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This paper investigates the acceptance of in-home telehealth by frail older adults and carers of the Transition Care Program (TCP), and evaluates telehealth acceptance as a predictor for usage compliance. A STRATIFIED RANDOM SAMPLE OF PARTICIPANTS WAS ALLOCATED TO ONE OF FIVE GROUPS: either a control group or to receive telehealth monitoring of their vital signs for a period of 12 or 24 weeks; with or without a medical alarm pendant. Before being trained in and using telehealth, the majority of participants and carers demonstrated acceptance of the technology by reporting that they perceived it would be \"useful\" and \"easy to use.\" This acceptance was also reported post-TCP (up to 12 weeks of usage). The \"perceived ease of use\" of the telehealth equipment increased significantly from pre-telehealth training and usage to post-TCP (up to 12 weeks of usage) (P = 0.001). There was no change, (pre-training and usage to post-TCP) in the \"perceived usefulness\" of the telehealth equipment. The telehealth acceptance constructs of \"ease of use\" and \"usefulness,\" at pre-telehealth training and usage, approached statistical significance as a predictor of future compliance (P = 0.06). \"Perceived ease of use,\" at pre-training and usage, had a positive relationship with future compliance (P = 0.02). There is currently limited knowledge about the influences and determinants of home telehealth compliance in frail older people and their carers, potentially a significant user group for the technology into the future. This study's finding that frail older people and their carers perceive that home telehealth is useful and easy to use demonstrates their acceptance of home telehealth as a therapeutic tool. Further, perceived ease of use of home telehealth is a significant predictor of compliance with frail older people and their carers' use of home telehealth. Additional research is required in order to identify other influences and determinants of home telehealth compliance with this group. Knowledge about the influences and determinants of home telehealth compliance may assist the development of targeted interventions aimed at encouraging high compliance with users who are recording lower reading rates.

Background Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors’ decision-making. In particular, it considers whether the fact that the law differs across Australia’s three largest states – New South Wales (NSW), Victoria and Queensland – leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity. Methods A cross-sectional postal survey of the seven specialties most likely to be involved in end-of-life care in the acute setting was conducted between 18 July 2012 and 31 January 2013. The sample comprised all medical specialists in emergency medicine, geriatric medicine, intensive care, medical oncology, palliative medicine, renal medicine and respiratory medicine on the AMPCo Direct database in those three Australian states. The survey measured medical specialists’ level of legal compliance, and reasons for their decisions, concerning the withholding or withdrawal of life-sustaining treatment. Multivariable logistic regression was used to examine predictors of legal compliance. Linear regression was used to examine associations between the decision about life-sustaining treatment and the relevance of factors involved in making these decisions, as well as state differences in these associations. Results Response rate was 32% (867/2702). A majority of respondents in each state said that they would provide treatment in a hypothetical scenario, despite an advance directive refusing it: 72% in NSW and Queensland; 63% in Victoria. After applying differences in state law, 72% of Queensland doctors answered in accordance with local law, compared with 37% in Victoria and 28% in NSW ( p  < 0.001). Doctors reported broadly the same decision-making approach despite differences in local law. Conclusions Law appears to play a limited role in medical decision-making at the end of life with doctors prioritising patient-related clinical and ethical considerations. Different legal frameworks in the three states examined did not lead to different decisions about providing treatment. More education is needed about law and its role in this area, particularly where law is inconsistent with traditional practice.

The purpose of this study was to determine the effects of 12-week Tai Chi (TC) training on the soleus (SOL) H-reflex modulation and plantarflexion muscle strength in older adults. Twenty volunteers were assigned into training ( N  = 14; 72.2 ± 3.7 years of age) and control ( N  = 6; 74.2 ± 6.1 years of age) groups. The participants in the TC group practiced Yang style TC 1 h per session, 3 sessions per week, for 12 weeks, guided by a qualified TC instructor. The ratio of the maximal peak-to-peak amplitude of SOL H-reflex ( H max ) to M-wave ( M max ) was determined during bipedal standing under four sensory conditions: stable surface and eyes open (SO), stable surface and eyes closed (SC), unstable surface and eyes open (UO), and unstable surface and eyes closed (UC). The maximal isometric plantarflexion muscle strength was also assessed by using a dynamometer. The results showed that the SOL H max / M max ratio increased significantly after the 12 weeks of TC training under the SC (37.0%), UO (33.3%) and UC (36.0%) conditions ( P  < 0.05). The maximal plantarflexion strength also improved significantly after training (19.8%; P  < 0.05). In contrast, the control group showed no significant changes in all measurements after the 12 weeks.

Purpose – The purpose of this paper is to identify the domains of performance needed by leaders in aged and community care not-for-profit organisations. Design/methodology/approach – Focus groups and individual interviews were conducted with senior managers employed by faith-based aged and community care not-for-profit organisations, academics in ageing and business fields and senior government employees from aged services departments and agencies in Australia. Results were content transcribed and analysed thematically in order to identify the major themes that emerged. Findings – A total of 37 people participated in the study. The domains of performance identified by participants as required of leaders in aged and community care were: professionalism; collaboration and teamwork; judgement and decision making; communication; scholarship and teaching; management; advocacy; and leadership. The performance requirements that were identified for leaders in aged and community care not-for-profit organisations were broader than just leadership per se. Research limitations/implications – The findings of this study suggest that the aged and community care not-for-profit sector has specific requirements for the performance of its leaders. Leadership is one of a number of performance attributes desirable in leaders in this sector. Practical implications – The aged and community care not-for-profit sector has distinctive needs and specific requirements of its leaders. Originality/value – It is recommended that a broad range of performance attributes are taken into account by aged and community care not-for-profit organisations when recruiting and training staff in leadership positions.

There is little understanding in Australia of the special issues faced by gay, lesbian, bisexual and transgender people in end-of-life care and advance care planning. This exploratory study aimed to achieve an initial understanding of these issues to inform the development of a larger study involving gay, lesbian, bisexual and transgender service users. Consultations were carried out with 19 service providers and 6 gay, lesbian, bisexual and transgender community members in the Northern Rivers and metropolitan Sydney areas of New South Wales, Australia. Participants reported barriers to health care service access due to discrimination, inappropriate care and lack of knowledge among both consumers and health care workers of legal rights at the end of life. While advance care planning can assist with improving end-of-life care, respondents reported a number of obstacles. These included a lack of knowledge and absence of perceived need and the additional obstacle of social isolation, leading to difficulties identifying alternative decision-makers. The study highlighted the need for education for gay, lesbian, bisexual and transgender people and health and aged care providers on existing legal provisions to prevent discrimination in end-of-life care.

In most developed countries, competent patients have the legal right to refuse any medical treatment; Advance Care Planning mechanisms extend this right to non-competent patients. However, some groups, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people, risk their wishes not being respected if they lose capacity, more than others. Little is known about medical practitioners' knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. One scenario (the focus of this paper) asked which of four plausible substitute decision-makers, including a same-sex partner, had the legal authority to make such decisions. The overall response rate was 32% (867/2702). Less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. LGBTI people face multiple obstacles to having their end-of-life wishes respected. Where healthcare providers are also ignorant of the partner's legal right to make such decisions, the problem is compounded. Improved legal education for clinicians and promotion of educational resources for members of the LGBTI community is needed.

Objective. There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions. Methods. A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis. Results. Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts - 'healthcare professionals choreograph the end of life' and 'patients and families are carried on an unplanned journey'. Conclusions. There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.

ObjectivesTo determine the role played by law in medical specialists' decision-making about withholding and withdrawing life-sustaining treatment from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed.DesignCross-sectional postal survey of medical specialists.SettingThe two largest Australian states by population.Participants649 medical specialists from seven specialties most likely to be involved in end-of-life decision-making in the acute setting.Main outcome measuresCompliance with law and the impact of legal knowledge on compliance.Results649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared with 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge.ConclusionsMedical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-life care.

Aim: To investigate acceptance and usage issues in relation to Telehealth products as used by frail older clients of the Transition Care Program and their carers. Method: The study design was a quasi-randomised controlled clinical trial. A stratified random sample of participants was allocated to one of five groups using a random number table. Study participants who were already in possession of a pendant alarm provided by the study service provider at study commencement, or were assessed as needing a pendant alarm, were allocated to the first number out of 1 (control group), 4 or 5 (home Telehealth monitoring with a pedant alarm up to 12 or 24 weeks) on the random number table list. If they were in possession of a pendant alarm that was not from the study service provider they were automatically allocated to the control group. If they were assessed as not needing a pendant alarm they were allocated to the first number on the list out of 2 or 3 (home Telehealth monitoring up to 12 or 24 weeks). In all instances, when a participant was allocated to the first applicable number on the list, that number was crossed off the list. Results: A total of 43 participants who commenced the study used Teleheath equipment. There was a 13% Telehealth reading failure rate. There was no significant difference between clients with and clients without carers for the reading failure rate. This non-significant difference was consistent across all of the identified reasons for why readings failed including staff not following up, participant non-compliance (with and without carer), equipment failure, participants not returning a call from the staff investigating non-reading and user error. Conclusion: If the health of the client requires high reading rate reliability, the fact that the client has a carer to assist them cannot be assumed to increase the safe usage of the Telehealth equipment for reading rate reliability. As such staff should ensure that they are diligent in monitoring in-home Telehealth regardless of the presence or absence of a carer.

This article illustrates how scenario planning (SP) and scenario analysis as can be conceptualised as practices contributing to an action research (AR) investigation of leadership development. The project described in this article was intended to strengthen leadership capacity in Australia’s rapidly changing aged care and community care sector. A research team comprising academics from three universities and managers from two faith-based not-for-profit organisations providing aged and community care participated in this study. As part of the research, two sets of scenario-based workshops were held: the first, to identify possible futures using SP; and the second, to deal with plausible scenarios these organisations are likely to face with the changes happening in the aged care environment in Australia by using scenario analysis. Although the researchers did not consider a link between practice theory and AR during the SP phase, practice theory became useful during the scenario analysis phase. The article includes a brief literature review followed by a discussion on the relationship between AR and practice theory. The processes used in the two sets of scenario workshops are then described in detail along with the data collected and analysed. The article concludes with some reflections on the use of scenarios in practice as well as an acknowledgment that practice theory would be useful in investigating leadership capability development.