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Abstract Background Improving the coordination and integration of health services is recognised nationally and internationally as a key strategy for improving the quality of diabetes care. The Australian Diabetes Alliance Program (DAP) is an integrated care model implemented in the Hunter New England Local Health District (HNELHD), New South Wales (NSW), in which endocrinologists and diabetes educators collaborate with primary care teams via case-conferencing, practice performance review, and education sessions. The objective of this study was to report on general practitioners’ (GPs) perspectives on DAP and whether the program impacts on their skills, knowledge, and approach in delivering care to adult patients with type 2 diabetes. Methods Four primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (

Abstract Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

Abstract Objective: This paper uses data from the seventh fortnightly Coronavirus (COVID‐19) Survey sent to women in the Australian Longitudinal Study on Women's Health to investigate the relationship between the COVID‐19 pandemic and the food and drink consumption of women born in 1946‐51, 1973‐78 and 1989‐95. Methods: A survey about changes in fruit, vegetable, discretionary food, takeaway and sugary drink consumption during the pandemic was emailed on 22 July 2020 to 28,709 women in three cohorts of the Australian Longitudinal Study on Women's Health. Thematic qualitative analysis was conducted on comments about changes in consumption, and basic quantitative analysis was included for context. Results: There were significant associations between age and all categories of food and drink consumption. Women wrote of lifestyle changes and choices during lockdowns, comfort and emotional eating, and access to food and drink changing their consumption behaviours. Conclusions: The COVID‐19 pandemic and interventions had both positive and negative impacts on the food and drink consumption behaviours of Australian women. Implications for public health: These findings can be used to directly influence practice around healthy food and drink consumption, highlighting enablers, including being at home, and barriers, including mental health, that should be considered.

Abstract Background Dedicated cardio-oncology services are emerging rapidly around the world in order to provide cardiovascular care (CV) for cancer patients. The perspectives of patients regarding their experience of cardiac surveillance during their cancer journey has not been qualitatively evaluated. Methods An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with a diverse range of community dwelling patients who attended a newly established cardio-oncology clinic in a large regional city in Australia. Data were analysed using an inductive thematic approach. Results Key themes were identified: (1) Access to a cardio-oncology clinic promotes information and understanding, (2) The experience of early CV intervention, (3) Factors promoting integrated care, (4) Balancing cancer treatment and CV symptoms and (5) Managing past and emerging CV risk factors. Conclusion As cardio oncology clinics continue to emerge, this study confirms the benefit of early access to a cardiologist for management of existing or emerging CV risk factors and diseases in the context of cancer treatment. Participants valued the opportunity for regular monitoring and management of CV issues that enabled them to continue cancer treatment. However, we identified gaps in education and support towards making positive lifestyle changes that reduce the risk of CV diseases in cancer patients.

Abstract Background Over recent decades an increasing number of adults will retain their driver’s licenses well into their later years. The aim of this study was to understand and explore the experience of driving and driving cessation in very old Australian women with self-reported eye disease. Methods An interpretative qualitative study. Participants were from the Australian Longitudinal Study on Women’s Health (cohort born in 1921–26), a sample broadly representative of similarly aged Australian women. Responses to open-ended questions were analysed using an inductive thematic approach, employing a process of constant comparison. Results Qualitative data were from 216 older women with eye disease who made 2199 comments about driving, aged between 70 and 90 years depending on the timing of their comments. Themes included: (1) Access to treatment for eye disease promotes driving independence and quality of life; (2) Driving with restrictions for eye disease enables community engagement and (3) Driving cessation due to poor vision leads to significant lifestyle changes. Conclusions Key findings highlighted driving cessation, or reduction, is often attributed to deterioration in vision. The consequence is dependence on others for transport, typically children and friends. Access to successful treatment for eye disease allowed older women to continue driving. We posit that occupational therapists can play an essential role in promote driving confidence and ability as women age. Trial registration: Not applicable.

Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.

Abstract Background Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities. Methods An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward. Conclusions While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

Abstract Objective: To assess the use of Medicare‐subsidised health services by women with and without dementia. Methods: Data from women of the 1921–26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non‐emergency GP attendances (short [30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. Conclusions: The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).

Objectives and importance of the study: To identify the value and contribution of the 45 and Up Study toward understanding and advancing healthy ageing. Study type: Narrative review Methods: A review of the purpose, process, and output of the 45 and Up Study in relation to the World Health Organization’s Healthy Ageing Framework. Results: The Sax Institute’s 45 and Up Study (the Study) is Australia’s largest longitudinal study of healthy ageing, with participants aged from 45 years to over 100 years followed over time through surveys and linked health and aged care data. The study is a powerful resource for understanding healthy ageing for the Australian population, identifying the factors that enable people to age well, widening inequities as people age, and prospects for healthy ageing for current and subsequent generations. To date, the participants have been followed for more than 15 years, providing information on the foundations of health in mid and later-life, factors affecting work, impacts of retirement, and the importance of housing, care, and aged services in improving the lives of people as they age. Moreover, since the Study cohort covers a wide age range, it is possible to divide the cohort into sequences, allowing comparisons of people in their 80s now (for example) with people who were aged in their 80s five, 10 or 15 years ago. Adding genetic and other biological and clinical data for some participants will further enhance the value of the project as a comprehensive study of healthy ageing. Conclusions: The Study provides a clear view of factors affecting healthy ageing within population, healthcare, environmental and policy contexts. Over time, the Study will increase in value with the capacity to inform health services, policy, and aged care and to contribute to an ongoing cycle of evaluation and reform to continue to meet the needs of successive generations of people in the later stages of their lives.

Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE).Methods: Data (n = 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE.Results: Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years).Conclusion: Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.

COPD is responsible for an increasing number of deaths worldwide. Smoking is the most reliable predictor for developing COPD later in life. However, women make up the majority of patients with COPD who have never smoked. There is therefore a need to identify other factors that can predict COPD in women. The aim of this study is to identify factors associated with increasing the risk of developing COPD later in life in women who have never smoked. Data from the Australian Longitudinal Study on Women's Health (ALSWH) cohort born between 1946 and 1951 were used to investigate potential predictors of COPD. Retrospective analyses were performed on data from two of the ALSWH surveys: wave 1 (1996) and wave 9 (2019). There were 3584 women who self-reported as being never-smokers (at waves 1 and 9) and did not have COPD at baseline, of which 109 had developed COPD at wave 9. Logistic regression showed a significant relationship between COPD at wave 9 and baseline breathing difficulties (p

Abstract Objective: To cross‐sectionally examine heavy episodic drinking (HED) and pre‐loading with alcohol among young Australian women in relation to the alcohol‐induced adverse outcomes of memory loss, vomiting and injury. Methods: A total of 7,800 participants, aged 20–25 years, from the 1989–95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log‐binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre‐loading. Results: The majority of participants reported HED (83.4%) and/or pre‐loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre‐loading increased, so did the risk of an adverse outcome. Conclusions: Both HED and pre‐loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre‐loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre‐loading, a related, yet unique risky drinking behaviour.

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers' expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults' caregivers.

Abstract Background The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes. Methods We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities. Results The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53–8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55–7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04–3.61] and 4.72 [CI 3.43–6.49]), and Hubei (AORs 2.36 [CI 1.82–3.07] and 4.11 [CI 2.80–6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases. Conclusion Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.

Introduction With population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing. Objectives and Approach Our goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time. Results The major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43). Conclusion / Implications Record linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.

Introduction: Research on disability largely draws on epidemiological data, often conducted in more developed countries. To date, there is little research related to older adults in Ghana, Africa. The purpose of this study was to strengthen understanding of how older adults in Ghana perform functional activities, referenced against the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) framework. Methods: Interpretative phenomenological analysis (IPA) of semistructured interview data was employed as the methodological approach. Using purposive criterion sampling, 8 older adults admitted to Komfo Anokye Teaching Hospital in Ghana, presenting with any identified health condition and/or frailty were recruited. Results: Analysis of interview data identified 5 interrelated themes: (1) feeling anxious, (2) feeling restricted, (3) understanding and admitting difficulty, (4) striving to be healthy and being productive, and (5) managing functional difficulty. These concerns were classified and related to the WHO-ICF, particularly the contextual factors. Discussion: This study examined in detail experiences of older adults performing functional activities. Our study highlights the relevance of the WHO-ICF framework for understanding the health needs of older adults, emphasizing the functional, social, and environmental factors influencing the functional status of older adults. The findings offer unique insight into the health needs of older adults, drawing attention to the implications for policy and care.

INTRODUCTION:In Ghana, the care needs of older adults in the later years has become a critical issue given population ageing and increased proportions of older adults with difficulties with functional abilities. However, factors related to caregiver availability is unknown. The purpose of this study was to examine how the World Health Organisation's International Classification of Functioning, Disability and Health (WHO-ICF) framework relates to caregiver availability for community-dwelling older adults in Ghana. This evidence will strengthen our understanding of the perceived unmet care needs of older adults in Ghana in Africa. MATERIALS AND METHODS:A hospital-based survey was conducted among 400 consecutively recruited older adult in-patients using a questionnaire at Komfo Anokye Teaching Hospital in southern Ghana. Multivariate logistic regression tested associations between caregiver availability and other factors as related to the WHO-ICF conceptual framework. RESULTS:Eighty-six per cent of the participants reported having an available caregiver. In the final parsimonious model, the environmental factors were highly related to caregiver availability, seconded by personal factors, and then health conditions. Body function and structure, activity, and participation variables were not statistically significant. Overall, the variables that were associated with caregiver availability were age, being a widow, having a single chronic condition, being hardly understood by friends and family, receiving no neighbourhood support, and having 2-4 children. Interaction existed between being a widow and living as a couple in relation to caregiver availability. CONCLUSIONS:Caregiver availability is associated with variables under the personal, health and environmental components of the WHO-ICF. Increased effort to strengthen the current and future welfare programs, including the health of older adults and their caregivers is relevant.

Abstract Objectives: With a rapidly ageing population, it is imperative to examine health service costs and plan appropriately for the future. This paper determines the factors related to extended hospital stay for ‘Rehabilitation’ or ‘Convalescence’, as defined by ICD‐10 coding, in acute hospital settings for older women in New South Wales, Australia. Methods: Participants were from the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. For this analysis, self‐reported survey data were linked to the NSW Admitted Patient Data Collection and the National Death Index. Results: Of the 3,979 participants, 88% had a hospitalisation in the 13‐year observation period, and 37% had either a rehabilitation or convalescence admission in an acute hospital setting. In the multivariate model, living in a regional or remote area was the only variable positively associated with having a rehabilitation or convalescence hospitalisation (AOR=1.58 [1.33, 1.87]). Conclusions: Area of residence is the determining factor for rehabilitation or convalescence hospital admissions. These long stay admissions are not necessarily inappropriate, but due to a lack of other non‐acute care options. Implications for public health: Increased availability of rehabilitation and respite care in non‐acute settings will not only improve older patient care, but will also reduce the burden on acute hospitals.

Abstract Objective: To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. Methods: A competing risk analysis from 8,867 Australian women born 1921–26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. Results: After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one‐year increase in age was associated with a relative 17% increased risk of RAC. Conclusions: Around one‐third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

Abstract Background Few studies explored the effects of nutritional changes on body mass index (BMI), weight (Wt), waist circumference (WC) and hypertension, especially for the older Chinese population. Methods By using China Health and Nutrition Survey 2004-2011 waves, a total of 6348 observations aged ≥ 60 were involved in the study. The number of participants dropped from 2197 in 2004, to 1763 in 2006, 1303 in 2009, and 1085 in 2011. Dietary information was obtained from participants using 24 hour-recall over three consecutive days. Height, Wt, WC, systolic and diastolic blood pressure were also measured in each survey year. The dietary pattern was derived by exploratory factor analysis using principal component analysis methods. Linear Mixed Models were used to investigate associations of dietary patterns with BMI, Wt and WC. Generalized Estimating Equation models were used to assess the associations between dietary patterns and hypertension. Results Over time, older people’s diets were shifting towards a modern dietary pattern (high intake of dairy, fruit, cakes and fast food). Traditional and modern dietary patterns had distinct associations with BMI, Wt and WC. Participants with a diet in the highest quartile for traditional composition had a β (difference in mean) of −0.23 (95 % CI: −0.44; −0.02) for BMI decrease, β of −0.90 (95 % CI: −1.42; −0.37) for Wt decrease; and β of −1.57 (95 % CI: −2.32; −0.83) for WC decrease. However, participants with a diet in the highest quartile for modern diet had a β of 0.29 (95 % CI: 0.12; 0.47) for BMI increase; β of 1.02 (95 % CI: 0.58; 1.46) for Wt increase; and β of 1.44 (95 % CI: 0.78; 2.10) for Wt increase. No significant associations were found between dietary patterns and hypertension. Conclusions We elucidate the associations between dietary pattern and change in BMI, Wt, WC and hypertension in a 7-year follow-up study. The strong association between favourable body composition and traditional diet, compared with an increase in BMI, WC and Wt with modern diet suggests that there is an urgent need to develop age-specific dietary guideline for older Chinese people.

Abstract Objective: To explore impact of incident osteoarthritis (OA) on health services use by Australian women born 1946–51. Methods: Secondary analysis of Australian Longitudinal Study on Women's Health survey data linked to Medicare Australia databases (2002 to 2011). Medicare services use was compared for two groups: OA group (n=761) – reported incident OA in 2007; Never group (n=4346) – did not report arthritis in time frame. Interrupted time series regression compared health services use over time. Results: The OA group had higher health services use than the Never group. Rate of services use increased over time for both groups. Rate of increase in quarterly doctor attendances was significantly lower for the OA group after onset of OA, with no corresponding change for the Never group. Conclusions: A pre‐existing higher use of health services is associated with reporting incident OA, compared to those who never report arthritis. After onset of OA, rate of doctor use reduced and allied health use increased, consistent with recommended Australian treatment guidelines. Implications: This study provides a rare insight into change in healthcare use for people reporting incident OA, against an appropriate comparison group, highlighting the importance of early diagnosis of OA to optimise effective use of health services.

OBJECTIVES: The aim of this study was to analyze the prevalence and determinants of time pressure among younger Australian women born between 1973 and 1978 over a 17-year period. METHODS: Using six surveys (N=14 247 at baseline in 1996) from the Australian Longitudinal Study on Women`s Health (ALSWH), we estimated fixed-effects ordered logistic regression models. RESULTS: More than two thirds of women felt rushed, pressured, too busy every day or a few times a week, and time pressure substantially increased over the observed 17-year period. Baseline estimates show that time pressure is significantly (P

Background: There is a paucity of studies that have explored the association between dietary pattern and cognitive function, and whether there is an interaction between dietary pattern and hypertension in relation to older people's cognitive functioning.Methods: We analyzed data from the China Health and Nutrition (CHNS) survey. Dietary data have been collected since 1991, and cognitive function interview data were collected between 1997 and 2006. We analyzed ten years of data, including 4,847 participants with 10,658 observations (aged ≥55 years). Exploratory factor analysis was used to identify dietary patterns. Cognitive function measures include cognitive global scores and verbal memory scores. Linear mixed models were used to investigate the association between dietary patterns, hypertension and cognitive function.Results: Three dietary patterns were identified by factor analysis, named “Traditional Chinese,” “Protein-rich,” and “Starch-rich” dietary pattern. A Protein-rich dietary pattern (high intake of milk, eggs and soymilk) was significantly associated with higher cognitive global scores and verbal memory scores, while the starch-rich dietary pattern (high intake of salted vegetable and legumes) was significantly associated with lower cognitive global and verbal memory scores. In addition, we found that participants with hypertension were independently associated with significant low cognitive function.Conclusion: The study reinforces the importance of diet in preventing cognitive decline among the older population. Identification of older populations who had hypertension should be targeted in intervention studies to maintain their cognitive health.

Background: No studies have been conducted to explore the associations between dietary patterns and obesity among older Chinese people, by considering gender and urbanization level differences. Methods: We analyzed data from the 2009 China Health and Nutrition Survey (2745 individuals, aged ≥ 60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Height, Body Weight, and Waist Circumference were measured. Exploratory factor analysis was used to identify dietary patterns. Multinomial and Poisson regression models were used to examine the association between dietary patterns and Body Mass Index (BMI) status/central obesity. Results: The prevalence of general and central obesity was 9.5% and 53.4%. Traditional dietary pattern (high intake of rice, pork and vegetables) was inversely associated with general/central obesity; modern dietary pattern (high intake of fruit, fast food, and processed meat) was positively associated with general/central obesity. The highest quartile of traditional dietary pattern had a lower risk of general/central obesity compared with the lowest quartile, while an inverse picture was found for the modern dietary pattern. These associations were consistent by gender and urbanization levels. Conclusions: Dietary patterns are associated with general/central obesity in older Chinese. This study reinforces the importance of a healthy diet in promoting healthy ageing in China.

There are few studies reporting the association between lifestyle and mortality among the oldest old in developing countries. We examined the association between food habits, lifestyle factors and all-cause mortality in the oldest old (≥80 years) using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). In 1998/99, 8959 participants aged 80 years and older took part in the baseline survey. Follow-up surveys were conducted every two to three years until 2011. Food habits were assessed using an in-person interview. Deaths were ascertained from family members during follow-up. Cox and Laplace regression were used to assess the association between food habits, lifestyle factors and mortality risk. There were 6626 deaths during 31,926 person-years of follow-up. Type of staple food (rice or wheat) was not associated with mortality. Daily fruit and vegetable intake was inversely associated with a higher mortality risk (hazard ratios (HRs): 0.85 (95% CI (confidence interval) 0.77–0.92), and 0.74 (0.66–0.83) for daily intake of fruit and vegetables, respectively). There was a positive association between intake of salt-preserved vegetables and mortality risk (consumers had about 10% increase of HR for mortality). Fruit and vegetable consumption were inversely, while intake of salt-preserved vegetables positively, associated with mortality risk among the oldest old. Undertaking physical activity is beneficial for the prevention of premature death.

Problem Ghana’s population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health. Approach We applied WHO’s knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services. Local setting Ghana has a well-structured health system that can adapt to meet the health care needs of older people. Relevant changes Six problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014. Lessons learnt The framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings.

ABSTRACT Objectives To examine the trend of the healthcare cost of arthritis in a population-based cohort of older women and to estimate the mean adjusted incremental healthcare costs, and selected percentiles. Approach This is a healthcare cost study based on individual-level data. Data included health survey and linked administrative data, from 2003 to 2009, from the Australian Longitudinal Study on Women’s Health. The Medicare Australia datasets include the Pharmaceutical Benefits Scheme (unit record data on claims for government-subsidized prescription medicines) and the Medicare Benefits Schedule (listing of health services subsidized by the Australian Government) datasets; they were the source for all healthcare utilization and cost data in this study. The main outcome measure was the incremental healthcare cost of arthritis (estimated from the Australian Government’s cost perspective) expressed as dollars per person per year. All costs were expressed in 2012 Australian dollars. Regression models were used to estimate the adjusted incremental costs of arthritis. The mean adjusted incremental healthcare cost of arthritis was computed using GLMs with a logarithmic-link function and a gamma distribution for costs. The adjusted incremental costs at the 25th, 50th, 75th, 90th and 95th percentiles were computed using Quantile Regression. These percentiles were chosen because cost data are skewed to the right and it was expected that there would be smaller differences between the lower percentiles but bigger differences between upper adjacent percentiles. Results Data from 4287 women were included in the analysis. Adjusted incremental healthcare cost of arthritis did not increase significantly from 2003 to 2009. However, there were indications that costs at the lower percentiles decreased slightly over the study period while costs at higher (above 50th) percentiles increased. The estimated median cost was $480 (95% CI: $498 - $759) per person per year in 2009. However, ten percent of women had more than 300% higher cost than the “average person” with arthritis. Conclusion Healthcare cost of arthritis represents a substantial burden. However, considering only overall cost does not provide a detailed picture of expenditure. Our results suggest that higher cost patients had different experiences in arthritis cost over time, compared to patients with lower costs, although overall cost has not increased over time. As healthcare spending is concentrated in the high-cost patients, characterising these patients and formulating initiatives that target them could have a considerable impact on improving care and lowering health expenditure due to arthritis.

ABSTRACT Objectives Anticholinergic medicines burden is common, can have negative impacts, and is problematic to identify. Many medicines used by older women have anticholinergic effects. Importantly for older women, where multimorbidity and use of multiple medicines is common, even when anticholinergic effect of an individual medicine is small, the anticholinergic effects of multiple medicines may be additive, constituting cumulative anticholinergic burden. This study describes medicines contributing to and predictors of anticholinergic burden among community-dwelling older Australian women. Approach Retrospective longitudinal analysis of data from the Australian Longitudinal Study on Women’s Health linked to Pharmaceutical Benefits Scheme medicines data from 1 January 2008 to 30 December 2010; for 3694 women born in 1921–1926.Anticholinergic medicines were assigned anticholinergic potency levels 0 to 3, according to the Anticholinergic Drug Scale. Anticholinergic Drug Scale ratings for all medicines used by each woman were summed across each six months to give an Anticholinergic Drug Scale score. Commonly used medicines were identified for women with high ADS scores (defined as 75th percentile of scores). Predictors of high ADS scores were analysed using generalised estimating equations. Results During 2008-2010, 1126 (59.9%) of women used at least one anticholinergic medicine. Median Anticholinergic Drug Scale score was 4. Most anticholinergic medicines used by women who had a high anticholinergic burden (Anticholinergic Drug Scale score > 9) had a low anticholinergic potency (Anticholinergic Drug Scale level 1). Increasing age, cardiovascular disease, and number of other medicines used were predictive of a higher anticholinergic burden. Conclusion High anticholinergic medicines burden in this group was driven by use of multiple lower anticholinergic potency medicines rather than use of higher potency medicines. While we might expect that doctors would readily identify anticholinergic burden risk for those using high potency medicines, they may be less likely to identify this risk for users of multiple low potency anticholinergic medicines. The paper will also discuss how GPs view these findings, and how to translate them into the prescribing setting.

Abstract Objective: The demographic and health aspects of ageing populations in Australia and New Zealand (NZ) are described. These data are relevant to compare impacts of policy and context in each country. Methods: Secondary analysis of international (Organization for Economic Co‐operation and Development, United Nations and World Health Organization) and domestic population and health data. Results: Both countries will experience a greater than 80% increase in the population aged 60‐plus years between 2013 and 2050. The increase in the 80‐plus population will be 200% or higher, resulting in 2.8 million Australians and more than 510,000 New Zealanders in this age group by 2050. The speed of ageing in both countries is higher than the average rate of increase in developed countries. Average life expectancy at birth and age 60 is higher in Australia than NZ, with the differences increasing slightly by 2050, and gaps between men and women consistently smaller in NZ than in Australia. However, a higher proportion of older Australians report living with a disability (53%) than older New Zealanders (45%). Conclusions: Australia and NZ are well aged in the context of a youthful Oceania region, with more similarities than differences between the countries. Implications: Both countries need to continue to monitor health trends, unravel the major population attributable risks, and identify preventative and other interventions that can stimulate and support declines in disability in older populations in the future, particularly for non‐indigenous older persons.

Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed to describe the association between body mass index (BMI) and habitual fruit and vegetable consumption in a large sample of 246,995 Australian adults aged 45 + year who had been recruited for the “45 and Up” cohort study. Fruit and vegetable intake was assessed using validated short questions, while weight and height were self-reported. Multinomial logistic regression was used, by sex, to assess the association between fruit and vegetable intake and BMI. Compared to the referent normal weight category (BMI 18.5 to 24.9), the odds ratio (OR) of being in the highest vegetable intake quartile was 1.09 (95% confidence interval (CI) 1.04–1.14) for overweight women (BMI 25.0–29.9) and 1.18 (95% CI 1.12–1.24) for obese women. The association was in the opposite direction for fruit for overweight (OR 0.85; 95% CI 0.80–0.90) and obese women (OR 0.75; 95% CI 0.69–0.80). Obese and overweight women had higher odds of being in the highest intake quartile for combined fruit and vegetable intake, and were more likely to meet the “2 and 5” target or to have five or more serves of fruit and vegetables per day. In contrast, overweight men were less likely to be in high intake quartiles and less likely to meet recommended target of 5 per day, but there was no consistent relationship between obesity and fruit and vegetable intake. Underweight women and underweight men were less likely to be in the highest intake quartiles or to meet the recommended targets. These data suggest that improving adherence to dietary targets for fruit and vegetables may be a dietary strategy to overcome overweight among men, but that overweight and obese women are already adhering to these targets. The association between fruit and vegetable intake and underweight in adults suggests that improving fruit and vegetables intakes are important for the overall dietary patterns of people in this group.

Abstract Objective: To examine the factors related to Papanicolaou (Pap) tests, mammography and cholesterol testing in mid‐aged Australian women as they age. Methods: Data were obtained from the 1946–51 cohort of the Australian Longitudinal Study on Women's Health, a prospective study of the health and lifestyle of Australian women. Data were collected via self‐report mailed surveys on a three‐yearly basis since 1996, when participants were aged 45–50. Demographic factors, health service use and health‐related factors were examined in relation to screening practices in a lagged analysis. Results: As women aged, they were less likely to have a Pap test and more likely to report having a mammogram and a cholesterol test. Smokers were less likely to have all screening tests, and HRT use and more general practitioner (GP) visits were associated with increased odds of having health checks. Compared to healthy weight, higher BMI was associated with increased odds of cholesterol testing but decreased odds for Pap testing; obese women had lower odds for mammography. Underweight women had lower odds for mammography and Pap testing. Worse self‐rated health and self‐report of a chronic condition were significantly related to increased likelihood of cholesterol testing. While some demographic and area of residence factors were also significantly associated with screening, large inequities based on socioeconomic status were not evident. Conclusions: Health and healthcare use are important determinants of screening. Implications: Greater advantage needs to be taken of opportunities to encourage women with more health risk behaviours and health problems to engage in screening.

Several animal and human studies have shown that zinc is associated with cellular damage and cardiac dysfunction. This study aims to investigate dietary zinc and the zinc-iron ratio, as predictors of incident cardiovascular disease (CVD) in a large longitudinal study of mid-age Australian women (aged 50–61 years). Data was self-reported and validated food frequency questionnaires were used to assess dietary intake. Energy-adjusted zinc was ranked using quintiles and predictors of incident CVD were examined using stepwise logistic regression. After six years of follow-up, 320 incident CVD cases were established. A positive association between dietary zinc intake, zinc-iron ratio and risk of CVD was observed even after adjusting for potential dietary and non-dietary confounders. Compared to those with the lowest quintile of zinc, those in the highest quintile (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI) = 1.08–2.62) and zinc-iron ratio (OR = 1.72, 95% CI = 1.05–2.81) had almost twice the odds of developing CVD (p trend = 0.007). This study shows that high dietary zinc intake and zinc-iron ratio is associated with a greater incidence of CVD in women. Further studies are required detailing the source of zinc and iron in diet and their precise roles when compared to other essential nutrients.

Background/objectivesFew studies have applied the Chinese Diet Balance Index (DBI) in evaluating dietary quality for Chinese people. The present cross-sectional study assessed dietary quality based on DBI for older people, and the associated factors, in four socioeconomically distinct regions in China.MethodsThe China Health and Nutrition Survey (CHNS) involves 2745 older Chinese people, aged 60 or over, from four regions (Northeast, East Coast, Central and West) in 2009. Dietary data were obtained by interviews using 24 hour-recall over three consecutive days. Four indicators: Total Score (TS), Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) from DBI were calculated for assessing dietary quality in different aspects.Results68.9% of older people had different levels of excessive cereals intake. More than 50% of older people had moderate or severe surplus of oil (64.9%) and salt (58.6%). Intake of vegetables and fruit, milk and soybeans, water, and dietary variety were insufficient, especially for milk and soybeans. 80.8% of people had moderate or severe unbalanced diet consumption. The largest differences of DQD scores have been found for people with different education levels and urbanicity levels. People with higher education levels have lower DQD scores (pConclusionDBI can reveal problems of dietary quality for older Chinese people. Rectifying unbalanced diet intake may lead to prevention of non-communicable diseases (NCDs). Dieticians and health care professionals need to increase dissemination and uptake of nutrition education, with interventions targeted at regions of lower socioeconomic status.

Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.