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Objective: This scoping review will describe models of palliative care for underserved populations in high-income countries – namely: people of culturally and linguistically diverse communities; people of low socioeconomic status; and people residing in rural areas. Introduction: Models of palliative care refer to the way palliative care services are delivered. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care; but what is not known is how these models can vary to meet the needs of underserved populations. Inclusion criteria: This scoping review will consider articles that focus on models of palliative care for underserved populations, irrespective of sex, age, or primary diagnosis. Methods: The databases – Medline (Ovid), Embase (Ovid), PsychInfo (Ovid), Emcare (Ovid), CINAHL (EBSCO), and Scopus – will be searched for articles published in English, in and from 2014. Two independent reviewers will screen articles on title/abstract, followed by the full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Data from included articles will be extracted using a data extraction tool developed for this review. Results will be narratively summarised. The review will be conducted in accordance with the JBI guidelines for scoping reviews.

This report summarises the findings from a project that investigated the psychological wellbeing and financial decision-making of older Australians in times of uncertainty, that is, the COVID-19 pandemic. The project was funded by Ecstra Foundation, a grant making charitable organisation committed to building the financial wellbeing of Australians within a fair financial system.

‘Forgotten Australians’ are the estimated half a million children who were placed in institutional care in Australia from the 1920s to the 1980s. Increasing numbers are entering older age but many are poorly positioned to age well and with the supports they need. This is often because the lasting effects of childhood institutional care have contributed to poor housing outcomes, including housing insecurity, reliance on social housing, prevalence of rental stress and experiences of homelessness. This report presents the results of a rapid review of the evidence on the long-term housing experiences and outcomes of people who spent time in childhood institutional care. It identifies service gaps that are likely to undermine the capacity of the housing and aged care sectors to improve the care and supports available for this group. This evidence review was complemented by qualitative interviews with community service practitioners and representatives of advocacy groups. The report highlights potential improvements to service delivery for people who experienced institutional care as children and directions for further research. This research begins to build a stronger evidence base around the housing and care needs of this group in mid- and later life.

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Denna studie har som syfte att få en förståelse för vilka aspekter av stress det finns bland studenter som läser fristående kurs på Institutionen för beteendevetenskap och lärande vid Linköpings Universitet. Studien undersöker hur studenter upplever stress samt vilken omfattning inre och yttre stressorer påverkar studentens studieliv. Studien tillämpar först en kvalitativ metod som sedan följs av en kvantitativ metod. Studien nyttjar två olika förhållningssätt, inledningsvis är studien induktiv och sedan kompletteras studien deduktivt. Studien består av nio kvalitativa intervjuer där fyra informanter representerar enheterna CSN, Studentbostäder, Studenthälsan samt Studievägledning vid Linköpings Universitet och fem informanter är studenter som läser fristående kurs på Linköpings Universitet. Studien består även av en enkätundersökning av 72 informanter som är studenter som läser fristående kurs på Linköpings Universitet. Studiens resultat är uppdelade i en kvalitativ och en kvantitativ del för att sedan analyserats och diskuterats i relation till varandra. I resultatet framgår att det både finns yttre samt inre stressorer som bidrar till att en student som läser fristående kurs upplever stress.

Refereed/Peer-reviewed Objectives: To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. Design: A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. Setting and Participants: This study included people who accessed HCP between January 1, 2016 and December 31, 2016. Methods: The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65 years old in 2016 was evaluated. Descriptive statistics were employed. Results: In 2016, 84,681 individuals received HCPs, of which 68.4% (n = 57,942) accessed HCP levels 1‒2, 26.0% (n = 22,057) accessed HCP levels 3‒4, and 5.5% (n = 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n = 27,787) started services that year and 16.7% (n = 14,117) moved to permanent residential aged care, 18.4% (n = 15,592) used respite care and 5.8% (n = 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. Conclusions and Implications: HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary.

“Forgotten Australians” are the estimated half a million children who were placed in institutional care in Australia from the 1920s to the 1980s. Increasing numbers are entering older age but many are poorly positioned to age well and with the supports they need. This is often because the lasting effects of childhood institutional care have contributed to poor housing outcomes, including housing insecurity, reliance on social housing, prevalence of rental stress and experiences of homelessness. This paper presents a review of the evidence on the housing experiences and outcomes of people who spent time in childhood institutional care. The evidence review was complemented by qualitative interviews with community service practitioners and representatives of advocacy groups. Based on the prior evidence and fieldwork, we identify data and service gaps that are likely to undermine the capacity of the housing and aged care sectors to improve the care and supports available for Forgotten Australians. We suggest potential improvements to service delivery for people who experienced institutional care as children and directions for further research. This paper contributes to a stronger evidence base around the housing and care needs of Forgotten Australians in mid- and later life. Refereed/Peer-reviewed

ObjectivesTo develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.DesignCross-sectional.SettingHome care recipients, Australia.Participants90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.Primary and secondary outcome measuresThe Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.ResultsIn 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).ConclusionA comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.

The home care package (HCP) scheme provides funds to eligible older Australians for social, personal and clinical care services, and aims to assist people to age in-home. Uncorroborated evidence suggests older Australians rely on health professionals – especially general practitioners – to prompt HCP assessments, choose service providers and manage HCP funds thereafter. This was confirmed in a survey involving 502 older Australians aged >65 years receiving HCP funds. As more Australians survive to older age, further research is needed to establish with general practitioners their needs regarding the delivery of in-home care information, clinic practice resources, trainee education and continuing professional development. Refereed/Peer-reviewed

Disasters occur frequently in Australia and will become more unpredictable and severe due to climate change. Some members of the Australian population, such as the elderly, the chronically ill and the socially isolated, are less likely to be prepared and more likely to be adversely affected by disasters. Although general practitioners (GPs) view the delivery of preventive health care as a priority, few preventive services focus on patients' resilience and ability to cope with unexpected stressors. This paper focuses on the individuals most vulnerable to disasters and the opportunities for GPs to facilitate the enhancement of disaster preparedness among these groups. General practitioners are ideally placed to identify vulnerable patients and refer them to services that may assist them in enhancing their disaster resilience. To reduce the burden on individual GPs, adjustments can be made to practice software systems that will use patient records to identify vulnerable individuals. Refereed/Peer-reviewed