional areas in determining their interests, wants and needs in developing a healthy lifestyles manual that would help them to become increasingly independent in organising and running activity programs. After extensive consultation, a manual was developed that largely reflected the wishes of older adults living in rural areas. Stage 2 entailed numerous rural workshops for older adults to assist them in learning how to use the manual and to begin implementing various leisure activities in their community. The project philosophy was to have the ownership of healthy lifestyle programs and leisure activities in the hands of the participants themselves. What they deemed to be important in terms of needs and wishes was included in the development, implementation and progress of both the manual and the activity programs. It was hoped that by giving ownership and control of healthy lifestyle programs to older adult volunteers, their motivation and interest in such programs would expand and become sustainable over time. This project evolved into a collaborative effort between the Rural Ageing and Lifestyle Group of Charles Sturt University and the Department of Community Health (Greater Murray Region). In this sense, it has become a model project demonstrating how two large organisations can pool resources, staff and skills to assist in improving the health of the community. A vast majority of the participants were complimentary concerning the effect of the Healthy Lifestyles Manual and subsequent programs, and optimistic about future prospects, both for the project and for their personal involvement in it. The common recognition of the importance of networking either through the Rural Ageing and Lifestyle Group, Greater Murray Community Health or directly between community groups was an encouraging outcome identified through questionnaires and verbal feedback. The workshops helped participants to better understand the many dynamics of health and successful ageing. They also affirmed the importance of the participants’ roles as volunteers in the community and the benefits that volunteering brings to both themselves and their community. One of the biggest outcomes was the development of healthy lifestyle groups in various communities, thus demonstrating the independence and 268 Australian Ageing Research Directory 2000 Health and Behavioural Sciences abilities of older adults to develop and run programs by themselves. Keywords: Older adults, rural, health, leisure, activities, volunteer 3.37 School of Behavioural and Community Health Sciences, University of Sydney 492 Title: Ageing men at risk: health, housing and service use Principal researcher: Dr C Russell, Professor H Kendig , Associate Professor S Quine, Dr G Sullivan Organisations: A Health and Ageing Research Program between School of Behavioural and Community Health Sciences, University of Sydney; Faculty Office, Faculty of Health Sciences; Department of Public Health and Community Medicine, Faculty of Medicine; School of Social Policy and Curriculum Studies, Faculty of Education Status: In progress Funding: National Health and Medical Research Council, $250,308 Timetable: 1999 - 2001 Outline: The Ageing Men's Health Project is an ethnographic study of the life histories and present circumstances of low income men aged 50 years and older, living alone in inner suburban Sydney, Australia. This group of men was selected for detailed investigation because of the well-documented vulnerability to premature mortality and other poor health outcomes for men who are on low incomes, never or previously married, living alone, and in insecure housing. An important focus of the three year study is to examine the pathways which have led some men into a precariously housed and apparently socially dislocated old age, and the ways in which their stories can inform policy development. The project is using participant observation and in-depth interviewing to explore the social worlds of ageing men in a range of accommodation and service settings, including public housing, private rental in rooming houses and hotels, low level aged care facilities, emergency shelters and other services for homeless people. Keywords: Health, housing, community services, social support, older men, pensions, living arrangements 493 Title: Independence and the frail elderly: Context dependency in health professional practice Principal researchers: Dr C Russell, Dr M Fitzgerald Organisations: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, University of Sydney; School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney Status: Completed Funding: ARC Small Grant, $12,000 Timetable: January 1999 - December 1999 Outline: Public policy aims to maximise the extent to which disabled aged persons can continue living independently at home. But previous research shows that the meanings which attach to such global concepts as independence are situationally and culturally defined and vary among different organisational settings and professional groups. This project investigated how one key group of aged care professionals conceptualises client independence, whether such definitions vary in different service settings, and how these get translated into practice. Findings will have important theoretical and practical implications for Australian Ageing Research Directory 2000 269 Health and Behavioural Sciences better understanding the relationships between policy formulation, program development, service delivery and client outcomes. Keywords: Independence, health service delivery, professional values 494 Title: Isolation as an interpretive social practice: A qualitative study of older people and their service providers Principal researchers: Dr C Russell, Dr T Schofield Organisation: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, University of Sydney Status: Completed Funding: ARC Institutional Grant, $15,000 Timetable: 1996 - 1998 Outline: This project investigated the phenomenon of social isolation in old age from the perspective of older people and professional service providers. It posed two questions. First, how do vulnerable older people conceptualise social isolation and what everyday life practices do they associate with it? Second, how do service providers construe the salient dimensions of social isolation in the lives of elderly clients and how are such conceptualisations embodied in their care practices? The problem was researched using indepth interviews with service providers and frail elderly clients. The findings have been compared with social policy constructions which problematise 'isolation' and are used to evaluate the ameliorative service strategies proposed therein. Keywords: Social isolation, ageing, health, policy, social practice 495 Title: Paid and voluntary work of older people in a rural setting Principal researchers: V Legge, R Cant, K O'Loughlin Organisation: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, University of Sydney (Health and Ageing Research Program) Status: In progress Funding: Ageing and Disability Department, NSW, $9,927 Timetable: Completion June 2000 Outline: The aims of this research are to (i) provide information about the strengths of older people in rural areas as employees; (ii) assist retirement planning consultants to focus appropriately on future patterns of work of rural people; (iii) allow rural councils to plan and provide appropriate services for older people in rural areas; (iv) allow rural councils and government departments to plan the use of volunteers in the delivery of services; (v) provide voluntary associations with information about planned voluntary work among older people in rural areas. The research examined the patterns of paid and voluntary work of older people, analysed the attitudes, experiences and values of older workers towards paid work and analysed the attitudes of employers towards older workers. The research also focused upon the intentions of older people to engage in voluntary work after a retirement income stream became available. Keywords: Rural, volunteering, work, voluntary work, older workers, rural health 270 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 496 Title: Perceived well-being of Singaporean seniors Principal researcher: Dr R Mitchell Organisation: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, University of Sydney Status: Completed Timetable: May 1996 - December 1996 Outline: This report presents the findings of a study which examined self-reported medication usage in English-reading Singapore citizens aged 60 years and over. A total of 546 persons volunteered to complete a questionnaire which asked whether or not they were taking medications for one or more of cardiovascular conditions, musculoskeletal conditions, arthritis, psychiatric disorders, respiratory disease, gastrointestinal disease, infective diseases, endocrine diseases or other conditions. Subjects were divided into two strata, the ‘young old’ and the ‘old old’. The most frequently used medications in both age groups were for cardiovascular conditions, endocrine diseases and arthritis. As expected, the “old old” group were taking more medications (mean 1.95 medications per day) than the younger group (mean 1.59). The self-reported nature of the data and the limitations in the sampling are also discussed. It is concluded that medication usage reported in this study reflects a very positive public health outcome for the health strategies initiated by the government of Singapore. Keywords: Elderly, well-being, gender differences, disease status 3.38 School of Community Health, Charles Sturt University 497 Title: Emotional labour in aged care Principal researchers: Ms C A Bevan, Ms S M Gattuso Organisation: School of Community Health, Charles Sturt University Status: Near completion Funding: University Faculty Seed Grant, $1,700; British Council, $2,500 Timetable: Mid 1998 - mid 2000 Website: [email protected] Outline: The research examines emotional reactions of female staff employed as professional carers while also caring for an elderly parent, and the influence of the combination of worker/familial relationships on formal care of older people. The research considers how caring for older people confronts women carers, especially those at midlife, with emotional challenges and that reactions are mediated through other relationships past and present. The guiding idea of the research is that the formal carer’s practice is influenced by experiences of such personal relationships and by the confronting of personal ageing. Australian and UK comparative data is employed in the study. Keywords: Emotional labour, ageing, formal care, informal care, worker/familial relationships, empathy, effective practice 3.39 School of Health, University of New England 498 Title: The lives of elderly widowed women who live on the land: A life history approach Principal researcher: Mrs M B de la Rue Co-researchers: Associate Professor I Coulson, Associate Professor V Minichiello Australian Ageing Research Directory 2000 271 Health and Behavioural Sciences Organisation: School of Health, University of New England Status: Nearing completion Funding: Nil Timetable: January 1996 - January 2002 Outline: The purpose of this qualitative research, with the primary focus on the elderly widowed woman who lives on the land, is to explore, from their perspective, the meaning of health and well-being, the influence that geographic location has on their lives and maintenance of health and well-being, and, the influence of gender on their experience of widowhood and ageing and the maintenance of health and well-being in their lives. “Living on the land” for the purpose of this study means living in the country away from any large provincial region or town. Social constructionism theory provided the philosophical boundaries with social-feminist and symbolic interactionism theoretical perspectives, whilst a life history research methodology provided direction for the data collection and analysis. Five women, aged 78-88 years, widowed for at least two years, not suffering from any major illness or disability, and currently living on the land, voluntarily participated in the study, from geographical locations of Central -Western, Central, South-Western, South-Burnett, Central Coastal Regions of Queensland and Central-Western New South Wales. Data collection was collected from each informant via preliminary interviews, in-depth interviews, photo-analysis, autobiographies and a personal reflective log maintained by the researcher. Whilst each informant’s life history is unique, preliminary analysis suggests that the influence of having a dynamic transaction with their environment (living on the land) in their prewidowhood, becoming a widow, and post-widowhood phases of life, has a profound influence on the maintenance of their health and well-being. Other preliminary analysis suggests that deriving strength from a spiritual relationship with the land, the need to survive and be a survivor, meaningful support from a particular son, also played a role in their maintenance of health and well-being. Finally, the influence of gender highlighted the consequences of widowhood for elderly women living on the land, in such themes as self-empowerment to passages to freedom by having new challenges, rewards for staying on the land, reorganisation of life, and threats to their security and safety net by being denied access to resources of which their urban counterpart enjoys by environmental conditions, inadequate roads and tele-communications, and the current rural economic crises. Keywords: Gerontology, elderly women, rural health, life history research 3.40 School of Health and Human Performance, Faculty of Arts, Health and Sciences, Central Queensland University 499 Title: Predicting functional mobility in elderly adults aged 60 years and over Principal researcher: S A Longden Organisation: School of Health and Human Performance, Faculty of Arts, Health and Sciences, Central Queensland University Status: Completed Timetable: August 1999 - March 2000 Outline: Functional mobility is one’s ability to perform the physical tasks vital for independent living. Functional mobility is a basic human need, and the maintenance of which is necessary for a high quality of life, and the reduction of social isolation, disability, falls, hospitalisation and mortality. Previous research has identified muscular power, strength, endurance, flexibility, balance and cardiovascular endurance, as being the physiological parameters associated with functional mobility. This study was undertaken to (i) determine 272 Australian Ageing Research Directory 2000 Health and Behavioural Sciences which of these were most crucial to an individual’s functional mobility status; and, (ii) develop a model useful for the prediction of one’s functional mobility. Thirty-one community-residing and healthy males (n=10) and females (n=21) over 60 years of age, were purposively recruited from the Rockhampton community as participants for this study. A descriptive correlative study design was employed, with a step-wise multiple correlation used to determine which predictor variable(s) could accurately predict performance on the criterion variable. This information was then used in the development of the functional mobility prediction model. Participants’ functional mobility was assessed by their performance on a physical performance test/obstacle course (the criterion variable). The obstacle course utilised had proven validity and reliability and consisted of the following items: standing from a seated position, walking a set course, bending to retrieve a floor weight, stepping over an object, turning on the spot, and climbing up and down stairs. The participants were then assessed on these predictor variables: muscular power (peak torque relative to bodyweight during hip flexion and extension on an isokinetic dynamometer), muscular strength (peak torque relative to bodyweight during hip flexion and extension on an isokinetic dynamometer), muscular endurance (% decline in total work performed between 0-10 and 2030 repetitions during hip flexion and extension on an isokinetic dynamometer), flexibility (range of motion during hip flexion and extension, goniometre), balance (time taken to recover from a dynamic perturbation, EMG timing data from Soleus muscle), and cardiovascular endurance (a six-minute walk test). Results indicated that muscular power, muscular strength, muscular endurance, flexibility, and balance were significantly correlated to functional mobility performance. However, the step-wise multiple regression analysis revealed that muscular strength, and flexibility were the only predictor variables that made significant contributions to the prediction of functional mobility; accounting for 31% of the total variance. This study has been the first to identify which physiological parameters are most crucial for functional mobility. This information can now be used in intervention studies to prove a cause-and-effect between improving performance on these variables and subsequent improvements to functional mobility. Nonetheless, these results may be used as a pre-emptive device highlighting the need, and benefit, for senior citizens to partake in a functional physical activity regime aimed at improving their functional mobility. Government bodies, health promotion professionals and researchers and health care practitioners can use these results, and the developed prediction model, as a tool to identify functional mobility impairments. Keywords: Ageing, functional mobility, power, strength, endurance, balance, flexibility 3.41 School of Health and Human Services, La Trobe University, Bendigo 500 Title: A population perspective of access to public transport or older people in rural Victoria Principal researcher: Ms S Corcoran Co-researchers: Ms J Ellis-Scheer, Dr E James Organisation: La Trobe University, Bendigo Status: Current Timetable: February 1999 - June 2000 Website: http://www.bendigo.latrobe.edu.au/health/hstud/jme/ageing.htm Outline: The main aim of this project was to identify access to transport for older people. Collection districts are the smallest unit used in the Australian Bureau of Statistics Census data collection. This project determined the proportion of collection districts situated in the Loddon-Mallee region that have access to public transport. The collection districts were Australian Ageing Research Directory 2000 273 Health and Behavioural Sciences classified according to Accessibility Remoteness Index of Australia (ARIA): highly accessible, accessible, moderately accessible, and remote. Collection districts were included if they were identified as having a high proportion of older people. A map of the collection districts in the Loddon-Mallee region that have access to public transport will be produced. Keywords: Transport, rural, older people, access 501 Title: Constructions of self in later years Principal researcher: Ms J Ellis-Scheer Co-researcher: Professor J.W. Scheer Organisation: La Trobe University, Bendigo Status: Ongoing Timetable: 1998 - December 2000 Website: http://www.bendigo.latrobe.edu.au/health/hstud/jme/ageing.htm Outline: The general focus of this project is on the subjective constructions of 'successful' or 'healthy' ageing that individuals have to cope better with the experience of change associated with the ageing process. Personal Construct Theory has been used to provide the theoretical and methodological focus of the study. Participants include elderly people from country Victoria and from small town and middle-sized city backgrounds in Germany. Keywords: Self-identity, personal construct psychology, repertory grids, older people 3.42 School of Health and Human Services, University of Western Sydney 502 Title: Asset and health dynamics of the “old” old Principal researchers: Professor J McCallum, Associate Professor L Simons Co-researchers: Dr D Mitchell, Professor B Willis, Professor H Akiyama Organisation: School of Health and Human Services, University of Western Sydney Status: Commissioned Funding: Industry partners, plus SPIRT/ARC application 2000, $443,500 Timetable: 2000 - 2002 Website: fohweb.macarthur.uws.edu.au/choir/ Outline: Asset and Health Dynamics of the “Old” Old study (AHEAD) proposes to collect data in order to model linkages over time between health, social relations and economic wellbeing. The study tests the hypothesis that the course of age-related changes in health can be offset by three types of resources: economic resources, claims on government programs and family support. The study will match questions with AHEAD Japan which completed its baseline study late 1999 and with the AHEAD-USA national study. Keywords: Policy analysis, economics of ageing, social relations, linkages 503 Title: Continuum of care and health outcomes project Principal researchers: Dr B Shadbolt, Professor J McCallum Co-researchers: Ms S Rubenach, Dr T Nakamura Organisation: School of Health and Human Services, University of Western Sydney; Clinical Epidemiology and Health Outcomes Centre, ACT Health Status: In progress Funding: Department of Health and Aged Care, Ambulatory Care Program, $600,000 Timetable: 1995 - ongoing 274 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Website: fohweb.macarthur.uws.edu.au/choir/ Outline: Some 5,543 persons were sampled from ACT hospitals and given an extensive interview in hospital and one week, 6 weeks, 3 months and 6 months after discharge. Around 1,500 respondents 65 years and over are being intensively investigated for factors related to health and well-being outcomes, co-morbidity and progress with specific health conditions and procedures. Extensive record linkage to the longitudinal personal interviews allows detailed analysis of service use. Keywords: Service use, hospital services, post-discharge outcomes, health outcomes 504 Title: Cross-cultural measurement of depression in old age Principal researchers: Professor J McCallum, Associate Professor A Mackinnon Co-researchers: Professor G Andrews, Mr I Anderson Organisation: School of Health and Human Services, University of Western Sydney; Mental Health Research Institute of Victoria Status: Completed Funding: World Health Organisation Healthy Ageing Studies Timetable: 1995 - 2000 Website: fohweb.macarthur.uws.edu.au/choir/ Outline: Three validatory comparative analyses using confirmatory factor analysis were conducted on the Centre for Epidemiological Studies Depression Scale. The first analysis compared Australia, Canada, Japan and USA results for older people and found that Japan was an outlier in responses to positive affect items. The second analysis of the South East Asian region compared Indonesia, North Korea, Nyanmar, Sri Lanka and Thailand. The final analysis of the Eastern Mediterranean region compared Bahrain, Egypt, Jordan and Tunis. The Centre for Epidemiological Studies Depression Scale appears to be a robust instrument for cross-cultural measurement of symptoms of distress. Keywords: Cross-cultural, depression, measurement, international study, measurement instrument 505 Title: Ensuring quality of later life Principal researchers: Professor John McCallum, Professor Peter Botsman Co-researchers: Mr W Pearse, Mr A Clark, Ms S Keogh Organisation: School of Health and Human Services, University of Western Sydney Status: Completed Funding: Southern Cross Homes, $35,000 Timetable: 1998 Website: fohweb.macarthur.uws.edu.au/choir/eqoll.htm Outline: Ensuring Quality of Later Life is a policy analysis and preliminary costing study about how to maintain a high quality aged care system in the future. It is composed of two parts: a financing model for long-term care and a strategy for celebrating the strengths and contributions of older Australians. The financing model proposed a 1.1% levy of taxable income paid through Medicare, superannuation, health insurance or approved continuing care retirement communities. Keywords: Quality of later life, policy analysis, financing model, aged care system Australian Ageing Research Directory 2000 275 Health and Behavioural Sciences 506 Title: Improving post-acute care outcomes for older people Principal researchers: Professor J McCallum Co-researchers: Dr D Jackson, Ms R Bye, Mr A Owen Organisation: School of Health and Human Services, University of Western Sydney Status: Completed Funding: Ageing and Disability Department, New South Wales, $100,000 Timetable: 1997 - 1999 Website: fohweb.macarthur.uws.edu.au/choir/ Outline: In 1997-1998, 579 people aged 70 years and over were followed after discharge from hospital (mean age 78, range 70-103 years, 58% women). They were interviewed extensively at the time of discharge, at one and twelve weeks. Approximately 150 people 70 years and over were drawn from continuous in-patient flows at each of four sites: Campbelltown (high aboriginal), Dubbo (regional), Fairfield (high migrant) and Sutherland hospitals. The study validated outcomes measures for older people and identified factors related to better outcomes. Keywords: Post-acute care, discharge, post-discharge outcomes, outcome measures 507 Title: Lifestyle and psychosocial determinants of healthy ageing in a multi-ethnic prospective study of Australians 65 years plus Principal researchers: Dr R Osborne, Professor J McCallum Co-researchers: Dr D English, Dr A Hodge, Dr G Giles, Dr J Hopper, Dr R Borland Organisation: School of Health and Human Services, University of Western Sydney Status: Planned Funding: National Health and Medical Research Council application, $600,000 Timetable: Commence 2001 Website: fohweb.macarthur.uws.edu.au/choir/ Outline: The study proposes to measure indicators of healthy ageing, specifically physical and mental functioning, in 5,543 members of the Melbourne Collaborative Cohort Study who will be 65 years and over in 2001 and who were free of diseases in the 1990 baseline survey. This is a classic incidence study design. Some 4,112 have Anglo-Celtic background, whilst 684 are Greek and 747 Italian born Australians. The hypothesis is that the Mediterranean lifestyle not only reduces diseases, but improves healthy ageing. Keywords: Healthy ageing, epidemiology of ageing, nutrition, lifestyle 508 Title: The Australian-Japan partnership in community care Principal researchers: Professor J McCallum, Professor R Kobayashi Co-researchers: Professor P Saunders, Ms R Calder, Dr D Graham, Ms L Racic, Dr T Nakamura Organisations: School of Health and Human Services, University of Western Sydney; Ministry of Health and Welfare, Japan; Commonwealth Department of Health and Aged Care, Australia Status: Current Funding: Australian Government, $190,000; Japanese Government, $120,000 Timetable: August 1998 - June 2000 Website: fohweb.macarthur.uws.edu.au/choir/ 276 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: Ageing was the first topic chosen for collaborative work under an agreement between the Japanese Ministry of Health and Welfare and the Australian Department of Health and Aged Care. Teams of academic and government experts met first in Sydney and Canberra, then later in Tokyo to draw up detailed comparisons of ageing in the two countries and to visit facilities and government departments. Keywords: Comparative research, international studies, policy analysis, community care, ageing 509 Title: The Dubbo study of the health of the elderly Principal researchers: Associate Professor Leon Simons, Professor John McCallum Co-researchers: Professor Y Friedlander, Ms J Simons Organisations: School of Health and Human Services, University of Western Sydney; Lipid Research Centre, St Vincents and University of New South Wales Status: Current Funding: National Health and Medical Research Council, NHF, $80,000 per annum to 1998; pharmaceutical companies Timetable: 1987 - ongoing Website: fohweb.macarthur.uws.edu.au/choir/ Outline: In 1985, 2,805 people living in Dubbo who were born before 1930 were recruited into a multidisciplinary longitudinal study. All respondents completed a comprehensive medical examination and a multidisciplinary one hour questionnaire. Subsequently they completed a short follow-up survey every two years and death, hospital, nursing home and hostel records are continuously monitored. At the end of 1999, there were 1,869 survivors of whom 50 were living in nursing homes. The study has produced over 40 peer-reviewed publications in national and international journals about topics such as cardiovascular heart disease, stroke, diabetes, depression, social support, disability and service use. Keywords: Longitudinal study, rural health, epidemiology of ageing 510 Title: Welfare of the aged in the Asia-Pacific Region: Australia, China, Japan and Malaysia Principal researchers: Professor J McCallum, Professor J Katala, Professor Y Someya, Professor R A Aziz, Professor Y J Rong Co-researchers: Ms S Saito Organisations: School of Health and Human Services, University of Western Sydney; Asia Pacific Centre, Fukuoka, Japan Status: Completed Funding: Asia Pacific Centre, Fukuoka, Japan, $500,000 Timetable: 1997 - 1999 Website: fohweb.macarthur.uws.edu.au/choir/ Outline: The project concentrated its research on four major cities - Shanghai, Sydney, Kuala Lumpur and Fukuoka. Detailed descriptions of the welfare systems in all four countries were undertaken. Subsequently, intensive interviews were conducted of older people in each of the cities. The impacts of culture, welfare traditions, religion and different levels of development on the well-being of older people are explored. Keywords: International study, comparative research, aged welfare, culture and ageing Australian Ageing Research Directory 2000 277 Health and Behavioural Sciences 3.43 School of Health and Nursing, University of Western Sydney 511 Title: The experience of family carers of aged persons with dementia living at home in Chinese speaking communities Principal researchers: Associate Professor H Ledgwidge, Mr A Fleming, Dr L Tan Organisation: School of Health and Nursing, University of Western Sydney Status: Completed Funding: Ageing and Disability Department, NSW, $9,640 Timetable: Completed Website: http://www:nepean.nws.edu.au Outline: This study investigates the experience of family carers of aged persons with dementia living at home in Chinese speaking communities. Special reference was made to Chinese cultural background in the study. Aspects studied include the nature and degree of care provided for the elderly relative with dementia; the effect of the caring role on the carers’ own life; aspects of care for which outside assistance would be beneficial; problems with accessing or utilising services provided by welfare services; and Chinese cultural issues associated with any aspect of the elderly person's dementia or the carer's role, especially in relation to the provision of assistance by external welfare agencies. Data collected was analysed to identify the issues and to reveal and document the themes relating from the survey and to explore their inter-relationships. Keywords: Dementia, non-English speaking background, carers, family carers, cultural issues, ethnic aged 3.44 School of Health Sciences, Deakin University 512 Title: Active Plus physical activity adherence study Principal researcher: Dr J A Jones Organisation: School of Health Sciences, Deakin University Status: Nearing completion Funding: Deakin University School of Health Sciences research grant Timetable: September 1999 - June 2000 Outline: Active Plus was a twelve week physical activity intervention. Its purpose was to develop muscle strength, balance and physical activity self efficacy aimed at maintaining physical function in sedentary or low active women aged 55-65 years (n=116). Participants were randomly allocated to supervised, home based walking, step exercise, or low active flexibility groups. Measures of muscle strength, balance, flexibility and physical activity selfefficacy were made pre and post intervention. Participants, independent of intervention, showed significant increases in leisure time energy expenditure, muscle strength, and sit and reach flexibility. There were significant decreases in fear of falling, and increases in balance self-efficacy and strength self-efficacy. While physical activity levels had risen sufficiently to provide health benefits during Active Plus, clearly the benefits would last only if activity was continued at, or near comparable levels. Thirteen months after the completion of the intervention all participants who had completed the interventions and measurement sessions (n=78) were contacted, without prior warning, by mail. They received copies of the original physical activity questionnaire from which Mets values were calculated, the self-efficacy and fear of falling scales, and a twelve monthly calendar in which they were asked to indicate all 278 Australian Ageing Research Directory 2000 Health and Behavioural Sciences disruptions of more than a week to their regular physical activity routines. Additionally, the very active were interviewed by telephone and asked why they were so active. The data provides information about adherence and reasons for adhering or not adhering and permits comparisons between physical activity levels, self-efficacy and fear of falling scores with those pre- and post intervention. The incidence of falls from pre-intervention to thirteen months later, can be examined and related to physical activity and self-efficacy levels. These studies have implications for the maintenance of independent function as well as quality of life in older women. Keywords: Physical function, older women, exercise adherence, strength, balance, selfefficacy 3.45 School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney 513 Title: Service pathways for ageing caregivers of adults with intellectual disability Principal researcher: Associate Professor G Llewellyn Co-researchers: Professor L Gething, Dr R Cant, Professor H Kendig Organisations: A Health and Ageing Research Program between School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney; School of Behavioural & Community Health Sciences, Faculty of Health Sciences; Faculty Office, Faculty of Health Sciences; Research Centre for Adaptation in Health and Illness, Faculty of Nursing, University of Sydney Status: Ongoing Funding: National Health and Medical Research Council, $141,946 Timetable: 2000 - 2001 Outline: There are approximately 90,000 Australian parents caring for an adult son/daughter with intellectual disability. These people are at significant risk from physical and emotional consequences of long-term caring and the compounding effects of their own and of their child's ageing. Despite this, ageing parent caregivers typically do not use health and community services until a crisis occurs. The goal of this project is to ensure that ageing parent caregivers use health and community services appropriately and that services are appropriate to their needs. The project aims to identify the pathways that lead to or prevent ageing parent caregivers accessing services, and to construct a model for ageing parent caregivers' involvement with services that could be tested with a randomised clinical trial. Narrative life history methods are being used to determine how ageing parent caregivers arrived at their present circumstances and factors which influence the caring relationship, its stresses and rewards, and their experiences and views concerning services. Service providers are participating in focus groups to examine perceptions and expectations of services for ageing parent caregivers. Characteristics of the study sample will be compared with state and national population benchmarks. The study is concerned to explore some of the issues related to caring over a lifetime, such as older parents may become disabled themselves; mothers may become widowed and left without spouse support, and adult sons and daughters with intellectual disability are living longer and they are likely to experience the early onset of additional, age-related disabilities. The expected outcomes of the study include identification of the influences on older parents’ use of health and community services; recommendations for the provision of health and community services to reflect older parents’ perceptions and motivations to undertake preventative measures and/or receive support or therapeutic services. The findings will inform planned development of a multi-dimensional strategy to provide Australian Ageing Research Directory 2000 279 Health and Behavioural Sciences cost-effective preventive health and community services for this largely neglected subgroup within the population of caregivers in Australia. Keywords: Service use, intellectual disability, caregivers’ burden, ageing parent, service pathways, life-long caring 514 Title: The nature of behavioural factors contributing to falls in older persons in public places Principal researcher: Ms L Clemson Co-researcher: Dr M Fitzgerald Organisation: School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney (Health and Ageing Research Program) Status: In progress Funding: Australian Research Council, $15,000 Timetable: January 2000 - December 2000 Outline: This study is investigating the nature of behavioural factors that contribute to falls in public places. It fills a gap in current research that has not evaluated behavioural factors as a causal factor in falls. The methodologies employed explore the older person's perceptions of the sequence of events and their behaviours contributing to the fall, situated within an understanding of the environment in which the fall occurred. Activity recall, reconstruction of the fall event and in-depth interviews are utilised. The findings of the study will play a part in health professionals developing preventive, evaluation and intervention strategies. Keywords: Falls, prevention 515 Title: The effectiveness of a community-based program for reducing the incidence of falls among the elderly: A randomized trial Principal researcher: Ms L Clemson Co-researchers: Ms R Twible, Associate Professor R Cumming, Professor H Kendig, Ms M Swann Organisations: A Health and Ageing Research Program between School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney; Department of Public Health and Community Medicine, Faculty of Medicine; Faculty Office, Faculty of Health Sciences; Central Sydney Area Health Service Status: In progress Funding: National Health and Medical Research Council, $202,535; Mercy Family Centre; Balmain Leagues Club Timetable: 2000 - 2002 Outline: This study is evaluating the effectiveness of a community-based program designed to promote risk assessment and management with older people at risk of falling. A randomised trial is being conducted over the next three years with an elderly population, living at home in the inner city suburbs of Sydney, who are aged 70 years and have had a fall. The program consists of seven weekly group sessions covering home and community safety, vision and falls, and exercise, followed by each participant receiving an occupational therapy home visit. The program focuses on risk appraisal and risk management activities designed and implemented for the elderly person using both group and individual experiences. Participants will be followed up for a one year period. The project will develop a manual that will allow health professionals to implement the program. Keywords: Falls, risk appraisal, risk management, prevention, occupational therapy 280 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 3.46 School of Public Health, La Trobe University 516 Title: Ageing with spinal cord injury Principal researchers: Dr G Murphy, Dr D Brown, Dr C Browning, Dr J Pierson Co-researchers: Dr A Young Organisations: School of Public Health, La Trobe University; The Victorian Spinal Cord Service, Austin and Repatriation Medical Centre Status: Planned Timetable: July 2000 - October 2001 Outline: This project comprises a cross sectional survey of four cohorts: (I) 15 years postinjury; (ii) 25 years post injury: (iii) 35 years post-injury; and (iv) 45 years post-injury. Survey instruments will include measures of physical functioning and an interview to identify respondents’ perceptions of the ageing process. Keywords: Spinal cord injury, ageing, quality of life 517 Title: Long-term outcomes of stroke: Sleep-disordered breathing Principal researcher: Dr J Pierson Co-researcher: Mr T Biddlecombe Organisation: School of Public Health, La Trobe University; National Stroke Foundation; University of Melbourne Status: In progress Funding: Resmed Inc., National Stroke Foundation, $20,000 per annum Timetable: March 2000 - March 2003 Outline: This project is part of a large study on long-term outcomes for stroke survivors, being conducted in conjunction with colleagues at the National Stroke Foundation and The University of Melbourne. The sleep-disordered breathing component of the study is being conducted in conjunction with Resmed Inc. and investigates a condition which is a significant risk factor for stroke and is also very common in the acute phase after stroke, affecting two thirds of patients. Breathing disorders during sleep are associated with a number of physical, psychological and social problems that have a negative impact on quality of life. For people who have suffered a stroke, these problems compound those caused by the stroke itself. Clinical observations suggest that symptoms of sleep-disordered breathing persist, in the long-term, after stroke, but empirical investigations of sleep disordered breathing in long-term stroke survivors are virtually non-existent and the effectiveness of therapy for the disorder has not been examined for such patients. The nCPAP device, developed by the Resmed, will be used in this project to test for the presence of sleep-disordered breathing in long-term survivors of stroke. It will also be used to treat sleep-disordered breathing in these subjects and the treatment’s effectiveness in improving functional status and quality of life will be evaluated. Investigation of the effectiveness of treatment for long-term stroke survivors is crucially important, as the treatment regime requires a degree of self-management, which may make it more suitable for use in the long-term after stroke, rather than in the acute post-stroke phase. Keywords: Stroke, sleep-disordered breathing Australian Ageing Research Directory 2000 281 Health and Behavioural Sciences 518 Title: Physical activity in older community dwelling adults Principal researchers: Dr C Browning, Professor H Kendig, Ms L LeDoeuf Organisations: School of Public Health, La Trobe University; Faculty of Health Sciences, University of Sydney Status: Ongoing Timetable: January 1999 - December 2000 Funding: Australian Research Council Small Grant, $10,000 Website: http://sph.latrobe.edu.au Outline: The aims of this project are to: (i) investigate types and levels of physical activity in older community dwelling adults aged 70 and over using a diary methodology; (ii) validate the Physical Activity Scale for the Elderly (PASE); (iii) examine the relationship between mood and physical activity in older adults using a prospective diary methodology. The sample for this project was identified in 1994 for the Health Status of Older People Project (entry 113) and is now being followed up by telephone biannually as part of the Health Behaviours and Outcomes in Older People project (entry 112). A random sample of 60 participants have filled in a two-week diary about their physical activity, mood and self-rated health. And the end of the diary data collection the participants completed the PASE. The diaries revealed daily fluctuations in activity levels which were related to changes in self-rated health and mood. Keywords: Physical activity, healthy ageing, older people, mood, self-rated health 519 Title: Psychosocial and communication profiles of older adults with sensory loss Principal researchers: Ms C Heine, Dr C Browning Organisation: School of Public Health, La Trobe University Status: Ongoing Timetable: January 1999 - December 2001 Website: http://sph.latrobe.edu.au Outline: The aim of the research is to investigate the communication and psychosocial profiles of older adults with sensory loss. The sample comprised 60 adults, aged 60 years and over who attend the Vision Australia Day Centre, Kooyong, Victoria. All participants completed a comprehensive survey aimed at evaluating their vision, hearing and psychosocial status. Both objective (Snellen visual acuity and pure tone hearing measurements) and subjective self-reports of vision and hearing status were made. The psychosocial assessment comprised the evaluation of participants’ adjustment to sensory loss, physical and mental health, quality of life, depression, optimism, mood and social support. Findings suggest that about 75% of participants had dual sensory loss (vision and hearing loss). Participants overall were well adjusted to their sensory disability and optimistic about their future. Their physical and mental health was good and there were few instances of depression. Most participants required assistance with instrumental activities of daily living but showed high positive affect and low negative affect. The amount of social contact and social activity was limited. The findings of this study highlight the rehabilitation needs of older adults with sensory loss and have implications for clients, health professionals and carers. Keywords: Sensory loss, older people, quality of life, adjustment, activity limitations, social support 282 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 520 Title: Quality of life and social isolation in older people Principal researchers: Mr A Joyce, Dr H Lindner, Dr C Browning, Professor H Kendig Organisations: School of Public Health, La Trobe University; School of Psychological Science, La Trobe University; Faculty of Health Sciences, University of Sydney Status: Ongoing Timetable: January 1999 - December 2001 Website: http://sph.latrobe.edu.au Outline: The aim of this project is to examine quality of life and social isolation in older people living in the community. The project consists of two phases. Phase 1 involves interviewing socially isolated older people in order to tap their experiences of social isolation and its meaning to them. The second phase is a study of the predictors and consequences of activity and the relationship of activity to quality of life using data from the Health, Behaviours and Outcomes in Older People study (entry 112). Keywords: Quality of life, adjustment, social support, social isolation 3.47 Southern Cross Institute of Health Research, Northern Rivers Area Health Service 521 Title: Stay On Your Feet Principal researchers: Ms A Kempton, Dr E van Beurden, Mr T Sladden, Ms E Garner Co-researcher: Mr J Beard Organisation: Southern Cross Institute of Health Research, Northern Rivers Area Health Service Status: Completed Funding: NSW Health Department and National Health and Medical Research Council Timetable: 1992 - 1995 Outline: The research objective is to evaluate a multi-strategic community-based intervention to prevent older people falling. The study design is a prospective cohort study comparing randomly selected samples from intervention and control area target populations (residents over 60 years). Repeat, cross-sectional (annual) reviews of falls-related hospitalisations were also conducted providing an independent measure of falls incidence in the target populations. The research is set in the North Coast of New South Wales, a large, rural region. It entails (i) a cohort study (1992-1995) of randomly selected subjects aged 60 years and over, enrolled via telephone interview into intervention and control area cohorts; (ii) a cross-sectional study (years 1991/92 to 1994/95) of all residents aged 60 and over, from intervention and control areas hospitalised with falls-related injuries. The study entailed a four year (1992-1995) multistrategic intervention targeting falls-related knowledge, attitudes, behaviours and risk factors. The main outcome measures were self-reported falls, falls-related hospitalisation incidence rates, falls-related knowledge, attitudes, behaviours and risk factor prevalence rates. At follow-up, there was a 22% non-significant lower incidence of self-reported falls and a 20% lower falls-related hospitalisation rate in the intervention compared to the control cohort. Increased falls knowledge, physical activity, safe footwear, improved balance and reduced intake of falls-related medications were observed in the intervention cohort. The study concluded that promotion of appropriate behaviours, environments and policies can improve falls-related outcomes given a commitment to involvement of older people and sufficient lead time. Keywords: Older people, falls, injury, community-based prevention Australian Ageing Research Directory 2000 283 Health and Behavioural Sciences 3.48 Southern Downs District Health Services, Queensland 522 Title: Aged care intervention project Principal researcher: Ms A Walker Organisation: Southern Downs District Health Services, Queensland Status: In progress Funding: Aged Care Reform Unit Timetable: April 1998 - June 2001 Outline: The anticipated outcome of the project is to develop an innovative and integrated approach to all levels of aged care service provision throughout the District. On completion, the District aims to have developed and trialled a continuum of care model which is cost effective, quality based, responsive to consumer and community needs, and adaptable and responsive to other rural health service regions. The project has five critical phases: (i) Project Officer orientation and Steering Committee establishment; (ii) mapping of provision of aged care services and documenting or processes; (iii) review of all documentation and research; (iv) strategic planning; (v) development of reform implementation strategies. An integrated approach to aged care is vital and will enable strategic planning for organisational reform within the Southern Downs District. Stages 1,2 and 3 are now completed, and strategies are now being developed to improve the quality of service delivery within and across existing services. Strategies will aim to: (a) eliminate duplication across services resulting in cost savings; (b) identify service delivery gaps to provide targets for the future; (c) establish a best practice methodology to improve cross agency management of consumers providing for quality care that is appropriate and timely. The project is perhaps broader in scope in that it not only aims to improve aged care within the residential aged care arena, but focus on consumer needs throughout the provokes of ageing. If quality care can be provided throughout the process of ageing, starting at the lower end of the needs scale (ie. need of assistance in the home), the consumer is more likely to require less complex intervention over the long term. The ideal scenario would be where: consumers are aware of available services; know where to access these services when required; consumers directed through the system providing a clear pathway to the services that best match their needs; over the long term, the consumer may well require short periods of acute care, followed by services that follow them back into the community to ensure continuity and completion of treatment. Keywords: Integration, continuum of care model, research, rural health 3.49 Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, University of Queensland 523 Title: The impact of the HIV/AIDS epidemic on the elderly in rural Uganda Principal researcher: A Williams Co-researcher: G Tumwekwase Organisation: Tropical Health Program, Australian Centre for International and Tropical Health and Nutrition, University of Queensland Status: Completed Funding: Help Age International UK Timetable: January 1995 - December 1998 284 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: All the aged members of the population of Kikole, a village in southwest Uganda took part in this study. Participatory research techniques were employed to explore the multiple factors influencing their well-being, and the relationships between these factors. Livelihood and lifecourse theories were employed, separately and then together, during the analysis of data obtained. Many factors other than material wealth were found to influence individual well-being. The AIDS epidemic has exacerbated the problems of the aged. Not only are they at risk of infection, but their children, particularly their urban-dwelling children have died, and continue to die from the disease. Parents are required to care for them as they die, to pay their burial costs, and assume responsibility for any orphaned grandchildren. They can no longer look forward to receiving support from these children as their abilities decline. The extended family does not provide support to the aged whose children have died. Women, in particular, experience disadvantage: they were more likely to be widowed, to be caring for orphans, and to have fewer surviving children from whom to obtain support. The strategies used by the aged to maintain their well-being and the well-being of those whom they are responsible are examined and shown to be related to individual ability and access to resources. Frailer, poorer, or more isolated individuals have fewer strategies available to them, even though their needs may increase as they adopt orphans or their children leave the village. Individual decline and demise is shown to take place without outside help, and in a situation of increasing deprivation. Keywords: Aged, ageing, lifecourse, vulnerability, HIV/AIDS, rural, socioeconomic factors Nursing 3.50 Australian Nursing Federation (Vic Branch) 524 Title: Survey of staffing levels in residential aged care (nursing homes) Principal researcher: Ms H Sellers Organisation: Australian Nursing Federation (Vic Branch) Status: Completed Funding: Nil Timetable: June 1998 Outline: This project aimed to identify any changes in standards of care and/or staffing levels and skills mix following proclamation of the Aged Care Act 1997. A survey was conducted of nurses working in Victorian nursing homes. The majority of respondents believed there had been a reduction in the number of qualified staff, and an increase in non-nursing duties, in the twelve month period following the proclamation of the Act. Standards of care and overall care hours were considered by most respondents to have declined, whilst work related injuries were believed to have increased. Keywords: Staffing levels, workforce changes, residential aged care, nursing homes 3.51 Centre for Nursing Research, School of Nursing, Queensland University of Technology 525 Title: Creating meaning, responsibility and choice: the lived experience of family in nursing homes Principal researcher: Dr U Kellett Australian Ageing Research Directory 2000 285 Health and Behavioural Sciences Co-researcher: Professor R Nay Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Timetable: 1994 - 1998 Website: http://www.qut.edu.au/health/nrs Outline: The purpose of this ontological-hermeneutic study is to gain a better understanding of the lived experience of family caring in nursing homes. By posing the research question What does it mean to be a family carer? the study challenges nurses to reflect upon the ways in which they approach the family care-giving process. Meaning was disclosed through an exploration of the life-world of fourteen family carers as shared in the telling of their stories of family caring. The passage of time framed how the family carers shared their whole stories illuminating the parts that were pertinent to their particular experience. In this way, the temporal and dynamic nature of the family and caring experience was highlighted. The family carers began their stories with tales of family life past, recognising something was wrong, and the experience of breakdown leading to permanent nursing home placement. Following placement of their relative, they revealed experiences of searching for and creating new possibilities of everyday caring, illuminating what mattered and, therefore, what motivated them to continue their caring role within a long-term aged care facility. They shared concerns defined as barriers which thwarted possibilities for engaged caring experience deemed significant and meaningful. And finally, some family carers discussed the ways in which they had learnt to feel positive about their experience through realising an ability to seize possibilities for themselves and their roles as future carers. By addressing the modes of being a family carer, this study challenges nurses to reflect upon what is it about being a family carer which makes such an existence meaningful, and how this fuller knowing is integral to a new conceptualisation of family practice in nursing homes. A conceptual redefinition of practice which will foster coping and activity, thereby promoting a context of caring that is familiar, stress-reducing, manageable and therapeutic. Keywords: Family care-giving, nursing homes, long-term aged care 526 Title: Evaluation of the effectiveness of in-home nursing health assessments as a means of providing preventive health care and improving health and functional status in a population of community-living older adults living alone Principal researcher: Professor M Courtney Co-researchers: Associate Professor H Edwards, Dr U Kellett, Ms J Stephan Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Planned Funding: Australian Research Council - SPIRT Scheme - APA(I) Timetable: 2001 - 2003 Website: http://www.qut.edu.au/health/nrs Outline: This project plans to undertake a 2x3 randomised control trial with baseline measures undertaken at commencement and six monthly intervals for one year. Participants will consist of community living older adults 75 years and over who are living alone who are not currently receiving community health care services. The intervention will consist of an in-home visit by a registered nurse to screen for medical, functional, and psychosocial problems and to provide suggestions and support to promote health and functional health status. Keywords: Evaluation, assessment, community care, functional status, prevention 286 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 527 Title: Families as care-givers: The long-term care experience Principal researcher: Dr U Kellett Co-Researcher: Professor R Nay, Ms D Gaskill Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Funding: New Researcher Grant, QUT $7,208 Timetable: 1995 - 1996 Website: http://www.qut.edu.au/health/nrs Outline: Family care-giving over the past few decades has emphasised the rational and functional aspects of care. As an adjunct to such research, this hermeneutic-phenomenological study highlights the importance of understanding the lived experience of family caring. In contrast to much family care-giving research which focuses upon the home care experience, this study involves in-depth interviewing and observations of fourteen families’ experiences of caring within a nursing home context. Hermeneutic analysis uncovers a number of themes of meaning which highlight the nature of the family caring experience. ‘Family life past’ shaped by commitment, closeness and belonging shaped how family carers attributed meaning to everyday caring activities and relationships. ‘Change in engaged involvement’ was discussed in terms of a powerful sense of role loss that justified the need to search for newfound ways of caring within an unfamiliar context. Those family carers who felt enabled to engage in activities and relationships, which enhanced their relatives’ quality of life, communicated ‘Possessing a sense of worth’. ‘Living with concern’ was discussed in terms of being out of control, not being heard, and possessing conflicting expectations of participation in care. ‘Fostering continuity’ to combat fear of change was fostered through learning to accommodate in such a way that future caring was anticipated positively. Discussion of these findings will challenge practitioners to: reconceptualise the nurse-resident-family relationship; appreciate the many ways in which family members’ involvement in caring provides significance in their lives; and understand family caregivers through a process of relating which fosters meaningful involvement in caring within a nursing home context. Keywords: Family care-giving, nursing homes, long-term aged care 528 Title: Improving pain management in aged care facilities Principal researcher: Ms R Nash Co-researchers: Associate Professor H Edwards, Mr R Thornton, Ms R Fleming Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: In progress Funding: Commonwealth Department of Health and Human Services, Quality Use of Medicines Program, $37,000 Timetable: April 2000 - April 2001 Website: http://www.qut.edu.au/health/nrs Outline: This pilot project will develop, implement and evaluate a two-pronged strategy for improving the assessment of pain and administration of analgesia by nurses working in aged care facilities. The strategy will be developed in consultation with key informants from the aged care environment and the community, and will comprise a “blueprint” for assessment and decision making with respect to residents’ pain (the Pain Management Flowchart) and an educational program (the Pain Management Program). The project will be undertaken across Australian Ageing Research Directory 2000 287 Health and Behavioural Sciences four aged care facilities, facilitating the operationalisation of both intervention and control conditions. Evaluation of the strategy will be undertaken by a variety of strategies including focus groups/interviews with nurse participants and other key informants, survey questionnaires and auditing of nurses’ documentation concerning pain assessment and analgesic administration. Keywords: Pain assessment, analgesic administration, pain education 529 Title: Maximising independence and autonomy for vulnerable older people in residential care: Facilitating best practice Principal researcher: Associate Professor H Edwards Co-researchers: Ms D Gaskill, Associate Professor P Morrison, Ms F Sanders, Ms E Forster, Ms R Fleming, Ms S McClure Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Funding: Commonwealth Department of Health and Aged Care, Healthy Seniors Initiative Project, $70,000 Timetable: 1997 - 1999 Website: http://www.qut.edu.au/health/nrs Outline: This study aimed to improve the quality of life of nursing home residents by promoting the use of independence supporting behaviours and to improve the links between residents and the community. An education program was developed in consultation with older people, residential care staff and community workers. The purpose of the program was to challenge the myths and stereotypes that many care staff hold toward ageing and older people and to specifically educate staff about the problems of reinforcing dependence in older people. The program required staff to examine strategies to promote resident independence during their daily care activities. Concurrent activities also provided residents with the opportunity to visit community centres. Prior to and following the seven week education program, self-report data were collected from staff and residents. Observational data were also collected of nurse-residents interactions. The interaction patterns were similar to those found in other studies in that there was a large percentage of time when residents were alone or not engaged in any constructive activities. Staff behaviours were more likely to support dependence than independence. Following the education program, residents were more likely to be doing constructive activities. Care staff behaviour also changed in that they responded more to residents, were more supportive of dependence and independence, but were less supportive of general social activities. While changes in staff behaviour were observed following the education program, staff and resident attitudes and perceptions showed minimal changes. Formative and summative evaluations of the education program indicated that care staff were challenged to consider their work practices and they found the program stimulating. There are many factors in the complex environment of residential care that may inhibit staff from shifting their care patterns from those that support dependence to those that support independence. The education program demonstrated that, when made aware of strategies to support independence, staff are willing to examine their practices. To facilitate long term changes in care practices, the concepts and strategies addressed in the education program need to be incorporated into ongoing staff development activities. An outcome of this project has been the development of a manual that could be used by residential care facilities to assist care staff to develop strategies to promote resident independence and autonomy. Keywords: Independence, nurse-resident interactions, education 288 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 530 Title: Meaning in family care-giving: The home care experience Principal researcher: Dr U Kellett Co-Researcher: Ms J Mannion Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Funding: Seeding Grant, QUT $8,000 Timetable: 1995 - 1996 Website: http://www.qut.edu.au/health/nrs Outline: To date family care-giving studies have considered family caring in primarily practical terms such as ‘how to do’ and ‘how to cope’. Research efforts have focused upon exploiting the productive elements of a certain conception of the essence of family caregiving. Thus despite a wealth of studies, the question of the nature of family care-giving is not well understood. This ontological-hermeneutic study highlights the importance of understanding the human experience of family caring at home. The study involved in-depth audio-taped interviews with seven family carers who care for an older relative at home. Thematic analysis of the transcribed interviews uncovered a number of common themes which highlighted unique and shared meanings family carers ascribed to their everyday existence as carers. The findings challenge practitioners to reconceptualise the nurse-family carer relationship, to appreciate the many ways in which family members’ involvement in care provides meaning and significance to their lives, and to understand family carers through a process of human relating which fosters families’ meaningful involvement in caring at home. Keywords: Meaning in caring, family care-giving, home care, community health 531 Title: Older patients in the acute care setting: Differences between rural and metropolitan registered nurses practice Principal researcher: Professor M Courtney Co-researchers: Dr S Tong, Ms A Walsh Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Funding: QUT Professorial Grant, $25,000 Timetable: 1998 - 1999 Website: http://www.qut.edu.au/health/nrs Outline: Two hundred and thirty-one acute care Queensland nurses completed and returned the developed questionnaire. Significant differences were found between rural and metropolitan nurses’ knowledge, attitudes and practices toward the older patients in their care. Rural nurses were more knowledgeable about older patients and reported more positive nursing practices toward them. However, metropolitan nurses report more positive attitudes toward the older patients in their care. As knowledge, attitudes and practices influence both length of hospitalisation and quality of care these deficits need to be addressed through educational interventions. Keywords: Acute care, older patients, nurses, rural, metropolitan Australian Ageing Research Directory 2000 289 Health and Behavioural Sciences 532 Title: Pain management and older patients in the acute care setting: A study of registered nurses’ knowledge, attitudes and experiences Principal researcher: Professor M Courtney Co-researchers: Dr S Tong Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Planned Funding: Australian Research Council – Large Scheme Timetable: 2001 - 2002 Website: http://www.qut.edu.au/health/nrs Outline: Age-related factors complicate both assessment and control of pain in older hospitalised patients. This research aims to establish new models of care to improve the management of pain of older hospitalised patients. The results of the research will increase the knowledge of pain management in older people and enable the development of strategies and a new model of care to ensure nurses are well positioned and well prepared to provide optimal nursing care for older patients. The delivery of new models of care has the potential to facilitate the speedy return of older people to their homes rather than to residential care facilities. Keywords: Acute care, older patients, nurses, pain management 533 Title: Policy and reform: Registered nurse practice in residential aged care Principal researcher: Ms L Venturato Co-researcher: Dr U Kellett, Dr A Cushing, Ms C Windsor Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: In progress Timetable: March 1998 - February 2001 Website: http://www.qut.edu.au/health/nrs Outline: One of the challenges facing the health care system and the nursing profession in the 21st century is the demand for high quality, yet cost effective residential aged care. Meeting this demand requires both the recruitment and retention of committed health care professionals and the development and implementation of appropriate plans and policy. This study explores the practice experiences of registered nurses in residential aged care facilities and the impact government policy and reform exerts on that practice. The purpose of this study is to challenge registered nurses to reflect on their role in residential aged care (what they do), and through consideration of policy and reform (why they do it), to explore their work practices and options for service delivery. Interview transcripts, policy documents and journal notes will be critically analysed in order to identify those aspects of practice and policy which support each other and those that do not. This study will discuss how policy shapes and influences the context of everyday practice in residential aged care. Particular attention will be given to discussing strategies that address traditions and practices that influence the recruitment and retention of registered nurses, and the development and implementation of appropriate plans and policy which address this issue. Keywords: Residential care, aged care policy, nursing practice 290 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 534 Title: Randomised trial and evaluation of an Australian National – Aged Care Quality Indicator Instrument (AN-ACQII) Principal researcher: Professor M Courtney Co-researchers: Associate Professor H Edwards, Dr U Kellett, Ms J Stephan Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Planned Funding: Australian Research Council – SPIRT Scheme – APA(I) Timetable: 2001 - 2003 Website: http://www.qut.edu.au/health/nrs Outline: This project plans to undertake a national randomised trial of an Australian National - Aged Care Quality Indicator Instrument (AN-ACQII). The nominal group technique will be used with key stakeholders (representatives from Commonwealth and State governments, professional organisations and associations, aged care industry organisations, etc) to identify, develop and refine key quality indicators and measures of quality care. Following piloting, a national trial will be undertaken in a stratified sample of 200 randomly selected aged care facilities throughout Australia for a period of one year. The stratification will be based on size, type of facility (stand alone or multistage), ownership and funding, and geographic location. Keywords: Quality indicator, residential care, randomised trial 535 Title: Supporting family carers in caring for older people in the community in Indonesia Principal researcher: Ms J Sahar Co-researchers: Professor M Courtney, Associate Professor H Edwards Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: In progress Funding: World Health Organisations Scholarship Timetable: 1999 - 2002 Website: http://www.qut.edu.au/health/nrs Outline: A quasi experimental design is being used to undertake the trial of a family carers training program and carer’s kit in community villages in Jakarta, Indonesia. The experimental group will undergo the family carer’s training program and receive the carer’s kit together with three follow-up support and advice home-visits at two-monthly intervals over a six-month period. The control group will receive the family carers’ training program and carer’s kit at the end of the study. Extensive health screening will be undertaken pre and post intervention. Data collected from the older person will include health status, utilisation of health services, activities of daily living, depression, social support and life satisfaction. Data collected from family carers will include knowledge and attitudes to older people, carer burden, depression, and social support and life satisfaction. Keywords: Community health, carer burden, family carers, health assessment, utilisation of health services 536 Title: Survey of the knowledge, attitudes and practices of older people in the acute care setting Principal researcher: Professor M Courtney Australian Ageing Research Directory 2000 291 Health and Behavioural Sciences Co-researchers: Dr S Tong, Ms A Walsh Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: Completed Funding: Australian Research Council, Small Grant, $10,000 Timetable: 1998 Website: http://www.qut.edu.au/health/nrs Outline: Many studies reporting nurses’ knowledge of and attitudes toward older patients in long-term care setting have used instruments designed for ‘older people’. However, few studies have investigated nurses’ knowledge of and attitudes toward ‘older patients’. In order to address these shortcomings, a self-report questionnaire was developed and trialed and compared to findings from Palmores’ FAQ. Preliminary findings suggest nurses’ attitudes toward ‘older patients’ were found to be not as positive as their attitudes toward ‘older people’. Keywords: Acute care, older patients, nurses, attitudes 537 Title: The transition of aged persons from home to retirement villages: policy for community development Principal researcher: Mr R Thornton Co-researchers: Professor B Handsford, Professor M Courtney Organisation: Centre for Nursing Research, School of Nursing, Queensland University of Technology Status: In progress Timetable: January 1998 - December 2001 Website: http://www.qut.edu.au/health/nrs Outline: This research is exploring the concept of transition through the personal experiences of aged persons moving from their home environment (independent living) to retirement village (community living). The need for such a transition in aged persons’ lives is often predicated by their inability to remain in their own home due to perceptions of an insecure living environment, structural issues with present living situation, loss of a partner, and diminished family support. When confronted with such issues, aged persons may be required to make decisions regarding more suitable living arrangements in an attempt to rectify same. In Australia, alternatives to the home living environment range from aged care facilities ( nursing homes and hostels) through to retirement villages. The approval to move into an aged care facility is determined as a result of a rigorous assessment performed by a government agency (Aged Care Assessment Teams - ACAT) and is focused on the provision of appropriate levels of care for people who can no longer maintain their own independence. This is not, however, an alternative for many aged persons who can still maintain a reasonable degree of independence if they are able to access a less institutional option. One option for these aged persons is to make the transition from home to community living through the purchase of a retirement village unit. While there is extensive research data available in the literature regarding aged care facilities, such as hostels and nursing homes, the retirement village setting remains relatively an unexplored domain and the transition into such a community has not been researched. Secondly, it appears that the residents of these centres are making this transition at a later stage of life and are facing increasing dependence on internal and external health resources which may not have been originally envisaged by developers. In an attempt to provide the ongoing care required, residents, prior to and following this transition, may seek access support from within the wider community. Through this research using a grounded theory approach, residents from five disparate geographical 292 Australian Ageing Research Directory 2000 Health and Behavioural Sciences areas will be interviewed within six months of making this transition. The research will attempt to reach a deep understanding of the reasons underpinning the need for these residents to make this transition and to also elicit factors which attract them into a retirement village setting. From this research a framework will be developed to better inform community service providers about the complexity of the issues faced by aged persons making this transition. It will also explore their subsequent ongoing health care requirements based upon their experiences. Keywords: Retirement villages, transition 3.52 Centre for Nursing Research & Development, School of Nursing, Curtin University of Technology 538 Title: Pilot study of stroke patients and their carers in Perth, Western Australia Principal researcher: Dr C Adams Co-researchers: Professor M Clinton, Ms E Baker, Mr K Jones, Dr T Tse, Dr A Passmore, Dr R Marquis Organisations: Centre for Nursing Research & Development, School of Nursing, Curtin University of Technology; School of Occupational Therapy, Curtin University of Technology; Sir Charles Gairdner Hospital, Perth Status: In progress Funding: Curtin University Research Scheme, Olive Anstey Nursing Fund, $8,000 Timetable: April 2000 - July 2000 Outline: This is a collaborative project between the School of Occupational Therapy and the Centre for Nursing Research & Development and the multi-disciplinary team caring for stroke patients at Sir Charles Gairdner Hospital. The project will forge collaborative links between the three departments for the purpose of research which will benefit the carers and the stroke patients they care for. The pilot study design is a descriptive study of stroke survivors discharged from Sir Charles Gairdner Hospital and their carers. It will involve about 30 patients and their carers. The target population is patients with a diagnosis of stroke who are discharged from the hospital. For the purpose of this study, a stroke is defined as a focal neurological deficit due to cardiovascular disease (Stroke Unit Trialists’ Collaboration 1999). People with stroke secondary to a surgical procedure will be excluded. Eligible patients must understand English, be discharged home and be dependent on a person (carer) to provide regular assistance with daily living activities. The carer will be the main person caring for the stroke patient at home. The definition of a carer for this study is the person providing the largest amount of care for the stroke patient at home. Basic demographic data will be collected about both the patient and the carer. The physical health of the patients and their ability to perform their Activities of Daily Living will be assessed at discharge and followed up one month later by research assistants using the Barthel Index. Training and inter-rater reliability will be established at the start of the study. The general health of the patient and their carers at the time of the patient’s discharge will be assessed using the WHOQol-Bref. Data collection will be repeated at one month after discharge. General health of both the carer and the patient will again be assessed by the WHOQol-Bref. The burden of caregiving experience by the carer will be determined by the Braithwaite scale. Where a stroke survivor or their carer are identified as high risk for depression, they will be asked to complete the Zung Self-reported depression scale. Social support and the use of formal of informal community support services will be quantified using a questionnaire. Data will be analysed in SPSS. Keywords: Stroke, carers, community, social support, quality of life Australian Ageing Research Directory 2000 293 Health and Behavioural Sciences 3.53 Centre for Research into Nursing and Health Care, School of Nursing & Midwifery, University of South Australia 539 Title: Coping with crisis: How Australian families search for and select an aged care facility for a family member upon discharge from an acute care setting Principal researchers: Professor J Cheek, Ms A Ballantyne, Ms M Tucker Organisation: Centre for Research into Nursing and Health Care, School of Nursing & Midwifery, University of South Australia Status: Completed Funding: The Australian Rotary Health Research Fund 1998-1999, $22,500 Timetable: March 1998 - March 1999 Website: http://www.unisa.edu.au/CRNHC/ Outline: This study aimed to describe and examine the search and selection process undertaken by families of individuals admitted to acute care settings (hospitals) who are assessed as requiring admission to an aged care facility such as a nursing home or hostel upon discharge. There is very little documented evidence of studies examining this process and its effects on the families concerned. In response to this gap in the literature, the researchers interviewed 25 families where a family member had been recently admitted to an aged care facility following discharge from an acute care setting. Where possible, both the family member admitting the resident (the sponsor) and the resident themselves were interviewed. The study explored the process undertaken and the issues involved from the point of view of these participants. The results provide valuable insights that can be used to inform and assist families who experience this process in the future, health care professionals working with families in this situation, and policy makers in the aged care arena. Keywords: Residential care, discharge, families, nursing homes, hostels 540 Title: Effects of casual employment on perceptions of well being among older people Principal researcher: Dr C Bradley Co-researcher: Ms U Dahl Organisation: Centre for Research into Nursing and Health Care, School of Nursing & Midwifery, University of South Australia; Social Options Australia Status: In progress Funding: SA Office for the Ageing, $43,000 Timetable: February 2000 - November 2000 Website: http://www.unisa.edu.au/CRNHC/ Outline: The effects of employment, particularly in a fulfilling and enjoyable job, on levels of well-being have been known for some time as beneficial to workers, and current Australian research indicates that this can extend to general health. One of the major changes in employment conditions in recent years has been a move to greater numbers of casual jobs on offer and about one quarter of Australian employees now work on a casual basis. Most casual jobs are hourly paid, are non-permanent and are often characterised by flexible hours. It is important to recognise the fact that casual employment suits some lifestyles (for example students and some workers with family responsibilities). However research shows that younger workers may want increased working hours, and half all casual workers prefer permanent work. Significantly, there appears to be very little research on the extent to which casual work is undertaken by older people, and the effects of such work upon them. The aim of the research is to explore feelings held by this group of workers and their perceptions about 294 Australian Ageing Research Directory 2000 Health and Behavioural Sciences the influence of casual work on health and well-being. Focus groups of organisation representatives will be held in both metro and rural centres, and a survey of older workers, including those living in the rural areas, will be run using a questionnaire and interviews. Keywords: Health status, part time employment, labour market 541 Title: Ensuring excellence: An investigation of the issues that impact on the registered nurse providing residential care to older Australians Principal researchers: Professor J Cheek, Ms A Ballantyne, Dr J Jones Co-researcher: Ms M Klecko Organisations: Centre for Research into Nursing and Health Care, University of South Australia; Aged Care and Housing Group Inc., South Australia Status: In progress Funding: Australian Research Council Strategic Partnerships with Industry, Research and Training Scheme; Aged Care and Housing Group Inc, $120,000 Timetable: January 2000 - December 2001 Website: http://www.unisa.edu.au/CRNHC/ Outline: The role of the registered nurse in residential aged care settings is problematic, yet is identified as a key factor in ensuring excellence in care provision to this group of older Australians. The aim of this study is to provide a comprehensive picture of the issues that impact upon the registered nurse providing care to older Australians living in residential care settings. This will contribute to best practice initiatives to enhance the health and well-being of older Australians and enhance the professional working life of registered nurses working in this sector. The study is being conducted in twelve residential aged care facilities in South Australia. Adopting a multifaceted approach, this qualitative study will use a range of data collection methods such as interviews and focus groups to identify and describe issues impacting on registered nurses. Building on this data participatory action, research workshops will be conducted with representatives invited from each of the twelve facilities to plan strategies addressing the identified issues impacting on the registered nurse in the provision of care. From this, recommendations to facilitate best practice with respect to registered nurses in residential aged care at the individual, organisational, and policy levels will result. Keywords: Registered nurse, older people, residential aged care, qualitative research 542 Title: Towards Aboriginal longevity Principal researcher: Dr A Barnes Co-researchers: Ms A Ballantyne, Ms J Burden Organisation: Centre for Research into Nursing and Health Care, School of Nursing & Midwifery, University of South Australia Status: Completed Funding: Department of Human Services Timetable: Completed June 1998 Outline: This research project provided a review of health and ageing factors that affect the Aboriginal population of South Australia and the consequential loss of longevity. Many Aboriginal and Torres Strait Islanders are being denied a basic human right – the right to an old age. In 1996 the Office for the Ageing initiated a comprehensive review of existing literature on premature ageing in the Aboriginal community of South Australia. This review is presented in two volumes: Volume 1 provides an overview of the “Health and Ageing in the Aboriginal Population of South Australia” and contributes to planning, policy and Australian Ageing Research Directory 2000 295 Health and Behavioural Sciences prioritising in the area. Volume 2 provides a comprehensive annotated bibliography of “Health and Ageing in the Aboriginal Population of South Australia” and examines available literature related to factors affecting premature ageing in Indigenous populations. The annotated bibliography explores differing aspects of Aboriginal ageing and health as represented in secondary data sources, including journal articles, dissertations, and conference papers. The review undertook a comprehensive examination of existing relevant literature since 1989. It analyses the literature and the issues and it highlights major areas for actioning under the four headings of policy development, basic research, services, development and education. The project carried out extensive searches of a range of electronic databases and peripheral sources. Further material was obtained through searching the Australian Bibliographic Network for books, conference papers, and research reports concerned with factors affecting ageing and health in Aboriginal communities. Keywords: Indigenous, Aboriginal, longevity, health, policy development, services 3.54 Department of Nursing and Public Health, RMIT University 543 Title: An investigation of the care and management practices associated with percutaneous endoscopic gastrostomy tubes in elderly patients with dysphagia secondary to cerebrovascular accident Principal researcher: Mr I McGrath Co-researcher: Ms A Paterson Organisation: Department of Nursing and Public Health, RMIT University Status: In progress Funding: RMIT University, $12,500 Timetable: February 2000 - December 2000 Website: http://www.bh.rmit.edu.au/naph/research.html Outline: The purpose of this study is to examine the long term effects of percutaneous endoscopic gastrostomy tube use and to explore the nursing care and management practices associated with nursing home residents who have percutaneous endoscopic gastrostomy tubes in-situ. The study will use an exploratory descriptive design. Directors of Nursing from nursing homes throughout Victoria will be contacted by telephone in order to collect data in relation to percutaneous endoscopic gastrostomy tube prevalence. A random sample of 20 nursing homes (ten from the Melbourne metropolitan area and a further ten from country locations) identified from the initial telephone contact as having residents with percutaneous endoscopic gastrostomy tubes in-situ will be selected for detailed examination. Permission will be sought to gather demographic information about residents being fed with percutaneous endoscopic gastrostomy tubes and to interview staff involved in the care of these residents. The format of this examination will include the administration of a questionnaire and several semi-structured interviews of nursing staff. Each interview will take approximately 30 minutes, the questionnaire will cover details of policies and protocols relating to the care and management practices, staff education, and assessment and rehabilitation strategies. If needed for further clarification, nursing notes will be used to identify problems that have been experienced with percutaneous endoscopic gastrostomy tubes. The detailed examination will include assessment of quality of care from the nurse perspective. Cost will be examined, for example, by comparing the daily expenditure per resident on food versus costs of enteral feeding. Issues of independence and self-provision examining trends and choices that have implications for individuals and communities in which they live will be explored. Ethical decision making in relation to assessment and maintenance of percutaneous endoscopic 296 Australian Ageing Research Directory 2000 Health and Behavioural Sciences gastrostomy tube feeding regimes will be examined, and recommendations will be made in relation to further education for carers involved with residents with percutaneous endoscopic gastrostomy tubes. Keywords: Nursing care, post stroke care, percutaneous endoscopic gastrostomy tubes, quality of life, nutrition, professional education, enteral feeding, dysphagia 3.55 International Institute of Hospice Studies, Flinders University of South Australia 544 Title: Palliative care nurse practitioners in aged care facilities Principal researcher: Emeritus Professor I Maddocks Co-researchers: Ms D Parker, Ms A McLeod, Mr P Jenkin Organisation: Southern Community Hospice Programme, International Institute of Hospice Studies, Flinders University of South Australia Status: Completed Funding: Ambulatory Reform Program, Commonwealth Department of Health and Family Services $87,000; Department of Human Services, SA Health Commission $50,000 Timetable: March 1998 - April 1999 Outline: The aims of the project were to develop a clear role for the palliative care nurse practitioner in aged care facilities; appoint and develop the knowledge and skills of ‘link nurses’ in aged care facilities; increase palliative care confidence, knowledge and skills of all staff in aged care facilities; encourage aged care facilities to become key providers of palliative care. Over a twelve month period, two palliative care nurse practitioners were employed by the Southern Community Hospice Programme to provide an education and consultancy service to aged care facilities in the southern region of Adelaide. During this time, 84 carers and nurses were trained as link nurses. Evaluation of the education and consultancy services indicated that dedicated palliative care nurse involvement in aged care facilities improves the knowledge, confidence and skills of the staff working in this area. Keywords: Advanced nurse practice, residential care, palliative care, dying, education 3.56 Nursing Department, Faculty of Sciences, University of Southern Queensland 545 Title: The socialization of beginning nursing students in academia to prevent ageism: An action theory approach Principal researcher: Mrs M B de la Rue Co-researcher: Associate Professor I Coulson Organisation: Nursing Department, Faculty of Sciences, University of Southern Queensland Status: Commissioned Funding: Queensland Nursing Council Timetable: 2000 - 2002 Outline: “Ageism” has been used to describe a process of systematic stereotyping and discrimination against old people because they are very old, in a similar vein as racism and sexism accomplish this with skin color and gender. The seriousness of this is that, whilst it has been found that all health care professionals demonstrate “ageism” both overtly and covertly in their practice, nursing students, at the beginning of their Bachelor in Nursing programs, have been found to be a major source of ageist treatment. The aims of this study is to, in nursing students at the beginning of their Bachelor in Nursing Pre-Registration course, (i) explore their attitudes towards ageism; (ii) explore the issues arising out of practicing Australian Ageing Research Directory 2000 297 Health and Behavioural Sciences ageism; and, (iii) empower the nursing students themselves to come to terms with the issues and make choices in relation to preventing reproduction of ageism in their future practice as a registered nurse. Participatory action research will provide the theoretical direction for this study. Data will be collected by focus groups. Keywords: Ageism, nurses, professional education 3.57 School of Nursing, Deakin University 546 Title: Does a Gerontic Nurse Specialist make a difference in acute care? Principal researcher: Professor H Cox Co-researchers: Professor L Ung, Ms L Raven Organisation: School of Nursing, Deakin University Status: In progress Funding: Nurse’s Board of Victoria Major Grant, $19,650 Timetable: April 2000 - April 2001 Outline: This project aims to identify any significant impact of a Gerontic Nurse Specialist on the functional status outcomes of elderly medical patients admitted to an acute care hospital with a diagnosis of heart failure. It also examines the relationship between (i) problems experienced by elderly patients with identified known risk factors, and (ii) functions performed by the Gerontic Nurse Specialist pertaining to these risk factors, and their functional status outcomes. Keywords: Aged care, elderly, acute care, functional decline 547 Title: The impact of using multi-sensory environments for leisure activity on the wellbeing of residents and carers in an aged care facility Principal researcher: Professor H Cox Co-researchers: Mr I Burns, Ms H Plant Organisation: School of Nursing, Deakin University Status: Completed Funding: Alzheimer’s Disease and Related Disorders Association of Australia, 1998 Dementia Research Grant, $10,000 Timetable: January 1999 - March 2000 Outline: This study set out to determine the effect on well-being of three environments in an aged care facility: a landscaped garden, a multi-sensory Snoezelen room and the usual lounge area of a nursing home. A rating scale was used to measure affect response from 24 elderly residents with dementia (Affect Rating Scale, Lawton, Van Haitsma, & Klapper, 1996). Trained observers rated each participant three times in each environment, with four ratings done in each twenty minute observation period. This gave a total of nine observations per resident: 216 observations and 1,152 ratings. In addition carers and relatives were interviewed to ascertain their beliefs about how residents respond to each of the environments, and how they themselves respond. Examples of findings from the study are that there is significantly more sadness in the living room than in either of the other areas (<.05), that the majority of affect states recorded in any setting were positive, with a strong shift from contentment to pleasure and interest (<.001) in the various environments. Significant differences were found in affect rating determined at different stages of resolution of dementia, with those in stage 1 indicating 58% pleasure, 48% for those in stage 2 and 28% in stage 3. Conversely, ratings of contentment for those in Stage 1 were 22%, 29% for those in stage 2 and 40% for those in 298 Australian Ageing Research Directory 2000 Health and Behavioural Sciences stage 3. Information gleaned from the interviews indicate that both the outdoor environment and the Snoezelen room are used and liked by staff for different reasons. The garden gives a sense of well-being from the fresh air, the plants and the water feature. The Snoezelen room, however, is a place of retreat where because of its meditative ambience is less likely to encourage interruption. Both carers and relatives indicated that residents responded most positively to the ability to hose in the garden. There is an element of ‘breaking the rules’ where normally gardens in nursing homes are manicured and not to be tampered with. Another important finding is that elderly residents with dementia need time to grow familiar with the Snoezelen environment and that an initial rejection of the environment should not be taken as final. Keywords: Multi-sensory environments, leisure, elders with dementia, well-being, residential care 3.58 School of Nursing (NSW), Australian Catholic University 548 Title: Access to and utilisation of community aged care services by elderly FilipinoAustralians in Southwestern and Western Sydney Principal researcher: Ms M Mayo Co-researcher: Dr C Leigh Organisation: School of Nursing (NSW), Australian Catholic University Status: Completed Funding: New South Wales Research Interest Group (NRIG) Timetable: February 1998 - November 1998 Outline: This research project sought to identify the community aged care needs of FilipinoAustralians residing in Southwestern and Western Sydney. Information collected in this study aimed to determine the awareness of elderly Filipino-Australians regarding the aged care services available to them in the community, and their access to and use of these services. A descriptive exploratory survey design was used. The sample consisted of 110 FilipinoAustralians, aged 60 and over, of normal health, currently residing in Southwestern and Western Sydney. Data was collected via a questionnaire developed by the researchers. Data analysis involved collating and presenting the data using descriptive statistics and cross tabulations. Findings reveal that the majority of the participants were aware of community services such as Home Care, the Australian Hearing Services, and Community Nursing. The participants gained their knowledge about community services from informal sources and non-government voluntary organisations. However, only a quarter (25%) stated they had used a community service. Language proficiency was found to be the major factor that influences the awareness of community services among Filipino-Australians. Transportation was the major factor that influenced the access to community aged care services. Age and gender were two other factors that affected both the access to and utilisation of community services. Recommendations arising from the research include service providers implementing information packages for general practitioners about community aged care services, and the enhancement of awareness of services via non-government, voluntary organisations such as Senior Citizens Groups. A need to improve the language proficiency of elderly FilipinoAustralians is also evident. Keywords: Filipino Australians, aged care services, awareness, access Australian Ageing Research Directory 2000 299 Health and Behavioural Sciences 549 Title: Falls in elderly nursing home residents: Registered nurses’ knowledge and practice Principal researcher: K Y Lee Co-researcher: Dr C Leigh Organisation: School of Nursing (NSW), Australian Catholic University Status: Completed Funding: Nil Timetable: February 1995 - August 1996 Outline: This study explored registered nurses’ (n=50) knowledge and practice of preventing falls among elderly residents living in nursing homes, a population prone to falls. The study was conducted in eight nursing homes in the Manly, Warringah and Pittwater local government areas of Sydney. A data collection instrument in the form of a 30-item questionnaire was developed to measure the knowledge of registered nurses. Experts validated the questionnaire, and a test-retest was conducted to assess the reliability of the tool. The registered nurses were also interviewed to explore their experiences of elderly nursing homes residents’ falls and the strategies used to prevent falls. Overall, the registered nurses’ knowledge level can be considered as satisfactory (scores ranged from 55% correct to 93% correct with a mean score of 72%), but some areas of concern emerged. For example, 60% of registered nurses studied still believe that the use of restraints could prevent falls, which is contrary to previously published findings. A third of the sample reported that they implemented effective precautionary measures that reduced the incidence of falls among residents in their care, but the remainder of the registered nurses indicated that they still lacked basic nursing strategies for fall prevention. Results indicate that registered nurses’ knowledge had no correlation with variables such as age, years of experience as a registered nurse working in a nursing home, current nursing position or even gerontological qualification. Forty per cent of the registered nurses suggested the need for more intensive information on falls prevention that could be incorporated into practice. Implications for administrators and gerontic nurses indicated the necessity to provide comprehensive knowledge and strategies for registered nurses in nursing homes to reduce the incidence of falls among residents. Keywords: Elderly, nursing home, falls prevention, Registered Nurses, knowledge 550 Title: Maintenance of a healthy lifestyle amongst older Filipino-Australian adults Principal researcher: Ms I Fischer Co-researcher: Dr C Leigh Organisation: School of Nursing (NSW), Australian Catholic University Status: Planned Funding: Current application Timetable: 1 April 2000 - 31 December 2000 Outline: There is a paucity of available data on healthy lifestyle habits and the associated health status of non-Australian born citizens. This preliminary study will focus on one special population (Filipino Australians, aged 45-65 years) to seek their perception of health status and their involvement in activities (physical/leisure) outside of work hours. This study will also identify plans which the participants envisage they will adopt on retirement from fulltime employment to maintain a good health status. Data will be collected with a questionnaire followed up by focus interviews. Keywords: Filipino Australians, physical activity, lifestyle habits, ethnic aged 300 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 551 Title: Masters Games: Healthy and Safe Physical Activity for Older Australians? Principal researcher: Ms E Rutherford Co-researchers: Ms I Fischer, Dr C Leigh Organisation: School of Nursing (NSW), Australian Catholic University Status: Completed Funding: ACU Incentive Grant $1,500 Timetable: 1 August - 31 December 1999 Outline: This preliminary study focused on a group of older persons competing in swimming and/or track events at the Australian Masters Games 1999. The 320 participants completed an anonymous questionnaire that consisted of open and closed-ended questions, and Likert scale response. Response sections included nutrition, stress management, sleep/rest and recreation, training regime, injury management and perceived health status. The results indicate that no significant difference could be established between genders or ages and perceived health status for swimmers or track event athletes, with participants’ self report information indicating a high level of healthy lifestyle behaviours. Training and injury management data highlight the necessity for community resources to be channelled into non-elite athletes’ training conditions and coaching in order to encourage older Australians to participate in safe physical activities. Keywords: Healthy lifestyle, physical activity, mature/veteran athletes 3.59 School of Nursing, Faculty of Health Sciences, University of Tasmania 552 Title: A fusion of horizons: towards an understanding of the meaning of being an older patient in an acute care setting Principal researcher: Ms B Walkem Organisation: Tasmanian School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Timetable: July 1995 - July 1997 Outline: There is extensive media coverage of the plight of older people in hospital and one could argue that this is of topical concern. Older people are being discharged ‘quicker and sicker’. This catchcry of the nineties implies that the economic rationalist approach to health care has a deleterious effect on the health outcomes of our older population. As the older population increases so does their need for health care, particularly in the acute care sector. While there is a host of empirical studies on the ageing process and the various phenomena related to the diversity of body systems, little is known of the experiences of older people who are acutely ill and admitted to hospital. The aim of this study is to provide an understanding of the meaning of being an acutely ill, older patient using an interpretive phenomenological approach. The experience of being acutely ill and in hospital is revealed through the narratives of four older patients admitted to a provincial hospital in Tasmania. The participants in the study related their experiences of admission to hospital in the accident and emergency department, the episode of acute illness and discharge home again. In relating their story of hospitalisation, the older participants shared with the researcher their reflections, their realities, their fears of health outcomes and their concerns of the everyday taken-for granted experiences of being an older patient. The participants described the experience of being an invisible receiver of nursing care delivered by invisible nurses. There was an undercurrent of dissatisfaction with nursing care when delivered in a rushed and impersonal manner to the Australian Ageing Research Directory 2000 301 Health and Behavioural Sciences older participants. There was concern with respect to the amount of time the older participants were detained in the accident and emergency department, waiting to be admitted to the ward. The participants view of nursing care vacillated between high praise associated with the highly technical care delivered in areas such as intensive care and coronary care and serious criticism for a lack of caring and concern for the individual, the patient. Less than favourable attitudes were exhibited towards the older patients by some nurses. The understandings gained from this study deserve further investigation, so that nursing can examine its practice from the perspectives of older people. Keywords: Hospitalised aged, phenomenology, hermeneutics, qualitative research, ontological, Heideggerian, nursing 553 Title: At the interface: Developing links between acute and community services in aged care Principal researcher: Mr A Robinson Organisations: School of Nursing, Faculty of Health Sciences, University of Tasmania; School of Nursing, La Trobe University Status: Nearing completion Funding: Nil Timetable: 1995 - 2000 Outline: Health reforms have progressively deinstitutionalised the provision of services whilst increasing the complexity of options and health care providers. As a result, the coordination of care through the health and community care system has become a major preoccupation of government and health care providers alike. The ageing of the Australian population further complicates this situation as the elderly are high users of health care services and have poorer health outcomes. This is a central concern of the study, which involved a group of service providers, a rural Aged Care Assessment Team (ACAT), who have a key function in assessing the health and social needs of aged clients. The members of the Aged Care Assessment Team participated in an action research project to develop and implement strategies to facilitate the transition of hospitalised aged clients across the interface of health and community care. Nurses in acute care hospitals and general practitioners in the community were targeted by the Aged Care Assessment Team members in a series of networking projects designed to improve assessment and referral outcomes for their aged clients. The findings highlight that employing a collaborative approach with health professionals working in strategic local and specific rural contexts, is a highly effective in developing their knowledge of services, and interest in and ability to create linkages between sectors in aged care. Reports from participants in the networking projects indicate that this enhances both assessment and referral outcomes for their aged clients. Keywords: Assessment teams, coordinated care, rural health, action research 554 Title: At the margin: Nurses' experience in the social assessment of the aged in an acute care context Principal researcher: Ms K Hill Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Funding: Nil Timetable: May 1999 - November 1999 Outline: In a climate of 'quicker and sicker' discharges, social assessment of hospitalised aged is emerging as an important component of health care particularly if their needs are to be 302 Australian Ageing Research Directory 2000 Health and Behavioural Sciences met following discharge. It is argued that nurses are in an ideal position to assess the needs of patients, however, little research has been conducted into the everyday 'process and practice' of assessment. With this in mind, this study utilised a critical research methodology to explore the experiences of four nurses in assessing the social needs of aged patients in an acute care context. In addition to giving the participants an opportunity to explore these experiences, consistent with the interests of critical research, the study also aimed to encourage them to critically reflect on the issues raised and explore possibilities for improving their assessment practices. Critical dialogues, the development of an 'issues paper' followed by a group discussion, facilitated this critical intent. Throughout the research process, the participants discussed a diverse array of complex issues associated with their experiences of assessing aged patients' social needs. The comments relating to their experiences indicate that social assessment practices on the ward are constructed as 'ad hoc', an adjunct to 'other' more important forms of care and have a marginal status. The findings of the research highlight an array of socio-political and cultural interests which, in part, mediate nurses' experience in the social assessment of the aged and situate them at the margins of this process. Keywords: Gerontological nursing, nursing culture, assessment, social assessment, critical research 555 Title: Caught in a bind: Nursing dialogues on caring for the aged in a contemporary acute care context Principal researcher: Ms B Francis Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Funding: Nil Timetable: May 1998 - November 1998 Outline: In the context of a changing population demographic in Australian society, the provision of health care services to aged people is becoming an increasingly significant issue. Given the substantial use of health care services by increasing numbers of aged people, mounting concerns have been raised in relation to the escalating costs involved in providing for the health care needs of this group. Of further significance to the provision of health care to the aged have been the reforms implemented in the acute care context aimed at reducing expenditure and improving efficiencies. These reforms have impacted both on the aged patients in hospitals and subsequently the nurses responsible for providing their care. A critical methodology was utilised in this study to explore the experiences of four registered nurses in providing care for the aged in a contemporary acute care context. Using this research approach, the participants explored their experiences in caring for aged people on a hospital ward and critically reflected on those experiences in order to uncover the operation of competing agendas in health care. A major theme that emerged during the conduct of the study was the sense of dissonance the nurses experienced in attempting to juggle the competing interests in their practices of caring for the aged. Keywords: Acute care nursing, nursing culture, gerontological nursing, dissonance, critical research 556 Title: Making sense of registered nurses' experiences caring for older people in an acute care setting Principal researcher: Ms D Lynch Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Australian Ageing Research Directory 2000 303 Health and Behavioural Sciences Status: Completed Funding: Nil Timetable: May 1999 - November 1999 Outline: Older people in Australian society comprise the majority of clients of acute care institutions and registered nurses must care for them on a daily basis. This research project seeks to make sense of registered nurses’ experiences, caring for older people, in an acute care setting. Utilizing a Heideggerian hermeneutic methodology, the study sought understanding from the experiences of these nurses, whilst caring for older people, in order to elicit meaning from their stories. By immersing herself in the data, several understandings were illuminated to the researcher by means of a fusion of horizons. These understandings revealed the nature of the phenomenon in question, in this case, a nursing mind-shift. Within the confines of the entrenched mechanistic, biomedical model, which is the focus of the acute care institution, these nurses have adjusted their own focus and consequently their actions, towards the individual client and towards more realistic, holistic nursing, when caring for older people. Keywords: Acute care nursing, nursing culture, gerontological nursing 557 Title: The continuing care conundrum: Nursing dialogues on discharge planning Principal researcher: Ms C Di Cocco Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Funding: Nil Timetable: May 1995 - November 1996 Outline: In the climate of today's 'health care revolution', discharge planning assumes an ever increasing importance. Increased hospital throughput, decreased lengths of stay, and the subsequent discharge of patients with higher levels of acuity into the community means that assisting these patients to successfully move from one level of care to another (such as hospital to home) is essential for a hospital's financial viability. To facilitate this process, effective discharge planning is essential. One group central to the discharge planning process are nurses. However, there is a paucity of literature that addresses what nurses actually 'do' in discharge planning and the cultural and contextual issues which potentially compromise their ability to perform these functions. The question posed in this study is, "What are nurses' experiences of discharge planning and what insights do they develop through critically reflecting on these experiences?" The study aims to address this question through a critical exploration of the experiences of five nurses who practice on an acute care ward in a large general hospital in northern Tasmania. Through a series of critical dialogues and a group discussion the nurses explored their discharge planning practices. A discussion of themes has been structured around the hidden nature of these practices and the apparent paradox between this and the central role they play in implementing the discharge planning process. Keywords: Discharge planning, nursing culture, acute care nursing, critical research 558 Title: The hospital discharge and early convalescence experience of older persons following colorectal surgery Principal researcher: Ms S Copping Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Funding: Nil Timetable: May - November 1999 304 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: Due to advances in medical care and technology, increasing numbers of older persons are being admitted to hospital and treated for acute illness and surgery. Such surgery not that long ago would have been deemed to risky. Colorectal surgery is one area of surgery which is becoming more common in the older population. Health care service providers around the world are becoming more and more concerned about the need for adequate discharge planning procedures. Discharge planning has become a priority in patient care with the nurse considered a key professional in assessing patient needs and helping patients and families to plan. Much of the research conducted in the area of older persons and discharge planning is focused on the rhetoric, process and prescriptions of discharge planning. There is limited research on how older persons actually experience the process. The aims of this study were to provide an understanding of how older persons experience being prepared for discharge from hospital and second to describe early convalescence at home following colorectal surgery. The study drew on a qualitative descriptive method with thick descriptive accounts of the experiences of six older persons. These descriptions have formed a sequence which begins with preparation for hospital, hospitalisation and surgery and finally the experience of convalescence at home following colorectal surgery. The study suggests that the six older persons had limited understanding of the process of discharge planning. They all experienced complications in their convalescence and for some there was a feeling that it might have been easier to cope if they had been informed about the possibility of the complications. The older persons appeared to have a limited understanding of the nurses’ role in the discharge process. Keywords: Colorectal surgery, discharge planning, convalescence, older persons 559 Title: Time and motion: How might nurses working within a rehabilitation ward view their practice - an ethnographic study Principal researcher: Ms M Campbell Organisation: School of Nursing, Faculty of Health Sciences, University of Tasmania Status: Completed Funding: Nil Timetable: May 1999 - November 1999 Outline: This study employs an ethnographic methodology to study the culture of rehabilitation nursing. Through engaging in participant-observations, reflective journalling, fieldnotes, and interviews with three experienced rehabilitation nurses, the culture of rehabilitation nursing was explored. Interpretation of this data revealed many issues that speak to a unique culture within rehabilitation nursing. Rehabilitation aims to restore and maintain functional independence in people who are recovering from injury, or are chronically ill or disabled. This focus is primarily concerned with physical abilities, and the ultimate goal of rehabilitation is to enable the patient to live independently within the community. The orientation of rehabilitation is reflected within the practice of rehabilitation nurses. The participants describe the ways in which they facilitate rehabilitation through 'standing back', and 'taking time'. The study reveals that within rehabilitation, nurses play an integral role. This role, however, becomes problematic to articulate within the context of the multi-disciplinary rehabilitation team, as the rehabilitation nurses struggle to meet the needs of their parents and the demands of the multi-disciplinary 'team'. This is apparent as nurses attempt to work within a philosophy of restorative care, against the imperative of 'getting the work done'. The participants describe this tension as restricting their attempts to meet the individual needs of patients, and also from acting to their full potential as rehabilitation 'experts'. The rehabilitation nurses in this study are highly committed to their practice, and despite the lack of recognition of their unique skills and important role in rehabilitation, they Australian Ageing Research Directory 2000 305 Health and Behavioural Sciences demonstrate a strong sense of self-identity. The concluding chapter describes possibilities for future research within rehabilitation, looking to exploration of both the experiences of rehabilitation nurses, patients, and rehabilitation 'therapists'. Keywords: Rehabilitation nursing, ethnography, multi-disciplinary team 3.60 School of Nursing and Health Studies, Faculty of Arts, Health and Sciences, Central Queensland University 560 Title: Aspirations for care: Analysis of the desires, needs and potential models to meet the care needs of elderly Aboriginal, Torres Strait and South Sea Islander peoples in the Rockhampton area Principal researchers: Dr M Williams, Ms B Fredericks Organisations: School of Nursing and Health Studies, Faculty of Arts, Health & Sciences, Central Queensland University; Aboriginal and Islander Resource Agency Status: In progress Funding: Department of Health and Family Services, $28,000 Timetable: 1998 - 2000 Outline: The purpose of the study is (i) to project the care needs of frail elderly members of the Aboriginal, Torres Strait and South Sea Islander peoples in the Rockhampton area for the next 10 years; (ii) to identify the care aspirations for the frail elderly indigenous and South Sea Islander peoples in the Rockhampton area; (iii) to compare care options currently provided for frail elderly indigenous and South Sea Islander peoples against the aspirations of the Rockhampton population; (iv) to present collaboratively developed recommendations to the Commonwealth on the care options appropriate to the future needs of the Rockhampton area's frail elderly indigenous peoples. This exploratory study will be based on a culturally appropriate combination of qualitative data collection methods (focus group, interview, site consultation and validation conference) supported by the analysis of descriptive statistical data collected from governmental and current aged care agencies. Analysis of data will involve content analysis of qualitative data that will be validated with participants to ensure accuracy of intent. Descriptive statistical analysis of quantitative data will be used to support the primary qualitative data. Data collection, validation and consultation with indigenous peoples will be facilitated by and primarily conducted by indigenous research personnel. Data analysis will be a collaborative activity between indigenous and non-indigenous researchers to promote cultural validity. Keywords: Frail aged, indigenous, aged care, care options 3.61 School of Nursing and Public Health, Edith Cowan University 561 Title: Perceived social support of family members of aged care facility residents and its relationship with family members' well-being and their support of relatives in residential care Principal researcher: Ms C Toye Co-researchers: Professor L Kristjanson, Associate Professor E Helmes Organisation: School of Nursing and Public Health, Edith Cowan University Status: Completed Funding: Nurses’ Memorial Centre, Olive Anstey Nurses’ Fund, Edith Cowan University Timetable: April 1997 - July 1999 306 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Outline: In this study, the researcher tested a model with a sample of 213 family members of residents of Australian aged care facilities and went on to develop an empirical model. Predictive relationships were initially hypothesised among incentives for family members to support residents, stress related factors in family members, their perceived formal and informal support, their psychological well-being, and the support they reported offering to residents. The researcher also developed the Relatives' of Aged Care Residents Assessment of Staff Support Tool to measure family members' perceptions of support from aged care facility staff. The researcher developed the Tool from data obtained at interviews with family members of Western Australian aged care facility residents and with aged care facility staff, and from a review of the literature. The instrument underwent testing and refinement procedures, including a factor analysis. The test-retest reliability coefficient for the unidimensional scale was found to be 0.99 over 2-3 days. Response options ranged from strongly disagree to strongly agree. Cronbach's alpha coefficient for the 27-item Relatives' of Aged Care Residents Assessment of Staff Support Tool was found to be 0.96. Findings of model testing confirmed hypothesised positive predictive relationships between residents' family members' well-being (the dependent variable) and both family members' perceptions of the residents' adjustment and the length of stay. Pressures related to the placement were confirmed as negatively predicting well-being in family members, and the degree to which family members felt attached to residents was confirmed as positively predicting their selfreported support of residents. The familial relationship between the family member and the resident was also confirmed as predicting family members' well-being. Support from aged care facility staff was not a significant predictor of family members' well-being and wellbeing failed to predict family members' support for residents. The empirical model developed accounted for 47% of the variance in family members' well-being and 23% of the variance in family members' self-reported support for residents. Findings of particular interest include the following: (i) Family members' perceptions of their informal support were found to account for 7% of the variance in support for residents and 5% of the variance in pressures experienced because of the placement. (ii) Pressures in family members negatively predicted their health and well-being. (iii) Being a residents' daughter was a positive predictor of pressures. Keywords: Residential aged care, family, informal support, staff support 3.62 School of Postgraduate Nursing, University of Melbourne 562 Title: An exploratory descriptive study of the context of nursing care in two dementia specific units Principal researchers: Ms M Nebauer, Professor J Parker Organisation: School of Postgraduate Nursing, University of Melbourne Status: Nearing completion Funding: Nil Timetable: Completion date - end 2001 Outline: This study is about the way nurses create a community within an institutional context in which they care for residents with dementia. Contemporary Western culture's philosophies of rationalism and liberal humanism construct ideas which are deeply embedded in multiple aspects of ways in which society constructs "ageing" and "dementia" as problems for which “solutions” must be sought. In terms of residential dementia care, these solutions are commonly found in the medicalisation of care, with foci on dementia as a disease and corresponding behaviour "management" strategies, tasks, time, rituals, unstimulating and lifeless environments, and impersonal care practices. This study challenges the mechanistic Australian Ageing Research Directory 2000 307 Health and Behavioural Sciences cultural construction that dementia care is a problem and that care of people with dementia is simply monotonous, hard and unrewarding work. The context in which dementia care occurs is vital for the well-being and quality of life of residents, families and nurses. Thus, in a dementia unit, difference and diversity of residents should be celebrated, encouraged and demonstrated in the acceptance of behaviours as meaningful ways of communication. Behaviours are seen as the constantly changing and often colourful expressions of the transient identities that residents assume to express emotions and needs. Additionally, while cognition in people with dementia is impaired, their senses are rarely affected. The various and different life paths of residents should be discovered and this knowledge used to provide a dionysian stimulation of the senses within an environment in which freedom of expression is valued and encouraged. The research is based on data gathered by interviews and participant observation during a qualitative research study within two dementia specific units. The first unit is a 30 bed acute psycho-geriatric assessment unit in which there was an interesting combination of major elements of the biomedical model combined with many elements of a postmodern community. Relationships were marked generally by strong feelings of support, warmth, empathy and social solidarity among nursing staff, warm, nurturing, close relationships between staff and residents and between staff and family members, but there was little evidence of an stimulating environment. The second unit is a large church owned aged care facility which includes a small 14 bed dementia specific unit for ambulant residents. There was little evidence of the postmodern community in the relationships among staff and between staff and family members. Relationships between nursing staff and residents in terms of warmth, empathy and nurturing were variable, and there was very limited attempt by nurses to ascertain individual preferences of residents and encourage expression of individual differences. The differences and difficulties within and between the two contexts of care are discussed, the influence of these different contexts on the caregiving patterns between nurses and residents is explored, and suggestions made for change. Keywords: Dementia, community, institutional care, context of care, nursing Psychology and Behavioural Sciences 3.63 Australian Psychological Society Ltd 563 Title: Psychology and ageing: Contributions to the International Year of Older Persons Principal researchers: Ms H Gridley, Dr C Browning, Professor L Gething, Associate Professor E Helmes, Professor M Luszcz, Ms J Turner, Dr L Ward, Dr Y Wells Organisation: Australian Psychological Society Ltd Status: Completed Funding: APS Directorate of Social Issues Timetable: 1998 - 2000 Website: www.psychsociety.com.au Outline: The Australian Psychological Society welcomed the International Year of Older Persons as an opportunity to consider the contribution of psychological research and psychologists to the well-being of older people. The Society established a Working Group with the task of producing a position paper which would showcase what psychology can bring to the understanding of the experiences of older persons, and set down some challenges which psychologists might take up in the interests of the well-being of older Australians. The paper produced by the Working Group addresses a spectrum of issues ranging from particular 308 Australian Ageing Research Directory 2000 Health and Behavioural Sciences clinical concerns to broader perspectives on life transitions and successful ageing. Some dimensions of ageism are examined in terms of how they affect community expectations of older people and the quality of aged care services, and the conditions which promote successful ageing are considered. An examination of key transitions likely to be experienced later in life, such as retirement, grandparenthood, relocation and widowhood, is presented, as well as a section on the scope and implications of cognitive ageing. An overview of the mental health of older Australians, together with a consideration of psychological interventions for specific mental health concerns, is included in order to begin addressing the underutilisation of psychological knowledge and services by older persons. Priority is given to the inclusion of Australian research. In examining the particular contributions of Australian psychologists on aspects of ageing, it is hoped to raise awareness within and beyond the discipline of the wide range of topics and the long-term implications of some of the research initiatives underway in this country. In addition to recognising such achievements, a focus on psychology and psychologists identifies a number of challenges facing educators and practitioners if the discipline and profession are to be ready to meet the needs of the current cohort of older Australians, not to mention the ageing “baby-boomer” generation. The paper offers recommendations for preparing the profession and the wider community to respond to the needs of an ageing population in ways which empower older persons rather than compound any challenges they may face. In developing a framework for this paper, contributors have attempted to be attentive to the consequences of ageism, stereotyping and pathologising of older persons' experiences, and to adopt wherever possible principles of empowerment, respect and recognition of the diversity and complexity of those experiences. The elements which constitute such diversity and complexity include cohort effects, ethnicity, gender, disability and resource distribution. A common thread underpinning the discussion is that of vitality of body, mind and spirit, a central aspect of the International Year of Older Persons' distinctive logo. Keywords: Psychology, ageing, ageism, cognitive change, successful ageing, mental health 3.64 Department of Psychological Medicine, University of Sydney 564 Title: A study of use of psychotropic medication in nursing homes Principal researcher: Associate Professor J Snowdon Organisation: Department of Psychological Medicine, University of Sydney; Central Sydney Area Health Service Status: Completed Funding: Janssen-Cilag Ltd Timetable: 1998, three months Outline: Medication records of all residents in nursing homes in a defined area of Sydney were examined, in order to compare the numbers of subjects taking different types of psychotropic medication in 1993 and 1998. There had been a significant reduction in use of neuroleptics, hypnotics and anxiolytics. The doses of antidepressants, when prescribed, were more in the therapeutic range than had been the case in 1993. Keywords: Nursing homes, neuroleptics, psychotropic medication, prescription habits 565 Title: Depression in nursing homes Principal researcher: Associate Professor J Snowdon Organisation: Department of Psychological Medicine, University of Sydney; Central Sydney Area Health Service Australian Ageing Research Directory 2000 309 Health and Behavioural Sciences Status: Completed Funding: Sydney Area Health Service Timetable: 1996 - 1997, six months Outline: Nurses in three nursing homes in Sydney used the Geriatric Depression Rating Scale to record levels of depression among residents. They were also seen by a clinical psychologist and/or a psychiatrist. Reliability between ratings was found to be good. The depression scale will now be used to examine rates at which general practitioners identify and treat depression in nursing homes. Keywords: Nursing homes, depression, assessment, rating scales 566 Title: The suicides of older persons Principal researchers: Associate Professor J Snowdon, Mr P Baume Organisation: Department of Psychological Medicine, University of Sydney; Central Sydney Area Health Service Status: Ongoing Funding: Area Health Service Timetable: 1999 - 2000 Outline: Files concerning all elderly people whose deaths were determined by a Sydney coroner to be by suicide were examined. Details concerning physical and mental illnesses, mode of death, age, sex, marital status and circumstances, were gathered, and analysis is being conducted. 208 files were viewed; a majority of those who died were depressed at the time of death, and 30% had seen psychiatrists at some time in their lives. A number had dementia. In a majority of cases, physical illness was considered to be a factor contributing to the suicide. Keywords: Suicide, old age, depression, medical illness, psychiatric illness, social factors, gender 3.65 Department of Psychology, Faculty of Arts, Victoria University of Technology 567 Title: Role of external circadian time cues in the sleep quality of older adults Principal researchers: Associate Professor D Bruck, Dr B Hood, Dr G A Kennedy Organisation: Department of Psychology, Faculty of Arts, Victoria University Status: Nearing completion Funding: Small ARC Grant Outline: Studies have shown that older people have less sleep that is poorer in quality than that of younger people. In some cases, differences in sleep quality and duration may be attributed to disease states and the aging process itself. However, even in people who are aging normally and disease free, there may be negative changes in sleep quality and duration. Age-related changes in sleep have been associated with alterations of the circadian `clock’ system that controls the sleep-wake cycle. The changes include decreased circadian amplitude, an advance in phase (resulting in the aged being more “morning” types than “evening” types), a shortening of the circadian period (i.e. less than 24 hours) and increased variability of the circadian rhythm acrophase (peak point) within the day. Reduced sleep quality in older people can lead to increased daytime sleepiness and napping, fatigue, increased accident rates, decreased well-being and increased use of sedative-hypnotic medications. Instability in sleep patterns of older people may also be linked to increased morbidity and mortality. The aim of this ongoing research program is to investigate the mechanisms underlying dysfunction of the circadian `clock’ system(s) that reduce sleep 310 Australian Ageing Research Directory 2000 Health and Behavioural Sciences quality and duration in older people. It has been shown that regular temporal exposure to zeitgebers (daily time cues) is essential for the normal phasing of the circadian rhythm of sleep-wakefulness (cf. jet-lag, shift-work). Behavioural interventions that involve manipulating zeitgebers, such as bright light therapy and increasing activity levels, can improve the integrity of the circadian system, and hence sleep-wake regularity. There is evidence that these two interventions are helpful in improving the sleep of older people. Therefore, a program of behavioural interventions aimed at increasing the amplitude of circadian rhythms may help older people with poor sleep. The rationale is that the most important behavioural interventions aimed at improving the sleep of older people are those that increase the person’s exposure to zeitgebers, thereby putatively increasing the amplitude of their circadian rhythm. The most important zeitgebers for humans include: (1) exposure to bright light (some evidence of the efficacy of morning light); (2) increasing daily activity levels (during the diurnal phase of the rhythm); and (3) regularity in lifestyle (including timing of daily activities, sleep/wake behaviours and food intake). The first phase of the research program will determine whether older people who are good and poor sleepers, differ with respect to their exposure to important zeitgebers (circadian time cues e.g. outdoor light, regularity of habit and exercise) under normal living conditions. In the second phase, exposure to zeitgebers in the poor sleep group will be increased in a controlled manner to ascertain whether this manipulation will improve sleep quality and duration. It is envisaged that simple, cost-effective, behavioural techniques may improve sleep quality and duration in many older people. The behavioural techniques could be implemented by a range of health professionals and have the potential to improve the quality of life and reduce the use of addictive, sedative-hypnotic medications. Keywords: Sleep-wake cycle, circadian rhythms, zeitgebers, older people 3.66 Department of Psychology, University of Adelaide 568 Title: Emotional and cognitive functioning of patients with Parkinson’s Disease Principal researcher: Dr J Mathias Organisation: Department of Psychology, University of Adelaide Status: Nearing completion Funding: Alzheimer’s Association of Australia Non-Alzheimer Dementia Research Grant, $8,000; Australian Research Council Small Research Grant, $5,000 Timetable: 1998 - early 2000 Outline: This study is designed to investigate the emotional and cognitive changes that occur in patients with Parkinson’s Disease. Parkinson’s Disease is one of the most common degenerative neurological disorders to affect the elderly and is marked by a range of motor, cognitive, psychological, and behavioural symptoms. Although it is generally accepted that Parkinson’s Disease can lead to significant changes in patients’ cognitive and emotional functioning, formal neuropsychological assessments of persons with Parkinson’s Disease generally focus on providing detailed assessments of cognitive functioning. Changes to personality and emotional functioning, on the other hand, tend to be evaluated more informally due to a lack of suitable measures. As a consequence, neuropsychological assessments of personality and emotional changes are often reliant upon informal observations of a person’s behaviour during a clinical assessment. Although useful, these subjective methods do not provide a detailed and objective psychometric assessment of a patient’s pre-illness and post-illness emotional functioning, thereby limiting the clinical utility of these procedures. This study is investigating the personality and emotional changes of patients with Parkinson’s Disease by undertaking a detailed evaluation of a recently Australian Ageing Research Directory 2000 311 Health and Behavioural Sciences developed measure, known as the Neuropsychology Behavior and Affect Profile, which was designed to assess the emotional and personality changes caused by a variety of neurological disorders. It is also examining the cognitive problems typically experienced by persons with Parkinson’s Disease, and the relationship between the emotional and cognitive functioning of these persons. Keywords: Parkinson’s Disease, clinical neuropsychology, cognitive functioning, personality, emotional changes 569 Title: Health status and health service usage of elderly hospital in-patients referred for neuropsychological assessment Principal researchers: Ms L A Denson, Dr H R Winefield Co-researchers: Dr K A Grimmer, Dr D Pritchard Organisation: Department of Psychology, University of Adelaide Status: Completed Funding: Royal Adelaide Hospital, Infrastructure support Timetable: July 1993 - July 2000 Outline: General hospital admission in the elderly is a marker for possible loss of function and increased support needs post-discharge. It also offers the opportunity for diagnostic evaluation and referral for appropriate community support services. Neuropsychological assessment is utilised in a number of interventions in the care of elderly individuals with cognitive impairment: to assist in the diagnosis of dementing disorders, to assess their severity, to support applications for appropriate community services, and in the last resort when state guardianship orders are sought. Evaluation of the outcome of such assessments, interventions and/or admissions is complex and measures should include health status, comorbidities, health service usage and caregiver burden as well as self-reported or proxy reported health-related quality of life. The study examined health status, comorbidities and health service usage (specifically usage of the Royal Adelaide Hospital) of 64 elderly individuals in the twelve months before and the twelve months after a hospital admission which included referral for neuropsychological assessment of possible dementia. Keywords: Dementia, health status, hospital admission, residential placement 3.67 Department of Psychology and Intellectual Disability Studies, RMIT University 570 Title: Knowledge about stroke within the Greek and Vietnamese communities Principal researcher: Professor T Thomas Organisation: Department of Psychology and Intellectual Disability Studies, RMIT University Status: Completed Funding: RMIT research grant Timetable: 1998 - 1999 Outline: Stroke is the third most common cause of death in Australia, accounting for 10 per cent of all deaths and 25 per cent of chronic disabilities. Unfortunately, stroke has not been treated as a separate public health issue, and it continues to remain a poorly understood illness by many Australians. The prevention of stroke constitutes a serious issue, especially for many overseas-born Australians of non-English speaking backgrounds. The general lack of awareness of health-related risks and the varied beliefs about the causes of illness present significant barrier and difficulties. It is important that the different values and beliefs around health-related behaviour are examined, acknowledged, and understood. A necessary first step 312 Australian Ageing Research Directory 2000 Health and Behavioural Sciences towards such an acknowledgment involves a greater understanding of the influence of culture on stroke knowledge. The aim of the research project is to investigate the understanding of stroke, within two large communities in Australia, the Vietnamese and the Greek communities. Over 200 members of the two communities were interviewed individually. The results indicated there are gaps in the knowledge about stroke and stroke treatment in these groups. Keywords: Stroke, ethnic aged, health knowledge 3.68 Discipline of Behavioural Science, School of Population Health Sciences, University of Newcastle 571 Title: Randomised controlled trial to improve appropriate use of medicines in elderly people in general practice: Effect on health outcomes Principal researchers: Ms J Cockburn, Ms J Byles, Ms S Pit Co-researchers: D Henry, P Glasziou Organisation: Discipline of Behavioural Science, School of Population Health Sciences, University of Newcastle Status: In progress Funding: National Health and Medical Research Council Year 1: $77,271, Year 2: $77,872, Year 3: $66,373 Timetable: February 1999 - February 2003 Outline: A randomised controlled trial is being used to test the following hypotheses: (i) that in a randomised controlled trial of people aged 60 years and over, the reported accidents and falls will be significantly lower in the intervention group compared with the control group at three and twelve months follow-up; (ii) that in a randomised controlled trial of people aged 60 years and over, the reported health related quality of life (as measured by the SF-12) will be significantly higher amongst older people in the intervention group compared with the control group at three and twelve months follow-up. A random sample of general practitioners from the Hunter region of New South Wales will be invited to participate in the study. Consecutive patients over the age of 60 who present to each general practitioner over the study period in each surgery will form the patient sample. Randomised controlled methods will be used to assess the effectiveness of a multi-faceted intervention for reducing inappropriate use of medicines and improving health outcomes in elderly people. The intervention will involve (i) refining existing guidelines for appropriate medication taking for use locally; (ii) detailing guidelines on appropriate medication use to general practitioners; (iii) computerised, individualised feedback to practitioners about “at-risk” medication use amongst their elderly patients; (iv) the opportunity for review of medications. The health outcomes will be accidents and falls, and quality of life. The impact of the intervention on medication use in elderly people will also be assessed. The costs of implementing the intervention will be documented in order to estimate the cost-benefits in terms of direct costs and project savings in health care costs. The acceptability of the interventions for practitioners and patients will be monitored. Telephone surveys will be used to measure health outcomes at three and twelve months follow up. Keywords: Health promotion, general practice, quality use of medicine, quality of life, falls, aged Australian Ageing Research Directory 2000 313 Health and Behavioural Sciences 3.69 Human Motor Control Laboratory, School of Psychology, University of Tasmania 572 Title: Movement disorders: Linking age-related deficits and Parkinson’s Disease Principal researchers: Professor J J Summers, Dr S A Wilson, Dr F A Kagerer Co-researcher: Dr W D Byblow Organisation: Human Motor Control Laboratory, School of Psychology, University of Tasmania; Division of Nursing, University of Auckland, New Zealand; Department of Sport and Exercise Science, University of Auckland Status: In progress Funding: Australian Research Council, Large Grant Scheme, $125,400 Timetable: 1998 - 2000 Outline: The aim of the research project is to examine the relationship between motor slowing, associated with ageing and bradykinesia in Parkinson’s Disease. Stream A consists of neurophysiological (Transcranial Magnetic Stimulation) and clinical measures of motor slowing in the aged and Parkinson’s Disease. Stream B examines biophysical constraints on interlimb coordination. In Stream A, transcranial magnetic stimulation was used to examine motor cortex excitability in the elderly and patients with Parkinson’s Disease. Single pulse transcranial magnetic stimulation was applied to right or the left hemisphere of seven young controls aged 18-34 years, seven elderly subjects (aged 69-75 years), seven Parkinson’s Disease patients (aged 46-67 years) to evoke motor evoked potentials from the either bilaterally or only contralaterally activated abductor pollicis brevis. On the behavioural level, visual choice reaction times were assessed. No group differences were found for threshold intensity and hemispheric symmetries were present in all three groups. Onset latencies and silent period durations were shorter in young controls than in the elderly or the Parkinson’s Disease patients; this was also found for the indicating increased inhibitory processes in these subjects. Motor evoked potentials durations were similar in all groups. Bilateral abductor pollicis brevis activation resulted in significantly shorter onset latencies, shorter silent period durations, and longer motor evoked potentials durations in all groups as compared to when only the contralateral abductor pollicis brevis was activated. The movement times of the reaction times were significantly longer in the elderly subjects and the Parkinson’s Disease patients than in the young controls. Although there was no direct correlation within each group between onset latency or silent period duration, and the movement times, a discriminant analysis performed on these variables showed that silent period duration and movement times together discriminated best between the three groups, indicating that the increased movement times might be mediated by increased inhibitory processes in the elderly and the Parkinson’s Disease patients. The increased motor evoked potentials durations (due to longer offset latency) after bilateral abductor pollicis brevis activation suggest ipsilaterally induced changes in the excitability of the crossed corticospinal projections. This effect appears not to be altered in old aged or in Parkinson’s Disease. In Stream B, data collection is in progress for a study examining upper limb coordination dynamics in ageing and Parkinson’s Disease. As the same participants are being used for experiments in both streams, the relationship between measures of functionality (Stream A) and interlimb coordination (Stream B) can be assessed. Keywords: Interlimb coordination, dynamics, neurophysiology, motor slowing, transcranial magnetic stimulation 314 Australian Ageing Research Directory 2000 Health and Behavioural Sciences 3.70 School of Psychology, Curtin University of Technology 573 Title: A comparison between an ecologically valid planning task and other cognitive tasks in normal ageing and Parkinson’s Disease Principal researchers: Ms N Gasson Co-researcher: Dr J Bell Organisation: School of Psychology, Curtin University of Technology Status: Nearing completion Outline: The research investigated the changes in cognitive abilities that occur over the adult lifespan, and those that occur as the result of Parkinson’s Disease. Using principles of ecologically valid cognitive assessment, it investigated a number of issues neglected in other studies such as covariate control. It was expected that the use of ecologically valid cognitive tasks would provide a more positive picture of cognitive ageing than that provided by traditional cognitive measures. Study One was conducted to establish the reliability of some aspects of validity of a recently developed, ecologically valid task of planning ability. Fiftythree participants, aged between 30-40 years, completed the planning task (the Shopping Task) and the Assessment of Wisdom-Related Knowledge Task to establish convergent validity. Two versions of the Shopping Task were administered three months apart in order to establish delayed, alternate forms of reliability. Results showed a significant inter-rater reliability and a significant delayed alternate forms of reliability, and the Shopping Task was concluded to be a reliable and valid measure of planning ability. To assess performance on the ecologically valid planning task in relation to previously established cognitive ageing patterns (eg. hold vs decline view), a number of marker abilities were also assessed. Study Two investigated differences in performance on planning, memory, learning and word knowledge tasks across the adult life span. Fifty-five people aged 25-35 years, 42 aged 45-55 years, and 62 aged 65-75 years, participated, completing tasks of working memory, short term memory, recall and recognition memory, planning, attentional flexibility, learning and word knowledge. Results showed significant age declines for working memory and learning. Performance did not differ between the groups on the planning tasks or measure of attentional flexibility. Results suggests that cognitive abilities involving a capacity/speed component are impaired with advancing age. Also cognitive abilities involving the accumulation of knowledge and ability to learn new information remain stable (although capacity decreases) into old age. Study Three involved the investigation of the effects of Parkinson’s Disease on cognitive abilities. Thirty people with Parkinson’s Disease and 30 matched control participants completed the cognitive tasks used in Study Two. People with Parkinson’s Disease had deficits on tasks of working memory, planning, attentional flexibility and learning. The pattern of results indicate that the cognitive deficits associated with Parkinson’s Disease lie in tasks that require the use of organisational strategies, self-initiation, goal setting and monitoring, and tasks that are poorly constrained; those abilities that remain intact include passive skills and well-constrained tasks. The results also demonstrate that the effects of Parkinson’s Disease on cognitive abilities do not result from accelerated ageing, but are specific to the disruption to dopaminergic systems in the brain. Overall the patterns of cognitive functioning in old age and in Parkinson’s Disease have led to the proposal of several strategies that will improve quality of life for these groups. Keywords: Planning, ageing, cognition, Parkinson’s Disease Australian Ageing Research Directory 2000 315 Health and Behavioural Sciences 574 Title: Stressors experienced while awaiting admission to an independent living facility Principal researchers: Ms J Thornton, Ms K Aitken Organisation: School of Psychology, Curtin University of Technology Status: Completed Funding: Nil Outline: This study investigated the experience of relocation for individuals awaiting admission (or recently admitted) to an independent residential facility in Perth, Western Australia. Health concerns were identified as the main reason for relocation, followed by fears about personal safety and home security. Respondents believed relocation would provide peace of mind and a secure future for themselves and their partner. The act of leaving home was not in itself perceived as stressful but as physically difficult. Keywords: Relocation, health concerns, security, grief and loss, social support, independent living facility 575 Title: A follow up study of new residents six months after entering an independent retirement facility Principal researchers: Ms J Thornton, Ms J Lloyd Organisation: School of Psychology, Curtin University of Technology, Western Australia Status: Completed Funding: Nil Outline: A follow up study of the experiences of the respondents studied previously (entry 574) was undertaken six months after relocating to an independent living facility. Themes of safety and security, grief and loss, and a sense of belonging were identified. Belonging/not belonging appeared to dichotomise participants. Bereaved participants and those feeling abandoned by their families were most at risk of experiencing unhappiness about relocation. Coping mechanisms observed as useful were pragmatism, spirituality, partner support, continuity of life, and fellowship. Counselling is suggested as a support for residents experiencing difficulties, especially in maintaining or reinstituting social networks. Keywords: Relocation, health concerns, security, grief and loss, social support, independent living facility 3.71 School of Psychology, Edith Cowan University 576 Title: Knowledge and attitudes of sexuality in the elderly among educators of health care professionals Principal researcher: J L Chapman Co-researcher: Dr E Helmes Organisation: School of Psychology, Edith Cowan University Status: Completed Outline: Many elderly adults have concerns regarding sexuality, including the impact of chronic disease on sexual function. Typically, society has negative attitudes toward expressions of sexuality by the elderly with misconceptions, negative stereotyping and myths compounding ageist perceptions that the elderly become asexual with age. Thus knowledge of and attitudes toward sexuality in the elderly has become an area of interest over the past several decades. In an attempt to promote sexual expression as a right for the elderly and physiological changes viewed in terms of positive adjustment, White (1982) developed an instrument to determine knowledge of and attitudes towards sexuality of elderly people. The 316 Australian Ageing Research Directory 2000 Health and Behavioural Sciences Ageing Sexual Knowledge and Attitude Scale (ASKAS) is designed to measure the knowledge of and attitudes toward sexuality held by elderly individuals, or any group of people who have an impact upon the sexual expression of elderly people. This study determined the knowledge of and attitudes toward sexuality in the elderly among educators of health care professionals in three English-speaking countries, Australia, New Zealand, and South Africa. A total of 838 questionnaires were distributed via the heads of 114 departments of nursing, medicine, psychology, social work, occupational therapy and physiotherapy in 28 Australian, 7 New Zealand, and 7 South African universities. A total of 363 were returned, giving a response rate of 43%. The overall mean score of 42.4 (SD=12.2) reflected above average levels of knowledge as compared to previous samples. Attitudes and levels of knowledge were correlated, and both were also correlated with age. Holding a medical degree was the single predictor of knowledge of sexuality, while the best predictor of attitudes toward sexuality in the elderly was age. Neither knowledge nor attitudes were well predicted by the demographic and experiential variables. There were no notable differences across countries or across professions in terms of knowledge of and attitudes toward sexuality in the elderly. Keywords: Education, psychology, geriatric medicine, healthy ageing 577 Title: Psychologists’ and counselors’ therapeutic practices with elderly people in Australia Principal researchers: Dr E Helmes, Dr S Gee Organisation: School of Psychology, Edith Cowan University Status: In progress Outline: Increases in longevity are resulting in larger numbers of older people making use of the health care system. The provision of effective health care requires that the beliefs and attitudes of the health care professionals do not lead to biases against any particular age group. Such ageism in those in the health care professions can lead to negative consequences for the group about which adverse stereotypes are held. Ageist attitudes toward older people are widespread in society. The common knowledge that older people have more health problems can lead to the assumption that the complaints of older people are due to physical causes, when they may in fact be psychological in origin. Such patterns have been observed in various health care professions in other countries. This study examines the sensitivity of psychologists and counselors to symptoms of depression in older people. Vignettes describing either a 42-year-old or a 72-year-old woman with symptoms of depression were randomly distributed to practising psychologists and counselors across Australia. The results are currently being analysed, but preliminary results show fairly pervasive reduced likelihood of a diagnosis of depression for the vignette with the older woman. Rates of correct diagnosis of depression vary widely across different States as well. Keywords: Depression, ageism, education, health care professionals 578 Title: Self-efficacy and depression in older adults: differences between volunteers and non-volunteers Principal researcher: A Govindan Co-researcher: Dr E Helmes Organisation: School of Psychology, Edith Cowan University Status: Completed Australian Ageing Research Directory 2000 317 Health and Behavioural Sciences Outline: Volunteering has been found to play an important role in the lives of older adults. The general beneficial effects of volunteering have been widely established. However an investigation on the specific effects volunteering can have on older adults’ perceptions of their abilities has yet to be established. It is important to investigate whether volunteering in later life has a positive effect on one’s perception of oneself or one’s self-efficacy. Individuals with high levels of self-efficacy tend to believe they are more capable of handling stressful situations and are less likely to feel helpless and dependent and thus feel more confident of their ability to function independently. The present study investigated self-efficacy and depression among 87 older persons who volunteer and 84 older persons who do not volunteer. Depression was assessed with the Geriatric Depression Scale and self-efficacy with the General Self-Efficacy Scale (Schwarzer et al., 1997). The study contrasts volunteers and nonvolunteers on self-efficacy, depression, age and years of education as the hypothesised dimensions along which volunteers differ from non-volunteers. It further hypothesised that self-efficacy and depression would be the two factors that best discriminate between volunteers and non-volunteers. A restrictive definition of volunteering was used: volunteers were involved in regular, structured activities. A total of 350 questionnaires were distributed, with 171 usable ones returned, a response rate of 49%. The mean age of the sample was 67.8 years (SD = 7.78). The results support the hypotheses. All four factors discriminated between volunteers and non-volunteers and self-efficacy and depression were the two factors that accounted for most of the difference. The results of the present study highlights the importance volunteering can have in fostering self-efficacy in older people. The present study, though exploratory in nature, has a number of important implications for promoting independent functioning in later life and improving the quality of life of older people. Keywords: Community care, depression, volunteering 579 Title: Survey of legal practice patterns in assessing mental competence in the elderly Principal researcher: Dr V E Lewis Co-researchers: Dr E Helmes, Dr A Allan, J McLernon, H Osmancevic Organisation: School of Psychology, Edith Cowan University Status: In progress Funding: Edith Cowan University, Faculty of Health & Human Sciences Internal Research Grant, $4,414 Outline: The current and projected growth in the ageing population will lead to an increasing number of elderly persons seeking legal assistance regarding such matters as the making of wills, financial planning, and issuing powers of attorney. Legal practitioners therefore will invariably be placed in the position of the front-line professional, having to consider the possibility of incapacity or incompetence, while simultaneously attempting to uphold the ethical criteria of the law (eg. respect for autonomy, presumption of competence, and civil rights). The established practice of common law of using cognitive capacity as a yardstick for the evaluation of decision-making capacity is fraught with problems, and this suggests that current practices may be causing difficulties for solicitors. Many older people may have subtle and complex mental dysfunction resulting from age-related illnesses that can have far reaching effects when they make life decisions and choices that require legal assistance. The chief purpose of this study is to survey legal practitioners in Australia with respect to their current practice in assessing competency in the elderly, to ascertain the difficulties entailed, problems that can ensue as a result of such an assessment, and their views regarding the advisability for appropriate education that would include input from health care professionals. To date, a total of over 1,000 surveys have been distributed to both urban and rural legal professionals in several Australian states. The current return rate approximates 25% and 318 Australian Ageing Research Directory 2000 Health and Behavioural Sciences additional surveys will be mailed in the near future. The study will also be extended to include legal practitioners in South Africa. Keywords: Assessment, dementia, carers, caregiving, education, capacity, cognitive processes 3.72 School of Psychology, Flinders University of South Australia 580 Title: Paths to psychological well-being in older adults Principal researchers: Dr Ranzijn, Professor M Luszcz, Professor J Keeves, Professor N Feather Organisation: School of Psychology, Flinders University of South Australia Status: Completed Funding: APA Scholarship, Flinders University Research Budget Timetable: 1993 - 1998 Outline: The aim of this research on well-being was to test path models of the influence of psychological variables on the psychological well-being of older adults. It included confirmatory factor analyses of various measures of psychological well-being (self-esteem, morale, depression) and analyses of change in well-being over a two year period, using the structural equation modelling paradigm with the LISREL8 software package. Data from a large population-based sample of adults between 70 and 103 (the Australian Longitudinal Study of Ageing) showed that psychological well-being was very robust to changes in health and social involvement. A strong sense of usefulness persisted that was related to measures of well-being, and there was little indication of psychological distress. Suggestions were made for modifications to the structure of scales used to gauge psychological well-being, and there were strong indications that the core of psychological well-being can be construed as orthogonal factors of positive and negative affect. Keywords: Psychological well-being, path analysis, confirmatory factor analysis 3.73 School of Psychology, University of New England 581 Title: Early cognitive decline in elderly persons: The potential therapeutic value of transdermal nicotine Principal researchers: Dr I Price, Mr M Howe Organisation: School of Psychology, University of New England Status: Data collection completed 1999. Write-up and publication ongoing Funding: Smoking and Heart Research Foundation of Australia, $80,000 Timetable: August 1997- April 2000 Outline: The project examined the potential therapeutic value of transdermal nicotine on preclinical indicators of Alzheimer’s disease. One hundred and twelve people, many with a known familial incidence of Alzheimer’s disease, but in good health and dementia-free, completed three neuropsychological assessments corresponding to before, during, and after, the wearing of one, or two, 7 mg/24 hour patches. A phase-in period of two weeks, followed by a four week period at full dose, followed by a two week phase-out period was employed. The assessment instruments used were the Buschke Selective Reminding Task, the Fuld Object Memory Evaluation Task, the Digit Symbol subscale of the WAIS, the Stroop colour naming task, and the General Health Questionnaire. A clinical interview was used to assess Australian Ageing Research Directory 2000 319 Health and Behavioural Sciences experiences and difficulties associated with the wearing of nicotine patches over this timeframe. The analysis is still ongoing but early results indicate a significant improvement over time on all measures of memory and cognition and a significant improvement over time on all measures of memory and cognition and a significant improvement in social functioning. However, analyses comparing dosage groups and those at risk versus those not at risk found few significant interactions. The most promising result was a significant difference in word acquisition in the Fuld OME and the Buschke SRT in the nicotine group compared to the no nicotine group. This might indicate an effect of nicotine on word finding ability in elderly people. Keywords: Preclinical, Alzheimer’s disease, transdermal, nicotine 3.74 School of Psychology, University of New South Wales 582 Title: Ageing, cognition and compensation: The possible circumvention of age-related declines via long term-working memory Principal researcher: Ms M Borzycki Co-researcher: Associate Professor S Andrews Organisation: School of Psychology, University of New South Wales Status: In progress Timetable: March 1997 - September 2000 Outline: This research program explores the information processing capabilities of healthy and active, community-dwelling adults. It has replicated well-documented findings of agerelated differences favouring the young in a number of aspects of basic cognition. In particular, it has sought and located instances where an expert skill “offsets” age-related cognitive differences that would normally adversely affect older adults’ performance. Research to date has found evidence for compensation within an expert’s chosen field. The degree with which this compensation can be extended to domains beyond the particular field of expertise is currently being assessed. If compensation can be demonstrated in domains unrelated to specific expertise, it may be possible to foster the same compensatory mechanisms in older adults who are not expert in a particular domain. Keywords: Cognition, expertise, compensation 3.75 School of Psychology, University of South Australia 583 Title: Fear of crime in older South Australians Principal researchers: Dr R Ranzijn, Professor K Howells, Ms C Walsh, Ms J Nakos, Ms K Richardson, Ms V Wagstaff, Ms A Pengelly Organisation: School of Psychology, University of South Australia Status: Current Funding: University of South Australia $8500. Timetable: 2000 Outline: This project aims to examine the factors in fear of crime in a South Australian older population. It will investigate how fear of crime is related to quality of life and influences decisions about whether to live independently or in residential care. It is hoped that the project will develop a profile of the needs of older adults in this group for safety and security, assist in policy and service developments to improve personal feelings of safety, confidence and quality of life in older adults, and produce suggestions about possible intervention strategies 320 Australian Ageing Research Directory 2000 Health and Behavioural Sciences and programs. This is a collaborative project with input from the Council on the Ageing, Department of Human Services, and the Tea Tree Gully Council Keywords: Fear of crime, safety and security, community services, relocation, supported accommodation 584 Title: Indigenous aged care Principal researchers: Dr R Ranzijn, Associate Professor M A Bin-Sallik Organisation: School of Psychology, University of South Australia; Unaipon School, University of South Australia Status: Current Funding: Aged Care and Housing Group, South Australia Timetable: 2000 Outline: The aim of this project is to investigate whether supported accommodation organisations can contribute to the provision of culturally-appropriate aged care for Aboriginal elders in South Australia. It is a scoping study which will explore models of best practice in indigenous aged care. It is not designed to be a comprehensive needs survey of all Aboriginal communities in South Australia, but representatives from regional as well as urban communities will be consulted. Keywords: Indigenous, Aboriginal elders, aged care and housing 585 Title: Mature aged employment Principal researchers: Dr R Ranzijn, Associate Professor E Carson, Professor T Winefield, Ms D Price Organisation: School of Psychology, University of South Australia Status: Current Funding: University of South Australia, $5,000 Timetable: 2000 - 2001 Outline: The main aim of this project is to perform the groundwork for an ongoing research program into the factors in mature aged employment and unemployment and to develop strategies to increase the workforce participation of older workers. Keywords: Mature aged employment, productive ageing, economics of ageing 586 Title: More effective employment of mature adults Principal researchers: Dr R Ranzijn, Ms S Hall Organisation: School of Psychology, University of South Australia Status: Completed Funding: Department of Industry and Trade, South Australia, $5,000 Timetable: 1999 Outline: This project comprised a scoping study the aim of which was to investigate factors in premature retirement and barriers to ongoing work participation. For this study mature adults were defined as 45 years old or more. Given that the median age of retirement is 55 years, and is declining, most people will live for many years after retirement, and postretirement life is likely to be longer than working life. Over the past 5 years one in four Australian companies has reduced their proportion of workers aged 45 years or more. Jobseekers are less successful with age. 39% of 45-54 year-old job seekers are unsuccessful, this proportion rises to 56% if aged 55 or more. There are strong pressures for companies to Australian Ageing Research Directory 2000 321 Health and Behavioural Sciences ‘clear older workers out’ to make way for new blood and new technologies. The age considered ‘too old’ is declining, currently sitting at around 30 years old. The study identified a range of strategies to increase workforce participation of older adults. Keywords: Retirement, mature aged employment, physical activity, economics of ageing 587 Title: Recreation and sporting facilities and services for older people Principal researchers: Dr R Ranzijn, Ms D Price Organisation: School of Psychology, University of South Australia Status: Completed Funding: Department of Industry and Trade, South Australia, $5,000 Timetable: 1999 Outline: This project comprised a scoping study into the economic opportunities afforded by population ageing in South Australia in the area of recreation and sporting facilities and services. It was found that people are moving away from the ‘traditional’ activities of older people and are looking for a greater variety of activities more suited to a complex and flexible lifestyle. Multiculturalism is a relatively untapped mine of new and exciting sporting and recreational activities. Increasingly, older people will seek out physical activities that fit with a holistic lifestyle, key elements being variety, comfort and safety, hedonism and enjoyment, and moderate but not excessive physical challenge. It was predicted that in the future older people will seek out physical activities that are integrated with travel and tourism, natural locations, intellectual stimulation and learning, and the good food and wine that characterise the South Australian lifestyle. Keywords: Recreation and sport, physical activity, economics of ageing 588 Title: The impact of changes on the well-being of older adults Principal researchers: Dr R Ranzijn, Professor J Keeves Organisation: School of Psychology, University of South Australia Status: Current Timetable: 1993 - 2001 Outline: This project is an extension of earlier work into the effect of changes in health and social involvement on subsequent well-being. Whereas the earlier research analysed data from only two waves of data collection from the Australian Longitudinal Study of Ageing, the present project will analyse data from all six waves after the present wave of data collection has been completed. The analytic methodology will be to use difference scores as predictors of changes in well-being and other variables, including psychological variables. Keywords: Psychological well-being, path analysis, analysis of change 322 Australian Ageing Research Directory 2000 Social Sciences Social Sciences Community Services and Social Welfare 4.1 Anglican Home Inc, Western Australia 589 Title: Anglican Homes resident satisfaction survey Principal researchers: Ms T Fidock, Ms K Park Organisation: Anglican Homes Inc, Western Australia Status: Completed Funding: Self funded, $15,000 Timetable: April 1999 - March 2000 Outline: A quantitative study was developed in order to ascertain the level of resident satisfaction in relation to care, services and facilities across nursing homes, hostels, dementia specific hostels and independent living centres. The entire population of 1,600 residents was surveyed. An overall response rate of 70% was achieved. The surveys included questions under the following critical areas: care, dignity and respect, social life, design, facilities and staff service. The findings are presented in two formats, facility by facility and consolidated. Keywords: Residential care, resident, survey, centre, resident satisfaction 4.2 Benevolent Society of NSW 590 Title: Taking charge: Managing decisions for later life Principal researcher: Ms B Squires Co-researcher: Ms S Wall Organisation: Centre for Education & Research on Ageing, Concord Hospital; Benevolent Society of NSW Status: Completed Funding: NSW Committee on Ageing, Ageing and Disability Department Timetable: June 1999 - October 1999 Website: http://www.coa.nsw.gov.au Outline: This study looks at the steps people can take to plan ahead for a time when they are unable to make health and financial decisions for themselves, including advance care directives, enduring powers of attorney etc. It looks at changes that may be needed to make these tools easier to use such as how to ensure that older people, their doctors and financial advisers are fully informed, at the same time ensuring that older people are protected from exploitation. The research built on earlier studies undertaken by the contracted organisations and literature searches. Keywords: End-of-life decision making, advance health directives, enduring power of attorney, enduring guardianship, living wills, financial exploitation Australian Ageing Research Directory 2000 323 Social Sciences 4.3 Bentley Aged Care Service, Bentley Health Service 591 Title: Night Functional Dependency Index Principal researcher: Dr P K Loh Co-researchers: Dr M D Donaldson, Mrs U Adams, Ms E Ong Organisation: Bentley Aged Care Service, Bentley Health Service Status: Completed Funding: Internal Timetable: February 1999 - September 1999 Outline: Assessments of function in the elderly are often based on the Barthel Index which measures the functional ability of individuals to provide personal self care and thus perform their activities of daily living. Nocturnal activities of daily living are also important in determining independence or level of function and historically have been documented by recording qualitative descriptions of frequency of nursing activities. This study sought to utilise a night time functional quantitative measure to aid in night functional assessment and risk stratification for discharge planning. The Night Functional Dependency Index contains ten items and is scored out of 100. It has been shown that if patients score above 75 on this index and the Barthel Index, they will be suitable for independent living and discharge home. A score of 60 seemed to be a pivotal point between independence and dependence, and below 65 on the Barthel Index and the Night Functional Dependency Index usually indicated nursing level of care. It is believed this index can be used to determine outcome and assist in determining discharge destination after rehabilitation. Keywords: Activities of daily living, night time dependency 4.4 Carers Association of South Australia Inc. 592 Title: Progress towards…carers vision 2000: A report on the outcomes of the planning day held by the Carers Association of South Australia on April 1999 Principal researcher: Carers Association of South Australia Inc Organisation: Carers Association of South Australia Inc Status: Ongoing Outline: In 1996, Carers Association of South Australia and South Australian Carers developed a vision of services and policies for carers for the year 2000. Thirteen key service and policy areas were identified on which progress was needed by 2000. Each year since, a Vision 2000 planning day has been held to measure progress toward the vision. By invitation, groups of carers (including elderly carers), carer support groups (including rural carer support groups), service providers, Association staff and senior managers and government officers were formed and asked to rate progress on each of the thirteen areas. The report summarises their responses and compares their rating with previous ratings. The combined view of these groups show that progress on policy and service development for carers has slowed over the last year and the barriers to progress are increasing. Keywords: Carers, needs, policy 324 Australian Ageing Research Directory 2000 Social Sciences 593 Title: Review of rural carer support development: Eyre carers, Northern Country carers, South East carers, River Murray and Mallee carers Principal researcher: Carers Association of South Australia Inc Organisation: Carers Association of South Australia Inc Status: Completed Timetable: 1999 Outline: Carers Association of South Australia has run the Rural Carer Support Project (across rural South Australia) since 1996. The 1999 review highlighted the effectiveness of the community development self-help methodology used and the need to continue this approach in the future. By the end of 1999, a mutual support network had been established involving 1,500 rural carers across South Australia. Carers participating in the review indicated that they are now better informed and acknowledged as carers, have stronger networks and friendships with other rural carers, have greater ability and confidence to offer other carers support, have better health, are less stressed and have less feelings of powerlessness. Nearly half these carers are over 60 years of age. Keywords: Community development, self-help, rural carers, support networks, reviews 594 Title: Report on a survey of carer respite needs and carer respite services in the southern country region of South Australia Principal researcher: Carers Association of South Australia Inc Organisation: Carers Association of South Australia Inc Status: In progress Timetable: Complete June 2000 Outline: Carers Association of South Australia auspices and oversees the Southern Country Carer Respite Centre funded under the Commonwealth Staying At Home Program. In 1998, a survey of carers and respite service providers was carried out to gain a snapshot of needs and services in the area. Key findings were that nearly 50% of the 164 responding carers were over 64 years of age and a significant proportion of the 164 carers had never used respite. It also showed access to respite was difficult in part because the 60 responding services providers were not evenly distributed across southern country South Australia. In 2000, a follow-up survey was carried out to identify changes and progress that may have occurred. Keywords: Respite, rural carers, rural carer needs 595 Title: Report on a survey of carers in the Western Region Of Adelaide Principal researcher: Carers Association of South Australia Inc Organisation: Carers Association of South Australia Inc Status: In progress Timetable: June 2000 Outline In 1998, Carers Association of South Australia received HACC funding for the Western Carer Support Project designed to develop carer supports in the western suburbs of Adelaide. The project has collected a wide range of data on a self-selected sample of carers it has contact with. This data has been collated and is summarised in a report that shows 64% of carers in contact with the project are over 60 years of age. Keywords: Carers, needs assessment Australian Ageing Research Directory 2000 325 Social Sciences 596 Title: Review of the Carer Retreats Program and follow up report: Carer retreats 1999: A statistical profile Principal researcher: Carers Association of South Australia Inc Organisation: Carers Association of South Australia Inc Status: Completed Timetable: 1999 Outline: Carers Association of South Australia administers the Home and Community Care funded Carer Retreats Program for South Australia. The program review found retreats help carers to cope better, feel less stressed, build networks of carers, offer support to other carers, acquire new knowledge, have new people to turn to, and develop new skills. Retreats also give carers more energy, better health and they experience the benefits of a retreat for months. In 2000, the Association produced a follow up report “Carer Retreats 1999: A Statistical Profile” which shows, of carers attending retreats, 37% are over the age of 60 and 11% of male carers and 26% of female carers attending live outside of Adelaide. Keywords: Carer, retreats, respite 4.5 Carers Association Victoria Inc. 597 Title: Putting carers in the picture: Improving the focus on carer needs in aged care assessment Principal researchers: Ms G Pierce, Ms J Nankervis Organisation: Carers Association Victoria Inc. Status: Completed Timetable: 1998 Outline: The project aims to encourage more emphasis on carer needs in aged care assessment and to help the service providers who work with and support carers. The study looks at carers’ perspectives of their needs when being assessed and the formal and informal supports and interventions which they need when caring. Keywords: Carers, caregiving, assessment 598 Title: Carers speak out: A consultation on community services with carers in the Southern Metropolitan and Grampians Region Principal researchers: Ms J Nankervis, Ms J Robeiro Organisation: Carers Association Victoria Inc. Status: Completed Timetable: 1999-2000 Outline: Consultations with 350 carers were carried out in a regional area and a metropolitan area of Victoria to ascertain carers’ views on services, to improve Carers Association Victoria ability to support and advocate on behalf of carers and to encourage carers to lobby on their own behalf. The consultation involved carers of people with a mental illness, carers of the frail aged and carers of people with a disability with a special bi-lingual consultation held with carers in the southern region. The consultations involved firstly contacting carer support group facilitators, secondly, discussions with carers in small groups and finally feedback from carers and consideration for future action. Keywords: Carers, caregiving, rural health 326 Australian Ageing Research Directory 2000 Social Sciences 4.6 Carers NSW 599 Title: Coping at home: Carers’ use and non-use of community services Principal researcher: Ms T Payne Co-researcher: Professor F Ehrlich Organisation: Carers NSW Status: Completed Funding: Commonwealth Department of Health and Family Services, Health and Family Services Research and Development Section Timetable: July 1997 - August 1998 Outline: This study arose out of an earlier study done by Carers NSW which showed that unmet need for services among informal carers of elderly people or those with a disability or chronic illness who called Carers NSW was very high. It sought to understand why these carers were not getting the services or extra services they said they needed. Using a structured questionnaire, 300 in-depth telephone interviews were conducted from amongst carers who called Carers NSW for a Carer Support Kit in the period 18 August 1997 to 11 February 1998. Seven focus groups of carers were also held around the state. A quota sampling method was used to select 300 respondents and to ensure that the gender ratio in the sample reflected that in the carer population of NSW and that carers of people with a variety of conditions were included. The study found that the barriers to service use were numerous. Individual carers often have multiple barriers to service use. The barriers could be grouped into five categories (in descending order of importance): values and attitudes; practical; informationbased; conflict-based; other. A number of strategies are needed to overcome these barriers. Keywords: Carers, service use, support 600 Title: Focus on carer counselling needs and options Principal researchers: Ms G Rose, Ms K Wood Organisation: Carers NSW Status: Completed Funding: Home and Community Care Program, Commonwealth Department of Health and Aged Care and NSW Ageing and Disability Department Timetable: 1995 - 1997 Outline: The primary purpose of this project was to: identify carer counselling needs, consider appropriate responses to these needs, explore whether there are issues and counselling needs particular to carers that could inform current discourse about the values of developing a carer-specific counselling model, investigate existing generalist counselling services for future carers referral, and make recommendations for future service directions and resource allocation. Consultations with carers and service providers were undertaken, current carer research was reviewed and pilot counselling approaches were designed, implemented and evaluated. The study concluded that a range of counselling and support services need to be made available to carers and that counselling services recognise and respond to issues frequently identified by carers. It was also concluded that agencies need to take into account the diversity of carer cultures and lifestyles when planning services. The telephone was also considered to be a crucial component of carer counselling services. Keywords: Carers, counselling, support Australian Ageing Research Directory 2000 327 Social Sciences 601 Title: Picking up the threads: A study of former carers Principal researcher: Ms T Payne Co-researcher: Dr S Graham Organisation: Carers NSW Status: Completed Funding: NSW Ageing and Disability Department, Small Research Grants Program, $9,980 Timetable: August 1998 - June 1999 Outline: This study aimed to identify the factors which facilitated or hindered the post-caring adjustment of 50 elderly former spouse carers. Because of the nature of caring as an often intense activity, the study hypothesised that the intensity of caring would impact upon the capacity of carers to “pick up the threads” of their lives once their spouse had died. The extent of the carer’s ability to fulfil various social roles and to participate in the life of the community was used as the indicator of their adjustment. Participation was measured in terms of the number of interests and activities undertaken. The study was small and exploratory in nature. Members of the sample were predominantly women due to the difficulty in recruiting male respondents. The carers came from across New South Wales. No control group of noncarers was included. The research found that the post-caring adjustment is a complex and individual process in which carer’s re-evaluate their lives and adapt to their new circumstances. Each person does this at their own rate and in their own way. Carers with the greatest number of supports adjusted more easily to life after caring. A number of factors facilitated or hindered the post-caring adjustment. These included: family support, the carer’s personality, help from friends and neighbours, faith/religious belief, help from community services, carer support groups, grief counselling and other supports (for example, from volunteers or churches). Each of these factors was of a dual nature; whether it helped or hindered the post-caring adjusted depended on the quality of the support provided. Keywords: Carers, former carers, bereavement, support 4.7 Council on the Ageing Queensland Inc. 602 Title: NESB Program Support Agency report: Pilot project to improve access to mainstream Home and Community Care (HACC) services for people from non-English speaking backgrounds Principal researcher: Ms K Sivadorai Co-researcher: Mr T Rivera Organisation: Council on the Ageing Queensland Inc. Funding: Home and Community Care Program Status: Completed Timetable: November 1995 - April 1997 Outline: Statistics indicate that one in four older persons will come increasingly from nonEnglish speaking backgrounds. However, older Australians of an ethnic background are not a homogeneous cohort of the population in terms of their linguistic, cultural and religious diversity. The goal of the pilot project was to improve the quality and appropriateness of service delivery to HACC service clients from a non-English speaking background. Three specific services, namely Home Care, respite care and Meals on Wheels services were the focus of the study. A methodology that is qualitative, participatory, experiential and one of reflection and observation was adopted. Project strategies focused on providing information and education, developing sensitivity through discussions and influencing policy. The project 328 Australian Ageing Research Directory 2000 Social Sciences found that there was a need for greater understanding of access and equity issues in service provision, that service providers may not recognise that non-English speaking background persons eligible for HACC services are a HACC special needs group. There is a tendency for monocultural values of service providers to inform the manner of service delivery. Certain service providers show a lack of sensitivity to cultural issues. The view that non-English speaking background persons do not access mainstream services because ethno-specific services are adequately meeting their needs is prevalent. Availability of family, informal and community supports for non-English speaking background persons is assumed by service providers. The ability of non-English speaking background clients to articulate needs produces better outcomes in terms of participation in home care and respite services. Among non-English speaking background persons, there appears to be little understanding of the determinants of eligibility, and of how services operate. The ongoing support of management has been found to be vital to the successful implementation of project activities. Mainstream services face a challenge to develop a flexible structures and adaptable models of service delivery to meet the needs of NESB clients. To some extent, disadvantage to non-English speaking background persons may be exacerbated by involvement with some ethno-specific service providers who do not have the capacity to meet all the needs of clients. If areas of cooperation and protocols for effective networking between mainstream and ethno-specific service providers are identified, the disadvantage may be reduced. Information strategies targeted at non-English speaking background older persons may raise awareness of alternative and/or additional care arrangements. An adequate investment of resources to encourage and support organisational access and equity initiatives targeted at non-English speaking background older persons is strongly recommended. Such resource allocation would enable the Council on the Ageing Queensland Inc. to provide information, expertise and program support to mainstream HACC service providers as they develop programs to respond to the linguistic and cultural needs of non-English speaking background persons. Recommendations focused on the need to provide culturally appropriate services and good quality care for people from a non-English speaking background. This focus hinges on the responsibility of service provider organisations funded by HACC to ensure that the current policies, procedures and practice produce equitable outcomes for non-English speaking background persons. Keywords: NESB aged, ethnic aged, HACC services 603 Title: NESB Program Support Agency Stage 2 report: Sources and resources: Linkaging people from non-English speaking backgrounds and mainstream HACC services Principal researcher: Ms F Jordan Co-researchers: Ms H Heim, Mr T Rivera Organisation: Council on the Ageing Queensland Inc. Funding: Home and Community Care Program Status: Completed Timetable: January 1998 - July 1998 Outline: This report presents the findings of the mainstream HACC service providers who provide services to frail/aged persons and the ethnic community organisations in the Brisbane metropolitan area. These surveys formed the second phase and completed the project. The second phase of the project had two parts - a survey of mainstream HACC services and a survey of ethnic communities and HACC services, as well as the links which ethnic communities had with government and community agencies. The second survey identified the main functions of the ethnic organisations, the contacts which they have with government and community organisations, reciprocal links and their clients receiving HACC services now and Australian Ageing Research Directory 2000 329 Social Sciences a projection for the future. It also identified the linkages which individual service providers had with ethnic communities and the structure of provider organisations in terms of the ethnicity of paid and unpaid staff, their clientele, the collection of ethnicity data and staff training. The survey found that it is questionable whether mainstream HACC services have a commitment to providing services for clients from non-English speaking backgrounds and whether they recognise and value cultural diversity. The number of clients of non-English speaking backgrounds catered for in mainstream HACC services is very small with HACC expenditure for people of non-English speaking backgrounds at only 1.75% of the total Queensland HACC budget. Only eleven HACC services out of the 74 mainstream services provided ethno-specific services to clients from non-English speaking backgrounds. The changes in attitudes and the decision to consider the needs of people from non-English speaking backgrounds needs to occur on a number of levels - managers within the Statewide Health and Non Government Services Unit of Queensland Health, need to give policy direction and make budgetary allowances; Area HACC managers to give encouragement and support to HACC service providers; management committees of the HACC service providers to include the needs of people from non-English speaking backgrounds in their philosophy of care, strategic and implementation plans for their services. The staff, both paid and unpaid, should have a commitment to valuing differences, wanting to include clients from nonEnglish speaking backgrounds in their services and making the necessary provision in their targeting. Three models of care are recommended - ethno-specific services provision, partnership or multicultural model, bringing together individuals with different skills and experience, and linkages involving the linking of two or more partners to deliver culturally appropriate aged care. 50% mainstream HACC services did not employ personnel from nonEnglish speaking backgrounds. Linkages and reciprocity between mainstream HACC services and local ethnic communities is very poor, with promotion of their services in the ethnic communities below 25%. Presentation of information in languages other than English also rated below 25%. The shortage of interpreters continues with difficulties occurring at assessment and in preparation of care plans and treatment. Recommendations cover a number of distinct areas from responsibilities of Commonwealth and state governments, individual HACC providers, non-government peak ethnic organisations, to the involvement of both large and small ethnic communities themselves. Keywords: NESB aged, ethnic aged, HACC services 4.8 Deaf Society of NSW 604 Title: Collection of data from older deaf people: Use as the basis for establishment of relationships with residential institutions Principal researcher: Mr P Bonser Organisation: Deaf Society of NSW Status: Completed Funding: Ageing and Disability Department, NSW, $9,000 Timetable: Completed Outline: This entailed a survey of the needs of older deaf people, not living in their own homes, and their accommodation needs in hostels and nursing homes. The data was then analysed to help formulate appropriate accommodation options for older deaf people on NSW. In particular, the report looks at how older deaf people could use mainstream accommodation services and what if any modifications would be required. Keywords: Deafness, aged care residential facilities, hostels, nursing homes 330 Australian Ageing Research Directory 2000 Social Sciences 4.9 Eastern Domiciliary Care Service 605 Title: Comprehensive dementia support: An integrated regional service for the eastern suburbs Principal researcher: Dr R Penhall Organisation: Eastern Domiciliary Care Service Status: In progress Outline: The project aim is to improve the support available to people with dementia and their carers in the eastern suburbs of Adelaide by creating more coordinated and cost effective services that can respond flexibly to individual needs and circumstances. The project will reorient clinical practice within the support programs of Eastern Domiciliary Care Service and Aged Care & Housing Group Inc. through a more comprehensive understanding of the available range of service and community resources and so better meet consumer needs by enabling choice through information and providing options. Both organisations have a commitment to using current funds more effectively for better outcomes and continuity of care. Policies will support single assessment and integrated care. The outcome will promote regional service delivery and achieve coordinated care outcomes with a range of other services identified in the early stages of the project. The project will change work practices that will be sustained beyond the funding period. Successful application of the project will link the expertise of two services and their separate programs and build upon the current range of skills in dementia care. It will reorient the service ethos to changing work practices, greater client focus and better coordinated care outcomes. The project requires consultation with community and staff and relevant other support organisations to identify the full range of needs and possible resources. In addition, coordinated care outcomes will be identified and all participating organisations will work towards these. The recipient clients and carers will become more informed of the range of options available to support their lifestyle choices and promote their community living, by reducing stresses around the need for continuing care. The outcome will support the development of fully coordinated regional services by inclusion of the public hospital. Keywords: Dementia support, service delivery, continuity of care, carers 606 Title: Domiciliary care case management project Principal researchers: D Gursansky, B Gameau, P Eckert, L Sellars, J Commane Organisation: Eastern Domiciliary Care Service Status: In progress Outline: Final year social work students will be engaged ‘contractually’ as consultants to a reference group representing service practitioners and case managers of the four metropolitan domiciliary care services to examine case management in the organisations. The expected outcomes will be (i) a consolidated statement of the breadth of services covered by each domiciliary care service in metropolitan Adelaide; (ii) awareness of the various ways in which care plans are developed in the domiciliary care services; (iii) specification of the activities undertaken by case managers in domiciliary care to allow presentation of case management as a key service delivery approach; (iv) collation of a profile of the case managers working across the domiciliary care services. Keywords: Domiciliary care, case management, case managers Australian Ageing Research Directory 2000 331 Social Sciences 607 Title: Eastern regional collaboration project Principal researchers: D Whelan, H Radoslovich Organisation: Eastern Domiciliary Care Service Status: In progress Outline: The project aim is to facilitate the further development of cooperative, collaborative and integrative practice amongst service providers addressing the needs of the HACC target group in the Eastern metropolitan area of Adelaide. The expected outcomes are (i) investigation of a range of different models of collaborative service delivery; (ii) assessment of the applicability of those models to the eastern metropolitan region; (iii) agreement and adoption of a collaborative model for the eastern metropolitan region; (iv) development and implementation of the preferred collaborative model. Keywords: HACC, community care, collaborative model, service models 608 Title: Meeting together (Inbarendi): Working toward a collaborative approach to Aboriginal health Principal researcher: D Loveday Organisation: Eastern Domiciliary Care Service Status: Nearing completion Outline: The project aims to define the aboriginal population and its health status in the eastern region compared with the general population and identify barriers to accessing mainstream services. The outcomes will be an awareness of strategies for change in mainstream services to improve access by aboriginal persons, and the facilitation of a funding submission to achieve the implementation of those strategies. Keywords: Aboriginal health, health status, indigenous health, service access 609 Title: Metric for activities of daily living Principal researcher: P Bastian Organisation: Eastern Domiciliary Care Service Status: In progress Outline: This project aims to develop weights for activities of daily living. It is intended to create a ratio scale for measuring personal and instrumental activities of daily living to enable quantification of disability. Keywords: Metric scale, disability, measurement, activities of daily living 610 Title: Outcome after stroke: Post rehabilitation follow-up measures of physical performance, physiological responses to graded exercise and ratings of perceived exertion during different modes of exercise Principal researchers: B Barnard, P Hamdorf, R Penhall Organisation: Eastern Domiciliary Care Service Status: Planned Outline: This project will conduct follow-up measurements in a group of post cerebrovascular accident survivors. It will facilitate the assessment of any changes that may have occurred since previous testing in functional performance, physiological responses and ratings of perceived exertion from a range of exercise modalities. Keywords: Stroke, stroke outcome, rehabilitation, cerebrovascular accident 332 Australian Ageing Research Directory 2000 Social Sciences 611 Title: The prevalence of malnutrition in a population of geriatric domiciliary care recipients Principal researchers: C McIntosh, A Russo, A Comachio, R Penhall, J Morley, M Horowitz, I Chapman Organisation: Eastern Domiciliary Care Service Status: In progress Outline: This project aims to determine the prevalence of malnutrition using the MiniNational Assessment in a population of community-dwelling, elderly individuals receiving domiciliary care and to ascertain whether the Mini-National Assessment can be used to predict outcome at 12 months in this population. The project outcome will be the identification of a subset of the elderly population receiving care and support who could be targeted for prevention or treatment of protein-calorie malnutrition, without having to measure biochemical indices of nutritional status. Keywords: Malnutrition, domiciliary care, community dwelling elderly 4.10 Fronditha Care Inc. 612 Title: Forty years later. A demographic and needs analysis study of Victorian Australian Greek elders Principal researcher: Mr C Tsingas Organisation: Fronditha Care Inc. (formerly Australian Greek Society for Care of the Elderly) Status: Completed Funding: Department of Human Services, Victoria Outline: The focus of the study is the demographic characteristics of Greek speaking elderly people, their residential and community based support needs, and the strategies required to responsively meet those needs. Study objectives were (i) to use Australian Bureau of Statistics data, to prepare a demographic analysis of the Greek speaking elderly people in Victoria, including gender, geographic distribution by municipality, age, income, accommodation, household type, competency in English and age of arrival in Australia; (ii) to survey the needs and issues confronting the Greek speaking elderly people aged 65 years and over; (iii) to identify those factors that impede access to the existing service system as perceived by consumers; (iv) to make recommendations on how service providers and the Greek community should be responding to the identified issues. A sample of 250 Greek speaking elderly people over the age of 65 years throughout the Melbourne metropolitan area were interviewed through a structured questionnaire. Key findings included (i) the projected dramatic increase in the number of 65 plus age group from 11,850 in 1996 to 30,038 by 2016; (ii) the majority of the current 65 plus age group do not speak English well or not at all; (iii) access to community support services is limited; (iv) Greek speaking elders are underrepresented in mainstream community services. Keywords: Ethno-specific, Greek elderly, importance of culture, importance of language, nonEnglish speaking background, NESB elders Australian Ageing Research Directory 2000 333 Social Sciences 4.11 Helping Hand Aged Care Inc., South Australia 613 Title: Community consultation in northern metropolitan Adelaide Organisation: Helping Hand Aged Care Inc., South Australia; Council on the Ageing Status: Planned Funding: Internal Timetable: July 2000 - October 2000 Outline: As a significant provider of community and residential services in northern metropolitan Adelaide, Helping Hand Aged Care wishes to improve and expand current service provision in the region. It has been strategically recognised within the organisation that the community consultation is paramount to the planning and development of future services. In order to obtain the most objective information a decision was made to partner the Council on the Ageing to carry out the research, without reference to the organisation. In order to ensure that Helping Hand is in touch with the community in the northern region, the project will seek views of older people to determine: (i) how they want services to be shaped for them in the future; (ii) how they want to be involved in service development; (iii) how they would like services to be coordinated between service providers; (iv) how they wish to be involved as volunteers in service delivery; (v) how Helping Hand can better publicise and promote its services to the community. In the early stages, consultation with current and potential clients will be undertaken through a variety of means in order to achieve the largest and most variable sample. This will be undertaken via focus groups, individual interviews via telephone or person to person. Keywords: Consultation, future service needs 614 Title: Mid north regional profile of veterans and their widow(er)s Principal researcher: Ms B Hartwig Organisation: Helping Hand Aged Care Inc., South Australia Status: In progress Funding: Residential Care Development Scheme, Department of Veteran Affairs, $11,540 Timetable: Completion July 2000 Outline: This funding directly relates to the establishment and functioning of new Community Care Package Programs. The significant number of veterans living in the Mid North rural region of South Australia was recognised. It is imperative in the establishment phase that emphasis be placed on research and planning. The aim of the study is to establish a regional profile of veterans; this will include investigating their specific needs including their health status. The major goal will be the application of findings to policy and procedure development within the program and as a guide to future directions. As a component of the activities, there is a further aim to establish links and working relationships with local Ex Service organisations. The consultancy will use existing and previously collected data to establish the profile and needs assessment. Data will be collected locally by interviews with groups and individuals using a qualitative approach by content analysis. Existing data will be researched and analysed using a quantitative approach. Health status will be analysed on a broad basis through self-reporting and discussions with general practitioners where these discussions can be established. Keywords: Veterans, rural, Community Care Packages 334 Australian Ageing Research Directory 2000 Social Sciences 4.12 Hostel and Care Division, Home Care NSW 615 Title: Modifying the home environment for people with dementia Principal researcher: Ms M O'Sullivan Organisation: Hostel and Care Division, Home Care NSW (now disbanded) Status: Completed Funding: Ageing and Disability Department, NSW Action Plan on Dementia Timetable: 1998 Website: www.add.nsw.gov.au Outline: The study's aim was to examine the home environment for people with dementia and to document possible solutions to common problems facing people with dementia and their carers. Information was collected from a number of sources: (i) 11 people with early stage dementia who were aware of their declining skills and had developed techniques to compensate; (ii) from a separate project involving 40 people with dementia living in Lake Macquarie where people were offered an assessment of their house and then given help with modifications; (iii) 16 carers with detailed responses; (iv) 70 service providers including Occupational Therapists, Community Options workers, and Home Maintenance & Modification Services; (v) a large number of manufacturers, wholesalers, retailers and tradespeople for information about products equipment and modifications. The study produced information of strategies, modifications, and products for adapting the home environment so that a person with dementia can remain independent for as long as possible and continue to participate in their day to day care and in activities they enjoy. The information has been collated in a publication called At home with dementia. Keywords: Home modifications, dementia, carers, environment 4.13 Institute for the Service Professions, Edith Cowan University 616 Title: A profile of the service professions responding to elder abuse Principal researcher: P Weatherill Co researchers: S Murray, L Hopkins Organisation: Institute for the Service Professions, Edith Cowan University Status: In progress Funding: ISP Targeted Grant, $10,000 Timetable: January 2000 - July 2000 Outline: This project aims to establish profiles of the proliferation of Western Australian service professions currently responding to elder abuse. It is part of a larger study examining responses to elder abuse, domestic violence and sexual assault as other areas of personal violence. It will address the needs of the professionals providing human services to seniors, women and families. The project will analyse the range of theoretical frameworks underpinning service provision and how they inform practice. Training needs and existing training provisions will be examined with particular reference to Edith Cowan University teaching programs in these areas. The study includes interviews with staff and volunteers at 70 human service agencies in both rural Western Australia and Perth. It is expected that data will show the training gaps for the professions responding to elder abuse, and to begin mapping the organisations and professions who respond to elder abuse cases in their daily work. Keywords: Elder abuse, training, professionals, professions, service provision Australian Ageing Research Directory 2000 335 Social Sciences 4.14 Julia Farr Services 617 Title: Computerised dietary management for tracking food nutrients in a disability services nursing home population Principal researcher: Ms J Martin Organisation: Dietetics, Julia Farr Services Status: Completed Timetable: June 1998 Outline: Meeting nutrition requirements of residents in nursing homes involves planning menus suited to the population. This is highlighted in disability services where chewing and swallowing problems as well as physical eating difficulties are common. Prevalence of undernutrition is reported to be as high as 60% in institutionalised older people. Australian Dietary Guidelines and Recommended Daily Intakes for Australians provide standards for menu assessment. Food intake charts provide information about individuals. These assessment processes require the services of an experienced dietitian. They do not provide ongoing monitoring to measure the suitability of the menu and foods offered. The Buckeye Dietary Management System is a computer software program linking diet with menus. Individual meal plans provide the means whereby dietary requirements can be juggled and daily production orders adjusted. Food intake over five days using production lists for 42 residents over 65 years of age were analysed. The Body Mass of population was described. Production lists over five days for dining areas were used to calculate nutrients of food offered. The study showed that computerised dietary management systems provide the means whereby nutrition parameters can be measured and the information used to improve the profile of foods offered on the menus ad thereby the nutritional status of residents in a long term care facility. Keywords: Nutrients, disability, nursing home, malnutrition, dietary guidelines, menus 618 Title: Descriptive analysis as a method to describe perceived sensory characteristics of food items on a modified texture menu Principal researcher: Ms J Martin Organisation: Dietetics, Julia Farr Services Status: Completed Timetable: April 1996 - August 1996 Outline: Modified texture foods and thick consistency fluids are used as treatment for individuals with breakdown in competence of chewing and swallowing (dysphagia). Suitability of menu items is decided by the speech pathologist in the therapeutic setting and standards set in the catering department accordingly. Commercially used descriptions of the required food processing include soft, minced, vitamised, pureed, mashed or cut up. Confusion over the correct texture required commonly leads to overprocessing, which may cause nutritional compromise for the client as well as a lack of appealingly presented meals. A food tasting panel approach can improve the situation given an appropriate measuring tool. This work aimed to develop such a tool, based on an assessment by the panel of a range of foods processed at Julia Farr Services. A numerical scoring system, giving a range of values along a continuum, describes the characteristics of each menu item. A maximum score for both texture and consistency guides the decision as to suitability of the product for the prescribed diet. The panel was trained in the process of sensory analysis. Organisation support was obtained given the likely outcome of quality improvement for the food service. 336 Australian Ageing Research Directory 2000 Social Sciences Standardised commercial foods were provided for three trial sessions to facilitate reliability. Reference foods were subsequently chosen for the continuum of each of the sensory characteristics. Reliability of members in the use of the questionnaire was evaluated by presenting several foods four times each. With six members to test each food, and six or seven foods per week, the process took twenty weeks. Of all characteristics, texture of meats in soft diets is probably the most contentious issue. Based on 50 food items generally included in soft diets, a cut off for acceptability was deemed to be 13. The research showed that a quantitative method for testing texture and consistency of foods in services with dysphagic patients provides improved accuracy in the determination of menu items, and the cooking and processing recommendations. Follow up testing provides quality assurance in this area. Keywords: Dysphagia, hospitals, nursing homes, menus, texture, food consistency, sensory 619 Title: Skin integrity study Principal researcher: Ms L Boyle Co-researchers: Ms J Vincent, Ms E Turner Organisation: Lifestyle program, Julia Farr Services Status: Ongoing Funding: Trust funds Timetable: September 1996 - ongoing Outline: This study aimed to provide information about the skin integrity and pressure area status of every resident in the Lifestyle program at Julia Farr Services. Due to the increasing number of aged people requiring 24 hour care, staff set out to assess all the residents’ skin integrity with a view to maximising prevention of skin breakdown and minimising development of pressure areas. A multidisciplinary team, comprising the program manager, nurse unit managers, wound care and continence advisors, dietitian, medical officer and enrolled and registered nurses from each ward, undertook a skin integrity audit and implemented another audit every six months. The objective was to document current skin integrity, relative to Waterloo Pressure Risk Assessment, highlighting areas of risk and need. Following the second audit, results revealed an increase in compromised skin integrity during the summer months. There were three reasons for this: increased heat; the inability of neurologically and brain damaged residents to thermostatically adjust; and extended periods in wheelchairs. Full scale interventions ensued with wheelchair and seating assessments implemented and where possible, new pressure relieving cushions and wheelchairs were obtained. Keywords: Evidence based, multidisciplinary, prevention, assessment, pressure-relieving 4.15 NSW Committee on Ageing 620 Title: Volunteering and older people Principal researcher: Ms S Fogg Status: Completed Funding: NSW Committee on Ageing project funding (Ageing & Disability Department) Timetable: February1999 - October 1999 Website: http://www.coa.nsw.gov.au Outline: This study aimed to examine older people’s interest in volunteering. Governments, policy makers and community organisations are increasingly viewing older people as a potential rich new source of volunteers. But does volunteer work feature in older people’s own retirement plans? A Two Way Street: Older people and volunteering reports on research Australian Ageing Research Directory 2000 337 Social Sciences in 1999 into older people’s interest in volunteering, and what might make them more likely to take up volunteer work. The research consisted of a written survey, asking 2,000 people (Seniors Card holders) in the Central Coast and Ryde/ Hunters Hill areas questions about their interest in volunteering. A 40% return rate was achieved. Two consultations were held in the same locations, and a literature search was conducted. Keywords: Volunteering, older people, unpaid work 4.16 Office of Seniors Interests, Western Australia 621 Title: Seniors’ perceptions of their safety at home and in the community Principal researcher: Ms G Hall Organisation: Office of Seniors Interests, Western Australia; Insight Research Ltd Status: Completed Funding: Self-funded Timetable: October 1997 - October 1998 Outline: This study aimed to measure seniors’ (people aged 60 or more) perceptions of their safety at home and in the community, compared to adults under 60. An age-stratified sample of 3,000 was drawn from the WA Electoral Roll and posted to respondents. A response rate of 43% was achieved, with a larger proportion of seniors responding. Seniors reported less experience of crime than younger respondents, and felt no less safe from crime from day to day, and no more at immediate risk of crime, than younger respondents. However, seniors tended to believe that they were targeted for crime because of their age, and that the most common type of crime against seniors was assault (which was contrary to their own reported experience and all statistical findings). It was concluded that seniors’ beliefs about crime were at variance with their own experience and feelings of risk, and that sensationalist media coverage may be the cause of part of this discrepancy. Keywords: Crime, safety, fear, older people 4.17 Parkes Aged Care Service 622 Title: Falls Management Programme: Intervention with referred fallers Principal researcher: Ms D Tooley Co-researcher: Dr K Fleming Organisation: Parkes Aged Care Service Status: Completed Funding: Ageing and Disability Department, NSW, $14,910 Timetable: 1998 - 1999 Outline: This study involved identification of 50 older people living in their own home in Parkes and Forbes in Central Western NSW who fell. Those referred undertook a comprehensive assessment by the Parkes Aged Care Service using the Falls Management Tool followed by recommendation of intervention strategies to their general practitioner and primary care providers. The program aimed to evaluate the Falls Management Tool in identifying risk factors associated with falls in older people, identifying factors associated with falling in the community and to develop strategies to reduce falling and injuries resulting from falls. Results of this study support a specific community focus for falls programmes separate to any implemented in residential facilities and hospital. Keywords: Falls, falls management, intervention 338 Australian Ageing Research Directory 2000 Social Sciences 4.18 Silver Chain Nursing Association 623 Title: The Home Independence Project Principal researcher: Dr G Lewin Co-researchers: Associate Professor E Helmes, Ms H O’Connell, Ms C Coster, Ms B Wheeler, Ms D Gardner Organisation: Silver Chain Nursing Association Current status: In progress Funding: Silver Chain Foundation Timetable: September 1999 - September 2000 Outline: The Home Independence Project has the specific objective of developing and testing a more cost-effective model for home care by designing services that will maintain or improve individuals’ functioning and health status and increase their independence and autonomy and thus reduce, or limit, their need for formal services. The present project has been designed to have three components: identification of the most appropriate client group(s), development of the service model, and pilot testing of the model with 50 clients. Given the demonstration of positive client outcomes by the pilot study, it is the intention of the researchers to then conduct a controlled intervention study that examines the effectiveness and costs in both the short and the longer term, of the Home Independence Project intervention as compared to the usual home care services provided by Silver Chain. Keywords: Independence, home care, ageing, service models 4.19 Southern Domiciliary Care, South Australia 624 Title: Manutention: An intervention programme for the reduction of manual handling related injuries Principal researchers: Ms C Spencer, Mr J English Organisation: Southern Domiciliary Care, South Australia Status: Completed Timetable: June 1994 - ongoing. Evaluation Report - February 2000. Outline: The investigator undertook an internal evaluation report on the Southern Domiciliary Care & Rehabilitation Service’s Manutention Programme. Manutention is a method of handling loads that is particularly suited to lifting people and moving industrial loads. The Manutention training method was developed by Paul Dotte, a physiotherapist and the founding president of SIFAM (the international organisation for Manutention). Manutention uses physiotherapy principles and techniques from the martial arts, weightlifting and abseiling. It involves pivoting, counter-balance, bracing and lunging to decrease muscular strain often associated with load-handling. This programme was adopted by Southern Domiciliary Care & Rehabilitation Service in mid 1994 in recognition that staff engaged in therapy activities for the elderly are at risk of injury. An examination of the available data revealed statistically significant reductions in working days lost by Southern Domiciliary Care & Rehabilitation Service’s staff due to all types of injury since the introduction of Manutention. On average, 32 working days were lost due to injury prior to the introduction of Manutention in comparison with 19 days post programme facilitation. The importance of addressing manual handling issues with a dedicated programme is supported by the data which revealed that non-manual handling injuries accounted for only 23.6% of the reported injuries in comparison to 76.4% for manual handling ones. Although the Manutention programme did not reduce the average lost working days for staff members in comparison to Australian Ageing Research Directory 2000 339 Social Sciences any predecessor manual handling initiatives ( a constant of 20 days lost was reported for these periods), there was however a reduction (10%) in the number of reported injuries from 159 pre-Manutention to 129 post-Manutention, over a like time period as well as a 10% reduction in
