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Cognitive screening via telehealth is increasingly employed, particularly during the COVID-19 pandemic. Telephone adaptations of existing cognitive screening tests must be validated across diverse populations. The present study sought to evaluate an existing 26-point telephone adaptation of the Mini-Mental State Examination (tMMSE) in a sample of older Aboriginal Australians. Additionally, we aimed to evaluate a telephone adaptation of the urban version of the Kimberley Indigenous Cognitive Assessment short-form (tKICA screen).A sub-sample (n = 20) of participants (aged 55-69 years; 11 women) who had completed an in-person cognitive assessment (MMSE and KICA screen) within the past 6 months as part of the Koori Growing Old Well Study completed telephone-based cognitive testing without an assistant.There was moderate correlation and reasonable agreement between MMSE versions (rResults indicate that telephone administration of the MMSE and/or KICA screen is not equivalent to in-person testing for older Aboriginal people, and further revision and evaluation are required.

Objectives To examine the role of frailty in risk of re-hospitalisation and mortality for aged care residents following a fall injury hospitalisation. Methods Retrospective analysis of linked hospitalisation and aged care data of adults aged ≥65 years residing in aged care. A semi-competing risk analysis examined risk of hospital readmission. Results Residents who had intermediate or high frailty, who were aged 70-79 or 80-89 years, who had 1-2 or ≥3 comorbidities, sustained a hip fracture, and who had either low, moderate or high complex health-care requirements had a higher risk of being readmitted to hospital. Frailty was not associated with mortality for those with no hospital readmission or mortality after readmission. Conclusions Frailty is an important prognostic factor associated with readmission for residents of aged care hospitalised for a fall injury. Frailty screening could assist to identify people at a high risk of re-hospitalisation following a fall injury.

Objective To examine associations between fall risk factors identified previously in other populations and falls among Aboriginal people aged 60 years and older, living in New South Wales, Australia. Methods Interviews were conducted with older Aboriginal people in five urban and regional communities. Associations between past falls and 22 fall predictor variables were examined using linear and multiple regression analyses. Results Of the 336 participants, 80 people (24%) reported at least one fall in the past year, and 34 (10%) reported two or more falls. Participants had an increased fall risk if they were female; used three or more medications; had arthritis, macular degeneration, depression, history of stroke; were unable to do their own housework; or were unable to do their own shopping. Conclusion Falls were experienced by one-quarter of study participants. Fall risk factors identified for older Aboriginal people appear to be similar to those identified in the general population. Understanding of fall risk factors may assist with the development of appropriate and effective community-led fall prevention programs.

Objective To compare trends, causes, and outcomes of fall-related traumatic brain injury (TBI) between community-dwelling (CD) individuals and residential aged care facility (RACF) residents. Methods Hospitalisation and RACF administrative data for 6635 individuals aged ≥65 years admitted to all NSW hospitals for fall-related TBI from 2008–2009 to 2012–2013 were linked. Results Of the 6944 hospitalisations, 20.8% were for RACF residents. Age-standardised hospitalisation rates were almost fourfold higher for RACF residents than CD individuals (standardised rate ratio 3.7; 95% CI 3.4–4.1); but increased at a similar annual rate of 9.2% (95% CI 0.3–19.0) and 7.2% (95% CI 5.6–8.9), respectively. Compared to CD individuals: a higher proportion of falls in RACF residents were furniture-related (21.4% vs 9.9%); resulted in haemorrhage (82.5% vs 73.7%); and death (23.1% vs 14.9%). Overall, 7.7% of hospitalisations for CD individuals resulted in new permanent RACF placement. Conclusion Residential aged care facility residents have higher hospitalisation rates and poorer health outcomes than their CD counterparts.

AIMS To describe the availability of aged care and dementia services in public hospitals in New South Wales (NSW), Australia in 2006/2007. METHOD Hospitals were surveyed about issues relevant to dementia in acute care including the types of aged care wards and staff, policies, practices, clinics, community services and resources for dementia care. RESULTS Responses were obtained from 163 hospitals (82%); responding hospitals represented 93.4% of NSW hospital beds, 96.7% of multiday episodes of care. Hospitals that had a Specialist Mental Health Service for Older People (SMHSOP) and an Aged Care Service (ACS) had the highest levels of dementia-related services and policies. Few hospitals without ACS or SMHSOP had clinics for dementia assessment, secure beds for disturbed behaviour, or services to manage patients with dementia and medical or behavioural comorbidity in the community. CONCLUSION Dementia services in NSW hospitals are closely aligned with ACS and SMHSOP, with limited dementia services in hospitals without ACS or SMHSOP.

About one in five older Australians were born overseas. However, there has been very little information published in Australia or internationally about dementia in persons from culturally and linguistically diverse (CALD) backgrounds. This limits our ability to plan for and provide evidence-based medical care, social care and aged care services to persons from CALD backgrounds. This paper describes challenges to conducting CALD dementia research; these include sampling, having valid instruments and costs. Nine key research recommendations in the areas of epidemiology, community knowledge, carers, service delivery, screening and assessment, medical management, residential aged care and minority CALD reached by consensus by an expert group are presented. The paper closes with some strategies to encourage CALD research. The material presented here will provide guidance for future research endeavours.

Objectives:To evaluate the predictive value of the Aged Care Psychiatry Unit (ACPU) Falls Screen and to describe the outcomes associated with falls in an acute aged care psychiatry unit. Methods:The development of the ACPU Falls Screen for use in an acute aged care psychiatry unit is described. Consecutive admissions to an acute aged care psychiatry unit were assessed prospectively with the ACPU Falls Screen, Health of the Nation Outcomes Scale for older persons (HoNOS 65+) and the Resource Utilisation Groups Activities of Daily Living (RUG ADL) Scale. Details of all falls and their consequences were documented on a falls incident form. Other information, extracted from medical records, included psychiatric and medical diagnoses, psychotropic medication prescription, electroconvulsive therapy (ECT), length of stay and demographic data. Multiple logistic regression was used to examine putative predictors of falls. Results:Ninety-five admissions were included in the sample, of which 28 (29%) had falls. Multiple falls occurred in 16% of admissions. No serious injuries were recorded. Falls were associated with significantly higher scores on the ACPU Falls Screen, behavioural overactivity and recent receipt of ECT. However, falls were not associated with significant differences in psychiatric outcome, although multiple falls were associated with an increased length of stay. Receiver operating characteristic (ROC) curves for the ACPU Falls Screen indicated it had poor predictive value for falls. Conclusions:Falls are common in acute aged care psychiatry units. The ACPU Falls Screen was not a good predictor of falls. Universal precautions should be taken to prevent falls, particularly after ECT and in admissions with behavioural overactivity.

Objective: To determine the outcome of treatments for vocally disruptive behaviour (VDB) in nursing homes provided by psychogeriatric and geriatric outreach services. Method: Nursing home residents referred to six psychogeriatric and geriatric outreach services for treatment of VDB were examined pre- treatment and followed-up for three months by a research nurse. All recommended treatments for VDB and the effects of implementation were recorded. Main outcome measures were the Cornell Scale for Depression in Dementia, the Dementia Behaviour Disturbance Scale and measures of nurse satisfaction. Results: Three-month outcome data was available for 22 residents, of whom four had died. Of the remainder, six (33%) had objective improvement in VDB. The nursing home staff rated the outreach teams as at least ‘somewhat’ helpful in 61% of cases surviving three months and was particularly satisfied with medication advice. No specific treatment appeared to be more effective. Conclusions: Reduction in VDB obtained through interventions by psychogeriatric and geriatric outreach teams was modest, but nursing home staff found most of the teams to be helpful. Aged care outreach services should provide support to nursing home staff in the management of challenging behaviours.

To describe the availability of aged care and dementia services in public hospitals in New South Wales (NSW), Australia in 2006/2007.Hospitals were surveyed about issues relevant to dementia in acute care including the types of aged care wards and staff, policies, practices, clinics, community services and resources for dementia care.Responses were obtained from 163 hospitals (82%); responding hospitals represented 93.4% of NSW hospital beds, 96.7% of multiday episodes of care. Hospitals that had a Specialist Mental Health Service for Older People (SMHSOP) and an Aged Care Service (ACS) had the highest levels of dementia-related services and policies. Few hospitals without ACS or SMHSOP had clinics for dementia assessment, secure beds for disturbed behaviour, or services to manage patients with dementia and medical or behavioural comorbidity in the community.Dementia services in NSW hospitals are closely aligned with ACS and SMHSOP, with limited dementia services in hospitals without ACS or SMHSOP.

Objectives: To quantify the physical health of admissions to an acute psychogeriatric unit (PGU) and to determine whether measures of physical health predict psychiatric outcome at discharge and mortality at 12 months. Method: Prospective audit of PGU admissions over 12 months using the Physical Health Schema (PHS) to quantify physical health. Results: There were 88 admissions categorised into four principal psychiatric diagnostic groups: major depression (46), dementia (20), delirium (7) and ‘;other’ diagnoses (15). The mean number of organ systems affected by physical illness was 3.9 per admission (sd 1.5, range 1–8), which did not differ between psychiatric diagnostic groups. On the PHS, neurological disorders were the most severe and disabling conditions, with gastrointestinal and musculoskeletal disorders the other main acute conditions, and cardiovascular and sensory disorders the other main chronic conditions. Ratings of global outcome as recovered/improved were associated with significantly fewer chronic organ systems affected by physical illness than unchanged/worse outcomes (Model x2= 8.01, df = 1, P = 0.005) and ADL score (Model x2= 6.33, df = 1, P = 0.012). Mortality 12 months after discharge was predicted by PHS acute illness scores (Model x2= 7.94, df = 1, P < 0.005) and ADL score (Model x2= 6.43, df = 1, P < 0.05). Conclusion: Acute PGUs are best co-located near geriatric medical wards in general hospitals due to high rates of physical illness.

Objective: To describe nursing home referrals to a multidisciplinary psychogeriatric outreach service. Methods: Retrospective case note audit of all nursing home referrals to a psychogeriatric outreach service in Sydney during 1996. Results: Of 106 referrals (mean age 76.9 years) from 22 nursing homes, 101 (95%) were assessed in the home. Behavioural problems were identified in 87 referrals (82%), usually being associated with chronic organic brain syndromes including dementia (n = 75, 86%). Aggressive behaviours (45%), agitation (32%), uncooperativeness (17%) and vocally disruptive behaviour (16%) were the most frequently identified problems. Depression was diagnosed in 33 referrals (31%), often comorbid with dementia (n = 16). Multiple diagnoses were present in 58 (55%) referrals. The most frequent treatment recommendations related to the use of nursing interventions (73%), psychotropic medication (70%), behavioural programs (29%) and family involvement (29%). Admission to the acute psychogeriatric ward occurred in 18 cases (17%). Conclusion: Psychogeriatric services should provide adequately staffed outreach teams to nursing homes.