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Background Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. Aims To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use. Methods Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N  = 550) in 2019 and four nursing homes in Tokyo (N  = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N  = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. Results Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. Conclusion Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference. [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]

Objective: To describe the economic and cost considerations of mobile X‐ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents. Methods: Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis. Results: Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co‐payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co‐payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs. Conclusions: Mobile X‐ray services providers charge residents an upfront co‐payment for business viability, which can be a barrier to some residents wishing to access MXS. [ABSTRACT FROM AUTHOR]

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]

Background: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). Objective: The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. Methods: Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. Results: Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. Conclusions: Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. [ABSTRACT FROM AUTHOR]

Background Frailty is common among residential aged care services (RACS) residents; however, little is known about how frailty changes over time in this population. This study aimed to estimate minimally important difference (MID) in frailty to then describe: frailty change over 12 months; and factors associated with worsening frailty. Methods Prospective cohort study across 12 RACS sites of a single aged care organisation in South Australia (n  = 548 residents, mean age 87.7 ± 7.2 years, 72.6% female). Frailty was measured using a frailty index (FI) with 12 months between baseline and follow-up. MID was calculated cross-sectionally (anchor-based using self-reported health, and ½SD for distribution-based). Results Between-person MID for the FI was identified as 0.037 (anchor-based) and 0.063 (distribution-based). Using the conservative value of 0.063 as the basis for change, 32.3% (n  = 177) of residents remained stable, 13.7% (n  = 75) improved, 33.0% (n  = 181) worsened and 21.0% (n  = 115) died over 12 months. In a multivariable analysis, significant predictors of the dichotomous outcome of worsening and death at 12 months were: being malnourished (odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.23, 3.75), at risk of malnutrition (OR = 1.98, 95%CI = 1.34, 2.91) and diabetes (OR = 1.61, 95%CI = 1.06, 2.42) compared to those who remained stable or improved. Conclusions A 6.3% change in frailty for RACS residents is a conservative MID. Frailty is dynamic in RACS residents, and stability or improvement was possible even for the most-frail. Treatments such as nutritional interventions, exercise and diabetes management are likely to benefit frailty. [ABSTRACT FROM AUTHOR]

Aim: Sarcopenia is a common disorder of loss of muscle mass and function among older adults; however, few studies have examined screening instruments for sarcopenia risk in residential aged care services (RACS). The aims of this study were to measure sarcopenia risk in RACS residents using the SARC‐F, describe factors associated with sarcopenia risk and examine the predictive validity of the SARC‐F for 12‐month mortality. Methods: This was a prospective cohort study carried out in South Australian RACS across 12 sites. In total, 541 residents (mean age 87.7 [7.3] years, 72.6% women) were included in the study. Sarcopenia risk was measured using a modified SARC‐F (≥4 point cut point). Results: We identified 89.5% (n = 484) of residents at risk of sarcopenia. Significant (P > 0.05) predictors of sarcopenia risk in multivariable analysis included the presence of diabetes (relative risk [RR] = 1.08), classification as most‐frail (RR = 1.06) and smaller Nursing Home Life Space Diameter (NHLSD) score (RR = 0.99). Mortality was observed in 20.9% (n = 113) of residents over a 12‐month follow‐up. Classification as at‐risk of sarcopenia was a significant predictor of 12‐month mortality; however, it had a poor area under the receiver operator curve (0.56), and a low positive predictive value (23.1%). The best performing cut‐point of ≥7 also had poor discriminative ability (under the receiver operator curve = 0.66, positive predictive value = 30.8%). Conclusions: Sarcopenia risk is extremely common among RACS residents and its presence is a significant contributor to 12‐month mortality. Low discriminative ability for the SARC‐F was noted across multiple cut‐off scores for predicting mortality at 12 months. Diabetes management and promoting physical activity and nutrition among RACS residents are likely to influence sarcopenia risk positively. Geriatr Gerontol Int 2022; 22: 206–212. [ABSTRACT FROM AUTHOR]

Objectives This study examined the impact of the residential environment, measured by the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, on risk of mortality or entry into Permanent Residential Aged Care (PRAC). Design A retrospective cohort study using data from the Registry of Senior Australians (ROSA) was conducted. HAVEN Index values were matched to the ROSA by residential postcode. Study setting and Participants Older individuals living in metropolitan Adelaide and receiving their first eligibility assessment for aged care services between 2014 and 2016 (N  = 16,944). Main Outcome Measure Time to death and entry into PRAC were the main outcomes. Results A higher HAVEN Index value, which represents a favourable residential environment, was associated with a lower risk of mortality and delayed entry to PRAC. For every 0.1 unit increase in HAVEN Index value, the risk of mortality is 3% lower (adjusted hazard ratio [HR], 95% confidence interval [CI] = 0.97, 0.96–0.99) and the risk of entry to PRAC is 5% lower (adjusted subdistribution HR, 95%CI = 0.95, 0.94–0.97) in the first 2 years following aged care assessment. After 2 years, the HAVEN Index was not associated with the risk of transition to PRAC. Conclusion Place-based health inequalities were identified in Australians seeking aged care services, demonstrating that a better understanding of local neighbourhoods may provide insight into addressing ageing inequalities. Spatial indexes, such as the HAVEN Index, are useful tools to identify areas where populations are more vulnerable to adverse health outcomes, informing responses to prioritise local improvements and health interventions to enable healthy ageing. [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]

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]

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]

Objective: To examine the predictive validity of the FRAIL scale for mortality, and diagnostic test accuracy (DTA) against the frailty phenotype (FP). Measurement: Frailty was measured in 846 community‐dwelling adults (mean age 74.3 [SD 6.3] years, 54.8% female) using a modified FRAIL scale and modified FP. Mortality was matched to death records. Results: The FRAIL scale demonstrated significant predictive validity for mortality up to 10 years (Frail adjHR: 2.60, P <.001). DTA findings were acceptable for specificity (86.8%) and Youden index (0.50), but not sensitivity (63.6%), or area under the receiver operator curve (auROC) (0.75). DTA estimates were more acceptable when a cut‐point of ≥2 characteristics was used rather than ≥3 in the primary DTA analysis. Conclusion: The FRAIL scale is a valid predictor of mortality. DTA estimates depend on FRAIL scale cut‐point used. This instrument is a potentially useful frailty screening tool. [ABSTRACT FROM AUTHOR]

Background: Fall-related hospitalisations from residential aged care services (RACS) are distressing for residents and costly to the healthcare system. Strategies to limit hospitalisations include preventing injurious falls and avoiding hospital transfers when falls occur. Aims: To undertake a root cause analysis (RCA) of fall-related hospitalisations from RACS and identify opportunities for fall prevention and hospital avoidance. Methods: An aggregated RCA of 47 consecutive fall-related hospitalisations for 40 residents over a 12-month period at six South Australian RACS was undertaken. Comprehensive data were extracted from RACS records including nursing progress notes, medical records, medication charts, hospital summaries and incident reports by a nurse clinical auditor and clinical pharmacist. Root cause identification was performed by the research team. A multidisciplinary expert panel recommended strategies for falls prevention and hospital avoidance. Results: Overall, 55.3% of fall-related hospitalisations were among residents with a history of falls. Among all fall-related hospitalisations, at least one high falls risk medication was administered regularly prior to hospitalisation. Potential root causes of falling included medication initiations and dose changes. Root causes for hospital transfers included need for timely access to subsidised medical services or radiology. Strategies identified for avoiding hospitalisations included pharmacy-generated alerts when medications associated with an increased risk of falls are initiated or changed, multidisciplinary audit and feedback of falls risk medication use and access to subsidised mobile imaging services. Conclusions: This aggregate RCA identified a range of strategies to address resident and system-level factors to minimise fall-related hospitalisations. [ABSTRACT FROM AUTHOR]

Objective: To assess the changes in fifth‐year medical students' perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty after a 4.5‐week geriatric medicine course. Methods: Students' perceived importance and competence was assessed before and after the course using a 26‐item Likert scale questionnaire with scores ranging from 1 to 6. Results: Students' perceptions of the importance of defining frailty (P =.01), explaining what frailty is (P =.03), advising on nutritional needs (P =.001) and exercise (P =.001) and prescribing an exercise program (P <.001) significantly improved after the course. Medical students' perceived competence in assessing, diagnosing and managing frailty was low to moderate precourse and increased significantly postcourse (2.3 [1.2] 4.9 [2.9], mean [IQR], P <.001) across all items. Conclusion: An appropriate curriculum focusing on geriatric health conditions such as frailty can improve senior medical students' perceived importance and competence in assessing, diagnosing and managing frailty. [ABSTRACT FROM AUTHOR]

Background Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. Methods In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. Results The final scale incorporated 14 domains, each conceptualized with 3-6 response levels. All domains were rated as "understood well" by most participants (range 64-94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. Conclusions The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway. [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]

Aim: Frailty is a state of decreased physiological reserve and vulnerability to stressors. Understanding the characteristics of those most at risk of worsening, or likely to improve their frailty status, are key elements in addressing this condition. The present study measured frailty state transitions and factors associated with improvement or worsening frailty status in the North West Adelaide Health Study. Methods: Frailty was measured using the frailty phenotype (FP) and a 34‐item frailty index (FI) for 696 community‐dwelling participants aged ≥65 years, with repeated measures at 4.5‐year follow up. Results: Improvement in frailty state was common for both tools (FP 15.5%; FI 7.9%). The majority remained stable (FP 44.4%; FI 52.6%), and many transitioned to a worse level of frailty (FP 40.1%; FI 39.5%). For both measures, multimorbidity was associated with worsening frailty among non‐frail participants. Among pre‐frail participants, normal waist circumference was associated with improvement, whereas older age was associated with worsening of frailty status. Among frail individuals, younger age was associated with improvement, and male sex and older age were associated with worsening frailty status. Conclusions: Frailty is a dynamic process where improvement is possible. Multimorbidity, obesity, age and sex were associated with frailty transitions for both tools. Geriatr Gerontol Int 2018; 18: 1549–1555. [ABSTRACT FROM AUTHOR]

Background: Postprandial hypotension (PPH) occurs frequently, particularly in older people and those with type 2 diabetes, and is associated with increased morbidity and mortality. The magnitude of the decrease in blood pressure (BP) induced by carbohydrate, fat, and protein appears to be comparable and results from the interaction of macronutrients with the small intestine, including an observed stimulation of mesenteric blood flow. It is not known whether artificial sweeteners, such as sucralose, which are widely used, affect BP. Objective: The aim of this study was to evaluate the effects of intraduodenal sucralose on BP and superior mesenteric artery (SMA) blood flow, compared with intraduodenal glucose and saline (control), in healthy older subjects. Design: Twelve healthy subjects (6 men, 6 women; aged 66-79 y) were studied on 3 separate occasions in a randomized, double-blind, crossover design. After an overnight fast, subjects had concurrent measurements of BP and heart rate (HR; automated device), SMA blood flow (Doppler ultrasound), and blood glucose (glucometer) during intraduodenal infusion of 1) glucose (25% wt:vol, ~1400 mOsmol/L), 2) sucralose (4 mmol/L, ~300 mOsmol/L), or 3) saline (0.9% wt:vol, ~300 mOsmol/L) at a rate of 3 mL/min for 60 min followed by intraduodenal saline for a further 60 min. Results: There was a decrease in mean arterial BP (P < 0.001) during intraduodenal glucose [baseline (mean ± SEM): 91.7 ± 2.6 mm Hg compared with t = 60 min: 85.9 ± 2.8 mm Hg] but not during intraduodenal saline or intraduodenal sucralose. The HR (P < 0.0001) and SMA blood flow (P < 0.0001) also increased during intraduodenal glucose but not during intraduodenal saline or intraduodenal sucralose. As expected, blood glucose concentrations increased in response to glucose (P < 0.0001) but not saline or sucralose. Conclusions: In healthy older subjects, intraduodenal administration of the artificial sweetener sucralose was not associated with changes in BP or SMA blood flow. Further studies are therefore warranted to determine the potential role for artificial sweeteners as a therapy for PPH. This trial was registered at http://www.ANZCTR.org.au as ACTRN12617001249347. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital. Methods: This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (posttrial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P≤0.05). Results: Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or effectively preventing hospital falls (odds ratio 0.12). Clinicians' recommendations resulted in subsequent technological refinement of the tool, and provision of an additional iPad device for more efficient use. Conclusion: This study adds to the limited pool of knowledge about clinicians' attitudes toward health technology use in falls avoidance. Clinicians were willing to use the HIT tool, and their concerns about its usability were addressed in ongoing tool improvement. Including end-users in the development and refinement processes, as well as having high staff uptake of new technologies, is important in improving their acceptance and usage, and in maximizing beneficial feedback to further inform tool development. [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]

Aim An Observed Structured Clinical Examination ( OSCE) was integrated into the assessment for senior medical students undertaking a 4.5-week geriatric medicine teaching block at one campus. The feasibility and acceptability of an OSCE were examined . Methods Students completed eight questions regarding the OSCE using a 6-point Likert scale and two additional questions, using free text, highlighting the strengths and potential areas for improvement. Changes were made every 6 months over a two-year period in response to student evaluation. Results Improvements included adjusting the format to conform with end-of-year examinations and introducing simulated patients. Following these improvements, students perceived improved structure and sequence to the assessments, improved opportunity for demonstration of skills and knowledge and that the assessment was fair. Conclusion This preliminary research provides evidence that it is feasible to introduce OSCE as a form of assessment into a geriatric medicine teaching programme and student evaluation can be used to inform improvements. [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]

Aim To investigate analgesic use and pain in people with and without dementia in Australian residential aged are facilities. Methods A cross-sectional study of 383 residents of six residential aged are facilities was conducted. Nurses assessed self-reported and clinician-observed pain. Analgesic use data were extracted from medication charts. Logistic regression was used to investigate factors associated with analgesic use. Results Analgesics were administered to 291 (76.0%) residents in the previous 24 hours. The prevalence of analgesic use was similar among residents with and without dementia (79.3% vs 73.4%, P = 0.20). Residents with dementia had a higher prevalence of self-reported pain than those without dementia but similar prevalence of clinician-observed pain. In residents with dementia, high care residence and dementia severity were associated with analgesic use. Conclusion The prevalence of analgesic use was similar among residents with and without dementia. Both self-reported and clinician-observed measures are needed in regular pain assessments. [ABSTRACT FROM AUTHOR]

Aim: To examine the association of nutritional screening tools (NSTs) and anthropometric measures with hospital outcomes in older people. Methods: In 172 patients aged ⩾70 years admitted to a Geriatric Evaluation Management Unit (GEMU), nutritional status was measured using the Mini-Nutritional Assessment (MNA), MNA-short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Simplified Nutritional Appetite Questionnaire, calf circumference (CC), mid-arm circumference (MAC) and BMI. Results: Malnutrition according to the MNA occurred in 53 (31%) patients. Functional change was associated with GNRI (Beta coefficient (β), 95% CI = 0.17, 0.001-0.33) and CC (β, 95% CI = 0.17, 0.01-0.33); GEMU length of stay was associated with MNA-SF-BMI (β, 95% CI = -0.02, -0.003 to -0.004) and MNA-SF-CC (β, 95% CI = -0.02, -0.003 to -0.001). MAC was associated with discharge to higher level of care (OR, 95% CI = 0.88, 0.81-0.96). Conclusion: In hospitalised older people, admission NSTs and anthropometric measures associate with discharge outcomes. [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]

Aim To evaluate whether ' Meals on Wheels' ( MOW) improves health and reduces hospital admissions in poorly nourished ( PN) older people. Methods Two hundred and fifty older South Australians were retrospectively classified: (i) PN ( MNA score <24) receiving MOW ( MOW PN); (ii) PN not receiving MOW (non- MOW PN); and (iii) well-nourished ( WN). Data regarding their health were compared. Results Health outcomes at baseline for MOW PN and non- MOW PN were not different, but both were worse than the WN. Over 12 months, weight loss was ∼2-3 times greater in both PN than WN groups. Hospital admissions were not different for MOW PN compared with non- MOW PN and WN, but non- MOW PN had 2.9 as many admissions and spent 5 days more in hospital than WN (all Ps < 0.05). Conclusion Providing MOW to nutritionally vulnerable older people may not prevent age-related decline in health, although a potential reduction in hospital admissions warrants investigation. [ABSTRACT FROM AUTHOR]

Background: admission to a Geriatric Evaluation and Management Unit (GEMU) can optimise a patient's chance of functional recovery.Objective: to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes, both at discharge and at 6 months.Design: prospective, observational study.Setting and participants: consecutive GEMU patients aged ≥70 years.Methods: patients were classified as ‘frail’ or ‘at high risk of functional decline’ using several frailty and functional decline instruments. Predictive ability was evaulated using logistic regression and area under receiver operator characteristic (ROC) curves (auROC).Results: a total of 172 patients were included. Frailty prevalence varied from 24 to 94% depending on the instrument used. Several instruments predicted patients at risk of poor outcome, including the Frailty Index of Accumulative Deficits (FI-CD), Fried's Cardiovascular Health Study index, the Study of Osteoporotic Fractures index, an adapted Katz score of activities of daily living (ADL), Instrumental ADL, the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie (SHERPA) and grip strength [odds ratio (OR) range of 2.06–6.47]. Adequate discriminatory power for discharge outcome was achieved by the FI-CD (auROC = 0.735, P < 0.001) and an adapted Katz score (auROC = 0.704, P = < 0.001). The FI-CD also showed adequate discriminatory power for a poor 6-month outcome (auROC = 0.702, P < 0.001).Conclusion: frailty and functional decline instruments can predict older patients at risk of poor outcome. However, only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points. [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]

Life-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1 year. Prospective cohort study. Twelve nursing homes including 556 residents, mean age 87.73 ± 7.25 years, 73.0% female. Life-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale. NHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n = 527) and wing (86.4%, n = 485). One-half of the residents left their wing daily (51.0%, n = 284), and over one-quarter (26.4%, n = 147) ventured outside their nursing home at least weekly. Significant associations (P <.05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P <.05) of lower mortality, lower falls rate, and higher QoL at 1 year when compared with moderate or low mobility. Given the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL. [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]