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Background: Nursing students encounter older people in all health care sectors; however, few choose a career primarily focused on older person's care. Aim: To explore the challenges to teaching older person's care to Bachelor of Nursing students and how pre-registration nursing students are prepared to care for older people, part of a large study investigating content on care of older people in Australian nursing curricula. Methods: A purposive sample of Australian nurse academics involved in Bachelor of Nursing curriculum development or delivery completed a telephone-assisted survey. Qualitative content analysis of two open-ended questions was undertaken. Results: All Australian schools of nursing participated, and 45 nurse academics were interviewed. Reflecting on the challenges of teaching older person's care to nursing students, most participants felt the curriculum was too crowded and some called for a 4 year degree. In addition, students’ ageist attitudes, fuelled by unrealistic portrayals of nursing in popular culture, were reinforced by curricula being acute care focused and the ageist attitudes of some nurse academics. Conclusions: Teaching older person's care in Australian nursing curricula is challenged by insufficient time and ageism among students and academics. Regulatory bodies need to urgently provide direction so that nursing curricula content aligns with emerging Australian health care priorities, in particular the health care needs of older people.

Background: Nurses are the largest group of registered healthcare professionals and are fundamental to delivering health and aged care in Australia. Aim: To explore how nursing students report clinical experiences when caring for older people as part of a larger study investigating how care of the older person content is included in Australian undergraduate nursing curricula. Methods: A population sample of all Australian nursing schools that offered a Bachelor of Nursing degree (n = 35) in 2019. Nurse academics involved in curriculum development or delivery were recruited. A telephone-assisted survey was used, and qualitative content analysis undertaken. Results: All schools of nursing participated in the survey, representing a response rate of 100%. The acute care focus of nursing curricula meant clinical experiences for nursing students related to older person's care commonly occurred in residential aged care facilities in the first year of the degree. Student reports of these experiences varied, with a majority of respondents reporting mixed or negative feedback associated with a lack of preparation and inadequate supervision. Conclusions: This study highlights the: significance of the timing of nursing students’ clinical placements in residential aged care; the selection of appropriate care homes; and the need for the right clinical teaching staff who can supervise high quality learning experiences for students.

Background: Meeting the complex health needs of an increasing number of older people is a critical workforce challenge for the Australian health and aged care sectors. Nurses are the largest group of registered health care professionals and fundamental to delivering health and aged care in Australia. However, while nursing students encounter increasing numbers of older people in all health and aged care settings, little is known about how they are educationally prepared to care for them. Aim: To investigate the curriculum content and method of teaching the care of older people in Australian Bachelor of Nursing degrees. Methods: A population sample of all Australian nursing schools offering Bachelor of Nursing degrees. Nurse academics involved in subject coordination or curriculum development were recruited. A telephone-assisted survey explored ‘the care of older people’ in Australian undergraduate nursing curricula. Descriptive statistical analyses were undertaken. Results: The response rate was 100%. Curricula were acute care focused with content specific to the care of older people scaffolded across curricula. A variety of teaching and learning methods were reported. Clinical experiences with older people occurred in residential aged care settings, generally in the first year of the degree. Conclusions: Preparation of pre-registration nurses for the care of older people requires improvement in curricula content and clinical experience to equip graduates to provide safe, person-centred care that meets the needs of older Australians.

The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.

© 2019 AHHA. Objectives: To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods: A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results: With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39-1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs. Conclusions: This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs. What is known about the topic?: Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI o

Background: Maintaining the health and well-being of family carers of people with dementia is vital, given their potential for experiencing burden associated with the role. The study aimed to help dementia carers develop self-efficacy, be less hassled by the caring role and improve their health and well-being with goal-directed behaviour, by participating in an eight module carer coaching program. Methods: The study used mixed methods in a pre/post-test/follow-up design over 24 months, with assignment of consented dementia carers to either individualised (n = 16) or group coaching (n = 32), or usual carer support services (n = 43), depending on preference. Care-giving self-efficacy and hassles, carer health, well-being and goal-directed behaviours were assessed over time. Analysis of Variance (ANOVA) was used to compare changes over time and the effects of coaching on carer self-efficacy, hassles and health, using the Univariate General Linear Model (GLM). Results: All carers were hassled by many aspects of caring at baseline. Participants receiving coaching reported non-significant improvements in most areas of self-efficacy for caring, hassles associated with caring and self-reported health at post-test and follow-up, than did carers receiving usual carer support. Group coaching had greater success in helping carers to achieve their goals and to seek help from informal and formal support networks and services. Conclusion: The study outcomes were generally positive, but need to be interpreted cautiously, given some methodological limitations. It has been shown, however, that health staff can assist dementia carers to develop self-efficacy in better managing their family member's limitations and behaviour, seek help from others and attend to their health. Teaching carers to use goal-directed behaviour may help them achieve these outcomes.

© 2015 Future Medicine Ltd. Aim: To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation. Materials & methods: iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes. Interim results: A person-centered aged care home (socio-cultural context) and care/lifestyle services (interactional environment) can produce positive outcomes for aged care clients (subjective experiences) in the simulated environment. Conclusion: Further testing will define essential characteristics of a person-centered care home.

© International Psychogeriatric Association 2015. Background: Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting. Data obtained during the Person-Centered Dementia Care and Environment (PerCEN) randomized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants. Methods: Data were obtained from PerCEN participants: individual semi-structured interviews with care managers (29), nurses and care staff (70); telephone surveys with family members (73); staff reports of care approaches; and 131 field note entries recorded by the person-centered care and environment facilitators. Data were interpreted inductively using content analysis, code building, theme development, and synthesis of findings. Results: All data sources confirmed that, when adopted, the person-centered model increased the number and variety of opportunities for resident interaction, improved flexibility in care regimens, enhanced staff's attention to resident needs, reduced resident agitation, and improved their well-being. Barriers and enablers for the person-centered model related to leadership, manager, staff and family appreciation of the model, staff's capacity, effective communication and team work among direct care staff, care service flexibility, and staff education on how to focus care on the person's well-being. Conclusions: Successful knowledge translation of the person-centered model starts with managerial leadership and support; it is sustained when staff are educated and assisted to apply the model, and, along with families, come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being. The Australian New Zealand Clinical Trials Registry number is ACTRN 12608000095369.

Aim: To identify key issues and factors affecting retention of qualified nurses who care for older people and persons with dementia in Australian acute, subacute, community and residential health-care settings. Background: As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention. Methods: Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach's alpha range 0.75-0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents. Results: In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support. Conclusions: Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration. Implications for nursing management: Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention. © 2013 John Wiley & Sons Ltd.

Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. Results: From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. Conclusion: The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369. Copyright © International Psychogeriatric Association 2014.

Background: A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care - CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program.Methods: Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by

Aim: To assess the feasibility and the effects of a multi-component education toolkit that used the Aged Care Funding Instrument behaviour (ACFI-BEH) scores to trigger care planning for older people experiencing behavioural and psychological symptoms of dementia (BPSD). Method: Forty-six older people and 209 staffand managers from five Sydney metropolitan residential aged care (RAC) facilities participated in this pre-post intervention pilot study. Results: The face validity and accessibility/acceptability of the toolkit was established, but potential utility of the ACFI-BEH in informing care planning was proven to be negligible. The ACFI-informed education toolkit did not lead to statistically significant improvements in care planning practice or reduce the severity/frequency of the targetted BPSD. Care plan quality remained low post intervention, with between 31% (N = 12/39) and 65% (N = 13/20) of care plans not addressing the persons' BPSD, nor utilising the ACFI information in relation to BPSD. Conclusion: This study has underscored the problems associated with current care planning practice in RAC settings and the need for developing strategies to ensure quality and safe care through individualised care planning practices. Our study processes, results and lessons discussed in this paper could assist future research on this type of research in RAC settings. © eContent Management Pty Ltd.

Background: Dementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting. However, the impact of dementia care mapping and person centred care on staff has not been well researched. Objectives: The impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout, general well-being, attitudes and reactions towards resident behavioural disturbances, perceived managerial support, and quality of care interactions. Design: A cluster-randomised, controlled trial. Settings: The study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area, Australia, with comparable management structures, staffing mix and ratios, and standards of care. Participants: 194 consenting managers, nurses, therapists and nurse assistants working in the participating sites. Methods: Intervention care sites received training and support in either person centred care (. n=. 5) or dementia care mapping (. n=. 5); control sites continued with usual dementia care (. n=. 5). Staff outcomes of those three groups were assessed before, directly after the four month intervention (. post) and after a further four months (. follow-up). The primary outcome measures were the Maslach Burnout Inventory-Human Services Survey and the 12-item General Health Questionnaire. Analysis involved repeated measures analyses of variance for each of the outcome measures and adjustment for potential confounders to limit bias. Results: The Maslach Burnout Inventory-Human Services Survey results showed that change over time in emotional exhaustion scores differed between the three groups. Post-hoc analyses for each group separately revealed that the only significant time effect was in the dementia care mapping group (p=0.006), with emotional exhaustion scores declining over time.

Person-centered care (PCC) for people with dementia is a system of care that is based on the belief that personhood can be maintained despite cognitive impairment. A recently conducted cluster randomized trial (Chenoweth et al., 2009) demonstrated that PCC was effective in reducing agitation in people with dementia who were in residential care. This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions. The success of the PCC intervention was related to this two-pronged approach, which included support from managers. Implementation of PCC requires a whole-of-system approach, which includes formal and informal learning. © 2012 Copyright Taylor and Francis Group, LLC.

Aim: To provide further validation of the Environmental Audit Tool (EAT) by describing data on scores from 56 facilities and comparing the scores of facilities with a purpose-built dementia environment with those with non-purpose-built designs. Methods: Fifty-six facilities were assessed with the EAT. EAT scores for 24 purpose-built environments were compared with 32 non-purpose-built environments using a Wilcoxon rank-sum test. Results: Descriptive data on EAT scores are presented across all facilities. Facilities scored well on safety/security, familiarity, highlighting useful stimuli and privacy. Purpose-built unit scores were significantly higher than those for non-purpose-built environments for nine of 10 subscales of the EAT and the overall EAT score. Conclusion: The EAT can assess the quality of homelike environments in residential aged care facilities for people with dementia, differentiate between the quality of design in various types of facilities and provide an evidence basis for devising improvements. © 2011 ACOTA.

Purpose: Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidence-based nursing by evaluating the efficacy and cost effectiveness of implementing PCC and PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369). Design/Methods: The 3-year study commenced in 2009 in 38 eligible government-accredited residential dementia care homes in New South Wales, Australia. Study participants include 605 consented residents over 60 years of age with dementia and 380 consenting permanent direct-care staff. The study employs a factorial, group-randomised, cohort design with stratification to evaluate the main effects of PCC and PCE and their joint effects (PCC + PCE), compared with Usual Care (UC) and Usual Environment (UE) on QOL, QOC and BPSD in dementia. Results: The primary outcomes analysis will use a mixed-model analysis of covariance to determine the effects of PCC and PCE on resident QOL and BPSD, and QOC, adjusting for stratification and other potential confounders. The incremental cost of providing PCE and PCC over UC and UE will be calculated; costs and outcomes will be presented as a cost-consequence analysis and cost-effectiveness ratios will be estimated as a cost per unit change in resident QOL and BPSD. Implications: This cluster-randomised trial will rigorously test Kitwood's Social-Psychological Theory of Personhood in Dementia (Kitwood & Bredin 1992). The results will provide timely and solid evidence that can inform policy and nursing practice development in improving the person

Aim. To present evidence-based factors for the recruitment and retention of licensed nurses caring for older people and persons with dementia. Background. The international nurse shortage crisis is intensified in the aged and dementia care sector. Strategies to address this crisis rely on qualitative, quasi-experimental, anecdotal and unsubstantiated literature. Design. Systematic literature review. Method. Search terms 'nurse''nurses''nursing''clinical supervision''staff''staffing''staff mix''staff levels''recruitment''retention''aged care''gerontology''gerontological''dementia care''residential''nursing home,' were used in all possible combinations and applied in a wide range of relevant academic databases, with secondary hand searches of selected bibliographies. Results. Two hundred and twenty-six papers were retrieved and scanned, with 105 chosen for closer examination that were relevant to recruitment and retention strategies for dementia and aged care nursing. Twenty-five of the papers chosen for review were rated at level 2++ to 3, according to the guidelines of the National Institute for Health and Clinical Excellence (The NICE Guidelines Manual, National Institute for Health and Clinical Excellence, London). The 25 critically reviewed papers are organised as promising strategies for (1) nurse recruitment and (2) nurse retention. Conclusions. The intrinsic rewards of the caring role attract nurses to dementia and aged care. Essential strategies linking recruitment with retention are: careful selection of student nurse clinical placements and their ongoing supervision and education, training for skills, leadership and teamwork for new and existing nurses, increased staffing levels, pay parity across different health settings and family friendly policies. Relevance to clinical practice. A family-friendly, learning environment that values and nurtures its nursing staff, in the same way as nurses are expected to value and care for their patients and residents, i

An Inner Spherical CVT (ISCVT) transfers engine power by utilizing the traction force of the lubricant fluid film on the contact point between concave and convex spherical rolling bodies. Since the concave and the convex contact surfaces of the ISCVT are exactly spherical parts, they have a large circular (not elliptic) contact area, and the ISCVT mechanism has a larger torque capacity, less spin loss, and better stability than other traction drive mechanisms. The IVT (Infinitely Variable Transmission) performances also can easily be embodied in the ISCVT. In this work, we developed a prototype of the ISCVT for a motorcycle with a 125cc single cylinder engine having a maximum torque of 13.73 Nm at 8,000 rpm. The design parameters were determined, and the transmission performances were evaluated by optimal design procedure. The transmission efficiency, the life time, the maximum severe stresses on each part of the ISCVT, and the work needed for varying speed ratio were theoretically investigated, and the efficiency performances were experimentally measured. The manufactured prototype was installed in an actual motorcycle, which was fixed on the test-bench equipped with a dynamometer. The parasitic loss of the prototype and the cross-sectional road load performance were tested. The power efficiency of the simulated prototype was between 87̃92%, and the life span was more than 50,000 hours. The tested overall power efficiency was around 70̃92% under frequent driving conditions, which is an impressive performance in a motorcycle transmission despite the small difference from the simulation. © 2009 The Korean Society of Automotive Engineers and Springer-Verlag Berlin Heidelberg GmbH.

Australia, like other western nations, is experiencing a new trend within its prison population - the ageing inmate. This 'greying' of the population presents a unique challenge for the correctional environment. Specific needs of this population may not be well met within a correctional facility due to the physical environment layout and surroundings, restricted health service access and unaccommodating facilities and programmes. This is compounded by limited visits from family and friends. This paper outlines some of the general needs of the older male inmate and the difficulties this poses for correctional and health services. Current international initiatives and programmes used to address the ageing population's needs are briefly examined, as are the implications for Australian and international correctional and health services wishing to implement such schemes. The applicability of Government Legislation, pertaining to the standards of care in the community, to correctional aged care programmes and facilities is discussed. © 2007 Taylor & Francis.

The Australian health care system exists within a particular sociopolitical environment which characterises its modus operandi and thus, the patient's and health professional's experiences of the system. Consumers' experiences are affected by their race, age, gender, ethnicity and class, and their relationships with health care staff. Health staff's experiences are largely affected by the interplay of the various health professions, manifested as power relations. This is particularly notable in the case of overseas qualified nurses (OQNs). With the growing reliance on, and acceptance of OQNs in Australia, the issue of their access to positions of power within the health system is worthy of analysis. This paper aims to provide a critical examination of the issues and challenges relating to the employment of OQNs within Australia and international contexts, strategies developed to enhance their employment experiences within the Australian health care system and their opportunities to contribute to the development of contemporary Australian nursing practice.