Division of Aged Care and Rehabilitation

A Shared Vision

The Division of Aged Care and Rehabilitation will become a centre of excellence for clinical practice, academic activities and research in aged care.

Located in the Bankstown – Lidcombe Hospital, this Division consists of the following Units: Rehabilitation, Stroke Unit, Acute Geriatrics, Aged Care Psychiatry and the Bankstown Aged Care Assessment Team. Staffing includes Nursing Medical and Allied Health.

Divisional Research

• Benefits of a Combined (acute & rehabilitation) Stroke Unit
• Delirium in Stroke Patients
• Discharge Summary
• Dysphagia in the Elderly
• End of Life Care Plan
• Epidemiology Study of Parkinson’s disease
• Hip Protector Study
• Medication Communication and Education
• NAT-2 Polymorphism and Parkinson’s Disease in Hong Kong Chinese
• Stroke in the Elderly – The Impact of Ethnicity on Stroke Risk Factors and Functional Outcomes

Collaborated Projects

• NAT-2 Polymorphism and Parkinson’s Disease in Hong Kong Chinese
• Neuromelanin Assays for Diagnosing PD
• Parkin Gene and Parkinson’s disease
• Water Exercises and Stability in the Elderly
• Comparison of stroke risk factors and outcomes between Australian and Mainland Chinese

Other

• Annual Report

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Research Office

The research office is responsible for coordinating many of the research generated by Geriatricians working in the Department of Aged Care and Rehabilitation. This office is made up of two full time research staff, a visiting research fellow and many volunteers.

Benefits of a Combined (acute and Rehabilitation) Stroke Unite

Team members: Y. Ang (Singapore), Daniel Chan, D. Heng (Singapore), Qing Shen 
Status: Research completed, paper published in MJA 2003

Organised care in a stroke unit has been shown to improve patient outcomes. Our aim was to compare the length of stay (LOS), functional outcome and discharge destination of patients managed in our unique combined acute and rehabilitation stroke unit (ward 2B), with those of the other rehabilitation units of New South Wales, which do not combine acute care. A secondary aim was to study the effects of the stroke unit on the LOS and mortality of acute stroke episodes.

Delirium in the Elderly

Team members: Triet Bui
Status: Planning

Delirium is a common condition in hospitalised elderly. Delirium is found to associate with morbidity and mortality. Frequent shifting of patients during their hospital stay could be one of the risk factors for delirium. In Bankstown Hospital, a stroke unit has been set up for patients who suffer from acute stroke. In this unit, the same medical team treats all stroke patients. The aim of this study is to determine if the incidence of delirium in patients admitted to our stroke unit is lower than other hospitals.

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Discharge Summary

Team members: Kevin Johnstone, Daniel Chan, Felicity Bagnall,
Status: In progress, paper submitted to Age & Aging

Discharge summaries allow communication between hospitals and General Practitioners and are essential for continuity of patient care. Despite this important function the most junior doctor on the medical team usually writes them. An internal audit and survey of General Practitioners and aged care facilities within the Bankstown sector of the South Western Sydney Area Health Service revealed significant shortcomings in the discharge summaries of patients discharged from the Aged Care Unit at Bankstown-Lidcombe Hospital.

The hospital generic discharge summary was changed to a new and specific aged care discharge summary and Jumbo’s received an education program at the beginning of term with regular review and feedback throughout the term. After three months a second survey was performed which revealed a significant improvement in the quality of discharge summaries accompanying patients discharged from the unit. JMO’s benefited from extra education and the development of a problem-based approach to writing discharge summaries.

Dysphagia in the Elderly

Team member: Triet Bui
Status: In progress

Dysphagia is a prevalent problem in the elderly patient population and causes significant morbidity and mortality. Patients with dysphagia are at risk of aspirating oral contents into their airways with potentially serious consequences. The severity of dysphagia is proportional to the increased risk of pneumonia and death. The aim of this study is to examine the outcome of patients who were found to be dysphagic during their admission to Bankstown-Lidcombe Hospital.

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End of Life Care Plan

Team members: Bankstown: Daniel Chan, Bin Ong, Roger Li, Junguang Liu, UNSW: Kai Zhang, Jeffrey Braithwaite, Rick Iedema
Status: Completed, paper in press

In recent years, there has been an increase in the proportion of elderly people admitted to hospital in the year before their death. The ramifications of these trends are huge from a health economics perspective. Furthermore, we know that our hospital bed numbers are shrinking steadily. The significant trends of increase hospitalisation in the elder near their end-of-life will no doubt put further pressure on the already strained situation in hospitals.

In Bankstown local government area, we have a rich ethnic and cultural diversity. We are interested in the utilisation of beds for the elderly of this ethically and culturally diverse group of people in their last-year-of-life. We are also interested in the documentation and follow through of “medical care plans” and “not for resuscitation orders” in such diverse group of people in our hospital.

Epidemiology Study of Parkinson’s Disease

Team members: Roger Li, Junguang Liu, Margaret Karr
Status: In progress
Granting body: SWSAHS

Parkinson's disease (PD) is a disorder of the central nervous system. PD may appear at any age, but it is uncommon in people younger than 30, and the risk of developing it increases with age. It occurs in all parts of the world. PD may result from a combination of genetic and environmental factors. Certain drugs, diseases and toxins also may cause symptoms similar to those of Parkinson's disease.

The major aims of this project are to identify environmental risk factors for Parkinson’s disease as well as to determine the prevalence of Parkinson’s disease and other causes of Parkinsonism amongst older people in a community within Australia.

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Hip Protector Study

Team members: Gillian Brown, Felicity Bagnall, Lorraine Pike, Terry Choy, Daniel Chan, Margaret Karr
Status: In progress

Hip fracture after a fall has been recognised as a significant problem in the elderly population. The risk of hip fracture can be reduced by a larger body mass index. However compliance rate for wearing a protector is very low. Discomfort and inconvenient are the two major reasons for non-compliance.

The aims of this study are:

1. To design a new hip protect 
2. To examine the effectiveness of the newly designed hip protector in providing protection against fracture

Medication Communication and Education

Team members: Kevin Johnstone, Dale Duvall, Rosaline Khan, Qing Shen, Margaret Karr
Status: Stage 1 completed.
Granting body: Australian council of Safety and Quality in health care, SIIPS I

With an ageing population, drug related problems in the elderly are also increasing. This is partly due to polypharmacy and partly due to lack of patients’ understanding or knowledge of their medication. One way to reduce the incidence of drug related problem in the elderly is to provide patients with a good understand of their medication. 

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NAT-2 Polymorphism and Parkinson’s disease in Hong Kong Chinese

Collaborators: Prince of Wale Hospital
Team members: Daniel Chan, Mary Lam, Ross Wong (POWH), Wai Tak Hung (UTS), David WiIcken (UNSW)
Status: Research completed, paper submitted
Granting body: Donation

The slow acetylator genotype for N-acetyltransferase 2 (NAT2 genotype) may be associated with Parkinson’s disease (PD) amongst Caucasians and the genotype is common in both Caucasian and Chinese populations. The aim of this study is to investigate the association between the slow acetylator genotype for N-acetyltransferase 2 and Parkinson’s disease (PD) in a Chinese population.

Stroke in the Elderly – The Impact of Ethnicity on Stroke Risk Factors and Functional Outcomes

Team members: Dennis Cordato, Daniel Chan, Qing Shen
Status: In progress

Stroke is the leading neurological disorder causing death or disability among adults. It is also the most common neurological reason for hospitalisation. Risk factors for stroke include hypertension, diabetes mellitus, smoking, hyperlipidemia and age. The majority of the stroke studies have reported the incidence of stroke risk factors, subtypes and functional outcomes for all stroke patients. Until recently, elderly subjects aged > 65 years, have been largely ignored as an independent group. Bankstown-Lidcombe Hospital has a unique opportunity to study stroke risk factors and functional outcome in elderly subjects (age ≥ 65 years) due to its existing and functional stroke units and the diverse, multicultural nature of its community referral base.

The aims of this study are: 

1. To analyse stroke risk factors and functional outcome
2. To determine the beneficial effects of our stroke unit care model on stroke outcomes 

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Comparison of stroke risk factors and outcomes between Australian and Mainland Chinese patients

Status: In progress

A collaboration study with a number of hospitals in Sydney metropolitan area hospitals and Shanghai No.1 People’s hospital.

Neuromelanin Assays for Diagnosing PD

Collaborators: Prince of Wales Medical Research Institute

Parkin Gene and Parkinson’s Disease

Collaborators: DKY Chan chief investigator with Chinese University of Hong Kong and Garvan Institution

Water Exercise and Stability in the Elderly

Collaborators: Dr Steve Lord of Prince of Wales Medical Research Institute

A controlled trial was conducted to determine whether a 22-week program of water exercise could improve physical functioning in older people. Eight-five subjects participating in a water activity program (mean age 71.8 years, SD=8.8) and 44 control subjects (mean age 76.5 years, SD=7.2) recruited from retirement villages took part in the trial.

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Allied Health Discipline Specific Information

Orthoptics
The Orthoptist's role in this Division is to:
Advise the multidisciplinary team of the level of all visual components 
Add to the diagnosis
Advise strategies to help patient to cope 
Advise on compensatory mechanisms already being used by patients
Refer ocular pathology
Orthoptic intervention
Counsel patients & relatives-current & pre-existing conditions
Education role
A part time service is provided. Every patient admitted to the Stroke Unit with a diagnosis of Stroke / TIA is assessed. From other wards by referral.

Occupational Therapy
The occupational therapists role in the aged care and rehabilitation setting is to assess individual’s previous and current abilities to complete activities of daily living and to assist in their safe discharge from hospital.

Interventions by occupational therapists may include:

• Self care assessment, cognitive and perceptual assessment;
• Retraining individuals to independently complete activities such as showering, dressing, toileting, feeding and domestic tasks such as cooking;
• Home visits to assess an individual’s safety and independence within their home environment.
• Home modifications eg. installation of grab rails, bathroom modifications, ramps;
• Prescription of adaptive equipment to enhance independence eg. wheelchair, raised toilet seats, shower chair etc;
• Education and advice for clients and carers regarding managing daily tasks safely eg. manual handling, energy conservation, falls prevention;
• Liaises with the multidisciplinary team regarding client’s needs eg. community services.

Speech Pathology
Speech Pathology services are provided to adult in-patients as well as an outpatient adult service for people less than 65 years. A speech pathologist on the Aged Care Assessment Team also provides adult outpatient and domiciliary services for people over the age of 65 years with communication or swallowing difficulties.

Speech pathologists are typically involved in the assessment and management of:

• Communication difficulties resulting from a stroke, dementia, progressive neurological disorders (e.g. Parkinson’s Disease, Huntington’s Disease) and cognitive deficits. Examples include: difficulty with understanding or expression, slurred or unclear speech, pragmatics and social skills.
• Swallowing impairments (e.g. choking, recurrent chest infections from aspiration, dehydration and malnutrition).
• Voice Disorders
• Communication and swallowing disorders in patients with a tracheostomy or laryngectomy

Speech Pathologists provide patient/family education and support to assist individuals and families to manage and overcome their difficulties, and to promote independence, participation and self-fulfilment.

Education of doctors, nursing staff, other professionals and the community is an important part of the Speech Pathologist’s role, together with consultation, education and health promotion activities.

Nutrition & Dietetics
The dietitian is available to all patients on referral. Inpatients may be referred for issues such as malnutrition, poor oral intake on texture modified diets, poorly controlled diabetes, high cholesterol, renal disease etc. The dietitian individually assesses patients and may provide a modified diet (such as high energy/high protein) for inpatients and will give any necessary advice and counselling regarding diet changes for home. The dietitian works closely with the speech pathologist with patients on modified texture/thick fluid diets. The dietitian also has an integral role to play in establishing appropriate regimes for patients requiring tube feeds.

The Nutrition Department also runs several outpatient clinics during the week, which are open to the community on referral. The Nutrition Support Clinic is set aside for malnourished patients and hospital staff may refer any appropriate patients by contacting Allied Health Reception.

Physiotherapy

Social Work

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Rehabilitation

Inpatient services are located on Ward 2A. Outpatient Medical & Allied Health services are also available

Unit Philosophy
To promote the physical, psychological, emotional, spiritual and social well being of our clients, their relatives and significant others, by observing the highest standards of professional and personal ethics and skilfully and conscientiously practising procedures and techniques.

Goals

• To develop and maintain an environment providing optimal care of the client
• To promote personal and professional development of the staff working in the unit

Functions
Rehabilitation service aims to assist patients to achieve the highest possible level of independence physically, psychologically, socially and economically after loss of function or ability due to disease or injury. This is achieved through a combined and coordinated use of medical, nursing and allied health professional skills. It involves individual assessment, participation of family, discharge planning, continuity of care in the community and follow-up for review.

Development
The Rehabilitation Unit was established in January 1986, which currently has 20 beds. The average length of stay varies. The amputee patients require a more involved program and their length of stay could be up to sixty days or more.

Aims

• To provide a full and comprehensive rehabilitation service for patients with mobility problems resulting from: amputation, arthritis, trauma (fractures) and acute illness complicated by impaired mobility
• To provide both undergraduate and transitional support program training for medical nursing personnel, occupational therapy and physiotherapy students
• To undertake research and participate in continuous quality assurance program

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Stroke Unit

Inpatient services are located on Ward 2B. Outpatient Medical & Allied Health services are also available

Unit Philosophy
The Unit promotes the continuity of care between acute, rehabilitation and community care.

The Unit works in partnership with other hospital and community staff, agencies and organisations to provide a coordinated network of care, which meets the needs of the patient and their families/carers.

Staff within the unit work together as members of an interdisciplinary team, and develop high standards of clinical expertise in the management of stroke through education, training, and research.

Patients and their families /carers are considered as part of the team, and are kept informed and are consulted with respect to treatment and management plans.

Patients and their families /carers are provided with the necessary information, education and training to enable them to achieve optimal health and quality of life within their own environment.

Discharge planning is a shared responsibility between the patient, their families/carers and every member of the health care team. Discharge planning commences on the day of admission, and attempts to meet the needs of the patient on discharge from hospital.

The Unit continually improves its services through a quality management approach, and utilises various measurement tools and data collection to evaluate the standards and quality of care provided.

Stroke Rehabilitation commences on the day of admission and involves a continuum of care from the acute to post-discharge stage.

The Unit utilises the available human physical and financial resources in an effective and cost-efficient manner to deliver high quality services which aims to meet the needs of the patients and their families/carers.

The Unit continually strives to incorporate latest techniques and evidence based practice into operational procedures and treatment regimens.

The Unit actively undertakes teaching and research activities; provides educational and research opportunities for staff, undergraduate and postgraduate students; and develops and maintains kinks with academic institutions

Mission

• The nursing service at Ward 2B aims to provide safe, comprehensive, economic, need-based and client-focussed care in order to maintain an optimal quality of life for Stroke-affected people of the Bankstown Local Government area.
• With a twenty-bed capacity, the Nursing service takes an holistic approach to the provision of acute care and rehabilitation of people affected by Stroke. Clients are treated, additionally, for other ongoing medical problems
• An important function of the Nursing service is to initiate and facilitate the maintenance of regular, ongoing assessments by the whole Stroke Team. Such assessment is directed towards

1. Ensuring that the maximum possible number of Stroke-affected people can benefit from access to the service
2. Assuring that each Stroke-affected person is given every opportunity to survive their Stroke
3. Reducing patients’ length of stay whilst,
4. Striving for the best possible outcome in term of function and discharge destination.

When Stroke-affected people start to recover, the priority of nurses moves gradually away from life-saving acute care towards rehabilitation. The main aim of rehabilitation is for each person to become as independent as possible in every way. As the emphasis moves towards assisting people to help themselves and resuming a normal lifestyle, education and support become the main roles.

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Acute Geriatrics

Inpatient services are located on Ward 2C. Outpatient Medical & Allied Health Services are also available

Ward 2C is an Acute Medical Aged Care Unit. It consists of 20 medical beds. Most of our clients admitted to this Unit are aged over 65. The care we provided is life-centred and multidimensional.

Unit Vision
To provide the best care to all of our clients, relatives and significant others.

Goals

• Promote well-being of our clients, relatives and significant others.
• Provide a comprehensive in-patient care, assessment and discharge planning for the aged people in a multidisciplinary team environment.
• Ensure continuity of care for all our clients from hospital to community.

Functions

• To decide what is the best treatment for our clients.
• Cross referrals among the Allied Health Professionals.
• General assessment of the ability of the client by the multi-disciplinary team.
• To ensure adequate community service support for our clients after discharge.
• Facilitate the process of Hostel or Nursing Home placement if needed.

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Aged Care Psychiatry

Aged Care Psychiatry has four components. These components are:

Ward 2C is an Acute Medical Aged Care Unit. It consists of 20 medical beds. Most of our clients admitted to this Unit are aged over 65. The care we provided is life-centred and multidimensional. 

1. Inpatient Service - Ward 2D is a 20-bed unit with 12 Aged Care Psychiatry (ACP) beds and 8 medical swing beds. The 12 ACP beds are designed specifically to accommodate cognitively impaired elderly and or frail patients who require intervention for their behaviour or who require psychiatric assessment and management in general. This unit is also suitable for managing on a voluntary basis; frail and or elderly people who have a psychiatric disorder but are not cognitively impaired. As the unit is not gazetted, patients cannot be referred in under the Mental Health Act involuntarily.
2. Aged Care Psychiatry Consultation Liaison Service
3. Outpatient Service
4. Community Team Outreach Service

Neuropsychology

Neuropsychology services are provided for both inpatients and outpatients of the hospital. A specific outpatient service is also provided for Aged Care Psychiatry Outpatients as well as a limited outpatient's clinic. All referrals are negotiated directly with the neuropsychologist and patients must have a written request for consultation including relevant background information.

Service Description
Neuropsychology is a service tailored specifically for persons with or suspected of having acquired brain damage. The major patient groups currently serviced are aged care psychiatry, geriatric medical-surgical, neurology and stroke rehabilitation.

Outpatient Referral Criteria
Adult residents of Bankstown local government area who require neuropsychological assessment. Referrals are processed and placed on a waiting list for the neuropsychologist to contact the patients and arrange appointments when available.

Services Provided
The main role of the Neuropsychology service is to provide assessments of patients who have, or are suspected of having brain impairments. These are required to provide information about:

• the presence and type of disease
• the extent of disease and associated cognitive impairment
• the pattern of recovery (or decline)

The information is used for:

• establishing a diagnosis as well as prognosis
• determining goals for rehabilitation
• discharge planning
• planning appropriate management within the community

Phone: (02) 9722 7260

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Bankstown Aged Care Assessment Team

The Aged Care Service is located at Bankstown Hospital in the Aged Care/Allied Health Building.

Telephone: 9722 7300 for referrals and enquires
Weekdays: 8.30 am – 5 pm

We assist and support General Practitioners, other primary care providers and carers in looking after frail and disabled aged people.

Anyone can contact us for information and assistance. Referrals can be made by ringing the Intake Officer on 9722 7300.

The services we provide include:

• Assessment of clients in their homes by health professionals
• Organisation of community support services
• Rehabilitation – this may be at the hospital, in the home, or in a residential facility. It can include Physiotherapy, Occupational Therapy, Speech Pathology or Social Work
• Podiatry is available to pensioners who are unable to attend to their own foot care, and who have special foot ailments
• Assistance with continence problems – our Clinical Nurse Consultant can assess, advise and organise management of problems
• Equipment Loan Pool – provides short term loan of equipment to people living at home
• Our Occupational Therapists will assess and arrange forsupply of equipment and home modifications
• PADP (Program of Appliances for Disabled People) provides long term supply of equipment (eg wheelchairs, oxygen etc) to pensioners, low income people and war veterans
• Frail Aged Day Care (English, Arabic, Greek, Chinese, Vietnamese, Italian, Polish and Communities of the former Yugoslavia). These are social activity programs for frail and disabled aged who are socially isolated
• Information about Nursing Homes and Hostels is available. Appropriate assessment and placement can be organised
• Respite care can be arranged for aged and disabled people
• Carer support is available through support groups and counselling
• The Aged Care Service has a Health Promotion Officer who supports staff and the community to improve the health of the Aged in Bankstown.
• Community Neuro psych (Kay Kan)

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2001 Annual Report of the Division of Aged Care and Rehabilitation

STAFF ISSUES

The most significant human resource issue facing the Division in 2001 was the shortage of registered nurses to work on the wards. Quite often vacancies were filled with casual and vacancy staff.

2 Bankstown Health Service RNs have undertaken Rehabilitation programs within Aged Care to develop new skills and career paths.

CLINICAL ACTIVITY DATA

Aged Care Assessment Team
The average number of referrals to Aged Care have increased from 175 per month July 2000 to June 2001 to 195 July to December 2001. This represents an increase of 11.5%.
Ward Length of Stay

2A Rehabilitation	2B Stroke Unit
2C Aged Medical	2D Psychogeriatrics

*The major factor impacting on length of stay in the Aged Care and Rehabilitation wards is the general shortage of nursing home beds. 

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HACC Enhancements

Mobility Group
Notification A successful submission to Department of Veterans Affairs gave us a grant of $32,000 to establish an outdoor mobility retraining area and employ a therapist 8 hours a week for 12 months to target Veterans in the mobility group. The project was completed in October 2001. The outdoor mobility area services both inpatients and outpatients. 4 Mobility Groups were held in 2001 with 20% Veterans attending.

Seniors Week
The Annual Seniors Week Seminar a joint Aged Care and Bankstown City Council project, was held at Bankstown RSL, this year attracting 260 senior residents of Bankstown. The program included presentations on health matters, education, health promotion, information stalls and entertainment. 130 evaluations were completed with positive comments.

International Year of Volunteers
Department of Family Services granted $ 1400 to Aged Care to thank Day Care Volunteers for their support. 20 volunteers were taken to Centrepoint Tower Restaurant and presented with plaques.

Carer Support
The Carer Respite Centre functions as an integral part of the Aged Care Service. Providing Carer Support and flexible respite to Aged and Disabled people in Bankstown.

Carer Respite Centre and NHHILS staff secured funding from Coolabooroo Neighbourhood Centre to take carers on an excursion and lunch.

A new group titled the LAP group (Life After Placement Carer Support group) was formed and meets monthly in different Nursing Homes.

A new Carer Support Group has also been developed.

Gentle Exercise in Residential Aged Care Facilities
Funding was received from SWSAHS Health Promotion Unit for us to train Diversional Therapists and Recreational Officer in Residential Aged Care Facilities. 17 facilities participated and 12 continue to run gentle exercise programs.

Older Men’s Group
The Aged Care Service worked with Chester Hill Neighbourhood Centre to apply for a Bankstown Council Community grant to develop a group for older men in the Community. A grant of $4,400 was received and a 20-week program “Just for Older Men” was established. The 20-week program included education, health promotion, and social activities. It is proposed that the group will continue with a core group of men.

Nursing Home / Hostel Information Kit
The Nursing Home Hostel Information and Liaison Service developed a kit containing information about placement in Aged Care Faculties. The kit is available to Aged Care staff, other health professionals and community members.

Day Care
Frail Aged Day Care programs are operated 5 days per week from 3 Senior Citizens Centre under the coordination of our Diversional Therapist. The highlight of this year for 21 clients was a 3-day holiday to the Central Coast. Day Care programs provide service to 114 clients.

POLICIES/GUIDELINES

• Guidelines for treating dysphagic patients are being developed
• Our division has contributed to the PEG feeding tube guidelines.
• Implementation of intern discharge summaries education and review project

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TEACHING ACTIVITIES
Medical
The Division has been quite actively involved in post-graduate teaching of medical registrars in the past year. This has resulted in a registrar successfully passing RACP Viva exam.

The Division is also involved in undergraduate medical teaching. 4th, 5th and 6th Year students participate in the program. The teaching program will be expanded this year to include 3rd Year students.

There is also an active teaching program for junior medical staff. Sessions occur biweekly on a regular basis. The objectives of the sessions are to educate and train junior staff about topics in Aged Care, as well as to enhance their skills in the area of evidenced based medicine by developing their understanding and evaluation of studies published in journals.

Nursing
The Division has participated in the education of nursing personnel at various stages of their training. There have clinical placements of students from various universities including Charles Sturt and Western Sydney. There have also been new graduates participating in the Transitional Support Program and trainee enrolled nurses gaining skills in specialty clinical placements.

ACAT CNSs Aged Care has also presented sessions to enrolled Nurses in the Refresher course.

Allied Health
University graduates from a variety of professions have spent time in the various aged care and rehabilitation wards, including ACAT.

Work experience
The division has participated in the work experience programs of various schools and TAFE.

Community workshops and seminars

NHHILS organised 4 workshops on “Depression in Older People” for Community Aged Care Package staff. There were 71 participants. It is proposed to run more workshops on depression and related disorders.

ACAT Staff have participated in working parties and forums to assist in the development of services within the Health Service and the Community. These have included the Mental Health for Aged Review, Medical Rehabilitation Consultation, and Health Promotion Consultation. Collaboration with other organisations to develop protocols and an assessment tool for Comprehensive Assessment for complex care clients occurred over 12 months. The process has been arduous but should achieve good outcomes for clients. From this process the Bankstown Sector Community Liaison meetings have reconvened.

Presentations by Aged Care have included:

• Information sessions on Aged Care to Salvation Army;
• War Widows;
• Carers of People with Dementia;
• Centrelink Seniors Week Seminary;
• Legacy 100;
• Safety in the Home and Falls Prevention to 30 Home Care field workers and 30 clients;
• “Staying on your Feet” to Older Women Wellness Centre;
• “Nutrition and Exercise” St Luke’s Social Club;
• “Stroke and Swallowing” and Role of Speech Pathologist from EDC groups and Yagoona N/H

QUARTERLY SEMINARS
Planning has commenced for a seminar titled “Stroke-Our Unique Approach”. This will be the first of 4 multidisciplinary seminars planned for the year. Seminar topics include “History of the Stroke Unit”, “Features of Intervention”, “and Nursing in Stroke Management “, “After Discharge” and “Outcomes of Management”.

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ORGANISATIONAL VISITS

• Dr Yan Ang who was on a Singaporean Government scholarship was attached to our Stroke Unit for six months. The relationship was mutually beneficial. Dr Yan Ang reported that she found her visit most helpful and informative, while the Division gained some valuable assistance with research and evaluation of the Stroke Unit.
• Furthermore we have a visiting fellow Dr Liu Junguang from China, who is also currently assisting with research under the supervision of Professor Chan.
• The Division has also developed some valuable international links with health ministries in Asia. This has resulted in multiple visits from various countries in Asia which include two delegations from the Ministry of Health in China, two delegations from Shanghai Health Bureau, one delegation from Health Ministry in Korea and one delegation from Health Ministry in Malaysia. Multiple individual visits have occurred, and these have included Professor Wang from Shanghai, Professor Yu from Beijing, one Malaysian doctor studying Masters Degree in Geriatrics and two Indian doctors studying their Masters Degree in Geriatrics.
• At a local level we have hosted a visit from Dr Charles Pain, Director of Medical Services in SWSAHS. The staff members of the psychogeriatric ward were also hosts to visitors from the John Hunter Hospital, which included the Director of Clinical Service and her team. These guests were interested in learning about the structure of the unit and the services provided.

Publications, Conferrence Presentations, Lectures and Seminars

a) Referred Journals

1. Chan DKY. Parkinson’s disease and its differentials: diagnoses made easy. Australian Family Physician 2001; 30(11): 1053-1056
2. Chong R, Evans L, Chan DKY. Dementia of Lewy Body Disease—literature review and illustrated case report. Australian Journal on Ageing 2001; 20: 96-99
3. Chan DKY, Hung WT, Wong A, et al. Validating a screening questionnaire for Parkinsonism in Australia. Focus on Parkinson’s disease 2001; 13:15-17
4. Chan DKY, Dunne M, Wong A, et al. Pilot Study of Prevalence of Parkinson’s disease in Australia. Neuroepidemiology 2001; 20:112-117 
5. Chan DKY, Mellick GD, Hung WT, Ng PW, Woo J, Kay R. Lack of association between CYP1A1 polymorphism and Parkinson’s disease in a Chinese population. Journal of Neural Transmission - General Section 2002; 109: 35-39
6. Low JA, Chan DKY. Air Travel in Older people. Age and Ageing 2002;31:17-22
7. Ong E, Chan D. Samonella infection in an elderly patient. Journal of Hong Kong Geriactrics Society 2002;11:42-44
8. Chan Daniel KY, Chong R, Basilikas J, Mathie M, Hung WT. Survey of major chronic illnesses and hospital admissions via the emergency department in a randomized older population in Randwick, Australia. Emergency Medicine 2002; 14:387-392
9. Chan Daniel Kam Yin. A New Hypothesis (Concept) of Diagnosing Alzheimer’s disease. Journal of Gerontology: Medical Sciences series 2002;57:M645-647
10. Wang Shaoshi, Chan Daniel Kam Yin, Gilles David. Advantages of comprehensive therapy (stroke unit) for acute stroke. Chung-Hua Nei Ko Tsa Chih Chinese Journal of Medicine 2002;11:721-722
11. Chan DKY, Mellick GD, Hung WT, Woo J. Genetic and environmental risk factors and their interactions for Parkinson’s disease in a Chinese population. Journal of Clinical Neuroscience 2003; 10:313-315
12. Double KL, Rowe DB, Hayes M, Chan DKY, Blackie J, Corbett A, Joffe R, Fung VS, Morris J, Halliday GM. Identifying the pattern of olfactory deficits in Parkinson’s disease using the brief smell identification test (B-SIT). Archives of Neurology 2003; 60, 545-549
13. James Low, Daniel Kam Yin Chan, Richard Chye. Treatment of Recurrent Aspiration Pneumonia in End-Stage Dementia- Preferences and Choices of a Group of Elderly Nursing Home Residents". The Internal Medicine Journal (in press)
14. DKY Chan, MKP Lam, R Wong, WT Hung, DEL Wilcken. Strong association between N-acetyltransferase 2 genotype and PD in Hong Kong Chinese. Neurology 2003; 60:1002-05
15. Ang, YH; Chan, DKY ; Heng, D; Shen Q. Patient outcomes and length of stay in a stroke unit offering both acute and rehabilitation services. Medical Journal of Australia 2003; 178:333-36

b) Conference Presentations/Posters

1. Australian Society for Cellular & Molecular Gerontology 2001. Chan DKY, Mellick GD, WT Hing, et al. Genetic and Environmental risk factors and their interactions for Parkinson’s disease in a Chinese Population (Poster presentation).
2. Hong Kong Association of Gerontology 2001. Chan D, Yan A. Benefits of a Combined Acute and Rehabilitation Stroke Unit.
3. National Occupational Therapy Conference, Brisbane April 2001. Goodger S, Pearce A. An Evidence-based review of neurological splinting and casting.

c) International lectures

International invitations have been received by Professor Daniel Chan to give lectures overseas. These include invitations from the Shanghai Health Bureau to lecture in Shanghai, and Capital University of Beijing and the Ministry of Health of China, to lecture in Beijing.

d) Workshops and Seminars

NHHILS organised 4 workshops on “Depression in Older People” for Community Aged Care Package staff. There were 71 participants. It is proposed to run more workshops on depression and related disorders.

ACAT Staff have participated in working parties and forums to assist in the development of services within the Health Service and the Community. These have included the Mental Health for Aged Review, Medical Rehabilitation Consultation, Health Promotion Consultation. Collaboration with other organisations to develop protocols and an assessment tool for Comprehensive Assessment for complex care clients occurred over 12 months. The process has been arduous but should achieve good outcomes for clients. From this process the Bankstown Sector Community Liaison meetings have reconvened.

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RESEARCH ACTIVITIES
Our division has won two research grants totally $30,000. One grant is from the Health Research Foundation of South Western Sydney and the other from the Australian Council for Safety and Quality in Health Care.

Current research areas include:

• “How to improve Education and Communication of Medication with Elderly Patients”;
• “Care Planning Survey for Patients who have died within last year”;
• “Hip Protector Study”; 
• “Epidemiology Study of Parkinson’s Disease” and;
• “Stroke Unit Outcomes and Performance Evaluation”;
• “Stroke in the elderly, risk factors and their management, and associations with ethnicity”

Professional Development / Activities

A/Prof. Daniel Chan

1. Panel of experts – (Chronic and Complex Care, clinical expert reference group) - NSW Health Department.
2. Member of Health Care in The Community Working Group - NSW Health Department.
3. Member of Stroke Working Party-Greater Metropolitan Transition Taskforce, NSW
4. Member of Stroke Advisory Committee. SWSAHS
5. Member of Asia Pacific Committee, Royal Australian College of Physicians.

Dr Tram Bui

1. Area Stroke Committee
2. NSW Branch AFRM (Secretary)
3. Convenor 2001 AFRM, ASM
4. Committee member for scientific program organisation
5. Member Area PADP Committee
6. Member Bankstown Disability Committee

The other staff specialists have details of their professional development on request.

Nurse Ha Doan has completed the one-year diploma course in Aged Care Psychiatry (distance education) which was funded by the ACPS Research and Education Fund.

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