An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants’ and the concept of personas to develop a number of discrete “thermal personalities”. Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent di erent approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful. Original publication at MDPI: https://doi.org/10.3390/ijerph17228402 © 2020 by the authors. Licensee MDPI.
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While the optimal mean annual temperature for people and nations is said to be between 13 °C and 18 °C, many people live productive lives in regions or countries that commonly exceed this temperature range. One such country is Australia. We carried out an Australia-wide online survey using a structured questionnaire to investigate what temperature people in Australia prefer, both in terms of the local climate and within their homes. More than half of the 1665 respondents (58%) lived in their preferred climatic zone with 60% of respondents preferring a warm climate. Those living in Australia's cool climate zones least preferred that climate. A large majority (83%) were able to reach a comfortable temperature at home with 85% using air-conditioning for cooling. The preferred temperature setting for the air-conditioning devices was 21.7 °C (SD: 2.6 °C). Higher temperature set-points were associated with age, heat tolerance and location. The frequency of air-conditioning use did not depend on the location but rather on a range of other socio-economic factors including having children in the household, the building type, heat stress and heat tolerance. We discuss the role of heat acclimatisation and impacts of increasing air-conditioning use on energy consumption.
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Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical-professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia.
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Introduction: In March 2014, the New South Wales (NSW) Government (Australia) announced the NSW Integrated Care Strategy. In response, a family-centred, population-based, integrated care initiative for vulnerable families and their children in Sydney, Australia was developed. The initiative was called Healthy Homes and Neighbourhoods. A realist translational social epidemiology programme of research and collaborative design is at the foundation of its evaluation. Theory and Method: The UK Medical Research Council (MRC) Framework for evaluating complex health interventions was adapted. This has four components, namely 1) development, 2) feasibility/piloting, 3) evaluation and 4) implementation. We adapted the Framework to include: critical realist, theory driven, and continuous improvement approaches. The modified Framework underpins this research and evaluation protocol for Healthy Homes and Neighbourhoods. Discussion: The NSW Health Monitoring and Evaluation Framework did not make provisions for assessment of the programme layers of context, or the effect of programme mechanism at each level. We therefore developed a multilevel approach that uses mixed-method research to examine not only outcomes, but also what is working for whom and why.
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The purpose of this study was to determine if there are differences inoverall language ability and vocabulary of either Australian or overseasborn bilingual Dutch–English children and the possible parental influenceon these children’s language development. The participants were 86 children aged 4–12 years living in Australia and either born there or overseas in the Netherlands. Standardized language assessments were used to assess children’s expressive and receptive language skills in Dutch and English. Children born in Australia scored significantly higher on English language assessments and lower on the Dutch language assessments. When children’s parents frequently spoke Dutch with their children, they had significantly better Dutch skills, and when parents spoke primarily English at home, their children had better English skills. Based on outcomes on the questionnaires, multivariate logistic regression identified that storytelling and reading books in the heritage language contributed significantly to children’s Dutch lan- guage development). The study could not identify factors that contribute to English language development in Dutch children in Australia. However, for the Dutch language, frequent storytelling and reading books in Dutch are both important factors for development of the native language.
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To date, a range of qualitative and mixed-methods approaches have been applied to assess the age-friendliness of cities and communities. The Age-Friendly Cities and Communities Questionnaire (AFCCQ) has been developed to fill a gap for a systematic quantitative method approach to evaluate baseline age-friendliness in cities and communities and then measure ongoing efforts to become more age-friendly, aligned with the model by the World Health Organization (WHO). As such, it offers a valid and valuable quantitative method for cities to assess age-friendliness. This paper presents the process and results of a study undertaken to test the validity and reliability of the AFCCQ for the Australian context. It is part of a broader cross-cultural project seeking to test the AFCCQ across Europe, Asia, Oceania, and North America to generate methodological insight and comparable data. Informed by consultation with local experts in population and ageing research, as well as with people aged 65 and over, the instrument proved reliable in the Australian context before being distributed to 334 older people in Greater Adelaide for validation. Results show that the AFCCQ-AU proved a valid and reliable tool for evaluating the age-friendliness of larger cities and communities in Australia. Overall, the total score indicated moderate-good satisfaction with the age-friendliness features of the Greater Adelaide Region with the domain of Housing scoring highest (highly satisfactory). Psychometric validation and cluster analysis led to the identification of five typologies of older people living in Greater Adelaide, characterised by distinct socio-demographic profiles and concomitant experiences and evaluations of age-friendliness. This Australian validation adds further weight to the role of the AFCCQ in being able to assess the age-friendliness of cities and communities across the WHO's Global Network for Age-Friendly Cities and Communities. Used in combination with the rich and nuanced qualitative data at the local level, the tool has the ability to create significant outcomes for older people and their communities.
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Older people are often over-represented in morbidity and mortality statistics associated with hot and cold weather, despite remaining mostly indoors. The study “Improving thermal environment of housing for older Australians” focused on assessing the relationships between the indoor environment, building characteristics, thermal comfort and perceived health/wellbeing of older South Australians over a study period that included the warmest summer on record. Our findings showed that indoor temperatures in some of the houses reached above 35 °C. With concerns about energy costs, occupants often use adaptive behaviours to achieve thermal comfort instead of using cooling (or heating), although feeling less satisfied with the thermal environment and perceiving health/wellbeing to worsen at above 28 °C (and below 15 °C). Symptoms experienced during hot weather included tiredness, shortness of breath, sleeplessness and dizziness, with coughs and colds, painful joints, shortness of breath and influenza experienced during cold weather. To express the influence of temperature and humidity on perceived health/wellbeing, a Temperature Humidity Health Index (THHI) was developed for this cohort. A health/wellbeing perception of “very good” is achieved between an 18.4 °C and 24.3 °C indoor operative temperature and a 55% relative humidity. The evidence from this research is used to inform guidelines about maintaining home environments to be conducive to the health/wellbeing of older people. Original publication at MDPI: https://doi.org/10.3390/atmos13010096 © 2022 by the authors. Licensee MDPI.
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OBJECTIVE: To assess the reliability and validity of a shortened version of the Rainbow Model of Integrated Care (RMIC) measurement tool (MT). The original version of the measurement tool has been modified (shortened) for the Australian context.DESIGN: Validation of the psychometric properties of the RMIC-MT.SETTING: Healthcare providers providing services to a geographically defined rural area in New South Wales (NSW), Australia.PARTICIPANTS: A sample of 56 healthcare providers providing mental and physical healthcare.MAIN OUTCOME MEASURES: The psychometric properties of the tool were tested using principal component analysis for validity and Cronbach's alpha for reliability.RESULTS: The tool was shown to have good validity and reliability. The 35 items used in the shortened version of the tool were reduced to 29 items grouped into four dimensions: community-governance orientation, normative integration, functional integration and clinical-professional coordination.CONCLUSIONS: The shortened version of the RMIC-MT is a valid and reliable tool that evaluates integrated care from a healthcare provider's perspective in NSW, Australia. In order to assess the tool's appropriateness in an international context, future studies should focus on validating the tool in other healthcare settings.
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Ageing brings about physiological changes that affect people’s thermal sensitivity and thermoregulation. The majority of older Australians prefer to age in place and modifications to the home environment are often required to accommodate the occupants as they age and possibly become frail. However, modifications to aid thermal comfort are not always considered. Using a qualitative approach this study aims to understand the thermal qualities of the existing living environment of older South Australians, their strategies for keeping cool in hot weather and warm in cold weather and to identify existing problems related to planning and house design, and the use of heating and cooling. Data were gathered via seven focus group sessions with 49 older people living in three climate zones in South Australia. The sessions yielded four main themes, namely ‘personal factors’, ‘feeling’, ‘knowing’ and ‘doing’. These themes can be used as a basis to develop information and guidelines for older people in dealing with hot and cold weather. Original publication at MDPI: https://doi.org/10.3390/ijerph16060935 © 2018 by the authors. Licensee MDPI.
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Background: Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. Methods: Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD). Results: The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup <5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0-1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands. Conclusions: This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.
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