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Aims: Comprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according to Beers criteria; and cumulative anticholinergic and sedative medication exposure calculated with Drug Burden Index (DBI). Specifically, to quantify exposure to these measures on admission, changes between admission and discharge, associations with adverse outcomes and medication costs. Methods: Established new retrospective inpatient cohort of 2000 adults aged ≥75 years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross‐sectional analyses of index admission data from cohort. Results: Cohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI > 0 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (−3.8% [−5.4, −2.1]) and mean DBI score (−0.02 [−0.04, −0.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88). Conclusion: In this large cohort of older inpatients, usual hospital care results in an increase in number of medications and small reductions in PIMs and DBI, with variable associations with adverse outcomes. [ABSTRACT FROM AUTHOR]

Objective: Inadequate nutrient intakes have been linked with poor dentition in older adults. The aim of this study was to investigate the associations between the composition of functional tooth units (FTU) and nutrient intakes in older men. Design: A cross-sectional study with a standardised validated diet history assessment and comprehensive oral health assessments. FTU were categorised by dentition type: (i) Group A (Natural FTU Only), (ii) Group B (Natural and Replaced FTU) and (iii) Group C (No Natural FTU). Attainment of nutrient reference values (NRV) for sixteen micronutrients was incorporated into a micronutrient risk variable, dichotomised 'good' (≥ 12) or 'poor' (≤ 11), and for seven macronutrients into a macronutrient risk variable, dichotomised 'good' (≥ 5) or 'poor' (≤ 4). Setting: Subjects selected from the local Sydney geographical areas. Participants: Community-dwelling older men (n 608). Results: 32 % (n 197) of participants were categorised as Group A, 27 % (n 167) as Group B and 40 % (n 244) as Group C. In adjusted logistic regression analysis, being in Group C, compared with Group A, was associated with intakes below NRV recommendations for fibre (OR: 2·30, 95 % CI 1·30, 4·05). Adjusted analysis also showed that men in Group C, compared with Group A, were more likely to have poor intake of macronutrients (OR: 2·00, 95 % CI 1·01, 3·94). Conclusions: Our study shows statistically significant associations between the composition of FTU and poor macronutrient intakes. Maintaining natural pairs of occluding FTU may be important for attaining adequate nutrient intakes in older men. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and falls in the Concord Health and Ageing in Men Project (CHAMP).Methods: CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses.Results: We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio [IRR] 1.66, 95% confidence interval [CI] 1.16-2.37, compared with those with more education) and those with low occupational position (1.45; 1.09-1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position.Conclusions: Lower educational level and occupational position predicted a higher falls rate in Australian-born men; the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions. [ABSTRACT FROM AUTHOR]

Background: Conflicting evidence exists regarding the association of socioeconomic status (SES) with mortality among older people and little is known about the mechanisms underlying this association. We investigated the association of SES with mortality among older Australian men. We also investigated potential mediating effects of health-related behaviours in SES-mortality associations.Methods: We used data from a prospective population-based cohort (the Concord Health and Aging in Men Project), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score were assessed at baseline. Longitudinally assessed alcohol consumption, smoking, physical activity, and body mass index were investigated as potential mediators. Associations were quantified using Cox regression.Results: We evaluated 1527 men (mean age: 77.4 ± 5.5 years). During a mean follow-up time of 9.0 years, 783 deaths occurred. For deaths from all causes, the adjusted hazard ratio (HR) for the lowest tertile of cumulative SES score versus the highest tertile was 1.44 (95% CI 1.21 to 1.70); the corresponding sub-HRs were 1.35 (0.96 to 1.89) for cardiovascular disease (CVD) mortality; 1.58 (1.15 to 2.18) for cancer mortality, and 1.86 (1.36 to 2.56) for non-CVD, non-cancer mortality. SES-mortality associations were attenuated by 11-25% after adjustment for mediating health-related behaviours.Conclusion: Low SES is associated with increased mortality in older Australian men and health-related behaviours accounted for less than one-fourth of these associations. Further research is needed to fully understand the mechanisms underlying SES inequalities in mortality among older people. [ABSTRACT FROM AUTHOR]

Objective: To describe an oral health care programme for older people in Residential Aged Care Facilities (RACFs) to improve access to care and support facilities.Introduction: Different models of residential care have been proposed, but few have been comprehensive (providing on-site health promotion and service delivery) or sustainable.Methods: A partnership model of oral health care, with dental services plus oral health education, was integrated into the community outreach services of a metropolitan hospital department of aged care. The programme provided annual oral health education and training to staff, and on-site dental care to 10 (RACFs).Results: None of the RACFs had received organised education or on-site dental service care prior to the programme. At the completion of the third year of the programme, 607 residents (75% of the total bed capacity for the 10 RACFs) had received an annual oral health assessment, and 271 (46.5%) had received on-site dental care. More than 120 nursing and allied health staff had received education and training in oral health support to residents. Oral cleanliness, the proportion not experiencing dental pain and referral for additional care decreased significantly over the period, but dental caries experience and periodontal conditions remained a concern.Conclusions: Sustainable domiciliary oral health services and oral health education are feasible and practical using a partnership model within the Australian health system. Adaptability, continuity and the use of oral health therapists/dental hygienists in the coordination and management of the programme further contribute to viability. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Weight loss is associated with bone loss; however, it is unclear whether loss of fat or loss of lean body mass plays the key role in this relationship. The aim of this longitudinal analysis was to clarify the relationship between hip BMD, hip BMC and whole body BMC with changes in fat and lean tissue mass in older men. Methods: The Concord Health and Aging in Men Project (CHAMP) is a population-based study in Sydney, Australia, involving 1705 men aged 70–97years. Bone mineral density (BMD) of the total hip, and bone mineral content (BMC) of the hip and whole body (WB), lean mass and fat mass were measured with Dual X-ray Absorptiometry (DXA). Multivariate linear regression models were used to assess relationships. Results: Over 2.2years of follow-up, 368(33%) men lost at least 2% of their body weight, which included a mean loss of 0.8kg/year of lean body mass and 0.9kg/year of fat body mass. Fat loss was strongly associated with BMD loss in men who lost weight. As a group, weight losers lost 1.0% of hip BMD annually compared to 0.2% in men who gained weight, with each kilo of fat loss associated with 0.6%/year hip BMD loss (p<0.0001). Lean mass was not associated with hip BMD loss in weight losers, however, lean mass change was associated with BMD change in men who gained weight (0.3% hip BMD increase per kilo increase of lean mass p<0.01). Conclusion: Maintaining body weight is important for bone health in elderly men. Body fat plays an important role in this relationship, which may reflect the additional metabolic function of adipose tissue. [Copyright &y& Elsevier]