Davina Porock

Due to historic and anticipated discrimination, engaging aged care services can see LGBTI+ older adults conceal their sexual orientation, gender identity or gender expression. Recommendations from the Australian Royal Commission into Aged Care claim to have addressed the needs of a range of diversity groups, including the needs of LGBTI+ older adults. However, on closer inspection, it appears diversity needs have been addressed as a collective. To give voice to the concerns of LGBTI+ older adults and LGBTI+ advocates, we isolated relevant content from the publicly available documents of the Royal Commission. Critical thematic analysis was used to identify recurring ideas and perspectives. Four themes were identified: (1) I used to be illegal and now I'm a priority, (2) We are not a list of equals, (3) Hidden identities and concealed communities and (4) It is time to let the pathfinders rest. Themes provide insight into the tensions between historic actions, social policy and present attitudes and actions. Fundamental to our findings are calls for greater recognition of the heterogeneity of people from diverse backgrounds and for providers to do more to facilitate inclusive safe spaces that enable LGBTI+ care recipients to maintain dignity and pride in later life.

Aim: This paper aims to explain the process of formulating a robust theory that comprehensively explains the nurse's role during the transition from curative to the palliative phase in advanced cancer care. Design: A qualitative theory synthesis approach was applied, utilising Turner's 9‐step theory synthesis method to integrate five grounded theories and 10 qualitative studies. The Walker and Avant method of concept development and analysis further ensured rigour. Methods: Turner's theory synthesis was used to formulate a more comprehensive, testable theory from five existing grounded theories and 10 other qualitative studies that explain the nurse's role in supporting and facilitating the transition from curative to palliative care in oncology. Results: The synthesis preparation stage involved a detailed literature review that located five grounded theories and 10 qualitative studies. The theory synthesis phase from steps 1–8 produced the following theory. ‘During transitions from curative to palliative care in advanced cancer, nurses perform various roles that fall within the known and recognised—“visible spectrum” and the unknown and unrecognised—“invisible spectrum”. Step 9 involves the refinement of the theory by further interrogation of its merit in the real world. Conclusion: Theory synthesis offers a new possibility of cumulating all the evidence research that is already done to adapt it to practice and helping to build theory‐driven evidence‐based practice. Impact: This paper offers a novel theoretical framework that explicates the visible and invisible roles of nurses in transitioning patients with advanced cancer from curative to palliative care. It contributes to clinical practice by clarifying complex nursing responsibilities that are often unacknowledged, such as brokering referrals, emotional reframing and cultural advocacy. The theory, validated through expert review, can inform curriculum development, support professional recognition and guide practice standards. Broader impacts include enhancing patient‐centred care, improving interdisciplinary collaboration and shaping policies that acknowledge the full scope of nursing work in oncology and palliative care transitions. Patient or Public Contribution: No patient or public contribution.

Objectives: The aim of this project was to evaluate the feasibility and acceptability of virtual reality (VR) as a leisure activity for people living in residential aged care. Virtual reality experiences may offer alternatives for residents with limited mobility, or during times when older people are unable to leave residential care.Methods: The intervention used VR videos delivered via a head‐mounted device. Video content was created by a local artist specifically for use with older Western Australian adults and used local content. VR sessions were videotaped for analysis. The evaluation included structured observation of video content to assess mood and engagement and post‐intervention interviews with participants.Results: Mood and engagement scores indicated overall favourable mood and considerable positive engagement with the VR experience. Interview content analysis reflected the enjoyment participants took in visiting places they had once been and the surprising ways that the experience made them feel and act as though they were actually there. Videos featuring coastal visits were the most popular and videos featuring music were the most engaging. Some participants found the head‐mounted device uncomfortable. VR was considered potentially beneficial for residents with limited mobility or living with cognitive impairment.Conclusions: Overall VR is a feasible and acceptable leisure activity for older people in residential care. The use of local content has the potential to prompt memories and generate new conversations. Future use of VR may consider different modes of video delivery and advancements in evaluation.

Pain recognition for culturally diverse people is complex as pain experience is subjective and influenced by cultural background. We compared the prevalence, intensity, and association of pain with neuropsychiatric symptoms (NPS) between immigrants and non-immigrants living with dementia in residential aged care homes (RACHs) who were referred to two Dementia Support Australia programs. Immigrant status was defined by the documented country of birth. Pain and NPS were assessed using PainChek (R) and the Neuropsychiatric Inventory, respectively. Subgroup analyses were also completed for English-speaking and non-English-speaking immigrants. A total of 17,637 referrals [immigrants, n = 6340; non-immigrants, n = 11,297] from 2792 RACHs were included. There were no significant differences for the prevalence of pain across all groups. Immigrants were slightly more likely to have moderate pain or severe pain than non-immigrants. Non-English-speaking immigrants had 0.5 points higher total pain scores on average (Cohen's d = 0.10 [0.05, 0.15], p < 0.001) than non-immigrants. Total pain score had a significant effect on total NPS severity scores in all groups. While pain prevalence is similar across groups, higher pain intensities are more common among immigrants living with dementia. Increased care staff awareness, education, and training about the potential effect of culture on pain expression is needed.

Objective: To describe staff and family members' opinions about closed‐circuit television (CCTV) in communal and private areas of residential aged care facilities (RACF), and to investigate how this relates to perceptions of care quality.Methods: A cross‐sectional survey was developed to capture perceptions of CCTV's influence on care quality, and acceptable locations for CCTV placement. Data were recorded as ordinal‐scale and open responses. Non‐parametric tests of association were conducted.Results: The survey was completed by 81 staff and 74 family members. Both staff and family were satisfied with care quality and safety, irrespective of CCTV use. More family members were in favour of CCTV in both public and private areas, compared to staff who favoured public areas. Staff and family assumed there was real‐time monitoring, leading to a belief that CCTV monitoring would improve safety and prevent falls and abuse. Concerns were raised that CCTV could be used instead of improving staff‐to‐resident ratios and interaction.Conclusions: Overall, participants supported the use of CCTV more in public than in private areas and believed it reveals and prevents poor care. There was no association between CCTV use and satisfaction with care. Closed‐circuit television can have positive impacts if all stakeholders are involved in implementation.

Background: The palliative prognostic score is the most widely validated prognostic tool for cancer survival prediction, with modified versions available. A systematic evaluation of palliative prognostic score tools is lacking. This systematic review and meta-analysis aimed to evaluate the performance and prognostic utility of palliative prognostic score, delirium–palliative prognostic score, and palliative prognostic score without clinician prediction in predicting 30-day survival of cancer patients and to compare their performance. Methods: Six databases were searched for peer-reviewed studies and grey literature published from inception to June 2, 2023. English studies must assess palliative prognostic score, delirium–palliative prognostic score, or palliative prognostic score without clinician-predicted survival for 30-day survival in adults aged 18 years and older with any stage or type of cancer. Outcomes were pooled using the random effects model or summarized narratively when meta-analysis was not possible. Results: A total of 39 studies (n = 10 617 patients) were included. Palliative prognostic score is an accurate prognostic tool (pooled area under the curve [AUC] = 0.82, 95% confidence interval [CI] = 0.79 to 0.84) and outperforms palliative prognostic score without clinician-predicted survival (pooled AUC = 0.74, 95% CI = 0.71 to 0.78), suggesting that the original palliative prognostic score should be preferred. The meta-analysis found palliative prognostic score and delirium–palliative prognostic score performance to be comparable. Most studies reported survival probabilities corresponding to the palliative prognostic score risk groups, and higher risk groups were statistically significantly associated with shorter survival. Conclusions: Palliative prognostic score is a validated prognostic tool for cancer patients that can enhance clinicians’ confidence and accuracy in predicting survival. Future studies should investigate if accuracy differs depending on clinician characteristics. Reporting of validation studies must be improved, as most studies were at high risk of bias, primarily because calibration was not assessed.

Aim: To test and validate a measure of primary health care (PHC) engagement in the Australian remote health context. Background: PHC principles include quality improvement, community participation and orientation of health care, patient-centred continuity of care, accessibility, and interdisciplinary collaboration. Measuring the alignment of services with the principles of PHC provides a method of evaluating the quality of care in community settings. Methods: A two-stage design of initial content and face validity evaluation by a panel of experts and then pilot-testing the instrument via survey methods was conducted. Twelve experts from clinical, education, management and research roles within the remote health setting evaluated each item in the original instrument. Panel members evaluated the representativeness and clarity of each item for face and content validity. Qualitative responses were also collected and included suggestions for changes to item wording. The modified tool was pilot-tested with 47 remote area nurses. Internal consistency reliability of the Australian Primary Health Care Engagement scale was evaluated using Cronbach’s alpha. Construct validity of the Australian scale was evaluated using exploratory factor analysis and principal component analysis. Findings: Modifications to suit the Australian context were made to 8 of the 28 original items. This modified instrument was pilot-tested with 47 complete responses. Overall, the scale showed high internal consistency reliability. The subscale constructs ‘Quality improvement’, ‘Accessibility-availability’ and ‘population orientation’ showed low levels of internal consistency reliability. However, the mean inter-item correlation was 0.31, 0.26 and 0.31, respectively, which are in the recommended range of 0.15 to 0.50 and indicate that the items are correlated and are measuring the same construct. The Australian PHCE scale is recommended as a tool for the evaluation of health services. Further testing on a larger sample may provide clarity over some items which may be open to interpretation.

Background: Untreated pain in aged care residents living with dementia has been linked to delirium, hospitalizations, inappropriate pharmacotherapy, disrupted activities of daily living, and reduced quality of life. Pain experiences and expressions are subjective and to a large extent culturally driven. As dementia advances, older immigrants living with dementia may revert to their culture and language of origin and may experience pain differently. Further, there is limited studies on the pain experience of immigrant residents living with dementia. This study aims to describe the pain experience in immigrants living with dementia in Australian residential aged care homes (RACHs).Methods: A sample of residents who were referred to Dementia Support Australia (DSA, a national behavior support service) for the period 01/06/2018‐30/06/2022 was eligible to be included in the study. Pain was assessed using PainChek^®, a validated point‐of‐care medical device for non‐verbal adults living with dementia. PainChek^® consists of six domains: Face (9 items), Voice (9 items), Movement (7 items), Behavior (7 items), Activity (4 items) and Body (6 items). The sum of domain scores produces a final score that match the following pain levels: 0‐6 (no pain), 7‐11 (mild pain), 12‐15 (moderate pain) and 16‐42 (severe pain). Immigration status was defined as country or place of birth reported other than Australia.Results: The eligible sample [n = 8607, 84.5 (7.0) y, 55.4% female, Alzheimer’s disease = 37.8%, vascular dementia = 12.9%, mixed dementia = 9.5%] had 4411 pain assessments completed, with an average total pain score of 9.4 (5.1). The prevalence of pain was 68.4% in the sample, with over one‐third of episodes represent mild pain (36.0%), and almost one‐third in moderate‐severe pain (20.1% and 12.2%, respectively). Among other factors, pain was the primary contributing factor (60.1%) in causing neuropsychiatric symptoms of dementia, such as agitation/aggression and depression. Top five countries of birth for DSA referrals were England, Italy, Greece, Scotland, and Germany.Conclusion: Pain is a prevalent clinical problem in immigrants living with dementia in Australian RACHs, who were seeking external behavior support for their neuropsychiatric symptoms.

Background: Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. Methods: This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek^® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. Results: Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen’s d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. Conclusion: This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.