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AbstractThis study investigates staff and family attitudes towards the use of the fences that surround many aged care facilities in Australia, in the context of indefinite detention of people with dementia. This indefinite detention has been described in a report from an Australian Senate Inquiry as "a significant problem within the aged care context", which "is often informal, unregulated and unlawful". Five focus groups comprising direct care workers, family members, nurse unit managers and facility managers discussed the reasons for and their attitudes towards fences. The results show a tension between the provision of physical and emotional safety. This is to say that even while it is illegal to detain people with dementia against their will, and even while participants understood the negative impact of fences on the well‐being and emotional safety of people with dementia, they accepted and supported the presence of perimeter fences because they provided the perception that fences kept people with dementia physically safe. This has implications for redressing the balance between physical and emotional safety in policy and practice.

AbstractConsumer‐directed care (CDC) was introduced as part of aged care policy reforms in Australia in 2012. CDC aims to promote choice and control for people with complex needs who need home care and supports. While more choices may bring benefits, information and resources are needed by people to navigate new and complex care‐related decisions. In 2017, we identified the resources available to support consumers of the new CDC Home Care Packages (HCP) program via an Internet search. Forty‐six resources were analysed to assess the adequacy of information to inform care choices. General information was most frequently found, but information to guide specific choices, such as choosing or changing service providers, was limited. Accessibility of information was limited for non‐English speakers and for people with low literacy or reduced capacity for decision making. No training opportunities were identified, and only one non‐partisan organisation offered support for decision making. Overall, the information and supports analysed were not adequate to assist older people to make choices to ensure consumer direction of care. There is an urgent need to improve the quality and accessibility of information and provide training and support for choice, particularly for those with limited decision‐making capacity, such as those living with dementia.

Abstract

Alcohol advertising during sporting broadcasts, as well as the sponsorship of sporting events by the alcohol industry, is common practice in Australia, as in many other countries. The strength of the association between alcohol and sports prompts consideration of the potential for children who watch televised sport to be exposed to a considerable amount of alcohol advertising, and to learn to associate alcohol with sport and sporting success. This paper reviews the current alcohol advertising regulations in Australia, particularly in reference to the protection of children. It then details a pair of studies designed to examine the extent and nature of alcohol advertising during sporting telecasts, and the potential effects on young people. The first, a frequency and content analysis of advertising during two popular Australian sports final series, found that alcohol advertising (particularly during a sporting competition with alcohol company sponsors) is extensive and contains both features known to be appealing to children and messages which could be interpreted as associating alcohol consumption with social and sporting success. The second, a qualitative study with grade 5 and 6 primary school students, found that young people have a high awareness of the alcohol sponsors and alcohol brands advertised during these sporting telecasts, and associate these products with sport and with positive personal characteristics and outcomes.

Copyright © 2009 John Wiley & Sons, Ltd.

Formative research was undertaken in the Illawarra region of New South Wales (south of Sydney, Australia) to identify local communication strategies to influence the help-seeking behavior of young people in relation to a new youth-focused general practice (or physician) led mental health service. Research with the target market (12–25years) revealed the need for a local campaign to address the stigma associated with the use of mental health services and the need to emphasize the central role of the general practitioner or physician to the service. The results also indicated that any overarching campaign should be complemented by segment-specific strategies which tailor not only communication variables and channels to reach different market segments, but also consider varying aspects of the product or service to reach a broad cross-section of the target group.

Background: Under-coding of dementia during hospitalisation results in an inability to identify all patients with dementia using hospital administrative data. Clinical coding can be viewed as a proxy for management; therefore, under-coding indicates dementia was not considered in the patient's management. While under-coding of dementia is well established, there is sparse evidence on whether dementia is coded in subsequent hospitalisations among patients with a known diagnosis. Objective: (a) To describe patterns of dementia coding over 5 years after a first-coded (i.e. index) admission for dementia; (b) to identify factors associated with clinical coding of dementia; and (c) to identify patient subgroups at risk of not being coded to inform future interventions to improve hospital identification and management of dementia. Method: Retrospective study of longitudinal hospital data from 1 July 2006 to 30 June 2015 for 7919 patients hospitalised during the 5 years' post-index admission for dementia in a regional local health district of New South Wales, Australia. Results: Dementia was coded in 63.9% of admissions in the 12 months following index admission for dementia; this decreased to 53.7% after 5 years. Patients were 20% more likely to have dementia actively managed when it co-occurred with delirium. Under-coding varied across conditions, with dementia more likely to be coded in admissions for falls and pneumonitis, and less likely for heart failure, pneumonia and urinary tract infection (UTI). Conclusion: The frequency with which dementia was not coded highlights opportunities to improve identification and management of dementia through dementia-specific care, enhanced clinical protocols, and interventions focused around heart failure, pneumonia and UTI admissions.

ABSTRACTConsumer‐directed care (CDC) programmes, in principle, provide consumers with choices around who provides care services to them, what services and when. However, literature around consumer behaviour of older adults, especially concerning the factors that may support home care choices, is sparse. The purpose of this study was to understand the decision‐making processes and spending preferences of community‐dwelling seniors assessed eligible for CDC home care services. We completed an explorative inquiry using a "think‐aloud" technique with eligible consumers in South Australia. The inquiry had two components. First, consumers used imitation money to simulate the purchase of home care supports while talking out loud their decision‐making processes. Then, semi‐structured interviews were completed to identify underlying thoughts that informed the decisions made and spending preferences. Fifteen consumers, mean age 82 years (range 70–94), participated. The most frequently prioritised choice was domestic assistance. However, choices were made based on a perceived hierarchy of need (due to limits placed on available budgets for care). Interview data revealed that the decision making and service preferences were also based on limited knowledge about what was available. Consumers revealed perceived value in purchasing expert advice to guide their choices and preference for relational not transactional service delivery.

AbstractDementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about their experiences, the ways in which their lives have been investigated, to inform future research, policy and practice. Using an established scoping review methodology, we identified seven papers that reported empirical research on the lived experience of LGBT+ people with dementia and their care partners. Only a single study reported on in two of the papers included people who were trans. This in itself reveals how rarely LGBT+ people are asked to speak about how dementia has shaped their lives in academic research. Our reflexive thematic analysis indicates that LGBT+ people with dementia and their care partners endure overlapping forms of disadvantage. This results in heightened experiences of fear and discrimination, lack of services and compounded social isolation. Importantly, while dementia was embodied as interference and loss by LGBT+ people, it was their gender and sexuality differences that provided solace, even in the face of disadvantage. Importantly, people's relationships with LGBT+ identities were framed as fundamental for safety, resilience and wellbeing, rather than a complicating or confounding factor in living with dementia.

Giving voice to the lived experiences of people with dementia across the globe, including Australia, Canada, Sweden and the UK, this critical and evidence-based collection engages with the realities of life for people living with dementia at home and within their neighbourhoods. This insightful text addresses the fundamental social aspects of environment, including place attachment, belonging and connectivity. The chapters reveal the potential and expose the challenges for practitioners and researchers as dementia care shifts to a neighbourhood setting. The unique 'neighbourhood-centred' perspective provides an innovative guide for policy and practice and calls for a new place-based culture of care and support in the neighbourhood