Lowitja Institute Repository

https://lowitja.intersearch.com.au/handle/1/1

We are Australia’s only Aboriginal and Torres Strait Islander community controlled health research institute, named in honour of our namesake and co-patron, the late Dr Lowitja O’Donoghue AC CBE DSG. We deliver high-impact quality research, knowledge exchange, and by supporting a new generation of Aboriginal and Torres Strait Islander health researchers. This repository contains information on Lowitja research outputs.
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Amplifying older Aboriginal and Torres Strait Islander women's perspectives to promote digital health equity: co-designed qualitative study.
Henson Connie; Chapman Felicity; Shepherd Gina; Carlson Bronwyn; Rambaldini Boe; Gwynne Kylie
Background: Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people's clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. Objective: This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. Methods: Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. Results: Participants comprised 24 Aboriginal and Torres Strait Islander women aged >=41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. Conclusions: Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Barriers and enablers to older Indigenous people engaging in physical activity - a qualitative systematic review.
Gidgup M.J.R; Kickett M.; Weselman T.; Hill K.; Coombes J.; Ivers R.; Bowser N.; Palacios V.; Hill A.
The objective of this qualitative systematic review was to synthesize all evidence to understand the barriers and enablers to older Indigenous peoples (aged 40 years and older) engaging in physical activity. Four databases were searched. Study quality was assessed from an Indigenous perspective, using an Aboriginal and Torres Strait Islander quality appraisal tool. Data were analyzed using thematic synthesis. There were 4,246 articles screened with 23 articles and one report included from over 30 Indigenous communities across four countries. Cultural Safety and Security was a key enabler, including developing physical activity programs which are led by Indigenous communities and preference Indigenous values. Colonization was a key barrier that created mistrust and uncertainty. Social Determinants of Health, including cost, were supported by successful programs, but if not addressed, were demotivators of engagement. Older Indigenous peoples identified barriers and enablers that can direct the development of sustainable, culturally appropriate physical activity programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Culturally safe, trauma-informed approach to cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people.
(2023-08-08) LoGiudice D.; Hughson J.; Douglas H.; Wenitong M.; Belfrage M.
Background: The population of older (age >=50 years) Aboriginal and Torres Strait Islander people is increasing, and the rate of dementia in this group is three to fivefold higher than in the general population. A high prevalence of risk factors across the life course likely contributes to these rates. Objectives: This paper highlights practical ways to apply best practice principles when addressing the detection of cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people and its management in the context of a person's family, carers and community. Discussion: Recognising culture, the collective nature of family and community decision making for a person, the ways to uphold respect for Elders and a trauma-informed approach are fundamental to the care of older Aboriginal and Torres Strait Islander people with cognitive impairment and dementia.
Deaths with dementia in Indigenous and non-Indigenous Australians: a nationwide study.
(2021-06-30) Waller M.; Buckley R.F.; Masters C.L.; Nona F.R.; Eades S.J.; Dobson A.J.
Background: The prevalence of dementia is generally reported to be higher among Indigenous peoples. Objective(s): The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. Method(s): De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer's Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as 'unspecified' type in Indigenous Australians. Result(s): The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as 'unspecified' on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group. Conclusion(s): This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.Copyright © 2021-IOS Press. All rights reserved.
Integrated care for adults with dementia and other cognitive disorders.
(2019-05-20) Draper B.; Low L.-F.; Brodaty H.
The importance of better care integration is emphasized in many national dementia plans. The inherent complexity of organizing care for people with dementia provides both the justification for improving care integration and the challenges to achieving it. The prevention, detection, and early diagnosis of cognitive disorders mainly resides in primary care, but how this is best integrated within the range of disorders that primary care clinicians are expected to screen is unclear. Models of integrated community dementia assessment and management have varying degrees of involvement of primary and specialist care, but share an emphasis on improving care coordination, interdisciplinary teamwork, and personalized care. Integrated care strategies in acute care are still in early development, but have been a focus of investigation in the past decade. Integrated care outreach strategies to reduce transfers from long-term residential care to acute care have been consistently effective. Integrated long-term residential care includes considerations of end-of-life care. Future directions should include strategies for training and education, early detection in anticipation of disease modifying treatments, integration of technological developments into dementia care, integration of dementia care into general health and social care, and the encouragement of a dementia-friendly society.Copyright © 2019, © 2019 Institute of Psychiatry and Johns Hopkins University.
Looking out across the front yard: Aboriginal peoples' views of frailty in the community - a qualitative study.
Lewis E.T.; Howard L.; Carroll R.; Howie A.; Kenning G.; Withall A.; Rockwood K.; Cardona M.; Radford K.; Schreyenberg K.; Peters R.
Objective: Frailty is one of the most significant challenges to healthy ageing. Aboriginal Australians experience some of the highest levels of frailty worldwide, and despite this, no studies have explored frailty from an Aboriginal perspective. This is important because Aboriginal understandings and priorities in frailty may differ from Western/mainstream frailty frameworks. Furthermore, this lack of research severely hampers healthcare planning and service delivery. As a starting point, this study aims to understand the experiences, attitudes, and perceptions that Aboriginal older adults hold regarding frailty. DesignA qualitative study that utilized the Indigenous research method of Yarning for data collection as a culturally appropriate process for engaging Aboriginal peoples. Yarning circles and one-on-one yarns with 22 Aboriginal adults aged 45+ years living in one Australian capital city took place online and over the phone to explore the views that Aboriginal adults hold around frailty. Data were analysed thematically by Aboriginal researchers. ResultsSeven key thematic areas were identified: (1) Keep in with culture; (2) Physical markers of frailty; (3) Frailty throughout the life course; (4) Social, cultural, and psychological understandings of frailty; (5) We want information about frailty; (6) Appropriate and positive wording; (7) Frailty assessment. ConclusionsThere was interest and engagement in the concept of frailty by Aboriginal older adults and approaches to frailty that extend beyond the physical to address cognitive, psychosocial, cultural and spiritual domains are likely to be more acceptable to this population. Culture and community connectivity are essential elements in preventing and alleviating frailty and have wider positive implications for Aboriginal health and wellbeing. Existing tools in practice to assess frailty are not aligned with Aboriginal cultural norms. Culturally appropriate frailty assessment methods co-designed with the community which incorporate holistic and multidimensional approaches are urgently needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Physical functional limitations among Aboriginal and non-Aboriginal older adults: associations with socio-demographic factors and health.
(2015-11-26) Gubhaju L.; Banks E.; MacNiven R.; McNamara B.J.; Joshy G.; Bauman A.; Eades S.J.
Background Australian Aboriginal people are disproportionately affected by physical disability; the reasons for this are unclear. This study aimed to quantify associations between severe physical functional limitations and socio-demographic and health-related factors among older Aboriginal and non-Aboriginal adults. Methods Questionnaire data from 1,563 Aboriginal and 226,802 non-Aboriginal participants aged >=45 years from the Sax Institute's 45 and Up Study (New South Wales, Australia) were used to calculate age- and sex-adjusted prevalence ratios (aPRs) for severe limitation [MOS-PF score <60] according to socio-demographic and health-related factors. Results Overall, 26% (410/1563) of Aboriginal participants and 13% (29,569/226,802) of non-Aboriginal participants had severe limitations (aPR 2.8, 95%CI 2.5-3.0). In both Aboriginal and non-Aboriginal participants, severe limitation was significantly associated with: being >=70 vs <70 years old (aPRs 1.8, 1.3-2.4 and 5.3, 5.0-5.5, within Aboriginal and non-Aboriginal participants, respectively), none vs tertiary educational qualifications (aPRs 2.4, 1.7-3.3 and 3.1, 3.0-3.2), lower vs higher income (aPRs 6.6, 4.2-10.5 and 5.5, 5.2-5.8), current vs never-smoking (aPRs 2.0, 1.6-2.5 and 2.2, 2.1-2.3), obese vs normal weight (aPRs 1.7, 1.3-2.2 and 2.7, 2.7-2.8) and sitting for >=7 vs <7 hours/day (aPRs 1.6, 1.2-2.0 and 1.6, 1.6-1.7). Severe limitations increased with increasing ill-health, with aPRs rising to 5-6 for >=5 versus no chronic conditions. It was significantly higher in those with few vs many social contacts (aPRs 1.7, 1.4-2.0 and 1.4, 1.4-1.4) and with very high vs low psychological distress (aPRs 4.4, 3.6-5.4 and 5.7, 5.5-5.9). Conclusions Although the prevalence of severe physical limitation among Aboriginal people in this study is around three-fold that of non-Aboriginal people, the factors related to it are similar, indicating that Aboriginal people have higher levels of risk factors for and consequences of severe limitations. Effective management of chronic disease and reducing the prevalence of obesity and smoking are important areas for attention.Copyright © 2015 Gubhaju et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source.
Staying engaged: experiences and opportunities for diverse populations to age well in Australia.
Liddle J.; Pachana N.A.
Within an ageing population, the experiences of older Australians are diverse. While disability and health changes affect half of older people, approximately three-quarters consider themselves to be in good, very good or excellent health. However, the outcomes and needed supports differ for different groups. Understanding the diversity of the population is key to understanding the needs, experiences and preferences for ageing well in Australia. Three key groups that have different ageing-related experiences and needs are: Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, and people living in rural and remote areas. Within Australia, Aboriginal and Torres Strait Islander people may experience starkly different ageing experiences in terms of unmet need, life histories, health outcomes and disability. However, Elderhood for Indigenous Australians is a highly-valued role, central to communities and an embodiment of ageing well and authentically. Understanding the diversity of the ageing experience within Australia also requires an acknowledgement of geographic pressures, with substantially fewer health and ageing care services being available in regional and remote areas. People's cultural heritage, languages, and life histories shape their ageing experiences, as does the geographic region in which they live. Across the diverse populations, physical and mental health, community engagement and social connectedness are regarded as key aspects of ageing well. Trends towards supporting continued community engagement are focussing on control returning to individuals and communities, places that support engagement and ways of enabling meaningful doing and connecting with others. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

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