Search

Background: The Australian government introduced temporary government-subsidised telehealth service items (phone and video-conference) in mid-March 2020 in response to the COVID-19 pandemic. The uptake of telehealth by patients with type 2 diabetes (T2DM) for consulting with GPs is unknown. Aim: To evaluate the uptake of telehealth consultations and associated patient characteristics in Australian general practice, including the frequency of haemoglobin A1c (HbA1c) tests and change in HbA1c levels by telehealth use, compared with guideline recommendations. Design & setting: This exploratory study used electronic patient data from approximately 800 general practices in Victoria and New South Wales (NSW), Australia. A pre-COVID-19 period from March 2019-February 2020 was compared with a pandemic period from March 2020-February 2021. Patients diagnosed with T2DM before March 2018 were included. Method: Telehealth uptake patterns were examined overall and by patient characteristics. Generalised estimating equation models were used to examine patient probability of 6-monthly HbA1c testing and change in HbA1c levels, comparing between patients who did and patients who did not use telehealth. Results: Of 57 916 patients, 80.8% had telehealth consultations during the pandemic period. Telehealth consultations were positively associated with patients with T2DM who were older, female, had chronic kidney disease (CKD), prescribed antidiabetic medications, and living in remote areas. No significant difference was found in 6-monthly HbA1c testing and HbA1c levels between telehealth users and patients who had face-to-face consultations only. Conclusion: Telehealth GP consultations were well utilised by patients with T2DM. Diabetes monitoring care via telehealth is as effective as face-to-face consultations. [ABSTRACT FROM AUTHOR]

Social participation is critical to the health and well‐being of older adults, however, participation often declines with age. Research has identified that personal and environmental factors such as high socioeconomic status and accessible transportation are associated with higher levels of social participation. However, the barriers and facilitators to social participation experienced by older adults receiving community aged care services remains largely unexplored. This qualitative study aimed to generate context‐rich data and identify the barriers and facilitators to effective community care services that can support older adults' participation in the community and contribute to individual well‐being. Semi‐structured focus groups were conducted with 40 community aged care clients and 21 staff members between January to July 2018 and thematic analysis was undertaken. Environmental factors, such as availability and accessibility of transportation services emerged as the most important factors influencing participation. Older age, self‐attitude towards one's own functional ability and limited social networks were important personal factors affecting participation. Proactive aged care services (e.g., engaged staff, tailored activities) were reported to assist with continual engagement in aged care services. In contrast, the type, location and accessibility of the activity, associated costs and limited options for accessible transportation were key barriers to older adults' social participation. Pathways contributing to positive engagement were complex and variable, but personal well‐being and local community resources emerged as important factors encouraging higher social participation. These findings are discussed in the context of the ongoing pandemic and implications for future aged care services are provided. [ABSTRACT FROM AUTHOR]

Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. We analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall‐related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy‐seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls‐related injuries, 5 falls‐related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls. [ABSTRACT FROM AUTHOR]

Objective: To estimate gout prevalence and examine associated factors in residential aged care facilities. Methods: Electronic data from 11 548 residents aged 65+ during 2014‐2017 from 68 residential aged care facilities in Australia were analysed. Gout prevalence was estimated, and regression was used to assess differences in comorbidities, sociodemographic factors and health status between residents with and without gout. Results: Over 10% of residents had gout. Most common comorbidities in these residents were hypertension (71.3%), heart disease (37.9%) and diabetes (33.0%) and they were more likely to have renal disease and historical myocardial infarction. The interaction between comorbid gout had complex interactions between age, sex and comorbidities for diabetes and depression was complex. Conclusions: Gout is common among older people in residential care but may be under‐recognised. Holistic management of gout is needed in this population, with careful consideration of chronic comorbidities and treatments. [ABSTRACT FROM AUTHOR]

Objective. Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods. We collected 3 years of data (2011-14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results. The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion. The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. [ABSTRACT FROM AUTHOR]

Objective The objective of the present study is to quantify utilisation of imaging for patients presenting to an ED with back pain, their characteristics and dispositions. Methods A retrospective cohort study of 1132 ED presentations for back pain to an Australian metropolitan ED in 2013 was performed. Patient demographics, rates of radiography, computed tomography or magnetic resonance imaging and rates of subsequent admission and ED re-presentation were analysed. Results Patients aged 26-35 years were the largest group presenting with back pain (19.4% of presentations), with the majority being female (52.3%). Imaging was requested at 29.5% ( n = 334) of presentations (radiography n = 297; advanced imaging n = 63). Patients over 70 years had higher imaging rates than younger patients (49.4% vs 25.5%, P < 0.001). Imaging was not associated with attendance during or outside office hours (29.3% vs 31.8%, P = 0.4). Of presentations, 34.1% resulted in admission, with no association between imaging and admission (31.8% vs 36.0%, P = 0.2) or ED re-presentation for back pain in the same year (6.5% vs 9.7%, P = 0.09). Conclusion This study provides benchmark data on the use of imaging for back pain in an Australian ED, an area which has been largely unexplored. The rate of imaging in the ED was higher than previously reported in a General Practice setting. Consistent with guidelines, patients older than 70 were more than twice as likely to receive imaging compared to younger patients. It was beyond the scope of the current study to determine whether these images were clinically indicated and further research is required to determine if initiatives to reduce imaging in this population are warranted. [ABSTRACT FROM AUTHOR]

• Social networks have a critical role in delaying dementia. • Being male, using more aged care services was related to higher cognitive function. • Higher social networks with family and friends was linked with better cognition. Social engagement has been linked to preserved cognitive functioning in later life. Yet, little is known about the specific network factors that best predict cognitive function in older adults. This study aimed to (i) characterize the quality and quantity of interpersonal relationships and (ii) explore the relationship between social network types and cognitive function in older adults receiving home- and community-based aged care services. Participants (n = 175) receiving aged care services participated in a structured interview regarding their cognitive function (Telephone Interview for Cognitive Status-Modified), social networks (Lubben Social Network Scale-12) and quality of life (European Quality of Life Scale). Socio-demographic and aged care service use factors were obtained from provider electronic management systems. Multiple regression analyses were conducted to examine the relationships between the size and composition of clients' social networks, aged care service use and cognition. The sample had a median age of 81 years (range 61-96) and most were women (65.8%). Over a third (37.6%) had cognitive impairment and reported moderately high social networks. Males had higher social networks, were receiving fewer hours but more types of services, and had significantly better cognitive performance. Age, network size and composition were not associated with cognitive performance. More extensive social networks were associated with maintenance of cognitive health for older adults in community aged care. Whether this is causal or a marker of better cognitive health requires a longitudinal approach, and ideally should be tested with interventions at community levels. [ABSTRACT FROM AUTHOR]