Papers by Lynette Goldberg
Innovation in Aging, 2017
Australasian Journal on Ageing, May 26, 2023
Public Health, Jul 1, 2019
Objective: Aboriginal people and Torres Strait Islanders are impacted by dementia at higher rates... more Objective: Aboriginal people and Torres Strait Islanders are impacted by dementia at higher rates and at a younger age of onset than the broader Australia population. Public health strategies to support this population require a thorough understanding of how Aboriginal people perceive dementia and dementia care support needs. The aim of this study was to investigate Aboriginal community understandings of dementia and their responses to dementia care. Study design: This study is a community participatory action research partnership. Methods: The mixed method study was undertaken in 2017 with members of a discrete Aboriginal community from rural Tasmania, Australia. Participants were older than 18 years, self-identified as an Aboriginal person and were living or had lived in the community studied. Data were derived from 50 participants who completed the 27-item Dementia Knowledge Assessment Scale (DKAS). Twelve of these participants also shared their dementia care experiences in individual interviews. Results: The DKAS results showed a low overall level of dementia knowledge, with a total mean score of 27.73 (scoring 51% on average) of a possible score of 54. The salient interview theme was the cultural obligation to care for family members living with dementia. Dementia care metaphors represented ways to protect family members living with dementia and maintain their ongoing connections to home and community. However, limited understandings of dementia affected their capacity to provide quality care. Conclusion: The findings contribute to public health scholarship involving Aboriginal community responses to dementia care. The study has resulted in important initiatives including a community-based dementia education program to ensure Aboriginal people impacted by dementia are provided with effective and culturally appropriate care.
Age and Ageing, Jul 17, 2020
Background: aspiration pneumonia increases hospitalisation and mortality of older people in resid... more Background: aspiration pneumonia increases hospitalisation and mortality of older people in residential aged care. Objectives: determine potentially pathogenic microorganisms in oral specimens of older people with aspiration pneumonia and the effect of professional oral care in reducing aspiration pneumonia risk.
Many adults with dementia in residential aged care are dependent on others for feeding and oral c... more Many adults with dementia in residential aged care are dependent on others for feeding and oral care. Langmore and colleagues in the United States have shown this co-related dependency is a strong predictor for aspiration pneumonia due to pathological oral microorganisms from saliva, tooth decay, and an unclean mouth migrating into the lungs and the inability of adults to cough and clear the aspirated material. The subsequent lung infection frequently results in hospitalisation, increasing frailty, and can cause death. Even when teeth are removed, oral pathogens remain a risk indicator for aspiration pneumonia as they line the mucosa I surface of the oral and pharyngeal cavities, including the tongue. Evidence-based and sustainable oral care needs to be an integral aspect of a paradigm shift to actively promote function, maintain health, and significantly reduce costs associated with ill health and hospitalisation for residents with dementia. Residents with dementia frequently take many medications that reduce salivary flow or create xerostomia, which increase the pathogenic bacteria. These bacteria cause tooth decay, gum inflammation, gum disease, and painful disruption of the oral mucosa and supporting structures. Chronic inflammation of oral tissues results in bacteria entering the bloodstream with detrimental effects on the body and brain. Associated oral pain frequently necessitates a diet of modified foods, compounding the risk for malnutrition, with associated changes in behaviour, frailty, and a compromised immune system. One potential strategy to prevent this cascade and decrease aspiration pneumonia risk is to screen the oral health and function of adults when they move into care. In Australian residential care communities, oral care for adults with dementia generally is delegated to extended care assistants or personal care workers (carers). Many view oral care as onerous and are reluctant to perform it; many have limited training to respond to changes in behaviour that may· indicate residents' distress; many do not understand how oral care is integral to the work of dentists, speech pathologists, dietitians, physiotherapists, and nurses to promote residents' function and overall health. In this project, an interdisciplinary team of a speech pathologist, dentist, nutritionist, and pharmacist worked with nurses and carers to screen 142 residents using the Oral Health Assessment Tool (OHAT), the Mini-Nutritional Assessment (MNA), the Yale Swallow Protocol, and the EuroQOL-5D-3L. Residents' diagnoses, age, gender, prescribed medications, and clinical signs of potential aspiration were documented from medical files. The administration of all four screening tools was generally able to be completed in 20 minutes. However, due to the conversations that ensued with residents, the expended time sometimes doubled. These conversations provided valuable insight into issues of concern to residents - information carers and nurses needed to know but often did not. Of the residents, 78% warranted referral to a dentist; 57% were at risk for malnourishment; 13% were actually malnourished; and 70% failed or refused the swallow protocol, indicating difficulty with, or apprehension about, swallowing thin liquids safely. Self-reported quality of fife ranged from 34-95% (M = 65%). The collaborative interdisciplinary team was instrumental in assisting nurses and carers to screen for, identify, and address issues in oral health and function. Residents are being tracked to determine the outcome of reduced aspiration pneumonia risk. Results will be available by August.
BMC Nursing, Jun 5, 2023
Background The oral health of many older Australians is poor and associated with many systemic he... more Background The oral health of many older Australians is poor and associated with many systemic health problems. However, nurses often have a limited understanding of the importance of oral healthcare for older people. This study aimed to investigate Australian nursing students' perception, knowledge, and attitude toward providing oral healthcare for older people and associated factors. Methods A cross-sectional study was conducted among final year nursing students studying at accredited nursing programs using an online self-reported 49-item survey. The data were analysed using univariate and bivariate analysis (t-test, ANOVA, Spearman's correlation test). Results A total of 416 final-year nursing students from 16 accredited programs in Australia completed the survey. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n = 229) and had limited knowledge about oral healthcare for older people (73%, n = 304); however, their attitude towards providing such care was favourable (89%, n = 369). A positive correlation was found between students' confidence in delivering oral healthcare to older people and their perceived knowledge (r = 0.13, p < 0.01). Results revealed a statistically significant positive association between students' experience in providing oral healthcare to older people and students' perception (t = 4.52, p < 0.001), knowledge (t = 2.87, p < 0.01), and attitude (t = 2.65, p < 0.01) mean scores in such care. Nearly 60% (n = 242) of participants received education/training in oral healthcare for older people at university, but this was often for less than one hour. Around 56% (n = 233) believed that the current nursing curriculum did not prepare them to provide effective oral healthcare to older people. Conclusion Findings suggested a need for nursing curricula to be revised to include oral health education and clinical experience. Knowledge of evidence-based oral healthcare by nursing students may improve the quality of oral healthcare for older people.
It is essential that people with dementia are afforded dignity and respect, and engaged socially ... more It is essential that people with dementia are afforded dignity and respect, and engaged socially for optimal support and care. This goal, that values and supports personhood, is not easily translated into practice. This chapter focuses on heightening awareness of the importance of providing person-centred, socially-engaged and dignity-preserving care and discusses the experiences and shared insights of 346 students enrolled in a unit in the online Bachelor of Dementia Care programme offered through the Wicking Dementia Research and Education Centre at the University of Tasmania. This focus enabled students to learn about and reflect with a ‘personhood lens’, building on their prior knowledge and experience. Further, this focus provided a theoretical framework through which students were able to enact person-centred values across care settings and contribute to the social reframing of dementia.
Policy studies (i.e. the scholarly, peer-reviewed analysis of the nature of the processes by whic... more Policy studies (i.e. the scholarly, peer-reviewed analysis of the nature of the processes by which policy is formed) is a very small research area within oral health. The study of, and advocacy for policy, has traditionally been conducted by government, the private sector and professional organisations.
BMC Neurology
BackgroundThe worldwide prevalence of dementia is rapidly rising. Alzheimer’s disease (AD), accou... more BackgroundThe worldwide prevalence of dementia is rapidly rising. Alzheimer’s disease (AD), accounts for 70% of cases and has a 10–20-year preclinical period, when brain pathology covertly progresses before cognitive symptoms appear. The 2020 Lancet Commission estimates that 40% of dementia cases could be prevented by modifying lifestyle/medical risk factors. To optimise dementia prevention effectiveness, there is urgent need to identify individuals with preclinical AD for targeted risk reduction. Current preclinical AD tests are too invasive, specialist or costly for population-level assessments. We have developed a new online test, TAS Test, that assesses a range of motor-cognitive functions and has capacity to be delivered at significant scale. TAS Test combines two innovations: using hand movement analysis to detect preclinical AD, and computer-human interface technologies to enable robust ‘self-testing’ data collection. The aims are to validate TAS Test to [1] identify preclini...
Australian Journal of Advanced Nursing
Objective: To investigate the perspectives of Australian nursing educators on the preparation of ... more Objective: To investigate the perspectives of Australian nursing educators on the preparation of Bachelor of Nursing students for the care of older people's oral health. Background: The Australian population is ageing. Older people with poor oral health are at increased risk of worsening health and chronic disease conditions. Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. Thus, it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. study design and methods: Semi-structured interviews were conducted with 13 participants, including course coordinators, lecturers, directors, and researchers at 10 universities delivering accredited Bachelor of Nursing programs across seven different states in Australia. Data were analysed thematically. results: Four themes were identified in nursing educators' perspectives: (1) the education of nursing students in providing oral healthcare is important, (2) there are notable gaps in nursing students' oral health education, (3) there are both internal and external barriers to strengthening oral health education across nursing programs, and (4) there is a need to develop and promote a shared oral health curriculum that includes interprofessional education and collaborative practice. Inherent in these themes was the need for a clear definition of the role of nurses in oral healthcare. Discussion and conclusion: It is recommended that administrators and policymakers develop nursing accreditation standards that specify the role of nurses in oral health education, and the scope of this education including interprofessional and collaborative practice, for the oral healthcare of older people. Infusing such standards in nursing curricula will better educate and prepare nursing students for effective practice and leadership in gerontological care.
Frontiers in Public Health, Mar 31, 2022
Introduction: This paper details the journey of eight Aboriginal women from Circular Head, a rura... more Introduction: This paper details the journey of eight Aboriginal women from Circular Head, a rural and remote area of NorthWest Tasmania, as they undertook an innovative 2-year program of tertiary studies in dementia to address a documented community need. The Chief Executive Officer of the Circular Head Aboriginal Corporation (CHAC) had identified difficulties being experienced by older members of the community. These difficulties included changes in behavior, memory, and communication, with profound consequences on social engagement and care needs from both individual and community perspectives. The community wished to know if a combined vocational and university program, completed on Country and in community, could serve as a culturally safe education pathway to empower Aboriginal members of a rural and remote area in providing community health and dementia education and care. Methods: The nationally funded program included a year-long face-to-face vocational Certificate III in Individual Support (Aging, Home, and Community) on Country, including within-community experience with adults with dementia. This face-to-face learning was combined with online study in the award-winning Bachelor of Dementia care offered by the University of Tasmania. Students received a PhD level stipend to support them in their studies and were guided by an Elder from their community. Results: All students completed their Certificate III. The number of units they completed toward the eight required for their Diploma of Dementia Care varied. Emergent themes from students' reflections were holistic and relational, highlighting achievements and challenges, the importance of on Country individual connections and community support, and the value of their current and future contributions to the community. Data from this mixed methods approach documented the impact of the innovative coupling of authentic, culturally appropriate experiential learning with broad and deep academic knowledge about dementia and evidence-based care. Conclusions: This program provided students with a work-related qualification embedded within a university education and increased the capacity and capability of this Aboriginal community to provide care for its members with dementia, a documented concern. The combination of vocational learning on Country with online university study established a pathway to improve students' access to and success in higher education and the professional workforce. Goldberg et al. Aboriginal Women Learning on Country This assisted in counteracting the negative influences of racism, stigma, rurality, and socioeconomic marginalization on educational opportunity for Aboriginal people. Data showed the need for flexibility with this learning journey, and the strengths and resilience of these women as they learned.
BMC Nursing, 2020
Background The recognised relationship between oral health and general health, the rapidly increa... more Background The recognised relationship between oral health and general health, the rapidly increasing older population worldwide, and changes in the type of oral health care older people require have raised concerns for policymakers and health professionals. Nurses play a leading role in holistic and interprofessional care that supports health and ageing. It is essential to understand their preparation for providing oral health care. Objective: To synthesise the evidence on nursing students’ attitudes towards, and knowledge of, oral healthcare, with a view to determining whether oral health education should be incorporated in nursing education. Methods Data sources: Three electronic databases - PubMed, Scopus, and CINAHL. Study eligibility criteria, participants and interventions: Original studies addressing the research objective, written in English, published between 2008 and 2019, including students and educators in undergraduate nursing programs as participants, and conducted in...
Innovation in Aging, 2017
An important strategy to increase knowledge, skills, and confidence of the workforce providing a ... more An important strategy to increase knowledge, skills, and confidence of the workforce providing a range of care to people with dementia is access to contemporary evidence-based education. This paper outlines the innovative, fully online Bachelor of Dementia Care degree offered by the Wicking Dementia Research and Education Centre at the University of Tasmania (Australia). It presents an exploratory singlecase study of 65 students in the first degree cohort: 31 students had previous university-level experience, 34 did not. All passed the units in which they had enrolled. Students with previous university-level experience showed significantly superior performance (p <.05) in only 3 of the 15 units all students had completed to date. Further, the average across-unit grade for students in both groups was no lower than a Credit (60-70%). As judged from comments on University surveys, discussion boards, and requests for help, students with no previous university-level experience needed time to adapt to the culture of university-level study, understand the nuances of ethical academic writing, and learn how to balance the intensity of studying over consecutive semesters with work and family responsibilities. These differences highlight the importance of scaffolding learning and providing step-by-step guidance for all students, but particularly those with no previous university-level experience. Findings give credence to the institutional and student support, curriculum planning, unit structure, and methods of presentation that are integral to this online degree to provide a successful online learning experience for mature-age non-traditional students.
Approximately 50% of residents in aged care are malnourished and dementia compounds this problem.... more Approximately 50% of residents in aged care are malnourished and dementia compounds this problem. This malnourishment problem has long been recognised, yet the translation of knowledge into the provision of person-centred, evidence-based nutrition care has not occurred. We present an ethnographic case study, conducted by an inter-disciplinary team, which examined care practices regarding food and fluids in one aged care home. We conducted a facility document audit, detailed observations of 7 residents with dementia, and interviews with 7 family- and 11 staff-members. We identified a range of barriers preventing evidence-based, person-centred nutrition care. For example, body mass index of residents was not monitored and prompts to encourage eating and drinking were often ineffective. Staff did not appear to have a ‘big picture’ view of the relationship between nutrition and hydration and key clinical health indicators; they viewed eating and drinking as tasks to be completed rather than social activities to be enjoyed. However, staff were aware of the key food and fluid issues experienced by residents and some beneficial care practices, such as small group dining. Why the presentation/topic will be of interest to conference participants: The study identifies barriers to person-centred care and highlights the importance of ongoing education to facilitate nutritional health and quality of life for people living with dementia in the aged care setting. Education and a focus on translation of research into practice will facilitate implementation of best practice nutrition care. Findings suggest that aged care home staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking, to work and learn together to implement evidence-based change. This is relevant to clinical and organisational leaders and other members of the Tasmanian aged care workforce who are striving to overcome the healthcare challenges presented by an ageing population with a high prevalence of dementia and at a high risk for being malnourished.
International Journal of Speech-Language Pathology, 2014
The sensory and gastrointestinal changes that occur with ageing affect older adults&amp;amp;a... more The sensory and gastrointestinal changes that occur with ageing affect older adults&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; food and liquid intake. Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of bioelectrical impedance analysis to measure hydration in 19 older women in residential care: 13 who viewed themselves as healthy and six with dysphagia. Mann-Whitney U analyses documented no significant between-group differences for Total Body Water (TBW), Fat Free Mass (FFM), Fat Mass (FM), and percentage Body Fat (%BF). However, when compared to previously published data for age-matched women, the TBW and FFM values of the two participant groups were notably less, and FM and %BF values were notably greater than expected. If results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.
Innovation in Aging
Poor oral health increases the risk of aspiration pneumonia for older people. This is due primari... more Poor oral health increases the risk of aspiration pneumonia for older people. This is due primarily to six pathogens found in the mouth: five bacteria and one fungus. With a cohort of older people who were dependent on others for their oral care, we analyzed the load and type of bacteria and fungi from swabs of cheek, gum, and tongue mucosa. There were no significant differences between the three sites for load of bacteria (H (2) = .89; p = .64); there were significant differences between the sites for type of bacteria (F (2,78) = 11.97; p <.001) with the tongue showing the greatest diversity. There were no significant differences between the three sites for load (H (2) = 2.94; p = .23) or type (F (2,77) = .46; p = .63) of fungi. We then investigated the effect of regular compared to evidence-based oral care over a six-week period, and whether evidence-based oral care could significantly reduce the absolute count of the six oral pathogens specifically related to aspiration pneumo...
International Journal of Environmental Research and Public Health
Restraint use in Australian residential aged care has been highlighted by the media, and investig... more Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified...
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Papers by Lynette Goldberg