Annual progress reports

"StandingTall-with our Mob": A holistic approach towards active and healthy ageing (1169824)

  • Professor Kim Delbaere (Chief Investigator A)
  • University of New South Wales
  • Budget: $990,165.20
  • Funding period: 2019 to 2024

Project Synopsis

Mortality rates in Indigenous populations are still higher than in non-Indigenous people worldwide, with life expectancy gaps of 6 to 10 years. Furthermore, the health and quality of life of older Indigenous people is threatened by high rates of falls, cognitive impairment and psychological distress. Population ageing in Indigenous communities worldwide, with associated age-related chronic diseases, goes unrecognised in terms of support, prevention and service needs.

In response to this need, we have co-created a healthy ageing program to improve care and support for older Indigenous peoples. Our program is culturally safe and considers underlying social determinants of Indigenous health and well-being. Furthermore, it meets evidence-based guidelines to safely and sustainably advance healthy ageing through balance exercise, cognitive training and stress reduction. It has been designed to meet the needs and expectations of its participants via information gathering in yarning sessions. Inclusiveness, attendance flexibility, and the inclusion of Indigenous culture in all activities are some examples that reinforce sustained adherence and foster an environment that is more conducive to health behaviour change.

This project is guided by an Indigenous Steering Committee, including Indigenous investigators and representatives from partnering communities, and has engaged Indigenous leadership from development through to evaluation. This project focuses on healthy ageing and people’s capacity to age well, on their own terms, with programs designed to strengthen physical capabilities and social and emotional wellbeing. By engaging with culturally appropriate healthy ageing programs, people may be able to improve quality of life by preventing or delaying health problems as they move into older age. Programs are tailored to match the needs of individual participants and, by incorporating elements such as bush medicine, artwork, and Language, the programs are culturally relevant and beneficial for older Indigenous people.

Progress report as of 30 April 2023

The "Ngarraanga Giinganay" group-based mindfulness program shows promising results with improvements observed for several participants in physical capacity, symptoms of depression, anxiety, stress, blood pressure and chronic pain. Participants also reported improved awareness of their surroundings including mindful eating. The StandingTall individualised gentle exercise program is delivered through an iPad and focuses on balance and dual-task training. Participants find the program enjoyable and easy to use, and have reported improved balance, balance confidence and awareness in their day-to-day life activities. We have found through ongoing feedback from trial participants, in addition to development and piloting phases, that our programs may be a useful adjunct to other successful ongoing community initiatives to support the wellbeing of Elders and older people.

A Framework for Healthy Ageing in the Torres Strait (1170393)

  • Professor Edward Strivens (Chief Investigator A)
  • James Cook University
  • Budget: $1,100,540.00 
  • Funding period: 2019 to 2025

Project Synopsis

At present, there is a lack of evidence around what it means to “age well” or how older adults can be supported to “age on Country” in Torres Strait Islander communities. The aim of this project is to develop a culturally appropriate framework of healthy ageing for Torres Strait Communities. This project will use the World Health Organisation intrinsic capacity model to develop valid measures of healthy ageing covering cognition, mood, vision/hearing, diet and physical activity. The proposed project has been developed with the community in response to feedback from our previous work in the Torres Strait. Ongoing community engagement and consultation will be a central component of the study. 

A mixed methods approach will be used. We will draw quantitative data from our previous work in the Torres Strait to develop culturally appropriate measures of intrinsic capacity within this population. As there are no specific culturally appropriate tools for measuring diet and physical activity, this project will develop, pilot and validate suitable tools for this purpose. The qualitative component of the research will be exploratory and used to develop the conceptual model of healthy ageing in the Torres Strait. A Continuous Quality Improvement and Participatory Action Research methodology will be used as this allows researchers and participants to understand and improve the practices in which they participate. 

This framework will be used to develop a conceptual model of healthy ageing that can be used to tailor culturally appropriate interventions across the lifespan. 

Progress report as of 30 April 2023 

The following activities have been carried out or are in progress: 

  • auditing of health service charts has been completed for four out of five sites and is in progress for the remaining one site. 
  • yarning circles have been completed in all five participating communities. 
  • initial data analysis of audits and yarning has commenced. 
  • Continuous Quality Improvement activities have commenced with four of the five sites. 
  • Remaining site to commence Continuous Quality Improvement activities within the next couple of months. 
  • preliminary findings are to be shared at conferences this year (national and international).

Exploring healthy ageing amongst Aboriginal Australians through the window of cancer (1170403)

  • Professor David Currow (Chief Investigator A)
  • The Sax Institute
  • Budget: $1,167,301.20
  • Funding Period: 2019 to 2023

Project Synopsis

Cancer is a significant component of the burden of chronic disease and the experience of ageing in Aboriginal people, ranking second only to cardiovascular disease as a contributor to the burden of disease. Cancer is primarily a disease of older people, and in Aboriginal people is likely to be associated with other significant co-morbidity. Aboriginal people have lower rates of survival from cancer relative to other Australians, and relatively little is known about how to reduce the burden of this chronic disease. This project is built on a 12-year collaboration between Aboriginal Community Controlled Health Services and the Sax Institute (with expertise in knowledge mobilisation); it was led by the NSW Cancer Institute, with state-wide responsibility for cancer services. Using the framework of Cancer Australia’s newly released Optimal care pathway for Aboriginal and Torres Strait Islander people with cancer, we worked with communities to identify evidence driven strategies to improve cancer care and support healthy ageing. The strategies were based on: (a) qualitative data from communities about their views on ageing as well as cancer and its treatment, the facilitators, barriers to the participation of older Aboriginal people in healthy ageing programs and services, cancer screening and treatment and their views about potentially useful strategies to improve care. This component was conducted in five communities in NSW (urban, rural and remote); (b) epidemiological data about the causes of poorer survival from cancer in older Aboriginal people; (c) an analysis of the cancer care pathways for older Aboriginal people in three to five partner communities. There is the potential for the identified strategies to be adopted at scale through the Aboriginal community-controlled health sector and across NSW through the work of the Cancer Institute.

Final report under review

 

Defining and predicting Healthy Ageing in Aboriginal and Torres Strait Island Populations (HATS)(1170422) 

  • Professor Leon Flicker (Chief Investigator A)
  • University of Western Australia
  • Budget: $931,119.40
  • Funding period: 2019 to 2025

Project Synopsis

There is no current model of healthy ageing in Aboriginal and Torres Strait Islander populations. Although there are many similarities to health-related quality of life, there remain fundamental differences to the domains and uses for a model of healthy ageing. In response to worldwide population ageing, the World Health Organization (WHO) recently released a blueprint for Ageing and Health (2015). This document has produced a framework that may be applied to all populations. This blueprint has adopted a life course approach to health determinants and proposed a broad-based intrinsic capacity of individuals that interacts with the environment and society. This framework will need to be strengthened with specific cultural aspects for Aboriginal and Torres Strait Islander populations. We will apply this approach to our previously studied populations of older Aboriginal and Torres Strait Islander peoples to define healthy ageing and incorporate information from new follow-ups of participants. These studies include both longitudinal and cross-sectional studies. Using our previous study cohorts from the last 15 years, we will determine barriers and enablers of healthy ageing.

Progress report as of 30 April 2023

We have extended our original inquiries in healthy ageing to include more extensive domains, most importantly, informed by Aboriginal and Torres Strait Islander viewpoints. We have been fortunate to work with the NHMRC Centre for Research Excellence (CRE) Good Spirit Good Life: Better health and wellbeing for older Aboriginal and Torres Strait Islander Australians. This CRE, led by Professor Dawn Bessarab, has allowed our team to explore other aspects of healthy ageing through an Indigenous lens that incorporates collective and holistic worldviews of health and well-being. It specifically supports the importance of the role of Country, role of the Elder and Community. We have also had extensive and valuable discussions about data sovereignty facilitated by some of our elders and yarning circles.

We have explored models of healthy ageing in Aboriginal populations using existing data, performed analyses and are currently preparing publications. We utilised the data from the Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Survey to examine cultural events, ceremonies, or organisations attended in last 12 months by people over the age of 45 years (n = 2730) and whether participation differed by age, gender and location.  We also explored whether participation differed by social factors.

Using our Kimberley data, we determined the outcomes of healthy ageing using the framework from the World Health Organization which defines healthy ageing as the process of maintaining intrinsic capacity that enables well-being in older age.  Of the original cohort, 16% had intact intrinsic capacity in all 5 domains at baseline. After an average of 6 years of follow-up, 20% of surviving participants had intact intrinsic capacity. The domains of vitality, mood, and cognition were most likely to be intact, while locomotion and sensory domains were least likely. Being female, having hypertension, pain, and history of falling were inversely associated with having intact intrinsic capacity in all 5 domains.

Designing Indigenous aged care with a ‘whole of community’ perspective (1170496)

  • Professor Alex Brown (Chief Investigator A)
  • University of South Australia
  • Budget: $741,947.30
  • Funding period: 2019 to 2023

Project Synopsis

Older Aboriginal peoples need aged care that aligns with their beliefs, customs and culture. In Stage One we will investigate older Aboriginal peoples’ views, experiences and understandings of what ‘healthy ageing’ means to them and their expectations of aged care support services and systems, taking into account the perspectives of their familial younger generations and wider Indigenous communities. In Stage Two, we will then assess aged care provider understandings of the needs of their Aboriginal clients and service delivery challenges in providing acceptable services in residential and community settings.  We will evaluate the extent to which service delivery practices and systems align with the “voice” of older Aboriginal peoples and their communities. In Stage Three, we will synthesise findings from Stages One and Two to inform a national stakeholder roundtable of government, policy and Aboriginal community leaders with the aim of providing practical solutions to ensuring the current aged care reforms are implemented effectively from the perspectives of older Aboriginal peoples and their communities.

Awaiting final report

 

Improving implementation of Health Assessments for Aboriginal and Torres Strait Islander clients in mainstream general practice: a cluster randomised controlled trial (1170385) 

  • Professor Robert Sanson-Fisher (Chief Investigator A) 
  • The University of Newcastle  
  • Budget: $745,056.50 
  • Funding period: 2020 to 2027 

Project Synopsis

The health and wellbeing disparities between Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal people) compared to non-Indigenous Australians is well documented and highlights the continued impact of events such as colonialization, the stolen, intergenerational trauma and racism. Primary care-based annual health assessments (health checks) are identified as an opportunity to address this health disparity. These annual health assessments examine the physical and psycho-social wellbeing of Aboriginal clients and facilitates prevention and early intervention for a range of health problems. However, in 2016/17, only 27%-41% of Aboriginal adults aged 15+ years received a health assessment. Additionally, the impact of health assessments on the quality of the health care provided and on patient health outcomes remains unclear. Research targeting health assessments for Aboriginal people has mostly focused on Aboriginal Community Controlled Health Organisations. However, over 60% of Aboriginal people regularly visit mainstream general practices. There is an urgent need to identify effective strategies to increase the delivery of quality health assessments and examine whether this leads to improved outcomes for Aboriginal people attending mainstream general practice. This study will use a cluster randomised controlled trial design across 22 general practice clinics and will examine:

  1. If a multicomponent initiative is effective and cost-effective in increasing the proportion of adult Aboriginal clients attending mainstream general practice with an up-to-date health assessment.
  2. If the multicomponent initiative increases the rate of provider adherence to best practice care and improves patient outcomes for clinically important tracer conditions.
  3. The mediating roles of health assessments and provider adherence to best practice care on selected health outcomes. This study will provide high-level evidence of the potential effectiveness of a multicomponent intervention in increasing annual health assessments for Aboriginal people attending mainstream general practice.

If effective, it has high potential for widespread adoption in Australia and can therefore contribute to improved health outcomes for Aboriginal people.

Progress report as of 31 May 2023

An Aboriginal Reference Group has been established, involving 8 individuals from across New South Wales. This group meets at least twice per year to advise on critical aspects of the study. Ethics approval was obtained from the Aboriginal Health and Medical Research Council on 1st August 2022. The research team are working with collaborating Primary Health Networks to ensure the study materials and intervention strategies are tailored to the practices and the Communities they serve. To date, 20 practices have agreed to participate in a medical record audit to establish current rates of health assessments in mainstream general practices. We have engaged PenCS to develop a remote data extraction tool – this tool is now complete and ready for use. Extraction, analysis and reporting of data regarding current rates of health assessments is planned to be completed in 2023. The cluster randomised controlled trial is expected to commence in late 2023, pending recruitment of final practices.