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Background: Advanced age is associated with decreased likelihood of colorectal cancer treatment. Here, we investigated the extent to which comorbidities are accountable for this lesser treatment. Methods: Using population‐based datasets, the pattern of care among CRC cases in South Australia during 2004–2013 was investigated. Models were used to investigate associations of age with each treatment type, and differences in these associations were explored by comorbidity and cancer site. Results: The presence of comorbidity was associated with a significantly weaker relationship of age with surgery and chemotherapy. The association of age with surgery also varied for colon and rectal primary cancer sites. Individual comorbidity types varied in their associations with each treatment category. For example, dementia was associated with less chemotherapy provision, however, it was not significantly related to the likelihood of surgery. Conclusion: This study indicates that the association of age with surgical treatment differed significantly by the CRC subsite. Comorbidity moderated the negative association of age with chemotherapy, and less so, with extent of surgery. Results were novel in indicating associations of multiple individual comorbidity types with CRC treatment modalities. The data suggest that different individual comorbidity types may have different effects on treatment and should be studied separately. [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]

Background The Australian Pharmaceutical Benefits Scheme ( PBS) reforms have been effective in reducing the price paid for medicines. South Australian public hospitals purchase medicines through competitive tendering, whereas the PBS purchases via reference pricing. There is currently little known about the price differences and relative utilisation patterns that exist for proton pump inhibitors ( PPIs) between South Australian public hospitals and the PBS. Aim To compare the prices and relative utilisation patterns of PPIs between South Australian public hospitals and the PBS. Method A retrospective price and relative utilisation comparison was conducted on five PBS-listed PPIs. Average weighted prices and total PBS expenditure were calculated under various scenarios derived from prices and/or relative utilisation in South Australian public hospitals. Results The average weighted price of PPIs in South Australian public hospitals was almost 70% cheaper than for the equivalent medicines on the PBS. Savings of $AUD440 million from 2011 to 2012 would have been achieved if the PBS price and relative utilisation of PPIs had been similar to that of South Australian public hospitals. Increased utilisation of cheaper off-patent PPIs in the South Australian public hospitals had a greater impact on total expenditure than the price differences between the PBS and the South Australian public hospitals in 2012. Conclusions Prices of PPIs in the PBS are more expensive than those purchased by South Australian public hospitals. Further savings to total PBS expenditure could be achieved by reducing prices further and promoting the use of off-patent medicines. [ABSTRACT FROM AUTHOR]

Background: Managing pain in residents of residential aged care facilities (RACFs) is challenging, especially for people with dementia. Clinicians must weigh the benefits of analgesic use against the potential for adverse events, particularly daytime sleepiness. Objectives: The aim was to investigate the association between analgesic use and daytime sleepiness in residents with and without dementia in RACFs. Methods: This was a cross-sectional study of 383 permanent residents from six low-level and high-level RACFs in South Australia. Main measures included analgesic use in the previous 24 h, analgesic load and self-reported daytime sleepiness. Covariates included relevant comorbidities (insomnia, depression, painful conditions), Charlson's Comorbidity Index, sedative load, self-reported and clinician-observed pain and dementia severity. Logistic regression was used to compute odds ratios (ORs) and confidence intervals (CIs) for the association between analgesic use and daytime sleepiness. Results: Analgesics were used by 288 residents (75.2 %) in the previous 24 h. These included paracetamol ( n = 264, 68.9 %), opioids ( n = 110, 28.7 %) and oral NSAIDs ( n = 14, 3.7 %). Overall, 116 (30.3 %) residents were categorized as having daytime sleepiness. Of those with dementia, 77 (45.6 %) were categorized as having daytime sleepiness. Opioid use in the previous 24 h was not associated with daytime sleepiness in unadjusted or adjusted analyses. Paracetamol use was positively associated with daytime sleepiness (OR 2.31; 95 % CI 1.20-4.42). Conclusion: Although daytime sleepiness occurred in a large number of residents, especially those with dementia, this sleepiness was not necessarily associated with use of opioids. The risk of opioid-induced sedation may have been managed by strategies including preferential prescribing of paracetamol to residents at risk of sleepiness, opioid discontinuation in residents who experienced sleepiness, and use of low doses of opioids. [ABSTRACT FROM AUTHOR]

Background Statins are associated with skeletal muscle adverse effects. These are generally considered mild and reversible, with more severe toxicity occurring rarely. There is little known regarding statin myotoxicity in Aboriginal and Torres Strait Islander Australians who are at high cardiovascular risk and likely to receive statins. Aims To describe features of serious statin-associated myotoxicity ( SSAM) occurring in Indigenous Australians and increase awareness of this condition. Methods Observational case series of SSAM in Aboriginal or Torres Strait Islanders. Cases were identified from personal clinical experience, referrals, reports to the Therapeutic Goods Administration, medical literature, an Internet search and reports from a histopathology laboratory. Information was collected onto a standardised data collection form. Results Fifteen cases of serious myotoxicity in Aboriginal or Torres Strait Islanders exposed to statins were identified from 2006 to 2012. The mean age was 55 (range 35-69). Painless weakness was the most common presentation. Interacting drugs were involved in seven cases. Biopsies were done in eight cases, three showed inflammatory polymyositis and five necrotising myositis. Three patients died and two had permanent severe disability. Resolution of symptoms after statin cessation was variable. Conclusions SSAM has occurred in the Indigenous Australian population with some fatalities. Awareness of the potential for SSAM is essential for early recognition and effective management to reduce probability of avoidable catastrophic harm. Safe, as well as effective use of medication, is essential for optimum health outcomes. Effective pharmacovigilance and therapeutic risk management are important for Aboriginal and Torres Strait Islander Australians. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of comorbid chronic diseases on mortality in older people., Design: Prospective cohort study (1992-2006). Associations between numbers of chronic diseases or mutually exclusive comorbid chronic diseases on mortality over 14 years, by Cox proportional hazards model adjusting for sociodemographic variables or Kaplan-Meier analyses, respectively., Setting: Population based, Australia., Participants: 2087 randomly selected participants aged ≥65 years old, living in the community or institutions., Main Results: Participants with 3-4 or ≥5 diseases had a 25% (95% CI 1.05 to 1.5, p=0.01) and 80% (95% CI 1.5 to 2.2, p<0.0001) increased risk of mortality, respectively, by comparison with no chronic disease, after adjusting for age, sex and residential status. When cardiovascular disease (CVD), mental health problem or diabetes were comorbid with arthritis, there was a trend towards increased survival (range 8.2-9.5 years) by comparison with CVD, mental health problem or diabetes alone (survival 5.8-6.9 years). This increase in survival with arthritis as a comorbidity was negated when CVD and mental health problems or CVD and diabetes were present in disease combinations together., Conclusion: Older people with ≥3 chronic diseases have increased risk of mortality, but discordant effects on survival depend on specific disease combinations. These results raise the hypothesis that patients who have an increased likelihood of opportunity for care from their physician are more likely to have comorbid diseases detected and managed.