Professor Mark Hughes

Background: There is a growing recognition of the need for collaborative partnerships between carers and healthcare professionals to ensure the delivery of safe and equitable healthcare for older persons. Involving and empowering carers to participate in healthcare decisions is beneficial for patients at risk of delirium, as carers are well placed to notice small behavioural changes that indicate delirium. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT) to prevent and manage delirium in the acute hospital setting was co-designed to support these care partnerships.
Aim: To explore carers' experience of PREDICT to support partnerships with healthcare professionals in the prevention and management of delirium
Method: A qualitative study grounded in empowerment theory explored carers' experience of PREDICT to support care partnerships in the prevention and management of delirium. Carers of older people at risk of delirium on a general medical ward in a regional hospital were exposed to PREDICT. Semi structured interviews were conducted with these carers following discharge. Reflective inductive thematic analysis was used to identify and analyse key themes from the data.
Results: Two key themes were identified: 'Carers Well Placed' and 'They Weren't Quite Themselves', and two sub themes: 'Feeling Unsupported' and 'Fear, Loss and Grief '.
Conclusions: PREDICT supports carers to better understand delirium and strengthens opportunities for partnership with nurses in its prevention and management. Approaches that prioritise education, engagement, empowerment, emotional support and empathy may enhance nurse-carer collaboration and contribute to more person-centred delirium care in acute hospital settings.

LGBTIQ+ people continue to experience barriers to accessing palliative care and poor palliative care outcomes, including fear ofdiscrimination, risk of abuse and neglect, and having their end-of-life wishes unmet. While co-design is increasingly being used toaddress the needs of minoritized communities, little is known about the processes of co-designing programs to improve palliativecare with LGBTIQ+ communities. This research evaluated a co-design process used to develop an eLearning intervention toimprove Australian palliative care providers’ awareness of the issues and needs of LGBTIQ+ people. Semistructured qualitativeinterviews (n = 11) were conducted with co-design team members (n = 8), which explored their expectations and experiences of theprocess over 10 months from 2022 to 2023. Co-designers were diverse people with a range of lived and professional experiences inpalliative care–related roles. Thematic analysis identifed three themes: co-designers shared common goals, the facilitation processenabled the participation of LGBTIQþ participants, and the substantial work required outside of co-design meetings to completethe intervention design. The study highlighted conditions that constrain co-design processes and the importance of specialistfacilitation and organizational support to manage these conditions within tight time and funding limitations. Limitations to co-design best practice can be mitigated by transparent and accountable communication with efective and supportive facilitation.

Introduction: Despite recent reforms, social exclusion and discrimination continue to impact sexually and gender diverse (SGD) Australians. Of concern is the greater loneliness reported among SGD people, particularly transgender and nonbinary people. Age is a factor related to loneliness that is much debated with further research needed to understand the extent to which it predicts loneliness among this population.
Methods: We analysed Australian data (n = 271) from the Global Pride Survey, administered in 2022, to understand age-based loneliness patterns among groups of SGD people. Drawing on the Health Equity Promotion Model, we examined the extent to which indicators of social positions, environmental context and individual- and social-level health risk and health pathways predicted loneliness.
Results: Through regression analysis, we identified that sexual diversity, gender diversity and being transgender did not appear as predictors of loneliness. However, being younger or middle-aged did emerge as a predictor of a higher level of loneliness, as did less social support, lower resilience and more frequent functional limitations.
Conclusions: While younger and middle-aged SGD people might be expected to be faring better than older people, in this study we identified that the older cohort reported less loneliness.
Policy Implications: SGD people continue to face the consequences of social exclusion and discrimination despite equality reforms. Social policy should ensure that loneliness programs are accessible to SGD people and that targeted programs are developing, including those that enhance intergenerational connections.

Background: Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
Aims: To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
Method: A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
Discussion: PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
Public and Patient Involvement: This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Trial Registration: Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025.

Gay men collectively participate in fewer sports than heterosexual men. An understanding of older gay men’s early sport experiences may pro-vide insights into what may have contributed to this reduced participation. Nonetheless, there is limited research focussing on older gay men’s experiences with sport. Via semi-structured online interviews, this hermeneutic phenomenological research investigated the early experiences of 21 Australian gay men aged 60 and over. Most participants spoke of homonegative experiences. Themes that emerged from the analysis were: Junior school sport was unpleasant; Sport was violence; My masculinity was denigrated; and I hate sport. Aimed at improving the health of older gay men, this research provides insights about the implementation of sport and physical activity programs. For this population, it is recommended that individual activities are con-ducted within inclusive and supportive environments that are sensitive to those who have had adverse childhood experiences.

COVID-19 exacerbated inequities for Australian LGBTQ+ older adults and impacted their ability to stay engaged in civic activities. This research note examines the extent to which voluntaryactivity changed for Australian LGBTQ+ older adults during COVID-19 and whether community connectedness predicts volunteering both pre-COVID and during COVID-19. We recruited an online sample of Australian LGBTQ+ older adults. 525 participants completed the survey, with 341 participants reporting data on volunteerism and connection to the LGBTQ+ community. The analysis revealed statistically significant differences between time, but not gender and sexuality, nor between gender and sexuality and time. Pairwise comparisons reveal that volunteering was statistically significantly higher pre-COVID than during COVID for these Australian LGBTQ+ older adults. COVID-19 changed volunteerism among older LGBTQ+ Australians. Over a third reported volunteering at least once a week or more prior to COVID. The sample saw an overall reduction of about 10% of volunteering during COVID-19, which is consistent with other national reports of a pandemicrelated reduction in volunteering among older Australians. The findings of this study suggest that, while volunteering plays an important role in the mental health and well-being of LGBTQ+ people, these participants were possibly willing to sacrifice the benefits of staying physically connected to the community to protect their own welfare, which may have implications for the social and political engagement of LGBTQ+ Australians.

Summary: There has been increased attention on the performance of social work researchers and strategies for strengthening the connection between research and practice. However, little is known about the research culture of social work discipline groups within universities and what contributes to a sustainable high-performance culture. Twenty experienced social work researchers from Australian universities were recruited and participated in qualitative interviews. Informed by a critical realist perspective, participants shared what they perceive as influencing social work research culture in university settings.

Findings: Participants reflected on the beliefs, values, and behaviors contributing to a positive research culture in universities and social work discipline groups. Four key themes were developed: research culture is enhanced when there is a cadre of research-qualified staff; collaboration enhances research culture; time for research needs to be protected; and the professional narrative about social work research influences research culture in universities. Precarious employment for research staff, limited focus on research training in social work qualifying degrees and workloads that focus primarily on administration and teaching were seen as inhibitors of research culture.

Applications: Attracting and retaining high-performing social work researchers assist in setting benchmarks for research performance, strengthening the quality and purpose of research training, supporting junior colleagues to navigate research systems, and creating opportunities for collaboration. While multidisciplinary collaborations within a particular field can sometimes detract from a focus on research culture in social work, they can also raise performance expectations and strengthen positioning for competitive grants.

Navigating complex and evolving practice environments requires resilient social workers. However, education's contribution to professional resilience development is underinvestigated. As part of a longitudinal, qualitative study, this article reports the findings on how social workers as students and then newly qualified practitioners perceived how their education fostered professional resilience. In stage one, interviews were conducted with 23 social work students from eight Australian universities in the final 12 months of their Master of Social Work (Qualifying) degree. In stage two, the sample was reduced to 19, with interviews occurring after approximately six months of practice. Framed by critical theory and social constructionism, narrative inquiry guided the analysis of participants’ perceptions. The results revealed professional resilience is relational and developed through curricula and pedagogy facilitating connection, building knowledge through critical reflection, and preparing students for the realities and complexities of practice. The study extends evidence that transitioning from student to practitioner is a crucial time in social workers’ careers. The findings identify that professional resilience can be fostered by responsive external resources and evidence-based programs offered by universities, practice organisations, and professional bodies.

Abstract
While Article 12 of the Convention on the Rights of the Child is often cited to assure children's right to express their views freely in all matters affecting them, little is known about the practices associated with giving due weight to their views in policy-making that impacts their lives. This paper reports on critical-participatory research exploring the practices of more than 100 policy actors, conducted with five young co-researchers with lived experience of Australian child protection and out-of-home care systems. Practices associated with giving due weight included: involving children as policy actors, listening, giving feedback and reporting back, and amplifying their views. Practices were constrained by discourses of authenticity/tokenism; bureaucracy and jurisdiction; the attribution of expertise; and limited funding and time. Research demonstrated opportunities for realising Article 12 through intergenerational dialogue and valuing the lived experience and agency of young people as policy actors.

Background
Delirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium.

Objective
To evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium.

Design
A pre–post-test intervention and observation study.

Main Measures
Changes in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium.

Participants
Participants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older.

Intervention
Nurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden.

Key Results
Participants included 25 carers (43% response rate) (n = 17, 68% female) aged 29–88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p =  < .001; CI 2.07–4.73). Carers’ intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up.

Conclusion
The prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.