Dr Claire Gough 

Research Fellow, ARIIA

As we age, our focus shifts from work to other activities that give us a sense of purpose and enjoyment. However, "Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities" (Royal Commission into Aged Care Quality and Safety, 2019). By 2066, it is expected that 23% of the Australian population will be aged 65 years and over (AIHW, 2024). This presents the aged care sector with the task of deciphering how to care for larger populations and support individuals to age well.

Allied health professionals, including occupational therapists, physiotherapists, exercise physiologists, podiatrists, and dietitians (among others), are experts in preventing, diagnosing, and treating a range of chronic conditions (AHPA, 2024). Allied health professionals have the skills to enhance and maintain functional mobility (which often declines with age), manage pain, and support ongoing independence. Therefore, the involvement of allied health professionals in aged care delivery can empower individuals to maintain function and participate in activities they enjoy.

At the 2024 ARIIA conference, we were joined by a panel of experienced allied health professionals to discuss "Ageing Well – Social Care, Allied Health, and Prevention." Hilary O’Connell described the decline and dependencies demonstrated with ageing and highlighted the importance of reablement to support individuals to be as independent as possible. Hilary suggested that increasing exercise can support the restoration of function and is often the difference between living at home and requiring residential aged care. Rik Dawson presented a range of technologies useful for increasing mobility and balance, suitable for use in aged care to support individuals to "thrive in older age." Rik discussed the complexities of providing physiotherapy in relation to current funding models. Stacey George presented outcomes from an evaluation of early intervention initiatives for healthy ageing in primary care, putting the spotlight on the need for quality-of-life measures across the ageing trajectory.

Questions from the floor shifted the focus from mobility, physiotherapy, and occupational therapy to the need for oral care and access to dentistry. There was rich discussion around the importance of maintaining oral health to support sufficient dietary intake, enabling older people to mobilize and participate in activities. Access to oral care and dentistry is perhaps overlooked in aged care and requires more attention to ensure that older people are ageing well. As usual, discussions turned to funding. While the benefits of allied health services in aged care are clear, the ability to access these professionals more regularly seemed to be restricted. Support for allied health is required to ensure that older people can maintain their independence, quality of life, and age well into the latter years of life.

We would like to thank Hilary O’Connell, Rik Dawson, and Stacey George for joining us at the ARIIA 2024 conference and sharing their expertise with us.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Professor Jennifer Tieman 

Director - ARIIA Knowledge and Implementation Hub (KIH)

There were 190,939 registered deaths in 2022, an increase of 19,470 since 2021. The number of people dying each year is increasing, and we are dying older, with 68% of deaths in 2022 among people aged 75 or over [ABS data, 2023]. For people aged 65 and over, the most common place of death was hospital (50%), followed by residential aged care (36%). For people aged 85 and over, residential aged care was the most common place of death (50%), followed by hospital (40%) [AIHW, 2021]. Aged care not only cares for older people but also for those nearing the end of life. The 2024 ARIIA Conference was brave enough to highlight this issue and challenge us to rethink the end-of-life care system. More importantly, conference delegates actively chose to participate in the discussion.

A distinguished and articulate set of speakers addressed the factors shaping the palliative care ecosystem, with particular reference to aged care. Dr. Helena Williams illustrated the complexity of need and decision-making through two case studies. She noted that the ability to provide care is hampered by 31% of GPs reporting a lack of confidence in providing appropriate palliative care to their patients due to patient complexity and inadequate or insufficient training and resources. Low uptake of ACDs further compounds care planning and delivery. Issues around legal matters at the end of life were explored by Dr. Katrine Del Villar. Concerns about ACDs being overridden, the role and practice of substitute decision-makers, futile or non-beneficial care, pain and symptom relief, and Voluntary Assisted Dying were all issues that clinicians and aged care workers had raised.

The possibilities and perils of technology in end-of-life systems were introduced by Anne Livingstone. Big data, sensors, home monitoring, virtual reality, and artificial intelligence are all poised to enter aged care and come into play in care at the end of life. While the possibilities are easy to see, concerns about governance, human-centered design, the commercial marketplace, expense, privacy, and interoperability all challenge integration into practice. Understanding the complexity of the state and national governance environment further complicates how change can be implemented into the system. While we think that evidence drives rational decision-making, Kate Swetenham reminded us that policy is often informed by consumer feedback, adverse events, reviews and commissions, funding instruments, and jurisdictional meetings.

Questions from the floor to the panel sought to understand why, as a community, we are not more willing to talk about death and dying and why there is such a fractured understanding of what palliative care is. The need to acknowledge the role that home care will play in care delivery was raised by those on the frontline of providing home care packages. Session attendees also reminded us of the diversity of those needing care at the end of life, as well as the diverse backgrounds, experiences, and beliefs of those providing care in aged care settings. Funding tensions, such as GP reimbursements and ANACC Class 1, State and Commonwealth responsibilities and interfaces, and the availability and capacity of family carers, were concerns expressed by the audience. The lack of willingness of philanthropy to engage with the sector was also seen as problematic. 

Such a rich discussion needs to find a pathway forward. Suggested directions included developing clinical leadership for palliative care in aged care that can drive policy and practice awareness. The business case for quality care needs to be developed not just for governments but for all funders. Encouraging family and community discussions and promoting the completion of advance care planning documents was seen as critical. However, respecting diversity in views across individuals, communities, and choices is essential. We need to advocate for models of integrated care that recognise changing needs over time and transitions in care. Finally, there was a consensus that we need to be proactive in recognising those who are in the last months or years of life. This provides time for planning, for family, and for good care right up to death.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

​Paul Ross

Librarian & Information Specialist, ARIIA

Searching online allows individuals to quickly access a vast array of information, resources, and services from around the world. As noted in previous blogs, this can include using search engines to connect with organisations, academic sources and governmental data. However, relying solely on search engines can lead to "information overload." Breaking your search into different approaches enables you to manage the information into specific groups, preventing information overload.

"Grey literature" describes research and information that has not undergone a formal peer-reviewed publication process. Anything outside this commercially published domain is considered as a "grey" area and is therefore classified as 'grey literature' which can include various types of content, from videos to policy documents, toolkits to blogs, and more.

Searching for grey literature should be conducted using a triangulated, three-point approach:

1. Initial Search within a Search Engine: Start by using a search engine to get a clear idea of what you are looking for and how your subject is described in the literature. Then, conduct a more focused search by limiting your search engine results to .ORG (organizational). Note the organization names that come up and bookmark these for further searching.
2. Use Lists of Relevant Organizations: Utilize lists of organizations in your area of interest, such as those provided by ARIIA (Organisations / Resources), PalliAged, and the Australian Government.
3. Search Within Organizations: Once you have a list of relevant organizations from your web searches and lists, look for either a resources or publications section on their websites. Use their site search function if available, though note that not all search functions are equal, and some may not find what you are looking for.

Pro-tip: To double-check an organization's site, use Google Advanced Search. In the “site or domain” section, enter the organization’s web address along with the terms you are looking for. Google will search the entire organization’s site, potentially finding information their internal search function may have missed.

By using a triangulated approach to search for grey literature from organizational sites, you can ensure a broad selection of sources beyond just an online search using a search engine. It is also recommended to bookmark any organizations you find, saving you time in the future and helping you build your own collection of knowledge. Since grey literature is continuously produced, visiting your library or academic specialist centres, especially those with special collections in your field of interest, can be beneficial.

Pro-tip: Connect with professionals in your field and ask them what sources of information they use.

In our final blog, we will complete the overall picture of searching online by looking into searching for information using online databases. To visit our previous blogs on the subject of searching online, check out our introduction and search sources blogs.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

​​Nadège Messier​

​​Grand-App AI Oceania​ 

​​​Nowadays, new technologies are being integrated into the aged care sector. These systems are becoming part of the 'Age-Tech' and offer numerous benefits for older people, caregivers and families in their day-to-day lives.

​New technologies provide real-time monitoring of vital signs, activity levels, and behavioural or environmental conditions, allowing caregivers and family members to respond promptly to emergencies such as falls, health crises, or accidents. These same remote care systems are now considered critical in improving an older person's safety whilst reassuring their caregivers and families.

​Prevention of risks within the home setting can now be calculated using a range of sensors and an Artificial Intelligence (AI) algorithm. Families who live away from their older relatives or older people who prefer to age in place rather than moving to assisted living facilities or move closer to their family which would take them away from their preferred environment, especially benefit from remote sensor technologies.

Many monitoring technologies include features to support communication between older persons, carers, healthcare providers and even families. These functions can facilitate collaboration, coordination of care, and timely communication of important information.

​By using monitoring technologies, seniors can maintain a greater level of independence and be healthy for longer while still receiving support and assistance as needed and according to the changes in their fitness levels.

​As children, nieces, nephews, and siblings, we all want our loved ones, our older people, to age well and be happy. We can acknowledge that changes in health conditions are a natural part of aging. Continuous monitoring enables the early detection of health issues or behavioural changes, allows timely intervention and treatment and can improve general health outcomes and support wellbeing.

​Additionally, these systems collect valuable data, which can be used to create customised care plans tailored to each older person's needs. An individualised plan ensures that each person receives the right care and support, optimising their overall health and quality of life. The data collected by these monitoring technologies can provide valuable insights into the seniors' health trends and patterns over time. This information can also guide data-driven decision-making regarding their care, lifestyle modifications, and treatment plans.

​Financially automated monitoring systems can streamline caregiving tasks, saving the effort of carers, seniors and families, increasing efficiencies and saving time for everyone involved. More than anything, it allows carers to focus on providing quality care and spending meaningful time with their older clients and residents. In addition, by helping prevent emergencies and hospitalisations, monitoring technologies can reduce healthcare costs for individuals and their families. Although it can appear expensive to set up initially, these can still potentially represent long-term savings for the older person and the health system.
 
Overall, new monitoring technologies empower seniors to age in place safely and comfortably while providing invaluable support to caregivers and peace of mind to families.​

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.