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We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.
Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.
Indigenous Australians experience higher levels of psychological distress compared to the general population. Physical activity is a culturally acceptable approach, associated with reduction of depressive symptoms. The protective properties of physical activity for depressive symptoms are yet to be evaluated in older Indigenous Australians.
A two-phase study design comprised of a qualitative thematic analysis following a quantitative regression and moderation analysis.
Firstly, a total of 336 Indigenous Australians aged 60 years and over from five NSW areas participated in assessments on mental health, physical activity participation, and childhood trauma. Secondly, a focus group of seven Indigenous Australians was conducted to evaluate barriers and facilitators to physical activity.
Regression and moderation analyses examined links between depression, childhood trauma, and physical activity. Thematic analysis was conducted exploring facilitators and barriers to physical activity following the focus group.
Childhood trauma severity and intensity of physical activity predicted depressive symptoms. Physical activity did not affect the strength of the relationship between childhood trauma and depression. Family support and low impact activities facilitated commitment to physical activity. In contrast, poor mental health, trauma, and illness acted as barriers.
Physical activity is an appropriate approach for reducing depressive symptoms and integral in maintaining health and quality of life. While situational factors, health problems and trauma impact physical activity, accessing low-impact group activities with social support was identified to help navigate these barriers.
This chapter examines ‘the Stainton Missal’, a small folio in 8s, which survives in York Minster Library. It was printed in Paris in 1516 for use in York. The provenance covers a narrow geographical field, spanning the Reformation in emblematic form. In the exactly 500 years of its life, to this day, it has never moved outside of a small triangle in North Yorkshire, between York itself and the edges of the Dales and the Moors. However, the sensational aspect of the book is concealed by these details. At the opening of the Te igitur at the beginning of the Canon, the eye is confronted, we might say assaulted, by a vigorous slash, diagonally across the image of the Cross. Below, through the next dozens of leaves, is another, deeper gouge, in the opposite direction to the slashed crucifix, forming a reverse cross. The book is an astonishing example of iconoclasm. In this chapter, this macabre object is opened out to the fate more broadly of the fate of ritual books. How does the destruction of books relate to their consecration or preservation, and how does this relate to the history of memory before and after the Reformation?
The first part of the introduction explores how historians and literary scholars have approached early modern memory and sketches the trajectory of recent work on the memory of the English and European Reformations. It then examines the ways in which the religious revolution transformed the memorial culture it inherited from the medieval past and the manner in which it engendered new strategies of remembering and forgetting, commemoration and amnesia. The second section explains the architecture and structure of the volume, which is divided into four parts (1) Events and Temporalities; (2) Objects and Places (3) Lives and Afterlives; (4) Bodies and Rituals. It probes the temporal; spatial and material; biographical; and ceremonial and corporeal dimensions of the memory of the English Reformation, establishing a series of conceptual frameworks for the essays that follow. The Reformation is reconceptualised less as a unitary moment of rupture than as ongoing struggle to reconfigure the nation’s ecclesiastical and cultural heritage and to accommodate the unruly legacy of the past. A prolonged development involving impulses towards both historical preservation and oblivion, it continues to be refought in memory and the imagination.
The dramatic religious revolutions of the sixteenth and seventeenth centuries involved a battle over social memory. On one side, the Reformation repudiated key aspects of medieval commemorative culture; on the other, traditional religion claimed that Protestantism was a religion without memory. This volume shows how religious memory was sometimes attacked and extinguished, while at other times rehabilitated in a modified guise. It investigates how new modes of memorialisation were embodied in texts, material objects, images, physical buildings, rituals, and bodily gestures. Attentive to the roles played by denial, amnesia, and fabrication, it also considers the retrospective processes by which the English Reformation became identified as an historic event. Examining dissident as well as official versions of this story, this richly illustrated, interdisciplinary collection traces how memory of the religious revolution evolved in the two centuries following the Henrician schism, and how the Reformation embedded itself in the early modern cultural imagination.
Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.
This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.
Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48–5.51).
Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.
This paper examines and critiques the ethical issues in postmortem sperm retrieval and the use of postmortem sperm to create new life. The article was occasioned by the recent request of the parents of a West Point cadet who died in a skiing accident at the Academy to retrieve and use his sperm to honor his memory and perpetuate the family name. The request occasioned national media attention. A trial court judge in New York in a two-page order authorized both the retrieval and use of the postmortem sperm.