Patricia Cain

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.

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.

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.

Objective: Understanding the concerns and experiences of people living with dementia from culturally and linguistically diverse backgrounds is critical to ensure culturally appropriate care is delivered. This study aimed to describe the current experiences and concerns of older people from culturally and linguistically diverse backgrounds using the publicly available evidence from the Australian Royal Commission into Aged Care Quality and Safety.Methods: This was a qualitative secondary analysis of the Australian Royal Commission into Aged Care Quality and Safety data to explore new and nuanced insights about care for culturally and linguistically diverse people living with dementia. Using the keywords to search the data corpus, we extracted a topic‐specific data set focused on dementia care and cultural diversity. Thematic analysis was used to identify and describe the present practices and challenges.Results: Our findings showed that the need for cultural connection for older people from culturally and linguistically diverse backgrounds increases as dementia progresses. Access to culture‐specific food and music facilitated connection with their culture of origin. Many older people from culturally and linguistically diverse backgrounds with dementia reverted to their language of origin; however, the inability to communicate due to a lack of language support impacted their health and well‐being, and care provision.Conclusions: Further work is needed to provide the necessary cultural experiences and language support to ensure comfort and equity in the provision of dementia care for Australians from migrant backgrounds.

Background: The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care.Methods: Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken.Results: Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings.Conclusion: Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.

Objectives To use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care. Design The Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective. Results Three overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure. Conclusions The results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step.

Risk is an innate and integral part of everyday life and is present in simple, everyday occupations and complex actions. Age-related stereotypes can mean older people have little opportunity to engage in activities that present some degree of risk. The present study explores the discourse around risk and older people in the context of the COVID-19 pandemic. We investigated news media as a reflection of the dominant public discourse around older people's behaviour to identify how risk is represented in relation to occupational engagement. Texts relating to older people and COVID-19 were sourced from the West Australian newspaper for a period of two months. Seventy texts were subject to Foucauldian discourse analysis to identify subject positions, location of risk and discursive features. Findings indicate that older people were segregated from the rest of society, with their behaviours framed in mostly negative ways. We identified three areas of discourse: vulnerable, and in need of protection; recalcitrant, and in need of management; and resilient, deserving of respect. While we recognise competing representations, implicit within the dominant discourse was the premise that older people were not capable of mediating risks and required ‘management’. These findings highlight the role of surveillance in restricting occupational engagement for older people and carry implications for older people, the public and therapists.