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Manufactured home villages (MHVs) are an increasingly popular housing option for older Australians. This paper reports a cross-sectional survey that sought to describe the health status and health service access of MHV residents. The survey tool comprised demographic and health status items, primary healthcare access perceptions and the World Health Organization Quality of Life tool (WHOQOL-BREF). One-hundred-eighty-six MHV residents from regional NSW completed the survey. Hypertension (54.8%) and arthritis (46.5%) were the most prevalent chronic diseases reported. Overall, respondents expressed a high level of satisfaction with the sense of safety and security (82.8%), neighbours (69.4%) and the overall location of the villages (66.7%). There was good to excellent internal consistency of all four WHOQOL-BREF domain scores, with a comparatively lower sample mean score for the 'Physical' and 'Psychological' domains. MHV residents are a significant cohort of older people with high rates of chronic disease and reasonably poor access to transport services, which affects their capacity to access health services. They also have comparatively low levels of quality of physical and psychological life along with low levels of satisfaction with their health. [ABSTRACT FROM AUTHOR]

Physical activity is an important component of standard care to ensure quality of life for prostate cancer survivors. This paper describes the frequency of physical activity management (physical activity counselling or referrals) by GPs for prostate cancer survivors. A secondary aim is to explore GP characteristics that may influence physical activity recommendations, such as GP or patient age, GP gender and GP geographical location. Analysis was conducted using the longitudinal survey data from the Bettering the Care and Evaluation of Health (BEACH) study. Consultations where prostate cancer was managed, but not classified as a new problem or associated with palliative care, were included. GPs provided physical activity recommendations at 2.0% (n = 58/2882) of prostate cancer survivorship management contacts. The physical activity management provided was physical activity counselling on 39 occasions and a physical activity referral on 19 occasions. All physical activity referrals were made to physiotherapy. After controlling for potential confounding factors, results showed that younger GPs used physical activity management at four-fold the rate of older GPs, and that GPs in major cities used physical activity management at twice the rate of rural GPs. No patient characteristics influenced physical activity management. Australian GPs rarely incorporate physical activity management as part of their management of prostate cancer. Strategies are needed to increase the frequency with which GPs recommend physical activity for prostate cancer survivors. [ABSTRACT FROM AUTHOR]

Falls are common among older people and a leading cause of injury-related hospitalisation. The immediate post-hospitalisation period is a risky time for further falls. This paper explores discharge strategies from the perspectives of older people hospitalised for a fall and liaison nurses assisting people to return home. Exploratory mixed methods were used. Semi-structured interviews with older people were conducted regarding their experience of the fall and discharge strategies. Quality of life, falls risk and functional capacity were measured by questionnaire. Liaison nurses were also interviewed. Interviews were audio-recorded, transcribed and thematically analysed. Mixed-method synthesis occurred using role-orderedmatrix analysis. Older people (n = 13) and liaison nurses (n = 6) participated. Older persons' quality of lifewas average and falls risk high. Thematic analysis revealed three key themes: 'falls are not a priority', 'information not given, or given and not retained' and 'reduction in confidence and independence'. Role-orderedmatrix analysis identified differences between acute and rehabilitative hospital stays. Older people hospitalised for a fall present a unique opportunity for implementation of falls prevention strategies. However, hospitalisation is often a time of crisis with competing priorities. Timing and relevance are crucial for optimal uptake of falls prevention strategies, with the primary care setting well-placed for their implementation. [ABSTRACT FROM AUTHOR]

Sexual difficulties relating to selective serotonin reuptake inhibitor (SSRI) medication have an impact on quality of life and are a common cause for non-adherence to medication. While most research has focussed on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the adverse sexual effects of SSRIs. This qualitative study, using Interpretive Phenomenological Analysis (IPA), investigated the experiences of 10 Australian women currently coping with the adverse sexual effects of this antidepressant by conducting semi-structured interviews. This paper presents one major theme from the study and reports the findings related to women's self-reported experiences of interacting with GPs in their search for answers and validation of their concerns. Findings from the study add to the current literature by providing an insight into how interactions with GPs impact on women's abilities to cope with adverse sexual effects. Empathic discussions and shared decision-making between GPs and women can provide the opportunity to improve the management of the adverse sexual effects of SSRIs and may lead to improved outcomes for women. [ABSTRACT FROM AUTHOR]

A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being 'better off' both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions.

The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded. [ABSTRACT FROM AUTHOR]

Background: Telemonitoring (TM) plays an important role in the self-management of chronic diseases. This study aimed to assess the feasibility of TM in early stages of chronic care for self-management and recognition of signs and symptoms of exacerbation, with a view to completing the TM program in an optimal timeframe to encourage independence and self-management. Methods: This study was conducted from 2019 to 2020. Included in the study were patients with chronic conditions at an early stage of their disease residing in the South Western Sydney region. Eligible patients were allocated a TM device for 6 months. Their routine tests data were sent in real time to health care professionals. Following assessment by a TM coordinator, suitable patients were off-boarded (deactivation of monitoring device) after 6 months. Data on hospitalisation/emergency department presentation and surveys were collected to assess the impact of TM on the level of the patient's understanding of their signs and symptoms of exacerbation, self-care, and quality of life. Results: Out of 44 patients approached, seven were off-boarded at the 6-month timeframe. The follow-up data on the hospitalisation/emergency department presentation during monitoring and 12 months post off-boarding showed a reduction in the frequency of hospitalisation/nil admissions. Patients reported an increased understanding of their health condition and confidence in managing their own health with the support of TM. Conclusion: The result demonstrates the feasibility of TM as a tool for health education and self-management in the coordination of care for chronic disease patients; however, the small sample size was a limitation. Self-management is an important aspect of the management of a range of long-term conditions. This study demonstrates the feasibility of telemonitoring as a tool for health education and self-management in patients with early stages of chronic diseases. Future research on a large cohort is required to optimise this model of care. [ABSTRACT FROM AUTHOR]

The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs. A move away from reactive, episodic models of health care delivery towards patient-focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. The OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs. [ABSTRACT FROM AUTHOR]

Although there is growing recognition of the effects of living with sleep disorders and the important role of primary care in their identification and management, studies indicate that the detection of sleep apnoea (OSA) and insomnia may still be low. This large representative community-based study (n = 2977 adults) used logistic regression models to examine predictors of self-reported OSA and current insomnia and linear regression models to examine the association of these sleep conditions with both mental and physical components of health-related quality of life (HRQoL) and health service use. Overall, 5.6% (95% confidence interval (CI) 4.6-6.7) and 6.8% (95% CI 5.7-7.9) of subjects selfreported OSA (using a single-item question) and current insomnia (using two single-item questions) respectively. Many sociodemographic and lifestyle predictors for OSA and insomnia acted in different directions or showed different magnitudes of association. Both disorders had a similar adverse relationship with physical HRQoL, whereas mental HRQoL was more impaired among those with insomnia. Frequent consultations with a doctor were associated with a lower physical HRQoL across these sleep conditions; however, lower mental HRQoL among those frequently visiting a doctor was observed only among individuals with insomnia. The adverse relationship between sleep disorders and physical and mental HRQoL was substantial and should not be underestimated. [ABSTRACT FROM AUTHOR]

This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one 'comorbid' condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the 'guiding principles' approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations. [ABSTRACT FROM AUTHOR]

Despite the large number of Australians with private health insurance (PHI), normative quality-of-life data are not available for this population. The Short Form (SF)-12 has been used to characterise the health-related quality of life of Australians in the general population, but there is debate concerning the appropriate algorithm that should be used to calculate its physical and mental component summary scores. The standard (orthogonal method) approach assumes that the mental and physical components are unrelated, whereas an alternate approach (the correlated method) assumes that the two components are related. A consecutive sample of 24 957 PHI members with four major initial disease conditions were administered the SF-12 via phone and 4330 participants were followed up at a mean of 16 months after the first survey. The SF-12 was scored using both the orthogonal and correlated methods, and both scoring models were assessed for model fit and ability to discriminate between the four major disease conditions. Confirmatory factor analysis demonstrated superior model fit and improved discriminative validity when the SF-12 was scored using the correlated method instead of the default orthogonal method. Further, the correlated method demonstrated utility by producing scores that were responsive to change over time. [ABSTRACT FROM AUTHOR]

Despite the evidence base for Internet-delivered self-help programmes, their application to cancer carers has not been reported. This feasibility study evaluated a 6-week internet cognitive behaviour therapy (CBT) programme for early stage cancer carers. The study participants comprised 13 carers who were recruited over a 17-month period. Measures included distress, quality of life and programme engagement. Changes over time were measured using effect sizes (Cohen's d), whereas acceptibility was assessed using qualitative feedback. Low enrolment and high attrition rates resulted in a failure to demonstrate feasibility. Large improvements in negative affect (d = 0.88) and emotional functioning (d = 0.62) were found. For treatment completers, the intervention holds promise in reducing distress. However, in light of the serious challenges with recruitment and retention, further research is needed to resolve participation barriers. [ABSTRACT FROM AUTHOR]