This study reviews the 'real world' potential (i.e. efficacy and effectiveness) of restorative approaches towards home care for frail older adults. Such approaches aim to go beyond traditional home care goals of 'maintenance' and 'support' towards improvements in functional status and quality of life. Our review of the literature included searches of health and gerontology databases as well as 'grey literature' across Australia, the UK and the USA. We provide an initial overview of the efficacy of a range of single component restorative interventions, including occupational therapy, physical therapy, health education and social rehabilitation. In order to answer questions about the overall efficacy and cost-effectiveness of restorative home care provision, we also review the nature of in-house programmes across the three nations as well as the evidence base for such programmes, particularly when they have been compared to home care 'as usual'. A range of positive outcomes has emerged, including improved quality of life and functional status and reduced costs associated with a reduction in the ongoing use of home care services postintervention. Questions remain about which components are most beneficial, which clients are likely to receive the greatest benefit, and the appropriate intensity and duration of such interventions.

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Data from an applied research project on ageism among health professionals were used to examine nurses' attitudes toward aging and working with older adults. Nurses were compared with groups of other health professionals, and sources of variation within the nurses (e.g., employer, work setting, gerontology education) were examined. Nurses had less accurate knowledge of aging than other health professionals. Nurses expressed higher anxiety about aging and were more likely to believe working with older adults was associated with low esteem in the profession. Nurses were more likely to hold positive attitudes if they worked for a service provider rather than an employment agency, had gerontology education, and worked outside the residential care sector. Improving education in gerontology is an important strategy in improving the attitudes of the profession toward older adults and could help to address nursing shortages in this sector.

This study examined the employment achievements of 219 spinal cord injured people and attempted to identify predictors which, individually and in combination, (a) discriminated between those who were in the labour force or not, and (b) correlated with the amount of time in employment post injury. Results indicated that at the time of the survey 26% were in fulltime work, 11% were in part-time work, 4% were unemployed and 59% were not actively seeking work. Multivariate analyses identi®ed three variables (impairment type, study since injury, level of pre-injury secondary schooling) which were related to both labour force participation and the amount of work undertaken post-injury. These results are discussed with reference to post-injury services that could be oered to spinal cord injured people who wish to return to work or gain employment.

The majority of people with severe traumatic brain injury (TBI) experience long-term disability and are unable to return to their usual activities. Services that offer community social and leisure participation programs are likely to reduce the social burden associated with severe TBI. The aim of this study was to gain an understanding of the personal effects of becoming engaged in community leisure activities. It was hypothesised that adults with severe TBI who participated regularly in leisure activities over a 6-month period would show measurable positive change in the domains of community integration, social support, mental health and quality of life (QOL). Participants numbered 25 adults (mean age 36.95 years) who had been referred to community leisure programs participated in the study. All participants had sustained severe injuries (post-traumatic amnesia > 1 month). A repeated measures design over 6 months was used. Assessment involved a semistructured interview, global subjective QOL rating and administration of standardised measures: SF-12v2, Neurobehavioral Functioning Inventory, Instrumental-Expressive Social Support-Scale, and Community Integration Questionnaire. Adults who participated regularly over 6 months reported positive and statistically significant changes in social integration and mental health. These findings support the use of assisted community participation programs for adults with severe TBI.