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OBJECTIVES: The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. METHODS: Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. RESULTS: A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. CONCLUSIONS: The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.

BACKGROUND: Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). METHODS: We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. FINDINGS: A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. INTERPRETATION: Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the en

OBJECTIVES: The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults. METHODS: A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region. RESULTS: A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region. CONCLUSIONS: Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait. CLINICAL IMPLICATIONS: • Current mental health screening tools are not applicable for the Torres Strait• More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities.

OBJECTIVE: To identify the specific risk factors for dementia in the Torres Strait. METHODS: This research was conducted as part of a cross-sectional dementia prevalence study conducted in the Torres Strait. Participants underwent a comprehensive health assessment, where data on risk factors were collected, and a Geriatrician assessment, which was used to establish dementia diagnoses. RESULTS: A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. Cerebrovascular disease, chronic kidney disease and older age were the most significant risk factors in this population. Once adjusted for age, cerebrovascular disease, chronic kidney disease, diabetes, low education and problems with mobility and incontinence were significantly associated with dementia. CONCLUSIONS: Reducing dementia risk in the Torres Strait requires multifactorial interventions to address potentially modifiable risk factors with a particular focus on addressing the development of chronic midlife diseases.

OBJECTIVE: To examine the prevalence of dementia and problems associated with ageing in the Torres Strait. METHODS: The study was conducted across all 18 island and 5 mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland. Participants underwent a comprehensive health assessment and a Geriatrician assessment, which were used to establish consensus diagnoses. RESULTS: A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. The prevalence of dementia in the sample was 14.2%, which was 2.87 times higher than the wider Australian population. CONCLUSION: Torres Strait Islander peoples share the increased risk of dementia seen in Aboriginal Australians compared to the wider community. This highlights the need for interventions to address this increased dementia risk for Aboriginal and Torres Strait Islander communities.

Aim: This study describes baseline audit results documenting cognitive impairment not dementia (CIND) and dementia and associated risk factors in Aboriginal and Torres Strait Islander peoples aged ≥50 years attending Aboriginal Community Controlled Health Services (ACCHSs). Method: A specialised chart audit tool was designed to identify documented dementia and CIND, and relevant risk factor profiles in patient health records. The audits were conducted as part of a stepped-wedge cluster randomised controlled trial. Twelve Aboriginal Controlled Community Health Services (ACCHSs) in four states across Australia were recruited and medical records of 1,662 patients aged >50 years were audited. The primary outcome measure is documentation of CIND and dementia along with the associated risk factors. Results: The mean age was 60.2 +/-8.2 years and 56% were female. The overall prevalence of documented CIND or dementia was low, reported for only 57 (3.4%) patients audited. The prevalence of risk factors was high, with nearly two-thirds (64.1%,) having ≥4 risk factors. These included high rates of hypertension (52.5%), diabetes (44.3%), dyslipidemia (42.3%), obesity (35.3%) and current smoking (35.3%). Conclusion: Our previous work demonstrated the true prevalence of dementia was 10% and CIND was 10% in Indigenous communities. The low detection of these conditions in the primary care setting, accompanied by high prevalence of associated risk factors for cognitive impairment, demonstrates the need for dementia specific culturally responsive primary care interventions that optimise brain health and support identification of cognitive impairment and dementia, using a community wide and holistic approach across the lifespan.

Background Rates of dementia and cognitive impairment in Australian Aboriginal and Torres Strait Islander populations are 3‐5 times higher than in the overall population. In addition, under‐detection of these conditions has been consistently confirmed, particularly in primary care. A national co‐design project called the Let’s CHAT (Community Health Approach To) Dementia aims to optimise detection rates and management of dementia and cognitive impairment in Indigenous primary care contexts. This will occur through the co‐development of a model of care, and outcome measures include data profiling the dementia risk of older Indigenous persons and current management of patients with confirmed or suspected cognitive impairment or dementia Method Six‐monthly medical record audits of patients aged 50 and over recording: basic demographic information, presence of dementia risk factors, current care practices in relation to dementia and co‐morbid conditions of ageing. Result Audits were conducted on patients (n=1675) in 12 primary health services across Australia. The mean age of patients was 60.3 (8.3). The top ten risk factors documented overall were: hypertension (50.9%), polypharmacy (46.7%), current smoking (43%), diabetes (42.9%), dyslipidaemia (41.1%), obesity (35%), depression (30%), mental health concerns (25.9%) cardiovascular disease (25.6.%) and low physical activity (19.1%), but there was some inter‐service variation in risk factor profiles. Documented evidence of health service assessment for, and investigation of, cognitive impairment was limited. Use and type of diagnostic tools varied widely between services (e.g. MMSE used with 0.6%‐45.9% of sample, KICA (culturally appropriate cognitive assessment tool) used with 0.0%‐5.0% of sample). Diagnoses of dementia and cognitive impairment (combined = 3.8%) are well below known prevalence rates in these populations (∼20%), although there is variation from service to service (range = 0.8% ‐8.9%). Conclusio

AIMS: To determine the incidence and severity of self-reported hypoglycaemia in a primary care population with type 2 diabetes. The study also aimed to compare incidence by treatment regimen. MATERIALS AND METHODS: A prospective observational study in 17 centres throughout the UK was conducted. Recruitment was based on treatment regimen (metformin alone, sulphonylurea-, insulin- or incretin-based therapy). Participants were asked to keep a blood glucose diary and self-report hypoglycaemia episodes [non-severe (self-treated) and severe (requiring external help)] over a 12-month period. RESULTS: Three hundred and twenty-five participants were enrolled, of whom 274 (84%) returned ≥1 monthly diaries. Overall, 39% reported experiencing hypoglycaemia; 32% recorded ≥1 symptomatic, 36% ≥1 non-severe, and 7% ≥1 severe episodes. By treatment, incidence (events per person/year) for any hypoglycaemia type was 4.39 for insulin, 2.34 for sulphonylurea, 0.76 for metformin, and 0.56 for incretin-based therapy. Compared with metformin, risk of non-severe hypoglycaemia was ~3 times higher for participants on sulphonylureas and > 5 times higher for those on insulin [incidence rate ratio (IRR) 3.02 (1.76-5.18), P < 0.001, and IRR 5.96 (3.48-10.2), P < 0.001, respectively]. For severe episodes, the incidence for sulphonylurea (0.09) was similar to metformin (0.07) and incretin-based therapy (0.07); for insulin the risk remained almost 5 times higher than metformin [incidence 0.32; IRR 4.55 (1.28-16.20), P = 0.019]. CONCLUSIONS: Hypoglycaemia represents a substantial burden for people with type 2 diabetes. Sulphonylureas and insulin are both associated with a risk of reported non-severe hypoglycaemia, but only insulin with severe episodes. This suggests the importance of the continued use of sulphonylureas in appropriate patients with type 2 diabetes.

© 2018 The Author(s). Background: Community-dwelling older persons with complex care needs may deteriorate rapidly and require hospitalisation if they receive inadequate support for their conditions in the community. Intervention: A comprehensive, multidimensional geriatric assessment with care coordination was performed in a community setting - Older Persons ENablement And Rehabilitation for Complex Health conditions (OPEN ARCH). Objectives: This study will assess the acceptability and determine the impact of the OPEN ARCH intervention on the health and quality of life outcomes, health and social services utilisation of older people with multiple chronic conditions and emerging complex care needs. An economic evaluation will determine whether OPEN ARCH is cost-effective when compared to the standard care. Methods/design: This multicentre randomised controlled trial uses a stepped wedge cluster design with repeated cross-sectional samples. General practitioners (GPs; n ≥ 10) will be randomised as 'clusters' at baseline using simple randomisation. Each GP cluster will recruit 10-12 participants. Data will be collected on each participant at 3-month intervals (- 3, 0, 3, 6 and 9 months). The primary outcome is health and social service utilisation as measured by Emergency Department presentations, hospital admissions, in-patient bed days, allied health and community support services. Secondary outcomes include functional status, quality of life and participants' satisfaction. Cost-effectiveness of the intervention will be assessed as the change to cost outcomes, including the cost of implementing the intervention and subsequent use of services, and the change to health benefits represented by quality adjusted life years. Discussion: The results will have direct implications for the design and wider implementation of this new model of care for community-dwelling older persons with complex care needs. Additionally, it will contribute to the evidence base on acceptabilit