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Objective: To investigate symptomatic and preventive medication use according to age and frailty in Australian and Japanese nursing homes (NHs). Methods: Secondary cross-sectional analyses of two prospective cohort studies involving 12 Australian NHs and four Japanese NHs. Frailty was measured using the FRAIL-NH scale (non-frail 0–2; frail 3–6; most-frail 7–14). Regular medications were classified as symptomatic or preventive based on published lists and expert consensus. Descriptive statistics were used to compare the prevalence and ratio of symptomatic to preventive medications. Results: Overall, 550 Australian residents (87.7 ± 7.3 years; 73.3% females) and 333 Japanese residents (86.5 ± 7.0 years; 73.3% females) were included. Australian residents used a higher mean number of medications than Japanese residents (9.8 ± 4.0 vs 7.7 ± 3.7, p < 0.0001). Australian residents used more preventive than symptomatic medications (5.5 ± 2.5 vs 4.3 ± 2.6, p < 0.0001), while Japanese residents used more symptomatic than preventive medications (4.7 ± 2.6 vs 3.0 ± 2.2, p < 0.0001). In Australia, symptomatic medications were more prevalent with increasing frailty (non-frail 3.4 ± 2.6; frail 4.0 ± 2.6; most-frail 4.8 ± 2.6, p < 0.0001) but less prevalent with age (< 80 years 5.0 ± 2.9; 80–89 years 4.4 ± 2.6; ≥ 90 years 3.9 ± 2.5, p = 0.0042); while preventive medications remained similar across age and frailty groups. In Japan, there was no significant difference in the mean number of symptomatic and preventive medications irrespective of age and frailty. Conclusions: The ratio of symptomatic to preventive medications was higher with increasing frailty but lower with age in Australia; whereas in Japan, the ratio remained consistent across age and frailty groups. Preventive medications remained prevalent in most-frail residents in both cohorts, albeit at lower levels in Japan. [ABSTRACT FROM AUTHOR]

Aim: Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre‐ and post‐HCP access to inform hypotheses around the effects of healthcare use and mortality risk. Methods: Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6‐ and 12 month periods post‐HCP access for 16 629 older adults. Results: Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait‐time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post‐receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post‐HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post‐HCP periods compared with in the wait time (AU$7.9, AU$7.1). Conclusions: Increased spending post‐HCP on inpatient care or non‐health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899–905. [ABSTRACT FROM AUTHOR]

Frailty is a biological syndrome that is associated with increased risks of morbidity and mortality. To assess the value of interventions to prevent or manage frailty, all important impacts on costs and outcomes should be estimated. The aim of this study is to describe the development and validation of an individual-based state transition model that predicts the incidence and progression of frailty and frailty-related events over the remaining lifetime of older Australians. An individual-based state transition simulation model comprising integrated sub models that represent the occurrence of seven events (mortality, hip fracture, falls, admission to hospital, delirium, physical disability, and transitioning to residential care) was developed. The initial parameterisation used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The model was then calibrated for an Australian population using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The simulation model established internal validity with respect to predicting outcomes at 24 months for the SHARE population. Calibration was required to predict longer terms outcomes at 48 months in the SHARE and HILDA data. Using probabilistic calibration methods, over 1,000 sampled sets of input parameter met the convergence criteria across six external calibration targets. The developed model provides a tool for predicting frailty and frailty-related events in a representative community dwelling Australian population aged over 65 years and provides the basis for economic evaluation of frailty-focussed interventions. Calibration to outcomes observed over an extended time horizon would improve model validity. [ABSTRACT FROM AUTHOR]

Background: Older Australians are major health service users and early diagnosis is key in the management of their health. Radiological services are an important component of diagnosis and disease management planning in older Australians, but their national utilisation of diagnostic services has never been investigated in Australia.Purpose: This study aims to evaluate the utilisation of major plain X-rays by Australians ≥ 65 years old.Methods: A population-based epidemiological evaluation and yearly cross-sectional analyses of X-ray examinations per 1,000 Australians aged ≥ 65 years old between 2009 and 2019 were conducted using publicly available Medicare Benefits Schedule and Australian Bureau of Statistics data sources. Age and sex specific incidence rate (IR) of plain X-rays per 1,000 Australians, adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a negative binomial regression model.Results: During the study period, the Australian population over 65 years old increased by 39% while the crude plain X-ray utilisation by this population increased by 63%. Most X-rays were conducted on extremities or the chest. Men used chest radiography more than women, and particularly for lungs, where the incidence increased the most in those ≥ 85 years old. There was an increase in X-rays of extremities and the hip joint between 2009-10 and 2013-14 in people ≥ 85 years old.Conclusion: The utilisation of plain X-rays of the chest, the gastro-intestinal tract and extremities was high and has increased among older Australians between 2009-10 and 2018-19. Plain X-rays remain a commonly used diagnostic tool for conditions affecting the older population. [ABSTRACT FROM AUTHOR]

Background: The Ambient Intelligent Geriatric Management (AmbIGeM) system augments best practice and involves a novel wearable sensor (accelerometer and gyroscope) worn by patients where the data captured by the sensor are interpreted by algorithms to trigger alerts on clinician handheld mobile devices when risk movements are detected.Methods: A 3-cluster stepped-wedge pragmatic trial investigating the effect on the primary outcome of falls rate and secondary outcome of injurious fall and proportion of fallers. Three wards across 2 states were included. Patients aged ≥65 years were eligible. Patients requiring palliative care were excluded. The trial was registered with the Australia and New Zealand Clinical Trials registry, number 12617000981325.Results: A total of 4924 older patients were admitted to the study wards with 1076 excluded and 3240 (1995 control, 1245 intervention) enrolled. The median proportion of study duration with valid readings per patient was 49% ((interquartile range [IQR] 25%-67%)). There was no significant difference between intervention and control relating to the falls rate (adjusted rate ratio = 1.41, 95% confidence interval [0.85, 2.34]; p = .192), proportion of fallers (odds ratio = 1.54, 95% confidence interval [0.91, 2.61]; p = .105), and injurious falls rate (adjusted rate ratio = 0.90, 95% confidence interval [0.38, 2.14]; p = .807). In a post hoc analysis, falls and injurious falls rate were reduced in the Geriatric Evaluation and Management Unit wards when the intervention period was compared to the control period.Conclusions: The AmbIGeM system did not reduce the rate of falls, rate of injurious falls, or proportion of fallers. There remains a case for further exploration and refinement of this technology given the post hoc analysis findings with the Geriatric Evaluation and Management Unit wards. Clinical Trials Registration Number: 12617000981325. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC). Design Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians. Setting Community. Participants In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015. Outcome measures Mortality and transition to PRAC. Results The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80–0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89–0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89–0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85–0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21. Conclusion It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA. [ABSTRACT FROM AUTHOR]

Objective: To assess long term survival and patient characteristics associated with survival following acute myocardial infarction (AMI) in Australia and New Zealand.Design: Cohort study.Setting, Participants: All patients admitted with AMI (ICD-10-AM codes I21.0-I21.4) to all public and most private hospitals in Australia and New Zealand during 2009-2015.Main Outcome Measure: All-cause mortality up to seven years after an AMI.Results: 239 402 initial admissions with AMI were identified; the mean age of the patients was 69.3 years (SD, 14.3 years), 154 287 were men (64.5%), and 64 335 had ST-elevation myocardial infarction (STEMI; 26.9%). 7-year survival after AMI was 62.3% (STEMI, 70.8%; non-ST-elevation myocardial infarction [NSTEMI], 59.2%); survival exceeded 85% for people under 65 years of age, but was 17.4% for those aged 85 years or more. 120 155 patients (50.2%) underwent revascularisation (STEMI, 72.2%; NSTEMI, 42.1%); 7-year survival exceeded 80% for patients in each group who underwent revascularisation, and was lower than 45% for those who did not. Being older (85 years or older v 18-54 years: adjusted hazard ratio [aHR], 10.6; 95% CI, 10.1-11.1) or a woman (aHR, 1.15; 95% CI, 1.13-1.17) were each associated with greater long term mortality during the study period, as was prior heart failure (aHR, 1.79; 95% CI, 1.76-1.83). Several non-cardiac conditions and geriatric syndromes common in these patients were independently associated with lower long term survival, including major and metastatic cancer, cirrhosis and end-stage liver disease, and dementia.Conclusion: AMI care in Australia and New Zealand is associated with high rates of long term survival; 7-year rates exceed 80% for patients under 65 years of age and for those who undergo revascularisation. Efforts to further improve survival should target patients with NSTEMI, who are often older and have several comorbid conditions, for whom revascularisation rates are low and survival after AMI poor. [ABSTRACT FROM AUTHOR]

Background: Understanding the health profile, service and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population. Aims: To examine the 2006–2015 trends in (i) comorbidities and frailty of individuals accessing aged care, and (ii) health services, medicine use and mortality after entry into long‐term care. Methods: Cross‐sectional and population‐based trend analyses were conducted using the Registry of Senior Australians. Results: From 2006 to 2015, 509 944 individuals accessed permanent residential care, 206 394 home care, 283 014 respite and 124 943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7–49.7%), as did the proportion with 5–9 comorbidities (46.4–54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6–12) to 10 (IQR 7–14), while remaining stable in home care (2006: 9, IQR 5–12, 2015: 9, IQR 6–13). Short‐term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95% CI 15.2–16.0) than 2015 (14.6%, 95% CI 14.3–14.9). Longer term (101–1095 days, 2006: 44.3%, 95% CI 43.7–45.0, 2015: 46.4%, 95% CI 45.8–46.9) mortality was higher in 2015 compared to 2006. Mortality in individuals accessing home care did not change. Conclusion: The health of older Australians accessing aged care programmes has declined while frailty increased, with an increasing use of medicine and worse long‐term mortality in some. Funding and care models need to adapt to this changing profile. [ABSTRACT FROM AUTHOR]

Background frailty is a dynamic condition for which a range of interventions are available. Health state utilities are values that represent the strength of an individual's preference for specific health states, and are used in economic evaluation. This is a topic yet to be examined in detail for frailty. Likewise, little has been reported on minimally important difference (MID), the extent of change in frailty status that individuals consider to be important. Objectives to examine the relationship between frailty status, for both the frailty phenotype (FP) and frailty index (FI), and utility (preference-based health state), and to determine a MID for both frailty measures. Design and setting population-based cohort of community-dwelling Australians. Participant in total, 874 adults aged ≥65 years (54% female), mean age 74.4 (6.2) years. Measurements frailty was measured using the FP and FI. Utilities were calculated using the short-form 6D health survey, with Australian and UK weighting applied. MID was calculated cross-sectionally. Results for both the FP and FI, frailty was significantly statistically associated (P  < 0.001) with lower utility in an adjusted analysis using both Australian and UK weighting. Between-person MID for the FP was identified as 0.59 [standard deviation (SD) 0.31] (anchor-based) and 0.59 (distribution-based), whereas for the FI, MID was 0.11 (SD 0.05) (anchor-based) and 0.07 (distribution-based). Conclusions frailty is significantly associated with lower preference-based health state utility. Frailty MID can be used to inform design of clinical trials and economic evaluations, as well as providing useful clinical information on frailty differences that patients consider important. [ABSTRACT FROM AUTHOR]

Identifying and removing access barriers to the timely provision of comprehensive health care is increasingly important for the wellbeing of Australia's rapidly ageing and frail populations, particularly those in non‐metropolitan settings. This study has examined if current general practice (GP) locations in non‐metropolitan South Australia (SA) and Western Australia (WA) are geographically accessible to the rapidly growing frail and prefrail populations known to have a high level of health service use and reduced mobility. Geospatial analysis linking 60‐kilometre GP service catchments, 2016 population counts, and 2027 population projections has estimated that the size of the frail and prefrail population that live outside these GP service catchments will double, reaching 7,800 people by 2027. The maldistribution of GP locations was most evident in WA. As regional and remote populations continue to age, the challenge of health service provision, including geographic access to care, must be resolved to ensure that populations in these areas have the best opportunity to age well. Geospatial methods linking service and demographic information, such as the approach used in this analysis, can aid in planning the equitable provision of health care for older Australians. [ABSTRACT FROM AUTHOR]

Objective (i) to describe the general practitioner utilisation of health assessments, management plans, coordination of team care arrangements and medication review item numbers within 6 months of an aged care eligibility assessment for home care packages (HCP) and (ii) investigate the impact of health assessments on the risk of mortality and entry into permanent residential aged care (PRAC) of individuals accessing HCP. Design and setting retrospective cohort study utilising data from the Registry of Senior Australians (ROSA) was conducted. Subjects 75,172 individuals aged ≥75 years who received HCP between 2011 and 2015. Outcome measure for objective 1: the use of comprehensive assessments (Medicare Benefits Schedule (MBS) items 705 or 707), management plans (MBS 721), coordination of team care arrangements (MBS 723), and medication reviews (MBS 900). For objective 2: time to death and entry into PRAC. Results of the 75,172 individuals, 28.2% (95% confidence interval (CI): 27.8–8.5%) had comprehensive assessments, 36.7% (95% CI: 36.3–37.0%) had management plans, 33.0% (95% CI: 32.7–33.3%) received coordination of team care arrangements and 5.4% (95% CI: 5.2–5.5%) had medication reviews. Individuals with a comprehensive assessment had a 5% lower risk of mortality (adjusted hazard ratio (aHR), 95% CI = 0.95, 0.92–0.98) but 5% higher risk of transition to PRAC (adjusted subdistribution HRs, 95% CI = 1.05, 1.02–1.08) compared to those who did not have these services. Conclusion the utilisation of health assessments was associated with a lower risk of mortality. There is an opportunity for increased use of item numbers in frailer individuals. [ABSTRACT FROM AUTHOR]

This pilot study aimed to examine the feasibility and effectiveness of a 6-months multi-component exercise program combined with twice daily consumption of either rice (RicePro) or whey-based (WheyPro) protein supplements (2 × 20 g of protein) on gait speed, grip strength and physical performance in community-dwelling pre-frail and frail older adults. Secondary outcomes included: frailty score, muscle mass, quality of life, nutritional intake, cognitive performance, depression and physical activity levels. A total of 70 participants (mean age 73.34 ± 6.85 years) were randomly allocated to either RicePro (n = 36) or WheyPro (n = 34). No adverse events were reported in regards to the exercise, however, several gastrointestinal symptoms were noted with the whey protein causing two-fold more symptoms compared to the rice protein. No differences were found between the groups (p > 0.05), except the total consumed energy (kJ) (p = 0.014) and fat (g) (p = 0.012) which was significantly lower in WheyPro. The results indicate that the quality of protein may not be as important as long as a sufficient amount is consumed. [ABSTRACT FROM AUTHOR]

Background: The public areas of the hospital built environment have hardly been investigated for their age-friendliness. Objective: This exploratory, multidisciplinary pilot study investigates the relationship between the physical environment and design of hospital spaces and older people's outpatient experience. Methods: Sixteen participants were recruited from a geriatric Outpatient Clinic at a metropolitan public hospital in Australia. Participants were engaged in a concurrent mixed-method approach, comprising a comprehensive geriatric survey, walking observation, semi-structured interview and an independent architectural audit. Results: Several elements arising from the hospital environment were identified as facilitators and barriers for its utilization and intrinsically related to participants' physical capacity. Discussion: Age-friendly hospital design needs to consider strategies to remove barriers for older adults of different capacities, thus promoting healthy aging. [ABSTRACT FROM AUTHOR]

Objective: Mental health disorders are a major health concern in older people and are associated with a higher risk of disability, frailty and early mortality. This study aimed to conduct a contemporary population-based assessment of the prevalence, trends and factors associated with mental health disorders in individuals who are living in permanent residential aged care (PRAC) in Australia. Methods: A retrospective cross-sectional study was conducted using national data from the Registry of Senior Australians, a national cohort of older Australians who had aged care eligibility assessment and entered PRAC between 2008 and 2016. Stepwise multivariate logistic regression modeling was applied to identify factors associated with mental health disorders. Results: Of 430,862 individuals included in this study, 57.8% had at least one mental health disorder. The prevalence of depression, phobia/anxiety and psychosis were as follows: 46.2% (95% confidence interval = [46.0%, 46.3%]), 14.9% (95% confidence interval = [14.8%, 15.0%]) and 9.7% (95% confidence interval = [9.6%, 9.8%]), respectively. The likelihood of having a mental health disorder was higher for those who were (adjusted odds ratio [95% confidence interval]) relatively younger, specifically for every 10-year increment in age, the odds of having mental health disorders was 44.0% lower (0.56, [0.55, 0.56]); female (1.33 [1.32, 1.35]); having increasing numbers of physical health comorbidities, 6–10 (1.26 [1.24, 1.29]) or 11–15 (1.48 [1.45, 1.51]) or more than 15 (1.64 [1.58, 1.71]) compared to people having less than five comorbidities; having limitations related to health care tasks (1.05 [1.04, 1.07]), meals (1.04 [1.02, 1.05]) or social and community participation (1.10 [1.08, 1.12]). Conclusion: The burden of mental health disorders in older Australians living in PRAC was high and individuals with these conditions tend to be younger, with several physical comorbidities and/or functional limitations. Understanding the profile of individuals with mental health disorders at entry into PRAC can be used as evidence for baseline resource allocation for this population and evaluation of future needs of mental health services. [ABSTRACT FROM AUTHOR]

The article informs that Australian Medical Services Advisory Committee recommended the listing of a Medicare Benefits Schedule (MBS) rebate for the call out fee for mobile X-ray services in aged care facilities for conditions that contribute to hospitalisation risk of older individuals. It mentions mobile radiology services utilisation by aged care residents.

Objectives: To develop and validate a frailty index, derived from aged care eligibility assessment data.Design: Retrospective cohort study; analysis of the historical national cohort of the Registry of Senior Australians (ROSA).Participants: 903 996 non-Indigenous Australians aged 65 years or more, living in the community and assessed for subsidised aged care eligibility during 2003-2013.Main Outcome Measures: 44-item frailty index; summary statistics for frailty index score distribution; predictive validity with respect to mortality and entry into permanent residential aged care during the five years after assessment.Results: The mean frailty index score during 2003-2013 was 0.20 (SD, 0.07; range, 0-0.41); the proportion of assessed older people with scores exceeding 0.20 increased from 32.1% in 2003-2005 to 75.0% in 2012-2013. The risks of death and entry into permanent residential aged care at one, three and five years increased with frailty index score level (at one year, high [over 0.35] v low scores [under 0.05]: hazard ratio for death, 5.99; 95% CI, 5.69-6.31; for entry into permanent residential aged care, 8.70; 95% CI, 8.32-9.11). The predictive validity (area under the receiver operating characteristic curve) of Cox proportional hazard models including age, sex, and frailty index score was 0.64 (95% CI, 0.63-0.64) for death and 0.63 (95% CI, 0.62-0.63) for entry into permanent residential aged care within one year of assessment.Conclusions: We used Australian aged care eligibility assessment program data to construct and validate a frailty index. It can be employed in aged care research in Australia, but its application to aged care planning requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the access of approved aged care services and factors associated with accessing these services. Methods: A retrospective cohort study was conducted (1/7/2003‐30/6/2013). The incidence of accessing permanent residential, home and respite care services within one year or transition care within 28 days of approval was evaluated. The association of participants' socio‐demographic characteristics, limitations, health conditions and assessment characteristics with service use was evaluated. Results: In 799 750 older Australians, the incidence of accessing approved permanent residential care within one year was 70.9% (95% confidence interval [CI] 70.8%‐71.0%), home care 49.5% (95% CI 49.3%‐49.7%) and respite 41.8% (95% CI 41.7%‐41.9%). The incidence of accessing transition care at 28 days was 78.5% (95% CI 78.2%‐78.7%). Aged care seekers', assessments' and assessors' characteristics are associated with service access. Conclusion: Monitoring the use of aged care service approvals is necessary for the identification of service access barriers to support evidence‐based policy changes. [ABSTRACT FROM AUTHOR]

Background: Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear.Objectives: This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP.Design: A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted.Setting: Home based aged care services, national cohort.Methods: Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP.Results: The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years.Conclusion: Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes. [ABSTRACT FROM AUTHOR]

Background Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. Objective We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. Methods A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. Results The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37–0.93) and hospitalizations (HR 0.67, 95% CI 0.46–0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80–2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47–0.96). Conclusions The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting. [ABSTRACT FROM AUTHOR]

Introduction: Nutrition is vital for health, and undernutrition can compromise physical and mental wellbeing. The prevalence of undernutrition among older community-dwelling adults attending general practice in Australia is not readily known. Objectives: The aims of the study were to determine the prevalence of malnutrition of the elderly in Australian general practice, to assess malnutrition-related factors and to describe the older people's perception about nutrition. Design: The study sample comprised 60 older people aged 75 years and above attending one general practice in South Australia. Methodology: The combination of qualitative and quantitative data provided a more complete account of nutrition and its meaning for the older person. Results: Three commonly used, validated nutritional screening tools were useful in determining undernutrition between 15 and 20% in a community population. One screening tool determined a 62% incidence of nutritional risk. Health characteristics determined almost 75% of participants identified at oral health risk. Frailty, medications and chronic disease were identified as factors associated with nutritional risk. Examination of older persons' perceptions about nutrition and wellbeing identified two major themes: older people have nutritional awareness but lack details, especially in relation to the benefits of protein intake, and there is limited awareness on the health benefits of good nutrition. Conclusion: This study confirms that nutritional risk is common in general practice. Understanding older person's perceptions of good nutrition is vital to be able to effectively change their nutritional status and plan amenable interventions. Screening practices with valid and reliable screening tools are imperative to ensure appropriate identification and management of older people at risk. [ABSTRACT FROM AUTHOR]

Objective To determine how well the Mini Nutritional Assessment ( MNA) Short Form ( MNA- SF) performed as a nutritional screening tool when calf circumference replaced body mass index ( BMI) as the included anthropometric measurement. Methods A total of 100 patients ≥70 years were recruited from a Geriatric Evaluation and Management Unit. Results Mean age of patients was 85.2 (6.1) years. By the full MNA, 40% of patients were malnourished. The MNA correlated highly with both of its short-form versions ( r = 0.87 and r = 0.90 for the BMI and calf circumference versions, respectively). Both MNA- SF versions also showed high accuracy in identifying malnutrition (au ROC values >0.89). Conclusions The MNA- SF is a rapid and accurate way to screen for malnutrition in hospitalised older adults. Substitution of BMI measurement with the time-efficient calf circumference measurement maintained MNA- SF accuracy. It is recommended that calf circumference measurement be used for nutritional screening by MNA- SF in a hospital setting. [ABSTRACT FROM AUTHOR]

Objectives To compare the FRAIL- NH scale with the Frailty Index in assessing frailty in residential aged care facilities. Design Cross-sectional. Setting Six Australian residential aged care facilities. Participants Individuals aged 65 and older (N = 383, mean aged 87.5 ± 6.2, 77.5% female). Measurements Frailty was assessed using the 66-item Frailty Index and the FRAIL- NH scale. Other measures examined were dementia diagnosis, level of care, resident satisfaction with care, nurse-reported resident quality of life, neuropsychiatric symptoms, and professional caregiver burden. Results The FRAIL- NH scale was significantly associated with the Frailty Index (correlation coefficient = 0.81, P < .001). Based on the Frailty Index, 60.8% of participants were categorized as frail and 24.4% as most frail. Based on the FRAIL- NH, 37.5% of participants were classified as frail and 35.9% as most frail. Women were assessed as being frailer than men using both tools ( P = .006 for FI; P = .03 for FRAIL- NH). Frailty Index levels were higher in participants aged 95 and older (0.39 ± 0.13) than in those aged younger than 85 (0.33 ± 0.13; P = .008) and in participants born outside Australia (0.38 ± 0.13) than in those born in Australia (0.34 ± 0.13; P = .01). Both frailty tools were associated with most characteristics that would indicate higher care needs, with the Frailty Index having stronger associations with all of these measures. Conclusion The FRAIL- NH scale is a simple and practical method to screen for frailty in residential aged care facilities. [ABSTRACT FROM AUTHOR]

Background Exercise has been proposed as a possible treatment for postprandial hypotension (PPH), yet, its use has not been extensively investigated. This study aimed to determine the effects of intermittent walking on blood pressure (BP) and heart rate (HR) following ingestion of a glucose drink in older people with PPH. Methods Thirteen persons with PPH were recruited and studied on 2 randomized days (control, intervention). On both study days, participants ingested 200 mL of water containing 50 g glucose, followed by ambulatory BP and HR monitoring 6 minutely for 60 minutes, then 15 minutely until 120 minutes. On the intervention day, participants walked at their usual pace for 30 m every 30 minutes for 120 minutes. Results On the control day, significant falls in systolic blood pressure (SBP) ( P < .005) and diastolic blood pressure (DBP) ( P = .016) were demonstrated between t = 0–120 minutes. On the intervention day, over the same period, there was no significant fall in SBP ( P = .520), however, DBP still fell significantly ( P = .045). There was a statistically significant difference ( P = .005) for the area under the curve for the change in SBP from baseline for the study days but not DBP ( P = .716). There was no significant change in HR (control: P = .854; intervention, P = .168) nor between the area under the curve ( P = .798) for the change in HR from baseline for the study days. Conclusions This study suggests that in older people with PPH, intermittent walking at a usual pace attenuates the fall in SBP after ingestion of a glucose drink. [ABSTRACT FROM AUTHOR]

Aims The aims were to evaluate the effect of a 4.5-week geriatric medicine course on 5th-year medical students' attitudes and self-perceived competency scores. Student performance in the summative multiple choice questions examination in 2011 was compared with results from 2008. Methods Pre- and post-course attitudes ( University of California, Los Angeles Attitudes Survey) and self-perceived competency surveys were administered to 65 5th-year medical students following a 4.5-week geriatric medicine course at one South Australian teaching hospital as part of course evaluation and improvement. Results Significant improvements in students' attitude (mean pre- and post-attitude score ( ± standard deviation): 3.34 (1.66) vs 3.66 (1.06); P < 0.001) and self-perceived competency (mean pre and post-competency scores: 2.89 (0.84) and 4.03 (0.56); P < 0.001) were observed. The 2011 multiple choice question results were much better than in 2008 (91.5 (3.6) vs 75.2 (7.9); P < 0.001). Conclusions A geriatric medicine course for senior medical students allows for improvement in attitudes and self-perceived competency scores. [ABSTRACT FROM AUTHOR]

Older people are often over-represented in morbidity and mortality statistics associated with hot and cold weather, despite remaining mostly indoors. The study "Improving thermal environment of housing for older Australians" focused on assessing the relationships between the indoor environment, building characteristics, thermal comfort and perceived health/wellbeing of older South Australians over a study period that included the warmest summer on record. Our findings showed that indoor temperatures in some of the houses reached above 35 °C. With concerns about energy costs, occupants often use adaptive behaviours to achieve thermal comfort instead of using cooling (or heating), although feeling less satisfied with the thermal environment and perceiving health/wellbeing to worsen at above 28 °C (and below 15 °C). Symptoms experienced during hot weather included tiredness, shortness of breath, sleeplessness and dizziness, with coughs and colds, painful joints, shortness of breath and influenza experienced during cold weather. To express the influence of temperature and humidity on perceived health/wellbeing, a Temperature Humidity Health Index (THHI) was developed for this cohort. A health/wellbeing perception of "very good" is achieved between an 18.4 °C and 24.3 °C indoor operative temperature and a 55% relative humidity. The evidence from this research is used to inform guidelines about maintaining home environments to be conducive to the health/wellbeing of older people. [ABSTRACT FROM AUTHOR]

Objectives: to determine the prevalence of under-nutrition using brief screening methods and to determine the relation between these results and (1) those of a more standard nutritional assessment and (2) discharge outcomes. Design: prospective study. Subjects: 65 (21 males) patients older than 65 years. Setting: sub-acute care facility. Measurements: the Mini Nutritional Assessment, standard nutritional assessment, 'rapid screen' and discharge outcome. Results: the prevalence of under-nutrition was high, ranging from 35.4% to 43.1%, depending on the screening method used. Compared to the standard nutritional assessment the 'rapid screen consisting of (1) body mass index <22 kg/m²; and/or (2) reported weight loss of > 7.5% over the previous 3 months and the two-tiered Mini Nutritional Assessment process (at-risk subjects (46% of total) further evaluated using standard nutritional assessment) had sensitivities of 78.6 and 89.5% and specificities of 97.3 and 87.5% respectively in diagnosing under- nutrition. Under-nourished patients as identified by the standard nutritional assessment (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017), the two-tiered Mini Nutritional Assessment process (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017) and the rapid screen (56.5% (under-nourished) versus 21.4% (nourished); P = 0.004) were more likely to be discharged to an acute hospital or an accommodation with increased support (poor discharge outcomes) than nourished patients. Conclusion: all screening methods identified patients more likely to have a poor discharge outcome. The highly specific hut less sensitive 'rapid screen' may be the best method in facilities with limited resources as it can be easily incorporated into nursing/medical admissions and avoids biochemical investigations in all patients. The more sensitive two-tiered Mini Nutritional Assessment is better if resources permit. [ABSTRACT FROM AUTHOR]

Deprescribing opportunities may differ across health care systems, nursing home settings, and prescribing cultures. The objective of this study was to compare the prevalence of STOPPFrail medications according to frailty status among residents of nursing homes in Australia, China, Japan, and Spain. Secondary cross-sectional analyses of data from 4 cohort studies. A total of 1142 residents in 31 nursing homes. Medication data were extracted from resident records. Frailty was assessed using the FRAIL-NH scale (non-frail 0–2; frail 3–6; most-frail 7–14). Chi-square tests and prevalence ratios (PRs) were used to compare STOPPFrail medication use across cohorts. In total, 84.7% of non-frail, 95.6% of frail, and 90.6% of most-frail residents received ≥1 STOPPFrail medication. Overall, the most prevalent STOPPFrail medications were antihypertensives (53.0% in China to 73.3% in Australia, P <.001), vitamin D (nil in China to 52.7% in Australia, P <.001), lipid-lowering therapies (11.1% in Japan to 38.9% in Australia, P <.001), aspirin (13.5% in Japan to 26.2% in China, P <.001), proton pump inhibitors (2.1% in Japan to 32.0% in Australia, P <.001), and antidiabetic medications (12.3% in Japan to 23.5% in China, P =.010). Overall use of antihypertensives (PR, 1.15; 95% CI, 1.06–1.25), lipid-lowering therapies (PR, 1.78; 95% CI, 1.45–2.18), aspirin (PR, 1.31; 95% CI, 1.04–1.64), and antidiabetic medications (PR, 1.31; 95% CI, 1.00–1.72) were more prevalent among non-frail and frail residents compared with most-frail residents. Antihypertensive use was more prevalent with increasing frailty in China and Japan, but less prevalent with increasing frailty in Australia. Antidiabetic medication use was less prevalent with increasing frailty in China and Spain but was consistent across frailty groups in Australia and Japan. There were overall and frailty-specific variations in prevalence of different STOPPFrail medications across cohorts. This may reflect differences in prescribing cultures, application of clinical practice guidelines in the nursing home setting, and clinician or resident attitudes toward deprescribing. [ABSTRACT FROM AUTHOR]

Reports on a patient suffering from lead poisoning in Australia. Symptoms which the patient was experiencing, including paranoia and a microcytic anaemia; Dangers of the failure to look for a reversible cause of dementia; Details regarding lead poisoning.

Background: Frailty and sarcopenia are age-related conditions with shared features and are both associated with adverse health outcomes. Relatively little is known about outcomes of these conditions in combination. The aim of this study was to examine the predictive ability of combined frailty and sarcopenia classification on mortality.Methods: Frailty was measured in 716 community-dwelling adults aged ≥65 years from the North West Adelaide Health Study (mean age 74.1(6.1) years, 55.5 % female) using the frailty phenotype (FP) and sarcopenia using the revised consensus definition from the European Working Group on Sarcopenia. Participants were classified as: neither frail nor sarcopenic, frail-only, sarcopenic-only, or both frail and sarcopenic. All participants had a minimum of 10 years of mortality follow-up.Results: We identified 2.8 % of participants as both frail and sarcopenic, 15.5 % as frail-only, and 3.5 % as sarcopenic-only. Classification as both frail and sarcopenic, in a multivariable model, resulted in significantly elevated mortality risk (HR = 3.52, p < .001), which was over three times that of those neither frail nor sarcopenic. Frail-only was also a significant mortality predictor (HR = 2.03, p = .001), while classification as sarcopenic-only was not a significant predictor of mortality (HR = 1.65, p = .141). There was no significant difference in severity of frailty (mean number of characteristics) or grip strength between frail-only and those with both conditions when stratified by sex.Conclusions: Individuals identified as frail would benefit from screening and assessment for sarcopenia, and vice versa for those identified as sarcopenic, as the mortality risk for individuals with these conditions in combination is nearly double that of each separately. [ABSTRACT FROM AUTHOR]

Introduction: Atypical femoral fractures (AFFs) are rare but a serious complication associated with prolonged use of bisphosphonates. However little is known about clinical outcomes of AFFs. The aim of this study is to compare the characteristics and postoperative outcomes between older patients with AFFs and typical femoral fractures (TFFs).Methods: A retrospective matched cohort study (each AFF was age- and sex-matched with three TFFs) of patients aged 65 years or older who were admitted to The Queen Elizabeth Hospital, South Australia between January 2011 and December 2013 was undertaken. Baseline characteristics of both groups were compared. The primary outcomes evaluated were level of independence in mobility at discharge and 3 months after surgery. Secondary outcomes included length of hospital stay, post-operative complications, rate of surgical revision, discharge destination (after acute hospital stay or rehabilitation), 28-day hospital readmission and 12-month mortality.Results: Ten patients (mean age: 78.1 years) with AFFs were compared with 30 matched TFFs. Patients with AFFs were predominantly female (90%) and 80% had been taking oral bisphosphonate. Nine of the AFFs had their fractures fixed with an intramedullary (IM) nail. The level of independent mobility at discharge (OR 0.31; 95%CI: 0.06-1.71; p=0.26) and at 3 months (OR 0.51; 95%CI: 0.10-2.53; p=0.47) were comparable between the two groups. Only one AFF patient treated with plate and screws required surgical revision, compared with none in the TFF group. Secondary outcomes were not significantly different between the two groups.Conclusion: Recovery of mobility and reoperation rates after surgery of patients with AFFs were favourable and did not differ significantly from TFFs. Further consideration should be given to using IM fixation in the management of AFFs in older people. [ABSTRACT FROM AUTHOR]

Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data. National retrospective cohort study. Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016. PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care–related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample. Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77–3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74–2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44–2.05); and history of skin disease (sHR 1.54; 95% CI 1.45–1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72–0.75). Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry. [ABSTRACT FROM AUTHOR]

To (1) estimate incidence, trends, and determinants of government-subsidized diagnostic radiography (ie, plain x-ray) services utilization by Australian long-term care facility (LTCF) residents between 2009 and 2016; (2) examine national variation in services used. A repeated cross-sectional study. Australian LTCF residents who were ≥65 years old. Medicare Benefits Schedule subsidized plain x-rays employed for diagnosing fall-related injuries, pneumonia, heart failure, and acute abdomen or bowel obstruction were identified. Yearly sex- and age-standardized utilization rates were calculated. Poisson and negative binomial regression models were employed. Facility-level variation was examined graphically. Overall and examination site–specific analyses were conducted. A total of 521,497 LTCF episodes for 453,996 individuals living in 3018 LTCFs were examined. The median age was 84 years (interquartile range 79-88), 65% (n = 339,116) were women, and 53.9% (n = 281,297) had dementia. In addition, 34.5% (n = 179,811) of episodes had at least one x-ray service. Overall, there was a 12% increase in utilization between 2009 and 2016 (from 535/1000 in 2009 to 602/1000 person-years in 2016, incidence rate ratio=1.02, 95% confidence interval 1.02-1.02). Factors associated with x-ray use included being 80-89 years old, being a man, not having dementia, having multiple health conditions (4-6 or ≥7 compared to 0-3), being at a smaller facility (0-24 bed compared to 50-74), facility located in the Australian state of New South Wales, or in major cities (compared to regional areas). National variation in x-ray service use, with largest differences observed by state, was detected. Plain x-ray service utilization by LTCF residents increased 12% between 2009 and 2016. Sex, age, dementia status, having multiple health conditions as well as facility size, and location were associated with plain x-ray use in LTCFs and use varied geographically. Differences in x-ray service utilization by residents highlight lack of consistent access and potential over- or underutilization. [ABSTRACT FROM AUTHOR]

The article presents the 6th position statement concerning under-nutrition and the aspects of older people from the Australian and the New Zealand Society for Geriatric Medicine. It says that this position statement represents the views of the Australian and New Zealand Society for Geriatric Medicine (ANZSGM) and was revised by associate professor Renuka Visvanathan and was approved by the Federal Council of the ANZSGM on September 7, 2007. It notes that this background paper specifically reviews aspects of the literature pertaining to under-nutrition in older people. This paper offers definitions on terms related to under-nutrition and the aspects of older people.

• Neighbourhood environment characteristics can influence older adults' health. • Frailty was associated to objective and subjective neighbourhood characteristics. • Frail adults were more likely to live in areas of lower residential density and higher accessibility to services. • Frail participants had worse perceptions of the environment. • Strategies to prevent frailty should consider the neighbourhood environment. The aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults. A cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents' perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty. Frail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables. Neighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment. [ABSTRACT FROM AUTHOR]

The article lists the reviewers of the journal including Robert Cumming, Elsa Dent and Jenny Abbey.