Distrust, Despair and Resistance to Care: Hospital Staff Reports on the prevalence of Elderspeak and their evaluation of an In-service aimed at reducing Elderspeak

Ms Elizabeth Savina1

1Redcliffe Hospital, Metro-North Hospital and Health Service , Redcliffe, Australia

Elderspeak is recognised as a common, but potentially harmful, communication style in aged care and other domains of society. It has been observed in up to 57% of interactions in aged care [1]. Elderspeak can lead to distrust and to older adults withdrawing from the therapeutic relationship. Elderspeak has also been seen to significantly increase the likelihood of Resistance-to-Care behaviours. No studies have looked at the prevalence of Elderspeak in the hospital setting, or at education programmes aimed at hospital staff.

A survey of Queensland Health’s internal resources revealed no in-services focussing specifically on Elderspeak. Additionally, a search for published educational materials on the internet indicated very limited resources. A 20 minute in-service was developed from a review of literature. It was piloted with 20 nursing staff with a special interest in caring for older adults. It covered the nature and underlying causes of Elderspeak as well as practical ways to consciously control the voice to ensure a respectful communication style. The feedback indicated the in-service was highly valued in terms of its relevance and the practical skills developed.

The next phase will see the in-service workshopped with a group of health consumers to ensure that the training is driven by their perspectives. The in-service will be then be delivered to 60 nursing staff. Staff will be asked to rate their frequency of use of features of Elderspeak (Sing-song Voice, High Pitch, Use of Pet Names), how often they perceive their colleagues using them and what patient characteristics are most likely to elicit Elderspeak (e.g. age/frailty/cognitive impairment). They will be asked to rate their confidence in reducing their use of Elderspeak. They will also be asked to rate the significance of any barriers to reducing Elderspeak (e.g. time pressure, cognitive load).

References

[1] Bradford, L.S., End, C., & Xavier A.L. Impact of an elderspeak in-service training on resident well-being, self-esteem and communication satisfaction. Graduate Student Journal of Psychology 2010. Vol. 12 P. 14-22


Biography:

Elizabeth Savina has practised as a Speech Pathologist for over 18 years, with the last 10 years focussing on Acute care and Voice Therapy. She has a strong interest in how the quality of the communication between health professionals and consumers influences care outcomes.

Food fortification in aged care and in community-dwelling older adults: A review of strategies and issues

Miss Danielle Cave1, Dr Karen Abbey1, Prof Sandra Capra1

1School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University Of Queensland, St Lucia, Australia

Fortification is the addition of ingredients to foods or beverages, to make them more energy and nutrient-dense, without increasing the portion size. This food-first approach is commonly used as a nutrition support strategy in aged care homes, for residents who are malnourished or at risk of malnutrition. The aim of this study was to determine the scope and strength of published works exploring relationships between food fortification strategies, mode of delivery and sustainability in aged care and community-dwelling older adults. A narrative review was conducted. Literature from PubMed, Embase, CINAHL, Scopus and relevant grey literature was searched. All dates and study designs were included. Joanna Briggs Institute methodology was used to assess the quality of studies. Of 3152 records screened, twenty-two studies were included. Five studies were rated moderate and 17 studies were rated high quality. The majority of studies used pre-made food fortification, rather than fortifying foods on-site. Additionally, the majority of studies fortified foods with either micronutrients or macronutrients, not both. There was heterogeneity across studies, including the mode of delivery and ingredients used for food fortification. No studies identified strategies to embed food fortification within the foodservice system, or identified staffing needs or concerns and only 2 studies measured any aspect of the costs associated with food fortification. The literature is silent on comprehensive costs. No clear sustainable strategies for implementing food fortification in these settings could be identified. We expect that costs are of importance in the aged care sector and future research should include intervention costs of food fortification, as well as other strategies to support embedding food fortification within the foodservice system. Malnutrition is a critical issue in aged care and is the business of all staff. Research is required to provide further insight into the acceptability and sustainability of food fortification interventions.


Biography:

Danielle Cave is a Dietitian and PhD Candidate at The University of Queensland, under the supervision of Professor Sandra Capra and Dr Karen Abbey. She has previously worked as a Dietitian for Encara, providing services to aged care homes across South-East Queensland. Danielle holds a Master of Dietetics Studies from the University of Queensland and Bachelor of Nutrition Science from Queensland University of Technology.

The benefits of a combined cognitive and functional-task based exercise program for older adults with mild cognitive impairment: preliminary findings from a pilot study

Mrs Luciana Theodoro De Freitas1, Adjunct Professor Tilley Pain1,2, Associate Professor Fiona Barnett2

1Queensland Health, Townsville, Australia, 2James Cook University, Townsville, Australia

Background: Dementia is a leading cause of disability worldwide including Australia. Effective interventions are urgently needed to prevent or slow progression of the disease and its overall burden to the person, community and health services. It is known that 14% of people with Mild Cognitive Impairment (MCI) can progress to dementia. Although, no high-quality evidence exists supporting pharmacologic and non-pharmacological intervention for MCI, exercise programs show promise. This pilot-study aimed to identify the feasibility and acceptability of a combined cognitive and functional-task based exercise program.

Method: A mixed methods approach using qualitative and quantitative measures was used. Outcome measures for the quantitative data included cognitive and functional assessments. Initial and post intervention assessments included Neurobehavioral Cognitive Status Examination, Verbal Fluency Test, Verbal Learning Test, Trial Making Test A and B, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. Individual interviews were conducted with caregivers and participants of the ten-week intervention program.

Results: Approximately 80% of the 23 participants completed the program demonstrating its acceptability. Interim results show significant improvements in several cognitive and functional areas. The improvements demonstrate the non-pharmacological intervention is beneficial for people at risk of dementia. The qualitative findings suggest the program is viewed positively by participants and caregivers. Some of the benefits described by the participants are evident in their activities of daily living including development of strategies to remember important tasks such as taking medication.

Conclusion: The combined cognitive and functional-task based exercise program demonstrated significant improvement on cognitive and functional abilities for people with MCI. Non-pharmacological interventions can be used safely as a health promotion program minimising the dementia burden in the current aging population.


Biography:

Luciana is a passionate Occupational Therapist currently employed as a Clinical Research Coordinator in Queensland Health in collaboration with James Cook University.  She has a strong commitment for evidence based approaches and values research through clinical experiences. Her current research explores interventions which improves not only cognition but occupational engagement for people with mild cognitive impairment. She is highly interested in research within aged care and adult mental health population.

A systematic review of assessment tools and factors used to predict discharge from acute general medical wards

Ms Aruska D’Souza1,2, Associate Professor Catherine Said1,3, Ms Melanie Tomkins2,3, Ms Nina Leggett2,3, Ms Jacqueline Kay2, Dr Catherine Granger1,2

1University of Melbourne, Parkville, Australia, 2Melbourne Health, Parkville, Australia, 3Western Health, Sunshine, Australia

Background: Timely discharge has potential to improve quality of care and reduce length of stay. This systematic review aimed to identify assessment tools (containing multiple items) and factors (single items) associated with discharge destination (home, subacute or residential care) in general medical inpatients.

Method: Protocol registered a priori on PROSPERO (CRD42017064209).  Five electronic databases were searched. Studies were eligible for inclusion if they were: a prospective or retrospective quantitative study design, with a minimum of 20 adult acute general medical inpatients and published in English. Outcomes of interests were assessment tools or patient factors with statistical correlations with discharge destination. Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively.

Results: Twenty-three studies were included. Within included studies, tools and factors spanned ‘cognitive’, ‘functional’, ‘mobility’, ‘medical’, ‘social’ and ‘other’ domains. Fifteen tools associated with discharge were identified; 13 were associated with discharge to residential care, 11 with discharge home and 2 with subacute. The most commonly researched tools were the Mental Status Questionnaire/Short Portable Mental Status Questionnaire, the Mini-Mental State Examination, the Barthel Index, the Katz Index and the Lawton ADL Index (each investigated in two studies). Thirty-nine factors associated with discharge were identified; 28 were associated with discharge home, 15 with subacute and 23 with residential care. The most commonly researched factors were age and patient/carer’s wishes about returning home (each investigated in eight studies).

Discussion: The large number of tools and factors found, as well as their distribution across several domains, exemplifies the complexities of discharge planning. There is no single tool that best predicts discharge destination for this complex cohort. Further research is needed to determine the psychometric properties of the tools identified as well as additional predictors of subacute care.


Biography:

Ms D’Souza is a senior physiotherapist who graduated from La Trobe University in 2010 and has worked in the public health system for over eight years. She currently works at the Royal Melbourne Hospital. Ms D’Souza was the successful recipient of the Mary Elizabeth Watson Early Career Fellowship in Allied Health and commence a PhD part time at the University of Melbourne. Her PhD topic aims to investigate discharge from acute general medical wards. She is the lead researcher in a systematic review, two observational studies and a qualitative study. Ms D’Souza was successful in a poster presentation at the 2017 national Australian Physiotherapy Association conference and a table top discussion at the 2018 Australian Association of Gerontology conference.

12

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2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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